Assessment of the Knowledge and Attitude of Child Abuse among School Children in Chennai City - A Cross Sectional Study

Keywords

Child Abuse; Physical Abuse; Emotional Abuse; Child Helpline.

Introduction

Childhood is the formative period in human life, where most of the personality development takes place during this golden period.[ 1-3] A Child’s mind is very soft, receptive and plastic with fine and long-lasting impressions.[4] During childhood, an individual may encounter certain unforgettable trauma of which child abuse being one of it.[5]

Child abuse or maltreatment is any kind of physical, sexual, and/ or psychological maltreatment or neglect of a child or children, especially by parent or caregiver.[6] Child abuse may include any act or failure to act by a parent or a 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 in which thechild interacts.[6]

The World Health Organization (WHO) defines child abuse and maltreatment as “all forms of physical and/or emotional ill-treatment, sexual abuse, neglect or negligent treatment or commercial or other exploitation, resulting in actual or potential harm to the child’s health, survival development or dignity in the context of a relationship of responsibility, trust or power.[7] According to the WHO an estimate of 40 million children worldwide are victims of child abuse every year.[8]

In India about 37% of children belong to the age under 18 years. [9] In 2007 the Ministry of Women and Child Development conducted a National Survey on child abuse in India and reported that 53% of the children experienced sexual abuse and 20% reported severe sexual abuse.[10] It is studied, that children who are abused showed less confidence and low self-esteem and decline in the intellectual functioning due to their attachment disturbance and subsequent lack of emotion competence in many situations. [11] Child abuse cases remain unreported for numerous reasons such as lack of awareness, fear of being accused, parental desire to curb publicity, fear to handle police and court cases.[4]

In literature there are numerous studies conducted about the knowledge and awareness of Child abuse among medical professionals, school teachers and parents in India, [4, 6, 12-14] but there are no studies conducted among school children in Chennai. Child abuse and its threats can be prevented by understanding the knowledge of children about it and hence the aim of the present study is to assess the knowledge and attitude of Child Abuse among school children in Chennai city.

Materials and Methods

Study Design and Sample

The present study is a questionnaire-based cross-sectional survey conducted among children attending Government schoolsin Chennai, which was carried out in January 2020. The study group was a convenience sample of 172 children, between 12-14 years. Thesample size was calculated based on previous studies with a power of 80% using the Open Source Epidemiologic Statistics for Public Health, OpenEpi, Version 3 software.

Data Collection Tool

A11-item structured questionnaire was formulated consisting of questions regarding the knowledge and awareness on child abuse among children.The questionnaire was framed in English and was validated by a group of experts in the field.

Data Collection Procedure

Consent was obtained from the parents and school authorities prior to commencement of data collection. The purpose of the study was explained and the confidentiality of the data was assured. The questionnaire was distributed among 172 government school children. The questions were explained to the children in Tamil language for better understanding. The questionnaires once filled were collected, tabulated and passed in a blind manner to a statistician for the analysis of the results.

Statistical Analysis

Descriptive statistics and chi-square test were used to analyse the statistical differences in response.

Results

Out of 172 children, 93 (54%) were girls and 79 boys (46%) [Table 1]. 65% of the children were aware about child abuse, but only 10% of them knew about its signs and symptoms which was statistically significant. Physical abuse was the most common type of abuse according to the children (68.6%) which was not statistically significant. 80.3% of the children did not encounter any form of child abuse which was statistically significant. 69.2% of the children were not aware about the prevention of child abuse. 91.8% of the children wanted more education and information on child abuse, which was statistically significant [Table 2].

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Table 1:

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Table 1: Demographics of the Participants.

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Table 2:

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Table 2. Knowledge and awareness of children about Child abuse.

Discussion

Child maltreatment is a critical public health issue, withlifelong health consequences not only for the victim but also to theirfamily.[ 15] Childhood maltreatment can affect the long-term wellbeing to a large extent,[16] and children who have suffered abusive parenting are at a high risk of becoming abusive parents in future. [17]

This survey was conducted among school children to assess the knowledge and awareness about child abuse. Understanding the knowledge of children in this aspect would help correcting the voids present and raise social awareness about its reporting and prevention. The present study reported that 65% of the children were aware of child abuse, but only 10% of them were aware about its signs and symptoms which include anger, unusual fears, bruise and scars. Jasmine KP et al., in their study among higher secondary school children showed that 18% had high awareness, 56% had average awareness and 26% had low awareness on child abuse.

