Identification Of Child Abuse Research Articles

Protocolized abuse screening to decrease provider bias and increase capture of potential events

BackgroundEarly identification of child abuse is critical to prevent death and disability. Studies suggest implicit bias of providers may lead to overrepresentation of minority and impoverished children in child abuse reporting. At our institution, universal screening for sexual and physical abuse for all children under 18 years of age was implemented in 2016. A rigorous, objective evaluation protocol focusing on the mechanism of injury and exam findings to improve recognition and eliminate bias was implemented in 2019.FindingsDemographics and clinical characteristics of patients less than 18 years of age were abstracted by chart review (2014–2015) and from a forensic database (2016–2022). International Classification of Diseases codes 995.5 (version 9) and T76.12XA (version 10) were used to identify patients before the establishment of forensic database. Relative frequency and patient characteristics of the three time periods (pre universal screening: 2014–2015, post universal screening: 2016–2019, post protocol implementation: 2020–2022) were compared using Chi-square tests and modified Poisson regression. Universal screening significantly increased the number of cases identified. The demographic profile of potential victims by race significantly changed over the reporting periods with an increased number of white children identified, consistent with state demographics. The proportion of publicly insured patients trended down with universal screening and protocol implementation, despite a significant increase in the number of children publicly insured in the state during this time.ConclusionThese single institutional results lend support to objective, evidence-based protocols to help eliminate bias surrounding race and poverty.

Identification of Child Abuse and Neglect Based on the Perception of Training Physicians in Jeddah, Saudi Arabia.

Introduction Child abuse and neglect (CAN) affects many countries, including Saudi Arabia (SA). CAN in SA is more commonly detected in hospitals. Therefore, healthcare professionals must identify and report the cases. This study aims to assess knowledge and perceptions toward CAN among training physicians. Methodology A cross-sectional survey was conducted through a self-administrated structured questionnaire and involved 123 residents and fellows who deal with children in Jeddah, SA. The participants were recruited using convenient sampling methods. Descriptive statistics, t-test, and Chi-square test were used for statistical analysis. Results We found that approximately 78% would report their findings to the legal authority, document them, and assess their consistency with parents and the child's explanation. However, only 41.5% of the participants would report CAN to the proper authority. Most participants believed that CAN should be redefined according to Saudi culture and religious standards. In contrast, 68.9% of the participants believed that CAN cases are under-reported in SA. The main barrier to not reporting is the fear of consequences (63.4%). About 77% of the participants agreed to the need for further training. Identifying the CAN indicators was higher among those who handled a CAN case previously (median = 66.67, p = 0.023). Conclusions In conclusion, the study showed that appropriate undergraduate and postgraduatecurriculum training should be developed to strengthen future healthcare practitioners in dealing with CAN cases to protect children's welfare.

Psychosocial Traumatic Environments: A Clinical Case of Childhood Abuse

Traumatic psychosocial environments directly impact adult life. Compromised self-esteem, emotional self-regulation, and interpersonal relationships are observed, and a predisposition to the presence of mental and personality disorders is exacerbated in cases of sexual abuse. Science has presented quantitative and statistical studies on child abuse and a limited number of studies that have investigated the consequences and long-term impacts on the lives of individuals who suffered maltreatment in childhood and did not have access to forms of protection or social support after the identification of child abuse, especially in Brazil. Therefore, this case report is a qualitative study of an ideographic nature which aims to evaluate the “particular” form of abuse repercussions in the life of a 60-year-old woman, giving voice to the victim of child abuse through the process of the investigation and complex analysis of her life history and family relationships. The psychological assessment protocol included a semi-structured interview, active listening, a genogram, and a mental status examination. The results reveal the coexistence of a rigid and violent environment with the presence of physical punishment and child sexual abuse. Self-injurious episodes and suicide attempts began in adolescence. Changes in mood, changes in remote memory, negative thoughts, self-injurious behavior, suicidal ideation and attempts, clinical comorbidities, a lack of interest in romantic relationships, and the repetition of behaviors that perpetuate the cycle of abuse and violence (physical, psychological, and patrimonial) were identified. The diagnostic criteria for bipolar disorder with dependent and borderline personality traits have been established. The case requires a multi-disciplinary follow-up with the use of medication to control and remit the symptoms.

