Perceived behavioral problems of school aged children in rural Nepal: a qualitative study

Chinese Medicine

Mark J.D. Jordans⁵  Brandon A. Kohrt¹  Matthew D. Burkey³  Nagendra P. Luitel⁴  Dristy Gurung⁴  Nawaraj Upadhaya⁴  Ramesh P. Adhikari² 

[1] Department of Psychiatry and Behavioral Sciences, Duke Global Health Institute, Duke University, Durham, USA;Padma Kanya Multiple Campus, Tribhuvan University, Kathmandu, Nepal;Division of Child and Adolescent Psychiatry, Johns Hopkins School of Medicine, Baltimore, USA;Research Department, Transcultural Psychosocial Organization (TPO), Kathmandu, Nepal;Center for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK

关键词: Qualitative;    Psychosocial;    Nepal;    Child behavior problems;   

Others  :  1223204
DOI  :  10.1186/s13034-015-0061-8

 received in 2015-03-24, accepted in 2015-06-22,  发布年份 2015

【 摘 要 】

Background

Studies on child behavioral problems from low and middle income countries are scarce, even more so in Nepal. This paper explores parents’, family members’ and teachers’ perceptions of child behavioral problems, strategies used and recommendations to deal with this problem.

Method

In this study, 72 free list interviews and 30 Key Informant Interviews (KII) were conducted with community members of Chitwan district in Nepal.

Result

The result suggest that addictive behavior, not paying attention to studies, getting angry over small issues, fighting back, disobedience, and stealing were the most commonly identified behavioral related problems of children, with these problems seen as interrelated and interdependent. Results indicate that community members view the family, community and school environments as being the causes of child behavioral problems, with serious impacts upon children’s personal growth, family harmony and social cohesion. The strategies reported by parents and teachers to manage child behavioral problems were talking, listening, consoling, advising and physical punishment (used as a last resort).

Conclusions

As perceived by children and other community dwellers, children in rural Nepalese communities have several behavioral related problems. The findings suggest that multi-level community-based interventions targeting peers, parents, teachers and community leaders could be a feasible approach to address the identified problems.

