Received: September 15, 2015; Accepted: October 15, 2015; Published: October 23, 2015
Citation: Mogaddam M, Merdad L, Alamoudi N, Meligy OE, El-Derwi D (2015) Prevalence of Child Abuse in Saudi Arabia from 2000-2015: A Review of Literature. J Oral Hyg Health 3:189. doi: 10.4172/2332-0702.1000189
Copyright: © 2015 Mogaddam M, et al.This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Unfortunately, there have been only limited reports about the prevalence of child abuse and neglect in Saudi Arabia (SA). Determining the magnitude and extent of this phenomenon is essential to construct an effective strategy to counter and prevent it. The aim of this review was to provide an overview of the prevalence of child abuse and neglect in SA over the past 15 years (2000-2015). Studies were gathered by reviewing published papers in the Medline and Google Scholar databases reporting the prevalence of child abuse and neglect in SA over the past 15 years. In 2007, the prevalences of physical abuse, sexual abuse, and neglect in previous studies were 70%, 15%, and 15%, respectively. Between 2000 and 2008, the prevalence of child physical abuse and neglect was greater than other forms of abuse. Additionally, the annual report of the National Family Safety Registry noted the same findings. In 2014, a study in Al-Kharj found that psychological abuse was most prevalent among teenagers. In conclusion, child physical abuse and child neglect were the most prevalent forms of abuse over the last 15 years, whereas the recognition of emotional abuse started late compared with other forms of abuse. Awareness of the phenomenon of child abuse and neglect is improving in SA. Consequently, the detection and reporting of such cases are growing across the nation.
Child abuse; Child Physical Abuse; Child sexual abuse; Child psychological abuse; Child emotional abuse; Child neglect; Saudi Arabia
The Centers for Disease Control and Prevention (CDC) defines child maltreatment as “any act or series of acts of commission or omission by a parent or other caregiver that results in harm, potential for harm, or threat of harm to a child . The term commission (i.e. child abuse) is used to describe any intended act that may cause harm, potential harm, or threat of harm to a child . While omission (i.e. child neglect) describes the failure of caregiver/s to deliver child basic needs (physical, emotional, medical/dental, and educational) to protect him/her from harm or potential harm . Acts of commission (child abuse) could be physical, sexual, or psychological . On the other hand, types of acts of omission (child neglect) are physical, emotional, medical/dental, or educational .
Types of child abuse (acts of commission): Physical abuse, which is defined as “the intentional use of physical force against a child that results in, or has the potential to result in, physical injury” . In other words, any intentional action that can cause physical damage to the child is considered physical abuse. Emphasizing on expression intention is related to the physical act itself even if there were no or little consequences of that act.
Physical discipline and corporeal punishment are forms of physical abuse even if it doesn’t cause any physical damage to the child because of the intention of power using . Münchausen syndrome by proxy and shaken baby syndrome (abusive head trauma) are also forms of physical abuse [2,3].
Münchausen syndrome by proxy is defined as reporting false signs and symptoms by the caregiver/s, which display the child to extensive medical care and unnecessary hospitalization . Münchausen syndrome by proxy is the most difficult type of abuse to be detected, because the healthcare providers usually depend on the caregiver/s to give the medical history of the child. Moreover, that type of abuse is common in mentally ill children .
Sexual abuse, which is defined as “ any completed or attempted (uncompleted) sexual act, sexual contact with, or exploration of a child by a caregiver” . Physical harm to genital areas is categorized as sexual abuse .
Psychological abuse is defined as “intentional caregiver/s behavior that conveys to a child that he/she is worthless, flawed, unloved, unwanted, endangered, or valued only in meeting another’s needs” .
Types of child neglect (acts of omission): There are several types of child neglect. Physical neglect, were the caregiver/s failed to deliver the child suitable and essential elements of survival, such as, nutrition, clothing, hygiene, and shelter, etc. . Emotional neglect, were the caregiver/s failed to fulfill the emotional needs of the child or by abandonment child mental health . Medical/ dental neglect, were the child doesn’t get the appropriate health services for diseases prevention or actual disease treatment . Educational neglect, were the caregiver/s don’t offer or don’t give attention to child schooling and education .
