1. Allama Iqbal Medical College, Lahore, Pakistan; gulrukh_zahra65@gmail.com
2. Allama Iqbal Medical College, Lahore, Pakistan; zhra202312@gmail.com
3. Allama Iqbal Medical College, Lahore, Pakistan; successfulrana21@gmail.com

*             Correspondence: gulrukh_zahra65@gmail.com

Keywords: autism, prevalence, incidence, frequency, Asian countries

1. INTRODUCTION

A narrow range of interests, repetitive habits, and varied degrees of poor social behavior, language, and communication abilities are characteristics of a group of conditions collectively referred to as “autism spectrum disorders” (ASD) [1]. Several investigations have looked into the different factors that contribute to the emergence of autism spectrum disorders (ASD). Among these variables include variations in immunology, biochemistry, neuroanatomy, prenatal influences, and environmental exposures [2]. The difficulties caused by ASD are known to be lifelong and can seriously affect a person’s capacity for functioning, social interactions, and financial security. Not only do these impacts affect the individuals with ASD, but also their families and the larger community. According to a theory, early autism screening promotes early intervention and better outcomes. Professionals with the necessary training can diagnose children with autism spectrum disorder (ASD) as early as 18 months to 2 years of age. On the other hand, children may not receive a diagnosis until later in life [3]. An estimated [1] child in every 100 is thought to have autism spectrum disorder (ASD) worldwide. The prevalence estimates of ASD have grown over time and can vary greatly throughout various sociodemographic groups.5. One in 59 eight-year-old children in the USA has an ASD diagnosis.6. It is estimated that 3.9% of people in Asia suffer from autism spectrum disorder (ASD) [7]. ASD prevalence rates in South Asia range from 0.09% in India to 1.07% in Sri Lanka, according to a recent comprehensive study [8]. This suggests that ASD is spreading more widely throughout the area. Likewise, 0.14 to 2.9% of Arab nations that are close to the Persian Gulf experience high frequency [9]. The total frequency of autism spectrum disorder (ASD) in Asia is less clear due to the absence of a formal ASD-monitoring network [10]. Determining the precise prevalence of autism is essential for calculating the financial impact the disorder has on the family and for making well-informed choices about the allocation of resources and support. Additionally, it enables us to pinpoint local and environmental risk factors linked to the condition [11]. Despite the abundance of research on the prevalence of autism in different Asian nations, there may be differences in the study’s scope and caliber. Some nations may have less published studies accessible, but they have nevertheless made significant attempts to look into the frequency of autism. With the help of this study, we want to close the gaps in our understanding of the prevalence of autism in Asian countries by performing a thorough review of the data. The epidemiology of autism is provided by this study [12], which will enable us to customize therapy to address resource constraints, encourage early detection, and have an impact on local public health policies.

2. MATERIALS AND METHDOS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines13 were followed in this investigation. Online resources like PubMed and Google Scholar were used to retrieve the English-language papers published between 2015 and 2022. The terms “autism,” “autistic disorder,” “autism spectrum disorders,” “pervasive developmental disorders,” and “Asperger syndrome” were among the many terms used to search the databases. After that, the reference lists of the related studies were looked through to find other relevant papers. These inclusion criteria were used to choose the studies. Collaborative or cross-sectional study designs published in English between 2010 and 2022. Research studies that used reliable tools to diagnose autism 3) Research that offered prevalence data 4-Studies conducted using human subjects 5) a neighborhood with a specific focus. The following were the exclusion criteria: 1) Research uses redundant or repetitive data.The literature lacks comprehensive textual materials on research.3) Research that makes use of obscure or covert detection techniques.4) Research and qualitative studies turned in as theses or dissertations. To ensure data integrity, all databases were first thoroughly examined using sophisticated search methods, and duplicate research was eliminated. Following that, a list of relevant papers was gathered for further evaluation. Using predetermined inclusion and exclusion criteria, the titles and abstracts of the surviving papers were carefully reviewed in the first step. The studies’ applicability was assessed in a second stage that comprised examining the full texts of relevant articles and removing any study that was thought to be irrelevant. Following a thorough inspection, we classified the papers and took pertinent information out of each research study. The obtained data was then arranged in a table for better viewing. I The first author; (ii) The year of publication; (iv) Environment (rural and urban, community and facility based); (iii) Country Age ranges, sample size, and reported prevalence of ASD are (v) diagnostic standards and screening methods (vii, viii). Every research finding that was excluded from the study was meticulously noted and documented.

