Abstract
Child maltreatment is a poorly recognized phenomenon worldwide, and many pediatric healthcare professionals do not receive adequate training in child abuse and neglect evaluations. In response to the paucity of child maltreatment literature on low- to middle-income countries, this study aims to determine the education and training needs of medical professionals at the Centre Hospitalier Universitaire de Kigali (CHUK) with respect to child abuse and neglect identification, investigation, evaluation, and case management. Data collection took place in July and August 2019 at CHUK in Kigali, Rwanda. A mixed-methods approach was employed, including semi-structured qualitative interviews with sixteen healthcare professionals (3 pediatricians, 7 pediatric residents, 2 nurses, and 4 social workers) at CHUK and a systematic chart review of child maltreatment cases evaluated at the hospital from July 2015 to July 2019. Interviews with professionals revealed perceived gaps in training regarding child maltreatment case evaluation, reporting, and management. Study participants noted the need for standardized, hospital-wide protocols for the handling of confirmed abuse and neglect cases as well as expanded curriculum on the topic throughout professional education. Chart reviews demonstrated inconsistent and sparse documentation of maltreatment cases in hospital records. In conjunction with our findings, we provide informant-based suggestions for the improvement of child abuse and neglect case management at CHUK, including consistent training modules, inter-departmental collaboration, and systematic documentation. Beyond the hospital, participants widely agreed that child maltreatment awareness and prevention measures should be implemented at the community level with professionals from CHUK getting involved in local efforts.
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References
Agathonos-Georgopoulou, H. (1992). Cross-cultural perspectives in child abuse and neglect. Child Abuse Review, 1(2), 80–88. https://doi.org/10.1002/car.2380010204
Al Odhayani, A., Watson, W. J., & Watson, L. (2013). Behavioural consequences of child abuse. Canadian Family Physician, 59(8), 831–836.
Ards, S., Myers, S., Malkis, A., Sugrue, E., & Zhou, L. (2003). Racial disproportionality in reported and substantiated child abuse and neglect: An examination of systematic bias. Children and Youth Services Review, 25(5/6), 375–392. https://doi.org/10.1016/S0190-7409(03)00027-6.
Argent, A. C., Bass, D. H., & Lachman, P. I. (1995). Child abuse services at a children’s hospital in Cape Town. South Africa. Child Abuse & Neglect, 19(11), 1313–1321. https://doi.org/10.1016/0145-2134(95)00091-L
Badoe, E. (2017). A critical review of child abuse and its management in Africa. African Journal of Emergency Medicine, 7, S32–S35.
Bottoms, B. L., Nielsen, M., Murray, R., & Filipas, H. (2004). Religion-related child physical abuse: Characteristics and psychological outcomes. Journal of Aggression, Maltreatment & Trauma, 8(1–2), 87–114. https://doi.org/10.1300/J146v08n01_04
Clarke, V., & Braun, V. (2014). Thematic analysis. In Encyclopedia of critical psychology (pp. 1947–1952). Springer, New York, NY.
Cluver, L. D., Meinck, F., Steinert, J. I., Shenderovich, Y., Doubt, J., Herrero, R. R., & Gardner, F. (2018). Parenting for lifelong health: A pragmatic cluster randomised controlled trial of a non-commercialised parenting programme for adolescents and their families in South Africa. Bmj Global Health, 3(1), 000539. https://doi.org/10.1136/bmjgh-2017-000539
Coore Desai, C., Reece, J. A., & Shakespeare-Pellington, S. (2017). The prevention of violence in childhood through parenting programmes: A global review. Psychology, Health & Medicine, 22(sup1), 166–186. https://doi.org/10.1080/13548506.2016.1271952
Currie, J., & Widom, C. S. (2010). Long-term consequences of child abuse and neglect on adult economic well-being. Child Maltreatment, 15(2), 111–120. https://doi.org/10.1177/1077559509355316
Dako-Gyeke, M. (2018). Perspectives of key informants on child abuse: Qualitative evidence from northern Ghana. Child and Adolescent Social Work Journal, 36(2), 155–169. https://doi.org/10.1007/s10560-018-0560-6
Finkelhor, D. (1994). The international epidemiology of child sexual abuse. Child Abuse & Neglect, 18(5), 409–417. https://doi.org/10.1016/j.chiabu.2008.07.007
Flaherty, E. G., Sege, R. D., Griffith, J., Price, L. L., Wasserman, R., Slora, E., & Binns, H. J. (2008). From suspicion of physical child abuse to reporting: Primary care clinician decision-making. Pediatrics, 122(3), 611–619. https://doi.org/10.1542/peds.2007-2311
Hay, T., & Jones, L. (1994). Societal interventions to prevent child abuse and neglect. Child Welfare, 73(5), 379–403.
