Behavioural problems among children living in orphanage facilities in Karachi, Pakistan: comparison of children in an SOS village with children in conventional orphanage : a cross-sectional study

Introduction Psychologists have long believed that growing up in an institution like an orphanage limits a child\u27s mental development. Though some studies may report, but direct evidence to support this hypothesis is not available. Current figures from the general population of children have indicated the rising burden of poor mental health in our part of the world. This study aims to compare the mental health status of children living in an SOS village with those living in conventional orphanages. SOS village is an international movement/facility for orphaned children that started in Austria after World War II, their basic philosophy is to provide a family setup in raising their children. Subjects and Methods A cross-sectional study was conducted during July 2007 to September 2007 on 330 children of 4 — 16 years of age from an SOS village and other conventional orphanages in Karachi. Face-to-face interview were performed, and mental health of children was assessed using the Strengths and Difficulties Questionnaire (SDQ) that was administered to children\u27s foster mothers and teachers. Prevalence of emotional, conduct, hyperactivity, peer relationship, pro-social behavior and overall behavioral problems among children in an SOS village and conventional orphanages were identified on multi informant ratings. Additionally, multivariable models were built with foster mother\u27s ratings as response variable using Generalized Equating Equations (GEE) to identify factors independently associated with the conduct problems and overall behavioral problems of children. According to our study a child was screened positive for behavioral problems, if he/she scored 18 and above on total difficulties of SDQ (which is a validated cutoff for the Urdu* Version), while validated cutoffs were also utilized for sub scales of behavioral problems. Results The study estimated the overall prevalence (foster mother rating) of behavioral problems among children living in orphanage facilities in Karachi as 33%. The prevalence among SOS village children was 27.8% and that among conventional orphanage was 39.7%. The factors independently associated with the overall behavioral problems of children were wasting (OR adj = 1.77, 95% CI: 0.92 — 3.41), \u3c 5 years of length of stay with the facility (OR adj = 1.83, 95% CI: 0.86 — 3.90), and foster mother\u27s depression (OR adj = 1.93, 95% CI: 0.76— 4.89). Moreover, there was a significant interaction between facility and gender. There was no difference in the behavioral problems of male children between SOS and the conventional orphanage (OR adj = 0.87, 95% CI: 0.29 — 2.60), however, female children in the conventional orphanage were at a much higher risk relative to those living in SOS. (OR adj = 9.86, 95% CI: 3.22 — 30.16). Furthermore, the study estimated the overall prevalence (foster mother rating) of conduct problems among children living in orphanage facilities in Karachi as 50%. The prevalence among SOS village children was 51.6% and that among conventional orphanage was 49%. The factors independently associated with the abnormal rating on conduct problems of children were foster mother depression (OR adj = 4.48, 95% CI: 2.22 — 9.03), and child\u27s malnourishment (OR adj = 1.91, 95% CI: 1.25 — 2.92), while every one year increase in length of stay at the facility had a protective effect on conduct problems (OR adj = 0.87, 95% CI: 0.77 — 0.98). There was a significant interaction between facility and gender with regards to impact on SDQ conduct problems. There was no difference in the conduct problems of male children between SOS and the* An Indic language that is the official literary language of Pakistan, essentially identical to Hindi in its spoken form but in its literary form heavily influenced by Persian and Arabic and written in an Arabic alphabet. conventional orphanage (OR adj = 0.43, 95% CI: 0.15 — 1.24), however female children in conventional orphanage were at much higher risk as compared to female in SOS village. (OR adj = 6.98, 95% CI: 2.44 — 19.93). Moreover, there was a significant interaction between gender and parental living status. There was no difference in the conduct problems of male children with regard to their parental living status (OR adj 1.01, 95% CI: 0.69 — 1.45), however females had a protective effect against conduct problems when they had no parent alive. (OR adj = 0.25, 95% CI: 0.09 — 0.67). Conclusion Our findings suggested a high burden of behavioral problems among children living in orphanages of Karachi, Pakistan. However, comparable data from this population is not available. Behavioral problems among the SOS village and other conventional orphanages were not found to be significant. This study has also showed that wasting, length of stay with facility; foster mother depression, and interaction of facility with gender were significantly associated with overall behavioral problems of children. On the other hand, foster mother depression, malnourishment, length of stay, interaction of facility and gender, and gender and parental living status were significantly associated with conduct problems. This study has identified certain amenable risk factors like foster mother depression, malnourishment, wasting etc and there is a felt need that proper and timely measures can lead to alleviating these risk factors. These strategies include proper and timely screening coupled with routine monitoring and evaluation. Though cross sectional study cannot establish causality, programs to improve mental health that target the factors and vulnerable segments of population identified by our study are likely to be effective. Efforts are required to promote such programs in Pakistan