title: Health of conflict-affected children in South Sudan. Children's roles, skills and competencies in identifying health threats, proposing solutions and implementing action
Creators: name: Muller, Brigitte
Publisher: name: University of Liverpool Repository
Year: 2014

description: ABSTRACT 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