Child Maltreatment
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Child abuse epidemiology and prevention, with epidemiology in Saudi Arabia
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Child Maltreatment
- 1. Presented by: Wael Alzhrani Preventive Medicine KSA
- 4. • Every child has the right to health and a life free from violence. • Each year, though, millions of children around the world are the victims and witnesses of physical, sexual and emotional violence. WHO & INTERNATIONAL SOCIETY FOR PREVENTION OF CHILD ABUSE AND NEGLECT
- 5. Child maltreatment is a huge global problem with a serious impact on the victims’ physical and mental health, well-being and development throughout their lives and, by extension, on society in general . WHO & INTERNATIONAL SOCIETY FOR PREVENTION OF CHILD ABUSE AND NEGLECT
- 6. • In the past, child abuse was not readily recognized and, therefore, tended to be ignored. • Internationally, child abuse has only become more visible over the past two decades. • Sari N, Büyükunal SNC. A study of the history of child abuse. Pediatr Surg Int 1991;6:401-6
- 7. •The historical literature offers enough proof that child abuse has always existed, showing that it has been practiced by many societies since ancient times. Sari N, Büyükunal SNC. A study of the history of child abuse. Pediatr Surg Int 1991;6:401-6
- 8. • 40 million children subjected to abuse each year. • Approximately 5 children die every day because of child abuse. • 1 out of 3 girls and 1 out of 5 boys will be sexually abused before they reach age 18.
- 9. • Approximately 20% of women and 5–10% of men report being sexually abused as children, • while 25–50% of all children report being physically abused.
- 10. The lifelong consequences of child maltreatment include impaired physical and mental health, poorer school performance, and job and relationship difficulties.
- 11. Ultimately, child maltreatment can contribute to slowing a country's economic and social development.
- 14. •Child maltreatment is any act or series of acts of commission or omission by a parent or other caregiver ,that results in harm, potential for harm, or threat of harm to a child.
- 15. •Words or overt actions that cause harm, potential harm, or threat of harm. •Physical abuse •Sexual abuse •Psychological abuse
- 16. •Failure to provide needs or to protect from harm or potential harm •Physical neglect •Emotional neglect •Medical and dental neglect •Educational neglect •Inadequate supervision •Exposure to violent environments
- 17. Physical discipline and corporal punishment are forms of physical abuse
- 19. • Abused children often suffer physical injuries including cuts, bruises, burns, and broken bones. • In addition, maltreatment causes stress that can disrupt early brain development .
- 20. • As a result, children who are abused or neglected are at higher risk for health problems as adults. • These problems include alcoholism, depression, drug abuse, eating disorders, obesity, high-risk sexual behaviors, smoking, suicide,
- 21. Global prevalence of child maltreatment
- 24. In 2014, the World Health Organization (WHO) estimated that 23% of children worldwide were physically abused
- 26. 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 64% 67% 74.20% 81.40% prevalence of Physical Abuse, 2010
- 27. According to the World Health Organization (WHO), 20% and 5-10% of girls and boys, respectively, had experienced sexual abuse universally
- 40. 0 0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 1.8 2 Physical abuse Sexual abuse Psychological abuse Child neglect 2 1 0 0 Karthikeyan et al., Total = 3
- 42. 0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1 Physical abuse Sexual abuse Psychological abuse Child neglect 1 0 0 0 Abdulgani et al., Total = 1
- 43. 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% Physical abuse Sexual abuse Psychological abuse Child neglect 49% 15% 3% 32% Al Eissa and Almuneef, Total = 133
- 45. 0% 10% 20% 30% 40% 50% 60% Physical abuse Sexual abuse Psychological abuse Child neglect 54% 12% 0 33% NFSR (National Family Safety Registry) , Total = 378
- 47. 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% Physical abuse Sexual abuse Psychological abuse Child neglect 13% 87% 0 0 Almadani et al,, Total = 87
- 56. Admission to Ward 33.3% Admission to PICU 13.1% Out patient 46.9% Fatalities 1.9%
- 60. 0 10 20 30 40 50 60 Physical abuse Sexual abuse Psychological abuse Child neglect 0 0 54 0 Elarousy and Al-Jadaani, Total = 54
- 61. 0% 5% 10% 15% 20% 25% 30% 35% 40% Physical abuse Sexual abuse Psychological abuse Child neglect 29% 7% 38% 25% Al Eissa et al, Total = 4016
- 63. Child abuse and neglect are sensitive issues in SA, and most caregivers will not seek medical help except in severe abuse and neglect scenarios, which may have affected the accuracy of the reporting and the overall prevalence of this issue
- 64. Finally, most of the included studies were case reports, case series studies, and cross- sectional studies, thus limiting the accuracy of detecting the exact extent of the problem.
- 66. Physical abuse and neglect were shown to be the most prevalent forms of maltreatment of children in SA
- 67. Awareness of child abuse and neglect is improving in SA.
- 68. the detecting and reporting of such cases are increasing, which may facilitate further improvement of actions to counter child abuse
- 69. More large-scale studies and the recording of all available data in a national level registry are recommended.
