4 knowledge, attitude and

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 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


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


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


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.



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


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


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


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



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


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.

REFERENCES:

1. Deshpande A, Macwan C, Poonacha K. S., Bargale S,

Dhillon S, Porwal P. Knowledge and attitude in regard to

physical child abuse amongst medical and dental

residents of central Gujarat: A cross-sectional survey. J

Indian socpedodprev dent. 2015;33(3):177-82.

2. UN Convention on the Rights of the Child (With

Optional Protocols).

3. Saini N. Child Abuse and Neglect in India: Time to act,

JMAJ, 2013;56(5):302-309

http://www.unicef.org/crc



http://www.unicef.org/crc

4. John V, Messer LB, Arora R, Fung S, Hatzis E, Nguyen

T. Child abuse and dentistry: A study of knowledge and

attitudes among dentists in Victoria, Australia. Aust Dent

J. 1999; 44:259-67.

5. Dong M, Giles WH, Felitti VJ. Insights into causal

pathways for ischemic heart disease: adverse childhood

experiences study. Circulation. 2004;110:1761–1766

6. Ministry of Women and Child Development,

Government of India. Study on Child Abuse: India 2007.

http://www.wcd.nic.in/child abuse.pdf.

7. National Commission for Protection of Child Rights

(NCPCR). Eliminating Corporal Punishment in Schools.

http://www.ncpcr. gov.in/publications_reports.htm.

8. O'Donnell M, Scott D, Stanley F. Child abuse and

neglect—is it time for a public health approach? Aust N Z

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9. Al-Jundi SH, Zawaideh FI, Al-Rawi MH. Jordanian

dental students' knowledge and attitudes in regard to

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10. Sonbol HN, Abu-Ghazaleh S, Rajab LD, Baqain ZH,

Saman R, Al-Bitar ZB. Knowledge educational

experiences and attitudes towards child abuse amongst

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11. Cairns AM, Mok JY, Welbury RR. The dental

practitioner and child protection in Scotland. Br Dent J

2005; 199:517-20.

12. Thomas JE, Straffon L, Inglehart MR. Child abuse and

neglect: Dental and dental hygiene students' educational

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13. Kirankumar SV, Noorani H, Shivprakash PK, Sinha S.

Medical professional perception, attitude, knowledge,

and experience about child abuse and neglect in Bagalkot

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SocPedodPrev Dent 2011; 29:193-7.

14. Lazenbatt A, Freeman R. Recognizing and reporting

child physical abuse: A survey of primary healthcare

professionals. J Adv Nursing. 2006; 56:227-36.

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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