Physical abuse (68.2%)was regarded as the most common type of abuse in the present study, followed by emotional abuse (22.6%), neglect (5.7%) and sexual abuse (3.1%). 41% of the children chose to report to their parents during an event of abuse. Salzinger et al., reported that physically abused children were observed to be more disliked and less popular when compared to their non-abused counterparts.[18] The relationship of physically abused children with their friends were found to demonstrate less intimacy, more conflict, and more negative effect than nonabused children.[19] In the present study 55.2% of the children agreed that beating was a form of physical abuse, which is in accordance with a study done by Stephen SS et al., who reported that 95.3% of children were aware that being hit by the stick, belt, whip etc., is unacceptable.[3] Bussien et al., reported contrary results stating that most of the children thought that their abuse was a normal proceeding.[20]

A large number (80.3%), in the present study responded that they did not personally encounter any form of abuse. Adolescents often did not report their abuse for reasons like shame, fear of the consequences, threat by the abuser and causing distress to their parents, hence they preferred to maintain it a secret and assumed that managing the situation was their own responsibility.[ 21] Children also would approach an adult if they were abused, as adults would believe the allegations made by them.[3] In the present study, children responded that they would report to their parents (39.5%), Child help line (28.5%), police (22.1%) and teachers (9.9%) if they were abused. Child helpline play an integral role in helping children deal with issues like violence at home, bullying, health, abuse, sexuality, and also make referrals in case of emergencies.[22] Child helplines are relatively easy and cost-effective to establish when compared to other formal child protection reporting centres like schools, police, child protection authorities or health care centres. Child helplines provide a confidential channel for children to speak openly and receive advice without confronting the formalities of a child protection system. [23] Child helplines also present the opportunity to capture cases of violence from particularly vulnerable populations of children who have very limited access to, or are afraid to reach out to, formal reporting centres.[23] Data reveal that over 3 million counselling contacts were received by child helplines from 84 countries/ territories in 2017 and 2018, out of which the most common reason for call was abuse and violence in Africa, America and Caribbean region. It was the second most commonly cited reason in the Middle East and North Africa and third in Europe and the Asia-Pacific region.[23] In the present study 54.1% of the children were unaware about the child helpline. Crisma et al., reported that adolescents were either ignorant about the existence of social and health services and the type of help they provide or had wrong information about these services.[21]

This study reported that 69.2% of the children were not aware about the prevention of child abuse. Organizations like American Academy of Pediatrics (AAP), The Centers for Disease Control and Prevention (CDC), and the HarvardCenter on the Developing Child directly associate child maltreatment prevention to strengthening families, improving developmental outcomes, and promotion of child and family safety, stability and nurturance.[24] Majority of the children (91.7%) wanted more information and education on child abuse. Children participating in school-based child abuse programs had a better knowledge on it.[25] Rispens et al., in their study concluded that programmes which focus on skill training, allowing sufficient time for children to integrate selfprotection skills into their cognitive repertoire were preferred by school children.[26]

Conclusion

Within the limitations of the study, it can be concluded that school children lack the knowledge about the signs and symptoms, the prevention and the reporting personal after an abuse. There is also a need in gaining more information andknowledge about Child abuse. This can be achieved by including topics on child abuse in their school curriculum and conduction schoolbased child abuse awareness programmes.

Author Contributions

Author 1 (SubaArockiaraj) – Conception of topic, data collection and manuscript preparation. Author 2 (TrophimusGnanabagyan- Jayakaran) -Conception of topic, study design, reviewed and edited the manuscript.Author 3 (Chithra Sivakumar)– Study design, data collection and manuscript preparation. All the authors have equally contributed in developing the manuscript.

Acknowledgement

The authors would like to acknowledge the support rendered by the Head Master of Government Higher Secondary School, Porur, Chennai and all the faculty from the Department of Pediatric and Preventive Dentistry, SRM Dental College, Ramapuram, Chennai.