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Infanticide and illegal infant abandonment in Malaysia

Razali S, Kirkman M, Ahmad SH, Fisher J

Child Abuse Negl, 2014 Oct;38(10):1715-24.
PMID: 25048164 DOI: 10.1016/j.chiabu.2014.06.008

Infant abandonment and infanticide are poorly understood in Malaysia. The information available in the public arena comes predominantly from anecdotal sources. The aim of this study was to describe the prevalence and characteristics of infanticide and illegal infant abandonment in Malaysia and to estimate annual rates for the most recent decade. Summaries of data about infanticide and illegal infant abandonment were gathered from police records; the annual number of live births was ascertained from the national registry. The estimated inferred infanticide rates for Malaysia were compared with the infanticide rates among countries of very high, high, medium, and low rankings on the Human Development, Gender Inequality, and Gini indices. From 1999 to 2011, 1,069 cases of illegal infant abandonment were recorded and 1,147 people were arrested as suspected perpetrators. The estimated inferred infanticide rate fluctuated between 4.82 and 9.11 per 100,000 live births, a moderate rate relative to the infanticide rates of other countries. There are substantial missing data, with details undocumented for about 78-87% of cases and suspected perpetrators. Of the documented cases, it appeared that more boys than girls were victims and that suspected perpetrators were predominantly Malays who were women, usually mothers of the victim; the possibility of arrest bias must be acknowledged. Economic and social inequality, particularly gender inequality, might contribute to the phenomena of infanticide and abandonment. Strategies to reduce rates of infanticide and illegal infant abandonment in Malaysia will require strengthening of the surveillance system and attention to the gender-based inequalities that underpin human development.
The assessment of the readiness of five countries to implement child maltreatment prevention programs on a large scale

Mikton C, Power M, Raleva M, Makoae M, Al Eissa M, Cheah I, et al.

Child Abuse Negl, 2013 Dec;37(12):1237-51.
PMID: 23962585 DOI: 10.1016/j.chiabu.2013.07.009

This study aimed to systematically assess the readiness of five countries - Brazil, the Former Yugoslav Republic of Macedonia, Malaysia, Saudi Arabia, and South Africa - to implement evidence-based child maltreatment prevention programs on a large scale. To this end, it applied a recently developed method called Readiness Assessment for the Prevention of Child Maltreatment based on two parallel 100-item instruments. The first measures the knowledge, attitudes, and beliefs concerning child maltreatment prevention of key informants; the second, completed by child maltreatment prevention experts using all available data in the country, produces a more objective assessment readiness. The instruments cover all of the main aspects of readiness including, for instance, availability of scientific data on the problem, legislation and policies, will to address the problem, and material resources. Key informant scores ranged from 31.2 (Brazil) to 45.8/100 (the Former Yugoslav Republic of Macedonia) and expert scores, from 35.2 (Brazil) to 56/100 (Malaysia). Major gaps identified in almost all countries included a lack of professionals with the skills, knowledge, and expertise to implement evidence-based child maltreatment programs and of institutions to train them; inadequate funding, infrastructure, and equipment; extreme rarity of outcome evaluations of prevention programs; and lack of national prevalence surveys of child maltreatment. In sum, the five countries are in a low to moderate state of readiness to implement evidence-based child maltreatment prevention programs on a large scale. Such an assessment of readiness - the first of its kind - allows gaps to be identified and then addressed to increase the likelihood of program success.
Protecting children from violence and maltreatment: a qualitative comparative analysis assessing the implementation of U.N. CRC Article 19

Svevo-Cianci KA, Hart SN, Rubinson C

Child Abuse Negl, 2010 Jan;34(1):45-56.
PMID: 20060588 DOI: 10.1016/j.chiabu.2009.09.010

(1) To identify which United Nations Convention on the Rights of the Child (CRC) recommended child protection (CP) measures, such as policy, reporting systems, and services for child abuse and neglect (CAN) victims, individually or in combination, were most important in establishing a basic level of child protection in 42 countries; and (2) to assess whether these measures were necessary or sufficient to achieve basic child protection in developing and industrialized countries.
Prevalence of childhood sexual abuse among Malaysian paramedical students

