Objective to determine the prevalence of psychological disorders among institutionalized orphans in rural and urban settings in Kenya. Design A cross-sectional descriptive method was adopted. Quantitative methods were employed using self-administered questionnaires (ReADS) for the children to identify emotional disorders. The teacher-rated Rutter’s scale for the identification of emotional and behavioral problems was also used. Focus group discussions were held with selected key staff of the orphanages to gain an understanding of the objectives of the various orphanages and how the orphans viewed the institutions, according to the caretakers. Setting the study was conducted in two study settings in Kenya: urban and rural. The representative study sites for both urban and rural were selected using purposive sampling. Subjects Six hundred and seventy three children aged 8 years and above were interviewed. Teachers were also interviewed regarding their own observations about the children's emotional and behavioral problems. Results both orphans and non-orphans had high levels of psychological distress with a statistically significant difference on separation anxiety subscale (p = 0.021). Total orphans had a higher prevalence of depression of 2.9% than non-orphans who had a depression prevalence of 2.6%.Depressionco-existed with obsessive-compulsive disorder with a prevalence of 13.4% among non-orphans and 10.4% among total orphans. Separation anxiety prevalence was higher among on-orphans (16.7%) and (11.7%) among total orphans, than other categories of children. Children in the rural setting were twice more likely to suffer from psychological disorders than the children in the urban setting. There were statistical differences for obsessive-compulsive disorder and panic disorder subscales (p = 0.031 and p = 0.040 respectively). Focus groups discussions revealed that staff in the orphanages could not easily identify psychological disturbances. Conclusions Children in institutions have emotional and behavioral problems that need to be identified and managed. Children suffer from depression and other co-morbid illnesses such as obsessive-compulsive disorder, generalized anxiety disorder, separation anxiety and social phobias early as 8 years and these ought to be recognized early to prevent debilitating psychiatric illnesses later in adulthood. This study concluded that parental deprivation either through death or separation from significant attachment figures was a major factor affecting the psychological well-being of a child. It is important for teachers and other adults to learn how to identify psychological problems in children. From the findings of this study, institutionalization is not the only practical response to the orphan crisis.
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