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Title: Health of conflict-affected children in South Sudan : children's roles, skills and competencies in identifying health threats, proposing solutions and implementing action
Author: Muller, Brigitte
ISNI:       0000 0004 5350 6494
Awarding Body: University of Liverpool
Current Institution: University of Liverpool
Date of Award: 2014
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Background: This research was conducted in 2010, in Akobo County, Jonglei State, South Sudan, a region with a long history of inter-ethnic conflict. Consideration of children in situations of armed conflict tends to focus on their protection and frequently portrays children as passive victims. Previous research and evaluations of child participatory programming, however, provide powerful testimonies as to the capacities and desire of children to be more involved. The aim of this research was to explore children’s health needs from a child perspective and to determine existing and potential opportunities and challenges for children to participate in health decision making. Methodology: This research uses qualitative and quantitative methods for different but well defined purposes within the same overall research project. Qualitative methods including interviews, focus group discussions, non-participant observations and workshops were used to explore knowledge and perspectives related to children’s health needs, children’s risk exposure and available means of protection as well as children’s roles, skills and capabilities to engage in decision making. Subsequently, a cross sectional mental health survey was conducted to investigate exposure to traumatic events, Post-traumatic Stress Disorder (PTSD), anxiety and depression using the Harvard Trauma Questionnaire (HTQ) and the Hopkins Symptom Checklist (HSCL-25). Positive outcomes were identified using the Post-traumatic Growth Inventory (PTGI). Multivariate linear regression analysis was used to define associations between variables. Results: One hundred and forty-four children aged 7-18, 88 adult community members and 20 staff of service providers participated in the qualitative study. Psychological distress was identified as the main perceived health threat and as a potential challenge to children’s participation. The qualitative findings further illustrate children’s suffering, but also the resilience and adaptability of children affected by armed conflict and their capacity and motivation to contribute and take action to improve their everyday life. Adult community members showed a high level of trust and belief in children’s strength, ability and willingness to address issues, take risks and make decisions. At the same time, adults voiced great concerns about losing authority and control over their children if children were given more rights. Interviews with service providers showed that half of them had consulted with children at some point during program implementation. A higher degree of children’s participation, where children have the initial idea and decide how the project is to be carried out, with adults available but not taking charge, was found to be an issue of concern to child mandated agencies alone. Three hundred and fifty-three children aged 12-18 participated in the cross-sectional mental health survey. The survey findings showed a high prevalence of experienced traumas and adverse mental health outcomes: 64.5% of the children met symptom criteria for PTSD, 72.2% of the children met symptom criteria for anxiety and 65.4% of the children met symptom criteria for depression. Linear regression analysis showed statistically significant relationships between orphan hood (p<0.01), ‘material deprivation’ (p<0.001), ‘witnessed general violence’ (p<0.01), ‘witnessed death, abduction and injury of loved ones’ (p<0.01) and adverse mental health outcomes. The PTGI demonstrated a high prevalence of positive change (PTG) as a result of the most traumatic event in children in all five categories: ‘spiritual change’ (73%), ‘relating to others’ (67%), ‘personal strength’ (60%), ‘appreciation of life’ (54%) and ‘new possibilities’ (52%). Regression analysis showed a significant positive relationship between PTG and post-traumatic stress (p<0.001) suggesting that growth and symptom severity may be independent of each other, that is, both growth and psychological distress can co-exist. Conclusion: The direct impact of armed violence has significantly contributed to extremely high levels of trauma exposure while the long term consequences of conflict such as poverty, the destruction of social networks and family relationships have deprived children of their support system. Our findings indicate that PTG and posttraumatic stress can go hand in hand. According to the theory that PTG results from the struggle with highly challenging life circumstances these findings indicate that the trauma categories associated with post-traumatic growth have threatened children’s pre-trauma view in a significant way, thus fostering PTG in the individuals attempt to assimilate the traumatic event into a new, modified world view. This study further demonstrated that children’s participation can provide an important opportunity in conflict settings to address mental health and to re-build or maintain positive relationships among children and between adults and children.
Supervisor: O'Dempsey, Timothy Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available