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Issues In Child Abuse Identification And Reporting In Nigeria: Role Of The Nurse In Overcoming These
Date Posted: 09/Sep/2019
The problem of child abuse is a global pressing problem across the globe, especially in developing countries, including in Nigeria. Available evidence shows that from the last century that about 2,000 child deaths (ages 0-17) were recorded annually as a result of abuse and neglect in the United States, and an additional 160,000 cases resulted in serious injuries in 1990 alone (Daro & McCurdy, 1991). While adequate statistics might be lacking on the drivers and consequences of child abuse in Nigeria, the situation is likely to be worse due to problems inherent in socioeconomic and cultural relationships which serves as a foundation for child abuse. However tragic and sensational the problem of child abuse may be, the counts of deaths and serious injuries provide limited insight into the pervasive long-term social, behavioral, and cognitive consequences of child abuse and neglect. Reports of child abuse or maltreatment alone also reveal little about the interactions among individuals, families, communities, and society that lead to such incidents.
Developed societies are making considerable effort to understand the menace and address it. Unfortunately, this has not been the case for developing countries like Nigeria. Nigeria has not yet recognized the complex origins or the profound consequences of child abuse. The services required for children who have been abused or neglected, including medical care, family counseling, foster care, and specialized education, are virtually non-existence, and where available are expensive. Such services are often limited to governmental effort, with the private sector and non-governmental organizations slowly catching up. and are often subsidized by governmental funds. Equally disturbing, research suggests that child abuse or maltreatment cases are highly related to social problems such as juvenile delinquency, substance abuse, and violence, which require additional services and severely affect the quality of life for many Nigerian families.Providing global incidence of child abuse,the World Health Organization reportedabout a decade ago that there are more than 40 million children globally that are considered victims of child abuse annually (Piltz and Wachtel, 2009). In Nigeria, children face the menace of abuse ranging from physical injuries, abandonment, sexual abuseto child labour. In fact, child abuse is becoming alarming in the country, with government’s efforts to combat the problemyielding little or no result.
Although child abuse is a common problem in Nigeria, effort at reporting and identifying it has received little attention. This is probably due to the emphasis placed on the more prevalent childhood problems of malnutrition and infection. Another possible reason is the general assumption that in every African society, the extended family system always provides love, care and protection to all children. Yet, there are traditional child rearing practices which adversely affect some children, such as purposeful neglect or abandonment of severely handicapped children, and twins or triplets in some rural areas. With the alteration of society by rapid socioeconomic and political changes, various forms of child abuse have been identified, particularly in the urban areas. These may be considered the outcome of abnormal interactions of the child, parents/guardians and society. They include abandonment of normal infants by unmarried or very poor mothers in cities, increased child labour and exploitation of children from rural areas by urban elite families, as well as abuse of children in urban nuclear families by childminders. Preventive measures include provision of infrastructural facilities and employment opportunities in the rural areas in order to prevent drift of the young population to the cities. This would sustain the supportive role of the extended family system which is rapidly being eroded. Also, there have been some issues in identifying and reporting of menace in Nigeria which calls for frantic efforts to remedy the situation. There is need for more effective identification and reporting of child abuse issues, and greater awareness of the existence of child abuse in our society by stakeholders including professional nurses. In line with this urgent need, the paper seeks to address the following objectives:
•To explain the concept of child abuse  
•To state the issues in child abuse identification and reporting in Nigeria
• To state the roles of nurses in overcoming those issues 
Concept of Child Abuse
The child is the bedrock of any society and as such needs to be trained, adequately handled and protected. Children are the greatest assurance of the continuity of the human society. Without children today, there will be no society of humans tomorrow. Yet children are the most vulnerable members of the society. Onwe (2014)stated that Nigerian children are highly vulnerable to income gap or poverty, cultural values, religious incidence and unacceptable economic and social factors. This vulnerability usually exposes children to abuse. Olok-Ake (2000)described child abuse as all sorts of injustice, abnormality and inhuman treatment given to the young feeble ones by the adult generation. The African Network for the Protection and Prevention of Child Abuse and Neglect (ANPPCAN) defined child abuse as the physical, emotional or sexual exploitation by parents, guardians or others. 
