Awareness and knowledge of child abuse amongst physicians - a descriptive study by a sample of rural Austria

Understanding Child Abuse and Neglect Indications: Insights From Medical Students

BACKGROUND

Child abuse is a severe issue that impacts medical professionals and patients globally. It can lead to discomfort, risk, or even the demise of a child. One of the most significant facets of a doctor's work involves providing aid to those in need; since children are more dependent on others for care and safety, they should receive attention that is even more special in quality. Hence, this study aims to assess the views, professional experiences, and comprehension of Saudi Arabian medical students regarding child abuse and neglect (CAN).

METHODOLOGY

This study was carried out at Dr. Soliman Fakeeh Hospital. It involved 65 students who were either victims of child abuse or the relatives/family members of child abuse victims.

RESULTS

The participants' awareness of several critical components of CAN was considerable. However, their understanding regarding the reporting of CAN cases was rather meager. Furthermore, their views of and professional experience with CAN were not excellent in terms of quality.

CONCLUSIONS

Saudi Arabia should implement an extensive plan to prevent the abuse of children at any level, given the nation's clinical experience and expertise in this field. The nation's pediatricians should direct as well as assist in this process, thereby playing a major role in preventing and addressing CAN cases.

Knowledge, Awareness, and Attitude of Physicians Toward Child Abuse: A Cross-Sectional Study

INTRODUCTION

Child abuse refers to any type of mistreatment of a child, perpetrated by a parent, caregiver, or another individual in a custodial capacity, which may lead to instances of physical, sexual, or emotional abuse. Physicians play a crucial role in identifying and managing this phenomenon in the healthcare setting, as the number of unreported cases increases globally.

METHODS

A questionnaire-based cross-sectional study was conducted between 2022 and 2023 among physicians practicing in Saudi Arabia to assess their knowledge, awareness, and attitude toward child abuse. The data were analyzed using IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York, United States).

RESULTS

A total of 153 physicians were involved in this study, in which 65 participants (42.5%) indicated poor awareness of child abuse, while 79 participants (51.6%) indicated moderate knowledge of child abuse. Additionally, lack of knowledge was the most common barrier to reporting child abuse in 87 participants (56.9%). A positive significant correlation was identified between awareness and knowledge and between knowledge and attitude. Also, it was found that a higher attitude score was more associated with being male, having less experience, practicing in the emergency medicine department, and working in a governmental hospital.

CONCLUSION

These results highlight the significance of implementing specialized training programs and workshops focused on identifying and reporting child abuse, as well as providing guidelines for recognizing signs of abuse and taking appropriate intervention measures.

Child Abuse and Neglect: Awareness among Dental Students

Child abuse and neglect (CAN) have significant consequences for children's health and well-being. Dentists play an important role in identifying and reporting CAN cases. This study aimed to assess knowledge and attitudes toward CAN among dental students. A cross-sectional study was conducted among dental students, comparing second-year (preclinical) and fifth-year (clinical) students, both male and female, in the College of Dentistry at King Saud University during the first semester of the 2022/2023 academic year, using a questionnaire with 23 multiple-choice questions and an electronic link. The results revealed that most dental students (96%) were aware of CAN, with social media being the most utilized source of information (85%). However, the dental college was noticed as the least utilized source (50%). Most dental students recognize the significance of CAN in dentistry and expressed an intense interest in learning how to effectively deal with such cases. Only a small proportion, 16%, of dental students reported experiencing incidents of CAN in their clinical practice. In general, there were statistically significant differences between preclinical and clinical students, but there were no significant differences in awareness between female and male students when the source of information and role in dealing with CAN were taken into consideration. Both preclinical and clinical dental students were aware of CAN, although there were concerns about their ability to cope with it. The results emphasize the importance of comprehensive education and training programs across the dental curriculum about CAN.

Identifying the Challenges of Child Abuse Detection Among Emergency, Pediatrics, and Family Medicine Practitioners in Saudi Arabia

BACKGROUND

Child abuse is a significant issue across many countries. Despite the situation's innate understanding, many children are not reported to authorities and continue to experience abuse, sometimes even death. Healthcare professionals must be alert for abuse in any child who appears with injuries that are out of the ordinary because it is easy for indicators of child abuse to go unnoticed in a busy emergency department. The current study aims to evaluate and detect the challenges in diagnosing and reporting cases of child abuse among healthcare practitioners in emergency, pediatrics, and family medicine.

