title: Behavioral problems among children living in orphanage facilities of Karachi, Pakistan: comparison of children in an SOS Village with those in conventional orphanages.
abstract: OBJECTIVE
  This study compared the behavioral problems of children living in an SOS Village, which attempts to provide a family setup for its children, with those living in conventional orphanages.
  
  
  METHODS
  We conducted a cross-sectional survey of 330 children, aged 4-16 years, living either in an SOS or other conventional orphanages of Karachi, and assessed their behavioral problems using strengths and difficulty questionnaire (SDQ). Behavioral problems on composite SDQ and subscales, rated by foster mothers, were compared between children in the two groups using χ(2) test of independence. Multivariable models were built, using generalized estimating equations (GEE) regression approach, to identify factors independently associated with behavioral problems.
  
  
  RESULTS
  The overall prevalence of behavioral problems was 33%. On univariate comparison, we found that groups did not differ in their overall behavioral problems, while they were significantly different on the peer problem scale (P = 0.026). The model for composite SDQ behavioral problems identified five factors: wasting, <5 years length of stay in the facility and foster mother's depression, while facility type and sex of the child were part of a significant interaction. Foster mother depression, child's malnourishment and fewer years of stay at the facility were associated with conduct problems, while the child's sex, facility type and child's parental living status were part of two interactions.
  
  
  CONCLUSIONS
  We found a high burden of behavioral problems among children living in orphanages of Karachi, Pakistan. Foster mothers' depression and child's nutritional status, which are associated with behavioral problems, can be target of interventions to reduce behavioral problems of children living in orphanages.
authors.affiliation: Aga Khan University, Karachi, Pakistan. zohra.lassi@aku.edu
authors.forename: Zohra S
authors.initials: ZS
authors.lastname: Lassi
authors.forename: Sadia
authors.initials: S
authors.lastname: Mahmud
authors.forename: Ehsan U
authors.initials: EU
authors.lastname: Syed
authors.forename: Naveed Z
authors.initials: NZ
authors.lastname: Janjua
mesh_terms: D000293:Adolescent; D002648:Child; D002653:Child Behavior Disorders / Q000175:diagnosis*; D002675:Child, Preschool; D005190:Family / Q000523:psychology*; D005260:Female; D005581:Foster Home Care / Q000523:psychology*; D006306:Health Surveys; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D009752:Nutritional Status / Q000502:physiology; D019372:Orphanages; D010154:Pakistan