Levi, B. H., & Brown, G. (2005). Reasonable suspicion: A study of Pennsylvania pediatricians regarding child abuse. Pediatrics, 116(1), e5-e12. http://www.pediatrics.org/cgi/doi/https://doi.org/10.1542/peds.2004-2649
Levi, B. H., & Portwood, S. G. (2011). Reasonable suspicion of child abuse: Finding a common language. The Journal of Law, Medicine & Ethics, 39(1), 62–69. https://doi.org/10.1111/j.1748-720X.2011.00550.x
Levi, B. H., Crowell, K., Walsh, K., & Dellasega, C. (2015). How childcare providers interpret ‘reasonable suspicion’ of child abuse. In Child & Youth Care Forum (Vol. 44, No. 6, pp. 875–891). Springer US. http://dx.doi.org/https://doi.org/10.1007/s10566-015-9302-5
Mathews, B., & Kenny, M. C. (2008). Mandatory reporting legislation in the United States, Canada, and Australia: A cross-jurisdictional review of key features, differences, and issues. Child Maltreatment, 13(1), 50–63. https://doi.org/10.1177/1077559507310613
May-Chahal, C., & Cawson, P. (2005). Measuring child maltreatment in the United Kingdom: A study of the prevalence of child abuse and neglect. Child Abuse & Neglect, 29(9), 969–984. https://doi.org/10.1016/j.chiabu.2004.05.009
Meinck, F., Cluver, L. D., Boyes, M. E., & Loening-Voysey, H. (2016). Physical, emotional and sexual adolescent abuse victimisation in South Africa: Prevalence, incidence, perpetrators and locations. Journal of Epidemiology and Community Health, 70(9), 910–916. https://doi.org/10.1136/jech-2015-205860
Mikton, C., Mehra, R., Butchart, A., Addiss, D., Almuneef, M., Cardia, N., & Raleva, M. (2011). A multidimensional model for child maltreatment prevention readiness in low-and middle-income countries. Journal of Community Psychology, 39(7), 826–843. https://doi.org/10.1002/jcop.20474
Moen, K., & Middelthon, A. L. (2015). Qualitative research methods. In Research in medical and biological sciences (pp. 321–378). Academic Press.
Morantz, G., Cole, D. C., Ayaya, S., Ayuku, D., & Braitstein, P. (2013). Maltreatment experiences and associated factors prior to admission to residential care: A sample of institutionalized children and youth in western Kenya. Child Abuse & Neglect, 37(10), 778–787. https://doi.org/10.1016/j.chiabu.2012.10.007
Muhire, H. B., Tuyisenge, L., Hakizimana, F. X. B., Ball, A., & Cartledge, P. (2020). Reporting child abuse in Rwanda: Attitudes and practices of physicians—A cross-sectional survey. PAMJ-Clinical Medicine, 3(131). https://doi.org/10.11604/pamj-cm.2020.3.131.22334
Norman, R. E., Byambaa, M., De, R., Butchart, A., Scott, J., & Vos, T. (2012). The long-term health consequences of child physical abuse, emotional abuse, and neglect: A systematic review and meta-analysis. PLoS Medicine, 9(11), e1001349. https://doi.org/10.1371/journal.pmed.1001349
QSR International Pty Ltd. (2020) NVivo (released in March 2020), https://www.qsrinternational.com/nvivo-qualitative-data-analysis-software/home
Putnam-Hornstein, E., Wood, J. N., Fluke, J., Yoshioka-Maxwell, A., & Berger, R. P. (2013). Preventing severe and fatal child maltreatment: Making the case for the expanded use and integration of data. Child Welfare, 92(2), 59.
Rwandan Ministry of Health. (2017). Violence against children and youth survey in Rwanda: Findings from a national survey, 2015–2016. Rwanda: Kigali.
Sargeant, J. (2012). Qualitative research part II: Participants, analysis, and quality assurance. Journal of Graduate Medical Education, 4(1), 1–3.
Southall, D., & MacDonald, R. (2013). Protecting children from abuse: A neglected but crucial priority for the international child health agenda. Paediatrics and International Child Health, 33(4), 199–206. https://doi.org/10.1179/2046905513Y.0000000097 Epub 2013 Sep 24.
Speizer, I. S., Goodwin, M., Whittle, L., Clyde, M., & Rogers, J. (2008). Dimensions of child sexual abuse before age 15 in three Central American countries: Honduras, El Salvador, and Guatemala. Child Abuse & Neglect, 32(4), 455–462. https://doi.org/10.1016/j.chiabu.2007.03.026
M Stoltenborgh MJ Bakermans-Kranenburg LR Alink van IJzendoorn MH 2015 The prevalence of child maltreatment across the globe: Review of a series of meta-analyses Child Abuse Review 24 1 37 50 https://doi.org/10.1002/car.2353
Van, H. A. R., Dadds, M., & Armstrong, K. L. (1998). The child abuse lottery—Will the doctor suspect and report? Physician attitudes towards and reporting of suspected child abuse and neglect. Child Abuse & Neglect, 22(3), 159–169.
World Health Organization. (2004). ICD-10 : International statistical classification of diseases and related health problems: Tenth revision, 2nd ed. World Health Organization. https://apps.who.int/iris/handle/10665/42980
World Health Organization & International Society for Prevention of Child Abuse and Neglect. (2006). Preventing child maltreatment: A guide to taking action and generating evidence. Retrieved July 12, 2020, from http://www.ispcan.org/resource/resmgr/docs/preventing_child_maltreatmen.pdf
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This work was supported by McGill Global Health Programs and the Global Health Scholars Program (McGill University, Montréal, QC, Canada).
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Grunfeld, G., Akingeneye, P., Muhire, H.B. et al. Child Abuse Evaluations at the Centre Hospitalier Universitaire de Kigali (CHUK): Medical Education and Experience. Int. Journal on Child Malt. 5, 257–279 (2022). https://doi.org/10.1007/s42448-021-00107-4
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DOI: https://doi.org/10.1007/s42448-021-00107-4