Eur J Pediatr DOI 10.1007/s00431-013-2191-4
ORIGINAL ARTICLE
Prevalence and pattern of child abuse and associated factors in four secondary institutions in Enugu, Southeast Nigeria Josephat M. Chinawa & A. E. Aronu & B. F. Chukwu & H. A. Obu
Received: 9 September 2013 / Accepted: 15 October 2013 # Springer-Verlag Berlin Heidelberg 2013
Abstract In our society, child abuse is most often not recognized. In addition, little attention is focused on child abuse due to the menace of severe acute malnutrition and infections, which are the major pediatric problems in our setting. There is need therefore for public awareness of the existence of the various forms of child abuse in the society. The objective of this study is to determine the prevalence, pattern, socioeconomic implication, and factors associated with child abuse among secondary school students attending four secondary schools in Enugu. This is a prospective study where cases of child abuse were investigated using a convenience sampling of students attending four secondary schools in Enugu. A total of 372 subjects participated in the study comprising 192 (51.6 %) females and 180 (48.4 %) males (χ 2 =7.74, p =0.38). Their median age was 15.0 (12– 18)years. One hundred and sixty-six of 370 (44.8 %) made up of 85 (51.2 %) females and 81 (48.8 %) males reported that they had been hit repeatedly with an implement, showing no significant difference in the gender of respondents physically abused. Thirty-eight (10.2 %) respondents admitted that they have been forced or persuaded to have sexual experience against their wish as teenagers. A total of 58/346 (16.8 %) respondents admitted that they have been abused emotionally in one way or the other by either birth parents or other relatives who brought them up. Conclusions: Child abuse is a notable J. M. Chinawa (*) : A. E. Aronu : B. F. Chukwu : H. A. Obu Department of Pediatrics, University of Nigeria/Teaching Hospital (UNTH), PMB 01129, Enugu, Enugu State, Nigeria 400001 e-mail: [email protected] A. E. Aronu e-mail: [email protected] B. F. Chukwu e-mail: [email protected] H. A. Obu e-mail: [email protected]
problem among secondary school students and adolescents, though this is highly underreported as seen in this study. Keywords Child abuse . Pattern . Secondary school
Introduction Child abuse is the physical, sexual or emotional mistreatment, or neglect of a child or children [4, 8]. It can also be defined as child maltreatment as any act or series of acts of commission or omission by a parent or other caregiver that results in harm, potential for harm, or threat of harm to a child [15]. Child abuse can occur in a child’s home, or in the organizations, schools, or communities that the child interacts with. Child abuse is, however, more generally characterized by the deliberate infliction of physical, emotional, or sexual harm on the child. Child neglect can also incorporate a situation in which there is a failure to provide conditions which are essential for the health of the child [5, 7, 12]. The immediate impact of abuse or neglect on a child is tragic, more so, a longterm consequence, affecting children, their communities, and the commonwealth as a whole [18, 26]. Child abuse is often hidden, may occur over time, and is usually preventable [18, 27]. Child abuse kills thousands of children each year. WHO (World Health Organization) in 1996 estimated that each year, 155,000 of children die as a result of abuse and neglect [11]. Child abuse and neglect are not confined to any particular socioeconomic class, race, ethnicity, or religion [27]. Age however has a role in child abuse, for instance, children younger than 4 years are at the greatest risk of severe injury or death. There are a number of situations that place children at particular risk for being abused or neglected, including: parents who were themselves abused as children, teenage parents, parental or family substance abuse, parental depression, stress, or other mental health problems and family
Eur J Pediatr
violence, such as intimate partner violence, unemployment, and poverty [16]. Children of both sexes are represented almost equally in substantiated cases of neglect, physical abuse, and emotional abuse, while females are the victims of sexual abuse in most cases [13]. The age of children represented in both physical and emotional abuse is reasonably evenly spread among children aged up to 14 years. Sexual abuse, however, is overwhelmingly higher among females in the 10–14 years category, while the largest proportion of neglect cases is in children under the age of 5 years [13]. However, because many occurrences of child abuse and neglect go unreported or undetected, official figures do not necessarily state the true incidence. They tend to reflect only what state government agencies are doing [13]. Of all the spectrum of child abuse, child sexual abuse is the most worrisome. For instance, it was reported in 1986 that children of elementary schools (aged 6–12 years) and adolescent girls (13–19 years) in Benin City were the major victims of sexual abuse, with 48.2 % of reported cases over a 3-year period occurring in children below 13 years of age [19]. Ogunyemi [19] also reported some baseline findings from a community-based project on the incidence of child sexual abuse in two Nigerian urban centers. About 38 and 28 % of female and male respondents, respectively, reported being initiated to sex before the age of 18 years. These findings, among other things, point to frightening dimensions child sexual abuse may be assuming in Nigeria. Evaluation of the pattern of child abuse among secondary school students is a very vital issue often under reported in pediatrics practice, and its importance cannot be downplayed especially its impact on health which include post-traumatic symptoms, precocious sexualization, depression, anxiety, stigmatization, guilt, fear, sexual dysfunction, dissociative symptoms, eating disorders, substance abuse, prostitution, and regressive behaviors such as return to thumb-sucking or bed wetting, run away behavior, and academic problems [9, 23]. The problem of child abuse has also increased due to apparent lack of interest by researchers and paucity of empirical data which made it difficult to ascertain the prevalence of child abuse, particularly in Nigeria. Arresting this crippling problem of child abuse is an important issue in this twenty-first century [10]. We are not aware of any study of this nature from this city. This study was thus designed to bridge this gap with a view to determining the pattern of child abuse among children in a secondary school setting and associated factors. It is hoped that this will add to the body of knowledge available on these disorders, and the findings of this study could form the template for intervention strategies in helping reduce this social malaise and managing such cases.
