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EDUCATION OF CHILDREN ABOUT SEXUAL ABUSE, HOW FAR PARENTS AGREE.

Byline: Zobeida O. Eljaaly and Marwan A Bakarman

ABSTRACT

Child sexual abuse (CSA) is a worldwide problem which carries a consequent mental and psychological hazards to the victims. Using a cross sectional analytic study design, a sample of parents attending primary health care (PHC) centers in Jeddah, Saudi Arabia (n=400) was selected randomly and they were asked to be enrolled in the study by filling a predesigned self-administered questionnaire which was adopted from a previously used valid and reliable questionnaire. The data were verified, coded and entered in SPSS ver. 20 which was used also for statistical analysis. P value less than 0.05 was interpreted as an indication for significance. Most of the parents (95.5%) were willing to introduce educational programs in schools about prevention of CSA, however still a considerable proportion (27.1%) afraid that these materials could expose children to know too much about sex.

The great majority of the parents indicated that the talk with their children and give them advises that could protect them from CSA; however, almost one quarter of them (24.8%) disagree about providing children with audio-visual materials. Mothers, in particular issues were significantly more active in providing advises than fathers. Parents exhibited acceptable level of behavior towards CSA, still there are some issues that need to be clarified through multi- sectors intervention programs.

Keywords: child sexual abuse, parents' education, child education, Saudi Arabia.

1. INTRODUCTION:

Children have the right to live in a good health and free of violence. Millions of children around the world are suffering from physical, sexual and emotional violence. Sexual abuse is defined as the involvement of a child in sexual activity that he or she does not fully comprehend, is unable to give informed consent to, or for which the child is not developmentally prepared, or else that violates the laws or social taboos of society".

Many researches done around the world showed that almost 20% of females and 10% of males reported having been sexually abused as children[1-7]. Systematic review of studies published between 2002 and 2009 estimated that the prevalence of child sexual abuse worldwide ranged from 8 to 31 % for girls and 3 to 17 % for boys[8]. Maltreatment of those children will contributes to a wide-range of adverse physical and mental health outcomes which will affect the child and the society, over the course of a victim's life [1].

Children in the Arab countries are not immune from this problem, they exposed to all forms of child abuse and neglect. Studies done in Kuwait identified 27 abused children, 3 of them were sexually abused. Studies from Saudi Arabia identified 40 abused children, 6 of them with sexual abuse. A total of 150 hospital based cases were reported from Bahrain, 87 of them with sexual abuse [9]. It is important to understand what parents know about sexual abuse to their children to develop effective education program.

The objective of this study was to develop effective educational program to protect children from sexual abuse in Jeddah, Saudi Arabia.

2. MATERIALS AND METHODS:

This is a cross-sectional analytical study conducted among Parents attending the Primary Health Care (PHC) centres of the Ministry of Health (MOH) in Jeddah city in 2014.

The sample size calculated using Epi info Program version 6.4, the proportion in the equation was substituted by 50% to get the maximum sample size. Given a confidence level of 95% and power of 80%, the sample size accounted for 384. This number was rounded to 400, to compensate for possible dropout. There are 4 PHC sectors in Jeddah city; one PHC center was randomly selected from each sector. The sample was equally allocated over the selected 4 PHC centers. Therefore, 100 respondents were enrolled from each center; making a total of 400 respondents. Parents were selected from each PHC center using systematic random sampling method; by choosing every 5th attendants who was requested to be included in the study, of course the first participant was chosen by simple random numbers method. Verbal consent was considered as a prerequisite for inclusion; otherwise and in case of disapproval next attendants was requested to participate.

Data was collected using Self-administered questionnaire. It was used in several studies since 2005. Permission was taken from the authors to use the questionnaire in this study. Demographic data were structured by the researchers.

3. RESULTS:

The response rate was 100%; as the questionnaires were distributed and collected back in the same setting. Table 1 shows that although the great majorities of the interviewed parents (95.5%) agreed about prevention education program in the schools and (90.8%) of them would let their children learn about CSA prevention knowledge, yet, a considerable proportion (27.1%) still afraid about this education as it might induce too much topics about sex. It was also observed that only few parents perceived that there is no need for such type of education at young age as the child will get it as he/she grows up (9.8%), and 7.3% who belief that there is no need for such education as the problem of CSA is not common. Table 2 demonstrates the response of the participants to expected behavior that they could do with their children; The great majorities of the parents indicated that they would talk to their children about securing their private parts (92.3%),

Table1: Agreement of the respondents about aspects related to education of the children about child sexual abuse.

###Agree

###Queries and statements###Yes###No

###n(%)###n(%)

Agree to put CSA prevention education in schools###382 (95.5)###18 (4.5)

Willing to let your child learn CSA prevention###363 (90.8)###37 (9.2)

knowledge in schools

Afraid that CSA prevention education may induce your###108 (27)###292 (73)

child to know too much about sex

No need to conduct CSA prevention education, as###39 (9.8)###361 (90.2)

children will acquire such knowledge as they grow up.

CSA cases are very few, so it is unnecessary for children###29 (7.3)###371 (92.7)

to learn how to prevent CSA.

never to let someone to see it (86.3%), never to go with others even if familiar person (92.3%), or accepting gifts from strangers (91.3%) except after parents' permission and not to go with strangers who ask them to the nearest way to store (91.3%).

