Epidemiology of Child Maltreatment during the COVID-19 Pandemic in Saudi Arabia

The potential influences of COVID-19 and social vulnerability measures on child maltreatment in the United States: Spatial temporal cluster analysis and negative binomial regression

BACKGROUND

Although existing research has reported the impacts of COVID-19 on child abuse and neglect (CAN), little attention was paid to the relationship between spatial patterns in the trends of COVID-19 cases and their effects on the prevalence of CAN cases.

OBJECTIVE

This study examined the associations between trends of confirmed cases of COVID-19 and child removal due to physical abuse and neglect at the county level in the U.S while taking the social vulnerability into account.

PARTICIPANTS AND SETTING

This study utilized three secondary data sets nationally collected.

METHODS

Spatial-temporal cluster analysis was used to classify and assign trends in confirmed cases of COVID-19 into their distinctive clusters. These spatial-temporal clusters were then used as independent variables in the negative binomial regression (NBR) models.

RESULTS

Average cases of physical abuse and neglect increased as the growth rates of confirmed cases of COVID-19 were accelerated except for the counties assigned to the cluster characterized by moderately low increase and very high increases. NBR found social vulnerability measures have no effects on child removal due to physical abuse and neglect after controlling spatial-temporal clusters of the confirmed cases of COVID-19.

CONCLUSIONS

Our study indicates that concentration of disaster has certain effects on child maltreatment. This suggests that child welfare pay special attention to the areas that undergo steep increases in confirmed cases under public health crises.

Insights Into Child Abuse and Neglect in the Washington DC, Maryland, and Virginia (DMV) Area: Evidence and Opportunities

Child abuse and neglect (CAN) significantly impact health, the economy, and society. This narrative review examines CAN in the Washington DC, Maryland, and Virginia (DMV) region, comparing it with national and international levels. The review highlights high CAN rates in the DMV, driven by factors such as socioeconomic status, parental substance abuse, and child vulnerabilities. Screening and reporting challenges, exacerbated by the COVID-19 pandemic, impede accurate data collection. This review emphasizes the need for standardized reporting mechanisms, economic investment in public health, and intersectoral collaboration. It recommends targeted support for at-risk families, specialized care for vulnerable children, and the development of predictive screening tools. Continuous research on regional and cultural factors and the pandemic's impact is crucial for future resilience. Addressing CAN requires a comprehensive approach involving prevention, early detection, intervention, and policy reform to safeguard the well-being of children.

Identification of Child Abuse and Neglect Based on the Perception of Training Physicians in Jeddah, Saudi Arabia

Introduction Child abuse and neglect (CAN) affects many countries, including Saudi Arabia (SA). CAN in SA is more commonly detected in hospitals. Therefore, healthcare professionals must identify and report the cases. This study aims to assess knowledge and perceptions toward CAN among training physicians. Methodology A cross-sectional survey was conducted through a self-administrated structured questionnaire and involved 123 residents and fellows who deal with children in Jeddah, SA. The participants were recruited using convenient sampling methods. Descriptive statistics, t-test, and Chi-square test were used for statistical analysis. Results We found that approximately 78% would report their findings to the legal authority, document them, and assess their consistency with parents and the child's explanation. However, only 41.5% of the participants would report CAN to the proper authority. Most participants believed that CAN should be redefined according to Saudi culture and religious standards. In contrast, 68.9% of the participants believed that CAN cases are under-reported in SA. The main barrier to not reporting is the fear of consequences (63.4%). About 77% of the participants agreed to the need for further training. Identifying the CAN indicators was higher among those who handled a CAN case previously (median = 66.67, p = 0.023). Conclusions In conclusion, the study showed that appropriate undergraduate and postgraduate curriculum training should be developed to strengthen future healthcare practitioners in dealing with CAN cases to protect children's welfare.

Parental Home Safety Practices for Domestic Accident Prevention: How Prepared Were Parents for COVID-19 Confinement? A Cross-Sectional Study

(1) Background: Children are susceptible to home injuries. How prepared parents were to protect their children from accidents before and during the COVID-19 quarantine is uncertain. (2) Methods: We conducted a community-based, cross-sectional study in Greece between November and December 2021. We asked parents to complete an anonymous questionnaire voluntarily. Questions focused on accident-preventive measures taken at home during the COVID-19 quarantine. (3) Results: A greater proportion of parents took protective measures for a safer home before the lockdown than during the quarantine, while an interesting percentage of parents never utilized preventive measures for their children. Slightly more than half (58.6%) of parents did not seem to worry about a possible increase in domestic accidents during the quarantine. It was observed that those who had one or two children took more protective measures than those with more than two children. Older parents seemed to explain to their children how to access emergency services more often. Mothers stayed at home with the children more often, and their education affected the presence of some of the assessed measures. In our logistic regression modeling, parental concern about accidents was more related to the incidence of an accident during the pandemic and attendance at seminars. (4) Conclusions: Although the COVID-19 lockdowns disorganized family life, parents were aware of the importance of their parenting role in creating a safe environment for children, but according to the study, there is room for improvement.

