Seventeen Years of Specialist Child and Adolescent Mental Health Services in Nigeria: Evolution of Clinical Presentations at a Tertiary Teaching Hospital

Abstract Background Specialist child and adolescent mental health (CAMH) services in low-resource settings have developed in the context of limited specialist capacity, delayed recognition and fragmented referral pathways. The University of Ilorin Teaching Hospital (UITH), Nigeria, provides an opportunity to examine how the clinical profile of patients reaching specialist CAMH care changed as a dedicated service was established and developed. Methods We synthesised three successive UITH evidence windows: a published audit before establishment of a dedicated CAMH unit (2002–2006; n = 94), a medical audit of the first five years (2007–2011) of the dedicated unit (n = 73), and a retrospective review of clinical records from January 2012 to December 2024 (n = 200). The historical studies were used as contextual comparators rather than pooled as a single patient-level dataset. Contemporary diagnoses were coded according to ICD-11 and descriptive statistics were used. Results Mean age at presentation was 16.38 ± 2.49 years in 2002–2006, 12.64 ± 3.69 years in the first five years of the dedicated unit and 12.03 ± 4.26 years in 2012–2024. Schizophrenia accounted for 50% of diagnoses in the pre-unit audit and 30% in the early-unit audit, compared with 19.5% in the contemporary cohort. The early-unit audit reported mental retardation in 28.8% and ADHD in 11%; in 2012–2024, disorder of intellectual development accounted for 28%, ADHD 6% and autism spectrum disorder 5%. Among contemporary patients, 45% accessed orthodox psychiatric care only, while traditional healing, religious healing and mixed pathways accounted for 9.5%, 8% and 16%, respectively; 21% were undocumented. Conclusions Across successive UITH service eras, the population reaching specialist CAMH care was younger and diagnostically broader in the later periods than in the pre-unit audit. The findings describe changing specialist service utilisation rather than changes in population prevalence. Continued investment in early identification, referral networks, multidisciplinary capacity and culturally responsive pathways to care is warranted.