CHAPTER ONE

GENERAL INTRODUCTION

BACKGROUND TO THE STUDY

According to the United Nations (UN), despite all efforts to promote international awareness of the impact of crisis and or conflict and disease outbreak on the mental health of children and youths, there are still an estimated billion children living in these zones and regions (1). Children and youths continue to be disproportionately affected by crisis and or conflict and disease outbreak, and providing support for them should be a priority for the international community (2). Some of the experiences of children and youths during crisis, makes it difficult for them to have access to psychologically supportive environments and in some cases violation of their rights as outlined in the Convention on the Rights of the Child (3). The burden of mental disorders that results from conflict-related neglect, abuse and exploitation is particularly alarming. It is well documented that there are disparities between the mental health of children and youths in crisis zones experiencing diseases outbreaks and or conflicts (4). Experiencing crisis or conflict and disease outbreak like covid 19 during childhood and as a youth poses serious mental health risks and threats to their education and development. Exposure to different types of situations including putting a hold on going to school, the duration, and the nature of how these events unfold and are witnessed due to crisis or disease outbreaks can leading to traumatic events are all associated with the onset and severity of mental disorders among children and youths (5). It is important to recall that the most common mental disorders reported among children and youths exposed to conflict are PTSD and depression (6) Other disorders which have also been reported as well include acute stress reactions, attention deficit hyperactivity disorder (ADHD), panic disorder, anxiety disorders specific to childhood, and sleep disorders. In later childhood, children exposed to conflict-related trauma are predisposed to externalizing symptoms, such as behavioural problems and conduct or oppositional defiant disorders (7) In addition, children and youths exposed to armed conflict often experience comorbid psychopathologies, and symptoms of disorder may increase in number with age, with school-age children and youths being the most vulnerable (8).

In Sub-Saharan Africa, it has been reported that there 6.3 million refugees, 17.7 million internally displaced persons (IDPs), and over 900,000 were formerly displaced (9). Their mental health needs tend to be greater than among non-displaced and non-conflict-exposed individuals (10). High rates of post-traumatic stress disorder (PTSD) and depression, have been reported among African IDPs: a study involving the review of data from some African countries reported a prevalence of PTSD of 42% to 54% and a prevalence of depression of 31% to 67% among African IDPs (11). Similar studies carried out reported that 38% of Somali refugees in an Ethiopian refugee camp were found to have depression, and 54% of those in Darfur were found to have PTSD (12,13). Very little is known or documented in the scientific literature concerning the mental health disorders of displaced and conflict or crisis affected children and youths on the African continent. The scientific literature available on displaced populations in Africa focuses almost exclusively on adults. This knowledge gap is striking, given that 57% of the continent’s refugees are under 18 years old (14).

In Cameroon, children and youths aged 10 to 25 years have been faced with many challenges which can influence their mental health and thus leading to mental disorders due to many crisis situations such as; covid 19(2020) and cholera (2021) outbreaks and the sociopolitical crisis (2016) resulting in the displacements of persons, in the Southwest Region. Cameroon has a large youth population, with more than 60% of the populace under the age of 25, and they especially vulnerable to mental health problems related to these challenges due to a weak health-care system, an inadequate mental health workforce, insufficient financing to pay for health care, lack of access to mental health medications, and the added complexity posed by ongoing humanitarian crises. Additionally, the stigma of mental health problems continues to hinder and discourage individuals from seeking mental health care, further exacerbating the situation (15,16). It has been reported that 40% of the global population is under 24, but they receive only 12.5% assistance for mental health which makes up just 0.1% of the overall (17).  In addition to many other stressors which this very important but neglected age group mainly of youths aged 10 years to 24 years go through while living through the hardships that these crisis cause, they need more care and interest especially in low and middle income countries like Cameroon and specifically in the Southwest Region. So therefore the aim of this study will be to assess mental health disorders of children and youths aged 10 to 25 years in the South West Region of Cameroon through a cross sectional analysis.

Statement of the problem

Mental health conditions comprise 14% of the global disease burden, about 450 million people suffer from mental or behavioral disorders worldwide today, from which 154 million people from depression, 25 million people from schizophrenia, 91 million people from alcohol use disorders and 15 million from drug use disorders. About 81% of this is borne by populations in low and middle-income countries like Cameroon. Due to lack of resources and trained professionals, and poor mental health literacy limiting access to evidence-based solutions, only around 10% of their mental health needs are met (18,19).

Globally, individuals with mental illnesses are victimized for their illness and become the targets of stigma and discrimination (20). According to WHO, in Cameroon mental health issues are still a taboo about 40% of countries evident by lack of any mental health policy and also 30% have no programmes for mental health especially for children and youths, Cameroon happens to be an example. General public’s view about mental illness remains unfavorable, as the topic itself evokes a feeling of fear and even disgust fostering negative attitudes towards mentally ill people (21).

However, the crises and challenges in the Southwest Region of Cameroon, namely the Covid19 health crisis, cholera outbreak and the sociopolitical crisis, are likely to amplify mental illness among populations in general and young people in particular. Regarding the COVID-19 pandemic, well-being and mental health problems are amplified through death, isolation, lockdown of schools, loss of outdoor play time, material and social precariousness which can lead to several mental health disorders. Also, the socio political crisis in the Southwest Region characterized by kidnappings, violence and disruption of smooth attendance and functioning of schools, children and youths live in fear, depression, anxiety and stress which lead to dropping out of school and thus exposing the children and youths to unhealthy behaviors such drug abuse, withdrawal, unwanted pregnancies, child sexual abuse, banditry and survival sex. This crisis has resulted to the displacement and interruption of school with approximately 850,000 students being out of school and more than two million people require humanitarian assistance because of the physical and psychological consequences of the conflict for which access to both physical and mental health care remains reduced.

JUSTIFICATION OF THE STUDY

The prevalence of mental health related disorders among children and youths who have been displaced and those in conflict-affected zones have not been clearly defined (22,23).

So therefore, this study will enable the researchers and other stake holders to be able to have a better understanding based on the findings from this study to be able to assess mental health disorders of children and youths aged 10 to 25 years in the South West Region of Cameroon.

It will also help to facilitate the setting up of a local youth mental health service in the underserved municipalities of the Southwest Region like Buea, Limbe 1 and Tiko.

RESEARCH QUESTIONS

General Research Question

What are the mental health disorders of children and youth aged 10 to 24 years in the Southwest Region of Cameroon?

Specific Research Questions

1. What is the prevalence of mental health disorders in children and youths aged 10 to 24 years in the Southwest Region of Cameroon?
2. What is the severity of the mental health disorders in children and youths aged 10 to 24 years in the Southwest Region of Cameroon?
3. What is the level knowledge on mental health disorders of children and youths aged 10 to 24 years in the Southwest Region of Cameroon?
4. What measures have been put in place to manage mental health disorders of children and youths aged 10 to 24 years in the Southwest Region of Cameroon?

 RESEARCH OBJECTIVES

General Research Objective

To assess the mental health disorders of children and youth aged 10 to 24 years in the Southwest Region of Cameroon

Specific Research Objectives

This research will specifically seek to;

1. Determine the prevalence of mental health disorders in children and youths aged 10 to 24 years in the Southwest Region of Cameroon
2. Determine the severity of the mental health disorders in children and youths aged 10 to 24 years in the Southwest Region of Cameroon
3. Assess the level of knowledge on mental health disorders of children and youths aged 10 to 24 years in the Southwest Region of Cameroon
4. Identify the measures put in place to manage mental health disorders of children and youths aged 10 to 24 years in the Southwest Region of Cameroon