Academic journal article Bulletin of the World Health Organization

The Burden of Child Maltreatment in China: A Systematic review/La Charge De la Maltraitance Des Enfants En Chine: Une Revue systematique/La Carga del Maltrato Infantil En China: Una Revision Sistematica

Academic journal article Bulletin of the World Health Organization

The Burden of Child Maltreatment in China: A Systematic review/La Charge De la Maltraitance Des Enfants En Chine: Une Revue systematique/La Carga del Maltrato Infantil En China: Una Revision Sistematica

Article excerpt

Introduction

In the past decade there has been considerable growth in the analysis of the occurrence and consequences of maltreatment and other adversities in childhood. (1-3) The maltreatment of children has been found to impair the current and future health and well-being of the children in every country and cultural context in which it has been investigated. The morbidity, disability and mortality caused by child abuse and neglect lead to substantial human suffering, social disadvantage and economic loss. (4,5)

In China, research in this field has a short history. (6) There have been no national assessments of child maltreatment and only a few comprehensive provincial studies. However, the results of early descriptive surveys of child sexual (7,10) and physical abuse (11) and some more recent relevant data (12,13) have been included in global and regional reviews. (2,3,14,15) There has also been one systematic review that focused solely on the prevalence of child sexual abuse in China. (16) There have been no comprehensive studies in China that cover all forms of child maltreatment, examine the consistency of the apparent impacts of such maltreatment on health and well-being or estimate the probable economic consequences. The paucity of official statistics on the incidence of child maltreatment reported to judicial, educational, health and social services --and on the economic costs incurred by such services as a consequence of such maltreatment--also poses a major barrier to the development of an effective and evidence-based policy for child protection in China.

The purpose of this paper was to synthesize the results of previous community-based research on child maltreatment in China. We derived summative estimates of prevalence of emotional, physical and sexual abuse and neglect of children under 18 years of age. We also calculated the magnitude of associations between child maltreatment and consequent poor mental health and health-risk behaviours. We then estimated economic impact of child maltreatment in China. Our observations indicate both the extent to which this major cause of morbidity and disability has been overlooked in China and the research that is still required.

Methods

Systematic review

We searched PubMed, Embase, PsycInfo, CINAHL-EBSCO, ERIC and the Chinese National Knowledge Infrastructure for papers published from the inception of each database to 31 December 2013 using search term combinations of China with child abuse, emotional abuse, physical abuse, sexual abuse or child neglect--and their Chinese equivalents. Languages were restricted to English and Chinese. Two reviewers identified and screened potentially relevant articles in Chinese and English and independently assessed the quality of each study that met the inclusion criteria. To identify additional relevant studies, we contacted 18 researchers and organizations involved in child protection in China and checked the reference lists of key narrative reviews on child maltreatment in or around China. (6,13,14,16,17)

Prevalence studies were included if they met the following criteria: (i) published in a peer-reviewed journal; (ii) participants recruited from a student or general population; (iii) quantitative methods were used to estimate the prevalence of the maltreatment of participants when they were younger than 18 years; (iv) reported a lifetime prevalence of child maltreatment; and (v) the recorded maltreatment had been reported directly by the victims. Studies on the possible consequences--to the victims--of child maltreatment were included if these: (i) represented primary research that had explored the relationship between at least one form of child maltreatment and its impact on employment, education, mental health, physical health, health behaviours, aggression, violence, criminality, exposure to further violence or use of health services; (1) (ii) included the calculation of odds ratios (ORs) or relative risks (RRs) disaggregated by the type of maltreatment; and (iii) had not sampled on the basis of the presence of any specified outcome--since this would have invalidated the calculation of an OR or RR for that outcome. …

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