Journal of Public Health Policy and Planning

Editorial - Journal of Public Health Policy and Planning (2018) Volume 2, Issue 1

Child abuse-knowledge, attention and diffusion in the university hospital “Saint George”, Plovdiv in Bulgaria.

Pavel Timonov1*, Ivan Tsranchev1,2, Kristina Hadzhieva1,2, Plamena Dineva1,2

1Department of Forensic Medicine and Deontology, Medical University of Plovdiv, Bulgaria

2Unit of Forensic Medicine, University Hospital “Saint George”, Plovdiv, Bulgaria

Corresponding Author:
Pavel Timonov
Department of Forensic Medicine and Deontology
Medical University of Plovdiv, Bulgaria
Tel: 359888692166
E-mail: [email protected]

Received date: January 22, 2018; Accepted date: January 24, 2018; Published date: January 29, 2018

Citation: Timonov P, Tsranchev I, Hadzhieva K, et al. Child abuse-knowledge, attention and diffusion in the university hospital “Saint George”, Plovdiv in Bulgaria. J Public Health Policy Plann. 2018;2(1):61-63.

Copyright: © 2018 Timonov P, 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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Editorial

Child abuse is a worldwide problem, which includes physical, sexual and emotional abuse over children. This study aims to determine the prevalence and pattern of the non-accidental injuries in children among a sample at the University hospital “Saint George”, Plovdiv in Bulgaria.

A cross-sectional survey was conducted among a sample of 121 children of whom 72 (59.5%) were males and 49 (40.5%) were females. Analysed period was between 2011 and 2014. The average age for males is 13.20 years, compared to 12.03 years for female victims. The overall prevalence rate for child sexual abuse was only 19%, with rates being higher for females than males. The complete sexual relations represented the least reported type of child sexual abuse. The majority of the perpetrators was male and mainly from outside the home.

This research provides evidence for the existence of child abuse in different appearances in our society. It could help many organizations and government agencies in making new strategies for reducing and preventing the problem with child maltreatment, which is an actual worldwide social problem.

Child abuse is a complex of problems including physical, sexual and emotional abuse over children. The nature and importance of this complex of problems gained worldwide recognition in the term “child abuse syndrome” or “child maltreatment”, indicating that young children are at high risk to become victims of violence, leading to serious and nonpredictable consequences for their future, the quality of their lives, their families, and society at all. The annual incidence of abuse is between 15-40 cases per 1,000 children, and one million children become victims every year and more than 1,200 die as result of abuse [1,2].

In a systemic review on 32 studies, Kempe et al. [3,4] concluded that abuse was more common among children under the age of three years, and that multiple fractures were more common among children who suffered abuse. Ruaro et al. [5] showed that among every 1.000 children, ten are victims of abuse and that of these, 2% to 3% die. It is known that approximately 50% of the children who are victims of physical abuse who return home are subsequently beaten again. Of these, 20% end up dying. Therefore, there needs to be a high degree of suspicion in attending children with trauma that are poorly explained by the trauma mechanism [2].

Abuse and neglect of children is not unique only for Bulgaria and other European countries. It is a global problem which has significant consequences for public health [6]. The other important aspect of this problem is the discrepancies between actual rates and the number of cases reported to authorities. It is well established that most crimes against children are not reported [7], which induces many difficulties in making preventing programs about this worldwide problem. Violence of any type is a serious issue in the lives of children from all racial, cultural and economic backgrounds, and is a topic of enormous societal concern in any society [8]. The aim of this paper is to show the problem with child abuse in Bulgaria and its extent, by analyzing forensic data from the Department of Forensic Medicine and Deontology, Plovdiv in Bulgaria, related to child maltreatment. Furthermore, this study aims to determine the pattern and prevalence of child abuse syndrome in order to help in evaluation of this problem.

A cross-sectional survey was conducted among a sample of 121 children that were examined in the Department of Forensic Medicine in University Hospital - Saint George from 2011 to 2014. Statistical analysis was done using the SPSS version 17.0. The data were expressed as frequencies and mean ± SD. Chi square test and independent t-test were used as indicated. P-value was considered significant at level <0.05 [9,10] (Table 1).

Age group Total (n=121)
  No. %
1-6 7 5.78%
7-11 42 34.7%
12-17 72 59.52%

Table 1: Overall existence of child abuse in relation to sex.

Finkelhor’s [9] questionnaire for measuring sexual abuse was utilized in this study. Twelve different acts of sexual abuse were presented in the questionnaire (Tables 2 and 3).