Child abuse: knowledge, awareness, and experience among dentists in India

BackgroundMedical child abuse and neglect are part of a spectrum of conditions that can lead to significant morbidity and mortality in children. Recognition of these forms of child maltreatment is crucial to prevent harm. Dentists should have familiarity with the framework for diagnosing and reporting child abuse as the orofacial complex is the prime anatomical region to show any signs of abuse. AIM: The purpose of this cross-sectional study was to assess the knowledge, awareness, and experience of dentists in India on child abuse and their role as primary responders. METHODS: A self-administered questionnaire comprising 16 questions was distributed among dentists in India and responses were collected. The questionnaire included questions on the knowledge, awareness, and experience of dentists in child abuse identification, reporting, legal proceedings, and proposals for the betterment of the current scenario. The data collected were statistically analyzed.ResultsA total of 203 dentists responded to the questionnaires through online platforms. Among them, 78.3% were females, and 65.3% had an institutional practice. While the majority (72.4%) were confident in identifying the indicators of child abuse, the knowledge on reporting was alarming. 98% of participants expressed their need for comprehensive education and training.ConclusionThe gap between the knowledge about indicators and the confidence to report suspicious cases are notable in this study. Adequate interventions in the hour of need require the involvement of support agencies and funding at both government and local levels.

Recognizing Nonaccidental Trauma in a Pediatric Tertiary Hospital: A Quality Improvement Imperative.

The quality improvement (QI) team created hospital guidelines for suspected NAT, including age-based recommendations (care bundle). The team embedded an order for NAT evaluation into the electronic health record (EHR). The QI team provided education on child abuse identification and evaluation across the hospital. Hospital providers received written guides focused on enhancing communication with families. Outcome measures included monthly NAT bundle use and cases between incomplete bundles in children with suspicious injuries. Chart review of incomplete bundles helped accurately identify patients who needed NAT bundles and improved accurate NAT bundle completion for appropriate patients. Appropriate NAT bundle completion increased from 31% during the baseline period in January 2019 to 100% in April 2020 and remained at 100% for the remainder of the study period, ending June 2021. The number of patients between missed bundles was 11 from August 2019 until March 2020, when it increased to 583. There were no missed bundles from March 2020 through June 2021. Standardizing NAT evaluation and creating a NAT care bundle to facilitate the appropriate evaluation preceded an increase in appropriate bundle completion in patients <7 months old with possible NAT in the PED and inpatient units.

Identifying what works for whom: Implementation outcomes following iLookOut, a child abuse identification and referral training program.

iLookOut, a web-based child abuse training for early childcare professionals (ECPs), has been shown to improve knowledge and attitudes related to correctly identifying and reporting suspected cases of child abuse. The overarching goal of the present study is to examine "what works for whom" for iLookOut in order to identify strategies for optimizing learner outcomes. This prospective study enrolled 12,705 ECPs who completed iLookOut (November 2014-December 2018). We used structural equation models to test whether learner demographic and professional characteristics were differentially associated with implementation outcomes (i.e., acceptability and appropriateness) and whether these mediated subsequent indicators of training effectiveness (i.e., gains in knowledge). Consistent with previous research, individuals with lower baseline knowledge scores showed greater knowledge gains (β = -.57; p < .001). Greater knowledge gains were seen for learners who reported higher acceptability (β = .08; p < .001) or appropriateness (β = .14; p < .001). Implementation outcomes strongly associated with knowledge gains included acceptability for female learners and appropriateness for learners who had not completed high school or had >15 years of experience in childcare settings. Where mediation was found, for the majority of groups, appropriateness emerged as the driving mediator. Implementation outcomes emerged as important drivers of knowledge change for most groups. The iLookOut Core Training's use of a multimedia learning environment, video-based storylines, and game-based techniques were endorsed by learners and correlated with increases in knowledge. Future work should explore why aspects of the iLookOut training are rated as less acceptable or appropriate by some groups and what changes would improve efficacy for low performing learners.

