|Year : 2011 | Volume
| Issue : 3 | Page : 193-197
Medical professional perception, attitude, knowledge, and experience about child abuse and neglect in Bagalkot district of north Karnataka: A survey report
SV Kirankumar1, H Noorani2, PK Shivprakash2, S Sinha1
1 Department of Pediatric and Preventive Dentistry, M.A. Rangoonwala College of Dental Sciences, Pune, India
2 P.M.N.M. Dental College and Hospital, Bagalkot, Karanataka, India
|Date of Web Publication||10-Oct-2011|
S V Kirankumar
Department of Pediatric and Preventive Dentistry, M.A. Rangoonwala College of Dental Sciences, Azam Campus, Camp, Pune - 411 001, Maharastra
| Abstract|| |
Aims: The aim of this study was to analyze medical professional, perception, attitude, knowledge, and experience about child abuse and neglect in Bagalkot district, north Karnataka, India. Materials and Methods: Two hundred medical professional, working in both public and private sectors in the province were interviewed by a single operator. Descriptive analyses were carried out by using the obtained data. Results: Medical professional's perception about child abuse and neglect (CAN) is low and these professionals have poor attitude and knowledge toward CAN in accordance with the code of conduct and law. The available information and education is also poor. Conclusions: The results obtained from the study showed that there is lack of knowledge and poor attitude and perception about CAN among medical professionals that prevents them from detecting and identifying suspected cases. Continuing medical education is required to enhance the ability of professionals to detect CAN cases.
Keywords: Attitude, child abuse, knowledge, medical professional, neglect, perception
|How to cite this article:|
Kirankumar S V, Noorani H, Shivprakash P K, Sinha S. Medical professional perception, attitude, knowledge, and experience about child abuse and neglect in Bagalkot district of north Karnataka: A survey report. J Indian Soc Pedod Prev Dent 2011;29:193-7
|How to cite this URL:|
Kirankumar S V, Noorani H, Shivprakash P K, Sinha S. Medical professional perception, attitude, knowledge, and experience about child abuse and neglect in Bagalkot district of north Karnataka: A survey report. J Indian Soc Pedod Prev Dent [serial online] 2011 [cited 2014 Mar 10];29:193-7. Available from: http://www.jisppd.com/text.asp?2011/29/3/193/85807
| Introduction|| |
The child abuse and neglect (CAN) issue is one among the gray shades of the society. Each day, the safety and well-being of some children across the Nation are threatened by CAN. Intervening effectively in the lives of these children and their families is not the sole responsibility of any single agency or a professional group, but rather is a shared community concern.
CAN is defined as every kind of physical, sexual, emotional 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, trust or power.  (WHO - 1999)
Neglect refers to the failure of a parent toward the development of the child - where parent is in a position to do so - in one or more of the following areas: health, education, emotional development, nutrition, shelter, and safe living conditions. 
CAN definition consists of two meaning: (1) the results of a committed action (physical, sexual, emotional abuse) or (2) omission (neglect). The consequence of CAN is real or potential damage to the child's life, health, or development, especially for infants (1-4years), where in the commission or omission of an action could stake a claim on their future life and health. 
Five forms of abuse have been defined: physical, sexual, emotional, domestic violence, and neglect.  Approximately 50% of physical abuse results in facial and head injuries. Bite marks are rarely accidental and good indicators of abuse. Bites of a sexual nature occur on neck, breast, stomach, and genitals. Bite with central suck mark or thrust mark is highly indicative of sexual abuse. 
In one of extensive hospital study recently performed by da Fonseca et al showed that in cases where children had been physically abused, over 75% of the cases involved injuries to head, face, mouth, or neck. 
The prevalence of CAN is more wide spread than any other thing in the world. In USA more than 1000 child fatalities in 1 year associated with abuse have been reported whereas in Europe its prevalence varies from 5 to 30 cases per 1000 children annually, depending on the social background. 
India is home for 19% of the world's child population, with every fifth child in the world living in India. Forty-two percent of the Indian population is aged below 18. Some of the facts in India related to CAN are as follows. 
- India is country with huge population but birth registration is only just 62%.
- Every second child in India is underweight.
- Every third malnourished child in the world lives in India.
- One thousand one hundred four lakh children are child labors in the country [Sample Registration Office (SRO) 2000].
- Immunization coverage is very low.
- Decline in the female to male ratio is maximum in 0-6years: 927 females per 1000 males.
Women and children trafficking in India is high, number of missing children in India is about 44,476. Three to five lakh girl child are involved in commercial sex and organized prostitution.
This is according to the survey carried out by the ministry of women and child development, government of India in the year 2007 and it was done in 13 states.
Two out of three children were physically abused, out of 69% children 54.68% were boys. Eighty-eight percent were physically abused by parents and 65% of school going children reported facing corporal punishment (62% in government and municipal school). The states such as Andhra Pradesh, Assam, Bihar, and Delhi have almost consistently reported higher rates of abuse in all forms as compared to other states. In more than 50% of the cases, the site involved is the facial region. 
