4 knowledge, attitude and
TRANSCRIPT
University J Dent Scie 2019; Vol. 5, Issue 3 UniversityJournal of
Dental Sciences
KNOWLEDGE, ATTITUDE AND PRACTICE OF
MEDICAL AND DENTAL PROFESSIONALS
REGARDING CHILD ABUSE IN JABALPUR CITY –
A CROSS SECTIONAL SURVEY.
1 2 3 4 5 6Deepak P Bhayya, Astha Soni, Shilpi Dadarya, Prabhat Singh, Saurabh Tiwari, Swarnam PandeyDepartment of Peadiatric and Preventive Dentistry Hitkarini Dental College and Hospital,Hitkarini Hills, Jabalpur.
ABSTRACT : Aims and Objectives: The aim of this study is to determine the level of knowledge, attitude
and practice of medical and dental professionals regarding child abuse and neglect in Jabalpur, Central
India.
Materials & Method: A cross-sectional survey is being conducted among the medical and dental
professionals. Data will be collected from a self-administered questionnaire and will be evaluated for their
knowledge, attitude and practice towards child abuse.
Results: Study demonstrated an overall poor understanding of the problem, despite a very high level of
interest demonstrated by the respondents and a strong desire for further information about their
responsibilities and a clear need for all dentists to receive further formal training.
Conclusion: Study demonstrated an overall poor understanding of the problem, despite a very high level of
interest demonstrated by the respondents and a strong desire for further information about their
responsibilities and a clear need for all dentists to receive further formal training.
Keyword:
Child Abuse;
Knowledge; Attitude;
Practice, medical-dental
professionals.
University Journal of Dental Sciences, An Official Publication of Aligarh Muslim University, Aligarh. India 15
INTRODUCTION: Children are a heritage from the LORD;
offspring a reward from him (Psalm 127:3, Holy Bible), but
humans fails to respect that.[1]The UN Convention on the
Rights of the Child (UN CRC) (1989) is the most widely
endorsed child rights instrument worldwide, which defines
children as all persons up to the age of 18 years.[2]
The World Health Organization (WHO) has defined 'Child
Abuse' as a violation of basic human rights of a child,
constituting all forms of physical, emotional ill treatment,
sexual harm, neglect or negligent treatment, commercial or
other exploitation, resulting in actual harm or potential harm
to the child's health, survival, development or dignity in the
context of a relationship of responsibility, trust or power.[3]
In India there has been no understanding of the extent,
magnitude, and trends of the problem till 2007. Study on child
abuse scenario was done across the India in 2007 and result
suggested that, (i) two out of every three children are
physically abused and (ii) 72.2%children in the age group of
5–12 years were being physically abused.[1]
Four types of child abuse may be recognized:
1. Physical abuse, which occurs when a child suffers or is
likely to suffer significant harm from an injury inflicted by the
child's parent or caretaker;
2. Sexual abuse, which is the exploitation of the child for the
sexual gratification of an adult;
3. Emotional abuse, which occurs when a child's parent or
caregiver repeatedly rejects the child or uses threats to
frighten the child;
4. Neglect, which is a failure of the parent or caretaker to
provide for the child's basic needs such as food, clothing,
Research
Paper
Conflict of interest: Nil
No conflicts of interest : Nil
shelter and medical attention to the extent that the child's
health and development is, or is likely to be, significantly
harmed.[4]
Child protection is critical to the achievement ofMillennium
Development goals (MDG). These MDGs can't be achieved
unless child protection is an integral part of program &
strategies to protect children from child labor, street children,
child abuse, child marriage, violence in school and various
forms of exploitation.[3]
Child Abuse & Neglect (CAN) is a world widesocial and
public health problem, which exertsa multitude of short and
long term effects onchildren. The consequence of children's
exposure to child maltreatment includes elevated levels
ofpost-traumatic stress disorder, aggression, emotional and
mental health concerns, such as anxiety and depression. A
well designed epidemiologic, Adverse Childhood
Experiences (ACEs) Study5 revealed a high risk of heart
disease in adult survivors of maltreated children, after
correcting for age, race, education, smoking & diabetes.
A Government of India, Ministry of Women & Child
Development (2007) survey showed that the prevalence of all
forms of child abuse is extremely high (physical abuse (66%),
sexual abuse (50%) and emotional abuse (50%).[6] Amore
recent study by the National Commission for Protection of
Child Rights (NCPCR), conducted amongst 6,632 children
respondents, in 7 states; revealed 99% children face corporal
punishment in schools.[7]
Several developed countries of the world have well-
developed child protection systems, primarily focused on
mandatory reporting, identification and investigations of
affected children, and often taking coercive action. The
burden of high level of notifications and investigations is not
only on the families, but also on the system, which has to
increase its resources.8In these contexts, the problems of
child abuse and neglect in India need serious and wider
consideration, particularly among the underprivileged rural
and urban communities.
