Harsh corporal punishment of Yemeni children: occurrence, type and associations

Caregiver preferences for physically harsh discipline of children in rural Uganda

Purpose

Physically harsh discipline is associated with poor developmental outcomes among children. These practices are more prevalent in areas experiencing poverty and resource scarcity, including in low- and middle-income countries. Designed to limit social desirability bias, this cross-sectional study in rural Uganda estimated caregiver preferences for physically harsh discipline; differences by caregiver sex, child sex, and setting; and associations with indicators of household economic stress and insecurity.

Method

Three-hundred-fifty adult caregivers were shown six hypothetical pictographic scenarios depicting children whining, spilling a drink, and kicking a caregiver. Girls and boys were depicted engaging in each of the three behaviors. Approximately half of the participants were shown scenes from a market setting and half were shown scenes from a household setting. For each scenario, caregivers reported the discipline strategy they would use (time out, beating, discussing, yelling, ignoring, slapping).

Results

Two thirds of the participants selected a physically harsh discipline strategy (beating, slapping) at least once. Women selected more physically harsh discipline strategies than men (b = 0.40; 95% confidence interval [CI], 0.26 to 0.54). Participants shown scenes from the market selected fewer physically harsh discipline strategies than participants shown scenes from the household (b = -0.51; 95% CI, -0.69 to -0.33). Finally, caregivers selected more physically harsh discipline strategies in response to boys than girls. Indicators of economic insecurity were inconsistently associated with preferences for physically harsh discipline.

Conclusions

The high prevalence of physically harsh discipline preferences warrant interventions aimed at reframing caregivers' approaches to discipline.

Corporal Punishment and Child Development in Low- and- Middle-Income Countries: Progress, Challenges, and Directions

Most studies and reviews of studies on the developmental consequences of corporal punishment have focused on samples from the U.S. and other high-income countries. This study conducted a rapid review of the literature on the associations between corporal punishment and children's cognitive and social-emotional development in low- and- middle-income countries (LMICs). Information from more than 42 studies of children younger than 18 years living in 64 LMICs was reviewed. Overall, the reviewed studies show associations between corporal punishment and negative cognitive and social-emotional outcomes, and there is no evidence that corporal punishment may relate to any positive developmental outcome in LMICs. Yet, issues of internal and external validity are common in the literature. The current evidence indicates that corporal punishment might increase the risk of detrimental child outcomes in LMICs, but further research with stronger methodological designs including samples from multiple settings is warranted.

Nocturnal sleep duration trajectories in early childhood and school performance at age 10 years

Sleep plays a fundamental role in brain development and resultant functions. The aim was to verify whether nocturnal sleep duration during early childhood has long-term associations with academic achievement at age 10 years. The present study is part of the Quebec Longitudinal Study of Child Development, a representative cohort of infants born in 1997-1998 in the province of Quebec, Canada. Children with known neurological conditions were excluded from this cohort. Four trajectories of parent-reported nocturnal sleep duration at ages 2.5, 3, 4, 5 and 6 years were determined using a SAS procedure named PROC TRAJ. Sleep duration at age 10 years was also reported. Teachers provided data on academic performance when the children were age 10 years. These data were available for 910 children (430 boys, 480 girls; 96.6% Caucasians). Univariate and multivariable logistic regressions were performed using SPSS. Children who slept less than 8 hr per night at 2.5 years but normalized later on (Traj1) had three-five times the odds of having grades below the class average in reading, writing, mathematics and science compared with children who slept sufficiently (Traj3-4: 10-11 hr per night). Children who slept about 9 hr per night throughout childhood (Traj2) had two-three times the odds of being below the class average in mathematics and science. Sleep duration at age 10 years was not correlated with the academic performance. These results point to the presence of a very important early period during which sufficient sleep is needed to fine-tune the functions necessary for academic achievement later on.

Parents' self-reporting of Child Physical Maltreatment (CPM) in a low-middle-income country

BACKGROUND

Because of COVID-19 pandemic, families across the world are experiencing new stressors that threaten their health, and economic well-being. Such a stress may jeopardize parents-children relationship. We aim to investigate the magnitude of child physical maltreatment (CPM) by parents in Egypt during the COVID-19 pandemic, to relate it to parents' stress, and to identify other potential risk factors.

METHODS

This cross-sectional study assessed parent-reported CPM and their personal experience of stress, depression, and anxiety among a sample of Egyptian parents using an electronic survey. It included sociodemographic data, Depression, Anxiety and Stress Scale (DASS-21), and the Child physical maltreatment scale (CPMS). We also briefly assessed COVID-19 -related data.

RESULTS

Out of 404 respondents, (62.9%) and (32.9%) reported performing minor and severe CPM toward their children during the past 3 months, respectively. The age of youngest child, and anxiety score were significantly correlated with both minor and severe forms of CPM. While number of children, and online education system ratings were only significantly correlated with severe CPM. Parental definition of CPM was significantly correlated to minor CPM, but not to severe CPM.

CONCLUSIONS

CPM by parents is not uncommon in Egypt, especially during the COVID-19 pandemic. These findings highlight the importance of regular support and intervention that help parents learn parenting skills and the use of non-violent child disciplining methods.

The use of corporal punishment against children in Myanmar: An analysis of data from the 2015-2016 Myanmar Demographic and Health Survey

BACKGROUND

The corporal punishment of children is a significant public health concern; corporal punishment also violates children's rights and may have negative impacts on children's long-term health.

