Prevalence of child abuse/maltreatment and its associated factors among children aged 11 to 17 years in community settings of Karachi, Pakistan,

Harsh disciplinary practices are considered common in developing countries. However, scientific evidence lacks to support this. The primary aim of this study was to determine the total prevalence and subtypes of different forms (physical, emotional maltreatment and neglect) of child abuse and maltreatment in Karachi, Pakistan and to determine the associated factors following Belsky model at individual, relationship and community level. Method: A cross sectional survey of 800 dyads (children ranging from 11-17 years old and their parent) were selected from 32 clusters of Karachi, using multistage cluster sampling between December 2014 to March 2015. A structured questionnaire adopted from International society of child abuse and neglect (International child abuse screening tool for Parent: mother & father and Child). Prevalence of child maltreatment was estimated by mean child abuse score. Multiple linear regression technique (MLR) was used for analysis. Means with standard deviation were reported for continuous variables and for categorical variables, frequencies with percentages were calculated. B coefficients with 95% confidence interval were stated for significant associations. Results: Out of 800 participants dyads (800 parent and 800 children), 25 dyads were recruited from each study site. Mean score were 51.7+11.9 (child), 77.9+20.2 (mother) and 63.6+17.3 (father). Both parent and child responses revealed similar prevalence (43%) of child maltreatment. The mother\u27s responses showed a prevalence of physical (42%), emotional (50%) maltreatment and neglect (5.4%) whereas, father\u27s responses showed a prevalence of physical (39%), emotional (46%) maltreatment and neglect (9.7%). The child\u27s experiences showed a prevalence of physical (49%), emotional (50%) maltreatment and neglect (57%). A substantial proportion of participants were exposed to atleast one form of maltreatment on mother (58%), father (54%) and child (74%) responses, of which all three maltreatment forms experienced by children were 4%, 9% and 31% on mother, father and child responses respectively. With every one year increase in age of child, the mean estimated ICAST-Child score decreases by 0.638 (95% CI: - 1.002, -0.273). Children who are always bullied and mistreated by their siblings are at increased risk of getting maltreatment by parents (adjusted beta: 10.770 (95% CI: 8.801, 11.598)). Among children\u27 home environment where there is always verbal abuse and quarrel within family members, the mean estimated ICAST-Child score increases by 9.736 (95% CI: 7.133, 12.338). Moreover, among children who have no formal education, the estimated mean ICAST-Child score is 5.432 higher (95% CI: 2.540, 8.324). The mean estimated ICAST-Child score increases by 5.081 among male child as compared female child (95% CI: 3.786, 6.375). Among children whom parents have psychiatric illness, the estimated mean ICAST-Child score is 1.236 higher (95% CI: 0.063, 3.077). The mean estimated ICAST-Child score increases by 2.951 among children who belong to low socioeconomic wealth index (95% CI: 1.102, 4.880). Among middle ordered child, the estimated mean ICAST-Child score is 1.884 higher than first ordered or only child of family (95% CI: 0.336, 3.431). There is an interaction between parental exposures to childhood abuse and physical fighting with hard object among family members. Among children whom family always fight with each other and parents have exposure to childhood maltreatment, the mean estimated ICAST-Child score increases by 13.746 (95% CI: 7.193, 20.298). There is an interaction between age of mother and parental education. The estimated mean of ICAST-Child score increases 2.169 times for every 10 years increase in age of mother among children whom both formal have no formal school education as compared to children whom both parents have formal education. Conclusion: This study reflects hidden extent of child maltreatment and poly-victimization in Karachi. Our findings provide evidence to raise public awareness about malpractices and highlight the need to develop positive parenting program