53.22% children reported having faced one or the other forms of sexual abuse. States such as Andhra Pradesh, Assam, Bihar, Delhi, reported highest amount of child abuse. 21.90% child respondents faced severe form of sexual abuse. 50% abusers are persons known to the child or in a position of trust and responsibility. 
Emotional abuse and girl child neglect
Every second reported child was facing emotional abuse, with an equal percentage of affected girls and boys. In 83% of the cases, parents were the abusers. Girls who wished to be a boy was 48.4%. 
Across the world, around 21 million children were involved in child labor in 2004, around 1104 lakh only in India, with it having the world's highest number of working children. 
There are many studies that were carried out to assess the perception, knowledge, attitude of dentist regarding CAN. Studies concluded that they did not know much about CAN and they require continuing dental education regarding CAN. As we all know that medical professionals are the one who will come first in contact with the child and parents. They are the one who promote health and they are the preferred one for any kind of trauma or ill health. CAN was first reported in the year 1960 by a medical professional called Dr. C. H. Kemp. Considering the above-mentioned Indian facts and important role played by the medical professional, we aimed to carry out a study to assess perception, attitude, knowledge, and experience of medical professionals about CAN in Bagalkot district of north Karnataka.
| Materials and Methods|| |
The participants were medical professionals and medical students, who were selected randomly among professionals working and studying in private or public clinic and hospitals located as mentioned above. Two hundred medical professional and students were interviewed, among them 138 were medical professionals working in private and government hospitals and 62 were students. Among 138 professionals, 90 were working in S.N.M.C medical college Bagalkot and 48 were working in private clinics and government hospitals. The age of the participants ranged between 23 and 65 years.
A three-section questionnaire was used to obtain the data.
Information about the practioner's age, sex, type of degree, year of graduation, whether they are working in public hospitals or private clinic, and the number of patients seen per week.
Consisted of ten statements regarding CAN to assess the medico's perception, attitude, and knowledge about CAN in which the practitioner had to express his or her opinion as true, false, or I don't know.
Three simulated clinical cases were depicted using clinical descriptions requiring the practitioner to answer whether the depicted cases were compatible with cases of child abuse or neglect, based on the options described in the section.
Questions used in sections II and III.
- CAN is one of the most relevant cause of pediatric mortality. (T)
- Do you think medical professionals must protect the child's health? (YES)
- Have you ever received information, instruction, or training in diagnosing and reporting of suspected cases of CAN? (NO OF CASES)
- CAN is primarily associated with the low socioeconomic strata (levels)? (F)
- Prevalence of CAN in India is between 62% and 68% and male child is more physically abused than the female child. (T)
- More than 50% of CAN lesions are on head, face, and neck. (T)
- Bite marks observed on a child during the normal course of a medical checkup visit should be investigated as a possible indicator of child abuse? (T)
- Burns are often associated with many child abuse cases and they often have shape of hot objects? (T)
- Palatal petechiae can be considered as signs of physical and sexual abuse. (T)
- Neglecting child's education, medical, and dental health is a kind of maltreatment. (T)
- Do you think there is a strong correlation between dental neglect and the presence of physical neglect? (T)
- According to survey done by SRO in 2000, in India, there are around 1104 to 1112 lakh child laborers. (T)
- A 10-year-old female was admitted to the children's hospital for 7 weeks for seizures and respiratory distress. She gave a history of multiple fractures, multiple skin lesions on the ears, face, chest, abdomen, and extremities. These lesions were at various stages of healing and respiratory distress indicated multiple healing rib fractures. This most likely indicates (Child abuse).
- A 5-year-old male presents with his mother after an accident, with laceration of upper lip and upper-superior labial frenum, contusion of oral cavity, and subluxation of maxillary right central incisor. Radiographs show ankylosis of mandibulear right central incisor and pulpal calcification of maxillary left central incisor. His mother states that the accident happened at the playground the day before, and the child declines to speak about it (Child abuse).
- A 6-year-old female is being treated for rampant caries and recurring infection. Her oral condition has been diagnosed 4 months previously and her parents were informed of the need for restorative care. They failed to keep their last appointments and they finally showed up at the clinic because the child had such severe toothache that she could not go to school. This is indicative of (Child neglect)
Contents in the brackets indicate the right answers for the question.
