Maltreatment and Mental Health Outcomes among Ultra-Poor Children in Burkina Faso: A Latent Class Analysis

Abstract

Objectives: Research about the mental health of children in Francophone West Africa is scarce. This paper examines the relationships between adverse childhood experiences, including exposure to violence and exploitation, and mental health outcomes among children living in ultra-poverty in rural Burkina Faso.

Methods: This paper utilizes baseline data collected from 360 children ages 10-15 and 360 of their mothers recruited from twelve impoverished villages in the Nord Region of Burkina, located near the Sahel Desert and affected by extreme food insecurity. We used a Latent Class Analysis to identify underlying patterns of maltreatment. Further, the relationships between latent classes and mental health outcomes were tested using mixed effected regression models adjusted for clustering within villages.

Results: About 15% of the children in the study scored above the clinical cut-off for depression, 17.8% for posttraumatic stress disorder (PTSD), and 6.4% for low self-esteem. The study identified five distinct sub-groups (or classes) of children based on their exposure to adverse childhood experiences. Children with the highest exposure to violence at home, at work and in the community (Abused and Exploited class) and children not attending school and working for other households, often away from their families (External Laborer class), demonstrated highest symptoms of depression and trauma. Despite living in adverse conditions and working to assist families, the study also identified a class of children who were not exposed to any violence at home or at work (Healthy and Non-abused class). Children in this class demonstrated significantly higher self-esteem (b = 0.92, SE = 0.45, p<0.05) and lower symptoms of trauma (b = -3.90, SE = 1.52, p<0.05).

Conclusions: This study offers insight into the psychological well-being of children in the context of ultra-poverty in Burkina Faso and associated context-specific adverse childhood experiences. Identifying specific sub-groups of children with increased exposure to life stressors has implications for program developers. Study findings indicate a further need to explore the mental health consequences of traumatic experiences within the context of ultra-poverty and to develop integrated economic and psychosocial interventions that prevent or mitigate childhood adversities linked with the family-level poverty and violence in the family.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. The CONSORT study flow chart.

Fig 2. Adverse childhood experiences by gender among 10–15 year old children from ultra-poor families in rural Burkina Faso (N = 360).

Note: The prevalence numbers statistically different by gender are marked by asterisk (*).

Fig 3. Latent classes of exposure to adverse childhood experiences: Graphical displays of probabilities across each of the five classes.

No schooling (1), Religious schooling (2), Being promised in marriage (3), Physical abuse by adult family member (4), Emotional abuse by adult family member (5), Physical domestic violence (6), Severe hunger (7), Extreme poverty (8), Working with animals (9), Working for family (10), Working for other households (11), Doing paid work (12), Sent to work away (13), Working over 14 hours per week (14), Spending more than 28 hours per week on household chores (15) Hazardous labor (16), Begging (17), Physical abuse at work (18), Emotional abuse at work (19), Physical abuse outside of home (20), Emotional abuse outside of home (21).