Child Maltreatment
Child maltreatment continues to be a public health and social welfare problem across the world. The World Health Organization (WHO) defines child maltreatment as the different forms of child abuse and neglect, and includes the different forms of physical and emotional ills, sexual abuse, abandonment and manipulation resulting in real or latent harm to the child’s health, growth and self-worth (WHO, 2014). Statics on child maltreatment paint a grim picture on the situation, with national US estimates indicating that thereabouts of 1,500 children die annually of child maltreatment, with an estimated 41,000 homicides annually in the global scene (Schnitzer, Gulino& Yuan, 2013; WHO, 2014). Given such statistics, it is apparent that child maltreatment is a compelling problem with devastating effects on not only the child’s welfare, growth and development, but also on the healthcare system. The magnitude of the problem calls for swift action with an assessment of the gaps and opportunities for collaborative action to improve the health of the children. There are far reaching benefits to improved health for children in the US and across the globe, with the nurse playing an important role in the promotion of global health.
According to the World Health Organization (2014), child maltreatment is an international problem with grave life-long repercussions. Although the organization indicates the complexity of studying child maltreatment given the varying methods, definitions, statistics coverage and quality of the studies, available surveys point to child maltreatment as an international problem with far reaching effects on the global health system (Ali et al., 2014; Merrick &Latzman, 2014). At the international scene, WHO reports that about a quarter of all adults have been physically abused. The trend is particularly biased against women, who reports indicate that one out of every five have been sexually abused as children, a contrast with males who the reports indicate only one in every 13 have reported sexual abuse as children (WHO, 2014).
WHO (2014) further indicates that about 41,000 children under 15 die annually from maltreatment. This, however, is an underestimate given the amount of unreported deaths, and deaths attributed to other factors such as falls, burns and drowning, none of which are reported as resulting from child maltreatment (Ali et al., 2014; WHO, 2014). Further, Ali et al. (2014) report that about 40 million globally children under 14 years suffer a form of maltreatment. Most of these children suffer maltreatment from their parents or caregivers as a form of punishment or domestic violence. Cross-sectional surveys in regions around the world additionally paint a grave picture on the prevalence of child maltreatment. According to a survey by UNICEF on East Asia and the Pacific region, the prevalence of physical abuse ranged from 10 percent in China to 30.3 percent in Thailand of the total population of children surveyed reporting physical abuse (UNICEF, 2012). other studies carried out in different parts of the world indicate 37 percent of children reporting physical abuse in Egypt, close to half of parents in Romania have admitted to beating their children regularly, while 21% and 65% of urban and rural children respectively, in Ethiopia have reported bruises from parental beating. This is even as child deaths because of violence in developed countries show fluctuations, with some decreasing while others such as the US show increases (Gilbert et al., 2012).
The statistics herein show the magnitude of child maltreatment. The effects of the issue on the other hand, cut across the board from education and employment to mental health, with far reaching consequences on the health systems. Given the level of depression, sadness and anxiety, self-esteem and stigma among other mental issues that maltreatment causes on children, treatment of these mental health issues is not only expensive, but also takes a toll on the health practitioners who have to deal with such children (UNICEF, 2012).
Merrick and Latzman (2014) report that maltreatment impacts the children’s physical health both directly and indirectly. Bruises, burns, broken bones and STI, according to Merrick and Latzman (2014) all require medical attention, which puts a strain on the medical systems. Moreover, as a way of coping with the physical and mental abuse, some children resort to substance abuse and self-harming behavior, all of which require advanced medical health intervention to correct (Forsman&Langstrom, 2012). WHO additionally reports that the consequential effects on the children’s physical, mental and behavioral health can contribute to severe health risks such as contracting STIs, heart disease, cancer and suicide. All these have economic and human resource impact, particularly on the healthcare system that includes hospitalization costs, mental health treatment as well as protracted healthcare costs.
Sad however is that fact that even with such grave consequence on the mental and physical health of the children, as well as the strain on the healthcare system, there remains a wide gap for collaborative actions towards the improvement of children’s health. According to the Pereira (2013), one of the gaps in collaborative care is in the unequal investment between urban and rural polices, particularly in developing countries. Most of the policy makers concentrate on policies aimed at urban development leaving the larger children population in the rural areas to suffer (Pereira, 2013). Moreover, health services provided are particularly expensive, given the lack of social security coverage and therefore the inability of most families to support their children’s health.
While most developing countries may have a large number of charity organizations that deal with children, there is a huge gap of information. Most of the population is unaware of the existence of such services. Moreover, most governments do not care to form collaborative mechanisms between them and these charity organizations in provision of statistics and funds, which disadvantages the children in need of health care. Most of the children and mothers consequently remain hidden due to lack of suffice data and counting systems (Pereira, 2013). Even more is the gap in health workforces; there is a huge gap between rural and urban health workforce, where the urban facilities are well staffed while rural areas remain understaffed (Pereira, 2013).
