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Perception and Parent’s Knowledge about High Body Temperatures in Children and Treatment Methods at Home
Saleh M. Alqahtani
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DOI: 10.5742MEWFM.2019.93630

An investigation into the outcomes of biliary atresia in Sulaimani, Iraq
Adnan Mohammed Hasan, Mahdi Aziz Hama Marif, Mohammed Fadhil Abbas
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Rheumatoid arthritis may be one step further of systemic lupus erythematosus
Mehmet Rami Helvaci, Onder Tonyali, Mustafa Yaprak, Abdulrazak Abyad, Lesley Pocock
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Mass Casualty Training held on 2012 by Jordanian level 3 hospital-starbase, UN Mission in Liberia, discussion and review
Mohammed Z. Alhasan, Ashraf (Mohammad SH.) A, Odeh, Zuhier Ali A. Ikhwayleh,
Issam F. Alrbeihat, Ibrahim KH. Abuhussein
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Increased sexual performance of sickle cell patients with Hydroxyurea
Mehmet Rami Helvaci, Onder Tonyali, Mustafa Yaprak, Abdulrazak Abyad, Lesley Pocock
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May 2019 - Volume 17, Issue 5

Prevalence and Risk Factors of Childhood Abuse among Hadhramout University Students in Yemen

MD, MSc, Associate Professor of Community Health, Department of Community Medicine College of Medicine and Health Sciences, Hadhramout University, Republic of Yemen

Correspondence:
Fauzia F Bamatraf
Associate Professor of Community Health, Department of Community Medicine College of Medicine and Health Sciences, Hadhramout University.
Republic of Yemen
Mobile: +967 735306070
Email: ffbamatraf2008@yahoo.com

Received: March 2019; Accepted: April 2019; Published: May 1, 2019
Citation: Fauzia F Bamatraf. Prevalence and Risk Factors of Childhood Abuse among Hadhramout University Students in Yemen. World Family Medicine. 2019; 17(5): 42-54. DOI: 10.5742MEWFM.2019.93645

Abstract


Background:
Violence against children has long been recognized as a social problem throughout the world, and Yemen is no exception. This study aimed to determine the prevalence of various forms of child abuse, as well as identifying its risk factors and outcomes among Hadhramout university students in Al-Mukalla city, Hadhramout Governorate, Yemen

Methods: A cross-sectional analytical study was conducted in five colleges at Hadhramout university in the educational year 2015-2016. A multi¬stage sampling method was used for the selection of students. Data was collected by using Standardized Arabic Version of Child Abuse Screening Tool for Young Adults aged 18-24 years

Results: Overall, 395 students, (57.5%) were males. Of the students (88.4 %) reported exposure to some form of child abuse in the form of emotional (79.2%), physical (75.7%) or sexual abuse (35.2%) of which 12.7 were reported to have been forced into sexual assault. Parents were the main perpetrators of physical and emotional abuse, while persons outside the home were the main perpetrator of sexual abuse. The results showed significant association between child abuse, sex of students and the family environment. Male students were significantly more likely to be physically, emotionally and sexually abused. Child abuse was also significantly more prevalent among students coming from homes with domestic violence and psychological problems among parents. The main outcomes of exposure to child abuse were poor educational performance, anxiety or nightmares, depression, becoming prone to suicide, violent behavior, fear of the other sex and want revenge on the abusers.

Conclusion and Recommendations: Child abuse is a common phenomenon, with long-term adverse effects among Hadhramout university students. Early diagnosis and preventive educational interventions can play a critical role in reducing the prevalence of child abuse and its harmful consequences.