【 授权许可】

   
2015 Adhikari et al.

【 参考文献 】

• [1]Kieling C, Baker-Henningham H, Belfer M, Conti G, Ertem I, Omigbodun O et al.. Child and adolescent mental health worldwide: evidence for action. Lancet. 2011; 378:1515-1525.
• [2]Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C et al.. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the global burden of disease study 2010. Lancet. 2013; 380(9859):2197-2223.
• [3]Kessler RC, Berglund P, Demler O, Jin R, Walters EE. Lifetime prevalence and age‐of‐onset distributions of DSM‐IV disorders in the National Comorbidity Survey Replication. Arch. Gen. Psychiatry. 2005; 62:593-602.
• [4]Preventing suicide a global imperative. World Health Organization, Geneva, Switzerland; 2014.
• [5]Bongers IL, Koot HM, Ende J, Verhulst FC. Developmental trajectories of externalizing behaviors in childhood and adolescence. Child Dev. 2004; 75(5):1523-1537.
• [6]Alisauskas A, Simkiene G. Teachers’ experiences in educating pupils having behavioural and / or emotional problems. Spec Educ. 2013; 1(28):62-72.
• [7]Erskine HE, Ferrari AJ, Polanczyk GV, Moffitt TE, Murray CJL, Vos T et al.. The global burden of conduct disorder and attention-deficit/hyperactivity disorder in 2010. J. Child Psychol. Psychiatry. 2014; 55(4):328-336.
• [8]Atilola O, Balhara YPS, Stevanovic D, Avicenna M, Kandemir H. Self-reported mental health problems among adolescents in developing countries: results from an international pilot sample. J. Dev. Behav. Pediatr. 2013; 34:129-137.
• [9]Murray J, Anselmi A, Gallo EAG, Fleitlich-Bilyk B, Bordin IA. Epidemiology of childhood conduct problems in Brazil: systematic review and meta-analysis. Soc. Psychiatry Psychiatr. Epidemiol. 2013; 48:1527-1538.
• [10]Prior M, Virasinghe S, Smart D. Behavioural problems in Sri Lankan schoolchildren Associations with socio-economic status, age, gender, academic progress, ethnicity and religion. Soc. Psychiatry Psychiatr. Epidemiol. 2005; 40:654-662.
• [11]Syed EU, Hussein SA, Haidry S. Prevalence of emotional and behavioural problems among primary school children in Karachi, Pakistan – multi informant survey. Indian J. Pediatr. 2009; 76:623-627.
• [12]Pathak R, Sharma RC, Parvan UC, Gupta BP, Ojha RK, Goel NK. Behavioural and emotional problems in school going adolescents. Australasian Med J. 2011; 4(1):15-21.
• [13]Patel V, Flisher AJ, Nikapota A, Malhotra S. Promoting child and adolescent mental health in low and middle income countries. J. Child Psychol. Psychiatry. 2008; 49(3):313-334.
• [14]Kessler RC, Amminger GP, Aguilar-Gaxiola S, Alonso J, Lee S, Ustün TB. Age of onset of mental disorders: a review of recent literature. Curr Opin Psychiatry. 2007; 20(4):359-364.
• [15]Fergusson DM, Horwood LJ, Ridder EM. Show me the child at seven: the consequences of conduct problems in childhood for psychosocial functioning in adulthood. J. Child Psychol. Psychiatry. 2005; 46(8):837-849.
• [16]Moffitt TE, Arseneault L, Jaffee SR, Kim-Cohen J, Koenen KC, Odgers CL et al.. Research review: DSM-V conduct disorder: research needs for an evidence base. J. Child Psychol. Psychiatry. 2008; 49(1):3-33.
• [17]Human development report 2014. United Nations Development Programme (UNDP), New York, USA; 2014.
• [18]National population and housing census 2011. Central Bureau of Statistics, Kathmandu, Nepal; 2012.
• [19]Status of child rights in Nepal annual report 2008. National Human Rights Commission, Harihar Bhawan Lalitpur Nepal; 2008.
• [20]Nepal conflict report 2012. United Nations Office of the High Commissioner for Human Rights, Geneva; 2012.
• [21]Kohrt BA, Jordans MJD, Tol WA, Perera E, Karki R, Koirala S et al.. Social ecology of child soldiers: child, family, and community determinants of mental health, psychosocial well-being, and reintegration in Nepal. Transcult Psychiatry. 2010; 47(5):727-753.
• [22]Chhabra GS, Sodhi MK. Impact of family conflict on the psychosocial behaviour in male adolescents. J Nepal Paediatr Soc. 2012; 32(2):124-131.
• [23]Tol WA, Jordans MJ, Regmi S, Sharma B. Cultural challanges to psychosocial counseling in Nepal. Transcult Psychiatry. 2005; 42:317-333.
• [24]Hruschka DJ, Kohrt BA, Worthman CM. Estimating between- and within-individual variation in cortisol levels using multilevel models. Psychoneuroendocrinology. 2005; 30:398-714.
• [25]Regmi SK, Khalid A, Nepal MK, Pokhrel AK. A study of socio-demographic characteristics and diagnostic profile in psychiatric outpatients of TUTH. Nepalese J Psychiatry. 1999; 1:26-33.
• [26]Atilola O. Cross-cultural child and adolescent psychiatry research in developing countries. Global Ment Health. 2015;2.
• [27]Bolton P. Local perceptions of the mental health effects of the Rwandan genocide. J. Nerv. Ment. Dis. 2001; 189(4):243-248.
• [28]Applied Mental Health Research Group. Design, implementation, monitoring, and evaluation of mental health and psychosocial assistance programs for trauma survivors in low resource countries: a user’s manual for researchers and program implementers (adult version). Module 5: intervention selection, adaptation, and implementation. 2013. Available from:. http://www. jhsph.edu/research/centers-and-institutes/center-for-refugee-and-disasterresponse/response_service/AMHR/dime/VOT_DIME_MODULE5_FINAL.pdf webcite
• [29]Ojha SP, Jasmin M, Chapagain M, Tulachan P. Educational and Behavioural Problems among Sheltered Homeless Children. J Nepal Med Assoc. 2013; 52(191):457-461.
• [30]Vijayalakshmi K, Kumar CV, Rajamanickm H, Cherian A. Child rearing practices and psychological problems of children. Nurs Midwife Res J. 2007; 3(2):49-56.
• [31]Karki YB. Sex preference and the value of sons and daughters in Nepal. Stud. Fam. Plan. 1988; 19(3):169-178.
• [32]Patel V, Flisher AJ, Hetrick S, McGorry P. Mental health of young people: a global public-health challenge. Lancet. 2007; 369:1302-13013.
• [33]Harland P, Reijneveld SA, Brugman E, Verloove-Vanhorick SP, Verhulst FC. Family factors and life events as risk factors for behavioural and emotional problems in children. Eur. Child Adolesc. Psychiatry. 2002; 11(4):176-184.
• [34]Reed RV, Fazel M, Jones L, Panter-Brick C, Stein A. Mental health of displaced and refugee children resettled in low-income and middle-income countries: risk and protective factors. Lancet. 2011; 379:250-265.
• [35]Arman S, Keypour M, Maracy MR, Attari A. Epidemiological study of youth mental health using strengths and difficulties questionnaire (SDQ). Iranian Red Cresc Med J. 2012; 14(6):371-375.
• [36]Mesman J, Stoel R, Bakermans-Kranenburg MJ, van IJzendoorn MH, Juffer F, Koot HM et al.. Predicting growth curves of early childhood externalizing problems: differential susceptibility of children with difficult temperament. J. Abnorm. Child Psychol. 2009; 37:625-636.
• [37]Bordin IA. Epidemiology of childhood conduct problems in Brazil: systematic review and meta-analysis. Soc. Psychiatry Psychiatr. Epidemiol. 2013; 48:1527-1538.
• [38]Bharati S, Takao H. Schooling: knowledge, perception and practices of parents. J. Educ. Res. 2010; 2:44-51.
• [39]Violence against children in Nepal series 2. Center for Victims of Torture (CVICT) and UNICEF Nepal, Kathmandu, Nepal; 2004.
• [40]Engle PL, Fernald LCH, Alderman H, Behrman J, O’Gara C, Yousafzai A et al.. Strategies for reducing inequalities and improving developmental outcomes for young children in low-income and middle-income countries. Lancet. 2011; 378:1339-1353.
• [41]Kazdin AE. Premature termination from treatment among children referred for antisocial behavior. J Clin Child Psychol. 1993; 31:2-16.
• [42]Upadhaya N. “Distress, a door to happiness?” the meaning and etiology of everyday adolescent distress, in a Nepalese government high school university of Amsterdam. 2011.
• [43]Hiscock H, Bayer JK, Lycett K, Ukoumunne OC, Shaw D, Gold L et al.. Preventing mental health problems in children: the Families in Mind population-based cluster randomised controlled trial. BMC Public Health. 2012; 12(420):1-9.