Parents' Knowledge and Perception of Child Abuse and Neglect in the Eastern Province of Saudi Arabia

Background

Child maltreatment is a crucial issue worldwide that has negative consequences for children and their families. Inability to distinguish between traditional corporal punishment and abuse is part of the problem.

Objectives

To assess parents' knowledge and perception of child maltreatment and investigate the factors that influence their awareness.

Materials and Methods

This cross-sectional study recruited parents with at least one child aged <18 years. Data were collected using a self-administrated online questionnaire. Participants were categorized into two groups based on the median knowledge score.

Results

A total of 447 participants completed the questionnaire, of which 62% were female and the average age was 37 years. Almost two-thirds of the respondents (60.6%) consider child abuse and neglect (CAN) to be a common problem in Saudi Arabia. Only 53% had good knowledge of CAN, and more than one-third were unaware of the hotline number available to report any CAN. Almost half of the participants did not consider refusing childhood immunization or smoking in front of children to be a form of CAN. Logistic regression showed that higher education and family income levels were significantly associated with good knowledge (P = 0.013 and 0.003, respectively).

Conclusions

While most parents consider CAN to be a common problem in Saudi Arabia, they do not have adequate knowledge of what constitutes emotional abuse and neglect. These findings highlight the need for community-based education programs to increase parents and caregivers' awareness of child rights.

Exploring interrelationships of COVID-19 dimensions in Saudi Arabia: a systematic review

Background

COVID-19 affected the world threatening medical, social, economic and community dimensions. Along with the other countries of the world, Saudi Arabia also witnessed critical emergencies leading to serious disaster due mainly to the overcrowding at certain urban residential localities. Nevertheless, the situation handled meticulously not only with measures and combating strategies but also with documentations and researches to build sustainable confrontation systems and lateral programs.

Main body of abstract

This attempt is a consolidation of the academic efforts on COVID-19 in the country aiming to contribute to the knowledge base aiding to future planning on preparedness. An online survey of published academic research from peer reviewed journals were carried out during August-December 2022, using COVID-19 in Saudi Arabia as search criteria. Many areas of concern are assessed in the context which are classified into spread and burden, patient statistics, symptoms and other clinical dimensions, vaccinations and vaccine acceptance/hesitance, psychosocial impact, impact on education, impact on health staff, impact on migration, impact on nutrition, and control measures adopted.

Short conclusions

A consolidation of these research findings explains the scientific academic community alertness in raising up to the emergency pandemic situation, which facilitated strategy and policy formulations by the Government ministries and other governing bodies. These researches are linked to stagewise programmatic efforts to curtail the epidemic as a mode of accomplishments.

Identifying the Challenges of Child Abuse Detection Among Emergency, Pediatrics, and Family Medicine Practitioners in Saudi Arabia

BACKGROUND

Child abuse is a significant issue across many countries. Despite the situation's innate understanding, many children are not reported to authorities and continue to experience abuse, sometimes even death. Healthcare professionals must be alert for abuse in any child who appears with injuries that are out of the ordinary because it is easy for indicators of child abuse to go unnoticed in a busy emergency department. The current study aims to evaluate and detect the challenges in diagnosing and reporting cases of child abuse among healthcare practitioners in emergency, pediatrics, and family medicine.

METHODS

A self-administered online disseminated questionnaire was used for data collection during the period from October 1 to December 30, 2022. A cross-sectional study was conducted on emergency, pediatrics, and family medicine healthcare practitioners working in hospitals in healthcare centers in Riyadh, Saudi Arabia. All data were collected, tabulated, and statistically analyzed using SPSS 23.0 for (IBM Corp., Armonk, NY) Windows.

RESULTS

The study sample constituted 200 physicians working in the front lines of healthcare like emergency, pediatrics, and family medicine primary care services, 50.5% were males and 49.5% were females. 36.5% of participants were 31-39 years old. 42% were family medicine physicians, 36.5% were pediatricians, and 21.5% were emergency medicine. About 43% of participants attended an educational workshop on child abuse. Nineteen percent of participants are very familiar with the diagnosis of child abuse and 36% of participants reported one to three cases of child abuse in the emergency department in the last year, 5% reported four to six cases and 56.5% reported none. Forty-seven percent of participants reported diagnosing one to five cases of child abuse throughout their whole career, 13% reported 11-15 cases, 6.5% reported six to 10 cases and 28.5% reported none. Causes of underdiagnosis of child abuse by healthcare providers were reported as 63% inexperience, 59% inadequate time for physical examination, 59% lack of diagnosis protocol, 51% lack of confidence in communicating with parents, 36% physicians' cultural background, and 38% lack of confidence in the diagnosis. 93.5% of participants think that healthcare practices need further education for child abuse.

