1. Neglect & emotional abuse
Recognition of Child Abuse: are we using same definition Muna Al Saadoon, Fatma Al Hadifi, Basma Al-Said College of Medicine and Health Sciences, SQU. Ministry of Health, Oman
Introduction: The Sultanate of Oman ratified the Convention on the Rights of the Child in 1996, following that many Royal Decrees and laws have been issued to improve the services provided to children and to protect their rights(1). One of the achievement in this field is the development of 11 Child Protection Committees established in the different regions to receive reports of child abuse and provide protection services. Studies found that 2/3 of abused children are reported by professionals having contact with the child (teachers, lawyers, police officers, and social workers), while medical personnel accounted for only 8.2% (2). Recognition of abused children is not an easy task and sometimes it might be affected by the environment, culture and training. Such factors might result in missing cases of child abuse when the culture for example, accept corporal punishment for discipline or the use of cauterization of skin (wasam) as a traditional treatment modality. Hence considering cultural beliefs, and factors associated with defining cases of abuse are important to enhance detection and diagnosis. The aim of this study is to assess the abilities of professionals working with children to recognize child abuse based in different scenarios describing different types of abuse.
Method: 136 participants (social workers, nurses, psychologists and health educators) were involved in a 5-hour workshop on child protection (organized by the Ministry of Health) in September The topics discussed were child rights, definition and types of child abuse, consequences of child abuse and psychological intervention for victims. All participants were invited to participate in the study and those who accepted were requested to fill up a questionnaire that covers demographic factors of the participant and their response for 19 statements that describe scenarios of child abuse. Each participant was given the time to classify the statement into “abuse”, “don’t know” (if not sure) or “not abuse”. The form was filled up by the participants before starting and at the end of the workshop. A total of 94 participants answered the pre-workshop questionnaire and 82 returned back the completed form after the completion of the workshop (response rate 60.3%). Descriptive statistical analysis of the 82 participants completed questionnaires was done using SPSS v 21.
Results: The study sample was having more females (67.1%), majority married (84.1%) and having children (79.3%) (table 1).
Table 1. demographic factors and type of job
The participants responses to the scenarios indicate that the majority did not have problem in recognizing sexual abuse especially when there is physical contact with the child (98-100% reported the scenarios as cases of abuse).
The same was noted with cases of domestic violence (96.3%). Neglect and emotional abuse were not recognized by some participants (reporting cases as abuse ranged from 68.3%-95.1%). However, many had difficulties to recognize cases of physical abuse. Recognizing physical abuse of children in scenarios that described the use of physical discipline was low (ranging between %). Classifying the scenarios as abuse was more when the injury is severe (e.g. burns) and when the child is young (below 1 year).
The participants recognition and labeling of the scenarios as cases of abuse after the workshop improved. It was found that all types of child abuse were recognized more by the participants. The score of the participants in recognizing abuse was calculated by given a value of 1 for “abuse”, 2 for “don’t know” and 3 for “not abuse”. A low sore indicates better recognition of abuse. When comparing scores of participants before and after the conduct of workshop (mean of 26.8 and 22.1 respectively) the results did show statistically significant improvement in the detection
of abuse P = However, the impact of the
workshop on recognition was less in scenarios of
physical abuse. For example, the scenario that describes
“a 15-year-old child hit by the father using a stick
because he stolen money from his mother wallet” were
classified as abuse by 46.3% and 81.7% before and
after the workshop. On the other hand the scenario of
‘a 2-year-old boy hit softly by the father when he puts
his finger in the nose or diaper changed from 19.5%
before the workshop to 50% after the workshop.
Figure1. abuse types and recognition
Recognition
Physical abuse
Neglect & emotional abuse
Sexual abuse
Domestic violence
Discussion: The results pointed to less chances of recognizing physical abuse, emotional abuse and neglect compared to sexual abuse (figure 1). Accepted cultural norms, attitudes and perception of what is accepted as normal disciplinary methods in the society could be an explanation for this. Studies did show that being a parent and having training in child abuse and neglect, having experience with maltreated children, were significant factors in pre-school teachers' ability to recognize the possible signs of child abuse and neglect (3). This study also support the effect of training and educational activities in improving recognition of child abuse and neglect. But what was clear is that short training have less effect on improving recognition of physical abuse. Conclusion: the results support that health professionals training in child abuse and neglect can play an important role in changing attitude toward abusive practices and behaviors of care providers contributing to better recognition of abuse. Recommendations: Training of all professionals working with children is important to improve recognition of child abuse. There is also a need for studies to assess the community perception and acceptance of practices on children and educational activities to increase awareness about child and child abuse.
KNOWELDGEMENT: would like to thank all participant for accepting filling up the questionnaires
References
1. UNICEF Oman Charting progress towards child protection in Sultanate of Oman. Findings of a national consultative workshop, 27th October.
2. U.S. Department of Health and Human Services. Child maltreatment, www. acf.hhs.gov/programs/cb/stats_research/index.htm#can
3. Karadag SÇ, Sönmez S, Dereobalı N. An investigation of preschool teachers' recognition of possible child abuse and neglect in Izmir, Turkey. J Interpers Violence Mar;30(5): doi: / Epub 2014 Jun 13.