|Year : 2019 | Volume
| Issue : 2 | Page : 706-710
Knowledge and attitude regarding child abuse among primary health care physician in Abha, Saudi Arabia, 2018
Safar A Alsaleem1, Mohammed A Alsaleem1, Ahmed M Asiri2, Saif S Alkhidhran2, Waleed S. S. Alqahtani2, Mohammad S Alzahrani2, Huda A Assiri2, Khadejah M Alshahrany2, Awad S Alsamghan1
1 Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia
2 Medical Intern, College of Medicine, King Khalid University, Abha, Saudi Arabia
|Date of Web Publication||28-Feb-2019|
Dr. Safar A Alsaleem
Assistant Professor and Consultant of Family Medicine, College of Medicine -King Khalid University, Aseer, Abha City
Source of Support: None, Conflict of Interest: None
Backgrounds: Child abuse or child maltreatment is physical, sexual, or psychological maltreatment or neglect of a child or children, especially by a parent or other caregiver. Child abuse may include any act or failure to act by a parent or other caregiver that results in actual or potential harm to a child, and can occur in a child's home or in the organizations, schools, or communities the child interacts with. This study was conducted to assess the primary health care (PHC) centers' physicians' knowledge and attitude toward child abuse including its types, and child neglect with their behavior regarding reporting of abuse cases. Methods: A cross-sectional study was conducted in Abha which is the capital of Aseer Province, including all PHC physicians (about 475) working in PHC centers. Data regarding physicians' demographic characteristics, perception, and awareness regarding child abuse and neglect were collected by self-administrative questionnaire in the PHC center during their time between patients' consultation. Results: The study included 300 PHC physicians whose ages ranged from 25 to 50 years old with mean age of 28 years. About 65% of the physicians were males and 69% of them were married with about 73% having at least one child. Overall, 96.3% of the physicians recorded good awareness level regarding types of child abuse and 97.3% recorded good awareness level regarding child neglect patterns. Underreporting of child abuse cases was recorded by about 64% of physicians. Conclusion: Regarding child abuse and neglect, PHC physicians have good knowledge, optimal attitude, and positive perception. There was also the problem of underreporting of suspected child abuse cases among PHC physicians in Saudi Arabia, with many barriers to report, such as community traditions; unclear reporting strategy was identified.
Keywords: Child abuse, child neglect, emotional abuse, physical abuse, physician awareness, physician perception
|How to cite this article:|
Alsaleem SA, Alsaleem MA, Asiri AM, Alkhidhran SS, Alqahtani WS, Alzahrani MS, Assiri HA, Alshahrany KM, Alsamghan AS. Knowledge and attitude regarding child abuse among primary health care physician in Abha, Saudi Arabia, 2018. J Family Med Prim Care 2019;8:706-10
|How to cite this URL:|
Alsaleem SA, Alsaleem MA, Asiri AM, Alkhidhran SS, Alqahtani WS, Alzahrani MS, Assiri HA, Alshahrany KM, Alsamghan AS. Knowledge and attitude regarding child abuse among primary health care physician in Abha, Saudi Arabia, 2018. J Family Med Prim Care [serial online] 2019 [cited 2019 Oct 22];8:706-10. Available from: http://www.jfmpc.com/text.asp?2019/8/2/706/253054
| Introduction|| |
Childhood and adolescence are critical phases of human life, during which personality features are developed. Health status including mental and physical health largely depends on the quality of education and life in this period. Therefore, a silent and safe transition requires the support of family and community. Child abuse or child maltreatment is physical, sexual, or psychological maltreatment or neglect of a child or children, especially by a parent or other caregiver. Child abuse may include any act or failure to act by a parent or other caregiver that results in actual or potential harm to a child, and can occur in a child's home or in the organizations, schools, or communities the child interacts with. The World Health Organization (WHO) defines child abuse and child maltreatment as “all forms of physical and/or emotional ill-treatment, sexual abuse, neglect or negligent treatment or commercial or other exploitation, resulting in actual or potential harm to the child's health, survival, development or dignity in the context of a relationship of responsibility, trust or power.”
Child abuse includes many harmful activities and procrastination in performing parental tasks and responsibilities, leading to physical or mental harm, physical abuse, sexual abuse, misbehaving or neglecting the child, and death of the child., Evidence suggests that severity of child abuse tends to propagate, so early detection and intervention is now crucial in preventing victims from suffering severe abuses. Child abuse may cause stress, leading to changes in the nervous, cardiovascular, and immune systems, and metabolism. Child abuse would form inappropriate personality features and increase risk behaviors among children. Doctors have moral and legal responsibilities to report these cases to relevant governmental authorities or social welfare organizations to provide early interventions for victims and perpetrators and prevent further abuse.