Singh HS, Yiing WW, Nurani HN

Child Abuse Negl, 1996 Jun;20(6):487-92.
PMID: 8800523

There has been increasing awareness that sexual abuse of children is a problem in Malaysia. Existing data is based on notification of cases. Population based studies are required to plan services for sexually abused children. This study utilized trainee paramedical staff as a community population to determine the prevalence of childhood sexual abuse. An anonymous, self-administered questionnaire was given to student nurses and trainee medical assistants at the Ipoh School of Nursing and Hospital Bahagia Medical Assistant Training School. Questionnaires were distributed directly to all students in a classroom setting and retrieved after a 30-minute interval. Information collected included questions on personal experiences of sexual abuse. Sexual abuse was defined as rape, sodomy, molestation, or exhibitionism occurring to a child less than 18 years of age. Six hundred and sixteen students participated in the study; 6.8% of the students admitted to having been sexually abused in their childhood, 2.1% of males and 8.3% of females. Of those abused, 69% reported sexual abuse involving physical contact, 9.5% of whom experienced sexual intercourse. The age at first abuse was < 10 years in 38.1% of the cases; 59.5% were repeatedly abused and 33.3% had more than one abuser. Of the abusers, 71.4% were known to the respondent, 14.2% of whom were brothers, 24.5% relatives, and 24.5% a family friend. Further, 28.9% of all students knew of an individual who had been sexually abused as a child. While this population may not be entirely reflective of the community, this study does provide an indication of the prevalence of sexual abuse in Malaysian children. The prevalence figures in this study are lower than those reported in industrialized countries and this may reflect local sociocultural limitations in reporting abuse.
Childhood deaths from physical abuse

Kasim MS, Cheah I, Shafie HM

Child Abuse Negl, 1995 Jul;19(7):847-54.
PMID: 7583742

This paper gives a detailed account of 30 cases of childhood deaths caused by physical abuse, detected by the Suspected Child Abuse and Neglect (SCAN) team, General Hospital, Kuala Lumpur. They consisted of 12 Malays, 6 Chinese, 9 Indian, and 1 Indonesian child. Three cases could not be ascertained as to their ethnic origin. There were 13 male and 17 female children. The average age of the abused children was 2 years 5 months. The most frequent causes of death were intracranial hemorrhage and intraabdominal trauma. Of the 17 cases of intracranial hemorrhage, only four had X-ray evidence of skull fracture. This suggests the possibility of whiplash injuries with/without the abuser suspecting that he/she had injured the child. Of the 22 abusers who could be identified, there was no sex differentiation. Fathers formed the largest group of perpetrators, followed by mothers and childminders. Fifteen of the natural parents of the abused children were married, four were divorced and four were never married. Five of the abusers had aggressive personalities and three were drug addicts. Only one abuser was found to be an alcoholic even though a few were also under suspicion. For most cases, trigger factors could not be identified.
Child sexual abuse: psychosocial aspects of 101 cases seen in an urban Malaysian setting

Kassim K, Kasim MS

Child Abuse Negl, 1995 Jul;19(7):793-9.
PMID: 7583735

This paper describes a case note and interview study of a cross sectional sample comprised of all children seen and confirmed as being sexually abused between June 1985 and December 1990 by the Suspected Child Abuse and Neglect (SCAN) Team of Kuala Lumpur General Hospital. A total of 101 cases, which represented 18.2% of all child abuse cases, were seen together with their accompanying adults. Information about ethnicity, socioeconomic status, family constellation relationship of perpetrator to the child, and reported psychosocial factors that could have contributed towards the abuse were recorded. The Indian ethnicity group was found to be overrepresented. The mean age of children was 6-8 years, SD 4.1, with age ranging 1.5-16 years. Forty-one and one-half percent were in the age range 5-9 years. Among the important associated psychosocial factors found were the absence of another adult at home, unemployment, and history of drug abuse among the perpetrators.
Social factors in relation to physical abuse in Kuala Lumpur, Malaysia