Methodology Study area The study was carried out among teenagers in four secondary schools within an age range of 12–18 in Enugu metropolis.
Study population The questionnaire was self-administered to the students outside class and lecture hours. The school proprietress was asked for permission to recruit students. Consent was obtained from individual students through their principals after they had been told that their participation was completely voluntary in nature and that they could discontinue their involvement at any time. Anonymity and confidentiality of responses were also conveyed. We also assured them that teachers and caregivers would not be given access to the data. The subjects were children who attend secondary school in a private setting in Enugu metropolis. The secondary school provides a complete school health program. They have qualified teachers and health instructors. Students were chosen by systemic sampling from Form 1 to 3. Each form has about four classes with about 20 per class.
Study procedure The instrument employed for data collection was a structured self administered questionnaire developed from (Childhood Experience of Care and Abuse Questionnaire (CECA.Q). This questionnaire covers questions on all the types of abuses and socioeconomic classes of the parents. For purposes of this study, child abuse was defined as child maltreatment as any act or series of acts of commission or omission by a parent or other caregiver that results in harm, potential for harm, or threat of harm to a child [1].
Data analysis Data was analyzed with Statistical Package for Social Sciences (SPSS) software, version 20. Data presentation was in the form of tables and charts. Frequencies, proportions, and percentages were calculated for categorical variable. Results of continuous variables were expressed as medians. Pearson’s chi-square was used to test for relationship between categorical variables, while student t test was used to test significant relationship between continuous variables. Test of significance was set at p
ORIGINAL ARTICLE
Prevalence and pattern of child abuse and associated factors in four secondary institutions in Enugu, Southeast Nigeria Josephat M. Chinawa & A. E. Aronu & B. F. Chukwu & H. A. Obu
Received: 9 September 2013 / Accepted: 15 October 2013 # Springer-Verlag Berlin Heidelberg 2013
Abstract In our society, child abuse is most often not recognized. In addition, little attention is focused on child abuse due to the menace of severe acute malnutrition and infections, which are the major pediatric problems in our setting. There is need therefore for public awareness of the existence of the various forms of child abuse in the society. The objective of this study is to determine the prevalence, pattern, socioeconomic implication, and factors associated with child abuse among secondary school students attending four secondary schools in Enugu. This is a prospective study where cases of child abuse were investigated using a convenience sampling of students attending four secondary schools in Enugu. A total of 372 subjects participated in the study comprising 192 (51.6 %) females and 180 (48.4 %) males (χ 2 =7.74, p =0.38). Their median age was 15.0 (12– 18)years. One hundred and sixty-six of 370 (44.8 %) made up of 85 (51.2 %) females and 81 (48.8 %) males reported that they had been hit repeatedly with an implement, showing no significant difference in the gender of respondents physically abused. Thirty-eight (10.2 %) respondents admitted that they have been forced or persuaded to have sexual experience against their wish as teenagers. A total of 58/346 (16.8 %) respondents admitted that they have been abused emotionally in one way or the other by either birth parents or other relatives who brought them up. Conclusions: Child abuse is a notable J. M. Chinawa (*) : A. E. Aronu : B. F. Chukwu : H. A. Obu Department of Pediatrics, University of Nigeria/Teaching Hospital (UNTH), PMB 01129, Enugu, Enugu State, Nigeria 400001 e-mail: [email protected] A. E. Aronu e-mail: [email protected] B. F. Chukwu e-mail: [email protected] H. A. Obu e-mail: [email protected]
problem among secondary school students and adolescents, though this is highly underreported as seen in this study. Keywords Child abuse . Pattern . Secondary school
Introduction Child abuse is the physical, sexual or emotional mistreatment, or neglect of a child or children [4, 8]. It can also be defined as child maltreatment as any act or series of acts of commission or omission by a parent or other caregiver that results in harm, potential for harm, or threat of harm to a child [15]. Child abuse can occur in a child’s home, or in the organizations, schools, or communities that the child interacts with. Child abuse is, however, more generally characterized by the deliberate infliction of physical, emotional, or sexual harm on the child. Child neglect can also incorporate a situation in which there is a failure to provide conditions which are essential for the health of the child [5, 7, 12]. The immediate impact of abuse or neglect on a child is tragic, more so, a longterm consequence, affecting children, their communities, and the commonwealth as a whole [18, 26]. Child abuse is often hidden, may occur over time, and is usually preventable [18, 27]. Child abuse kills thousands of children each year. WHO (World Health Organization) in 1996 estimated that each year, 155,000 of children die as a result of abuse and neglect [11]. Child abuse and neglect are not confined to any particular socioeconomic class, race, ethnicity, or religion [27]. Age however has a role in child abuse, for instance, children younger than 4 years are at the greatest risk of severe injury or death. There are a number of situations that place children at particular risk for being abused or neglected, including: parents who were themselves abused as children, teenage parents, parental or family substance abuse, parental depression, stress, or other mental health problems and family
