Multisectoral framework for responding to the needs of children with neurodevelopmental disabilities and their families in Ethiopia: a scoping review with implications for policy

Abstract

The World Health Organization and the United Nations Children’s Fund call for multisectoral action to ensure the inclusion and well-being of children with developmental disabilities globally. Ethiopia has made policy efforts to support optimisation of early childhood development, but children with neurodevelopmental disabilities (NDDs) have additional, specific needs. This scoping review and policy analysis aimed to identify barriers and opportunities for multi-sectoral planning to address social determinants shaping the lives of Ethiopian children with NDDs and their families within the current Ethiopian policy context. A scoping review was conducted of Ethiopian research studies and policy documents. After screening, eligible evidence sources were included, and data were charted using a structured extraction form. Critical appraisal of empirical studies was conducted using the Mixed-Methods Appraisal Tool 2018. Using Lund et al.’s model for social determinants of mental disorders in relation to the Sustainable Development Goals, a qualitative framework synthesis of the identified studies was conducted, followed by an analysis of policies. The search identified 44 research studies (29 published and 15 theses) and 17 Ethiopian policy documents. The findings show that Ethiopian children with NDDs and their families experience intersecting challenges across four social determinant domains: economic, socio-cultural, neighbourhood, and demographic. Accessing services and ensuring social protection, inclusion, and safety of children with NDDs are prominent challenges fueled by stigma. Challenges are heightened for female caregivers, especially single mothers. Caregivers experience psychological distress, including suicidality. Spirituality and support from families, communities, and community-based organisations help cope. Formal support is scarce; the few identified interventions involve caregiver and healthcare worker training. The integration of services for children with NDDs into primary healthcare services is a potential strategy to increase access to services. Ethiopian children with NDDs and their caregivers experience intersecting challenges in accessing services, social protection and inclusion, and safeguarding. Ethiopian policies offer opportunities by prioritising social welfare, equity, protection of vulnerable communities, and early childhood development. However, policies lack explicit recognition and measures for children with NDDs. Multisectoral efforts involving robust research, inclusive policy development and implementation are needed to strengthen support for children with NDDs and their families.