INTRODUCTION: Paediatric sexual assault (SA) victims should be assessed for post-exposure prophylaxis (PEP) to mitigate the risk of sexually transmitted infections (STIs). We describe the clinical characteristics of children and young persons (CYPs) presenting with SA at KK Women's and Children's Hospital in Singapore, viral PEP (human immunodeficiency virus [HIV] and hepatitis B virus [HBV]) prescribing practices, and STI evaluation at follow-up. METHOD: Medical records of CYPs ≤16 years who presented with SA between January 2022 and August 2023 were reviewed, including assault and assailant characteristics, baseline and follow-up STI screening, PEP prescription, adherence and follow-up attendance. CYPs with SA in the preceding 72 hours by HIV-positive or HIV-status unknown assailants with high-risk characteris-tics were eligible for HIV PEP. RESULTS: We analysed 278 CYPs who made 292 SA visits. There were 40 (13.7%) CYPs eligible for HIV PEP, of whom 29 (82.9%) received it. Among those tested at baseline, 9% and 34.9% of CYPs tested positive for Chlamydia trachomatis and Gardnerella vaginalis, respectively. None tested positive for Neisseria gonorrhoeae, Trichomonas vaginalis, HIV, HBV or hepatitis C. Majority of CYPs tested were HBV non-immune (n=167, 67.6%); only 77 (46.1%) received the vaccine. Out of 27 CYPs eligible for HBV PEP with immunoglobulin, only 21 (77.7%) received immunoglobulin. A total of 37 CYPs received HIV PEP, including 8 who were retrospectively deemed ineligible. Only 10 (27%) completed the course. Overall, 153 (57.7%) CYPs attended follow-up, and none seroconverted for HIV or HBV. CONCLUSION We report suboptimal rates of HBV post-exposure vaccination, and low compliance to HIV PEP and follow-up among paediatric SA victims. Factors contri-buting to poor compliance should be examined to optimise care for this vulnerable population.
Humans ; Post-Exposure Prophylaxis/methods* ; Female ; Child ; Adolescent ; Singapore/epidemiology* ; HIV Infections/prevention & control* ; Male ; Sexually Transmitted Diseases/epidemiology* ; Retrospective Studies ; Hepatitis B/prevention & control* ; Follow-Up Studies ; Child, Preschool ; Sex Offenses/statistics & numerical data* ; Child Abuse, Sexual

INTRODUCTION: There is an increasing trend of physical child abuse cases reported in Singapore. Children presenting to the Emergency Department with injuries require a high index of suspicion for clinicians to distinguish those that are abusive in nature. MATERIALS AND METHODS: A retrospective study of children with diagnosis of NAI presenting to KK Women's and Children's Hospital (KKH) from June 2011 to May 2016 was conducted. RESULTS: There were 1917 cases reported from 1730 subjects, of  which: 8.8% of subjects had repeat visits; 55.2% of cases were male; and mean age was 7.69 years. Racial demographics were: Chinese 45.5%, Malay 33.4%, Indian 15.4% and Others 5.9%. The most frequent injuries sustained were head and neck (50.8%), limbs (32.2%), and chest (5.7%). Of the type of injuries, 55% had contusions, 21% had cane marks, 16% had lacerations, 4.4% had burn marks and 1% sustained fractures. Males were more likely to be caned ( <0.001); 54.9% of cases were admitted and 38.9% were discharged. Cases that presented without a parent ( <0.001), were known to Child Protective Service ( <0.001), or had a history of  parental substance abuse ( = 0.038), mental illness in caregiver ( = 0.021), or domestic violence ( <0.001) were more likely to require admission. CONCLUSION Analysing these factors provide a better understanding of  the presentation of  NAI cases, including 'red flags' and vulnerable groups who should have better protection.
Age Factors ; Child ; Child Abuse ; prevention & control ; statistics & numerical data ; Child, Preschool ; Cohort Studies ; Emergency Service, Hospital ; statistics & numerical data ; Ethnic Groups ; statistics & numerical data ; Female ; Hospitalization ; statistics & numerical data ; Humans ; Injury Severity Score ; Male ; Mandatory Reporting ; Needs Assessment ; Physical Abuse ; prevention & control ; statistics & numerical data ; Prevalence ; Retrospective Studies ; Risk Assessment ; Sex Factors ; Singapore ; Vulnerable Populations ; statistics & numerical data ; Wounds and Injuries ; diagnosis ; epidemiology

Children deserve a childhood free from abuse, where their basic physical, intellectual, emotional and social needs are met. Child abuse is defined as any act of omission or commission by a parent or guardian that would endanger or impair the child's physical or emotional well-being, or that is judged by a mixture of community values and professionals to be inappropriate. A total of 247 cases of suspected child abuse in Singapore was investigated in 2012. Physical abuse, sexual abuse, and physical neglect or emotional abuse accounted for 60%, 30% and 10% of these cases, respectively. Primary care providers play an important role in the early detection and referral of child abuse cases, which enable timely intervention to ensure the well-being of the child and prevent further abuse. Hospitals and other medical centres form the largest source of referrals of suspected child abuse.
Child ; Child Abuse ; diagnosis ; legislation & jurisprudence ; prevention & control ; Child Welfare ; Humans ; Parent-Child Relations ; legislation & jurisprudence ; Parents ; psychology ; Risk Factors

OBJECTIVETo develop the national neglect norms for urban primary school students in China.

