Screening for emotional and behavioural problems amongst 5-11-year-old school children in Karachi, Pakistan.

Background: While a number of studies in the western countries have provided estimates of prevalence for child psychiatric morbidity and associated risk factors, relatively little is known about child psychiatric problems and risk factors in developing countries like Pakistan.

Method: A cross sectional survey of 5-11-year-old children attending main stream private and community schools in Karachi was conducted. Seven private and eight community schools agreed to participate. About 1488 consent forms were sent to 700 parents of private school and 788 parents of community school children. A total of 675 parents agreed to participate in the study. The response rate was 45.4%. Assessment of children's mental health was conducted using Strength and difficulties questionnaire (SDQ) by parents based on cut-off provided by Goodman.

Results: About 47% children were rated as normal, 19% as borderline and 34% as abnormal by the parents. Ordinal regression was used to identify factors associated with parent's rating. The odds of female children of being normal was 1.5 times relative to male children, adjusting for school type and mother's education (ORadj = 1.5, 95% CI: 1.1-2.0). Children attending private schools were more likely to be normal as compared to community school children, adjusting for child's gender and mother's education (ORadj = 2.3, 95% CI: 1.3-4.0).

Conclusion: In the present study, prevalence of child mental health problems was higher than reported in studies from other countries. Prevalence was higher amongst children attending community schools. Consistent with most studies, male children were at a higher risk than females. There is a need for developing programs to train, sensitise and mobilize teachers and parents regarding child's psychological, emotional and behavioural problems with special attention to community schools. Since the male child is at a greater risk we should be cognizant of this while evaluating children for psychopathology.