OBJECTIVE

This study investigates the prevalence of corporal punishment of children in Myanmar and associated factors.

PARTICIPANT AND SETTING

This study is a secondary data analysis of the 2015-2016 Myanmar Demographic and Health Survey (MDHS). The study targeted 13,235 (weighted) children between 2 and 14 years old.

METHODS

Corporal punishment of children by caregivers was assessed using six questions that utilized UNICEF's child disciplinary module. Multiple logistic regression analyses were carried out to identify associated factors.

RESULTS

Nearly half of the children in the study (44.5 %; 95 % confidence interval (CI): 42.60, 46.50) were found to have been subjected to corporal punishment, and the most common form of corporal punishment was "spanking, hitting, or slapping the child on the bottom with a bare hand" (29.1 %; 95 % CI: 27.53, 30.80). Multivariable analyses revealed that a child's sex, age, education level, location of residence, and number of family members; the primary caregiver's sex and attitude toward corporal punishment; and the family's socio-economic status were all factors significantly associated with corporal punishment. The prevalence of corporal punishment of children in Myanmar was high, and many significant predictors were identified.

CONCLUSION

The implementation of child protection policies and the promotion of nonviolent parenting methods should be conducted immediately to community members. Community education should particularly focus on uneducated caregivers and families with low socioeconomic status.

Harsh Physical Discipline: Prevalence and Associated Factors Among Primary Caregivers of Pre-school Children in Ethiopia

Harsh parental discipline is ineffective and potentially harmful to children, yet it is still common, particularly in many African countries. Culturally responsive education programs are needed to shift parenting practices in African countries, but there is limited baseline research to inform such efforts. This study’s objectives were to establish the baseline prevalence of harsh physical discipline practices among primary caregivers of pre-school children in Ethiopia and to identify associated factors to inform intervention efforts. The well-established Parent–Child Conflict Tactics Scale section on physical assault was translated and administered to primary caregivers of 1139 pre-school children aged 4–6 years sampled from four regions of Ethiopia. Trained interviewers also collected basic socio-demographic data. Based on caregiver report, 52.5% (n = 598) of the children had experienced harsh physical discipline and an additional 12.7% (n = 145) experienced moderate physical discipline in their lifetimes. After controlling for covariates, the factors significantly related to increased likelihood of harsh discipline were geographic region, female caregivers, lack of employment, at least moderate perceived social status, and non-Muslim religion. These data establish a baseline from which to evaluate the impact of future educational interventions designed to shift practices. Information about the correlates can be used to tailor such intervention efforts toward those most likely to use harsh discipline practices.

Urgent call to action: Child rights and the state of child morbidity and mortality in Yemen

More than 2.3 million children under the age of five in Yemen suffer from acute malnutrition. Approximately 450,000 are expected to suffer from severe acute malnutrition and may die if they do not receive urgent treatment. In this context, without security, stability, and better access for farmers to have the means to resume growing food, children and their families continue to sink deeper and deeper into hunger and malnutrition.

Impact of COVID-19 pandemic and related isolation measures on violence against children in Egypt

BACKGROUND

Coronavirus disease 2019 (COVID-19) and related isolation measures have substantial adverse economic, social, and psychological consequences and expose children to increased risk of violence. The present study aimed to investigate the impact of the COVID-19 pandemic on violence against children in Egypt.

METHODS

An online survey, in Arabic, was disseminated during the period from 9 to 13 April 2020, to parents of children who were up to 18 years old residing in Egypt, selected using a snowball sampling technique, during the period from 25 March to 8 April during the implementation of the nationwide compulsory isolation measures against COVID-19 (25 March to 8 April 2020). The survey covered three areas: socio-demographic data, psychological impact measured using the Impact of Event Scale-Revised (IES-R), and violence against children during the past 2 weeks measured using a modified parent-report of a child abuse screening tool (ICAST-P) developed by the International Society for the Prevention of Child Abuse and Neglect.

RESULTS

Out of 1118 completed survey responses, 90.5% of children were subjected to violent discipline, 88.7% experienced psychological aggression, and 43.2% encountered severe physical punishment. Approximately 60% of respondents reported a moderate-to-severe psychological impact (IES-R scores ≥ 33), which was associated with a higher rate of violent discipline (OR: 9.3; 95% CI: 5.37-16.027; p < 0.001).

CONCLUSIONS

This is the first study in Egypt to provide evidence on the association of COVID-19 pandemic, its psychological impact, and increased rates of violence against children. Effective multilevel strategies are urgently required to protect children from violence and its catastrophic consequences during the continually evolving COVID-19 pandemic.

Observing sensitivity in slums in Yemen: the veiled challenge

This study represents the first video observation of parenting practices conducted in Yemen, where women are generally fully veiled, showing only their eyes, in the presence of strangers. A total of 62 mothers and children (aged 2-6 years) were filmed in their homes for 15 minutes during free interaction. The mothers' veils did not hamper the coding of sensitivity. Consistent with the socioeconomically deprived context, average sensitivity levels were low, but over 25% of mothers were rated as (very) sensitive. Mothers with a higher educational level and those experiencing more social support were more sensitive. About half of the mothers had their child perform household chores, which was related to lower sensitivity. Observations revealed frequent looking at the camera. Almost half of the mothers verbally expressed insecurity about the videotaping, and a third expressed awareness of being filmed. Interestingly however, these behaviors were unrelated to Ainsworth ratings of maternal sensitivity.

