Survellience system for child abuse: Bridging the gap between actual and hidden cases.

The dynamics of child abuse have been recognised as a global emerging social issue which is highly associated with child humiliation. The Government of Pakistan has taken many initiatives for addressing issues regarding child abuse and neglect and has designed laws to protect children against exploitation, abuse and violence; however, most of them are not enforced at all or poorly implemented due to lack of proper definition of child abuse and related terms, and different ways of reporting child abuse cases. Most of the non-governmental organisations (NGOs) in Pakistan target extreme cases of child sexual abuse such as child rape or commercial sexual exploitation of children, but cases of physical and psychological abuse are under-reported by the NGOs most of the time. A proper surveillance system is therefore required to identify the hidden cases of all types of child abuse that can lead to effective policy formulation and implementation

Effectiveness of transcutaneous bilirubin measurement in managing neonatal jaundice in postnatal ward of a tertiary care hospital in Pakistan

Introduction: Neonatal jaundice is a common cause of concern in immediate newborn period for parents as well as for the caregivers. Babies with visible jaundice are identified by the healthcare provider, and blood samples are sent for confirmation. Clinical expertise varies from person to person and may lead to sending excessive blood sampling. Obtaining blood bilirubin samples is a painful procedure; it predisposes the baby to infections and requires skilled health personnel. Moreover, laboratory tests are costly and time consuming, leading to unnecessary delays in commencing phototherapy and discharge from hospital. Transcutaneous bilirubinometer has been in use for a long time as screening tool in postnatal wards. With passage of time, its accuracy and validity have improved tremendously.Methodology: We aim to implement a quality improvement initiative to reduce the number of blood bilirubin samples using transcutaneous bilirubin (TcBR) nomogram in full-term, low-risk babies who are born at our hospital and are admitted in postnatal ward after birth. Using preanalysis and postanalysis study design, this study will be performed in two phases of 6 months each. Data regarding total number of admissions in postnatal wards, demographics, serum bilirubin(TSBR) samplings and need for phototherapy will be recorded in both phases. TcBR will be done and recorded in postimplementation phase.Analysis And Results: Comparisons between the two groups will be made. Primary outcome will be reduction in blood bilirubin samples for TSBR after the implementation of TcBr protocol. The proportion of infants having TSBR performed in both periods will be compared. Crude sampling cost of TSBR will be obtained from laboratory, and cost comparison between two phases will be done to look for difference

Longitudinal association between parental-to-child-maltreatment and self-reported generalized anxiety disorder symptoms in Pakistani adolescents

Background: Parent-to-child maltreatment is considered one of the risk factors for Generalized Anxiety Disorder (GAD) symptoms, but this hypothesis has not been adequately tested in Pakistani settings.Aim: This study aimed to examine the association between parent-to-child maltreatment and the risk of developing GAD symptoms among adolescents.Methods: The association of none to rare, occasionally, and frequently parent-to-child maltreatment with the incidence of GAD symptoms was investigated in a sample of 800 adolescents aged 11-17 years who were followed for two years. Parent-to-child maltreatment was assessed using ICAST-C (International child abuse screening tool). GAD Symptoms were determined by SCARED (Screen for children anxiety-related disorders). Cox Proportional Algorithm was used to estimate risk ratios.Results: Among children with both uneducated parents, frequently maltreatment was associated with 7.31 (2.20-24.04) times the risk of GAD symptoms compared to none to rare maltreatment. In contrast, the risk of GAD symptoms in frequently maltreated children was 5.58 times (1.40-21.97) than negligibly maltreated children with either educated parent.Conclusion: The frequency of parent-to-child maltreatment is significantly associated with an increased risk of developing GAD symptoms in which parental education plays a crucial role. Parents should be imparted with the awareness of the consequences of child maltreatment. In Pakistani settings the need to have this awareness is even more necessary due to the culturally acceptable disciplinary measures used by parents

Prevalence of child abuse/maltreatment and its associated factors among children aged 11 to 17 years in community settings of Karachi, Pakistan,

