Household illness,poverty and physical and emotional child abuse victimization: Findings from South Africa's first prospective cohort study

Department of Social Policy and Intervention

Household illness, poverty and physical and emotional child abuse victimization: Findings from South Africa’s first prospective cohort study

Meinck, F; Cluver, L & Boyes, M

Department of Social Policy & Intervention“Child Abuse in Families affected by AIDS”

Please cite or re-use presentation only with permission of the authors.

Background

Large burden of disease in South Africa (5) Correlation between violence and poor health (6) Association between household illness and child

maltreatment (7) Children in families where someone is ill with AIDS are

at higher risk for Poverty (Cluver et al 2008) Bullying (Cluver et al 2010) Stigma (Surkan et al 2010) Reduced positive parenting (Lachman et al 2013) Physical and emotional abuse (Cluver et al 2011)

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Background continued

Children affected by chronic illness are at higher risk for Less positive parenting (Evans et al, 2005) Negative family functioning (Steele et al, 1997) Poverty (Cluver et al, 2013)

Family poverty and disability is associated with Increased psychological stress (Kuo et al, 2012) Reduced positive parenting (Lachman et al, 2013) Poorer mental health (Kagotho & Ssewamala, 2012) Child conduct problems (Lewis & Hammond, 1996)

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Aims

Is household chronic illness predictive of child abuse?

Are there differences in risk for child abuse victimisation according to type of household illness?

Are these relationships mediated by other factors, namely poverty and disability?

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Research to inform policy

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Collaborative OVC research

programme

Universities: Oxford, Wits, UCT, UKZN

NACCA, NGOs e.g. UNICEF,

REPSSI, Save the Children



Methodology

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National study of Young Carers in AIDS-ill homesInterviewed 3516 children in 2 Provinces, Followed up 3401 children (97%) at T2, 1095 (31.2%) of them AIDS-affected 482 (13.7%) other chronic illness

Sampling

4 Health Districts, randomly selected Census Enumeration Areas, Door-to-door sampling in areas with HIV-

prevalence 30%+Measurements

Physical & Emotional Abuse: UNICEF measures for national level monitoring of OVC

Sexual Abuse: Items from Juvenile Victimization Questionnaire

All other items: measures validated or used in SA



Study sites

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Child abuse definition

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PHYSICAL ABUSE EMOTIONAL ABUSE SEXUAL ABUSE

any hitting, slapping or smacking with items or hands which hurt or left marks, or pulling hair or ears

any insults towards child or family, making child feel unwelcome, threatening child

inappropriate touching of sexual organs, having to touch other’s genitals, or forced sex

monthly or more frequently

monthly or more frequently

In the last year



0

5

10

15

20 18.2 19.216.6

20.7

5.9

BaselineFollow-up

% o

f ch

ildre

n re

port

ing

abu

sePrevalence rates of frequent physical and

emotional abuse

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Physical, emotional and sexual abuse according to family health status for boys

Physical Abuse Emotional Abuse Sexual Abuse0

5

10

15

20

25

HealthyOther-illAIDS-ill

% o

f ch

ildre

n r

ep

ort

ing

ab

use

p<.001

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p<.001



Physical Abuse Emotional Abuse Sexual Abuse0

5

10

15

20

25


% o

f ch

ildre

n r

ep

ort

ing

ab

use

Physical, emotional and sexual abuse according to family health status in girls

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p<.001



Differences in poverty and extent of disability according to health status

Poverty Disability Poverty & Disability0

10

20

30

40

50

60

70


% o

f ch

ildre

n r

ep

ort

ing

po

vert

y a

nd

/or

hig

h

leve

ls o

f d

isa

bili

ty

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p<.001

p<.001

p<.001



AbuseAIDS-illness

Disability

Poverty

Hypothesized pathways

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Pathway from family AIDS to physical abuse for boys and girls

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AIDS-illnessFrequent

physical abuse

Disability

Poverty

Indirect Effect: .046* CI 95% (.019 to .083)

.641* CI 95%(.491 to .791)r2= .210

3.790* CI 95%(3.548 to 4.033)r2= .250

.071* CI 95%(.027 to .116)

.030* CI 95%

.004 to .055)

Direct effect:.276* CI 95% (.060 to .493)


-2LL = 2989.48

*significant at p<.05



Pathway from other chronic illness to physical abuse for boys and girls

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other-illnessFrequent

physical abuse

Disability

Poverty

Indirect Effect: -.027* CI 95% (-.057 to -.011)

-.368* CI 95%(-.573 to -.163)r2= .197

.637* CI 95%(.267 to 1.008)r2= .045

.074* CI 95%(.029 to .118)

.046* CI 95%(.023 to .068)

Direct effect:-.294* CI 95% (-.581 to -.007)


-2LL = 2991.44




Pathway from family AIDS to emotional abuse for boys

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emotional abuse

Disability

Poverty


.131* CI 95%(.066 to 1.97)

.018 CI 95%(-.019 to .055)

Direct effect:.409* CI 95% (.089 to .730)

Indirect Effect: .070 CI 95% (-.081 to .203)

.690* CI 95%(.460 to .920)r2= .234

3.867* CI 95%(3.487 to 4.247)r2= .262

-2LL = 1364.81




Pathway from other chronic illness to emotional abuse for boys

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emotional abuse

Disability

Poverty


.138* CI 95%(.073 to .203)

.040* CI 95%(.009 to .072)

Direct effect:-.077 CI 95% (-.472 to .317)


-.403* CI 95%(-.701 to -.104)r2= .220

.614* CI 95%(.063 to 1.164)r2= .065

-2LL = 1370.82




Pathway from family AIDS to emotional abuse for girls

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emotional abuse

Disability

Poverty


.600* CI 95%(.402 to .799)r2= .195

.092 * CI 95%(.041 to .143)

.017 CI 95%(-.014 to .048)

Direct effect:-.019 CI 95% (-.240 to .278)


3.727* CI 95%(3.413 to 4.042)r2= .243

-2LL = 2031.00




Pathway from other chronic illness to emotional abuse for girls

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emotional abuse

Disability

Poverty


-.343* CI 95%(-.626 to -.061)r2= .183

.093* CI 95%(.042 to .144)

.019 CI 95%(-.009 to .046)

Direct effect:.038 CI 95% (-.286 to .362)


.8645* CI 95%(.143 to 1.146)r2= .031

-2LL = 2030.97




Summary

High prevalence rates of child abuse across the different abuse types

Children affected by AIDS are at higher risk of physical and emotional abuse

Indirect effect of poverty and in cases disability for AIDS-ill families

Lower levels of poverty in families affected by other chronic illness

Negative indirect effect of poverty and positive indirect effect of disability in families affected by other chronic illness

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Implications

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Clear differences in risk for child maltreatment according to illness type

Importance of recognizing that illness does not equal illness when providing services to families with ill members

Effective poverty reduction may be key in reducing child abuse victimisation in AIDS-affected families

Parenting support my be key in reducing abuse in families affected by all types of illness



Thank you!

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The Economic & Social Research Council

The Nuffield Foundation

The National Research Foundation

The John Fell FundThe Claude Leon

Foundation

National Department of Social Development

HEARD, University of Kwa-Zulu Natal

[email protected]

Contact details:

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Household illness,poverty and physical and emotional child abuse victimization: Findings from South Africa's first prospective cohort study