Child abuse in the West Bank of the occupied Palestinian territory (WB/oPt): social and political determinants

BACKGROUND

Child maltreatment is a global epidemic. It affects morbidity, mortality, social behavior, wellbeing, and quality of life of children. This study aims to assess prevalence of child abuse in the West Bank (WB) of the occupied Palestinian territory (oPt) and to determine some of its social and political associated factors.

METHODS

We analyzed secondary data obtained from a cross sectional study conducted on a sample representing Palestinian children on the West Bank and using the International Society for the Prevention of Child Abuse and Neglect (ISPCAN) tool. The ISPCAN Child Abuse Screening Tool for parents (ICAST-P) questionnaire was completed by 1107 Palestinian mothers to estimate physical and emotional child abusive practices at home for children aged 0-12 years. Univariate, bivariate, and multivariate binary logistic regression analyses were performed using the SPSS® version 20 to assess prevalence and predictors of child abuse.

RESULTS

Overall, around 34% of the West Bank-children were abused by their mothers. Results of the logistic regression analysis indicated that male children, children of younger mothers, children whose fathers were with low levels of education, children whose mothers reported low levels of parental warmth, and children whose parents were exposed to political violence were at greater risk of being abused.

CONCLUSIONS

Child abuse is highly prevalent among children of the Palestinian society in the West Bank. Policy makers need to pay more attention to this epidemic. The association between child abuse and political violence found in this study makes a just solution for Palestinians essential for improving the welfare of children and families.

Demographic and clinical characteristics of children seeking psychiatric services in the Nile Delta region: an observational retrospective study

Background

Epidemiological studies, describing both community and clinical samples of youth in need for psychiatric help, are rare in the middle east. To our knowledge, this is the first study that aims to investigate the demographic and clinical characteristics of a sample of children suffering from emotional and behavioral problems seeking psychiatric services in the Nile Delta region and the largest clinical sample to date in Egypt.

Methods

The files of all new cases who presented for care in the outpatient service for children and adolescents between August 2016 and July 2018 were reviewed. Ninety-six files were excluded due to missing data while another 18 files were found to be for adults (ages > 18 years old), so the sample included 886 cases.

Results

The ages of our sample (n = 886) ranged from 18 months to 18 years with an average of 7.5 (± 3.8) years. Most of our cases were male, school aged children, living within low-income households and predominantly coming from rural areas. The most common diagnoses were attention deficit hyperactivity disorder (ADHD) (22.6%), intellectual disability (ID) (13.7%), depressive disorders (13.3%), and disruptive behavior disorders (DBD) (12.3%). Strong protective effects were found for family integrity and stability. Corporal punishment and physical and sexual abuse were noted to be significant risk factors for internalizing and externalizing disorders in children and adolescents.

Conclusions

Except for males being a majority in our sample of children seeking psychiatric consultation, demographic patterns and prevalence of psychiatric disorders are comparable to other tertiary clinical samples in other parts of the world.

Maternal Harsh Physical Parenting and Behavioral Problems in Children in Religious Families in Yemen

The present study examined maternal religiosity as an underlying cultural factor in the effect of harsh physical parenting on child behavioral problems. Data was collected via a discipline observational task, religiosity-based vignettes, and a questionnaire in a group of 62 mothers and their children in slum areas in Yemen. Moderation and mediation models were tested, where the role of maternal religiosity as a predictor and a moderator in the association between harsh physical parenting and child behavioral problems was explored. Findings showed no direct association between harsh physical parenting, maternal religiosity, and child behavioral problems. However, maternal religiosity was found to significantly moderate the relationship between harsh physical parenting and child behavioral problems such that the positive association between harsh physical parenting and child behavior problems was stronger when parents were more religious. Implications of the moderating role of maternal religiosity on the association between harsh physical parenting and child behavioral problems are discussed.

The intersection of school corporal punishment and associated factors: Baseline results from a randomized controlled trial in Pakistan

Violence against youth is a global issue; one form of youth victimization is school corporal punishment. We use baseline assessments from a cluster randomized controlled trial to examine the prevalence of school corporal punishment, by gender, and the relationship to levels of peer violence at school, parent corporal punishment, youth food security and youth academic performance and school attendance in Pakistan. Forty homogenous public schools in the urban city of Hyderabad, Pakistan were chosen for randomization into the trial evaluating a youth violence prevention intervention. 1752 6th graders, age 11-14 years, were selected as the target population. Since schools are segregated by gender in Pakistan, data are from interviews in 20 boys' schools and 20 girls' schools. Overall, 91.4% of boys and 60.9% of girls reported corporal punishment at school in the previous 4 weeks and 60.3% of boys had been physically punished at home in the past 4 weeks compared to 37.1% of girls. Structural equation modeling revealed one direct pathway for both boys and girls from food insecurity to corporal punishment at school while indirect pathways were mediated by depression, the number of days missed from school and school performance and for boys also by engagement in peer violence. Exposure to corporal punishment in school and from parents differs by gender, but in both boys and girls poverty in the form of food insecurity was an important risk factor, with the result that poorer children are victimized more by adults.

Polyvictimization Among Children and Adolescents in Low- and Lower-Middle-Income Countries: A Systematic Review and Meta-Analysis

BACKGROUND

Most of the world's children and adolescents live in low- and lower-middle-income countries (LALMIC), but there is limited evidence about polyvictimization (experiences of multiple forms of victimization) among them. The aims of this article were to systematically review the evidence from LALMIC about the overall prevalence of polyvictimization and to identify the associations between polyvictimization and health and well-being among children and adolescents.