Many global reports concluded that child abuse has countless physical, psychological, social, and economical effects [4-6]. Body bruises, abrasions, burns, lacerations, internal organs injury, physical disabilities and death are common physical consequences of child abuse [7,8].While mental disorders like stress, which might trigger mental and neurological problems, health problems, and behavior problems, is the most seen psychological consequence of abuse [5,9].
Prevalence of child maltreatment globally
The prevalence of child maltreatment varies from one type to another and from one country and society to another.
Physical abuse: In 2014 the World Health Organization (WHO) estimated 23% of worldwide children were physically abused . In the USA, the Fourth National Incidence Study of Child Abuse and Neglect (NIS-4) concluded that 58% of American children are exposed to physical abuse at some point of their life . While in Germany, UK, and Denmark the prevalence of physical abuse was 12%, 8.2%, and 5.4% respectively [11-13] . In addition, Romania and Italy reported that around 5% and 8% of their children were exposed to physical abuse . Unfortunately, most African and Asian countries lack of recent and reliable statistics in this regard, yet old publications indicate high prevalence of physical abuse in these regions. In 2010, the International Journal of Epidemiology issued the results of Multiple Indicator Cluster Surveys (MICS) of 28 countries including the African region, and former Soviet and Yugoslavian countries, and some other countries such as Jamaica, Trinidad and Tobago, Yemen, Iraq, and Syria. The median physical abuse prevalence of African countries was 64.3%, and it was 45.5% in the former Soviet and Yugoslavian countries . While in Iraq, Syria, and Yemen it was estimated that 66.8%, 74.2%, and 81.4% respectively of children were physically abused . The Gulf region similarly has limited publication in this regard. In 2007, Al-Mahroos found in literature from 1987 to 2005 about 33% (50 out of 150) and 89% (24 out of 27) of total reported abuse cases to be physically abused cases in Bahrain and Kuwait respectively . More recent retrospective review of medical records, estimated about 64% (152 out of 237) of reported maltreated cases in Bahrain to be due to physical abuse .
Sexual abuse: According to the World Health Organization (WHO), 20% and 5-10% of females and males respectively had experienced sexual abuse universally . Twenty-four percent of American children were reported to be sexually abused through the sentinel survey method where all community specialists that deal with children were participated . Whereas 9% of Romanian children were sexually abused . In 2013, Germany reported the percentage of sexually abused children to be around 6% . In 2011, Radford et al indicated that 0.2% of British children had been sexually abused . In Vietnam, A study conducted in secondary school students showed that 19.7% of them were sexually abused . In 2007, Al-Mahroos, recorded the number of sexual abuse cases reported in the published medical literature or in national organizations over 18 years from 1987 to 2005 . The study reported 3 sexual abuse cases out of 27 total abuse cases in Kuwait (11%), and 87 out of 150 cases in Bahrain (58%) .
Psychological abuse: More than one fourth of children in the USA (27%) and 10.4% of children in the UK were recognized as psychologically abused [10,12]. In Denmark, stratified random sample of Danish children in 2013 showed that 6.1% and 4.4% of total female and male children were psychologically abused respectively . Iffland et al., found in 2013 that the level of psychological abuse in Germany was 10.2% . While Chili identified 8% of their children as psychologically abused . Burkina Faso and Cameroon had been estimated to have 83.4% and 86.1% of psychologically abused children respectively . To our knowledge, there is a deficiency of data about psychological abuse in the Arab world. According to the International Journal of Epidemiology in 2006, Iraq and Syria reported 79.9% and 83.1% of psychologically abused children respectively . Yemen, in the same year, showed the highest prevalence of psychologically abused children (92.3%) .
Child neglect: In 2010, a study showed that around 61% of US children have been neglected (47% neglected educationally, 38% physically, and 25% emotionally) . Around 22% of Canadian children were classified as neglected (19% physical neglected, and 11% educational neglected) . A total of 16.8% of UK children were reported to be neglected in 2011 . In Denmark, 3% from a sample of Danish children stated that they were exposed to physical neglect . Vietnam, as an example of Asian countries, revealed that around 29% of secondary school children were neglected . Moreover, girls showed higher prevalence of neglect than boys (33.4% and 24.9% respectively- P value<0.001) .
