Department of Pediatrics, University of Rwanda School of Medicine, Kigali, Rwanda.
Department of Pediatrics, Yale University, New Haven, CT.
J Dev Behav Pediatr. 2019 Oct/Nov;40(8):642-650. doi: 10.1097/DBP.0000000000000698.
Childhood behavior problems are underidentified in low- and middle-income countries. This study sought to systematically screen for behavior problems among children receiving medical care in Rwanda and investigate factors associated with behavior problems in this cohort.
The Pediatric Symptom Checklist (PSC) was translated into Kinyarwanda, following best practices. Children aged 5.9 to 16 years admitted to the inpatient ward of a referral hospital or seen in the outpatient department (OPD) were screened using the PSC. All PSC-positive children and every third PSC-negative child were referred for definitive assessment by a child mental health specialist.
Among 300 eligible children, 235 were recruited; none refused. PSC scores were positive in 74 of 234 cases (32%, 95% confidence interval 26%-38%); a total of 28 of 74 (40%) PSC-positive children completed mental health assessments. Of these, 16 (57% of those assessed, and 7% of the 235 who were screened) required treatment or further assessment; none of the PSC-negative children did. Screening sensitivity was 100%, and specificity was 71%, with favorable receiver operating characteristics curve and internal consistency. In a multivariate analysis, higher PSC scores were associated with OPD care, central nervous system trauma or infection, and indices of malnutrition and with the use of traditional, complementary, and alternative medicine (TCAM).
Behavior problems are common among Rwanda children seen in a referral hospital, particularly in the OPD, and are associated with use of TCAM. The Kinyarwanda PSC showed favorable screening characteristics and resulted in some 7% of children accessing needed mental health care.
儿童行为问题在中低收入国家普遍被低估。本研究旨在系统性地筛查卢旺达接受医疗护理的儿童的行为问题，并调查该队列中与行为问题相关的因素。
采用最佳实践将儿科症状清单（PSC）翻译为卢旺达语。使用 PSC 对住院病房或门诊部门（OPD）的 5.9 至 16 岁儿童进行筛查。所有 PSC 阳性儿童和每 3 个 PSC 阴性儿童都由儿童心理健康专家进行了明确评估。
在 300 名符合条件的儿童中，招募了 235 名；没有拒绝者。234 例中有 74 例（32%，95%置信区间 26%-38%）PSC 评分阳性；共有 74 例中的 28 例（40%）PSC 阳性儿童完成了心理健康评估。其中，16 例（接受评估者的 57%，筛查的 235 人中的 7%）需要治疗或进一步评估；PSC 阴性儿童无一例需要。筛查灵敏度为 100%，特异性为 71%，具有良好的接受者操作特征曲线和内部一致性。在多变量分析中，较高的 PSC 评分与 OPD 护理、中枢神经系统创伤或感染以及营养不良指数以及传统、补充和替代医学（TCAM）的使用有关。
在转诊医院就诊的卢旺达儿童中，行为问题很常见，尤其是在 OPD，并且与 TCAM 的使用有关。基尼亚卢旺达语 PSC 显示出良好的筛查特征，约有 7%的儿童获得了所需的心理健康护理。