METHOD

A systematic search of the English-language peer-reviewed literature to identify empirical, quantitative studies conducted in LALMIC between 2005 and 2015, assessing at least four forms of victimization among young people aged up to 19 years. Where prevalence of any victimization and of polyvictimization were reported, meta-analyses were performed.

RESULTS

A total of 30/8,496 articles were included in the review. Evidence was available from 16/84 LALMIC and methodology and quality varied. Pooled prevalence of experiences of any victimization was 76.8% (95% confidence interval (CI) [64.8%, 88.9%]). Prevalence of polyvictimization ranged from 0.3% to 74.7% with an overall estimate of 38.1% (95% CI [18.3%, 57.8%]). None of the studies examined the associations between polyvictimization and physical or reproductive health or quality of life. Polyvictimization was associated with increased likelihood of mental health problems and involvement in health risk behaviors.

CONCLUSIONS

Experiences of polyvictimization among children and adolescents in LALMIC are more prevalent than in high- and upper-middle-income countries and contribute to the burden of poor health among children and adolescents. Most LALMIC lack local data, and research is required to address this knowledge gap.

Comparing disciplinary methods used by mothers in Palestine and Qatar

This paper explores child disciplinary methods used by parents in Qatar and Palestine. In this study ICAST-P, an internationally recognized tool, was used with mothers reporting on one of their children up to their 12th birthday. It questions about disciplinary methods: nonviolent; physical: moderate and severe; and psychological methods that had been used in the previous year on the index child in the family. A comparative national cross-sectional household survey of mothers aged 25-50 years old was conducted in both Qatar and Palestine, both Arabic Muslim states, but with very different socio-economic and political contexts that place Qataris in a much more advantageous position. Our results show that the 1299 Palestinian mothers interviewed were younger, had more children and less education compared to the 1018 Qatari mothers. Fewer mothers from Palestine were working. The index child in Palestine tended to be younger with 60% being under 5 years, while 73.7% of Qatari children were over 5 years of age. Severe physical disciplinary methods were reported significantly more often, in Palestine, e.g. Kicking the child (P value < 0.001), using hand or pillow to prevent breathing (P value < 0.001) and hitting child with object or fist (P value < 0001). Moderate as well as psychological disciplinary methods were also significantly higher among Palestinian mothers (P value < 0.001). Our results suggest that challenging circumstances that Palestinian mothers experience, as compared to their Qatari peers, are associated with greater prevalence of the harsher forms of discipline. Our findings have policy implications and preventative strategies for child maltreatment in both countries.

Observing sensitivity in slums in Yemen: the veiled challenge

This study represents the first video observation of parenting practices conducted in Yemen, where filming women is a taboo, and women are generally fully veiled, showing only their eyes, in the presence of strangers. A total of 62 mothers and children (aged 2-6 years) were filmed in their homes for 15 min during free interaction. The mothers' veils were not experienced as hampering the coding of sensitivity. Consistent with the socioeconomically deprived context, average sensitivity levels were low, but over 25% of mothers were rated as (very) sensitive. About half of the mothers elected to have their child do household chores, which in turn was related to lower levels of sensitivity. Observations revealed frequent looking at the camera. Almost half of the mothers verbally expressed insecurity about the videotaping, and a third expressed awareness of being filmed. Interestingly however, these behaviors were unrelated to Ainsworth ratings of maternal sensitivity.

The relationships between violence in childhood and educational outcomes: A global systematic review and meta-analysis

This is the first study to estimate the association globally between violence in childhood on educational outcomes, addressing a significant gap in the current evidence base. Systematic reviews and meta-analyses were conducted to identify 67 and 43 studies respectively from 21 countries to estimate the relationship between different types of violence in childhood on educational outcomes including school dropout/graduation, school absence, academic achievement and other educational outcomes such as grade retention, learning outcomes and remedial classes. Findings show that all forms of violence in childhood have a significant impact on educational outcomes. Children who have experienced any form of violence in childhood have a 13% predicted probability that they will not graduate from school. Males who are bullied are nearly three times more likely to be absent from school and girls who have experienced sexual violence have a three-fold increased risk of being absent, AOR 2.912, 95% CI (0.904-4.92) and AOR 3.147, 95% CI (0.033-4.57) respectively. Violence in childhood also has a significant impact on children's academic achievement on standardized tests. This study shows how different forms of violence in childhood contribute to inequalities in education-for both boys and girls and that an increased investment in prevention is needed in order to meet the global Sustainable Development Goals of ending violence, raising learning outcomes and creating safe, non-violent and inclusive learning environments. More work is also needed to further define, monitor and measure the link between violence in childhood and educational outcomes in order to achieve the Sustainable Development Goals.

Child Abuse and the Eye in an African Population

Purpose

There is a paucity of data on child abuse and the eye in West Africa. Therefore, a need exists to determine the causes and circumstances surrounding these occurrences and their effects on the eye and vision in a pediatric population.

Methods

A 3-year study of consecutive cases of ocular features that presented to an eye clinic following a history suggestive of child abuse along with any associated eye injury was carried out. Socio-demographic characteristics were obtained, as were the presenting and posttreatment visual acuity, and a full clinical eye examination was also done.