Disparities in detection of suspected child abuse

BackgroundChild abuse is a significant cause of injury and death among children, but accurate identification is often challenging. This study aims to assess whether racial disparities exist in the identification of child abuse. MethodsThe 2010–2014 and 2016–2017 National Trauma Data Bank was queried for trauma patients ages 1–17. Using ICD-9CM and ICD-10CM codes, children with injuries consistent with child abuse were identified and analyzed by race. ResultsBetween 2010–2014 and 2016–2017, 798,353 patients were included in NTDB. Suspected child abuse victims (SCA) accounted for 7903 (1%) patients. Of these, 51% were White, 33% Black, 1% Asian, 0.3% Native Hawaiian/Other Pacific Islander, 2% American Indian, and 12% other race. Black patients were disproportionately overrepresented, composing 12% of the US population, but 33% of SCA patients (p < 0.001). Although White SCA patients were more severely injured (ISS 16–24: 20% vs 16%, p < 0.01) and had higher in-hospital mortality (9% vs. 6%, p = 0.01), Black SCA patients were hospitalized longer (7.2 ± 31.4 vs. 6.2 ± 9.9 days, p < 0.01) despite controlling for ISS (1–15: 4. 5.7 ± 35.7 vs. 4.2 ± 6.2 days, p < 0.01). In multivariate regression, Black children continued to have longer lengths of stay despite controlling for ISS and insurance type. ConclusionsUtilizing a nationally representative dataset, Black children were disproportionately identified as potential victims of abuse. They were also subjected to longer hospitalizations, despite milder injuries. Further studies are needed to better understand the etiology of the observed trends and whether they reflect potential underlying unconscious or conscious biases of mandated reporters. Type of studyTreatment study. Level of evidenceIII.

Legislating Mandatory Reporting of Child Abuse in India and China: A Divergence of Legislative Choice

Mandatory reporting is used as a tool for early identification of child abuse by countries around the world. However, there is variation in terms of the legislative models followed. The two models most commonly followed are universal mandatory reporting and stakeholder specific mandatory reporting. India and China joined the bandwagon and introduced legislation on mandatory reporting over a decade ago. While India has adopted the ambitious model of universal mandatory reporting, China has taken a more incremental and experimental approach with stakeholder-specific mandatory reporting. The paper aims to differentiate the legislative approaches taken by the two countries for introducing mandatory reporting for child abuse, by delving into the legislative history, legislative provisions, and implementation challenges for mandatory reporting in both jurisdictions. The paper does not comment on the sanctity of mandatory reporting, but is limited to a comparative analysis of the legislative strategies taken by India and China.

Providers Assessing Child Abuse and Neglect

Providers Assessing Child Abuse and Neglect

Screening Tools for Child Abuse Used by Healthcare Providers: A Systematic Review.

The early detection of child abuse is essential for children at risk. Healthcare professionals working at hospitals and in the community are often the first to encounter suspected cases of child abuse. Therefore, an accurate identification of child abuse is critical for intervention. However, there is no consensus on the best method to screen for child abuse. This systematic review was designed to evaluate the relevant psychometric properties and critically appraise the methodological quality of child abuse screening tools used by healthcare providers with children less than 18 years old. We searched the Cochrane Library, MEDLINE, Embase, CINAHL, Education Resources Information Center, PubMed, Airiti Library, and OpenGray databases for studies on screening tools used to identify abuse in children published through October 2019 in English or Chinese. Information regarding populations, assessment methods, and accuracy parameters were extracted. Study quality was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments checklist and Grading of Recommendation, Assessment, Development, and Evaluation criteria. Nine hundred thirty-nine abstracts and 23 full-text articles were reviewed for eligibility, and 15 screening tools for child abuse used by healthcare providers were identified. Screening tools often assess the presence of more than one form of abuse, but no single tool covered all forms. Of these, 10 tools screened for a single, discrete type of abuse, including nine physical abuse screening tools (three abusive head trauma tools) and one sexual abuse tool. Eighty percent (n = 12) of the screening tools had a moderate-to-high quality of evidence based on the Grading of Recommendation, Assessment, Development, and Evaluation criteria. However, none of these screening tools achieved an adequate level of evidence based on the COnsensus-based Standards for the selection of health Measurement INstruments checklist. In this systematic literature review, 15 assessment tools of child abuse used by healthcare providers were identified, of which nine screened for physical abuse. Screening tools must be valid, succinct, user-friendly, and amenable for use with children at every point of care in the healthcare system. Because of the paucity of informative and practical studies in the literature, findings related to the quality of child abuse screening tools were inconclusive. Therefore, future research should focus on the use of screening tools in the healthcare system to identify effective screening interventions that may help healthcare providers identify child abuse cases as early as possible.

