Assessment of knowledge and attitude about child abuse amongst parents visiting rural tertiary care hospital in central India.

INTRODUCTION: Child abuse is one of the pressing human rights issues which still needs to be highlighted for general public, especially in traditional societies. This study depicts perspectives of parents and caregivers.
METHODS: The study was, conducted amongst parents visiting paediatric department (OPD and ward) at Rural Tertiary care Hospital in central India. A questionnaire was prepared and filled by parents and then was statistically analysed.
RESULTS: It was seen that: 1. Majority of parents lack knowledge regarding children's education and protection (POSCO and RTE) 2. Most parents were in favour of having better career prospects for Male child. 3. Parents were also asked regarding physical, emotional and mental health of a child. Majority of the parents were of the opinion that children should be distinguished based on academic performances. The study also recommended various measures to combat child abuse. Copyright:

Background

Child abuse or child maltreatment is any kind of 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.

Child abuse is when harm or threat of harm is made to a child by someone acting in the role of caretaker. It is a worldwide problem with no social, ethnic, and racial bounds. The five main subtypes of child abuse and neglect are physical abuse, emotional maltreatment, neglect, sexual abuse and witnessing family violence.[1] Child abuse can be in the form of physical abuse, when the child suffers bodily harm as a result of a deliberate attempt to hurt the child, or severe discipline or physical punishment inappropriate to the child's age. It can be sexual abuse arising from subjecting the child to inappropriate exposure to sexual acts or materials or passive use of the child as sexual stimuli and/or actual sexual contacts. Child abuse can also be in the form of emotional abuse involving coercive, constant belittling, shaming, humiliating a child, making negative comparisons to others, frequent yelling, threatening, or bullying of the child, rejecting and ignoring the child as punishment, having limited physical contact with the child (e.g. no hugs, kisses, or other signs of affection), exposing the child to violence or abuse of others or any other demeaning acts. All these factors can lead to interference with the child's normal social or psychological development leaving the child with lifelong psychological scars.

”Chadi laage cham cham vidhya aye gham gham”.

This Marathi proverb reflects one of the physical child abuse undertaken by school teachers, though it was for better academic outcome from the child students. Irrespective of intention, the child may succumb to it with worsening of future. It is very much essential to know the knowledge and awareness of parents, so as to take the appropriate steps to curtail the incidence of child abuse in Indian population.

Abuse is the improper usage or treatment of an entity, often to unfairly or improperly gain benefit. Some of the factors that may contribute to the likelihood of abuse occurring include:[2]

Isolation and lack of support

Stress

Unrealistic expectations

Intellectual disability

Lack of parenting skills

Mental illness

Drug, alcohol or gambling problems

Low self-esteem and self-confidence

Poor childhood experiences.

The presence of one or more of these factors may be an indicator that a child could be neglected or abused.[2] According to a Save the Children, a non-profitable NGO the recent statistics regarding child abuse in India are:[3]

The number of cases registered for child abuse raised from 8,904 in the year 2014 to 14,913 in the year 2015, under the POSCO act. Sexual offences and kidnapping accounts for 81% of the crime against minors.

Preventive measures designed to ward off strangers were found to be ineffective as most of the offenders were either relatives, acquaintances or somebody they trust.

Uttar Pradesh emerged as the state with highest child abuse cases (3,078), followed by Madhya Pradesh (1,687), Tamil Nadu (1,544), Karnataka (1,480) and Gujarat (1,416).

The global scenario of the problem is:

Globally in 2014, 1 billion children aged 2-17 years experienced physical, sexual, emotional or multiple types of violence.[4]

A quarter of all adults’ report having been physically abused as children.[5]

One in five women and one in 13 men report having been sexually abused as a child.[5]

In 2014, children comprised 28 percent of detected trafficking victims.[6]

Every year, there are an estimated 41,000 homicide deaths in children under 15 years of age.[5]

(as per the data of UNICEF) [Figure 1][7]

Figure 1

Number of countries with available data in UNICEF databases for selection of child protection indicators (200-2014)

This project focus on knowledge of various forms of child abuse amongst parents. This study tries to focus on different forms of abuse (sexual or otherwise) and knowledge of parents regarding personal life and social life of their child.

The study evidently points out towards the following:

Majority of people will only intervene if somebody is hitting a child in public.