Despite the above effort, there is no generally accepted definition for the term ‘child abuse’. The terms child abuse and child maltreatment are often used interchangeably, although some researchers make a distinction between them, treating child maltreatment as an umbrella term to cover neglect, exploitation, and trafficking.However, it is generally referred to as the ill-treatment of a child by adults including parents, relative or non-relatives.Also called other terms such as child maltreatment and child victimization is physical, sexual, and/or psychological maltreatment or neglect of a child or children, especially by a parent or a caregiver. Child abuse may include any act or failure to act by a parent or a caregiver that may results in actual or potential harm to a child, and can occur in a child's home, or in the organizations, schools or communities the child interacts with. 
The literature is replete with various attempts at defining the meaning of child abuse. For example, Edu and Edu (1999) described child abuse as a willful maltreatment of a child. Suchmaltreatment according to them, can include actsof commission (abuse) and omission (neglect). Other scholars have presented a narrow definition of child abuse as being limited to life-threatening physical violence, includingsevere beatings, burns and strangulation whichare inflicted on children by adult members ofthe community. A broader definition however, laysemphasis on any treatment other than the mostfavourable care, and includes neglect, sexual oremotional abuse and exploitation. IT was from this broad perspective that Alokan (2010) described child abuse to include any behavior which neglects the child’s survival and developmental needs, causes physical or emotional injury, harassment or subjects the child to measures, situations and experiences which interfere with their healthy development towards adulthood (p. 240). However, the concept of child abuse is operationalized, it basically captures the flagrant abuse of children’sGod-given and constitution-guaranteed freedom,comfort and peace, by adults in the society. 
In Nigeria, for example, the rights of citizens inChapters 4, Section 30 and 40 of the 1999 constitutionof the Federal Republic of Nigeria guaranteesevery citizen’s basic and fundamental humanrights.Furthermore, child abuse violates the United Nations Declaration on Human Rights, the United Nations Convention on the Right of the Child and the African Charter on the Rights and Welfare of the African Child. From the above declarations and policy documents, the Nigerian child like every other child in the world has the right to live and such protects them from people trampling on their rights
This issues which is considered offensive to any genuine clear conscience, is becoming commonplace in many villages, towns and cities in Nigeria. Children in Nigeria are exposed vulnerably to engage in street/highway hawking, exploitative labour and domestic help, street begging, girl-child marriage, illiteracy and female genital mutilation. This is despite the effort by the Nigerian government and Non-Governmental Organization (NGOs) to curtail the menace of child abuse in the country. However, child abuse has persisted due to certain issues with the identification and reporting of this menace in Nigeria. This might be attributed to the fact that in Nigeria, the constitution did not make anydistinction between the rights of adults andchildren. Thus, children are expected to enjoythese rights. With the menace of child abuse inthe country, children are being denied some ofthese rights. This is further exercabated by the fact that different states andjurisdictions have developed their own definitions of what constitutes child abuse for the purposes of allowing child marriages due to religious or cultural grounds.
Types of Child Abuse
The World Health Organization distinguishes four types of child abuse or maltreatment: physical abuse,sexual abuse, emotional (or psychological) abuse, and neglect(World Health Organization and International Society for Prevention of Child Abuse and Neglect,2006).
Physical abuse: Among professionals and the general public, people often do not agree on what behaviors constitute physical abuse of a child(Noh & Helen,1994) Physical abuse often does not occur in isolation, but as part of a constellation of behaviors including authoritarian control, anxiety-provoking behavior, and a lack of parental warmth(International Encyclopedia of the Social Sciences, 2008). The WHO defines physical abuse as: 
Intentional use of physical force against the child that results in – or has a high likelihood of resulting in – harm for the child's health, survival, development or dignity. This includes hitting, beating, kicking, shaking, biting, strangling, scalding, burning, poisoning and suffocating. Much physical violence against children in the home is inflicted with the object of punishing(WHO& ISPCAN, 2006).