Key words: Child abuse, risk factors, outcomes, Hadhramout university students, Yemen


INTRODUCTION

Violence against children has long been recognized as a social problem throughout the world, and Yemen is no exception. Every year millions of children around the world are victims and witnesses of abuse. (1) Published studies have indicated that violence against children is a major concern for public health around the world. (2,3,4) Various international studies have found that 25-50% of all children have suffered severe and frequent violence, although rates may vary by country. (5,1) Every year, 40 million children aged 15 and below worldwide are neglected or abused. (6) The World Health Organization estimated that about 1,300 children die annually throughout Europe and Central Asia after being abused by their caregivers. (7) Globally, about 20% of women and 5-10% of men report being sexually abused in childhood, while 23% of the people reported being physically abused as children. (8)
According to the World Health Organization (WHO) definition “Child maltreatment is defined 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 the relationship of responsibility, trust or power”. (6) Child abuse is a complex process that results from the interaction of certain risk and protection factors at four main levels: individual, family, societal and community level. (9) These risk factors are not present in all social and cultural contexts but provide an overview when attempting to understand the causes of child abuse, such as age and gender (10,11) Other risk factors for child abuse by parents or caregivers have also been mentioned in many studies such as low education, age of young parents, unemployment, family environment, and mental disorders of parents such as depression, anxiety and drug abuse. (12,13) The impact of social and demographic risk factors on abuse varies according to the type of abuse. This lack of uniformity in the effects of social and demographic risk factors indicates that each type of abuse has somewhat distinct causes. (14) However, Kellogg et al. Mentioned that child abuse is the result of a set of interrelated familial, social, psychological and economic variables. (15)

Child abuse involves serious physical and psychological consequences that negatively affect a child’s health and well-being in general. (16) The child is definitely affected by abuse regardless of form or severity. It weakens the child’s physical and mental health and affects his or her risk behavior, resulting in different negative consequences. The life-long consequences of child abuse were found to impair the health of the present and future of children and their well-being in each country and the cultural context in which it was investigated. (17)

There is a paucity of studies on child abuse in the Arab world, which have very different family structures from Western countries that prevail in literature. (18) Arab countries are generally theocratic states, with families that are polygamous, sexually segregated, and extended. Children in the Arabian Peninsula are exposed to all forms of child abuse and neglect. However, the problem is ignored or even tolerated and accepted. Therefore, abused children continue to suffer and most aggressors go free, without punishment and without treatment. (19)

In Yemen, the living conditions for children are dreadful; between violence, poverty, and health problems, dangers of death are their everyday life. Children can be a victim of child abuse in their families or their school or in the general environment. These types of abuse can have serious consequences for their mental and physical health. (20) Child abuse is a violation of the fundamental human rights of the child and is the result of a combination of family, social, psychological and economic factors. Although the problem of child abuse and human rights violations is one of the most important issues on the international human rights agenda, in Yemen, until recently, the government did not intervene and child rights and protection are now being given importance. (20) Moreover, there are certain types of traditional practices that are accepted throughout the country, whether knowingly or unknowingly are to the extent of child abuse. The current socio-economic and political conditions make some children vulnerable and more at risk of abuse, exploitation and neglect. (20) In Yemen documented studies on child abuse are very rare. According to our knowledge, relatively few studies have addressed the problem of child abuse in Yemen, but none of these studies have studied all forms of abuse, particularly sexual abuse and related factors and their consequences, which so far might lead to underestimation of the size of the problem (21-24).

This study is the first attempt to determine the prevalence of various forms of child abuse physical, emotional and sexual abuse, as well as identifying it is risk factors and outcomes among Hadhramout University students in Al- Mukalla city Hadhramout Governorate, Yemen.


MATERIALS AND METHOD

This was a cross-sectional study conducted at Hadhramout University in Al-Mukalla city, the capital of the Hadhramout Governorate, Yemen. The target population consisted of all Hadhramout University students who were available during the academic year 2015-2016 of males and females, aged between 18-24 years old and Yemeni nationality who were invited to participate in the study. A sample size of 384 students was determined by using recommended statistical methods. (25) It was increased to 400 students for an expected non-response and to avoid any missing among participants during the data collection.

A multi-stage random sampling was performed. In the first stage, five colleges were randomly selected which were College of Medicine and Health Sciences, Sciences, Engineering and Petroleum, Arts and Girls. In the second stage, two departments from each college also were randomly selected. In the third stage, the sample size (400)

was proportionally distributed according to the proportion of students in the selected departments for each college. Simple random sampling was applied to select students from each department in selected colleges.

