April 2008 - Volume 2, Issue 2

UNDERSTANDING CHILD ABUSE AND ITS IMPLICATIONS FOR CONTROL IN NIGERIA

Enwereji, E. E College of Medicine Abia State University Uturu, Nigeria Email: hersng@yahoo.com Phone Number 08036045884

ABSTRACT Introduction Cultural and western world practices of bringing up children usually conflict on what constitutes child abuse. Child abuse is an emerging public health problem in Africa especially with increasing frequency of HIV/AIDS. The study aimed to identify local and scientific information on child abuse for a better understanding of the problem; also to note whether actions that culturally constitute child discipline could be termed as child abuse. This is necessary because reliable statistics are limited in most parts of Africa including Nigeria probably due to lack of understanding of what constitutes child abuse. Methods Review of relevant literature was done to integrate western and local knowledge of child abuse for effective control measures and better understanding of what constitutes child abuse. Data were analyzed qualitatively. Result Findings noted that actions like rape, incest, child prostitution, and sexual abuse, which are termed as child abuse in western cultures, are also viewed as child abuse in Nigeria. In contrast, activities like street trading, child battering, and child labour termed as child abuse in developed countries, are seen in Nigeria as traditional ways of training up a child. Conclusion: For effective control of child abuse, it should be integrated with primary, secondary and tertiary prevention strategies.

Key words and phrases: Child abuse, emotional neglect, local knowledge, health problems, Nigeria.

CONCEPTUAL FRAMEWORK AND STRUCTURE OF PAPER
Childhood years are treasured because that is the time when parents and/or guardians strive to fulfill their potential roles of nurturing so that children can develop to adolescents and live lives of fulfillment with their families, communities and societies. Children in African settings are viewed as future generations. Understanding exploitative actions against them has an important impact on their overall development. Since child survival is a key factor in developing countries including Nigeria, where the higherthe number of children in a family, the higher the rating of the economic and social status of that family, child abuse which most directly affects children's health and survival should not be encouraged. Unfortunately, dearth of information on better understanding of child abuse makes it relevant to use cultural and acceptable methods to prevent child abuse rather than importing strategies that are working in developed countries.

METHODOLOGY

The paper draws from literature from fields of medicine, public health, nursing, optometry, sociology, anthropology, education, psychology, biosocial sciences, and social psychiatry. Articles from peer-reviewed journals and materials from leading national organizations like African Networks for protection and prevention of child abuse and neglect in Nigeria. (ANPPCAN) were included.

What is already known on this topic
Child abuse is an emerging public health problem in Africa especially with increasing frequency of HIV/AIDS. Aggregate studies have shown that associated actions like physical beating, sexual violence, and others, which result in injuries, and expose children to blood borne infections including HIV/AIDS lead to child abuse^[1].

Unfortunately, reliable statistics are limited in most parts of Africa including Nigeria because of lack of understanding of what constitutes child abuse. The question is, what actions are classified as child abuse?

No doubt, authors view actions that constitute child abuse from different perspectives. Some see beating children mercilessly as ideal for child discipline^[1-3], others see this as serious child abuse^[4-6]. Traditionally, children are abused when food is denied, when served a different meal from the family menu and/or when given left over or putrefied food. Also children are abused when lured into having sex with blood relations, or when forced to carry heavy loads not commensurate with their ages.

The objective of this study is to understand actions that encourage child abuse so as to initiate prevention.

FACTORS THAT AFFECT CONTROL OF CHILD ABUSE:

Factors that discourage prevention of child abuse in Nigeria include:

Ignorance of what constitutes child abuse:
Review of previous works shows various conflicting opinions on attitudes that constitute child abuse. For instance, while ^[7-9] see battering deviant children as child abuse^[10], views this as a corrective measure. Lack of distinction between cultural and western styles of child upbringing is the major cause of faulty child rearing in developing countries^[11,12]. Therefore, programmes for reducing child abuse are dependent on individuals' perception of what is classified as child abuse.

Literacy level
Low literacy level is an important predictor of increased child abuse and of poor participation in activities to discourage child abuse^[13].

Therefore, health education programmes targeted at low literate groups and aimed at controlling child abuse should involve using non-print information materials like town criers, radio, video, and television based-education.

Organizational and co-ordination issues
Studies have shown that since the majority of parents and /or guardians live in rural areas so that effective child abuse control should be decentralized from the urban areas to rural^[13,14].
It would therefore be useful to incorporate child abuse control measures into existing primary health care programmes so as to involve community, local government and other interested groups.

