RESUMEN
"Background: This study investigated the emotional and behavioral problems of orphans in Rakai District; Uganda; and to suggest interventions. Studies; elsewhere; have shown orphans to have high levels of psychological problems. However; in Uganda such studies are limited and no specific interventions have been suggested. Methods: The study employed a cross-sectional unmatched case control design to compare emotional and behavioral problems of 210 randomly selected primary school-going orphans and 210 non-orphans using quantitative and qualitative methods employing standardized questionnaires; Focus Group discussions and selected Key Informant interviews. All children were administered Rutter's Children's Teacher Administered Behavior Questionnaire to measure psychological distress and a modified version of Cooper's Self-Report Measure for Social Adjustment. Standardized psychiatric assessments were done on children scoring 9 on the Rutter's Scale; using the WHO-ICD-10 diagnostic checklists. Results: Both orphans and non-orphans had high levels of psychological distress as measured using Rutter's questionnaire but with no significant statistical difference between the two groups (Rutter score 9; 45.1 et 36.5respectively; p= 0.10) and no major psychiatric disorders such as psychotic; major affective or organic mental syndromes. Psychological distress was associated with poor academic performance (p=0.00) in both groups. More orphans; than non-orphans had more common emotional and behavioral problems e.g. more orphans reported finding ""life unfair and difficult"" (p=0.03); 8.3 orphans compared to 5.1 of the non-orphans reported having had past suicidal wishes (p=0.30) and more reported past ""forced sex / abuse "" (p=0.05). Lastly; the orphans' social functioning in the family rated significantly worse compared to the non-orphans (p= 0.05). Qualitatively; orphans; compared to non-orphans were described as ""needy; sensitive; isolative with low confidence and self-esteem and who often lacked love; protection; identity; security; play; food and shelter."" Most lived in big poor families with few resources; faced stigma and were frequently relocated. Community resources were inadequate. Conclusion: In conclusion; more orphans compared to non-orphans exhibited common emotional and behavioral problems but no major psychiatric disorders. Orphans were more likely to be emotionally needy; insecure; poor; exploited; abused; or neglected. Most lived in poverty with elderly widowed female caretakers. They showed high resilience in coping. To comprehensively address these problems; we recommend setting up a National Policy and Support Services for Orphans and Other Vulnerable Children and their families; a National Child Protection Agency for all Children; Child Guidance Counselors in those schools with many orphans and lastly social skills training for all children."