Kasim MS, Shafie HM, Cheah I

Child Abuse Negl, 1994 May;18(5):401-7.
PMID: 8032970

Available evidence has shown that the type of abuse perpetrated on children depends considerably on the social and other factors inherently faced by these children. A total of 119 cases of physical abuse was detected by the Suspected Child Abuse and Neglect (SCAN) Team of General Hospital, Kuala Lumpur in 1991. Eighty-two cases were categorized as mild and 37 as severe. The average age of those mildly abused was 7.9 years, for those severely abused the average age was 4.2 years. The perpetrators of those mildly abused were often their own parents. However, among those severely abused, the child-minder was the most frequent abuser. Ninety-two of all cases were in families of social classes IV and V. In 47 cases, there was definite evidence of family disharmony or disruption. Among the 37 severely abused, the parents were either divorced or separated in 14 cases. There was a personality disorder in seven of the cases. Six of the abusers were also using drugs and nine were alcoholics. This paper shows that, even in a developing country, the social milieu is important in the type of abuse inflicted.
Spike in child marriage in Bangladesh during COVID-19: Determinants and interventions

Afrin T, Zainuddin M

Child Abuse Negl, 2021 02;112:104918.
PMID: 33412413 DOI: 10.1016/j.chiabu.2020.104918
Outcome of abusive head trauma in children less than 2 years: A single center study from a middle-income country

Ang SC, Marret MJ, Jayanath S, Khoo WV, Takwir MFM

Child Abuse Negl, 2021 Oct;120:105187.
PMID: 34218125 DOI: 10.1016/j.chiabu.2021.105187

BACKGROUND: Abusive head trauma (AHT) is a severe manifestation of physical abuse in young children. This study examines the outcome of AHT in children under 2 years and features associated with mortality and disability.
METHODS: Retrospective chart review of 72 children under 2 years diagnosed to have AHT between 2011 and 2018 at a tertiary teaching hospital in Malaysia. Demographic variables, clinical features, results of neuroimaging and their associations with outcome were explored.
RESULTS: The median age at presentation was 4 months, 78% were six months or younger and 68% were male. Two-thirds became unwell in the care of an alternative caregiver. Subdural hemorrhage was present in 98%. Mortality was 10%. Forty-nine survivors returned with median interval of 16 months (IQR 5-44 months) between discharge and last follow-up. At least 35% of 65 survivors were disabled with 29% having multiple disabilities. Multiple disabilities (61.1% versus 25.8%) and cognitive impairment (61.1% versus 22.6%) were significantly higher in children 3 years or older at last follow-up (p
Fulltext Unemployment and child maltreatment during the COVID-19 pandemic in the Republic of Korea

Kim YE

Child Abuse Negl, 2022 Aug;130(Pt 1):105474.
PMID: 34996620 DOI: 10.1016/j.chiabu.2021.105474

BACKGROUND: Risk factors for child maltreatment have been exacerbated during the COVID-19 pandemic, especially due to economic downfalls leading to parental job losses and poor mental health.
OBJECTIVE: This study aimed to examine the association between child maltreatment and unemployment rate in the Republic of Korea.
PARTICIPANTS AND SETTING: Nationally representative data at the province level were used.
METHODS: The monthly excess number of hotline calls related to child maltreatment during the COVID-19 pandemic was estimated for each province. Fixed effects regressions was used to examine the relationship between the excess number of hotline calls and unemployment rate.
RESULTS: The average excess number of hotline calls was significantly negative in the early stage of the pandemic, but became significantly positive afterwards except for some months with averages not statistically different from zero. The regression results showed that an increase of male unemployment rate by 1% was significantly associated with an increase in the excess number of hotline calls by 0.15-0.17 per 10,000 children for most dependent variables for the first year of the COVID-19 pandemic. The statistical significance of female unemployment rate was mixed with the opposite sign of the coefficient to that of male unemployment. Overall unemployment rate was not significant.
CONCLUSIONS: This study suggests that disruptions in child welfare services should be avoided to prevent underreporting of or delayed responses to suspected cases. Also, policies need to be designed considering potential pathways from economic downfalls, especially male unemployment, to child maltreatment.
Abusive head trauma in infants: An observational single centre study comparing developmental and functional outcome between 18 months and 5 years

Lai CD, Marret MJ, Jayanath S, Azanan MS

Child Abuse Negl, 2023 Nov;145:106434.
PMID: 37657172 DOI: 10.1016/j.chiabu.2023.106434