METHODSAccording to multi-stage stratified cluster sampling principle, 24 cities of 13 provinces (municipalities) in China were selected during December 1 to 31, 2008. A total of 1491 students in grade 1 - 3 and 2236 students in grade 4 - 6 were selected. Questionnaire was designed by authors and the final norms were determined through several statistical analysis methods, such as item analysis method, factor analysis method, reliability analysis method. The reliability analysis and validity analysis were used to test the stability and reliability of the norms. The evaluation criteria of the scale was determined by the percentile method, then the initial development of the norm was completed.

RESULTSThe two questionnaires of grade 1 - 3 and grade 4 - 6 students consisted of 55 and 57 items, respectively, whose item loadings were ranged from 0.301 to 0.687 and 0.321 to 0.730, which met the statistical requirements. For grade 1 - 3 students, the scale's total Cronbach α coefficients was 0.914, the total split-half reliability coefficients was 0.896, the Cronbach α coefficients of four level was above 0.737 except medical and social neglect, split-half reliability was ranged from 0.461 to 0.757; for grade 4-6 students, the scale's total Cronbach α coefficients was 0.916, split-half reliability was 0.883, except social neglect, the Cronbach α coefficients of other level was ranged 0.457 to 0.856, split-half reliability was ranged from 0.500 to 0.798. The total neglect cut-off score of the two scales grade 1-3 and 4-6 were 125 and 155, respectively.

CONCLUSIONThe structure of two norms was reasonable. The scales have good stability and reliability.

Child ; Child Abuse ; prevention & control ; statistics & numerical data ; China ; epidemiology ; Female ; Humans ; Male ; Reproducibility of Results ; Schools ; Students ; Surveys and Questionnaires

OBJECTIVETo understand the children neglect situation of left-behind children (children who do not grow up with their parents) and non-left-behind children in China's western rural and its influencing factors.

METHODSScales and evaluation methods in the "Chinese rural child neglected evaluation model" were used in this study. The investigation was conducted by using multistage stratified cluster sampling method; three countries were sampled randomly in Shanxi and Chongqing in November 2010, respectively. And, in every county, children from rural area aged from zero to six were randomly selected, with neglect rate and degree to describe their neglected status, using logistic regression analysis to analyze factors affecting the neglect rate.

RESULTSAmong 1568 subjects (859 left-behind and 709 living-with-parents), the total neglect rates were 29.78% (467/1568), and the total neglect degrees were 48.51 ± 6.49; the neglect rates for left-behind ones and living-with parents ones were 34.34% (295/859) and 24.26% (172/709) (P < 0.05); the neglect degree were 49.59 ± 6.54 and 47.19 ± 6.18 (P < 0.05). The neglect degree among left-behind ones and living-with parents ones between 0 to 2 years old were 48.59 ± 6.33 and 45.78 ± 5.94 (P < 0.05); in 3 to 6 years old group, which were 50.43 ± 6.60 and 48.25 ± 6.16(P < 0.05). The degrees in boy's group of these two kinds of children were 49.83 ± 6.67, 47.36 ± 6.28(P < 0.05) and girl's were 49.32 ± 6.38, 47.01 ± 6.08 (P < 0.05). On the other side, the neglect rate of left-behind and non-left-behind children between 0 to 2 years old were 39.33% (153/389) and 18.54% (56/302) (P < 0.05). The rates of boy's group were 34.91% (162/464) and 25.13% (94/374) (P < 0.05), and girl's were 33.67% (133/395) and 23.28% (78/335) (P < 0.05). Results showed that if the left-behind child's father was with lower education background, and the child and his mother feel stranger to each other, which led to the conclusion there was more chance for them to be neglected (OR values were 1.29 and 1.55, P < 0.05). If the non-neglected child's father was farmer or migrant worker and the relationship between the mother and father was poor, then there was more chance for them to be neglected (OR values were 0.85 and 1.92, P < 0.05).

CONCLUSIONThe situation of children neglect in the western rural regions in China is serious. Both the neglect rate and degree among left-behind children are higher than those living-with-parents children. The influencing factors of neglect rate are different in the two groups.