Local and western initiatives
Parents and/or guardians in Africa, including Nigeria should view child abuse as a problem and take concrete actions to tackle the problem in the continent. This could be achieved if functional organizations with similar interests came together to form pressure groups to fight against child abuse. A strong and united body can press on governments of member countries to include child abuse control strategies in available National Health Care programmes. One advantage of forming pressure groups would be to integrate local and scientific knowledge of child abuse for a better understanding of the problem without compromising good intentions and actions that govern successful child upbringing in Nigeria.

TYPES OF CHILD ABUSE

The study noted 5 interrelated types of child abuse and activities and /or behaviours that influence abuse from different perspectives. These are as follows:

Physical abuse
Studies have shown that more than three million children are physically abused in developing countries^[15]. Physical abuse has been found to constitute the most common type of child abuse. Physical abuse includes beating, abandonment, slapping, pushing, flogging, and other actions that leave serious injures on the abused^[16,17]. Also physical abuse includes denying children time for extracurricular activities^[18-20]. In Nigeria, most children do not have time for extracurricular activities because they assist in breadwinning jobs.

In understanding physical abuse, cultural methods for disciplining erring children such as starving, hitting on the head, putting pepper on the eyes and genital organs should be reviewed. While some authors like^[21,22] view these actions as processes of discipline, and ways of gaining ascendancy and control over children^[23-25], others see these actions as serious child abuse^[26-27].

However, beating is very common in developing countries including Nigeria. Parents beat their children and teachers beat their pupils. Beating has been described by^[28] as the causes of orthopedic injuries, intraocular and retinal hemorrhage, periorbital edema, fractures and bruises as well as the cause of long-term traumagenic effects on children.

While most of these actions enumerated above may not be perceived as child abuse in Nigeria and other developing countries, it is important to note that such actions could negatively influence development and survival of children. Children in African cultures are valued as resource pools from which future generations are predicted, therefore, actions meted to them should not be hazardous to their overall health.

Moral abuse
Moral abuse occurs when children are exposed to immoral influences. These include parents using abusive substances in the presence of their children, and/or sending children to purchase such materials^[29]. In Nigeria, children run errands of purchasing substances like cigarettes, alcohol and others for entertaining visitors. Such errands as noted by^[30] are regarded as abuse while studies by^[31] see this as part of children's obligation to parents and elders.
Studies by^[32] have identified actions that coerce young pupils into having sexual relationships as moral abuse. These actions include: rape, writing love letters, fondling breasts, buttocks, thighs, private parts, showing pornographic materials and also acting as "sugar daddies" or "sugar mummies".

Emotional abuse
Studies have identified conditions under which children are exposed to emotional abuse. These conditions include nurturing children under states of anxiety and confusion where tender loving care needed for overall development is denied. Also included are nurturing children where domestic violence, wife battering, poor interpersonal relationships and emotional instability abound^[33]. Further studies by Ellis showed victimization and rejection as serious emotional abuses, which lead to low self-worth and poor mental development^[34]. In traditional society, victimization and rejection are used to gain control. For instance, husbands use wife battering to gain ascendancy over erring women while parents and/or teachers use beating to subdue children's excesses and gain control and respect.

Medical abuse
Widner argues that medical abuse occurs when children are exposed to situations that encourage infections, isolation, depression and others^[36]. He identified external ear perforation, scarification, tribal marks, and others that encourage blood-borne infections such as HIV/AIDS, malaria and others as medical abuse. He viewed cultural import of female circumcision (female genital cutting/mutilation), which is aimed at checking excess libido and promiscuity as serious medical abuse. He emphasized that distortions of anatomical positions of varying tissues result in reproductive health problems including vesico-vaginal fistula (VVF) and/or vesico-rectal fistula (VRF), which encourage isolation and rejection of cases. The problem is that to date, female circumcision is widely practised in most rural areas of Nigeria and is not viewed as child abuse.

Widner found correlation between starvation, dental caries, water intoxication and child abuse. He noted that using starvation as a disciplinary measure to erring children exposed them to the risk of malnutrition and/or infections while mouth odour from dental caries result to isolation , rejection, depression and low self-esteem.

In water intoxication or forcing children to drink copious amounts of water , his studies showed that 60% of infants (0-3 months) who were forced to drink copious amounts of water (over 6 litres a day), died after drinking. The few that survived came down with seizures, emesis (vomiting), coma, hyponatremia (low blood salt) and others. Understanding water intoxication as an abuse is important in rural areas where inclusive breast-feeding is practiced, and water constitutes main source of fluid given to infants. Therefore, the need to understand this would avoid confusion in correct interpretation of exclusive breast-feeding.

Educational abuse:
Educational abuse occurs when children are exposed to actions like corporal punishment, hawking, street trading, and others that lead to school absenteeism and/or denial of basic education^[37].

