Abstract:
Background: Three-quarters of the burden of mental health problems occurs in low-andmiddle-income countries, but few epidemiological studies of these problems in preschool
children from sub-Saharan Africa have been published. Behavioural and emotional
problems often start in early childhood, and this might be particularly important in
Africa, where the incidence of perinatal and early risk factors is high. We therefore
aimed to estimate the prevalence and risk factors of behavioural and emotional problems
in young children in a rural area on the Kenyan coast.
Methods: We did a population-based epidemiological study to assess the burden of
behavioural and emotional problems in preschool children and comorbidities in the Kilifi
Health and Demographic Surveillance System (KHDSS, a database formed of the
population under routine surveillance linked to admissions to Kilifi County Hospital).
We used the Child Behaviour Checklist (CBCL) to assess behavioural and emotional
problems. We then determined risk factors and medical comorbidities associated with
behavioural and emotional problems. The strength of associations between the risk
factors and the behavioural and emotional problems was estimated using generalised
linear models, with appropriate distribution and link functions.
Findings: 3539 families were randomly selected from the KHDSS. Of these, 3273
children were assessed with CBCL. The prevalence of total behavioural and emotional
problems was 13% (95% CI 12-14), for externalising problems was 10% (9-11), and for
internalising problems was 22% (21-24). The most common CBCL syndrome was
somatic problems (21%, 20-23), whereas the most common DSM-IV-oriented scale was
anxiety problems (13%, 12-14). Factors associated with total problems included
consumption of cassava (risk ratio 5·68, 95% CI 3·22-10·03), perinatal complications
(4·34, 3·21-5·81), seizure disorders (2·90, 2·24-3·77), and house status (0·11, 0·08-
0·14). Seizure disorders, burn marks, and respiratory problems were important
comorbidities of behavioural and emotional problems.
Interpretation: Behavioural and emotional problems are common in preschool children
in this Kenyan rural area and are associated with preventable risk factors. Behavioural
and emotional problems and associated comorbidities should be identified and addressed
in young children.