Child Abuse Screening in the Emergency Department Before and After Implementation of a Formal Screening Tool

Background: &#x0D; Child abuse and neglect is a leading cause of mortality and morbidity in children. Victims of abuse often present to emergency departments due to these injuries. Early identification of suspected child abuse by emergency department staff allows the opportunity for intervention prior to a devastating injury. Signs of child abuse can be subtle and may not always be identified. Recent efforts have worked to improve suspected child abuse identification by implementation of validated screening protocols. Specifically, the IU Health Riley Emergency Department has recently implemented a new child abuse screening tool (effective on 15Apr2021). The Covid-19 pandemic has further exacerbated this issue, creating social isolation and additional socioeconomic stressors that contribute to child abuse. &#x0D; Method: &#x0D; A retrospective chart review was conducted to analyze patients identified for child abuse evaluation in the Riley emergency department. Patients prior to the implementation of the screening tool were identified by those undergoing a social work evaluation for child abuse. For patients presenting after implementation of the screening tool, all patients with a positive screen were reviewed. Charts were then reviewed for baseline demographics, diagnostic testing performed, and injuries identified. All data was recorded in an electronic Redcap database. &#x0D; Results: &#x0D; Implementation of a formal screening tool increased the number of patients identified for a child abuse evaluation (1.34% vs 3.17%) and those evaluated who had an injury also increased (1.15% vs 1.81%). More patients received a head CT scan after implementation of the screening tool (0.89% vs 1.07%), while the percentage of patients with an abnormal head CT decreased (62% vs 45%). &#x0D; Conclusions: &#x0D; Implementation of a formal screening tool for child abuse in the emergency department successfully improved identification of patients that should be further evaluated for child abuse. These results may be used to support implementation of the tool in additional emergency departments.

Experience with outreach services of a multidisciplinary team for child abuse identification

Identifying child abuse is sometimes challenging due to its various presentations. To facilitate timely identification of critical or complex cases of physical abuse outside our child protection center, we established an outreach multidisciplinary team (OMDT) to support Kaohsiung City Government in 2014. The objective of this study was to describe our experience of OMDT services during a 6-year period and examine its role in assisting law enforcement. We retrospectively analyzed all OMDT cases from January 2014 to January 2020. Clinical characteristics and OMDT reports were reviewed. After inspection by our OMDT, cases were determined as indicating either a high risk or low risk of child abuse. Associations among clinical characteristics, radiographic findings, OMDT decisions and case outcomes including law enforcement and prosecution were examined. Thirty-two cases (22 [68.8%] males and 10 [31.2%] females; mean age 24.2 months) received OMDT service, of whom 28 (87.5%) were admitted to the pediatric intensive care unit. The victims had an average of 2.2 types of wounds in 3.4 locations. The most common finding on radiography was subdural hemorrhage (18, 56.3%), followed by subarachnoid hemorrhage (31, 31.3%). Law enforcement was activated in 20 (64.5%) cases, and was only associated with the high-risk group as determined by the OMDT (p<0.05) but not with any other variables. Our experience indicates that an OMDT can play an important role in child protection and activating law enforcement for children with complex or critical physical abuse. We suggest that in Taiwan, OMDT services should be incorporated into child protection centers, National Health Insurance system and governmental child protection policies.

A randomized control trial of a child abuse mandated reporter training: Knowledge and attitudes

BackgroundDespite being well-positioned to identify maltreatment in the children that they provide care for and being legally required to report suspected child maltreatment, early childhood professionals (ECPs) make a limited proportion of reports to child protective services. It is critical to identify evidence-based interventions to improve the reporting practices of this group of mandated reporters allowing for the better protection of children from maltreatment. ObjectiveThe goal of the present study was to determine if iLookOut, an online child abuse identification and reporting training for ECPs, results in differential gains in knowledge and attitudes towards child abuse and its reporting among ECPs, as compared to an online standard training. Participants and settingBoth interventions were completed online by participants recruited from licensed child care programs in Southern Maine from October 2017 to January 2020. Eligibility criteria included being at least 18 years of age, English-speaking, and working as paid or volunteer staff at a licensed child care program taking care of children 5 years of age or younger. Of the 1152 enrolled individuals, 1094 provided complete pre- and post-intervention data. MethodsA randomized controlled trial comparing iLookOut with an online standard training. ResultsECPs who completed iLookOut significantly outperformed those who completed Standard mandated reporter training in terms of both knowledge (d=1.09 vs. 0.67) and attitudes (d=0.67 vs. 0.54) relative to pre-test scores. ConclusionsiLookOut is a promising candidate for widespread use in meeting the need for evidence-based training on child abuse and its reporting.