Corporal punishment, traditionally used by elders and teachers to gain supremacy over pupils is viewed by^[38] as abuse. Pupils are made to kneel on rough cement surfaces for offences like coming late to school and/or making noise in class and others.

Elders and/or guardians who use corporal punishment as a veritable method of child discipline should understand its negative impact of retarded growth on children and consider using a cascade of other methods that encourage development^[38].

CONTROL OF CHILD ABUSE

Public health concepts like primary, secondary and tertiary prevention strategies would be useful.
Primary prevention:

Training of individuals:
Control of child abuse should be translated into action by training personnel as health educators to identify public health issues on child abuse at community levels. Using Auxiliary Health Workers will be effective because of direct communication with peers which could easily influence attitudes. This training should be continuous and regular.

Public education:
Public education should be used to create awareness and sensitize society on programmes to control child abuse. Such programmes should be culturally sensitive, acceptable and community based.
Communities should be involved in developing and implementing programmes and centers for information dissemination should be created to reach people at grass roots levels.

Anti child abuse campaigns:
In Nigeria, there are only sporadic campaigns against child abuse organized by a few interested groups and non-governmental organizations. To protect children against risk behaviours (like child labour, trafficking and others), the Government should participate in this campaign by invoking appropriate legal sanctions to perpetrators of this. There is also need to integrate local and western methods of child rearing to evaluate the impact on children.

Environmental strategies:
Organizations that would act as child protection agencies at Federal, State and Local Government levels should be instituted. These protection agencies could initiate workable frameworks, guidelines and legislation to protect from child abuse. Efforts towards these developments would be to enlighten the public on child abuse control strategies, and thereby enforce guidelines and legislations on abuse.

The need for these could be exemplified with what happens in the Niger Delta parts of Nigeria, where children contribute to family income by abandoning their education and engaging in illegal scooping of oil thereby exposing themselves to hazards of oil spillage. Government could, in the circumstance, enunciate strong policies and legislation to prevent parents and their children from such environmental hazards that are capable of exposing them to medical problems like burns, cancer and others.

Secondary/ tertiary prevention:
Facilities for adequate management of child abuse should be made available at secondary and tertiary levels so as to take care of emerging multiple (psychological, social and physical) problems of anti child abuse campaigns and education. These referral and resource centers could be useful in providing diagnosis, detection and management of cases. Facilities for research would be highly needed to consistently evaluate the effectiveness of some interventions. This could be achieved through the use of available data in the anti child abuse prevention Agencies.

Diagnostic and treatment services:
In developing countries including Nigeria, budget for secondary and tertiary health care services is less than 5%, which is the expected minimum budget by World Health standards. Limited budget is a major problem in health sector service provisions. Lack of infrastructure and technical expertise negatively affect management of cases. Most health care services are inaccessible and unaffordable to the abused because of long distances, bad roads and lack of finance. These factors contribute to delay and/or entail poor management of emerging problems of child abuse.

Therefore, child abuse control measure should be established at zonal/tertiary centers so as to limit proliferation of under-utilized centers that may not serve the target groups.

Training of specialists:
The need to train specialists in various fields of endeavour for effective management of compelling problems of child abuse should not be overemphasized. Staff should be trained in Psychology, stress management, orthopaedics, rehabilitation, record keeping, palliative and data management. They should also be trained on how to identify child abuse. Scholarships and fellowships could be extended to such staff to motivate them.

Research:
Research is needed for effective evaluation of the control measures and treatment modalities. Outcomes of such studies may encourage greater understanding of child abuse and show how scientific and traditional knowledge could be integrated in child rearing. Data on child abuse should be made available for research, planning and relevant health care policy implementation for children.

FACTORS THAT NEGATIVELY AFFECT CONTROL MEASURES:

Nigeria is faced with many factors that negatively affect prevention of child abuse. Harsh economic conditions that force children to play breadwinner roles, breakdown of social networks and amenities due to poverty are among factors that discourage human and material developments in Nigeria. These factors affect understanding of child abuse.

CONCLUSION

There is lack of understanding of factors that influence child abuse in Nigeria. This lack of understanding stems from the fact that some researchers are unable to distinguish between child abuse and western and cultural styles of child discipline. The need to sustain lofty cultural norms and tradition of child rearing in Africa and Nigeria in particular,. should not lose trends of avoiding factors that influence child abuse. With concerted efforts, and well planned interventions, indigenous and western methods of child rearing could be coordinated and upheld without encouraging child abuse.

Acknowledgements

I am grateful to the Vice Chancellor, Abia State University, Nigeria for his financial and academic encouragement during the period of study.

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