Autism in Bangladesh: Current Scenario and Future Prospects

Background: Bangladesh is a developing country from South East Asia having population of  167 million. According the World health Organization supported survey 2009 there are 0.84% children are suffering from Autism Spectrum disorders. Against this magnitude of disease burden only 200 psychiatrists, and limited number of other l health professionals are serving the nation. Bangladesh has very well developed three tired health care delivery system but the service for autism is available only at the upper level of the pyramid. The community living at the rural and semi urban areas is devoid of appropriate services for their ward with Autism. To minimize this problem and provide an integrated service for all, the country needs to be incorporated the care for autism from the bottom of health service system, which is at the primary health care.  It is not possible to increase the number of skilled health professionals overnight, so this present project can create a group of skilled manpower who will be able to provide primary service to the children with autism and advice to the parents accordingly.

Objectives: To provide effective and better services for children with autism through primary health care by using existing resources and manpower. To train primary health care physicians as they become skilled to handle (screening, diagnosis and management) Autism and referred to next level when necessary. To reduce treatment gap and decrease the treatment cost Autism. To be establish the e-autism service by using web camera and internet.

Methods: For the capacity building the country need to trained the primary health care professionals who are working in 13000 community clinics.   A door step health care service system exists, just need to incorporate there the Autism related services. There are lack of multidisciplinary approach in Autism services; need to make a common framework for pediatrician, psychiatrists, psychologists and other support service staffs. Plan to make a national guideline for autism management. Need intensive but short term training on autism diagnosis and management for field level physicians. Training materials include manual for training consisted several modules and multimedia will be used.  Beside the training a cell phone and internet based web camera will be placed in every community health clinics and trained physicians can contact with the centrally placed autism experts 24 hour through a hot line  

Results:  The primary care physicians will be able to screen, assess, diagnose and manage primarily Autism Spectrum Disorders. They would be able to  refer the children to the next step rationally. The effectiveness of training will be reflected in the attitude, assessment and management plan of the primary health care physicians. Referral and back referral system will be established.

Conclusions: ‘When there is no way, create one’, with this proposition, country will able to deliver better services for Autism to the community where the number of health professionals and resources are inadequate.  By this notion, Bangladesh will change its autism scenario and set up an example for South East Asian countries as well as other developing countries.