Health facility-based prevalence and potential risk factors of autism spectrum disorders in Mali

Background: The prevalence of autism spectrum disorders (ASD) is 1-2% worldwide, 1 in 68 in the U.S, and unknown in Africa. ASD is under-diagnosed in Mali due to stigma and the lack of appropriate human resources and infrastructure.Objective: To determine the ASD frequency and potential risk factors in Mali.Methods: We identified all the health facilities and community-based organizations involved in the ASD diagnosis and management in Bamako. We established an ASD research and awareness platform in Mali, which encompasses community-based organizations and a multidisciplinary team including psychiatrists, psychologists, pediatricians, geneticists, and public health and social science specialists. Through this platform, we performed a survey in health facilities and organizations where patients with ASD are likely to seek care in Bamako. We reviewed the psychiatric patient registry to obtain basic epidemiological profiles of children with ASD, epilepsy and other psychiatric disorders.Results: We found a health facility-based prevalence of ASD of 4.5% (105/2,343) in Bamako. The mean age at the first outpatient visit was 7.64 ± 3.85 years old. First degree consanguinity of 29.5% (31/105) was more frequent in parents of ASD children versus age and sex matched controls OR= 4.37 [1.96-9.76] p=0.0001.Conclusion: Our data suggest that ASD is more common than expected in Mali. The established ASD awareness and research platform may improve the diagnosis and management of ASD by raising ASD awareness, training of Malian clinicians and researchers in early ASD screening and diagnosis, and strengthening research capacity in genomics of ASD and other mental disorders.Keywords: ASD, prevalence, consanguinity, health facilit