Child Maltreatment Among Saudi Pediatricians and Medical Students

Child Maltreatment Child Maltreatment between Knowledge, between Knowledge, Attitude and Beliefs Attitude and Beliefs Among Saudi Among Saudi Pediatricians Pediatricians and Medical Medical Students Students Yossef Alnasser Amani Albijadi and Waad Abdullah Dana Aldabeeb Alanoud Alomar Sara Alsiddiqi Yara Alsalloum

Child maltreatment is the abuse and neglect that occurs in children under 18 years of age. Introduction & Rationale In Saudi Arabia, the first case of child abuse was identified in 1990. Child maltreatment is not included in many medical schools and pediatric residency curriculums, which might limit knowledge and spread misconceptions.

To quantify level of knowledge and acceptance of child definitions. maltreatment Objectives To explore how do Saudi medical students, trainees and pediatricians feel about child maltreatment and reporting. To investigate impact of religion and traditions on beliefs maltreatment. toward child

Hypothesis We hypothesize that medical students and pediatric trainees have limited knowledge, oblivious attitude and misbeliefs regarding child maltreatment in comparison to experienced pediatricians. On the other hand, medical students and trainees might hold higher motives and willingness to learn about child maltreatment and their consequences.

Quantitative, observational, cross-sectional study. Methods Inclusion criteria: pediatricians, pediatrics trainees and medical students in different areas of pediatric services in King Saud University Medical City. Informed consent was obtained by stating the purpose of the study and assured the confidentiality of the responses.

Data Collection using self-administered online questionnaires in English which included Methods 1. 2. Socio-demographic characteristics. Questions to assess the level of knowledge and acceptance of child maltreatment. Pilot Study

Data Management Descriptive statistics were used to describe the categorical variables. Methods Data was analyzed using SPSS version 20.0 statistical software. Student t-test and chi-squared test were applied to assess the association between categorical study and outcome variables. A p-value of <0.05 was considered statistically significant.

Study Variables gender, level of physicians education and experience Methods Outcome Variables incidence of intention to report suspected cases of child abuse and neglect.

Results

Parents psychiatric illnesses Parents poor education Parental drug abuse/Alcoholism Parental history of child Abuse Low Socio-economic class. Behavioral problems. Childs mental retardation Child's Chronic diseases Domestic violence Single Parent/divorced. Teen parenting 0 10 20 30 40 50 60 70 80 90 100 Identified Risk Factors of Child Abuse

Psychiatric illnesses. Abusive behavior. Poor academic performance. Poor Self Esteem. Pathological diseases (DM, obesity, hypertension etc.). Social difficulties. Alcohol and drug abuse. Poor cognitive outcome. Growth retardation. 0 10 20 30 40 50 60 70 80 90 100 Consequences of Child Maltreatment

NO. n(%) YES n(%) Question. I am familiar with the child abuse and neglect definition 30 (23.6 %) 97 (76.4%) The definition of CAN is subject to culture and traditions 86 (67.7%) 41 (32.3%) Child abuse and neglect happens in Saudi Arabia 2 (1.6 %) 125 (98.4%) CAN is a high priority among other social and health problems in Saudi Arabia 30 (23.6%) 97 (76.4%) Current Medical Schools provide good background about CAN 106 (83.5%) 21 (16.5%) Current Pediatric Residency Programs provided you a good background to deal with CAN situations 99 (77.9%) 28 (22%) A Saudi national program to protect against child abuse and neglect exists 83 (65.4%) 44 (34.6 %) Our hospital has a CPS process and structure in place 79 (62.2%) 48 (37.8%) Current Saudi Law Enforcement System is equipped to deal with cases of CAN 101 (79.5%) 26 (20.5%) I feel reporting child abuse and neglect should be made Mandatory" per professional code of practice 3 (2.4%) 124 (97.6%) My colleagues would hesitate in reporting suspected CAN subjects in general 66 (52 %) 61 (48 %) CAN is preventable 14 (11%) 113 (89%) I need further specialized training to deal with child abuse and neglect 8 (6.3 %) 119 (93.7%) I am willing to be trained to deal with victims of CAN. 10 (7.9 %) 117 (92.1%) ? Table 1. Knowledge, Attitude and Beliefs of Medical Students and Physicians

100 90 80 70 60 50 40 30 20 10 0 Emotional abuse Shaken infant syndrome Physical abuse Sexual abuse Commercial and human trafficking Neglect Medical students and physicians were more likely to report sexual and physical abuse

12.000 11.049 10.457 10.000 8.000 6.000 4.000 3.720 3.019 2.734 2.000 2.045 2.382 1.858 Odds Ratio .940 0.000 Multivariate Logistic Regression

7 6 5 4 3 2 1 0 Juniors Experienced physicians Number of identified risk factors Number of identified CAN consequences Recognition of Risk Factors and Consequences of CAN

In positive attitude and willingness to obtain further training were observed among study participants. general, good basic knowledge, Conclusion Experienced knowledgeable and more likely to report neglect. physicians were more Finally, higher enthusiasm to report and acquire further training. However, reporting is a major observed defect. female respondents showed

Our results do not represent the city of Riyadh as a whole, but are only limited to one hospital, lack generalizability. Limitations Data was collected in the form of self administered questionnaires, the responses could be affected with recall bias.

Further education and training are needed to combat Child Abuse and Neglect in Saudi Arabia. Recommendations

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You treat a disease, you win, you lose. You treat a person, I guarantee you, you will win, no matter what the outcome. -Patch Adams

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