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Perceived Behavioral Problems of School Aged Children in Rural Nepal: a Qualitative Study

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Perceived Behavioral Problems of School Aged Children in Rural Nepal: a Qualitative Study King’s Research Portal DOI: 10.1186/s13034-015-0061-8 Document Version Publisher's PDF, also known as Version of record Link to publication record in King's Research Portal Citation for published version (APA): Adhikari, R. P., Upadhaya, N., Gurung, D., Luitel, N. P., Burkey, M. D., Kohrt, B. A., & Jordans, M. J. D. (2015). Perceived behavioral problems of school aged children in rural Nepal: a qualitative study. Child and Adolescent Psychiatry and Mental Health, 9, 25. https://doi.org/10.1186/s13034-015-0061-8 Citing this paper Please note that where the full-text provided on King's Research Portal is the Author Accepted Manuscript or Post-Print version this may differ from the final Published version. If citing, it is advised that you check and use the publisher's definitive version for pagination, volume/issue, and date of publication details. 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Download date: 02. Oct. 2021 Adhikari et al. Child and Adolescent Psychiatry and Mental Health (2015) 9:25 DOI 10.1186/s13034-015-0061-8 RESEARCH ARTICLE Open Access Perceived behavioral problems of school aged children in rural Nepal: a qualitative study Ramesh P. Adhikari1,2*, Nawaraj Upadhaya1, Dristy Gurung1, Nagendra P. Luitel1, Matthew D. Burkey3, Brandon A. Kohrt4 and Mark J.D. Jordans5,6 Abstract 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. Keywords: Child behavior problems, Nepal, Psychosocial, Qualitative Introduction Conduct or behavior problems include problems re- One third of the world’s population are children and lated to repeated violation of other’s rights, aggressiveness, adolescents, with the majority living in low and middle- hyperkinetic impulsive behavior, and missing classes or income countries (LMICs) [1] The World Health running away from school [5, 6]. The Global Burden of Organization estimates that neurological, mental and Disease report 2010 indicates that conduct disorder is behavioral disorders and self-harm contribute 12 % of among the 15 leading causes of disability adjustment life the global burden of disease [2]. Half of neuropsychi- years of children ages 5–19 years [7]. A study conducted atric disorders are estimated to have onset by the age of in five developing countries suggest that 10.5 % of adoles- 14 [3]. Globally, around 10 to 20 % of children and ado- cent suffer from mental health problems, with significant lescents suffer from a mental health problem [1] and proportion being conduct problems [8]. Likewise, 20.8 % suicide is one of the top three leading causes of death of children in Brazil [9], 11.7-13.7 % of school age children among adolescents [4]. in Sri Lanka [10], 34-36 % of children in Pakistan [11], and 30 % of children in India [12] suffer conduct or behav- ioral problems. * Correspondence: [email protected] Despite the importance of gathering evidence on child 1Research Department, Transcultural Psychosocial Organization (TPO), Kathmandu, Nepal behavior problems for individual development and pub- 2Padma Kanya Multiple Campus, Tribhuvan University, Kathmandu, Nepal lic health, there remains lack of data from low and Full list of author information is available at the end of the article © 2015 Adhikari et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http:// creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Adhikari et al. Child and Adolescent Psychiatry and Mental Health (2015) 9:25 Page 2 of 9 middle-income countries [1, 13]. Studies conducted in of children’s behavioral problems, and their ideas to address developed countries have shown that child conduct or the identified problems. behavior problems have negative impacts on children’s social, educational and economic performance in Methods later life [14, 15]. Childhood behavior problems also Study area predict involvement in anti-social behavior in adult- This study was conducted in Jutpani and Meghauli Vil- hood [16]. lage Development Committees (VDCs) of Chitwan dis- Nepal is one of the least developed countries in the trict in Nepal. Of the total population (Meghauli: 16,252; world in term of human development indicators with a Jutpani: 15,118) around two fifths are children in each Human Development Index (HDI) of 0.54 and a Gender VDC. The majority ethnic/caste groups in the study Inequality Index (GII) of 0.48 [17] The most recent 2011 VDCs are Janjati, followed by Brahmin/Chhetris, and national census counted a total population of 26.3 million; Dalits. This study targeted children aged 8–15 years as 44.4 % of the Nepali population are children (0–17 years). well as parents, community members, and school teachers The majority of the population (83 %) reside in rural areas identified as key stakeholders given their direct interac- [18]. In Nepal children suffer socio-economic problems tions with children and their potential influence on chil- including nutrition, shelter, domestic violence, forced dren’sbehavior. labour, caste/ethnic discrimination and lack of access to basic education and medical treatment [19]. The 10-year Design long armed conflict between the Government of Nepal Two qualitative methods (free list interviews and key in- and the Communist Party of Nepal (Maoist) has also had formant interviews) were used for data collection. Free a significant impact on children, including death, injury, list interviews provide a broad overview of a commu- abduction, displacement, abuse, and the disappearance nity’s perception of problems [27]. The open ended and killing of family members and relatives [20, 21]. question “Please tell us about the problems children Moreover, many children and adolescents in Nepal suf- between 8–15 years are facing in your community” was fer from psychosocial and mental health problems related asked during the free list interviews to identify the gen- to family break-up, changing family structure, domestic eral problems of children in the community. Initial data violence, and parental substance abuse [22]. analysis reviewed the list of general problems, identifying Behavior problems have not been thoroughly assessed and categorizing the behavior or conduct problems that among children in Nepal; however, a study of psycho- were most frequently mentioned. The five most fre- social counseling in Nepal reported aggression was one quently reported behavior problems were then explored of the most common reasons for presentation for mental in detail in key informant interviews. Key informant health care [23]. In another study, compared to other interviews specifically focused on probing related to mental health and psychosocial problems, aggression ex- identification of the problem, its perceived causes, per- plained the greatest amount of variance in cortisol as a ceived effects, what children/caregivers have done to ad- marker of hypothalamic pituitary adrenal axis function- dress these problems,
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