Harsh disciplinary practices are considered common in developing countries. However, scientific evidence lacks to support this. The primary aim of this study was to determine the total prevalence and subtypes of different forms (physical, emotional maltreatment and neglect) of child abuse and maltreatment in Karachi, Pakistan and to determine the associated factors following Belsky model at individual, relationship and community level. Method: A cross sectional survey of 800 dyads (children ranging from 11-17 years old and their parent) were selected from 32 clusters of Karachi, using multistage cluster sampling between December 2014 to March 2015. A structured questionnaire adopted from International society of child abuse and neglect (International child abuse screening tool for Parent: mother & father and Child). Prevalence of child maltreatment was estimated by mean child abuse score. Multiple linear regression technique (MLR) was used for analysis. Means with standard deviation were reported for continuous variables and for categorical variables, frequencies with percentages were calculated. B coefficients with 95% confidence interval were stated for significant associations. Results: Out of 800 participants dyads (800 parent and 800 children), 25 dyads were recruited from each study site. Mean score were 51.7+11.9 (child), 77.9+20.2 (mother) and 63.6+17.3 (father). Both parent and child responses revealed similar prevalence (43%) of child maltreatment. The mother\u27s responses showed a prevalence of physical (42%), emotional (50%) maltreatment and neglect (5.4%) whereas, father\u27s responses showed a prevalence of physical (39%), emotional (46%) maltreatment and neglect (9.7%). The child\u27s experiences showed a prevalence of physical (49%), emotional (50%) maltreatment and neglect (57%). A substantial proportion of participants were exposed to atleast one form of maltreatment on mother (58%), father (54%) and child (74%) responses, of which all three maltreatment forms experienced by children were 4%, 9% and 31% on mother, father and child responses respectively. With every one year increase in age of child, the mean estimated ICAST-Child score decreases by 0.638 (95% CI: - 1.002, -0.273). Children who are always bullied and mistreated by their siblings are at increased risk of getting maltreatment by parents (adjusted beta: 10.770 (95% CI: 8.801, 11.598)). Among children\u27 home environment where there is always verbal abuse and quarrel within family members, the mean estimated ICAST-Child score increases by 9.736 (95% CI: 7.133, 12.338). Moreover, among children who have no formal education, the estimated mean ICAST-Child score is 5.432 higher (95% CI: 2.540, 8.324). The mean estimated ICAST-Child score increases by 5.081 among male child as compared female child (95% CI: 3.786, 6.375). Among children whom parents have psychiatric illness, the estimated mean ICAST-Child score is 1.236 higher (95% CI: 0.063, 3.077). The mean estimated ICAST-Child score increases by 2.951 among children who belong to low socioeconomic wealth index (95% CI: 1.102, 4.880). Among middle ordered child, the estimated mean ICAST-Child score is 1.884 higher than first ordered or only child of family (95% CI: 0.336, 3.431). There is an interaction between parental exposures to childhood abuse and physical fighting with hard object among family members. Among children whom family always fight with each other and parents have exposure to childhood maltreatment, the mean estimated ICAST-Child score increases by 13.746 (95% CI: 7.193, 20.298). There is an interaction between age of mother and parental education. The estimated mean of ICAST-Child score increases 2.169 times for every 10 years increase in age of mother among children whom both formal have no formal school education as compared to children whom both parents have formal education. Conclusion: This study reflects hidden extent of child maltreatment and poly-victimization in Karachi. Our findings provide evidence to raise public awareness about malpractices and highlight the need to develop positive parenting program

Characteristics and patterns of individuals who have self-harmed: a retrospective descriptive study from Karachi, Pakistan

Background: Self-Harm (SH) is a major global public health problem under-researched in Pakistan due to religious and legal implications. This study aims to identify the characteristics and patterns among patients with SH and factors associated with the intent to die.Method: This retrospective descriptive study where SH cases presented to private tertiary care teaching hospital in Karachi, Pakistan, from January 2013 to December 2017 were extracted from HIMS records. Details related to demography, history, associated factors, access to methods used, and intent to die were collected on a structured proforma and analysed using STATA version 14. RESULTS: A total of 350 cases were analysed. More than half of the reported cases were in the age group 20-39 years. Though only one-fourth of the SH cases had a past psychiatric history, it was found to be significantly (P-value \u3c 0.05) associated with intent to die. Notably, 81% of the cases do not have a history of SH. Drug overdose (61.6%) and insecticides (36.6%) were the two most common methods used. Depression was identified in nearly half of the cases. The most common reason for attempting SH was inter-personal relationship issues (54.3%).Conclusion: This paper provides recent data on the characteristics and patterns associated with the intent to die of individuals who have self-harmed. In most cases of SH, past psychiatric history was not evident. Current psychiatric diagnosis and young adults were favoured in this study. The data from this study has limited representation for all demographic representation of SH cases from Pakistan as being from a single private hospital. There is a need for further research on SH in Pakistan

Effectiveness of a school based smokeless tobacco intervention: A cluster randomized trial

To assess the effectiveness of intervention in improving knowledge, attitude and perception regarding smokeless tobacco (SLT) use and its harmful effects and intention to quit SLT among school going adolescents. A school-based cluster randomized control trial was carried out in 18 secondary schools targeting male and female students from grades 6 to 10 in Karachi. Primary outcome was knowledge about hazards of smokeless tobacco (SLT) and secondary outcomes were attitude and Perception about hazards of SLT, and intention to quit SLT. We enrolled 738 participants in intervention group and 589 in the control group. Mean score of knowledge significantly improved in intervention as compared to control group (P value \u3c 0.01). Intention to quit was found to be proportionately higher (33%) in the intervention group as compared to control group. Generalized estimating equations were used to assess the association of factors with knowledge regarding harmful effects of SLT use. Significant predictors of increase in knowledge score were found in children: who had seen any anti SLT messages on social media in the past 30 days, who were getting information regarding harmful effects of SLT use in school or textbooks and who had friends using SLT. A school-based intervention was effective in increasing knowledge regarding the harmful effects of SLT use and intention to quit SLT use among school adolescents. Introduction of such educational programmes on a regular basis in schools or as part of school curriculum can have an impact on reducing prevalence of SLT use.Trial Registration NCT03418506. https://register.clinicaltrials.gov/NCT03418506

