Child maltreatment surveillance: enumeration, monitoring, evaluation and insight.

Application of epidemiologic surveillance to child abuse and neglect (CAN) presents specific challenges related to varying definitions and incident reporting. Definitions of abuse and neglect differ within and across countries, obscuring estimates of the true magnitude of the problem. Definitions also vary depending on the nature of the child protection system. Countries may lack legal or social systems with specific responsibility for responding to and recording reports of CAN, particularly countries where populations are remote or in flux (e.g. due to conflict). Underreporting of CAN results in underestimates of prevalence. Violence by caregivers toward children is often known only to the perpetrator, and depending on the developmental capacity of the child, the victim. Further, CAN cases may be reported to a wide variety of sentinels (e.g. educators, clergy, physicians, law enforcement, child welfare), or may not be reported to any official source at all. Social stigma and unintended consequences of reporting, as well as cultural and political barriers, also impact reporting both within communities and globally.