A JOINT MASTERS DEGREE PROGRAM BETWEEN UNIVERSITY OF GONDAR & AMANUEL MENTAL SPECIALIZED HOSPITAL IN INTEGRATED CLINICAL AND COMMUNITY MENTAL HEALTH PREVALENCE AND ASSOCIATED FACTORS OF ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD) AMONG CHILDREN AGE 6 TO 17 YEARS OLD LIVING IN RURAL AREA OF GIRJA DISTRICT, GUJI ZONE, SOUTHERN OROMIA REGIONAL STATE, ETHIOPIA. BY: HIRBAYE MOKONA LOLA (BSc) ADVISORS: ABEBAW GEBEYEHU (PhD) AEMRO ZERIHUN (MSc) THESIS TO BE SUBMITTED TO UNIVERSITY OF GONDAR, COLLEGE OF MEDICINE AND HEALTH SCIENCE, DEPARTMENT OF PSYCHIATRY AND AMANUEL MENTAL SPECIALIZED HOSPITAL FOR PARTIAL FULFILLMENT OF MASTERS DEGREE IN INTEGRATED CLINICAL AND COMMUNITY MENTAL HEALTH. August, 2015 ADDIS ABABA, ETHIOPIA Approved By Examining Board As members of examining boards of the final MSc thesis defense, we certify that we have read and evaluated the thesis prepared by: Hirbaye Mokona Prevalence and associated factors of attention deficit hyperactivity disorders (ADHD) among children age 6 to 17 years old living in rural area of Girja district, Guji zone, Southern Oromia regional state, Ethiopia We recommended that it was accepted as fulfilling the thesis requirement for MSc degree of integrated clinical and community mental health ____________________ ____________________ Chairman, department graduate committee Signature Date ___________________________ _________ ________ Name of advisors Signature Date _________________________ __________ _________ _________________________ __________ _________ Name of internal examiner Signature Date _________________________ ___________ __________ Name of external examiner Signature Date ________________________ _____________ __________ I hereby certify that I had read this thesis prepared under my guidance and recommended that it was accepted as fulfilling the thesis requirement. _________________________________ ___________ _________ Name of advisor Signature Date Acknowledgement First of all I would like to extend my special gratitude to my God for His great help during day and night from start to completion of my thesis. Secondly, I would like to extend my deep gratitude to my advisors Abebaw Gebeyehu (PhD), University of Gondar, and Aemro zerihun (MSc), AMSH, for their supportive and constructive comments from beginning to completion of my thesis. I would like to extend my warm gratitude to University of Gondar and Amanuel Mental Specialized Hospital for giving me this chance and financial support. I would like to thank Amanuel Mental Specialized Hospital Library for internet access and librarians for giving me necessary information. Also my deepest gratitude goes to Girja district health office for their cooperation, support and time devoted during data collection period. I would like to extend huge and warm thanks to supervisors and data collectors for their good job during data collection and the study participants for their valuable participation. Last but not the least my acknowledgement goes for those people who helped me directly or indirectly to achieve this thesis. I Acronyms ADDES Attention Deficit Disorder Evaluation Scale ADHD Attention Deficit Hyperactivity Disorder ADHD-I Attention deficit hyperactivity disorder inattentive ADHD-HI Attention deficit hyperactivity disorder hyperactive/impulsive ADHD-C Attention deficit hyperactivity disorder combined AMSH Amanuel Mental Specialized Hospital AOR Adjusted Odds Ratio APA American Psychiatric Association CD Conduct Disorder CDC Center of Disease Control CI Confidence Interval COR Crude Odds Ratio DBD Disruptive Behavioral Disorder DICA Diagnostic Instrument for Child & Adolescent DSM-IV Diagnostic & statistical manual of mental disorder forth edition FMOH Federal Ministry of Health ICCMH Integrated Clinical and Community Mental Health NSCH National Survey of children’s Health ODD Oppositional Defiant Disorder OR Odds Ratio SD Standard Deviation SPSS Statistical Package for the Social Sciences WHO World Health Organization I Table of content Contents page Acknowledgement ............................................................................................................ I Acronyms ......................................................................................................................... I Table of content .............................................................................................................. II List of Tables .................................................................................................................. IV List of Figures .................................................................................................................. V Abstract .......................................................................................................................... VI 1. Introduction ................................................................................................................. 1 1.1. Statement of the Problem ..................................................................................... 1 1.2. Literature review ................................................................................................... 3 1.2.1. Prevalence of ADHD among children ............................................................. 3 1.2.2. Factors Associated with childhood ADHD....................................................... 5 1.3. Justification of the study ........................................................................................ 8 2. Objectives ................................................................................................................... 9 2.1. General objective .................................................................................................. 9 2.2 .Specific Objectives ................................................................................................ 9 3. Methodology .............................................................................................................. 10 3.1. Study design and period ..................................................................................... 10 3.2. Study Area .......................................................................................................... 10 3.3. Source population ............................................................................................... 12 3.4. Study population ................................................................................................. 12 3.5. Inclusion and exclusion criteria ........................................................................... 12 3.5.1. Inclusion criteria ............................................................................................ 12 3.5.2. Exclusion criteria ........................................................................................... 12 II 3.6. Sample Size determination and Sampling techniques ........................................ 12 3.6.1 Sample size determination ............................................................................. 12 3.6.2 Sampling techniques/procedures ................................................................... 13 3.7. Study variables ................................................................................................... 15 3.7.1. Dependent variable ....................................................................................... 15 3.7.2. Independent variables .................................................................................. 15 3.7.3. Operational definition .................................................................................... 16 3.8. Data collection procedure ................................................................................... 16 3.9. Data quality assurance........................................................................................ 17 3.10. Data processing and analysis ........................................................................... 17 3.11. Ethical consideration ......................................................................................... 18 4. Results ...................................................................................................................... 19 5. Discussions ............................................................................................................... 32 6. Limitations of the study .............................................................................................. 36 7. Conclusion ................................................................................................................ 37 8. Recommendation ...................................................................................................... 38 9. References ................................................................................................................ 39 10. ANNEXES ............................................................................................................... 44 III List of Tables Table 1 Socio-demographic characteristics of children age 6 to 17 years old living in rural area of Girja district, Guji zone, southern Oromia regional state, Ethiopia, 2015. 20 Table 2 Socio-demographic characteristics of children’s family living in rural area of Girja district, Guji zone, southern Oromia regional state, Ethiopia, 2015. ..................... 22 Table 3 Clinical/biological factors of children and their mothers living in rural area of Girja district, Guji zone, southern Oromia regional state, Ethiopia,