An analysis of child abuse cases referred to a healthcare service provider in Pietermaritzburg: an evidence-based study.

Abstract

Child abuse has an historical presence internationally and in South Africa, where it persists at alarming rates. Much research focuses on sexual abuse, which appears to be the most prevalent form of abuse. However, literature and the current research also recognise the presence of emotional/psychological abuse, physical abuse and neglect. Child abuse presents with harmful consequences that extend to the victim, his/her family and the larger community. This quantitative and explorative study investigated the incidence and prevalence of child abuse cases found at a private practice in Pietermaritzburg, in the Msunduzi municipality, in KwaZulu-Natal (KZN), South Africa. The research sought to discover characteristics of abuse, pathways to intervention, risk and protective factors and necessary stakeholders to assist with this public health concern. Data was obtained through case files that were selected through non-probability sampling, specifically purposive sampling. Data was collected using a questionnaire developed by the researcher for the study. Content analysis coded the data to create descriptive and inferential (Fisher’s exact tests) statistics through MS Excel and SPSS. Bronfenbrenner’s ecological systems theoretical framework was used to interpret the data. The study’s sample comprised of 52 case files and found that sexual abuse was most prevalent, followed by emotional abuse and then physical abuse. Most abused children fell into the 6-10 years’ age group; were African; did not have a disability; were in primary school (Grades R-6); and presented with various problems at the healthcare service provider’s (HSP) practice. Surprisingly, males and females were almost equally affected. The study found that a child’s gender affects the type of abuse experienced. Fisher’s exact test showed a relationship between a victim’s father’s employment status and the type of abuse experienced. Living with 1-6 people showed more risk for abuse. Perpetrators included children and the abuse type was dependent on the abuser’s age and level of education. Various relationships were reported between the victim and the abuser. Many victims’ abuse was discovered through an examination by the HSP. Concerningly, over 13 of cases occurred in the school environment. Case prosecution was a major issue, with most cases having an unknown status and no files showed as completed with/without convictions. A common set of risk and protective factors did not emerge. Collaboration between stakeholders assisting victims of abuse does not seem to be occurring. Collaboration is needed between public services, like the Department of Education (DoE), the Department of Higher Education and Training (DHET), the Department of Health (DoH), Department of Justice (DoJ) and the Department of Social Development (DSD), and private services, as is enhanced education to help prevent and manage the alarming rates of abuse.