- 71. Child Maltreatment Programs •Aim to prevent the occurrence and/or the recurrence of child abuse & neglect by: • Increasing community awareness and knowledge (primary) • Intervening early in situations where risk factors are present (secondary) • Attempting to reduce the long-term impact where maltreatment has already occurred (tertiary)
- 72. •Define the problem using statistics that describe scale of maltreatment and characteristics of most affected. •Identify the causes and the risk factors that affect susceptibility to maltreatment.
- 75. Essentials for Childhood: Steps to Create Safe, Stable, Nurturing Relationships and Environments
- 76. Essentials for Childhood: Steps to Create Safe, Stable, Nurturing Relationships and Environments
- 77. Goal 1: Raise Awareness and Commitment to Promote Safe, Stable, Nurturing Relationships and Environments and Prevent Child Maltreatment
- 78. Goal 2: Use Data to Inform Actions
- 79. Goal 3: Create the Context for Healthy Children and Families through Norms Change and Programs
- 80. Goal 4: Create the Context for Healthy Children and Families through Policies
- 82. Thank you
Editor's Notes
- Every child has the right to health and a life free from violence. Each year, though, mil-lions of children around the world are the victims and witnesses of physical, sexual and emotional violence. Child maltreatment is a huge global problem with a serious impact on the victims’ physical and mental health, well-being and development throughout their lives and, by extension, on society in general
- Acts of commission are deliberate and intentional; however, harm to a child might not be the intended consequence. Intention only applies to caregiver acts—not the consequences of those acts. For example, a caregiver might intend to hit a child as punishment (i.e., hitting the child is not accidental or unintentional), but not intend to cause the child to have a concussion.
- Acts of omission are the failure to provide for a child's basic physical, emotional, or educational needs or to protect a child from harm or potential harm. Like acts of commission, harm to a child might not be the intended consequence.
- The prevalence of child maltreatment varies from one type to another and from one country and society to another.
- The prevalence of child maltreatment varies from one type to another and from one country and society to another.
- Unfortunately, most African and Asian countries lack recent and reliable statistics in this regard, yet older publications indicated a high prevalence of physical abuse in these regions.
- Vietnam, as an example of Asian countries, reported that approximately 29% of secondary school children were neglected
- Determining the magnitude of child abuse and neglect phenomena in SA is important to construct an effective prevention strategy and to counter abuse. A review aimed to provide an overview the prevalence of child abuse in SA over the last 15 years (from 2000 to 2015)
- In 2000, Karthiykeyan et al. published a case report discussing 2 physical abuse cases in Khamis Mushayt in the south of SA
- In 2007, Al-Mahroos searched the medical literature from 1987 to 2005 to determine the prevalence of child abuse and neglect in the Arabian Peninsula [15]. She found that 28 cases of 40 total reported abuse cases (70%) in Saudi Arabia were categorized as physical abuse cases or as cases of Münchausen syndrome by proxy
- In 2009, Al Eissa and Almuneef reported the prevalence rates of different forms of child abuse recognized by the Suspected Child Abuse and Neglect team (SCAN) at King Abdulaziz Medical City at National Guard, Riyadh, during three different time periods: 2000-2004, 2005-2006, and 2007-2008 [19]. The total number of investigated abuse cases was 133, of which 65 (49%) were categorized as physical abuse.
- The annual report of the National Family Safety Registry (NFSR) in 2010 noted that there were 378 reported cases of abuse and neglect in SA (National Family Safety registry 2010). Seventy percent (70%) of the cases (n=205) were reported as physical abuse, Münchausen syndrome by proxy, or shaken baby syndrome
- Furthermore, the annual report of the Hospital Based Child Maltreatment Registry in 2012 reported 263 cases of abuse, of which 94 cases (35.8%) were reported as physical abused (National Family Safety registry 2012). Moreover, it was reported that most of the cases were reported from urban areas of SA (Riyadh, Makkah, and the Eastern provinces) (National Family Safety registry 2012).
- In 1434-2013, Eighteen child protection teams around the country reported 212 child maltreatment events (172 children).
- Lack of reported cases from Tabuk, Asir, Najran, Hail, Al-Jouf, , or Northern Boarders regions dose not necessary mean absence of child maltreatment cases presenting to hospitals in these region. Child maltreatment cases in these regions could have been undiagnosed, not referred to the hospitals’ child protection teams, or were not reported by the team to the registry (Fig. 5-1). Probably for the same reasons 56% of the child protection centers across country did not report any cases in 2013 (table 5-1). The latter indicate that there is a need for continuous training of health care professional and the members of child protection teams in all regions in view of the high professionals turn-over rates in order to improve cases detection, referral, and reporting mechanisms.
- Elarousy and Al-Jadaani conducted a descriptive study in Jeddah in the west of SA in 2013 [24]. Among the convenience sample of 12- to 18-year-old children whom they recruited, 90% of the children were diagnosed as having experienced psychological abuse