BACKGROUND: Abusive head trauma (AHT) is a major cause of traumatic brain injury in infancy. This exploratory study compared standardized developmental assessment versus functional outcome assessment between 18 months and 5 years of age following AHT in infancy.
METHODS: Observational cross-sectional study after surviving AHT in infancy. Seventeen children between 18 months and 5 years of age underwent clinical examination, developmental assessment using the Schedule of Growing Skills II (SGS II) and functional assessment using the Glasgow Outcome Scale-Extended Pediatric Revision (GOS-E Peds). Additional clinical information was extracted from medical records.
RESULTS: Age at assessment ranged from 19 to 53 months (median 26 months). Most (n = 14) were delayed in at least 1 domain, even without neurological or visual impairment or visible cortical injury on neuroimaging, including 8 children with favourable GOS-E Peds scores. The most affected domain was hearing and language. Delay in the manipulative domain (n = 6) was associated with visual and/or neurological impairment and greater severity of delay across multiple domains. Eleven (64.7 %) had GOS-E Peds scores indicating good recovery, with positive correlation between GOS-Peds scores and number of domains delayed (r = 0.805, p
Is teacher violence a form of betrayal trauma? Relationship with mental health problems among young adults

Fung HW, Cong CW, Tan CS, Yuan GF, Liu C, He KL, et al.

Child Abuse Negl, 2023 Nov;145:106436.
PMID: 37690435 DOI: 10.1016/j.chiabu.2023.106436

BACKGROUND: Childhood trauma is one of the most preventable risk factors for mental health problems. Considering the substantial amount of time that young people spend in school during their early years, it is important to understand the potential impacts of teachers' behaviors on students' mental health.
OBJECTIVES: This study examined the relationship between exposure to teacher violence and mental health problems.
PARTICIPANTS AND SETTING: An international sample of young adults aged 18 to 24 (N = 283).
METHODS: Participants completed self-report measures of childhood trauma, exposure to teacher violence, depressive symptoms, post-traumatic stress, and alcohol misuse.
RESULTS: Exposure to teacher violence could be reliably and validly measured using the Teacher Violence Scale (TVS). Current mental health problems - including depressive symptoms, post-traumatic stress, and alcohol misuse - were associated with exposure to teacher violence during high school years, but not with childhood non-betrayal trauma.
CONCLUSIONS: Our findings expand the application of the betrayal trauma theory to school settings and point to the importance of preventing and managing teacher violence. It is important to provide more support and training to teachers and enhance monitoring measures in schools. More research on the prevalence and correlates of exposure to teacher violence is needed. We also provided first evidence supporting the reliability and validity of the English version of the TVS to facilitate future research.
Abusive head trauma: Annual medical costs for inpatient care of children managed at a single tertiary care centre in Malaysia

Rais UM, Marret MJ, Azzeri A

Child Abuse Negl, 2024 Dec;158:107126.
PMID: 39488966 DOI: 10.1016/j.chiabu.2024.107126

BACKGROUND: Abusive head trauma (AHT) is a leading cause of traumatic head injury in young children. This study estimated the annual direct medical cost of managing AHT at a single tertiary care centre in Malaysia.
METHODS: Criteria were set for categorisation of patients as moderate or severe based on resource utilisation. The two methods used for cost computation were (1) cost estimation based on predefined clinical pathways for case management (2) computation of actual costs using patient-level data from retrospective review of all AHT admissions in 2021. Both methods utilised a combination of activity-based and top-down costing according to availability of reference data. Costs are presented in USD.
RESULTS: Costs for 9 severe and 3 moderate cases in 2021 amounted to $70,532.16, of which 93 % was for severe cases. Cost estimate for moderate cases was $2009.88 while actual costs ranged between $749.37-3115.47 (median $1422.76). Cost estimates of $15,125.76-$17,958.18 for severe cases exceeded actual costs of $2195.57-$13,186.03 (median $7379.40) for severe cases due to shorter-than-expected duration of stay, with only 2 who underwent neurosurgical procedures. Major cost contributors were duration of stay, intensive care, ventilation and neurosurgical procedures.
CONCLUSION: Cost comparison utilising predefined treatment standards versus actual patient data which reveals major cost determinants enables refinement of budget allocation. Median medical costs for severe cases which exceeded the monthly income ceilings of low- and middle-income households in Malaysia demonstrate the economic burden of AHT, reinforcing the need to invest in prevention.
Moderated mediation analyses: Exploring the complex pathways between school bullying and suicidal ideation among vocational school students in China