METHODS

A self-administered online disseminated questionnaire was used for data collection during the period from October 1 to December 30, 2022. A cross-sectional study was conducted on emergency, pediatrics, and family medicine healthcare practitioners working in hospitals in healthcare centers in Riyadh, Saudi Arabia. All data were collected, tabulated, and statistically analyzed using SPSS 23.0 for (IBM Corp., Armonk, NY) Windows.

RESULTS

The study sample constituted 200 physicians working in the front lines of healthcare like emergency, pediatrics, and family medicine primary care services, 50.5% were males and 49.5% were females. 36.5% of participants were 31-39 years old. 42% were family medicine physicians, 36.5% were pediatricians, and 21.5% were emergency medicine. About 43% of participants attended an educational workshop on child abuse. Nineteen percent of participants are very familiar with the diagnosis of child abuse and 36% of participants reported one to three cases of child abuse in the emergency department in the last year, 5% reported four to six cases and 56.5% reported none. Forty-seven percent of participants reported diagnosing one to five cases of child abuse throughout their whole career, 13% reported 11-15 cases, 6.5% reported six to 10 cases and 28.5% reported none. Causes of underdiagnosis of child abuse by healthcare providers were reported as 63% inexperience, 59% inadequate time for physical examination, 59% lack of diagnosis protocol, 51% lack of confidence in communicating with parents, 36% physicians' cultural background, and 38% lack of confidence in the diagnosis. 93.5% of participants think that healthcare practices need further education for child abuse.

CONCLUSION

In conclusion, physicians in Saudi Arabia who participated in the study had good knowledge to diagnose a case of child abuse. Inexperience, inadequate time for physical examination, lack of diagnosis protocol, lack of confidence in communicating with parents, and physicians' cultural background were the main identified challenges for diagnosing child abuse. Familiarity with cases of child abuse was significantly associated with physicians' age, specialty, and level of training.

Child Abuse and Neglect Awareness among Medical Students

Physical, emotional, and sexual abuse and various forms of neglect of children have been encountered more frequently by healthcare providers, particularly physicians. However, mismanagement of child abuse and neglect (CAN) due to a lack of awareness of it can lead to substantial and serious consequences. This study primarily aimed to evaluate the awareness of CAN among medical students and compare it between preclinical and clinical males and females in Imam Abdulrahman Bin Faisal University in Dammam, Saudi Arabia. A cross-sectional study using a self-reported-based questionnaire was carried out to study child abuse and neglect awareness and compare preclinical and clinical male versus female medical students during the first semester in 2021/2022. The majority of the participants were aware of CAN (90.6%), agreed that CAN exists locally (96.6%), believed that CAN is important in the medical field (96.3%), and expressed the important role of physicians in participating in the management of CAN (84.3%). Some students did not know about the legislation of CAN in Saudi Arabia (15%). The results show a lack of exposure to real CAN cases (80.3%) and the need for more formal education (70.3%). In general, the students were comparable, but there were significant differences showing more awareness in female students compared to males and, similarly, more awareness in clinical-year students. Both clinical and preclinical medical students were aware of CAN, with some concerns regarding their competency in dealing with CAN. CAN should be given more weight in the medical school curriculum.

Knowledge and Attitude Regarding Child Abuse Among Primary Healthcare Physicians and Interns in Al Qassim, Saudi Arabia

Introduction

Child abuse can include physical abuse, psychological abuse, sexual assault, neglect, or failure to meet the child's basic needs. It can lead to major psychosocial problems resulting in long-lasting consequences for the child.

Objective

This study aimed to assess the knowledge and attitude (KA) of primary healthcare physicians and interns regarding child abuse in Al Qassim, Saudi Arabia.

Materials and methods

This multicenter, cross-sectional study was conducted among primary healthcare physicians and interns in the Qassim region, Saudi Arabia, from July to October 2020. A self-administered questionnaire was distributed among the targeted physicians using either an online platform or face-to-face interviews. The questionnaire was devised from the pre-tested literature and formal discussions with experts. A total of 292 primary healthcare physicians and interns participated in our study. A consent form and brief details of the study were given ahead of the recruitment. Data were tabulated in a Microsoft Excel spreadsheet (Microsoft Corporation, Redmond, WA); a separate codebook was prepared with a description of the variables and corresponding codes, and all statistical analyses were performed using IBM SPSS Statistics for Windows, Version 21.0 (IBM Corp., Armonk, NY).

Results

A total of 292 respondents were involved in the study. Among them, 45% (n=131) were medical interns, 39.4% (n=115) were residents, and the rest were either specialists (n=34; 11.6%) or consultants (n=12; 4.1%). Among the respondents, the KA level was found to be moderate, high, and low in 68.8%, 28.4%, and 2.7%, respectively. The overall mean KA score was 81.1 [standard deviation (SD): 9.56] out of a possible 115 points. Factors associated with high KA were age (>30 years), non-Saudi nationality, having children, and having studied outside Saudi Arabia; The only factor significantly associated with low levels of KA was being a pediatrician (p<0.001).