The data were collected by self-reported questionnaire, which consist¬ed of two parts. The first part was a sociodemographic questionnaire developed by the researcher includ¬ing information about students’ personal data (gender, age), education and employment status of parents, family income and questions about family structure (living with parents, or with others), number of people living in the same room (Crowding Index). The family living environment, alcohol abuse or drug addiction among parents was also included. Parents at home who argue with each other, hit or hurt each other, the presence of psychiatric problems among one or both parents were also inquired about.

In the second part a stan¬dard Child Abuse Screening Tool (ICAST) self-reported Arabic version questionnaire was used (32). The questionnaire is a multi-country collaborative questionnaire developed by the International Society for the Prevention of Child Abuse and Neglect (ISPCAN) with the assistance of UNICEF and the Oak Foundation. It has been reviewed by more than 100 professionals from different countries, translated into many languages including Arabic, and tested for validation and reliability. It is structured to report all forms of violence against children, more accurately and more representative of the true scope of the problem. This form retrospectively inquires of the the young adult about exposure to any type of child abuse before the age of 18 years. The questionnaire inquired about exposure of students to physical, emotional and sexual abuse. (32)

Emotional abuse was investigated by asking each student about any history of being insulted or criticized, hearing that he/ she was not loved by anyone, or was refused (one wished that he was not born or was dead), or were threatened. In terms of physical abuse, each student was asked about any history of being beaten, punched, or beaten with something that left marks such as a stick, whip, belt etc., kicked, severely shaken, burned, slapped and stabbed. In addition, students were asked about exposure to anyone placing chili in any part of their body to cause pain. With regard to sexual abuse, students were asked about the occurrence of inappropriate sexual behavior by the abuser during childhood, such as being spoken to in a sexual way by an abuser, fondled (their private parts) by an offender, forced to watch /or fondle an offender’s private parts, forced to show themself naked, forced to look at pornography or forced into Contact Sexual Assault.

The type of questions was yes / no. Students who answered with “Yes” to any of the above questions (about physical, emotional, and sexual abuse) were asked to report the types of abuse they had experienced and the relationship of the offender to the students (to detail who did it). In addition, the abused students were asked about the impact (outcome) of abuse on their life as to whether they have had poor educational performance, anxiety and nightmares, depressive symptoms, pain of unknown origin, fear of other sex, violent behavior acquired, thinking or attempted suicide or wishing revenge.

A pilot study was conducted among 20 students from two colleges not included in the main study, to ensure that the questionnaire items were clear, understandable and culturally acceptable. Data collected were checked for accuracy and completeness and were coded and entered into the Statistical Package for Social Sciences (SPSS) software version 20. Firstly descriptive statistics was used to present the frequencies and percentages for categorical variables, followed by bivariate and multivariate analysis in order to determine statistical association between the outcome and explanatory variables. Variables which showed significant association in the bivariate analysis were entered into multivariate logistic regression. Logistic regression analysis was done by calculating the adjusted Odds Ratios [aORs], and 95% confidence intervals and P-value level <0.05 was considered significant throughout the study.

Project approval was obtained from Hadhramout University, College of Medicine (HUCOM) and Community Medicine Department. A letter from the College of Medicine to the Dean of each of the five selected colleges was obtained to facilitate the process of data collection. The team followed ethical standards of confidentiality in participation. The objectives of the study were explained to the participants taking into account the moral and social difficulties, and each student was voluntarily invited to participate in the study. If the student agreed to participate, informed verbal consent was obtained from him/ her after confirming that the information to be collected would be used for scientific and research purposes only and the participants were asked not to write their personal identity information. In addition, each student received an envelope with the questionnaire to facilitate the return of completed questionnaire to a special ballot box that had been prepared in advance in each college library selected in the study to better ensure keeping of privacy and confidentiality in the study.