Exploration of Ghanaian radiographers’ reporting of suspected physical abuse amongst children

IntroductionThe success of the child protection process is dependent on rapid actions by healthcare professionals who encounter a child in possible need of protection and make appropriate referrals to statutory agencies. Clear rules that promote inter-professional working among health professionals is necessary to enhance child protection. AimTo explore the internal factors leading to bystander attitude towards reporting of suspected physical abuse amongst Ghanaian radiographers. MethodsTwenty radiographers across Ghana who have encountered suspected child physical abuse during practice interviewed. Data was collected using qualitative methodology using semi-structured interviews. Participants were radiographers who were selected using purposive sampling. Data was thematically analysed and managed with NVivo version 10. Themes developed formed the basis of the discussion. ResultsParticipants reported barriers such as training deficits, lack of knowledge in reporting regulations, and the absence of a framework or structures in place to guide suspected physical abuse (SPA) management. The results showed that the majority of participants were ignorant of the role of the social worker in identified cases of SPA. Additionally, there was no teamwork in the majority of the hospitals in the management of suspected physical abuse. ConclusionsParticipants’ behaviour towards child protection was congruent with the situation where an individual would assess the consequences of an action. Fear, lack of direction and collaboration characterised the management of suspected physical abuse. Implication for practiceThe timely identification of child abuse is key to providing the necessary intervention for the child. However, the mere identification of abuse would be of no use to the child when no action was taken by radiographers handling the case as a result of impediments on their way.

Kindeswohlgef\xe4hrdung \u2013 Ausweitung des Hellfeldes durch Neukonzeption der klinischen Kinderschutzarbeit

ZusammenfassungHintergrundDas Erkennen von Kindesmisshandlungen und der Umgang damit sind Herausforderungen im ärztlichen Alltag. Die Dunkelziffer bei Misshandlungen und Vernachlässigungen ist hoch.Ziel der ArbeitDas Ziel der Arbeit war, die Effektivität des neu strukturierten Kinderschutzprogrammes einer großen deutschen Kinderklinik zu untersuchen und durch die Präsentation der Vorteile der neuen Struktur die Verbesserung von Programmen für Kinder und Mediziner in anderen Kliniken anzuregen.MethodeEs wurden retrospektiv alle Kinderschutzfälle im Altonaer Kinderkrankenhaus vor und nach Neukonzeption der Kinderschutzarbeit über einen Zeitraum von jeweils 2 Jahren untersucht und miteinander verglichen. Die Kinderschutzgruppe war neu strukturiert worden und wurde nachfolgend von einer hauptamtlichen Kinderschutzkoordinatorin geleitet.ErgebnisDie Prävalenz der Verdachtsfälle und der erhärteten Fälle von Kindeswohlgefährdung ist im Untersuchungszeitraum nach Neukonzeption hoch signifikant erhöht. Im Zeitraum vor der Neukonzeption wurden 24 Fälle mit dem Verdacht auf Kindswohlgefährdung untersucht, 23 erhärtet, danach 124 Fälle untersucht, 89 erhärtet. Eine Stigmatisierung der Familien bei der Abklärung wurde trotz des signifikanten Anstiegs falsch-positiver Verdachtsfälle durch sensibles Vorgehen und eine Konfrontation erst bei Erhärtung des Verdachtes vermieden.SchlussfolgerungDas vorgestellte Konzept zum medizinischen Kinderschutz in Kinderkliniken scheint das Hellfeld bei Kindeswohlgefährdung effektiv auszuweiten. Sowohl die Reduktion nichtdetektierter Fälle mit der Verhinderung potenzieller Eskalation mit prolongiertem Leidensweg als auch die Verminderung der immensen gesellschaftlichen Folgekosten rechtfertigen die personellen Investitionen.

Child abuse and the role of a dentist in its identification, prevention and protection: A literature review

Child abuse, a reprehensible act, pervades all strata of society. Dentists are more likely to encounter such cases in their daily practice. However, such cases usually go unreported due to lack of adequate knowledge. Practitioners flinch from reporting these due to various reasons, and this sets up a vicious cycle which traps the victim leading to grave long-term consequences. This review aims to collect all literature available on PubMed, PubMed Central, MEDLINE, Google Scholar, and Google search engines on the role of dentists in child abuse identification and information and summarize these details. The review will shed light on the identification of abuse in dental settings, the various legal recourses and organizations related to it, and how dentists can better equip themselves to tackle such cases if they come across one. The review also makes certain recommendations by which dentists and healthcare providers in general can better prepare themselves for such contingencies.