Conclusion

Overall, the participants displayed adequate levels of KA regarding child abuse. Better KA was observed among expatriate physicians who were parents themselves and had earned their degrees outside the Kingdom of Saudi Arabia. However, pediatricians demonstrated poor knowledge with regard to child abuse.

Tipping the Scales: Factors Influencing the Decision to Report Child Maltreatment in Primary Care

Child maltreatment (CM) is an important public health issue linked to significant physical and mental health complications across the life span. Given the association between CM and health, general practitioners (GPs) and primary care nurses (PNs) are well-placed to identify and respond to this issue and are mandated to report suspected CM in many jurisdictions. Research has found that primary care doctors and nurses need support when responding to CM. This scoping review sought to answer the following question: What factors influence GPs and PNs decision to report CM when fulfilling their mandatory reporting duty? By exploring these factors, areas where support is needed were pinpointed. A systematic search was run across four databases: Medline (Ovid), PsycINFO, Embase, and CINAHL. Articles that reported on studies conducted in a location that had mandatory reporting legislation specific to CM and had a study population sampled from primary care were included in analysis. Thirty-three articles met the inclusion criteria. This review found that four principal factors influenced the decision to report CM: personal threshold of suspicion of abuse, relationship with the family, faith in the child protection system, and education and discussion. We conclude that improving the support and training to address these four areas may be beneficial for GPs and PNs in responding to CM.

Physical or psychological child abuse and neglect: Experiences, reporting behavior and positions toward mandatory reporting of pediatricians in Berlin, Germany

BACKGROUND

Child abuse and neglect (CAN) are common, with a high number of undetected victims. Since 2012, the German Federal Child Protection Act grants doctors an opportunity to circumvent their duty of confidentiality if they suspect CAN may be occurring, despite the reporting of CAN not being mandatory.

OBJECTIVE

This study examines pediatricians' reporting behavior in cases of CAN and what their attitudes are toward mandatory reporting.

PARTICIPANTS AND SETTING

All 378 primary care pediatricians and pediatric psychiatrists in the German capital of Berlin were asked to complete a questionnaire anonymously. The questionnaire was sent by mail to all primary care pediatricians (N = 302) and pediatric psychiatrists (N = 76) in private practice.

METHODS

Patterns of reporting, response tendencies, and correlations with socio-economic factors were described and statistically examined.

RESULTS

The response rate was 42% (N = 157). Of the pediatricians, 28% report every suspected case to the authorities. The majority, namely 73%, has difficulties in detecting CAN, and 64% would like additional training. Furthermore, 52% are aware of legally guaranteed counseling options being available if CAN is suspected. Whereas 71% consider mandatory reporting necessary to protect children more effectively, 57% are sure it would simplify their work.

CONCLUSIONS

More training on diagnosing CAN should be offered to pediatricians. It is necessary to have a full and frank discussion about making reporting mandatory in cases where there is a reasonable suspicion of CAN. Doctors believe that mandatory reporting standardizes and simplifies working procedures. It may possibly reduce the number of undetected cases of CAN and would allow more children and families access to early protection and supporting measures.

Knowledge and attitude regarding child abuse among primary health care physician in Abha, Saudi Arabia, 2018

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.

A Bibliometric Analysis of the Global Research Trend in Child Maltreatment

Child maltreatment remains a major health threat globally that requires the understanding of socioeconomic and cultural contexts to craft effective interventions. However, little is known about research agendas globally and the development of knowledge-producing networks in this field of study. This study aims to explore the bibliometric overview on child maltreatment publications to understand their growth from 1916 to 2018. Data from the Web of Science Core Collection were collected in May 2018. Only research articles and reviews written in the English language were included, with no restrictions by publication date. We analyzed publication years, number of papers, journals, authors, keywords and countries, and presented the countries collaboration and co-occurrence keywords analysis. From 1916 to 2018, 47,090 papers (53.0% in 2010⁻2018) were published in 9442 journals. Child Abuse &amp; Neglect (2576 papers; 5.5%); Children and Youth Services Review (1130 papers; 2.4%) and Pediatrics (793 papers, 1.7%) published the most papers. The most common research areas were Psychology (16,049 papers, 34.1%), Family Studies (8225 papers, 17.5%), and Social Work (7367 papers, 15.6%). Among 192 countries with research publications, the most prolific countries were the United States (26,367 papers), England (4676 papers), Canada (3282 papers) and Australia (2664 papers). We identified 17 authors who had more than 60 scientific items. The most cited papers (with at least 600 citations) were published in 29 journals, headed by the Journal of the American Medical Association (JAMA) (7 papers) and the Lancet (5 papers). This overview of global research in child maltreatment indicated an increasing trend in this topic, with the world&rsquo;s leading centers located in the Western countries led by the United States. We called for interdisciplinary research approaches to evaluating and intervening on child maltreatment, with a focus on low-middle income countries (LMICs) settings and specific contexts.