Eur J Pediatr
violence, such as intimate partner violence, unemployment, and poverty [16]. Children of both sexes are represented almost equally in substantiated cases of neglect, physical abuse, and emotional abuse, while females are the victims of sexual abuse in most cases [13]. The age of children represented in both physical and emotional abuse is reasonably evenly spread among children aged up to 14 years. Sexual abuse, however, is overwhelmingly higher among females in the 10–14 years category, while the largest proportion of neglect cases is in children under the age of 5 years [13]. However, because many occurrences of child abuse and neglect go unreported or undetected, official figures do not necessarily state the true incidence. They tend to reflect only what state government agencies are doing [13]. Of all the spectrum of child abuse, child sexual abuse is the most worrisome. For instance, it was reported in 1986 that children of elementary schools (aged 6–12 years) and adolescent girls (13–19 years) in Benin City were the major victims of sexual abuse, with 48.2 % of reported cases over a 3-year period occurring in children below 13 years of age [19]. Ogunyemi [19] also reported some baseline findings from a community-based project on the incidence of child sexual abuse in two Nigerian urban centers. About 38 and 28 % of female and male respondents, respectively, reported being initiated to sex before the age of 18 years. These findings, among other things, point to frightening dimensions child sexual abuse may be assuming in Nigeria. Evaluation of the pattern of child abuse among secondary school students is a very vital issue often under reported in pediatrics practice, and its importance cannot be downplayed especially its impact on health which include post-traumatic symptoms, precocious sexualization, depression, anxiety, stigmatization, guilt, fear, sexual dysfunction, dissociative symptoms, eating disorders, substance abuse, prostitution, and regressive behaviors such as return to thumb-sucking or bed wetting, run away behavior, and academic problems [9, 23]. The problem of child abuse has also increased due to apparent lack of interest by researchers and paucity of empirical data which made it difficult to ascertain the prevalence of child abuse, particularly in Nigeria. Arresting this crippling problem of child abuse is an important issue in this twenty-first century [10]. We are not aware of any study of this nature from this city. This study was thus designed to bridge this gap with a view to determining the pattern of child abuse among children in a secondary school setting and associated factors. It is hoped that this will add to the body of knowledge available on these disorders, and the findings of this study could form the template for intervention strategies in helping reduce this social malaise and managing such cases.
Methodology Study area The study was carried out among teenagers in four secondary schools within an age range of 12–18 in Enugu metropolis.
Study population The questionnaire was self-administered to the students outside class and lecture hours. The school proprietress was asked for permission to recruit students. Consent was obtained from individual students through their principals after they had been told that their participation was completely voluntary in nature and that they could discontinue their involvement at any time. Anonymity and confidentiality of responses were also conveyed. We also assured them that teachers and caregivers would not be given access to the data. The subjects were children who attend secondary school in a private setting in Enugu metropolis. The secondary school provides a complete school health program. They have qualified teachers and health instructors. Students were chosen by systemic sampling from Form 1 to 3. Each form has about four classes with about 20 per class.
Study procedure The instrument employed for data collection was a structured self administered questionnaire developed from (Childhood Experience of Care and Abuse Questionnaire (CECA.Q). This questionnaire covers questions on all the types of abuses and socioeconomic classes of the parents. For purposes of this study, child abuse was defined as child maltreatment as any act or series of acts of commission or omission by a parent or other caregiver that results in harm, potential for harm, or threat of harm to a child [1].
Data analysis Data was analyzed with Statistical Package for Social Sciences (SPSS) software, version 20. Data presentation was in the form of tables and charts. Frequencies, proportions, and percentages were calculated for categorical variable. Results of continuous variables were expressed as medians. Pearson’s chi-square was used to test for relationship between categorical variables, while student t test was used to test significant relationship between continuous variables. Test of significance was set at p
