Prevalence of emotional disorders among institutionalized care children in Nairobi suburb settings(Kenya).

Abstract

Introduction Studies show that whenever children exhibit emotional disorders, they are labelled as spoilt and are disciplined for showing their weaknesses, lowering their self-esteem. Qualitatively institutionalized children are needy, sensitive, and isolative with low confidence and self-esteem. In other observations they often lacked love, poorly equipped with first rank physiological needs(food, water, shelter) , had large poor backgrounds and limited resources, stigmatized and frequently relocated due to inadequate resources and therefore are less studied. Objective A study to determine the prevalence and variation of various emotional disorders among institutionalized care children in the suburb Materials and Methods . Sampling method: a purposive sampling (non probability sampling, convenience sampling. Design :.Descriptive cross-sectional study . Study site: The three statutory institutions namely Juvenile Remand Home, Kabete Rehabilitation (approved) SchoolandGetathuru Reception Centre. Study population .All institutionalized children in 3 institutions. Study instruments.Socio-Demographic Questionnaire – Researcher Designed(M.I.N.I. KID) Mini International Neuropsychiatric Interview for Children and Adolescents English Version 7.0.2 For DSM-5 with 24 variables. Results : A study to determine the prevalence and variation of various emotional disorders among 122 youths was undertaken in three statutory institutions in Nairobi, Kenya. Statutory institutions are government institutions which are offering safe custody to children who are in need of Protection and Care (destitute and orphans) as well as those who are in conflict with the law with minor crimes as opposed to juvenile criminals sentenced for 3 years at Borstal institutions. Total population was 700 from the statutory institutions. With 248 as sample size according to Krejcie&Morgans (1970). Those who met the inclusion criteria were 300. All were allowed to be participants and were briefed on the nature of the study, informed consent was then sought and signed by those who were above 18yrs, and those below 18yrs signed the assent form. Repatriation took place as cases of majority were either released or committed to other approved schools outside Nairobi The study registered a 100% response rate, all from 3 statutory institutions as follows: 50 (41.8%) from Juvenile Remand Home (JRH); 28 (23.0%) from Getathuru Reception Centre (GRC); 43 (35.2%) from Kabete rehabilitation School (KRS).The mean prevalence of all the emotional disorders assessed was 22.6%, comprising 21.31% males and 24.30% females (n=122). They were aged 12.83+ 0.26 years (14.00+.48 for Getathuru; 12.45+.40 for JRM; and 12.56+.44 for Kabete); with 4.08+0.22 siblings (3.53+.52 for JRH; 4.37+.38 for Getathuru; and 4.18+ .30 for Kabete RS); had completed 5.50+0.22 years in school (4.75+.33 for JRH; 6.75+ .43 for Getathuru; 5.58+ .36 for Kabete RS); and have been admitted since 2015.45+ 0.44 (2016.13+ .84 for IJR; 2015.58+ .81 for Getathuru; and 2014.92+ .67 for Kabete RS). The overall prevalence of emotional disorders is 23.00%, with variations as follows: juvenile Remand home (12.9%), Kabete Rehabilitation (28.9%) andGetathuru Centre (30.5%) (n=122). There is a relationship between specific phobia episode disorders (18.5% male and 51% female); generalized anxiety disorder (0% male and 2% female) and suicidality episode (24% male and 8% female). All the difference in prevalence for these three is partly attributed to gender influences (include p-values). There is a relationship between these five specific disorders and institutional affiliation: specific phobia episodes (X2=.039; n=117); post-trauma stress disorder (X2=.045; n=116); agoraphobia (X2=.008; n=119); suicidality (X2=.004; n=117); and major depression disorders (x2=.013; n=94), with a strong relation (Pearson’s’ R) exhibited by suicidality (R-0.32), Agoraphobia (R=0.321), and Post-traumatic stress disorders (R=0.25). A total of 295/1274 respondents experienced mental episodes, distributed by age as follows: 24.1% for ≤ 10 years; 23.3% for the 11-14 year olds; 21.1% for the 15-17 year olds; and 10% for adults aged ≥18 years. Age seemed a key factor in mental illness; as the two variables were inversely proportional. There was no correlation between age and emotional disorders studied; this poor to no relationship is proved further by the low Pearson’s R-values recorded (-0.021-0.178), all less than 0.2. Respondents exhibited emotional disorders as follows: 17.8% lower primary; 22.8% in upper primary; and 37.3% for secondary. The risk and prevalence seem directly proportional to the level of education (class reached)…as one matures, one is more likely to get a mental condition. Only specific phobia episode (X2=0.004; less than 0.05 bears a correlation with the respondents’ level of education. To qualify this further, an R-value of -0.362 is registered as the Pearson’s R-value. The registered prevalence of emotional disorders is 22.3%, varies with the state of parenthood of the respondents. Total orphans have registered a prevalence of 29.9%; those with both parents have a prevalence of 42.7%; 8.54% for those with only a father and 18.8% for those with only a mother. Mental disorders studied varied with schooling level as follows: 18.7% for lower primary; 22.6% in upper primary; and 28.7% for secondary. The risk and prevalence is therefore directly proportional with class reached. In terms of level of education and mental disorder, it is established that the majority of the mental conditions are not related at all with the level of education. Only three mental conditions among those studied have a relationship with education level: suicidality episode (p=0.046, n=191); specific phobia episode (p=0.018; n=189), and obsessive compulsive disorder (p=0.009, n=143) exhibit a relationship with education level. There is no statistical difference between specific emotional disorders and institution. Efforts should be put in to support both surviving parents is central to containing the emotional disorders. This is because families with both parents have lower prevalence of emotional disorders. Institutional management is a key factor in containing disorder; well managed institutions help stabilize children, thereby exposing them less to emotional disorders. With no significant relationship between institutional affiliation and prevalence of mental disorders, it’s imperative that private centres also seem to do fairly well. The government should strengthen its institutions to make them superior to the private ones. Conclusion This study confirms the presence of emotional disorders with high levels of depression (51.6%) and PTSD (34%) among children in institutional care. The study also highlights, that instutionalization, no matter the duration, contributes to the presence of the emotional disorders. Furthermore, the institutionalized children, who were total orphans, more vulnerable to these emotional disorders than the others. These findings concur with documented negative effects of parental deprivation and institutionalization on children’s wellbeing by John Bowlby and others. Parental status as a protective factor underscored by the finding of statistically significant lower prevalence of emotional disorders, in those with two parents.