Some 250 million children under five (43%) in low to middle income countries are at a higher risk of not achieving their full potential due to extreme poverty and not receiving nurturing care 1.
Although an increasing number of children in developing countries are surviving beyond birth, they start life at a major disadvantage because of multiple adversities in their early, formative years, says Dr Anusha Lachman, the South African representative of the African Association for Child and Adolescent Mental Health (AACAMH).
The combination of poverty, poor health and nutrition, leading to difficulties in learning and academic performance, not only affects the child’s future earning potential, but also contributes to transferring poverty to the next generation.
Dr Lachman was addressing delegates from across the continent attending the third African Diaspora Global Mental Health Conference held yesterday (18 September) in Cape Town, and said that “mental health policies are seriously lacking in early detection and prevention of lifelong suffering.”
The conference is hosted by the Africa Global Mental Health Institute (AGMHI) which brings psychiatrists and mental health professionals from all over the world together to create a collaborative network that shares resources and opportunities for development in the field of psychiatry.
Dr Lachman says that by young children not receiving the basic human right of nurturing care necessary for their physical and psychological development, “this poor start in life is estimated to result in a loss of about a quarter of average adult income per year while countries may forfeit up to twice their current GDP expenditures on health and education.2”
Over 45% of Africa’s population is made up of infants, children and adolescents and by 2030 it is estimated that the continent will have the greatest number of children under 18 years of age in the world3. Yet child mental health remains a stigmatised and isolated area of child and adolescent health, while sexual and reproductive health, infectious diseases, HIV and malnutrition still take the priority of policymakers on the continent.
“Only a fraction of children and adolescents have been reached and the most vulnerable in our societies – those living in rural areas, in extreme poverty, living with disabilities, and out of school children - have little or no access to mental health programmes and activities.”
“All indications are that we must reach families from—or even before—the time of conception, and that support is vital in the ﬁrst 1000 days of a child’s life. Young children have the best chance of maximising their potential when they are well nourished, cared for, exposed to learning opportunities from birth onwards, and protected from disease, violence, and stress.”
Dr Lachman says that early childhood is not only a period of special sensitivity to risk factors, but also a critical time when the benefits of early interventions are amplified and the negative effects of risk can be reduced. “The most formative experiences of young children come from the nurturing care received from parents, other family members, caregivers, and community-based services.”
She characterises nurturing care as a stable environment that promotes children’s health and nutrition, protects children from threats, and gives them opportunities for early learning, through affectionate interactions and relationships. But she warns that “for nurturing care to be effective, we need mentally well primary caregivers. Unfortunately, maternal mental disorders are approximately three times more prevalent in lower income countries, and less than 10% access treatment4.”
Child development starts at conception and the development of the young child’s brain is dependent on good nutrition and on certain types of experiences. Most families provide these experiences for their young children, but many cannot because of stresses and conditions that interfere with their ability to parent. The inﬂuence of some of these factors starts during the preconception period.
Families must be supported to provide nurturing care; they need material and ﬁnancial resources, and the knowledge, time, and skilled assistance when required. Families can be supported through the implementation of national policies, aﬀordable quality childcare, and provision of population-based services.