In Saudi Arabia, physical abuse and neglect were shown to be the most prevalent forms of maltreatment against children in Saudi Arabia. The awareness about child abuse and neglect is less in Saudi Arabia, but is improving. Consequently, the prevalence of detecting and reporting such cases is increasing, which might help in further improvement of actions. More large-scale studies and recording of all available data at the national-level registry are recommended.
The aim of this study is to assess the primary health care (PHC) centers' physicians' knowledge and attitude toward child abuse including its types, and child neglect with their behavior regarding reporting of abuse cases. It is crucial for safety and protection of children. No previous study assessed this regard at a PHC center level which is a cornerstone of delivering health care in Saudi Arabia.
| Method|| |
A cross-sectional study was conducted in Abha which is the capital of Aseer Province, including all PHC physicians (about 475) who were working in PHC centers. An English questionnaire was developed by researchers after intensive literature review and expert consultation for any suggestions, amendment, or modifications and to avoid any translation bias. The questionnaire consisted of five parts, namely, demographic data, concept, perception, professional experience, and reporting in Saudi Arabia the exploration of some situations representing forms of child abuse and/or neglect. Responses are reported on a Likert-type scale with responses ranging from 1 to 5: 1 (strongly disagree), 2 (disagree), 3 (not known), 4 (agree), and 5 (strongly agree). A pilot study was conducted on 15 physicians to test the questionnaire regarding comprehensiveness, applicability, validity, and reliability as well as time required for the interview. In accordance with the participants' feedback, some modifications were undertaken to fit the objectives of the study and within the cultural context of Saudi Arabia. The participants of the pilot study were excluded from the main study. Data were collected by a self-administrative questionnaire in the PHC center during their time between patients' consultation. Confidentiality and anonymity was maintained all through the research steps. The study was approved by the ethical committee. Prior to interview, verbal consent was taken from the respondents, and they will be informed about the aim and methodology of the study.
After data were extracted, revised, coded, and fed to statistical software IBM SPSS version 20. Statistical analysis was done using two-tailed tests with an alpha error of 0.05. P value less than or equal to 0.05 was considered to be statistically significant. Frequency and percent distribution were done for all data variables. The composite score for each domain (abuse and neglect constructs) items was calculated that ranged from 1 to 5, and it was considered to have good awareness if the composite score was between 4 and 5 points; otherwise, poor awareness was considered. Pearson's Chi-square test or exact tests were used to assess the significance of association between physicians' characteristics and their awareness level.
| Results|| |
The study included 300 PHC physicians whose age ranged from 25 to 50 years old with a mean age of 28 years. About 65% of the physicians were males and 69% of them were married with about 73% having at least one child. Residents constituted 86.3% of the physicians while only 4.7% were consultants. About 61% of the physicians were family physicians while others were general practitioners (GPs). As for experience years, 69.7% of the physicians had experience less than 5 years while 9.7% had experience more than 10 years [Table 1].
|Table 1: Personal data of primary health care physician in Abha, Saudi Arabia, 2018|
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[Table 2] illustrates physicians' agreement rate regarding general perception of child abuse. About 67.7% of the physicians agreed on the need to redefine child abuse and neglect in Saudi Arabia, according to our culture and religion. Also 64.3% of them recorded agreement regarding their willingness to report child abuse cases. About 62% of the participating physicians recorded their good training capability to deal with child abuse case. Also 64% of them agreed on that child abuse in Saudi Arabia is underreported. Only 7.7% of the physicians preferred limiting reporting of child abuse to life threatening injuries.
|Table 2: Agreement rate regarding general perception of child abuse as recorded among primary health care physician in Abha, Saudi Arabia, 2018|
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With regard to reasons of underreporting as recorded by the study physicians [Figure 1], unclear reporting procedure was the most recorded reason (43.7%) followed by community barriers to report cases (40.7%) and fear of parent's response (38.7%), while illegality to mandate reporting child abuse was the least frequent reason (16%).