Results

Fifty-six children with 56 affected eyes were examined. The male to female ratio was 1.8 : 1; the mean age was 8.25 ± 3.5 years; and the subjects were predominately primary school children 30 (53.6%). The most common ocular disorders were conjunctiva hyperemia (46.4%), corneal abrasion/ulcer (25.4%), hyphema/uveitis (42.9%), retinal detachment (7.1%), sclera rupture (7.1%), and globe perforation (21.4%). The intraocular pressure was raised in 17.9% of participants. Presenting versus posttreatment visual acuities showed normal vision in four (7.1%) vs. eighteen (32.1%), visual impairment in 12 (21.4%) vs. six (10.7%), severe visual impairment in 20 (35.7%) vs. 12 (21.4%), and blindness in 12 (21.4%) vs. 14 (25%), p < 0.001. The most common injurious agents were canes (25.0%) and sticks (17.9%). The people who inflicted the injuries were parents/relatives (uncles) in 35.7% of cases and the children themselves (accidents) in 21.4% of cases. Circumstances predisposing participants to eye injuries were child labor in 39.3% and beatings in 25.0%. Complications were cataracts (25.0%), corneal opacity (39.3%), and retinal detachment (7.1%).

Conclusions

Injuries commonly resulted from canes and sticks used during beatings, as well as from child labor, corporal punishment, accidents, and assaults. Legislation and laws need to be enacted to prevent negative psychosocial and economic impacts on the child, family and country as a whole.

School corporal punishment in global perspective: prevalence, outcomes, and efforts at intervention

School corporal punishment continues to be a legal means of disciplining children in a third of the world's countries. Although much is known about parents' use of corporal punishment, there is less research about school corporal punishment. This article summarizes what is known about the legality and prevalence of school corporal punishment, about the outcomes linked to it, and about interventions to reduce and eliminate school corporal punishment around the world.

Violence against the adolescents of Kolkata: A study in relation to the socio-economic background and mental health

This study attempts to understand the nature of violence suffered by the adolescents of Kolkata (erstwhile Calcutta) and to identify its relation with their socio-economic background and mental health variables such as anxiety, adjustment, and self-concept. It is a cross-sectional study covering a total of 370 adolescents (182 boys and 188 girls) from six higher secondary schools in Kolkata. The data was gathered by way of a semi-structured questionnaire and three standard psychological tests. Findings revealed that 52.4%, 25.1%, and 12.7% adolescents suffered psychological, physical, and sexual violence in the last year. Older adolescents (aged 17-18 years) suffered more psychological violence than the younger ones (15-16 years) (p<0.05). Sixty nine (18.6%) adolescent students stood witness to violence between adult members in the family. More than three-fifth (61.9%) adolescents experienced at least one type of violence, while one-third (32.7%) experienced physical or sexual violence or both. Whatever its nature is, violence leaves a scar on the mental health of the victims. Those who have been through regular psychological violence reported high anxiety, emotional adjustment problem, and low self-concept. Sexual abuse left a damaging effect on self-concept (p<0.05), while psychological violence or the witnessing of violence prompted high anxiety scores (p<0.05), poor emotional adjustment (p<0.05), and low self-concept (p<0.05). This study stresses the need to provide individual counselling services to the maltreated adolescents of Kolkata so that their psychological traumas can heal and that they can move on in life with new hopes and dreams.

Validating Screening Tool in Malayalam for Mental Disorders

OBJECTIVES

Valid screening tools are needed to identify Indian children and adolescents with mental health problems, both for clinical or research purposes. The present study validated the Strengths and Difficulties Questionnaire (SDQ) in Malayalam across different informants and sub-scales.

METHODS

A sample of 150 children and adolescents seen in a psychiatric clinic for children in Kerala, India was compared to a community sample of 1984 children from six surrounding urban and rural districts. Children in clinic and community samples were screened with the parent-report SDQ; those over 11 y completed the self-report SDQ. The community sample was also screened with the teacher-report SDQ and the clinical sample received formal diagnoses from a child psychiatrist blind to SDQ scores. The discriminative validity of the SDQ was investigated using Receiver Operator Characteristic (ROC) curves and by assessing Area Under the Curve (AUC).

RESULTS

The SDQ discriminated reliably between clinical and community samples for the SDQ total score and its subscales. Within the clinic sample, 49 % of patients qualified for more than one broad diagnostic grouping. The SDQ discriminated between diagnostic categories in the clinic sample, but did so most effectively for conduct disorders. Based on the cut-offs that generated the highest combined value of sensitivity and specificity, the estimated rate of psychiatric disorder in the community sample was 13.6 % (parent-report) and 7.3 % (self-report).

CONCLUSIONS

The SDQ is a useful screening tool for child and adolescent mental disorders for Malayalam speakers in Kerala, India.

Exposure to intimate partner violence reduces the protective effect that women's high education has on children's corporal punishment: a population-based study

BACKGROUND

Previous studies have shown that women's education is protective against corporal punishment (CP) of children. However, the effect that women's exposure to intimate partner violence (IPV) has on the association between women's education and children's CP has not been studied.

OBJECTIVE

To understand how the interaction between women's exposure to IPV and their education level influences the occurrence of children's CP at the household level.

METHODS

We selected 10,156 women who had at least one child less than 16 years old from cross-sectional data from the 2006-2007 Nicaraguan Demographic and Health Survey. Children's CP was defined as the punishment of children by slapping them, hitting them with a fist, or hitting them with a rope, belt, stick, or other object. IPV was measured by using a conflict tactic scale. The WHO Self-Reporting Questionnaire 20 (SRQ-20) was used to assess the women's mental health. We computed adjusted risk ratios (ARR) and 95% confidence intervals (CI) using Poisson regression with a robust variance estimator.