The aim of this study was done to assess the educational
experience, knowledge and attitude of medical and dental
professionals of Jabalpur city with regards to child abuse and
encourage the reporting of suspected cases.
METHODOLOGY: A cross sectional survey was carried
out among the medical and dental professionals practicing in
Jabalpur city at least since 1 year. An anonymous, self-
administered, close ended 10-question survey was
constructed using a multiple choice or yes / no format to
assess the knowledge, awareness and attitude towards child
abuse.
Residents of Hitkarini dental college and Netaji Subhash
Chandra Bose medical colleges of Jabalpur city were
included in this study. Residents of Pedodontics and
Preventive Dentistry, Oral Medicine and Radiology, Oral and
Maxillofacial Surgery, Endodontics and conservative
dentistry and Orthodontics from dental colleges; and
residents of Pediatrics, Radiology, and Orthopedics from
medical colleges were included. Dental and medical general
practitioners (graduates) who have minimum one year of
clinical experience were also selected. The questionnaire pro
forma was distributed personally and the professionals were
encouraged to complete all question on the same visit.
Data was entered in Microsoft excel 2016 for Windows.
Frequencies and percentages of responses for questionnaire
were calculated. To compare responses between different
groups Pearson's Chi-square test was applied. P value <0.05
was considered statistically significant. Data analyses were
performed using version 21.0 of the Statistical Package for
Social Sciences (IBM Corporation, Armonk, New York,
USA).
RESULTS: A total of 361 complete responses were
collected, among which 184 were dental practitioners
including both general dentists (111) and selected specialists
(73) and 177 were medical practitioners, including general
physician (106) and selected specialists (71).
Graph 1 show among dental professional 98.91% and among
medical professionals 100.00% study subjects were aware
regarding child abuse. Two study subjects among dental
professionals were not aware regarding child abuse, hence
they were excluded from further analysis.
Graph 1: Awareness among study subjects for child abuse.
Table 2 represents the 61.33% dental professionals and
54.80% medical professionals said they see 1-2 child abuse
cases in a month. 24.86% dental professionals and 39.55%
medical professional said they did not see any case of child
abuse in a month. Chi-square test showed significant
University Journal of Dental Sciences, An Official Publication of Aligarh Muslim University, Aligarh. India 16
University J Dent Scie 2019; Vol. 5, Issue 3
difference between dental and medical professionals for
number of child abuse cases seen in a month. Chi-square test
showed significant difference between post graduate and
graduate medical professionals for number of child abuse
cases seen in a month.
Table 2: Numbers of child abuse cases encountered in a
month.
Table 3 shows in overall sample Chi-square test showed no
significant difference between dental and medical
professionals for responses for recognition of a case of child
abuse. Chi-square test showed significant difference between
post graduate and graduate dental professionals for responses
for recognition of a case of child abuse. While among Medical
professionals Chi-square test showed no significant
difference between post graduate and graduate medical
professionals for responses for recognition of a case of child
abuse.
Table 3: Recognition of a case of child abuse.
In Graph 4 overall samples shows 18.23% dental
professionals and 2.82% medical professionals said male
children are most likely abused. Chi-square test showed
significant difference between dental and medical
professionals for responses for gender of the children are
more likely to be abused. Chi-square test showed significant
difference between postgraduate and graduate medical
professionals for responses for gender of the children are
more likely to be abused.
Graph 4: Gender of the children is more likely to be abused
Table 5 shows among overall samples 38.67% dental
professionals said working mother families where as 46.89%
medical professionals said step mother/father families are
having child abuse more commonly. Chi-square test showed
significant difference between dental and medical
professionals for responses for type of families abused more
commonly.
Table 5: Type of families abused more commonly.
Table 6overall sample shows Chi-square test showed no
significant difference between dental and medical
professionals for responses for agency appropriate to deal
with child abuse cases.
Dental professionals, 98.61% postgraduate and 73.39%
graduate dental professionals said that police are the agency to
deal with child abuse cases. Chi-square test showed
significant difference between post graduate and graduate
dental professionals for responses for agency appropriate to
deal with child abuse cases.
University Journal of Dental Sciences, An Official Publication of Aligarh Muslim University, Aligarh. India 17
University J Dent Scie 2019; Vol. 5, Issue 3
Table 6: Agency appropriate to deal with child abuse cases
Table 7 shows Overall sample, 20.44% dental professionals
and 29.94% medical professionals responded that they are
aware regarding Indian laws related to child abuse. Chi-
square test showed significant difference between dental and
medical professionals for responses for awareness regarding
Indian laws related to child abuse.
Table 7: Awareness regarding Indian laws related to child
abuse.