CONCLUSION

In conclusion, physicians in Saudi Arabia who participated in the study had good knowledge to diagnose a case of child abuse. Inexperience, inadequate time for physical examination, lack of diagnosis protocol, lack of confidence in communicating with parents, and physicians' cultural background were the main identified challenges for diagnosing child abuse. Familiarity with cases of child abuse was significantly associated with physicians' age, specialty, and level of training.

The prevalences, changes, and related factors of child maltreatment during the COVID-19 pandemic: A systematic review

BACKGROUND

The impact of the COVID-19 pandemic has been extensive and drastic during the twenty-first century. The increasing phenomenon of child maltreatment during the pandemic is a significant public health concern.

OBJECTIVE

This study is the first systematic review to analyze and summarize the prevalence rates, risk factors, and protective factors related to child maltreatment during the COVID-19 pandemic.

METHODS

Four electronic databases (PubMed, Web of Science, Scopus, Embase) were systematically searched. Some potential studies were also identified from the reference lists of previously included articles. The quality of the included studies was assessed by the National Institutes of Health (NIH) Quality Assessment Tool and Critical Appraisal Skills Program (CASP) Quality Assessment Tool.

RESULTS

A total of 35 articles were included in the analysis, with 16 having prevalence information and 22 having factor information. Sixteen studies were conducted in the US, the other 17 studies were from 12 countries, and only two studies contained mixed countries. The prevalences of child maltreatment during the pandemic varied widely in different types and measurements. The pandemic rates of physical abuse, psychological abuse, neglect, and sexual abuse were 0.1 %-71.2 %, and 4.9 %-61.8 %, 7.3 %-40 % and 1.4 %-19.5 %, respectively. There was a decline in allegations of child maltreatment and an increase in severe cases of child maltreatment during the COVID-19 pandemic. Lockdown measures and their side effects were the main risk factors contributing to child maltreatment.

CONCLUSIONS

This review calls for targeted measures to prevent child maltreatment during the COVID-19 pandemic and current and future lockdowns and more future replication studies conducted in countries other than the US.

Awareness of Child Abuse and Neglect Among the General Public in Saudi Arabia: A Systematic Review

Child abuse represents a serious problem worldwide. In Arab countries, the problem is complicated because abuse may be perceived as a method of discipline. This review aimed to describe awareness of the public in Saudi Arabia regarding child abuse. A search was performed in the databases of MEDLINE/PubMed, Scopus, Academic Search Complete (EBSCOhost), and Web of Science for articles published in English from the 1^st of January, 2000, to the 14^th of November, 2022. The search was conducted during the period from the 7^th to the 14^th of November 2022. The used search words were {"Child Abuse"} AND {"Saudi Arabia"} AND {"awareness"}. The risk of bias (ROB) was assessed using the Risk of Bias Instrument for Cross-Sectional Surveys of Attitudes and Practices. Six studies were included in this review. Most studies had high ROB in recruiting the participants, designing the questionnaires, and stating the rate of response. The awareness regarding physical abuse seemed fair in most studies, but the awareness about shaken baby syndrome was poor. Also, there was a misconception about the parent's right to discipline their children through corporal punishment. Most participants did not perceive a need for establishing protective laws or programs. Public awareness about emotional abuse and neglect was lower than in cases of physical abuse. The overall knowledge about child abuse seems to be fair, but poor knowledge was observed in some forms, such as shaken baby syndrome. The public concepts about physical punishment and the need for protective laws and programs are also negative and require more efforts to alter them.

Early Identification of Risk of Child Abuse Fatalities: Possibilities and Limits of Prevention

(1) Background: The aim of the study was to analyse the structure of registered fatal violent crimes against children under 5 years of age and to identify the main characteristics and risk factors of fatal violence against children in order to discuss the possibilities and limits of prevention of these crimes. (2) Methods: Mixed-method design: 1. retrospective statistical analysis of data extracted from Czech statistics about crime. 2. qualitative analysis of autopsy reports and construction of serial case study. The data were pooled from two different sources: 1. Statistics about crime against children aged 0 to 5 (n = 512). 2. Autopsy reports (n = 52) of children up to the age of five. (3) Results: The following indicators and risk factors were identified: mental disorder or cognitive deficits in parents, parents’ immaturity, poor parenting skills, inadequate parenting practices, absence of a deep emotional bond with the mother, lack of parents’ interest in catering to the children’s needs, parents’ addiction, an unprotected, hazardous environment and surroundings, household falling apart, incidence of suspected domestic violence, incidence of multiple bruises and untreated injuries, aggressively dominant parents, poverty, absence of adequate health care, medical neglect of a child, poor health of the child and failure to thrive. (4) Conclusions: The task for the state is to make effective use of all accessible mechanisms to improve the situation in families. Particularly in the context of the newly emerging situation of increasing uncontrolled violence in families in the context of the restrictions of the COVID-19 pandemic, this demand is more than urgent. Close attention should be paid to children who are not registered with pediatricians and fail to attend regular medical examinations. It is also vital to follow families in which violence has already been suspected in the past.