RESULTS

Women's exposure to IPV was associated with a 10-17% increase in the risk of children's CP. IPV and children's CP were associated with impaired women's mental health. Women's lifetime exposure to emotional IPV and controlling behavior by a partner significantly decreased the protective effect from women's high education level on children's CP. When women were exposed to emotional IPV, the protective effect from having a college education decreased from ARR=0.61 (95% CI 0.47-0.80) to ARR=0.98 (95% CI 0.80-1.19). A similar pattern was found among women exposed to controlling behavior by a partner, the protective effect decreased from ARR=0.71 (95% CI 0.53-0.90) to ARR=0.86 (95% CI 0.70-1.06).

CONCLUSION

This study shows how significant gains in one positive social determinant of children's well-being can be undermined when it interacts with men's violence toward women. Policies that aim to end children's CP must include actions to end women's exposure to IPV.

Understanding the mediating role of corporal punishment in the association between maternal stress, efficacy, co-parenting and children's adjustment difficulties among Arab mothers

This study, guided by the Family Systems Theory, examines the direct effect of maternal use of corporal punishment on children's adjustment difficulties. Also, it explores whether corporal punishment serves as a mediating factor in the relationship between several maternal characteristics, marital relationships, and children's adjustment difficulties. A total of 2,447 Arab mothers completed anonymous, structured, self-report questionnaires. The use of corporal punishment was generally strongly supported by the Arab mothers in our sample. A greater likelihood of using corporal punishment was found among mothers of boys rather than girls, among mothers with lower perceived self-efficacy to discipline children, and among mothers with a lower perception of their husbands' participation in child-related labor. In addition, the higher a mother's reports on disagreement with her husband about discipline methods and the stronger her level of maternal stress, the more likely she was to use corporal punishment. Corporal punishment also mediated the association between the above mentioned factors and child adjustment difficulties. Furthermore, a husband's emotional support and family socioeconomic status were directly associated to children's adjustment difficulties. The results of the current study emphasize the need to observe children's development within the context of their family systems and to consider the mutual influences of different subsystems such as marital relationships and mother-child interactions. Prevention and intervention programs should raise parents' awareness concerning the harmful effects of corporal punishment and take into account the impact of dynamic transactions of parental conflicts and disagreements regarding discipline methods on child outcomes.

Maternal child abuse and its association with maternal anxiety in the socio-cultural context of iran

OBJECTIVES

The prevalence of parental violence has been an area of major public concern. There are few available data detailing the ways parents and other caregivers discipline children, particularly in low and middle income countries. This study focuses on the prevalence of different types of maternal child abuse and its association with maternal anxiety in the socio-cultural context of Iran.

METHODS

Participants in this cross-sectional study consisted of 562 mothers with the last child aged from 1 month to 12 years old who attended the Amirkola Children's Referral Hospital in Mazandaran Province, Iran, seeking healthcare services for their children. Demographic characteristics of the mothers, their children and reactions to conflicts with children were evaluated by a validated version of Conflict Tactics Scale for Parent and Child. Also, the relationship between maternal anxiety and child abuse was assessed using the Spielberger State-Trait Anxiety Inventory. The association between variables was examined by Pearson correlation coefficient, independent t-test, one-way ANOVA, and multivariate regression.

RESULTS

The prevalence of mother-to-child corporal punishment, severe physical abuse and very severe physical abuse were 436 (78%), 260 (46%) and 180 (32%), respectively. Verbal emotional abuse was reported by 506 (90%) participants and nonverbal emotional abuse was reported in 374 (67%) cases. A correlation was observed between child abuse and mothers' age (p=0.02), as well as with the number of children in the family (p=0.03), and the mothers' trait anxiety (p<0.001).

CONCLUSION

Overall, the assessment of maternal child abuse should be an important focus for evaluation in mothers with anxiety and vice versa, when child abuse is suspected, maternal psychological assessment should be essential.

Child maltreatment: the Lebanese children's experiences

BACKGROUND

This study examined the prevalence, risk factors and consequences associated with child maltreatment in the home.

METHODS

The sample was 1028 (556 boys; 472 girls) Lebanese children aged 8-17 years (M = 11.89; SD = 1.67). Children were administered an interview questionnaire that included the International Child Abuse Screening Tool, the Trauma Symptom Checklist and the Family Functioning in Adolescence Questionnaire.

RESULTS

Approximately 30% of the children reported at least one incident of witnessing violence, 65% reported at least one incident of psychological abuse and 54% reported at least one incident of physical abuse over a 1-year period. The results showed an overlap between children's reports of witnessing violence in their homes and physical and psychological abuse that were associated with adolescents' trauma symptoms. Family-related variables significantly predicted three forms of child maltreatment.

CONCLUSION

These results highlight the importance of examining children's multiple experiences of violence in their homes in research designs, prevention efforts and policy mandates. However, it should be noted that estimates of prevalence (as opposed to estimates of the relation between variables which is relatively more robust to selection bias) are open to error because of the nature of our sample.

The relationship between organized violence, family violence and mental health: findings from a community-based survey in Muhanga, Southern Rwanda

BACKGROUND

The relationship between organized violence and family violence, and their cumulative effect on mental health in post-conflict regions remains poorly understood.

OBJECTIVE

The aim of the present study was to establish prevalence rates and predictors of family violence in post-conflict Rwanda. And to examine whether higher levels of war-related violence and its socio-economic consequences would result in higher levels of violence within families and whether this would be related to an increase of psychological distress in descendants.