Table 8 depicts Overall sample, 56.91% dental professionals
and 68.36% medical professionals responded that that Oral
bruises / laceration are the frequently encountered oral
injuries in child abuse cases. Chi-square test showed
significant difference between dental and medical
professionals for responses for awareness frequently
encountered oral injuries in child abuse cases.
Table 8: Oral injuries are frequently encountered in child
abuse cases
Table 9 shows overall sample Chi-square test showed no
significant difference between dental and medical
professionals for awareness regarding helpline number to
report child abuse cases. Dental professionals, 27.78% post
graduates and 15.60% graduate dental professionals were
aware regarding help line number to report child abuse cases.
Chi-square test showed significant difference between post
graduate and graduate dental professionals for awareness
regarding help line number to report child abuse cases.
Medical professionals, 47.89% post graduates and 3.77%
graduate medical professionals were aware regarding
helpline number to report child abuse cases. Chi-square test
showed significant difference between post graduate and
graduate medical professionals for awareness regarding
helpline number to report child abuse cases.
Table 9: Awareness regarding helpline number to report child
abuse cases.
Table 10 represents, overall samples 56.35% dental
professionals and 50.85% medical professionals responded
that Courses/workshop as further training to improve
University Journal of Dental Sciences, An Official Publication of Aligarh Muslim University, Aligarh. India 18
University J Dent Scie 2019; Vol. 5, Issue 3
knowledge for identification and reporting mechanism. Chi-
square test showed significant difference between dental and
medical professionals for responses for further training to
improve knowledge for identification and reporting
mechanism. Dental professionals, 61.11% post graduates and
53.21% graduate dental professionals responded that
Courses/workshop as further training to improve knowledge
for identification and reporting mechanism. Chi-square test
showed significant difference between post graduate and
graduate dental professionals for responses for further
training to improve knowledge for identification and
reporting mechanism.
Table 10: Further training to improve knowledge for
identification and reporting mechanism
DISCUSSION: An important prerequisite for reporting
suspected cases of child abuse is the basic knowledge about
what to look for and how to diagnose these cases. Response
was received from 361medical and dental professionals.
Result from table 1 shows significant difference between
dental and medical professionals, dentists encountering the
child abuse cases more frequently, possible reason could be
parents who abuse their children are less conservative and
careful in referring to dentists than physicians.
Data shows that 61.33% dental professionals and 54.80%
medical professionals encounters 1-2 child abuse cases in a
month. Most of the them recognized the cases of Child abuse
through the child behavior (59.12%).More frequently seen
was physical abuse, followed by sexual abuse. The findings
of the present study indicated a problem of lack of knowledge
in many areas related to signs of physical abuse, as has been
reported in similar studies in other parts of the world.9, 10, 11,
12Similar reports from India, Kirankumaret al., (2011)13
found that medical professionals of Bagalkot district of north
Karnataka had poor knowledge as they undervalued the topic.
Females are more likely to be abused but when we talk about
the physical abuse males predominate the number.
Women and child welfare is the agency thought to be more
appropriate to deal with child abuse cases, but most of the
participants reported police, which shows most of the
practitioners do not seem to fill their role sufficiently in child
protection matters.
Most of the practitioners are not aware of Indian laws and
helpline number to report child abuse cases, and more than
80% of them wished to improve their knowledge regarding
child abuse and prevention which shows positive attitude.
In our study hesitancy to report the cases is mainly due to lack
of adequate knowledge by both the professionals followed by
concerned about effect on practice by dental professionals.
Lazenbattet al(2006)14suggested that professional fear and
anxieties and lack of Knowledge act as barriers to recognize
and report abuse and that more specific education and support
for primary care professionals is required.
Level of knowledge was not significantly different between
medical and dental professionals necessitate critical revision
of the content in curriculum in regard to this topic. 50-56% of
responders wished to improve their knowledge by courses
and workshop. Modification in regular curriculum and
informed booklet were also one of the preferred means for
improving the knowledge.
CONCLUSION: Medical and dental residents are not
sufficiently prepared to endure their role in protection of child
from abuse. It was observed that there was a deficiency in
recognizing and reporting signs of physical child abuse. The
main reasons for not reporting child abuse included lack of
adequate history and possible effect on practice. Study
demonstrated an overall poor understanding of the problem,
despite a very high level of interest demonstrated by the
respondents and a strong desire for further information about
their responsibilities and a clear need for all dentists to receive
further formal training.
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CORRESPONDING AUTHOR:
Dr. Deepak P. Bhayya
Professor and Head,
Department of Peadiatric and Preventive Dentistry
Hitkarini Dental College and Hospital,
Hitkarini Hills, Jabalpur.
Email : [email protected]
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University J Dent Scie 2019; Vol. 5, Issue 3