We report an 11-month-old male who presented with recurrent seizures, subdural bleed, skull fracture, lightly pigmented hair, and fair lax skin. Copper and ceruloplasmin levels were low and gross deletion of ATP7A gene was found confirming the diagnosis of Menkes disease. The presence of subdural bleed and skull fracture prompted a referral to the Child Protection Unit to rule out child abuse.
Human ; Male ; Female ; Adult ; Infant ; MENKES KINKY HAIR SYNDROME ; NERVOUS SYSTEM DISEASES ; CENTRAL NERVOUS SYSTEM DISEASES ; BRAIN DISEASES ; BRAIN DISEASES, METABOLIC ; BRAIN DISEASES, METABOLIC, INBORN ; CERULOPLASMIN ; COPPER

Objectives: This study used a descriptive, qualitative design to explore the local understanding of child discipline and analyze the important link between parental discipline and child abuse. Methods: Focus group discussions and key informant interviews were conducted with parents, children, local leaders, and professionals in 6 rural communities in the Philippines. The respondents were asked which corrective behaviors they would consider acceptable or abusive to children by showing them a list of disciplinary acts. Results: The results showed an adequate understanding of the purpose and intent of child discipline. Children are generally disciplined to teach them good values, mold and shape their characters and equip them with a moral sense of right and wrong. Child discipline is considered already harmful if: the child sustains physical injuries and psychological pain; the disciplinary action is not commensurate to the offense committed by the child and is used frequently and repetitively, without any valid reason; when sensitive body parts such as the head are involved, and when the disciplinary action is not appropriate to the age, gender, physical and mental status of the child. Among the various types of disciplinary acts, counseling, beating or spanking, and withdrawing or reducing school allowance were considered most acceptable. Hanging, burning, and scalding were the most unacceptable or abusive disciplinary behaviors. Compared to parents, professionals, and local leaders, children were more lenient as they regarded certain inappropriate behaviors by adults as somewhat tolerable. Conclusion Despite having an adequate understanding of the purpose and intent of child discipline, there is still a need to educate parents, children, and local leaders about when a disciplinary act becomes harmful to children. Community stakeholders should also be informed about how and where to report the abuse once it is identified.
Child Abuse

Objectives: This study aimed to estimate the national prevalence of violence against Filipino children and youth as experienced in various forms and settings. Methods: About 3,866 young people aged 13-24 years from 172 randomly selected barangays (villages) nationwide participated in the survey. The questionnaire was self-administered, interviewer-administered, or interviewer-assisted, depending on the capability and preference of the respondent. Female respondents were interviewed or assisted by a female field assistant, while male field assistants guided the male respondents. The questionnaire was translated into seven local dialects and administered in the most comprehensible language to the respondent. Results: Overall, 80 percent of the 3,866 respondents experienced any one form of violence in the home, school, workplace, and community. More than 3 in five suffered from physical, psychological, and peer violence, while 22.4 percent were victims of sexual abuse. Ten percent were physically neglected, while a fourth felt psychologically neglected by their caregivers. More boys claimed to have been sexually abused and physically neglected, while more girls were bullied and witnessed psychological violence in the home. VAC prevalence was, however, found to be highest among LGBTQ+s compared to heterosexual males and females. Despite the high prevalence, less than 10 percent of respondents disclosed their experiences of abuse, primarily to friends and parents. About one in 10 ever sought help from a professional. Conclusion There is a need to improve the implementation of child protection programs at the local level, where violence issues of heterosexual boys and girls and LGBTs are addressed.
Violence ; Child ; Adolescent

Objective: Our goal is to identify an operational roadmap of core elements in the set-up of the Philippines General Hospital Child Protection Unit (PGH-CPU) established in 1997, and Child Protection Network (CPN) established in 2002. This roadmap will guide future improvement needs for PGH-CPU and CPN and could help accelerate the set-up of future child protection units or networks. Methods: Using the 5 pillars of the Care Continuum for Child Maltreatment for categorization of deliverables — multidisciplinary intervention, training, governance, research/publication, and prevention — we identified operational deliverables (excluding patient numbers and outcomes) of the PGH-CPU and CPN. These were qualitatively analyzed to identify trends across the past 20-years and along 5 pillars of the Care Continuum. Results: Identification and qualitative analyses of documented deliverables reveal pillar-specific and time-dependent trends across 5-year periods. This trend analysis identified the core elements central to the set-up of a CPU and reveal an operational roadmap in the set-up of CPUs in resource-constrained settings. Conclusions Case study review and qualitative analyses identify core elements that comprise a roadmap for need based prioritization in the set-up of CPUs/CPNs towards a comprehensive care continuum for child maltreatment. The 20-year experience in a developing nation context validates the roadmap
Continuity of Patient Care

