Emotional and behavioral problems and its associated factors among pre-school children of Mekelle, Tigray, Ethiopia: community based cross sectional study

Early childhood is a vital period for emotional, social, and behavioral development. During this stage, children may begin to show signs of emotional and behavioral problems (EBDs), yet this age group is often underrepresented in mental health research, especially in low-resource settings. Early detection and intervention are critical to prevent persistence of these problems into later life stages. This study aimed to assess the prevalence and factors associated with emotional and behavioral problems among preschool-aged children in Mekelle, Tigray, Ethiopia. A community-based cross-sectional study was conducted from April to May 2021, involving 633 preschool children selected through systematic random sampling. Emotional and behavioral problems were measured using the parent-reported Strengths and Difficulties Questionnaire (SDQ). Bivariate and multivariate logistic regression analyses were used to identify significant predictors. The total difficulties score indicated that 17.7% of children were at risk for emotional and behavioral problems. Among the SDQ subscales, conduct problems were the most prevalent (29.6%), followed by emotional problems (28.5%), pro-social difficulties (27.4%),hyperactivity (19.7%) and peer problems(11.6%).Factors significantly associated with emotional and behavioral difficulties included children aged 5-6 years (AOR 0.58, 95% CI 0.34-0.98), preterm birth (AOR 2.94, 95% CI 1.15-7.48), lack of breastfeeding (AOR 8.45, 95% CI 1.29-55.80), presence of health problems (AOR 3.51, 95% CI 1.31-9.42),caregivers without formal education (AOR 12.55, 95% CI 1.68-93.72), care by relatives other than parents (AOR 2.02, 95% CI 1.12-3.66),uneducated mothers (AOR 2.88, 95% CI 1.05-7.87), fathers employed by government or NGOs (AOR 0.42, 95% CI 0.20-0.85), widowed parents (AOR 4.34, 95% CI 1.21-15.67), caregivers with substance use history (AOR 3.82, 95% CI 1.08-13.51) and caregivers experiencing mental distress (AOR 3.48, 95% CI 1.99-6.06). Emotional and behavioral problems are common among preschool children in Mekelle. Early identification and provision of targeted support to caregivers, particularly addressing modifiable risk factors, could improve developmental outcomes for children in this setting.