Knowledge, Awareness and Practices of Forensic Dentistry: A Questionnaire Study among Dental Personnel Practicing in Bhimavaram Town, South India

Aims: The aim of study is to assess the knowledge and awareness on forensic odontology among dentists in Bhimavaram town Method and Material: A structured questionnaire comprising of 14 close ended questions (Sharma et al 2015) with slight modifications, validated through a pilot survey was distributed among 100 dentists residing at Bhimavaram town and were assessed. The questions were about importance of dental records and their maintenance, identification of child abuse or bite marks, importance of dental witness in the court of law for person identification and interest among dentists to learn about forensic odontology. Results: This present study showed that 90.9% MDS participants and 77.7% BDS participants were maintaining their dental records in their dental practice, though 94.5% MDS and 75.5% BDS were aware about forensic dental witness, only 1.8% of MDS participants were called by court of law for forensic evidence. Only 7.2% of MDS participants were trained and confident in handling forensic related cases. Conclusions: The results show that knowledge and awareness about forensic dentistry among BDS and MDS individuals are in primitive stage. However very few members of participants were trained in forensic dentistry which suggests that practice of same is to be progressed in Bhimavaram town.

Child abuse and physical health: A population-based study on physical health complaints among adolescents and young adults.

Aims: To investigate whether adolescents and young adults with a history of child abuse had more physical health complaints compared to their unexposed peers. We also aimed to estimate associations between different child abuse types with physical health complaints and associations between the number of child abuse types and physical health complaints. Methods: This population-based telephone survey over two waves included 506 adolescents and young adults exposed to child abuse and 504 non-abused peers aged 16-33 years. We applied linear regression analyses to investigate associations between child abuse types and physical health complaints, unadjusted and mutually adjusted for co-occurring abuse, and to investigate how the number of child abuse types associated with physical health complaints. Results: Participants exposed to child abuse reported significantly more physical health complaints. The child abuse types strongly co-occurred. When adjusting for co-occurring child abuse, only sexual and emotional abuse were significantly associated with physical health complaints. Physical health complaints increased with the higher number of child abuse types experienced. Conclusions: Our findings suggest that exposure to abuse, particularly sexual and emotional, during childhood predicts physical health complaints in adolescence and early adulthood. In a public health perspective, early identification of child abuse may be beneficial in preventing physical health complaints later in life.

Forensic odontology acquaintance among the students of a dental institution in Mysore City, India

Background: Forensic odontology utilizes the dentist's knowledge to serve the judicial system. It has itself as an important indispensable science in medicolegal matters and in particular in personal identification, gender determination, and age estimation. It plays an important role in mass disasters, child abuse, bioterrorism, etc. Taken together, forensic dentistry has become one of valuable tools worldwide to be used in identification processes.Objective: To evaluate the knowledge about forensic odontology among the students of a dental institution.Methodology: A cross-sectional study was conducted among final year, interns, and postgraduate students of JSS Dental College and Hospital, Mysuru. A self-administered, structured questionnaire written in English and validated through a pilot survey was given to all available and willing student participants. Questionnaire included significance of dental records, dental age estimation, identification of child abuse and individuals bite marks, as a witness in the court, lip prints along with the demographic data.Results: In the present study, 67% of the participants responded that DNA comparison was the most accurate method for person identification. About 27.3% responded tooth dimension and tooth morphology was the most accurate method of dental age estimation in elderly. Moreover, 89.1% reported their present knowledge level/awareness about forensic dentistry was not adequate.Conclusion: Forensic odontology must be introduced into the BDS curriculum effectively as a separate subject so that the students get well acquainted with the required knowledge for handling the medicolegal cases in their future practice.

A critical review of child abuse and its management in Africa.

IntroductionChild abuse in Africa is a major threat to the achievement of the sustainable development goals on the continent and has become increasingly topical with a dramatic increase in recognition and an appreciation of the long term harmful effects on the affected population. The aim of this review was to outline current management of child abuse (especially sexual abuse) and highlight current preventive practice that could be beneficial in a resource-limited environment.MethodsA search of Medline and reference lists of the literature on child abuse in African countries and relevant world literature was conducted in December 2016. The review was written narratively, rather than systematically as a general overview was desired, instead of a focused view of individual aspects of child abuse.RecommendationsOpportunities for early identification of child abuse, as well as research into preventative strategies should be prioritised. Establishing strong institutions and guidance to tackle abuse when it occurs is both beneficial to the survivors and the continent at large.