Plentiful of people to some extent agree that child abuse is just a form of sexual violence

Considerable amount of subject feels impartial about withdrawal of corporal punishment, neglection as a form of child abuse and verbally offending and humiliating as form of punishment.

There have been variable differences amongst parents on their opinion about violence against girls, their career choices and the amenities they provide to their male and female child.

Further study is compared with various research done:

Sexual abuse in adolescents in Kerala.[8]

Punitive parenting in contemporary parents of New Zealand.[9]

Bullying amongst school children.[10]

Child abuse amongst university students in Egypt.[11]

Further the study suggests various measures:

Training program for medical personnel.[12]

Raising awareness.[13]

Methodology

Sample size: about 200 families will be studied.

Type of study: cross sectional study.

Sampling procedure: Child belonging to urban and rural population will be included. Age limit taken is 15 years. Those families residing in Gram Panchayat area will be termed as rural and residing in Nagar Parishad or Zilla Parishad will be termed as urban families (having proof of residence as voting or Aadhar card).

Families visiting the paediatric department will be assessed (both OPD and Ward). Families of single parenting or child bearing widow will also be included. With the help of questionnaire, required information will be collected after having informed consent of respective parent. The identity and address noted will be kept confidential. Only the obtained information will be analyzed.

Data collection tool: A questionnaire in English language will be prepared to include various parameters of the study to ethical guidelines. Questionnaires will be explained to parents in their own local language like Hindi and Marathi.

Analysis plan: Data obtained will be statistically analyzed by using appropriate software.

The results of this study are as follows:

Majority of parents’ lack knowledge regarding different laws for children's protection and education [Figure 2].

Figure 2

Parent-child relationship (1)

Only 3% of parents are very well informed about POSCO act (protection of children against sexual offences act, 2012)

Only 28.5% of parents have knowledge regarding RTE act (right to education act, 2009)

These were parents who were residing in urban areas and were either doctors or teachers or principals.

Many parents whether rural and urban residents believe in providing in “almost” in terms of education and amenities but many (38.5%-64.5%) still believe that only girls are abused sexually [Figure 2].

Many parents (18.6%-43.7%) still believe that career choices of a male child matter more than a female child [Figure 3].

Figure 3

Parent-child relationship (2)

Opinion of parents regarding violence amongst children (bullying or fighting) and physical violence at home and school (corporal punishment) are very refined and decent [Figure 4].

Figure 4

Knowledge regarding the laws

More than 68.5% subjects believe that it is unjustified if their child bully others [Figure 5].

Figure 5

Different forms of child abuse (1)

More than 75% subjects disagree that a stubborn child only be handled by physical punishment [Figures 5 and 6].

Figure 6

Different forms of child abuse (2)

Around 69.6% of subjects are against corporal punishment [Figure 6].

When asked, regarding intervention if a parent is hitting their child 14.5% subjects said they would never intervene and 32% said they would intervene only if in public [Figure 7].

Figure 7

Offending a child's self-esteem

Many parents were unsure regarding the emotional element of the child [Figures 8 and 9].

Figure 8

Male and female differences

Figure 9

School factors

Around 53.3% subjects disagree that children can get mental problems like depression and anxiety [Figure 9].

Around 48.2% subjects have opinion that it is okay to verbally offend and humiliate the child as a form of punishment.

Prime part is 16.6-69.3% of subjects believe that it is necessary to discuss with the child before making important decisions concerning them.

Around 52.5% subjects disagree that neglecting a child is a form of child abuse.

Majority of parents (10.5-65.5%) believe that child abuse is just sexual violence.

Around 56.5% parents are in favour of differentiating children based on their academic abilities. This provides a background that only academically sound students should be provided with opportunities [Figure 9].

Around 53% parents agree that they frequently fight in front on their child.

Around 45.7% have opinion that it is fine if they do not provide the child with food for more than 8 hours as a form of punishment.

Around 42.1% parents agree frequently bribing their child.

Conclusion

The present study suggested the lack of knowledge amongst parents regarding child abuse, including sexual violence, physical violence, negligence and mental abuse. Abuse on children cannot be categorized based on gender as both male and female witness this some levels.

As a parent, it is very important to understand the child and their world. Patience is the key factor here. Sometimes, child abuse can result is psychosomatic and psychological disturbances leading to a stressful adulthood. More and more reforms are needed to spread awareness. More studies are need to be conducted amongst parents and children, which can include child labour, child trafficking, teen pregnancies and etc.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.