|Figure 1: Reasons of underreporting of child abuse in Saudi Arabia as recorded by primary health care physician in Abha, Saudi Arabia, 2018|
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As for PHC physician's awareness regarding child abuse types [Table 3], 91% of the physicians recorded burning for child misbehavior followed with smoking at presence of child (89.7%), severe beating with marks (88.7%), leaving child alone at home (84.7%), and throwing different objects at the child on anger (84.3%). Considering neglect types, refusing medical treatment of surgery necessary for the child was the most identified neglect type (89.3%) followed by refusing to send the child to school (87.3%), while paying no attention for child cleanliness was the least identified neglect type (65%). Overall, 96.3% of the physicians recorded good awareness level regarding types of child abuse and 97.3% recorded good awareness level regarding child neglect patterns [Figure 2].
|Table 3: Descriptives of primary health care physician awareness regarding child abuse and neglect forms, Abha, Saudi Arabia, 2018|
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|Figure 2: Overall awareness level regarding child abuse and neglect of primary health care physicians, Abha, Saudi Arabia, 2018|
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Finally, on relating level of awareness regarding child abuse with the physicians' characteristics [Table 4], all physicians aged above 40 years had good awareness level compared with 95.9% of younger age physicians. As for the gender, about 96% of both male and female physicians had good awareness level and nearly the same for married and unmarried physicians (96.6% and 95.7%). With regard to number of children, the awareness level was positively trended with having more children. All consultants recorded good awareness level compared with 96.5% of residents. Family physicians recorded higher awareness level regarding child abuse compared with GPs (97.3% vs. 94.8%, respectively). Also, years of experience was positively related to awareness level.
|Table 4: Distribution of primary health care physician awareness regarding child abuse by their personal characteristics, Abha, Saudi Arabia, 2018|
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| Discussion|| |
Childhood is a golden and enjoyable period of life. Protection of a child during this period is the responsibility of the professionals who care for the child. Beside the parents, teachers and physicians play a very important role. Child abuse and child neglect have negative psychological effect on children. This study aimed to focus on the role of the physician in this regard, mainly primary health practitioner or family physicians. In our research, we did not find such study in Saudi that studied the level of primary care physicians. In this study, child abuse and child neglect awareness were mostly good among physicians (96.3% and 97.3%, respectively). It is very important to raise such awareness because primary and family physicians are considered as the first and continuous contact with the child through their life. A study done by Mogaddam et al. concluded that the awareness of child abuse and neglect was improving in Saudi Arabia. This was also noticed by Chang and his colleague.
Kraus and Jandl-Jager found that the majority of physicians recognized the most common symptoms of child abuse. Alnasser et al. found that the Saudi medical students, pediatrics trainees, and pediatricians have good basic knowledge. Another study by Habib concluded that the overall knowledge of participants about some important aspects of child abuse and negligence was adequate. In China, Li et al. reported that there was insufficient knowledge of the health provider toward child abuse. This difference, it may be including all health professions in that study.
Yadav and his colleague observed that most of the family physicians had inadequate knowledge about the identification and management of cases of child abuse. Other studies, such as Hynniewta et al., that explore awareness among other important persons like teachers make a sense in the detection and prevention of child abuse and neglect. It found that the majority (84%) of the schoolteachers had average knowledge on child abuse and 10% and 6% of them had good and poor knowledge, respectively. These findings reflect the importance of raising awareness among physicians and teachers as caregiver and contact caregiver with child.
The present study recorded that 64% of primary physicians agreed that child abuse is underreported in Saudi Arabia. AlMadani et al. said that there was an increasing pattern of reports over recent years. Preidt stated that the reporting of child abuse cases among primary care providers showed that 21% of suspected cases were not reported. Moreover, Eads concluded that “Underreporting child abuse has become an epidemic.” A lot of reasons are mentioned for this; this study determined that the reasons of underreporting child abuse and neglect as recoded by physicians were unclear reporting procedures (43.7%), and it was the most common reason perceived by primary care physicians. In contrast to this, another study reported by Walsh et al. indicated that different or clearer policies or procedures represent only 11% of all needs to improve reporting while the need to improve screening process represented 29%. A total of 38.7% of participants report fear of parents or child's family's response toward the child as a reason to not report in our study; this reflects the cultural beliefs and interferes to hidden issues about child abuse and neglect making the highlight very important.
| Conclusions and Recommendations|| |
After reporting results, researchers found that, regarding child abuse and neglect, PHC physicians have good knowledge, optimal attitude, and positive perception. There is also the problem of underreporting of suspected child abuse cases among PHC physicians in Saudi Arabia, with many barriers to report, such as community traditions; unclear reporting strategies were identified. More support and clearer guidelines should be provided for PHC physicians to address this issue. Further training on child abuse can be another option to increase awareness and knowledge in reporting and such training should be made mandatory. It is an important role of PHC physicians to identify and report child abuse cases; it is essential that the knowledge of health care professionals be improved and practical plans for dealing with cases of child abuse and neglect or suspected child abuse be established.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Gilbert R, Widom CS, Browne K, Fergusson D, Webb E, Janson S. Burden and consequences of child maltreatment in high-income countries. Lancet 2009;373:68-81.