Durrant and Ensom, (2012)posits that most physical abuse is physical punishment "in intent, form, and effect". Overlapping definitions of physical abuse and physical punishment of children highlight a subtle or non-existent distinction between abuse and punishment(Saunders & Goddard, 2010).For instance, Paulo Sergio Pinheiro writes in the UN Secretary-General's Study on Violence Against Children: 
Corporal punishment involves hitting ('smacking', 'slapping', 'spanking') children, with the hand or with an implement – whip, stick, belt, shoe, wooden spoon, etc. But it can also involve, for example, kicking, shaking or throwing children, scratching, pinching, biting, pulling hair or boxing ears, forcing children to stay in uncomfortable positions, burning, scalding or forced ingestion (for example, washing children's mouths out with soap or forcing them to swallow hot spices) (Pinheiro, 2006).
Most nations with child abuse laws deem the deliberate infliction of serious injuries, or actions that place the child at obvious risk of serious injury or death to constitute instances of child abuse. Bruises, scratches, burns, broken bones, lacerations — as well as repeated "mishaps," and rough treatment that could cause physical injuries are indicators of physical abuse. (Theoklitou, Kabitsis& Kabitsi, 2012). Multiple injuries or fractures at different stages of healing can raise suspicion of abuse. 
Often, physical abuse as a child can lead to physical and mental difficulties in the future, including re-victimization, personality disorders, post-traumatic stress disorder, dissociative disorders, depression, anxiety, suicidal ideation, eating disorders, substance abuse, and aggression(Alice, 2016). Physical abuse in childhood has also been linked to homelessness in adulthood(Effects of Child Abuse and Neglect for Adult Survivors, 2014).
Sexual Abuse: Child sexual abuse (CSA) is a form of child abuse in which an adult or older adolescent abuses a child for sexual stimulation (U.S. National Library of Medicine, 2008). Sexual abuse refers to the participation of a child in a sexual act aimed toward the physical gratification or the financial profit of the person committing the act(Theoklitou,  2012) Forms of CSA include asking or pressuring a child to engage in sexual activities (regardless of the outcome), indecent exposure of the genitals to a child, displaying pornography to a child, actual sexual contact with a child, physical contact with the child's genitals, viewing of the child's genitalia without physical contact, or using a child to produce child pornography(U.S. National Library of Medicine, 2008,).Selling the sexual services of children may be viewed and treated as child abuse rather than simple incarceration (Brown, 2011).
Effects of child sexual abuse on the victim(s) include guilt and self-blame, flashbacks, nightmares, insomnia, fear of things associated with the abuse (including objects, smells, places, doctor's visits, etc.), self-esteem difficulties, sexual dysfunction, chronic pain, addiction, self-injury, suicidal ideation, somatic complaints, depression,post-traumatic stress disorder,anxiety other mental illnesses including borderline personality disorder(Roosa, Reinholtz,& Angelini, 1999) and dissociative identity disorder,(Philip, 1994) propensity to re-victimization in adulthood,(Messman-moore and Long, 2000)bulimia nervosa,(Hornor, 2010) and physical injury to the child, among other problems.(Dinwiddie, Heath, Dunne,2000) Children who are victims are also at an increased risk of sexually transmitted infections due to their immature immune systems and a high potential for mucosal tears during forced sexual contact.(Thornton, 2015) Sexual victimization at a young age has been correlated with several risk factors for contracting HIV including decreased knowledge of sexual topics, increased prevalence of HIV, engagement in risky sexual practices, condom avoidance, lower knowledge of safe sex practices, frequent changing of sexual partners, and more years of sexual activity.( Thornton, 2015)
Statistics from the United States indicates that approximately 15% to 25% of women and 5% to 15% of men were sexually abused when they were children (Whealin, 2016) Most sexual abuse offenders are acquainted with their victims; approximately 30% are relatives of the child, most often brothers, sisters, fathers, mothers, uncles or cousins; around 60% are other acquaintances such as friends of the family, babysitters, or neighbours; strangers are the offenders in approximately 10% of child sexual abuse cases. In over one-third of cases, the perpetrator is also a minor.(Finkelhor, 2009). 