METHOD

One hundred and eighty-eight parent-child pairs from four sectors of the district Muhanga, Southern Province of Rwanda, were randomly selected for participation in the study. Trained local psychologists administered structured diagnostic interviews. A posttraumatic stress disorder (PTSD) diagnosis was established using the PTSD Symptom Scale Interview (PSS-I) and child maltreatment was assessed by means of the Childhood Trauma Questionnaire (CTQ). Additionally, the Hopkins Symptom Checklist (HSCL-25) assessed symptoms of depression and anxiety in descendants.

RESULTS

Prevalence rates of child abuse and neglect among descendants were below 10%. Ordinal regression analyses revealed that the level of child maltreatment in descendants was predicted by female sex, poverty, loss of the mother, exposure to war and genocide as well as parents' level of PTSD and reported child maltreatment. Poor physical health, exposure to war and genocide, parental PTSD symptoms, and reported childhood trauma were significantly associated with depressive and anxious symptoms, while only exposure to war and genocide and poor physical health predicted the level of PTSD.

CONCLUSION

The results indicate that cumulative stress such as exposure to organized violence and family violence in Rwandan descendants poses a risk factor for the development of depressive and anxious symptoms. Besides the support for families to cope with stress, awareness-raising initiatives challenging the current discourse of discipline toward children in schools or at home need to be fostered.

Emotional abuse towards children by schoolteachers in Aden Governorate, Yemen: a cross-sectional study

Background

Emotional abuse is central to other forms of abuse. The primary objective of this paper was to estimate the prevalence of emotional abuse among pupils in basic education schools and the risk factors associated with it in Aden governorate, Yemen.

Methods

Four districts were randomly selected from across the governorate of Aden, 2 schools were selected at random in each district, and then 1066 pupils were randomly selected from the 8 schools. An anonymous self-administered questionnaire was used for data collection. Data were analyzed using Statistical Package for Social Sciences ver.15. Mean, standard deviation and chi square were used for descriptive statistics. Univariate and Multivariate logistic regression analysis was used to examine the associations between emotional abuse with pupils/parents characteristics.

Results

Pupils reported high rates of emotional abuse 55.2% at least once in their school lifetime. Male pupils had higher prevalence of emotional abuse 72.6% than females 26.1%. Teachers constituted the highest proportion of perpetrators 45.6%. Odds Ratio (95% confidence interval) showed statistically significant association between emotional abuse and pupils' gender, family type and father education: 9.94 (7.19-13.74), 1.40 (1.02-1.91), .58 (.39-.86) respectively.

Conclusion

Emotional child abuse was highly prevalent in pupils in basic school education. Pupils' gender, family type and father education were the main risk factors associated with emotional abuse.

Cross-national differences in questionnaires do not necessarily reflect comparable differences in disorder prevalence

PURPOSE

To examine whether the widely used Strengths and Difficulties Questionnaire (SDQ) can validly be used to compare the prevalence of child mental health problems cross nationally.

METHODS

We used data on 29,225 5- to 16-year olds in eight population-based studies from seven countries: Bangladesh, Brazil, Britain, India, Norway, Russia and Yemen. Parents completed the SDQ in all eight studies, teachers in seven studies and youth in five studies. We used these SDQ data to calculate three different sorts of "caseness indicators" based on (1) SDQ symptoms, (2) SDQ symptoms plus impact and (3) an overall respondent judgement of 'definite' or 'severe' difficulties. Respondents also completed structured diagnostic interviews including extensive open-ended questions (the Development and Well-Being Assessment, DAWBA). Diagnostic ratings were all carried out or supervised by the DAWBA's creator, working in conjunction with experienced local professionals.

RESULTS

As judged by the DAWBA, the prevalence of any mental disorder ranged from 2.2% in India to 17.1% in Russia. The nine SDQ caseness indicators (three indicators times three informants) explained 8-56% of the cross-national variation in disorder prevalence. This was insufficient to make meaningful prevalence estimates since populations with a similar measured prevalence of disorder on the DAWBA showed large variations across the various SDQ caseness indicators.

CONCLUSIONS

The relationship between SDQ caseness indicators and disorder rates varies substantially between populations: cross-national differences in SDQ indicators do not necessarily reflect comparable differences in disorder rates. More generally, considerable caution is required when interpreting cross-cultural comparisons of mental health, particularly when these rely on brief questionnaires.

Práticas educativas coercitivas de mães de diferentes níveis socioeconômicos

Este estudo comparou o uso de práticas coercitivas em mães de diferentes níveis socioeconômicos. Participaram do estudo 40 mães com filhos na faixa etária de 5 a 6 anos de ambos os sexos. Vinte mães eram de nível socioeconômico baixo e 20 mães eram de nível socioeconômico médio/alto de acordo com os critérios de Hollingshead. As mães responderam uma ficha de dados sociodemográficos e uma entrevista estruturada sobre práticas educativas maternas. Os resultados indicaram que as mães de nível socioeconômico baixo apresentaram maior frequência média de respostas na categoria punição física. Discutem-se as relações entre as variáveis sociodemográficas e as práticas coercitivas, destacando-se o efeito da escolaridade na maior variabilidade de repertório materno para a regulação do comportamento infantil.

Prevalence of violence against children in families in Tripura and its relationship with socio-economic factors

BACKGROUND

Violence against children is a deep-rooted social problem in India. The problem is also related to economic as well as cultural beliefs and practices. The objective of this study was to ascertain the prevalence and nature of violence experienced by the children in families in Tripura, India and its relationship with socio-economic factors.