Objectives: This paper presents the development of a local sexual assault investigation kit (SAK) that doctors in the Philippines could use to collect biological samples from victims of sexual abuse, including child patients, that would be used for DNA testing. The study also reports on a management system via courier service to protect the integrity of the samples that could be eventually used as evidence in court from the collection site to the laboratory with sufficient backup measures. Methods: Women and Child Protection Units (WCPU) from Manila, Baguio, Cebu, and Davao partnered with the DNA Analysis Laboratory, Natural Sciences Research Institute of UP Diliman (NSRI-UPD) DNA Analysis Laboratory in testing the utility of a prototype SAK for the collection of biological samples from child patients. From January 2002 to March 2006, samples were collected from patients who went to WCPU within 72 hours post-contact and consented to participate in the study. WCPU doctors collected biological samples guided by the patient’s narratives and packaged the samples while following detailed documentation and chain of custody procedures. SAKs were then sent via a designated courier service from WCPU to the NSRI-UPD DNA Analysis Laboratory for DNA testing. The WCPU kept half of the samples collected, following recommendations made during sectoral consultations that included members of the Research Group of the Philippine Judicial Academy, prosecutors, and defense counsels. Case samples were packed well by the WCPU and received at the NSRI-UPD DNA Analysis Laboratory. Due to budget limitations, only the internal genitalia and patients’ reference buccal swabs were subjected to DNA tests as reported by Maiquilla et al.1 The remaining SAK components and case records were kept in a dedicated and secure storage facility. DNA testing reports were sent to the WCPU, which released them to the child patients and their legal guardians. Results: One hundred fifty-four female children aged 2-18 years old and their legal guardians agreed to participate in the study. Based on the initial interviews of the social workers who conducted the evaluation, all the participants came from families with very low socioeconomic status. The WCPU doctors then complied with prescribed procedures. To date, NSRI-UPD DNA Analysis Laboratory records show that a subpoena for expert testimony had been issued in only one case out of the 63 cases (1.6%) that were positive for male DNA. No further information was available on the final decision in this case due to the absence of any order from the judge granting the laboratory access to court records. Likewise, WCPUs did not have any information on the remaining 62 cases that could have used the DNA test results as evidence if a case had been filed in court. Conclusion This study is the first to report the development and validation of a sexual assault investigation kit in the Philippines aimed at helping medical doctors in collecting and preserving critical biological samples for DNA testing. Using a dedicated courier service to send SAK from collecting agencies to the laboratory for DNA testing was successfully tested and resulted in faster delivery and significantly reduced overall cost. While DNA testing remains the most powerful tool for human identification and the technology has been available in the Philippines since 1997, certain factors have prevented it from being used routinely in sexual assault investigations, including those involving children.
Women and child protection units ; Sex Offenses

Objectives: The objective of this evaluation was to assess the effectiveness of Mindfulness for Safe Schools, a mindfulness-based intervention adapted for sexual abuse prevention during peer-to-peer dating among Filipino public school children in Grades 7 and 8. It was hoped that through the intervention, children would be able to regulate their emotions so that they do not react impulsively to emotionally stimulating events, especially during peer dating. The study consists of four levels of evaluation: reaction, learnings, and behaviors of teachers toward the program, as well as effect of the intervention on emotion regulation and peer conformity among students. Methods: This study utilized a mixed methods design using a concurrent embedded method. For teachers, quantitative surveys and focused group discussions were conducted to determine their reactions to the training, their learnings, and behaviors after the program, as well as their observations of students’ responses to the intervention. Focused group discussions were analyzed through thematic analysis. Effect of the program on emotion regulation and peer conformity among students were determined mainly through a pre and post-test survey and analyzed through paired samples t-test. Video content analysis of the classroom delivery was also conducted to determine student engagement during the program. Results: Teachers reacted favorably to the training workshops and were able to use what they learned from the workshops to increase their patience and understanding towards themselves, their job, and their students. Students also reacted favorably to the Mindfulness for Safe Schools modules and were observed to use the skills taught in the modules to regulate their emotions. Emotion regulation improved (t=3.47, significant with p=0.00) and susceptibility to peer pressure decreased (t=8.94, significant with p=0.00) for Grade 8 students (n=950) after the modules were delivered. However, teachers reported implementation issues, such as conflicting requirements of the program with their official workload, which may have affected program effects. Conclusion Our findings indicate that Mindfulness for Safe Schools was associated with improvements in emotional awareness, management of negative emotions, and showing care and respect for student peers. It also suggests that integrating mindfulness interventions in schools requires close coordination with all stakeholders: teachers, schools, and appropriate government divisions to ensure fidelity and reaching desired effects.
Mindfulness