RESULTS

A total of 400 questionnaires were distributed among Hadhramout University students, and all the questionnaires were received which gave a response rate of (100%) in the study. However, 5 questionnaires were excluded because the data was incomplete. The final number of participants was 395.

Table 1 shows the socioeconomic characteristics of the study population. Out of 395 students studied, males constituted the highest proportion (57.5%). Students’ ages ranged from 18 to 24 years. The majority (61%) of them were in the age group 20-21 years. More than (70%) of the students’ mothers were illiterate (can’t read and write) and (87.1%) housewives who do not work outside the home at all, while the majority of students’ fathers (90.1%) were educated and employed (94.9%). About two thirds of the student families (65.1%) had a monthly income > 60000 Y/ R. Most students (84.6%) live with their parents and (38%) live with more than two persons in same room in their home. The same table shows the family environment of students, where 14.1% of parents used alcohol or had drug addiction, 44.8% were arguing and 25.1% hit or hurt each other. While 9.9% of students lived with their parents where one or both suffers from psychological problems at home, and they use guns or knives to hurt or intimidate someone.

Table 1: Socio-demographic characteristics and family environment of Hadhramout University students

*Y/R = Yemeni Riyal (one US dollar = 570 Yemeni Riyals)

As shown in Table 2, of 395 students, 349 (88.4%) reported having experienced at least one form of abuse (physical, emotional or sexual) before 18 years of age. Of the three forms of child abuse measured in this study, 20.1% of the students reported that they were exposed to only one form of abuse, 44.4% were exposed to two forms, and 35.5% of students were exposed to all three forms of childhood abuse. The prevalence of emotional abuse among the students was 79.2%, physical abuse was 75.7%, and 35.2% were victims of sexual abuse. The most common types of emotional abuse reported by students were shouting or screaming, criticized or insulted (called by dirty names) and rejected (wished that he/she was never born) at (79.9, 70.7% and 25.2% respectively). The most common physical abuse type was hit/punched, kicked, hit with an object like stick, whip or belt and face slapped, (71.6%, 67.2%, 59.9% and 58.2%) respectively. However, only 12.7% and 4.0% of the students were subjected to physical abuse of a serious nature, including burning or placing chili in any part of the body and threatened with stabbing with knife, respectively. (Table 2)

With regard to sexual abuse, 79.9% of the students reported that they had been sexually spoken to by the abuser (verbal harassment), while 25.9% were forced to touch or view private body parts of the abuser, 20.9% of students had their private body parts fondled by an abuser, and 18.7% were forced to watch pornographic movies. On the other hand, 21.6% of them reported that they had been sexually assaulted. (Table 2)

Table 2: Distribution of students’ reported experience of different forms of abuse

*Each question was asked separately

Table 3 revealed that, parents were the main perpetrators of emotional and physical abuse, while the persons outside the home were the commonest perpetrators of sexual abuse. Further, other relatives participated in not a small percentage of contact sexual assault.

Clck here for Table 3: Perpetrators of various forms of child abuse among exposed Hadhramout university students

To detect the most important factors affecting different forms of child abuse, bivariate logistic regression analysis was first performed. The significance level is set at P <0.05 to ensure that all important variables are covered. The results showed that only students’ sex, mother’s education and family environment factors had significant association with all forms of child abuse. After determining the significantly associated factors (P<0.05) using bivariate logistic regression, all factors were entered in a multivariate logistic regression model. The results revealed that, there were statistically significant crude associations between the student’s sex and family environment. Factors with child abuse persisted after adjusting for other confounding factors, and the strength of associations varied depending on the form of abuse.

As shown in Table 4, child’s sex had independent effects on the majority of child abuse risk. Males were more likely to abuse than females. The strongest crude and adjusted associations between student’s sex and child abuse were observed for exposure to emotional abuse (AOR=4.44, P 0.001), followed by physical abuse (AOR=2.56, P 0.01) and sexual abuse (AOR=2.20, P 0.001). The results also showed that, parents who argued with each other at home were the first predictors