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CHILD ABUSE IN KUWAIT PROBLEMS IN MANAGEMENT

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									 CHILD ABUSE IN KUWAIT
PROBLEMS IN MANAGEMENT

        DR. Wafaa Al Ateeqi

 FRCPCH , FRCP (Edin) , DCH (Ireland)
Consultant in Pediatrics - Al Amiri Hospital
Program Director, Faculty of Pediatrics- KIMS
Introduction

▪ Corporal punishment has always
  been a subject of controversy.
▪ It has been defined as the use of
  physical force to inflict pain but
  not injury for the purpose of
  correction or control of child’s
  behaviors.
▪Child abuse is a world wide problem
  that is often underreported.
▪ Incidence of child abuse has been on
  rise over the last three decades due to

    - Actual increase of cases
    - Increased awareness
    - Early recognition
Child abuse was first described by
Kempe in 1962 and composes:
▪ Physical abuse and neglect
▪ Sexual abuse
▪ Emotional abuse
▪ Munchausen syndrome by proxy
▪ Non organic failure to thrive
Its believed that the number of
reported cases represents a minority
of actual cases as the problem is
frequently underreported.
Little is known about the extent of
child abuse in the Arab world, and
limited to only few reports.
The first report in an Arab Gulf Council
Country was in 1987 from Kuwait.

El-Hait SAS, Mosa A, Victorin L: Non-accidental
injury to children in Kuwait.
J Kuw Med Assoc 1987; 21:268-278
Several reports followed from Saudi
Arabia (similar cultural and religious
background)
Objective

To explore the extent of child abuse in
 Kuwait and to highlight the difficulties
 associated with its management
Subject and Methods

A retrospective analysis of medical
records of two hospitals in Kuwait
(Al - Amiri and Mubarak Al- Kabeer )
 between 1991-1998
Abuse was suspected when the nature
of injury could not be explained as
caused by an accident
An underlying haematological disorders
was ruled out in all cases
Results

Of 60.640 medical records , only 16 children were
identified
▪ Nationality: Kuwaiti         5 (38 %)
               Non Kuwaiti    11 (62 %)

▪ Sex :       Female          5
              Male           11

▪ Age :       Less than 1 year      6
              1-5 years             7
              6-9 years             3
Type of abuse
▪ Physical abuse   13
▪ Sexual abuse      2
▪ Munchausen syndrome by proxy   1
Summary of findings in 13
children with physical abuse
Bruises at unusual sites   10 (77%)
Burns                       5 (38%)
Intracranial haemorrhage    5 (38%)
Fractures                   3 (23%)
Deep cut wounds             2 (15%)
Perpetrators

▪   Mother           7
▪   Father           4
▪   Babysitters      2
▪   Household         1
▪   Not identified    2
Home characteristics of the
abused children
▪ Divorce                        4 (25 %)
▪ Parental psychiatric illness   4 (25 %)
▪ Serious marital problems       3 (18 %)
▪ Other disadvantageous          5 (32 %)
  home situations
Outcome in 16 children
   with child abuse
▪   Successful intervention   7 (44%)
▪   Lost follow-up            6 (38%)
▪   Emigrated                 1 (6%)
▪   Died                      2 (12%)
Interventional methods involved
paediatrician, social worker and in
some cases psychiatrists and the
police department.
Successful is defined that after
intervention, the child was returned to
the biological parents or alternative
home with cessation of abuse on
follow-up
Case 1

▪ An 18 month – Kuwaiti - male
▪ Bruises on face with fingers marks on
  face and back
▪ Cigarette burns on the hands
▪ Fracture right humerus ( Al Razi hospital)
▪ Discharged against medical advice after 24 h
▪ Abuser : ? father
Case 2

▪ A 9 month – non- Kuwaiti - male.
▪ Convulsions, right facial palsy, retinal
  haemorrhage.
▪ CT Scan head: subdural ,subarachnoid
  bleed
▪ Abuser: babysitter
▪ Missed the follow-up
Case 3
▪ A 40 days – Kuwaiti – female
▪ Convulsion, apnoeic episodes
▪ CT scan head: intracranial
  haemorrhage
▪ Admitted several time with convulsions
▪ Developmental delay
▪ Abuser: Mother
▪ Successful follow-up
Case 4

▪ A 3.5 year - non- Kuwaiti - male .
▪ Bleeding per rectum and painful
  defecation , perianal lacerations ,
  edema and patulous anus
▪ Low socioeconomic class and unstable
  marriage .
▪ Abuser : adult living in the same house
Case 5

▪ A 2.5 year -non- Kuwaiti - female .
▪ Recurrent vaginal discharge due to
  gonococcal infection .
▪ Parents working night shifts , large
  family household .
▪ Parents refused legal investigations .
▪ Abuser : unknown
Case 6

▪ A 20 month - non - Kuwaiti - male
▪ Recurrent admission to different
  hospitals with recurrent mouth ulcers ,
  granuloma of the tongue , dysphagia
  and pneumonias
▪ Admitted several time to ICU with
  severe mouth ulcers and unexplained
  acidosis
▪ The mouth lesions improved in the
  hospital and recur after discharge
▪ Admitted with severe oesophageal
  burns and fatal aspiration pneumonia.
Abuser : mother , using FLASH
In the sacred law of Islam all form of
frank abuse are unacceptable, yet
disciplinary physical punishment is, on
limited number of occasions,
permissible.
It should not exceed a minimal force
and there should be no bruises.
According to these criteria, all of the 16
children reported in this study suffered
unacceptable child abuse
Conclusions

▪ Child abuse is problem that is growing in
   its extent and complexity
▪ The number of child abuse cases reported
   in this study is a gross underestimate of the
   actual size of the problem.
▪ There are no clear guidelines for health
  professionals.
In Kuwait, parents, the perpetrators in
75% of our cases, have the full
authority to refuse admission and to
discharge their children before the
diagnosis and management.
▪ Temporary or permanent exclusion of
 a child from an abusive environment is
 the central issue in child protection.
▪ Adoption and fostering are acceptable
  in West countries
▪ In Islamic law is not acceptable
Recommendation for Health
Professionals
▪ High index of suspicion and the
  possibility of abuse should always be
  considered
▪ Child abuse should be reported
▪ Child protection register
▪ Urgently need to establish guidelines
  and legislation
Child Abuse in Kuwait: Problems in
Management

Wafaa Al Ateeqi,Issa Shabani, Aida Abdulmalik

Medical Principles and Practice 2002;11:131-135
Acknowledgement
Prof. Azza Shaltout
Dr. Faisal El-Khuffash

								
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