Determining the magnitude of child abuse and neglect phenomenon in SA is important to construct an effective prevention strategy and to encounter it. This review aimed to overview the prevalence of child abuse in SA in the last 15 years (from 2000-2015) in an effort to better estimate of the magnitude and extension of the problem.
The authors reviewed published papers at Medline database and Google scholar database that report the prevalence of child abuse in SA at the last 15 years. All studies that report the prevalence of child physical abuse in SA were included if they fulfilled the priori set criteria: 1- Published between 2000 and 2015. 2- Case reports, cross sectional and review studies. 3-English language. On the other hand, studies that investigate other outcomes and papers that presented unconfirmed cases of abuse were excluded. The search in the databases was performed based on these keywords:
||•Child physical abuse
|•Violence against children
|•Münchausen syndrome by proxy
||•Shaken baby syndrome
||•Child sexual abuse
|•Child psychological abuse
||•Child emotional abuse
|•Kingdom of Saudi Arabia
Each study was revised manually by the title and abstract for primary exclusion. Then, the remaining studies full text was revised and summarized. Many case reports and unconfirmed cases were found upon searching, which make the estimation of the child abuse prevalence very difficult.
Seven studies were accessed through Medline database and three studies were obtained from Google scholar database. One review study, three cross sectional study, two national level reports, two case series reports, and two was diagnosed case reports.
Karthiykeyan et al. in 2000 published a case report discussing 2 physical abuse cases in Khamis Mushayt city; south of SA . In 2007, Al-Mahroos searched the medical literature from 1987 to 2005 looking for the prevalence of child abuse and neglect in Arab Peninsula . She found 28 cases out of 40 total reported abuse cases (70%) in Saudi Arabia were categorized as physically abused cases and Münchausen syndrome by proxy . Al Eissa and Almuneef reported in 2009 the prevalence of different forms of child abuse that was recognized by the Suspected Child Abuse and Neglect team (SCAN) at King Abdulaziz Medical City at National Guard, Riyadh, in three different time periods: 2000-2004, 2005-2006, and 2007-2008 . The total investigated abuse cases were 133 cases which 65 (49%) of them was categorized as physical abuse . Also, they found that physical abuse against children was the most prevalent form of abuse during the time periods of 2000-2004 and 2005-2006 in comparison to the time period between 2007-2008 (61%, 76%, and 39% respectively) .
In 2008, a case report of physical abuse against 15 months old children by insulin needle was reported in Riyadh city . In 2010, a case report about a case of Münchausen syndrome by proxy about 19 month female child admitted to King Faisal Specialist Hospital and Research Center was published . The case was tricky and took long time to be diagnosed since it was the first report of Münchausen syndrome by proxy that resembles Gaucher disease in manifestations . The annual report of the National Family Safety Registry (NFSR) in 2010 mentioned that there were 292 reported cases of abuse and neglect around SA (National Family Safety registry 2010). Seventy percent (70%) of the cases (n=205) were reported as physically abused, Münchausen syndrome by proxy, and shaken baby syndrome. Furthermore, the annual report of the Hospital Based Child Maltreatment Registry in 2012 reported 263 cases of abuse that 94 cases (35.8%) were reported as physically abused (National Family Safety registry 2012). Moreover, it was reported that most of the cases were reported from the urban areas of SA (Riyadh, Makkah, and Eastern provinces) (National Family Safety registry 2012). In the same year, a study in Dammam city, eastern of SA reported 87 cases of abuse at 2 hospitals . About 13% of the cases were reported as physical abuse and 2.3% of them were reported as combined physical and sexual abuse .
A large-scale study was conducted on Al-Kharj; eastern south of Riyadh, between 2011-2012 using the ISPCAN Child Abuse Screening Tool-Child: Home version (ICAST-CH) found that 57.5% of adolescent who participated in the study experienced physical abuse .