Child ; Child Abuse ; prevention & control ; statistics & numerical data ; Child, Preschool ; China ; epidemiology ; Cross-Sectional Studies ; Family ; Female ; Humans ; Infant ; Male ; Parents ; Rural Population ; Surveys and Questionnaires ; Transients and Migrants

OBJECTIVETo learn the current situation of children neglect and its influencing factors among children aged from 0 - 6 years in rural Chongqing.

METHODSScales and evaluation methods in the "Chinese rural child neglected evaluation model" were used in this study. The investigation was conducted by using multistage stratified cluster sampling method in December 2010, and 822 rural children aged 0 to 6 years of three districts in Chongqing were randomly select for the survey, with neglect rate and the neglect degree to describe their neglect status, using logistic regression analysis to analyze factors affecting children neglect.

RESULTSThe total neglect rate and the neglect degree in the rural children were 35.64% (293/822) and 49.69 ± 6.45, respectively. The neglect degree in boys was higher than that of girls (boys: 50.23 ± 6.40 vs girls: 49.09 ± 6.47, P < 0.05). Further, Our data demonstrated both the neglect rate and the neglect degrees in children whose parents away from home were higher than that of the children whose parents stayed with them (neglect rate: 40.48% (202/499) vs 28.17% (91/323), P < 0.05; neglect degree: 50.64 ± 6.29 vs 48.23 ± 6.44, P < 0.05). Based on multivariate unconditional logistic regression analysis, the determinants of children neglect were: parents were away from home (OR = 1.61, 95%CI: 1.17 - 2.21), single mother and remarried family (OR = 1.39, 95%CI: 1.10 - 1.76), maternal occupation(OR = 0.81, 95%CI: 0.73 - 0.90), estrangement relationship between children and their mothers (OR = 1.42, 95%CI: 1.02 - 1.97).

CONCLUSIONThe neglect situation of rural children is serious in Chongqing, and the main factors are parents away from home, single mother and remarried family, maternal occupation, and estrangement relationship between children and their mothers.

Child ; Child Abuse ; prevention & control ; statistics & numerical data ; Child, Preschool ; China ; Female ; Humans ; Infant ; Male ; Rural Population ; Sampling Studies ; Surveys and Questionnaires

OBJECTIVETo explore the status of child neglect among urban areas children and adolescents aged 3 - 17 years in China.

METHODSUsing multi-stage stratified cluster sampling method, 8001 children and adolescents were recruited from 30 cities of 14 provinces in December 2008. The investigation was carried based on The 3 - 6 years old children Neglect Norms of city in China and The 6 - 17 years old children Neglect Norms of city in China. SPSS 13.0 was employed for analyzing neglect rate and degree for group of areas, age, sex and neglect type (including neglect of physical, emotional, educational, medical, safety and social).

RESULTSThe degrees of child neglect for urban children aged 3 - 6 (children aged 6 were not in school), 6 - 8 (children aged 6 were school children), 9 - 11, 12 - 14 and 15 - 17 were 42.2 ± 6.9, 42.8 ± 8.4, 42.1 ± 9.1, 46.4 ± 9.2 and 49.7 ± 8.4(P < 0.05), the neglect rates were 28.0% (326/1163), 28.8% (431/1496), 27.2% (543/1962), 22.4% (373/1664) and 32.8% (563/1716) (P < 0.05), respectively. There were differences in six neglect types for each group; the neglect degrees and rates were high in the group aged 12 - 14 and 15 - 17 (46.4 ± 9.2 and 49.1 ± 8.4, 22.4% (373/1664) and 32.8% (563/1716), respectively); for each neglect type, the neglect degree of children aged 15 - 17 were highest (52.8 ± 8.0, 47.3 ± 11.6, 49.5 ± 10.8, 42.4 ± 10.3, 52.2 ± 16.0, 56.0 ± 10.1). The degree and rate of neglect in West were highest, Middle was next, the East was lowest (the neglect degrees were 45.4 ± 9.1, 45.0 ± 9.3 and 44.0 ± 8.8, P < 0.05;the rates were 30.7% (1340/4361), 25.0% (756/3024) and 21.2% (131/616), P < 0.05). Degree and rate of child neglect for children without siblings were lower than children with siblings (the neglect degrees were 44.2 ± 9.0 and 47.6 ± 9.1, P < 0.01; the rates were 26.1% (1572/6017) and 33.0% (655/1984), P < 0.01). Neglect degree of school children aged 6 years old (43.1 ± 7.3) was higher than children not in school (40.7 ± 7.8) (P < 0.01), but neglect rate was lower (the rates were 35.4% (60/169) and 21.3% (84/394), P < 0.01).