Also, it was noted that the great majority (87%) of the parents would tell their children that, in case of sexual abuse might happen, they should inform their parents or trusted adults. On the other hand, it was found that only one quarter of the parents (24.8%) pointed that they would provide their children with audiovisual materials about CSA prevention. Table 3 shows that a significantly higher percentage of males (12.1%) than females (5.1%) are not seeing that CSA is not that much to necessitate learning children about its prevention, therefore, it was noted that a significantly higher percentage of females (95.6%) are taking with children about securing their private parts, refusing to show it to anybody (89.5%) and not to obey anyone who is asking them to show the way to the nearest store (93.5%) if compared to males who showed significantly lower percentages pless than 0.05.

Table 2: Expected parents' behaviors regarding CSA education to their children.

###Behaviors###Agree

###Yes###No

###n(%)###n(%)

###Talked with their children about their private###369 (92.3)###31 (7.7)

###parts

###and said they should not be touched by others.

###Told child if someone wants to see or touch their###345 (86.3)###55 (13.7)

###private parts, they should say `No'.

###Told child if sexual abuse happens, parents or###348 (87.0)###52 (13)

###other trustworthy adults should be told.

###Told children do not go with others, even###369 (92.3)###31 (7.7)

###familiar

###grown-ups, unless they had parental permission.

###Told child not to accept gifts from strangers,###365 (91.3)###35 (8.7)

###unless they had parental permission.

###Told child that if a person they did not know ask###365 (91.3)###35 (8.7)

###him to show him the way to the nearest store,

###they should say NO.

###Provided books or audiovisual material about###99 (24.8)###301 (75.2)

###CSA prevention for their children.

Table 3: Differences in agreement and expected behaviors of the respondents about aspects related to education of the children about child sexual abuse according to gender

Queries and statements###Agree

###Males###Females###P-

###n(%)###n(%)###Value

CSA cases are very few, so it is###15(12.1%)###14 (5.1)###0.013

unnecessary to teach children how to

prevent CSA.

Talked with their children about their###106(85.5%)###263 (95.6)###0.001

private parts.

Told child if someone wants to see or###98(79.0%)###247 (89.5)###0.005

touch their private parts, should say NO.

Told child if a person they did not know###107(86.3%)###258 (93.5)###0.017

ask him to show him the way to the

nearest store, they should say NO.

Table 4: Differences in agreement and expected behaviors of the respondents about aspects related to education of the children about child sexual abuse according to monthly income.

Queries and###Agreement according to monthly income in SR

statements###less than 5000###5000-###10000+###P-

###less than 1000

###Value

###n (%)###n(%)###n(%)

Are you afraid that###36(36.7%)###31(25.8%) 41(23.2%)###0.049

CSA prevention

education may induce

your child to know too

much about sex

Provided books or###17(17.3%)###27(22.5%)###54(30.3%)###0.045

audiovisual material

about CSA prevention

for their children.

4. DISCUSSION:

Children are vulnerable to risks of sexual abuse/exploitation due to their innocence, tenderness, and powerlessness [10]. It is well documented that the trauma of child sexual abuse is associated with psychological maladjustment that may begin shortly after the abuse and continues into adulthood [11]. The role of the parents is substantial for ameliorating the impact of CSA on their children either on the short or long run [12]; therefore, the current study targeted parents to explore their level of knowledge about CSA. Although that the prevalence of CSA was not within the scope of the current study, however, it was important to know the level of awareness of the parents about the popularity of the problem as it reflects their perception about its magnitude that could influence their behaviors in prevention.

Putting in mind that no community is exceptional from the problem even conservative ones; for example, in Arab countries, despite the conservative culture, child abuse is being experienced by a significant number of children [13]. In the current study, the great majorities of the respondents (93.8%) know that CSA is a common problem worldwide. Fifty-five studies from 24 countries were included. Prevalence estimates ranged from 8 to 31 % for girls and 3 to 17 % for boys, the study came out with two important conclusion; first is the popularity of the problem in different countries; second is the inconsistent tools for addressing the problem [2]. Almost similar findings were revealed in one of the Gulf countries (Kuwait), through a cross sectional survey on youth aged (mean age 17 years); about 17.4% experienced some sorts of sexual abuse; most of the perpetrators were members of the extended family [14].

Despite that few minorities of the parents in the current study pointed to the familiar persons exclusively as the most likely to sexually abuse children, however, almost one half of them (49.1%) expressed that familiar and acquaintance persons are equally the same. The picture was more clear in USA, where it was found that almost 95% of the sexual abuse of youngsters is done by family members, those who work with children, or those who know them; and strangers formed about five percent of the reported documented cases [15]. Although that the children claim should be taken seriously when disclosing such situations; current study showed that only 37.5% of the parents indicated that, in most instances, they should believe children who report that they had been sexually abused. This neglect of the claim of the children would have several consequences, for example in USA, it was reported that 84% of sexually abused children was unreported.

This is because many parents either hesitated or do not want their child labeled as a survivor of sexual abuse and makes the decision to deal with it privately rather than involve law enforcement [15]. Moreover, underreporting could be explained by the notion that most of the molesters are familiar person or one of the family members.

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13. Al-Fayez GA, Ohaeri JU, Gado OM. Prevalence of physical, psychological, and sexual abuse among a nationwide sample of Arab high school students: association with family characteristics, anxiety, depression, self-esteem, and quality of life. Social psychiatry and psychiatric epidemiology. 2012;47(1):53-66.

14. Ohaeri JU, Al-Fayez GA. Child sexual abuse data from an Arabian Gulf country revisited. Guest editorial. 2013;10(4):84.

15. Friedman N. Child sexual abuse prevention: a critical role of parents. Caming magazine. 2010;5(3).
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