Trauma Total (n=121)
  No. %
Abrasions, scratches 20 16.53%
Bruises 80 66.11%
Testicular rupture 1 0.83%

Table 2: Distribution of the type of child abuse.

Sex Male Female Total P value
n=5 n=18 n=23
Acts of sexual abuse No. % No. % No. %
Tried to kiss or hug you in a disturbing way against your will 4 80% 6 33.30% 10 43.50% 0.003
Kissed various parts of your body - - 5 27.80% 5 21.70% 0.04
(not just your face) against your will    
Forced you to sit on his or her lap, 1 20% - - 1 4.30% 0.5
and rubbed against you to reach sexual satisfaction        
Tried to force you to expose your genitals - - - - - - -
Exposed his or her genitals - - 1 5.50% 1 4.30% 0.5
Forced you to touch his or her genitals - - 2 11.10% 2 8.70% 0.08
Touched your genitals against your will - - 1 5.50% 1 0.5
Watch pornographic pictures and movies - - - - - - -
Take photos when you are naked (nude photos) - - - - - - -
Put his finger or object in your genitals or anus - - 2 11.10% 2 8.70% 0.08
Tried to have intercourse with you against your will - - - - - - -
Have intercourse with you against your will - - 1 5.50% 1 4.30% 0.5

Table 3: Distribution of the type of child sexual abuse in relation to gender.

Table 1 presents the number of children who experienced child abuse depending on their age groups. According to the sex of victims males were 72 (59.5%) and females were 49 (40.5%).

There was a significant statistical difference between males and females abused, p value<0.05.

The mean age of male victims was 13.20 ± 1.48 years, compared to 12.03 ± 2.43 years for female victims. There was not a significant difference between the mean age of onset of abuse for male and female victims (p>0.05).

Table 2 demonstrates the distribution of the different types of abuse. The first most common reported type of trauma was the presence of bruises. Only one of all analyzed cases of child abuse was detected with a serous traumatic injury (testicular rupture with positive ultrasound imaging).

The overall prevalence rate for child sexual abuse was only 19% (23 children), with rates being higher for females than males. The complete sexual relations represented the least reported type of child sexual abuse. The majority of the perpetrators was male and mainly from outside the home.

Table 3 presents the distribution of the type of sexual abuse in relation to sex. Kissing and hugging in a disturbing way against his/her will represented the most reported type of sexual abuse where (32.6%) of the studied group. There was significant statistical difference (p<0.05) in this type of sexual abuse between male and female victims.

The small number of victims could be explained with the fact that most cases of physical abuse in Bulgaria usually stay unreported and usually end up in hospitals and less of them to the police and the Department of Forensic medicine and Deontology. Presented statistical information and results about assessment of victims of child abuse in our Department of Forensic medicine for period of three years showed that most of cases were male children, which was also reported in other retrospective studies [11,12]. In cases of sexual abuse, prevalence had females, what was reported by other authors [13,14]. The major age group was the group between 12-17 years, which fact was on opposite side to the data reported by other authors [15]. Many of traumatic injuries found over the vicitms were specific for blunt force trauma and many of injuries were caused by objects like knifes, bats, rods and belts. These causative objects usually were presented with superfacial, mild traumatic injuries- bruises, abrasions and wounds. The same findings were reported by another statistical research [12]. World Health Organization reported that in the world died 31000 children less than 15 years old in the 2002- year, as a result of serious child maltreatment, and the number was really underestimated [16]. It was also well known that for each death, there are on average from 150 to 2400 substantiated cases of physical abuse over children [17].

Child abuse is a common problem worldwide, and its physical and psychosocial effects may lead to serious consequences for the abused children, their families and society. It is linked to changes in the mental and behavioral development, leading to increased risk of dangerous behavior in the future [18]. Prevention from child abuse needs the organization of the efforts of health workers, especially the medical doctors and also many people from different occupations in the country. It is an important point to improve the knowledge and skills of the health care personnel about the in time detecting, diagnosis, treatment and prevention of child abuse [19]. Family physicians have an important role in the process of detecting cases of child abuse in their practices. They are responsible for reporting these cases to child welfare agencies, preventing further harm to identified children as well as to other children which are in these problematic families. Family physicians can provide further support and education to these problematic families. One of persisting problems in child abuse it is the growing part of hidden, not reported cases of child abuse. These not reported cases mask the real dimensions and severity of the problem. For this direction, further research in large study population is recommended. It is a great need for a successful management based on the prevention of child abuse and the protection of children and their rights. Our retrospective research could help many formal organizations and government agencies in making new strategies for reducing and preventing the problem with child maltreatment.

References