CONCLUSIONNeglect degree and rate of urban children and adolescents aged 3 - 17 years in China were both high, and neglect deserved more attentions.

Adolescent ; Child ; Child Abuse ; prevention & control ; statistics & numerical data ; Child, Preschool ; China ; Cross-Sectional Studies ; Female ; Humans ; Male ; Urban Population

OBJECTIVETo explore the status of child neglect among rural areas children aged 0 - 6 years in China.

METHODSA total of 7411 rural children aged 0 - 6 years old who were composed of two age groups (3315 children aged 0 - 2 years old and 4096 children aged 3 - 6 years old) were multistage stratified randomly sampled from 84 villages which were representative of 10 provinces of China, in accordance with sex and age in November 2010. To identify the child neglect based on the Neglect Norms for Children Aged 0 to 2 and 3 to 6 Years Old in Rural Areas of China, SPSS 13.0 was employed for analyzing neglect frequency and degree for every group of different age, sex and neglect type (including physical, emotional, educational, medical, safety and social neglects). χ(2) test and analysis of variance were also used.

RESULTSThe degree of child neglect for the children aged 0 - 2 years old was 45.01 ± 7.56, the neglect frequency was 54.9% (1819/3315); the degree of child neglect for the children aged 3 - 6 years old was 44.42 ± 7.57, the neglect frequency was 53.8% (2203/4096). The neglect frequency of children aged 0, 1, 2 years old were 58.5% (654/1117), 52.2% (597/1144), 53.9% (568/1054) (P < 0.05). For children aged 3 - 6 years old, the degrees of emotional and safety neglect for males (44.60 ± 7.86, 36.82 ± 9.03) were higher than females (44.03 ± 7.72, 36.25 ± 9.05) (P < 0.05); and the frequencies of emotional and social neglect for males (16.8% (349/2072), 28.3% (586/2072)) were also higher than females (14.1% (286/2024), 24.8% (503/2024)) (P < 0.05). All children of two age groups suffered neglect mainly on one of the six neglect types (incidences were 20.6% (683/3315) and 22.7% (931/4096)). For 0-2 age groups, the higher neglect frequencies happened in the single-parent family and the remarried family (62.5% (15/24) and 63.2% (12/19)), but for children aged 3 - 6 years old groups, it happened in the single-parent family (60.0%, 27/45).

CONCLUSIONDegree and frequency of child neglect among children aged 0 to 6 years old in the rural areas of China are high, and we should find out risk factors and provide efficient prevention measures.

Child Abuse ; prevention & control ; statistics & numerical data ; Child, Preschool ; China ; Cross-Sectional Studies ; Female ; Humans ; Infant ; Male ; Rural Population ; Surveys and Questionnaires

OBJECTIVETo develop the national neglect norms for rural children aged 3 to 6 years, which are suitable for Chinese situations.

METHODSAccording to the multi-stage stratified cluster sampling principle, 84 towns of 10 provinces or municipalities were selected in China. Children aged 3 to 6 years were surveyed in November 2010, the sample of analysis were 3240 (of whom males were 49.6% (1608/3240) and the Han nationality were 93.3% (3023/3240)). Questionnaire was designed by authors and deleted items that did not meet the requirements through several statistical analysis methods, such as item analysis method, factor analysis method, reliability analysis method. The reliability analysis and validity analysis were used to test the stability and reliability of the norm. The evaluation criteria of the scale was determined by the percentile method, then the initial development of the norm completed.

RESULTSAfter deleting inappropriate items by statistical processing, finally, the scale consisted of 57 items, and included 6 neglected dimensions (physical neglect, emotional neglect, educational neglect, safe neglect, medical neglect and social neglect). Its item loadings ranged from 0.359 to 0.789, which met the statistical requirements. The scale's total Cronbach α coefficients 0.904, the total split-half reliability coefficients were 0.820, the 6 neglect dimensions' Cronbach α coefficients ranged from 0.620 to 0.815, the 6 neglect dimensions' split-half reliability coefficients ranged from -0.034 to 0.789, the scale's parallel reliability were 0.785 and it's re-test reliability were 0.613. After construct validity, external validity and content validity testing, the result showed that this scale could effectively reflect the real neglected status of children investigated. The total neglect cut-off score of this scale were 121.

CONCLUSIONThe scale has good stability and reliability. And it adapts Chinese conditions and it's convenient to operate.

Child Abuse ; diagnosis ; prevention & control ; Child, Preschool ; China ; Female ; Humans ; Male ; Psychological Tests ; Reproducibility of Results ; Rural Population ; Sampling Studies ; Surveys and Questionnaires ; standards

Child ; Child Abuse ; prevention & control ; Humans