Behavioral problems among children living in orphanage facilities of Karachi, Pakistan: comparison of children in an SOS Village with those in conventional orphanages

Purpose 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 v2 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. Conclusion 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