Jiang H, Qu F, Long Q, Chong ST, Nan J

Child Abuse Negl, 2025 Mar 26;163:107429.
PMID: 40147106 DOI: 10.1016/j.chiabu.2025.107429

BACKGROUND: School bullying can affect adolescent suicidal ideation (SI), but the mediating and moderating effects behind this association are still unclear, especially for students in vocational schools.
OBJECTIVE: This study explored the relationship between school bullying and suicidal ideation (SI) among vocational school students in China, and it constructs a moderated mediation model to examine the mediating effects of physical anhedonia (PA) and social anhedonia (SA), as well as the moderating effects of cognitive reappraisal (CR) and expressive suppression (ES).
PARTICIPANTS AND SETTING: Convenience sampling was conducted. The sample included 13,675 vocational school students (57.7 % female) with an average age of 15.88 years (ranging from 13 to 21) from 13 vocational schools in Hainan Province, China.
METHODS: Participants completed questionnaires on demographics, school bullying, PA, SA, CR, ES, and SI.
RESULTS: The results showed that the prevalence rates of PA, SA, and SI among bullied students were significantly higher (40.7 %, 37.8 %, and 34.0 %, respectively). Mediation analysis revealed that school bullying had a significant indirect effect on SI through PA and SA (accounting for 42.4 % of the total effect), with SA being the key mediator. Moderated mediation analysis confirmed that CR moderated the mediating effects of school bullying via PA/SA on SI, and ES moderated the mediating effects of school bullying via SA on SI. ES did not moderate the relationship between school bullying and SA in the female group.
CONCLUSION: School bullying induces SI by impacting PA and SA, and CR and ES moderate this process. This provides theoretical support for developing effective intervention measures to alleviate the negative impact of bullying on mental health.
Gender differences in the prevalence and psychopathological mechanisms of internet addiction among Iranians aged 18 to 24: A nationwide study

Hammood YM, Abdullaeva B, Abdullaev D, Sunitha BK, Yajid MSA, Singh A, et al.

Child Abuse Negl, 2025 Mar 25;163:107428.
PMID: 40138740 DOI: 10.1016/j.chiabu.2025.107428

BACKGROUND: The rapid advancement of technology has revolutionized interaction, learning, and entertainment but also led to Internet addiction, characterized by excessive internet use causing impairment or distress.
OBJECTIVE: The study explores gender differences in prevalence, risk factors, and clinical aspects of Internet addiction among Iranian youth, highlighting cultural and societal influences.
METHODS: A nationwide sample of 3149 individuals aged 18 to 24 was categorized into two groups: those with Internet addiction (n = 1040) and those without (n = 2109). Participants completed the Childhood Trauma Questionnaire-28, Dissociative Experiences Scale (DES), Difficulties in Emotion Regulation Scale (DERS), and Internet Addiction Test (IAT). Data analyses were conducted using SPSS software version 26, with a significance level set at <0.05.
RESULTS: Overall prevalence of Internet addiction was found to be 33 %, with a higher incidence in males (63.3 %) compared to females (36.7 %) (χ2 = 13.28, p = 0.001). In men, the severity of Internet addiction was significantly linked to emotional abuse (β = 0.20, p˂0.001), DES (β = 0.39, p˂0.001), and DERS (β = 0.16, p˂0.001) (F(3, 654) = 89.85, p˂0.001, R2 = 0.29); while in women, it was associated with emotional abuse (β = 0.18, p˂0.001) and dissociative experiences (β = 0.16, p˂0.001) (F(2, 379) = 13.70, p˂0.001, R2 = 0.06). The DES partially mediated the relationship between emotional abuse and IAT scores in both genders, whereas DERS only did so in males.
CONCLUSIONS: The study suggests Internet addiction as a maladaptive coping mechanism for early emotional abuse, highlighting the need for prevention programs and emotion regulation interventions. Future research should consider longitudinal effects and cultural influences.

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