The GALENOS approach to triangulating evidence: a structured approach for integrating information from human and animal studies.

Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterised by persistent deficits in social communication and interaction, and restricted, repetitive patterns of behaviour, interests, or activities []. The World Health Organization (WHO) estimates that approximately one in every 100 children is diagnosed with ASD globally []. In the United States, the Centers for Disease Control and Prevention (CDC) reported a prevalence of 1 in 36 children aged eight years in 2020, up from 1 in 44 in 2018, underscoring a rising global burden [, ]. The male-to-female diagnostic ratio remains approximately 3:1, although emerging evidence suggests that ASD is systematically underdiagnosed in females []. In sub-Saharan Africa, epidemiological data on ASD remain scarce, creating significant gaps in service planning []. Nigeria has reported the highest diagnosed caseload in the region []. Studies from East Africa, particularly Kenya, document especially challenging caregiving contexts characterised by insufficient services and constrained social support []. Older paternal age has been identified as a risk factor for ASD across multiple large-scale population studies [–], though the mechanisms linking parental age to ASD risk remain incompletely understood. In Ghana, research on ASD caregiving remains nascent and methodologically sparse. The limited evidence available indicates that cultural misconceptions, including attributions of ASD to spiritual or supernatural causes, delay diagnosis, reinforce stigma, and impede access to evidence-based intervention [, ]. Institutional support for children with ASD is inadequate, and families disproportionately absorb the burden of care with minimal formal assistance []. The psychosocial toll of caregiving for a child with ASD is well documented. At the time of diagnosis, caregivers commonly experience grief-like responses including disbelief, anxiety, and emotional distress [, ]. Over time, unrelieved caregiving demands compromise physical health, mental health, marital relationships, and employment [–]. Mothers are disproportionately affected due to gendered caregiving norms []. This study contributes to the literature by examining the intersection of weak disability policy implementation, widespread acceptance of supernatural explanations, and the near absence of formal respite and psychosocial services for caregivers. Although studies in high-income and some low- and middle-income countries have explored caregiver burden and coping, the Ghanaian context, especially the roles of faith-based coping, traditional medicine use, and structural financial exclusion, remains insufficiently studied. Addressing this gap is critical for informing context-specific, evidence-based policy and practice. The present study aimed to explore the lived experiences of both family and institutional caregivers of children with ASD in the Central Region of Ghana, specifically examining the challenges they face and the coping strategies they employ, with a view to informing evidence-based policy and practice. Specifically, the study sought to: