Efforts at improving child-health and development initiatives in sub-Saharan Africa had focused on the physical health of children due to the neglect of child and adolescent mental health (CAMH) policy initiatives. A thorough and broad-based understanding of the prevalent child mental-health risk and vulnerability factors is needed to successfully articulate CAMH policies. In this discourse, we present a narrative on the child mental-health risk and vulnerability factors in sub-Saharan Africa. Through an ecological point of view, we identified widespread family poverty, poor availability and uptake of childcare resources, inadequate community and institutional childcare systems, and inadequate framework for social protection for vulnerable children as among the risk and vulnerability factors for CAMH in the region. Others are poor workplace policy/practice that does not support work-family life balance, poor legislative framework for child protection, and some harmful traditional practices. We conclude that an ecological approach shows that child mental-health risks are diverse and cut across different layers of the care environment. The approach also provides a broad and holistic template from which appropriate CAMH policy direction in sub-Saharan Africa can be understood. 1. Introduction The last century witnessed considerable changes in the nature and pattern of child and adolescent health problems, significant among which is the unequivocal recognition of mental disorders as a source of childhood morbidity [1]. This recognition is not unconnected with emerging evidence from multinational epidemiological surveys that mental and behavioural problems among children and adolescents are common and a worldwide phenomenon [2]. Childhood mental disorders are also associated with significant distress to the child and a major burden to the society [3–5]. Though there is yet to be any conclusive evidence that childhood mental disorders are relatively more prevalent in low-resource countries, there are indicators to suggest that the global burden of childhood mental health problems is likely to be concentrated in low- and middle-income (LAMI) countries. In the first instance, 85% of the world’s child and adolescent population live in the LAMI countries [6]. Secondly, the LAMI regions of world have poorer child-related social indicators [7], a situation which can increase the risk of childhood mental health problems [8]. Among the LAMI regions of the world, children living in sub-Saharan Africa in particular face a life of poverty, poor nutrition, and social
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