A cross-sectional exploratory study of knowledge, attitudes, and practices of emergency health care providers in the assessment of child maltreatment in Maputo, Mozambique

BACKGROUND

In Mozambique, and other low-income countries (LICs), there is little information on the burden of child maltreatment (CM). Emergency care services (ECS) play an important role in recognizing, treating, and intervening in situations of CM. We aim to identify knowledge, attitudes, and practices regarding CM among health care providers in ECS at Mavalane General Hospital in Maputo, Mozambique.

METHODS

This exploratory cross-sectional study evaluates the knowledge, attitudes, and practices of health care providers to diagnose and treat cases of CM. A 25 min, pilot-tested verbal interview questionnaire was administered to 49 physicians and nurses working in ECS at Mavalane General Hospital. Interviews were completed between October-November 2010. Data were managed and analyzed in SPSS 14.0 and descriptive statistics were generated.

RESULTS

Of 49 health care providers, 83.6% reporting receiving no, or very little CM education or training. Only 61.2% had knowledge of physical abuse as a main form of child maltreatment and 38.8% were able to identify corresponding symptoms of physical abuse. Sexual abuse as a main form of CM was mentioned by 26.5 and 2% cited its symptoms. While 87.7% of health care providers strongly agreed or agreed that they hold an important role in preventing CM, 51.1% also strongly disagreed or disagreed that they feel confident diagnosing and treating CM cases. In regards to follow-up, 14.3% strongly disagreed or disagreed that they know where to refer victims for further follow-up and an additional 14.3% did not know whether they agreed or disagreed.

CONCLUSION

This study revealed knowledge gaps in emergency health care provider knowledge of the main forms of CM and their symptoms. The fact that a majority of health care providers in our sample did not receive information specific to CM in their medical education and training could explain this gap, as well as their unawareness of where to refer victims. Given that health care providers believe they play an important role in identifying and treating CM, future research should focus on raising physician awareness of CM and developing education and training materials grounded in cultural contexts to build response capacity in Mozambique and other LICs.

Child abuse and neglect in the Jaffna district of Sri Lanka - a study on knowledge attitude practices and behavior of health care professionals

Background

Victims and perpetrators of child abuse do not typically self-report to child protection services, therefore responsibility of detection and reporting falls on the others. Knowledge on child protection is essential for the first contact person and such information is sparse in research literature originally coming from Sri Lanka. Anecdotally, several cases of child abuse have been missed out at the first contact level. Therefore we undertook this survey to assess the knowledge, attitudes towards child protection and the experiences of medical officers, nursing officers and social workers on child protection.

Method

This was a descriptive analytical study carried out in hospitals and the community during March–October 2016. An anonymous content validated self-administered questionnaire was used as the study instrument. Knowledge, Attitude, Practices and Behaviour were assessed via multiple choice questions and responses according to Likert score. Three anonymised case records were given as case vignettes to be studied by the participants and their responses were also recorded on the questionnaire.

Results

Among the 246 responders 156 (63.4%) were doctors. All groups of professionals identified the forms of child abuse correctly and the social indicators of child abuse was correctly identified in 152 (61.7%). Majority failed to identify the features of the perpetrator. Majority of the professionals showed a favourable response in attitude when dealing with child maltreatment. 153 (62%) had suspected child abuse in their career and 64% of them had reported it to the authority. Fifty two (21%) had attended a training workshop on child abuse and 65.8% of the responders were not satisfied with their knowledge. 229(93%) of them indicated that they wanted some form of education on child maltreatment. The Knowledge, Attitude and Behaviour towards child abuse were significantly good on people with experience in the field of Paediatrics and Judicial Medical work, when compared to those who did not have the experience in these two fields. (p value< 0.01).

Conclusion

Although the knowledge among health professionals regarding child abuse and care was satisfactory, further areas need reinforcement. The attitude was more positive, the behavior and practices on child maltreatment needed reinforcement via workshops and continuing medical education.