Fallon B, Trocmé N, Fluke J, MacLaurin B, Tonmyr L, Yuan YY. Methodological challenges in measuring child maltreatment. Child Abuse Negl 2010;34:70-9.
May-Chahal C, Cawson P. Measuring child maltreatment in the United Kingdom: A study of the prevalence of child abuse and neglect. Child Abuse Negl 2005;29:969-84.
Child abuse and neglect by parents and other caregivers” (PDF). World Health Organization. p. 3. Archived (PDF) from the original on 2016 Mar 04. Retrieved 2016 Mar 08.
Krug EG, Mercy JA, Dahlberg LL, Zwi AB. The world report on violence and health. Lancet 2002;360:1083-8.
Straus MA. Corporal punishment and primary prevention of physical abuse. Child Abuse Negl 2000;24:1109-14.
Eija P, Mika H, Aune F, Leila L. How public health nurses identify and intervene in child maltreatment based on the national clinical guideline. Nurs Res Pract 2014;2014:425460.
Ghezelseflo M, Rostami M. Relationship of child abuse with personality features and high risk behaviors in adolescents. J Kermanshah Univ Med Sci 2015;19:93-101.
Straus MA. Beating the Devil out of Them: Corporal Punishment in American Families and its Effects on Children. 2nd
ed. New Brunswick, NJ: Transaction Publishers; 2000.
Hospital-Based Child Maltreatment Registry: The Annual Report (2012) Council of Health Services. Saudi Arabia.
“National Family Safety Registry Annual Report 2010”.
Al Eissa M, Almuneef M. Child abuse and neglect in Saudi Arabia: Journey of recognition to implementation of national prevention strategies. Child Abuse Negl 2010;34:28-33.
Al-Eissa MA, AlBuhairan FS, Qayad M, Saleheen H, Runyan D, et al
. Determining child maltreatment incidence in Saudi Arabia using the ICAST-CH: A pilot study. Child Abuse Negl 2015;42:174-82.
Mogaddam M, Kamal I, Merdad L, Alamoudi N, El Meligy O, El-Derwi D. Prevalence of child abuse in Saudi Arabia from 2000 to 2015: A review of the literature. J Oral Hyg Health 2015, 3:6
Chang A, Oglesby A. Child abuse and neglect: Physicians' knowledge, attitudes, and experiences. Am J Public Health 1976;66:1199-201.
Kraus C, Jandl-Jager E. Awareness and knowledge of child abuse amongst physicians-A descriptive study by a sample of rural Austria. Wien Klin Wochenschr 2011;123:340-9.
Alnasser Y, Albijadi A, Abdullah W, Aldabeeb D, Alomair A, Alsaddiqi S, et al.
Child maltreatment between knowledge, attitude and beliefs among Saudi pediatricians, pediatric residency trainees and medical students. Ann Med Surg 2017;16:7-13.
Habib HS. Pediatrician knowledge, perception, and experience on child abuse and neglect in Saudi Arabia. Ann Saudi Med 2012;32:236-42.
Li X, Yue Q, Wang S, Wang H, Jiang J, Gong L, et al
. Knowledge, attitudes, and behaviours of healthcare professionals regarding child maltreatment in China. Child Care Health Dev 2017;43:869-75
Yadav S, Datta M. Assessment of knowledge of family physicians regarding risk factors associated with child abuse. Int J Med Res Prof 2017;3;301-05.
Hynniewta B, Jose TT, Anjali KG. Knowledge and attitude on child abuse among school teachers, in selected urban English medium schools of Udupi District. Manipal J Nurs Health Sci 2017;3:32-6.
AlMadani O, Bamousa M, Alsaif D, Kharoshah MA, Alsowayigha A. Child physical and sexual abuse in Dammam, Saudi Arabia: A descriptive case-series analysis study. Egyptian J Forensic Sci 2012;2:33-7.
Walsh W, Jones L. Factors that Influence Child Abuse Reporting: A Survey of Child-Serving Professionals. Durham, NH: Crimes against Children Research Center; 2015.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4]