3. RESULTS AND DISCUSSION

About 17,200 studies were located during the first literature search. After removing duplicate studies and records disqualified for various reasons, 2,200 records remained for further examination. Upon meticulous scrutiny of the abstracts and titles, 1,800 studies that did not meet the qualifying criteria were excluded from further analysis. We performed full text retrieval on the remaining 400 studies. 200 papers were assessed for eligibility during the screening phase; 191 articles were excluded from consideration following a comprehensive textual analysis, as they did not meet our required standards. Ultimately, this systematic review contained nine publications. Many countries’ studies, particularly those in the Asian region, were published between 2012 and 2022. It is very challenging to compare research on autism spectrum disorder (ASD) because different countries use different screening tools, diagnostic standards, and methods. These modifications may result in a considerable variation in the stated prevalence rates. There was significant heterogeneity in the autism screening and diagnostic criteria used in these research. Studies on the prevalence of autism from South Asia are scarce. Only papers from Bangladesh, India, and Nepal that reported the incidence were found between 2012 and 2022. In a research done in a rural context with a sample size of 4098, Heys et al. [16] estimated the frequency to be 0.3%, with Nepal reporting the greatest prevalence among South Asian nations. In a semi-urban setting, Poovathinal et al. [14] did a study with a sample size of 18,840 and discovered a prevalence of 0.23%. The prevalence was reported to be 0.075% in a rural context with a sample size of 5286 people from Bangladesh [15]. According to East Asia Studies, the prevalence was found to be between 1% and 3.22% in China [18] and Japan [19]. Studies conducted in west Asia have estimated the prevalence to be 0.48%, 0.28%, and 0.062%, respectively, in Iran [22], Saudi Arabia [21], and Israel [20]. A national population-based study conducted in Vietnam [17] found that the prevalence of autism was 0.758% in South East Asia. The sample sizes for each of these investigations varied from 1023 to 1.32 million. The age range covered a span of 1 to 30 years. We examined the updated prevalence of nine Asian nations in this systematic review. Iran had a prevalence of 0.062%, while Japan had a prevalence of 3.22%. The country with the highest prevalence was found to be Japan. This could be the reason for the rise in the prevalence of autism spectrum disorder (ASD) in Japan between 2009 and 2023. This nationwide increase may be the result of increased public awareness of the illness. However, other factors, including those unrelated to the etiology of ASD and those connected, such as differences in service accessibility, may also have an impact on disparities in the incidence at the regional level [23]. Taiwan, Hong Kong, and Mainland China had 26.6 incidences of autism for every 10,000 persons, according to a systematic review [24]. Given that this figure is significantly lower than that of Western countries, it is possible that underdiagnosis in these places exists. This Chinese study, which was included in our analysis, was conducted in Jilin City, where data from special and mainstream schools were available. The findings indicated that, at 1%, China’s autism prevalence is almost the same as that of Western countries [6]. The study was conducted in Bangladesh, a south Asian nation, and the results showed a comparatively low incidence of 0.075%. The first set of reported prevalence data from India consisted of preliminary findings. These findings were derived from a midterm report that was sent to the project’s sponsoring organization [25]. Poovathinal et al. [14] reported that the latest prevalence data from Kerala, a state in south India, showed a greater prevalence of autism than a previous study [25]. There should be concern as this points to a significant increase in the prevalence of autism in India. Among the articles we studied, the Nepalese study stands out since it is one of the few that was conducted in a low-income, rural area. The estimated prevalence of autism in this study was 3 per 1000, which is less than the reported rates in high-income countries (HICs), where it ranges from 10 to 20 per 1000, according to Elsabbagh et al.’s 2012 study [26]. The prevalence in the Nepalese study was also lower than that of the only other low-income country (LIC) study conducted in Uganda, where the estimated rates among 1 to 10-year-olds were assessed to be 12 to 13 per 1000, as reported by Kakooza-Mwesige et al. in 2014 [27]. Autism spectrum disorders (ASDs) were found to be extremely common in Vietnamese children between the ages of 18 and 30 months, with a frequency of 0.758%, or 1 in 132 children. According to the study, there is a correlation between an elevated risk of ASD and having heritable genetic traits, being a boy, and living in an urban area [17]. It is noteworthy that this population-based, epidemiological, nationally representative study was the first of its kind in Vietnam. Vietnam has a lower prevalence of ASD than more industrialized countries like the United States, where the rate was estimated to be 1.68% [6]. Iran distinguishes out as one of the few countries that thoroughly screens children for autism spectrum disorder (ASD). This examination is an essential part of a national Iranian screening program that is directly linked to school enrolment. As a result, families must participate in the screening process. But just 40% of five-year-olds in the country have had an autism screening up to this point. However, children in large cities have been checked at a disproportionately higher rate [22]. Nonetheless, the prevalence rates (6.26 per 10,000) for Iran discovered in this study are significantly lower than those for the USA established by Bertrand et al. in 2001 [28]. That study found that up to 40 youngsters out of every 10,000 were diagnosed with autism condition. among our 2010 Israeli study, we found a prevalence rate of 0.48% for autism spectrum disorder (ASD) among children between the ages of 1 and 12 [20]. These figures correspond to the global average estimates of 0.62% [26] that Elsabbagh et al. published in 2012. These findings suggest that the prevalence of ASD in Israel is similar to the average rates reported worldwide in those pertinent research. According to a study we conducted in Saudi Arabia, 2.81 cases of autism spectrum disorder (ASD) were found for every 1,000 children aged 6 to 12 who attended Makkah and Jeddah’s ASD-specific schools or rehabilitation facilities [21]. This occurrence is consistent with findings from past studies carried out in Saudi Arabia and other Arab countries [29]. These findings imply that the prevalence of ASD is comparable throughout the various Arab countries in the area. Since the published research from Asia that is included in our study exhibits methodological inconsistencies, direct comparisons are challenging. There are differences in case definitions, screening instruments, diagnostic criteria, and age groups assessed. Various tools’ diagnostic techniques, sensitivity, and specificity may cause misclassification bias. Variations in the target population size also affect prevalence comparisons. The results’ limited applicability to other Asian countries is a result of their exclusive emphasis. In order to evaluate prevalence in a comprehensive and comparable manner, a standardized approach is needed.

4. CONCLUSION

Our study’s goal was to conduct a detailed analysis of Asian autism spectrum disorder (ASD) prevalence research. The assessment notes variations in the screening procedures and diagnostic criteria applied by the studies, which complicates comparisons. Accurate and trustworthy diagnoses of autism spectrum disorder (ASD) are crucial for informing future policy in developing Asian nations. More research is needed to gather information for better management, early intervention, and resource allocation in these regions 30 because there is a lack of information on the prevalence of ASD in different Asian countries.

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