The questionnaire data were collected using Microsoft Access. The database contained 200 records each consisting of 15 variables. Wilcoxon and Kruskal-Wallis nonparametric tests for continuous variables (that is, percentage of correct answers to the questionnaire and percentage of correct answers to the clinical cases) were used because of the abnormal distribution of frequencies. To study the possible predictors of correct answers and of the probability of having experienced CAN cases, a stepwise logistic analysis was used.
| Results|| |
The results were gathered through the questionnaires and they were as follows: only 65.5% of medical professional considered that CAN can be one of the most prevalent cause of pediatric mortality. Ninety-two percent of medical professional agreed that protection of child's health is their duty as stated in the code of conduct and law. Only 47.5% of them have received information, instruction, and training in diagnosing the suspected cases, the number of cases reported were only five. A low socioeconomic stratum was considered by 71% of medical professional to be associated with CAN, which is not true. Fifty percent of medico's did not know the prevalence of CAN in India. Of them 68.5% did not know the most common part of the body that is involved in CAN. In addition, of the 65% answered correctly that bite marks could be considered as possible indicator of child abuse. Only 44.5% medicos could answer correctly that burns associated with child abuse will have the shape of the object. Out of them 55% consider that palatal petechiae can be a sign of sexual abuse. Professionals considering neglecting child's health and education as child's maltreatment was 64.5%. Only 49% of them agree that there is a correlation between the dental neglect and physical neglect.
The results of clinical cases are: only 50% of them could understand the first two questions of descriptive cases are child abuse. Only 27% of them could differentiate between CAN.
| Discussion|| |
The results of this study show that most of the interviewed professionals are aware of their duty to protect child's physical and psychological health. Considering how damaging abuse and neglect can be to child's health, life, and development, medical professionals must act to detect, treat and prevent it.
In one of the study, 45-86% dentist were aware of their legal obligations. An inadequate educational background in child maltreatment was reported by 22-75% of respondent dentist. 
There are many factors that influence the ability to recognize and report CAN. These include the following. 
- Lack of awareness of legal responsibilities and protections.
- Uncertainties about what constitutes CAN.
- Lack of training in identifying characteristics of children who are victims of CAN.
- Uncertainties regarding the assessment of a patient's problem: Is it abuse or neglect?
- Lack of knowledge and skill in reporting procedures.
- Uncertainties regarding the outcome of reporting: Will it be beneficial for the patient or is reporting only a punitive action, with no useful outcome?
- Poor experience or relationships with local authorities.
- Reluctance to interfere in the parent-child relationship.
- Fear of legal involvement.
- Fear of detrimental effects on the individual's practice.
Our study revealed that only 65.5% medical professionals had good attitude in perceiving CAN as pathology, but the responses for other variables were not satisfactory. A very low percentage, 50%, of medicos were aware about the incidence of CAN in India.
Only 43.5% of the practitioners recognized that palatal petechiae and bruises could be a sign of sexual and physical abuse. This finding was consistent with previous study conducted by S. Manea (2007) among the dentists. Moreover, 52.5% of the participants did not receive any kind of information, instruction, or training in diagnosing or reporting CAN. The lack of clinical knowledge of CAN is evident by the fact that only 47.5% of the medical personnel recognized CAN in their career.
Some of programs to prevent CAN are
1. Family support approaches
- Training in parenting
- Intensive family preservation services
2. Training for health professionals
- Continuing education program
- Providing them diagnostic and treatment guidelines
3. Legal and related remedies
- Child protection services
- Arrest and prosecution policies
4. Community based effort
- School programs
- Prevention and educational campaigns
| Conclusions|| |
Our study revealed that
- The incidence and prevalence of CAN is underestimated by medical professionals;
- Ninety-two percent of medical professionals agree that protection of child's health is their duty, but 35.5% medical professionals have a poor attitude in perceiving CAN as pathology.
- Most of the medical professional are unable to confront suspected cases even though they may be aware of the medico legal responsibility of their job.
- Child neglect is the least known even though they are most frequently occurring.
This study of the perception, knowledge, and attitudes of medical professionals in Bagalkot district about CAN has demonstrated a poor overall understanding of the problem. This gives a clear indication for further formal training and continuing medical educational programs are required.
| References|| |
|1.||Manea S, Favero GA, Stellini E, Romoli L, Mazzucato M, Facchin P. Dentists perception, attitude, knowledge, and experience about child abuse and neglect in northeast Italy. J Clin Pediatr Dent 2007 Fall;32:19-26. |
|2.||Dr. Loveleen Kacker IAS, Srinivas Varadan, Pravesh Kumar. Study on Child Abuse. India: Ministry of Women and Child Development, Government of India; 2007. |
|3.||Kilpatrick NM, Scott J, Robinson S. Child protection: A survey of experience and knowledge within the dental profession of New South Wales. Australia. Int J Paediatr Dent 1999;9:153-9. |
|4.||Lee LY, Ilan J, Mulvey T. Human biting of children and oral manifestation of abuse: A case report and literature review. ASDC J Dent Child 2002;69:92-5, 14. |
|5.||Jessee SA. Physical manifestation of child abuse to the head, face and mouth: A hospital Survey. ASDC J Dent Child 1995;62:245-9. |
|6.||Adair SM, Yasrebi S, Wray IA, Hanes CM, Sams DR, Russell CM. Demographic, education, and experiential factors associated with dentists decision to report hypothetical cases of child maltreatment. Pediatr Dent 1997;19:466-9. |
|7.||Davis GR, Domoto PK, Levy RL. The dentists role in child abuse and neglect, issues, identification, and management. ASDC J Dent Child 1979;46:185-92. |