Cracks within the health systems additionally create gaps for collaborative measures towards the improvement children’s health. Health systems within some countries do not monitor some disadvantaged groups such as orphans, children with disabilities and unregistered children (Pereira, 2013). Mostly, this means that the governments or charity organizations have no way of knowing the existence of such children, and therefore attending to them. Such children therefore remain in health suffering as no one recognizes their existence.
Opportunities for collaboration however exist as a means of improving children’s health. One of the opportunities is a collaborative approach between governments, charity and non-governmental organizations in addressing the problem of missing data for vulnerable groups (Pereira, 2013). This is possible through routine collection of data. The collection data can occur within the local, national and international fronts to ensure the correct representation of children in need of health care (Pereira, 2013). Such multi-sectorial collaboration in the collection of data can also be used in dispensing healthcare to these vulnerable groups through premeditated programs.
Opportunities additionally exist in the involvement of political authorities in tackling the health issues. This is possible through collaboration of local health care providers with local leaders, and forming representative groups to address the health issue at the local, regional and national levels (Pereira, 2013). This collective effort should involve the vulnerable groups, organizations dealing with these groups as well as government health organizations and practitioners, which can eventually effect changes in policies to cater for the rural population and the vulnerable groups (Pereira, 2013).
The purpose of the collaborative measures is to work towards the improvement of global health, whose benefits traverse to each country in the world, the US included. As a member of the international community, leader in research, technology and health care, the US spends billion in global health improvement initiatives. With an improving global health therefore, it will be possible for the US to focus on ways of improving the social, health and economic well-being of its population. This will include better performance in maternal health, improved social welfare and programs to improve the economic status of the bulk of the population. According to the US Global Health Strategy (n.d.), health is at the very core of human progress. With improved global health, it will therefore be possible for US families to work towards supporting each other, the children to get education, women to deliver successfully, as well as for infants to grow and thrive (US Global Health Strategy, n.d.).
To enjoy these benefits however, health practitioners are instrumental. Nurses in particular play a major role in the improvement of global health. Nurses provide about 90 percent of healthcare services in the world, yet few of them are involved in policy drafting or the promotion of global health diplomacy (Breda, 2012). It is high time therefore, that nurses should play an active role in the drafting of policies as well as become health scholar activists towards improved global health (Breda, 2012).
Many poor countries have a shortage in physicians and other medical practitioners. The role of the nurse in this case goes beyond their training, and they are therefore required play even greater roles in delivery of health care. It is in such places therefore that the nurse becomes a physician, a midwife, counsellor and pediatrician with the health of the patients in her hands. Under such circumstances therefore, the nurse’s role traverses their duty as medical assistants to a human rights activist, an advocate for better international relationsas well as works towards interdisciplinary partnerships towards the improvement of global health (Breda, 2012).
Many countries start programs and initiatives aimed at the improvement of health in the said states. For most of the programs and initiatives, nurses play a major role in not only running the programs and initiatives, but also ensuring that these programs and initiatives achieve their objectives. These nurses additionally provide training to student nurses, traditional birth attendants in rural areas as well as supervise the activities of other nurses. Convincingly therefore, nurses are indeed the very fabric that holds together the medical profession and the fuel to every healthcare initiatives and programs.
References
Ali, N., S. et al. (2014). Magnitude and Factors Associated with Child Abuse in a Mega City of Developing Country Pakistan. Iran Journal of Pediatrics, 24(2), 140-146
Breda, K., L. (2012). What is nursing’s role in international and globalHealth? TextoContextoEnferm, Florianópolis, 21(3), 491-492
Forsman, M., &Långström, N. (2012). Child maltreatment and adult violent offending: Population-based twin study addressing the ‘cycle of violence’ hypothesis. Psychological Medicine, 42(9), 1977-83
Gilbert, R., Fluke, J., O’Donnell, M., Gonzalez-Izquierdo, A., Brownell, M., Gulliver, P., . . .Sidebotham, P. (2012). Child maltreatment: Variation in trends and policies in six developed countries. The Lancet, 379(9817), 758-72
Merrick, M., T. &Latzman, N., E. (2014). Child Maltreatment: A Public Health Overview and Prevention Considerations.The Online Journal of Issues in Nursing19(1). Retrieved from http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-19-2014/No1-Jan-2014/Child-Maltreatment.html
Pereira, H. (2013). The Killer Gap: A Global Index of Health Inequality for Children. World Vision
Schnitzer, P. G., Gulino, S. P., & Yuan, Y. T. (2013).Advancing public health surveillance to estimate child maltreatment fatalities: Review and recommendations. Child Welfare, 92(2), 77-98
UNICEF (2012).Child Maltreatment: Prevalence, Incidence and Consequences in the East Asia and Pacific Region. Bangkok: UNICEF
US Government (n.d.).Global Health Initiative: Strategy Document. US Government
WHO (2014).Child maltreatment.WHO. Retrieved from http://www.who.int/mediacentre/factsheets/fs150/en/