A case report was published in 2000 was documenting a sexual abuse case against 7 years old boy in Khamis Mushayt city . In 2007, 6 cases out of total 40 abuse and neglect cases that reported in the literature were diagnosed as sexual abuse against children (15%) . Moreover, Al Eissa and Almuneef found in 2010 about 20% of the reported abuse and neglect cases at Riyadh city was categorized as sexual abuse cases . The annual report of the National Family Safety Registry (NFSR) in 2010 reported around 16% (47 out of 292 cases) sexual abuse cases . Two years later, the prevalence was increased when the Hospital-Based Child Maltreatment Registry reported 56 cases of sexual abuse cases out of 263 total maltreatment cases (21.3%) in SA . In Dammam city, Almadani et al. reported 85% of the abuse cases to be sexually categorized in 2 main hospitals in the city . Al Eissa et al. found that 14% of the stratified multistage cluster random sample of 15-18 year schools adolescents in Al-Kharj city were sexually abused .
Psychological abuse was the least reported form of abuse especially in former years. In 2010, Al Eissa and Almuneef investigated the prevalence of child abuse cases between 2000-2008 by the Suspected Child Abuse and Neglect team (SCAN) at King Abdulaziz Medical City at National Guard, Riyadh . They reported only 5 cases of psychological abuse in 2007-2008 . Additionally, the annual report of national family safety registry in 2010 did not diagnose any psychological abuse cases among 292 reported abuse and neglect cases . The Hospital-Based Child Maltreatment Registry found 5.3% of all reported abuse cases (14 out of 263 cases) were registered as psychological abuse in 2012 .
Elarousy and Al-Jadaani conducted a descriptive study in Jeddah city; west of SA in 2013 . Among the convenient sample of 12-18 years old children they recruited, 90% of the children diagnosed with psychological abuse . In 2014, 75% of the cases that was diagnosed by Al Eissa et al. in Al-Kharj city as psychological abuse .
Al-Mahroos found a total of 40 cases of child abuse and neglect in the literature about SA, 6 of them were classified as neglect cases (15%) . Al Eissa and Almuneef reported 43 cases of child neglect in Riyadh at the time period of 2000-2008 and more than third of them (42%) were diagnosed at 2007-2008 .
In 2010 and 2012, a national level report in the SA found that 41% and 38% respectively of abuse cases were under the definition of child neglect [2,7]. In 2014, half of the cases reported in Al-Kharj city at 2014 were categorized as neglect cases . Table 1 summarizes the findings of the published papers about the prevalence of child abuse and neglect in SA during 2000-2015.
|Authors, year||Physical abuse||Sexual abuse||Psychological abuse||Child neglect||Total|
|Karthikeyan et al., 2000 ||2||1||0||0||3|
|Al-Mahroos, 2007 ||28||6||0||6||40|
|Abdulgani et al., 2008 ||1||0||0||0||1|
|Al Eissa and Almuneef, 2010 ||65||20||5||43||133|
|NFSR, 2010 ||205||47||0||126||292|
|Al-Owain et al., 2010 ||1||0||0||0||1|
|Almadani et al, 2012 ||11||76||0||0||87|
|Elarousy and Al-Jadaan, 2013 ||0||0||54||0||54|
|Al Eissa et al., 2014 ||1175||287||1533||1021||2043|
Table 1: Summary of published papers about the prevalence of child abuse and neglect in Saudi Arabia during 2000-2015.
This study considered only in 2 databases, which might underestimate the number of abuse and neglect cases. Searching in more databases and including hospital records might result in higher prevalence of child abuse and neglect cases. In addition, child abuse and neglect is a sensitive issue in SA and most caregiver/s will not seek medical help except in sever abuse and neglect scenarios that might affect the accuracy of reporting and overall prevalence of this issue. Finally, most of the included studies were case reports, case series studies, and cross sectional, which limit the accuracy of detecting the exact extension of the problem.
Physical abuse and neglect were shown to be the most prevalent forms of maltreatment against children in SA [2,7,19,23]. The awareness about child abuse and neglect is improving in SA. Consequently, the prevalence of detecting and reporting of such cases is increasing, which might help in further improvement of actions to face it. More largescale studies and recording of all available data at national level registry is recommended.
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