Psychological abuse
There are multiple definitions of child psychological abuse. Specifically in 2013, the American Psychiatric Association (APA) added Child Psychological Abuse to the DSM-5, describing it as "nonaccidental verbal or symbolic acts by a child's parent or caregiver that result, or have reasonable potential to result, in significant psychological harm to the child. (Donald, 2014). In 1995, APSAC defined it as: spurning, terrorizing, isolating, exploiting, corrupting, denying emotional responsiveness, or neglect" or "A repeated pattern of caregiver behavior or extreme incident(s) that convey to children that they are worthless, flawed, unloved, unwanted, endangered, or only of value in meeting another's needs (John, 2011)
Other authorities have defined it as the production of psychological and social defects in the growth of a child as a result of behavior such as loud yelling, coarse and rude attitude, inattention, harsh criticism, and denigration of the child's personality.(Theoklitou, 2012) Other examples include name-calling, ridicule, degradation, destruction of personal belongings, torture or killing of a pet, excessive criticism, inappropriate or excessive demands, withholding communication, and routine labeling or humiliation.(National Center for Victims of Crime, 2011)In 2014, the APA stated that:
"Childhood psychological abuse [is] as harmful as sexual or physical abuse."
Psychological maltreatment is "the most challenging and prevalent form of child abuse and neglect."
"Given the prevalence of childhood psychological abuse and the severity of harm to young victims, it should be at the forefront of mental health and social service training(American Psychological Association, 2015)"
Corroborating this position, Jeremy (2015) provided evidence that victims of emotional abuse may react by distancing themselves from the abuser, internalizing the abusive words, or fighting back by insulting the abuser. Emotional abuse can result in abnormal or disrupted attachment development, a tendency for victims to blame themselves (self-blame) for the abuse, learned helplessness, and overly passive behavior (National Center for Victims of Crime, 2011).
Neglect: Child neglect is the failure of a parent or other person with responsibility for the child, to provide needed food, clothing, shelter, medical care, or supervision to the degree that the child's health, safety or well-being may be threatened with harm. Neglect is also a lack of attention from the people surrounding a child, and the non-provision of the relevant and adequate necessities for the child's survival, which would be a lack of attention, love, and nurturing.(Theoklitou, 2012)
Some observable signs of child neglect include: the child is frequently absent from school, begs or steals food or money, lacks needed medical and dental care, is consistently dirty, or lacks sufficient clothing for the weather.("Chronic Neglect", 2012). The 2010 Child Maltreatment Report (NCANDS), states, "as in prior years, neglect was the most common form of maltreatment". ("Child Maltreatment 2010: Summary of Key Findings", 2012)
Neglectful acts can be divided into six sub-categories: ( "What is Child Abuse and Neglect?", 2015)
Supervisory neglect: characterized by the absence of a parent or guardian which can lead to physical harm, sexual abuse or criminal behavior;
Physical neglect: characterized by the failure to provide the basic physical necessities, such as a safe and clean home;
Medical neglect: characterized by the lack of providing medical care;
Emotional neglect: characterized by a lack of nurturance, encouragement and support;
Educational neglect: characterized by the caregivers lack to provide an education and additional resources to actively participate in the school system; and
Abandonment: when the parent or guardian leaves a child alone for a long period of time without a babysitter.
Neglected children may experience delays in physical and psychosocial development, possibly resulting in psychopathology and impaired neuropsychological functions including executive function, attention, processing speed, language, memory and social skills. Researchers investigating maltreated children have repeatedly found that neglected children in foster and adoptive populations manifest different emotional and behavioral reactions to regain lost or secure relationships and are frequently reported to have disorganized attachments and a need to control their environment. Such children are not likely to view caregivers as being a source of safety, and instead typically show an increase in aggressive and hyperactive behaviors which may disrupt healthy or secure attachment with their adopted parents. These children have apparently learned to adapt to an abusive and inconsistent caregiver by becoming cautiously self-reliant, and are often described as glib, manipulative and disingenuous in their interactions with others as they move through childhood.(Golden & Prater, 2009) Children who are victims of neglect have a more difficult time forming and maintaining relationships, such as romantic or friendship, later in life due to the lack of attachment they had in their earlier stages of life. 

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