Association between maternal experiences of intimate partner violence and child stunting: a secondary analysis of the Demographic Health Surveys of four South Asian countries

Objectives To determine the association between maternal exposure to intimate partner violence (IPV) and child stunting using the Demographic Health Survey (DHS) data comparing four South Asian countries.Design A secondary analysis.Setting Data from the seventh round of the DHS data of four South Asian countries; Pakistan, Nepal, India and Maldives.Participants Married women of reproductive age (15–49 years) from each household were randomly selected, having at least one child less than 5 years of age for whom all anthropometric measures were available.Outcome measure The exposure variable was maternal IPV including, sexual violence, physical violence or both. The outcome variable was moderate or severe stunting, measured based on the height-for-age Z-score of children aged 6–59 months old . Multiple Cox proportional regression analyses were used separately on each country’s data to determine the association between maternal IPV and child stunting.Results The prevalence of IPV among women ranged from 10.17% in the Maldives to 31% in India. The burden of child stunting was the lowest in the Maldives at 14.04% and the highest in Pakistan at 35.86%. The number of severely stunted children was the highest in Pakistan (16.60%), followed by India (14.79%). In India, children whose mothers were exposed to IPV showed a 7% increase in the prevalence of moderate to severe child stunting (OR 1.07; 95% CI 1.01 to 1.14). Additionally, in Nepal, severe stunting was strongly associated with the prevalence of physical IPV (OR 1.66; 95% CI 1.01 to 2.87).Conclusion Our study findings suggest that maternal exposure to IPV is associated with child stunting. Further research investigating the relationship between IPV and child outcomes using improved and advanced statistical analyses can provide substantial evidence to enhance public awareness and potentially reduce the burden of child stunting in South Asian countries

Intergenerational transmission of child maltreatment: Predictors of child emotional maltreatment among 11 to 17 years old children residing in communities of Karachi, Pakistan

Objective: Families where parents had childhood history of victimization may likely to abuse their children; hence contributing as an important predictor of child emotional maltreatment (CEM). This study aimed to determine the relationship of intergenerational abuse with CEM among 11-17 years old children residing in peri-urban and urban communities of Karachi, Pakistan.Method: Structured interviews were conducted with 800 children and parents-pair using validated questionnaire International Child Abuse Screening Tool for Child (ICAST-C) comprised of 4 domains. Domain of child emotional maltreatment was considered as outcome (CEM-score). The relationship between Parental history of childhood victimization and CEM-Score was measured using linear regression.Results: The average CEM-score was came to be 19+5.2 among children whom parental history of childhood victimization was present (P \u3c 0.001). The estimated mean CEM-score increased by 5.59 units (95% CI= {2.61, 8.51}) among children whom parents had a history of childhood victimization (Intergenerational abuse) with severe physical familial abuse.Conclusion: The current study provided evidence on intergenerational transmission of maltreatment suggesting early prevention to break the cycle of child maltreatment through generations. Preventive measures can be taken, once a parental history of childhood victimization has been identified, by providing appropriate services to those families who belong to lower socioeconomic status, where mothers are young, presence of siblings\u27 rivalry/ bullying and/or violence among family members. However, these factors do not explain a complete causality of the intergenerational transmission therefore additional factors, for instance parenting styles must be taken into consideration

Factors associated with parenting stress among mothers of children with developmental disabilities: A cross-sectional study

Introduction: Parents of children with developmental disabilities, particularly mothers, are likely to suffer from stress. Nevertheless, the association between parenting stress and the type and extent of disability is far from evident.Methods: To examine the relationship between parenting stress, and type and extent of disability, we collected demographic details and the Parenting Stress Scale from 250 mothers of children with a developmental disability attending special-education schools in Karachi. Type and extent of disability were diagnosed by the school’s psychologist based on DSM criteria. Adjusted beta-coefficients along with a 95% confidence interval were reported using multiple linear regression.Results: The overall mean parenting stress score among mothers was found to be 43.2 (95% CI: 42.3–44.1). A total of 80 mothers (32%) had a child with Intellectual disability (ID), 60 (24%) with Attention deficit hyperactivity disorder (ADHD), 41 (16%) with Autism, and 69 (28%) with Down syndrome. A large proportion of these children (41%) had mild symptoms and around 26% had severe disability. Multivariable analysis showed that the estimated mean parenting stress score was higher for mothers of children with severe autism (β: 8.09, 95% CI: 3.07, 13.11), severe ID (β: 7.45, 95% CI: 3.71, 11.19) and severe ADHD (β: 7.03, 95% CI: 2.62, 11.44) compared to mothers of children with mild autism, ID, and ADHD.Conclusion: Nurturing a child with special care needs is challenging for mothers. Appropriate clinical services aiming to support parents of children with various disabilities should offer resources to educate and enable mothers to manage their child’s disabilities and needs. Tailored parenting interventions must also be introduced to reduce the levels of stress among mothers