Caregiver Characteristics Associated with DBDs Among School Going Children in Uganda

Background and Purpose: Disruptive behavior disorders (DBDs) are one of the most common mental health disorders among children and adolescents globally and are associated with adverse developmental outcomes in adolescence and adulthood. In sub-Saharan Africa (SSA), prevalence rates of DBDs range from 12 to 33%. In a recent study among school going children in Uganda, 6% and 2% of the participants scored positive on oppositional defiant disorder (ODD) and conduct disorder (CD). Primarily based in the western world, existing research indicates that family poverty/socioeconomic status, parental marital status, biological/non-biological caregiver status and parental education are associated with DBDs. However, there is limited research on the relationship between caregiver characteristics and DBDs in sub-Saharan Africa. Therefore, our study seeks to examine caregiver correlates associated with DBDs including ODD and CD among school going children in southwestern Uganda.

Methods: We analyzed baseline data (N=2110) from the NIH-funded SMART Africa (U19 MH110001) scale up study in Southwestern Uganda. The study recruited caregivers of children, ages 8-13, from 30 public primary schools. In this study, we examined disruptive behavior challenges, specifically ODD and CD using the DBD, Iowa Conner’s (IO) and Impairment scales. We conducted binary logistic regression analyses to assess caregiver characteristics associated with DBDs.

Results: Results indicated that children living with males primary caregivers were 0.80 times (OR=0.80, P<.10) less likely to screen positive for DBDs compared to those with female primary caregivers/parents. In addition, the odds of screening positive for DBDs were 1.34 times (OR=1.34; P<.05) higher for children living with non-biological caregivers relative to biological parents. Family social economic status measured by asset index, parental education level and marital status were not statistically significant in the model.

Implications and conclusion: Two caregiver characteristics were significantly associated with child disruptive behavior challenges. Specifically, living with male primary caregivers was associated with a less likelihood of DBDs. It is possible that some behaviors will be perceived as less problematic by male caregivers. Moreover, male caregivers may not be directly engaged in the day-to-day life of children, and hence be aware of children’s behavioral challenges. On the contrary, living with caregivers other than biological parents increased the odds of a child-screening positive for DBDs. Given the high numbers of children living with extended families in this area, it is particularly critical to use family interventions (e.g., multiple family groups) to strengthen the parenting skills of non-biological caregivers and support families in addressing child behavioral challenges in SSA, including in Uganda.