METHODS

A group of 320 children (160 males and 160 females) studying in Class VIII and IX and aged between 14-19 participated in the study after obtaining their informed consent from eight randomly selected English and Bengali medium schools in Agartala, Tripura (India). Data were collected by using a specially designed 'Semi-structured Questionnaire.

RESULTS

Findings revealed that about 20.9% (67/320), 21.9% (70/230) and 18.1% (58/230) of the children experienced psychological, physical and sexual violence respectively. Male children were more likely to be victims of psychological and physical violence while female children experienced more sexual violence (p less than 0.01).Further analysis of data revealed some relationship between violence against children and nuclear family(p was less than 0.01), uncongenial and/or disturbed family environment (p was less than 0.01)and dominating, short-tempered and/or aggressive parent personality (p was less than 0.01),irrespective of the nature of the violence. Physical violence was found to be more prevalent in high income families (p was less than 0.01) while children from the lower income group of families experienced more psychological violence (p was less than 0.01). Sexual violence was found to be equally prevalent in all socio-economic groups. The study also clearly indicated that academic performance of violence-experienced children, irrespective of nature of violence and socio-economic groups was poor compared to academic performance of non-violence-experienced children (p was less than 0.01).

CONCLUSIONS

About one-fifth of the children under study did experience violence in Tripura. Findings speak in favor of an intervention program for creating awareness among parents and teachers about the issue of violence against children, targeted at parents when they meet for periodic parent-teachers meetings in the educational institutions. ‎

Parents' self-reporting of child physical maltreatment in Yuncheng City, China

OBJECTIVE

To investigate the prevalence of child physical maltreatment (CPM) by parents in a city locating in central-western region of China and identify associated risk factors.

METHODS

Cross-sectional survey was carried out among a randomly sampled population of primary school students' parents in Yuncheng City. Data on parental CPM during the past 3 months, definition of CPM, Parenting Scale, parent-child interaction attitudes, social support, socio-demographic background were collected by a self-report questionnaire. Logistic regression analyses were used to investigate the associations between CPM and related risk factors.

RESULTS

Of parents from 1,394 primary school students, there were 595 (42.7%) and 301 (21.6%) of them reported that they had minor/severe CPM behaviors toward their children during the past 3 months, respectively. The risk factors that were significantly associated with both prevalence and frequencies of minor/severe CPM included child problem behaviors, overreactivity and hostility parenting.

CONCLUSION

CPM by parents is not uncommon in China. More attention should be paid to programs that help parents learn parenting skills and use nonviolent child discipline.

Child abuse in 28 developing and transitional countries--results from the Multiple Indicator Cluster Surveys

BACKGROUND

Child abuse is a recognized public health and social problem worldwide. Using data from the Multiple Indicator Cluster Surveys (MICS) we aimed to (i) compare different forms of child abuse across countries and regions, and (ii) examine factors associated with different forms of child abuse.

METHODS

Information on child abuse was available in 28 developing and transitional countries from the third round of the MICS conducted in 2005 and 2006 (n = 124 916 children aged between 2 and 14 years). We determined the prevalence of psychological, and moderate and severe physical abuse for the preceding month and examined correlates of different forms of child abuse with multilevel logistic regression analysis.

RESULTS

A median of 83, 64 and 43% of children in the African region experienced psychological, and moderate and severe physical abuse, respectively. A considerably lower percentage of children in transitional countries experienced these forms of abuse (56, 46 and 9%, respectively). Parental attitudes towards corporal punishment were the strongest variable associated with all forms of child abuse. The risk of all forms of child abuse was also higher for male children, those living with many household members and in poorer families.

CONCLUSIONS

Child abuse is a very common phenomenon in many of the countries examined. We found substantial variations in prevalence across countries and regions, with the highest prevalence in African countries. Population-based interventions (e.g. educational programmes) should be undertaken to increase public awareness of this problem. Actions on changing parental attitudes towards corporal punishment of children may help to prevent child abuse. The specific local situation in each country should be considered when selecting intervention strategies.

Parenting attitudes and infant spanking: the influence of childhood experiences

OBJECTIVES

To assess associations among maternal childhood experiences and subsequent parenting attitudes and use of infant spanking (IS), and determine if attitudes mediate the association between physical abuse exposure and IS.

METHODS

We performed a prospective study of women who received prenatal care at community health centers in Philadelphia, Pennsylvania. Sociodemographic characteristics, adverse childhood experiences (ACEs), attitudes toward corporal punishment (CP), and IS use were assessed via face-to-face interviews, conducted at the first prenatal care visit, 3 months postpartum, and 11 months postpartum. Bivariate and multiple logistic regression analyses were conducted.

RESULTS

The sample consisted of 1265 mostly black, low-income women. Nineteen percent of the participants valued CP as a means of discipline, and 14% reported IS use. Mothers exposed to childhood physical abuse and verbal hostility were more likely to report IS use than those not exposed (16% vs 10%, P = .002; 17% vs 12%, P = .02, respectively). In the adjusted analyses, maternal exposure to physical abuse, other ACEs, and valuing CP were independently associated with IS use. Attitudes that value CP did not mediate these associations.

CONCLUSIONS

Mothers who had childhood experiences of violence were more likely to use IS than mothers without such experiences. Intergenerational transmission of CP was evident. Mothers who had experienced physical abuse as a child, when compared to those who had not, were 1.5 times more likely to use IS. Child discipline attitudes and maternal childhood experiences should be discussed early in parenting in order to prevent IS use, particularly among at-risk mothers.