Prevalence of Disruptive Behaviors Among School Going Children in Southwestern Uganda

Introduction

Disruptive Behavioral Disorders (DBDs) are chronic, impairing, and costly Child and Adolescent Mental Health (CAMH) challenges that, when left untreated, carry a high price resulting in disruptions in school performance, friendships and family relations. Yet, there is dearth of prevalence data on CAMH challenges within Sub Saharan Africa (SSA), with estimates ranging from 12 to 33%. Primary reasons appear to relate to lack of contextually and culturally aligned measurement and country-specific surveillance systems.

For example, in Uganda, studies that have estimated CAMH challenges were conducted among children in specialized children’s clinics. One study found that 11% of the participants had Attention Deficit Hyperactivity Disorder (ADHD) symptoms. While providing important data, the studies primarily focused on children within a specialty clinic. Given the negative outcomes associated with DBDs, detecting these emerging behavioral challenges early on is vital to develop and implement appropriate prevention interventions. Thus, this study aims to estimate the prevalence rate of behavioral challenges among school going children and adolescents, utilizing a school-wide based sample in southwest Uganda.

Methods

We present baseline results from a five-year scale-up study (2016-2021), funded by the National Institute of Mental Health (NIMH) set across 30 public primary schools in the greater Masaka region, a region heavily impacted by poverty and HIV/AIDS. We draw on baseline screening data from caregivers of 2434 children, ages 8 to 13 years. Participants were screened using the Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD) – both subscales of the Disruptive Behavior Disorders (DBD) scale, Iowa Connors and Impairment scales. About half of the children in the sample were female (52%), with a mean age 10.27 years and enrolled in primary four (grade four) at a participating school. All caregivers provided active consent to participate in the study. Univariate and bivariate analyses were used to estimate prevalence rates of behavioral challenges among school going children and adolescents.   

Results

Of the 2434 participants screened: 1) 136 (6%) evidenced a positive score on ODD and 42 (2%) screened positive on CD; 2) 234 (9.61%) of participants were reported to have elevated symptoms on the Iowa Connors caregiver report scale. We only found a statistically significant positive correlation between Iowa Connors Scale and an impairment domain on “children with mental challenges relating with brothers or sister”, (r = 0.251, p = .05). Finally, 25% of children were described by their caregivers to experience impairment in at least four of the seven domains of the Impairment scale. 

Conclusion

The results indicate the presence of behavioral challenges among school going children in Uganda. This demonstrates the need for further research in the area of CAMH and also the need to use diagnostic assessments to further assess children that screened positive. In addition, given the negative outcomes associated with behavioral challenges as children transition to adolescence and adulthood, detecting these emerging behavioral challenges early on is critical to develop appropriate interventions.