Search

OBJECTIVE: To investigate the association between Parent to Child Maltreatment and the occurrence of anxiety disorder symptoms among Pakistani adolescents under 18 years. METHOD: A prospective study was conducted to examine the effect of frequency of Parent to child maltreatment (PTC) on the occurrence of anxiety disorders in a community setting. A sample of 800 adolescents who reported none to rare, occasional, and frequent PTC were followed for the occurrence of anxiety disorder symptoms over two years. PTC was evaluated using ICAST-C (International child abuse screening tool). Anxiety disorder symptoms were evaluated using the SCARED (Screen for children anxiety-related disorders) tool. Risk ratios were estimated using Cox Proportional Algorithm. RESULTS: The risk of occurrence of anxiety disorder symptoms in adolescents who have exposure to frequent PTC is 3.8 times (2.9, 4.9) as compared to those with none to rare exposure to PTC. Among adolescents suffering frequent PTC whose, mothers also reported a history of domestic violence, the risk of anxiety disorder symptoms is 3 times (2.2, 4.1) higher. Female gender (RR 1.5; 1.2–1.9), stressful home environment (RR 1.4; 1.1–1.8), and parental substance abuse (RR 1.6; 1.2–2.0) are significant predictors of anxiety disorder symptoms. CONCLUSION: Frequent PTC is significantly associated with the occurrence of anxiety disorder symptoms among Pakistani adolescents. Given these findings, there is a dire need to develop specific interventions to address anxiety disorder symptoms among adolescents and to develop programs to prevent parent to child maltreatment.

Parents of children with developmental disabilities, particularly mothers, are likely to suffer from stress. Nevertheless, the association between parenting stress and the type and extent of disabi...

Internet addiction has been seen to rise significantly during the SARS-CoV-2 pandemic especially during the quarantine period. Closure of offices, marketplaces, educational institutes, and lack of social interactions has led to an upsurge in the usage of the internet not only for academic and work but also for relaxation and a muddle through monotonic life amidst pandemic. It is essential to understand the effects of this addiction on the general population. Young's and Temperance's model; one of the behavioral models explain behavioral changes among individuals related to internet addiction amidst crisis. This paper aims to discuss how the intercalated interplay between biological characteristics such as brain plasticity, psychological and predisposing characteristics, environmental and need-based factors during the pandemic have led to internet addiction. This could help health authorities in developing effective methods to reduce internet addiction prevalence through preventive measures like counselling, therapeutic interventions, and a hotline service.

Background: Internet addiction has proved to have detrimental effects on the mental health wellbeing of people. During COVID19, these effects are amplified significantly; therefore, this study aims to assess the effect of internet addiction (IA) on the presence of depression among the Pakistani population amidst COVID 19. MethodsA cross-sectional design was employed using an anonymous web-based survey link. This link was disseminated via different social media platforms. The "Young's Internet Addiction Test" (IAT) and "Depression, Anxiety, and Stress Scale-21" (DASS-21) screening tools were used to measure Internet addiction (IA) and level of depression respectively. Adjusted odds ratios along with 95% confidence interval were reported using multinomial logistic regression for the association of IA and other predictors associated with depression. Results A total of 1145 individuals has completed this survey. Overall, the prevalence of severe and extremely severe depression was found to be 9.7% and 16.4% amidst the Pakistani population during the Covid-19 outbreak. The odds of extreme depression were 15 times more among (AIU) addicted internet users (95% CI: 8.26-28.8) and 7 times more among (PIU) problematic internet users (95% CI: 4.57-12.05) as compared to (NIU) normal internet users. ConclusionIn the aftermath of COVID 19, depression was found to be significantly related to internet addiction. This study determined that addicted and problematic internet users are more prone to suffer from depression.

Background Internet addiction has surfaced as a significant concern to public health in these unprecedented Covid19 times due to social distancing and lockdown. This study aims to determine the burden of internet addiction and related psychosocial factors among the Pakistani population amidst COVID-19 Methods An analytical cross-sectional survey was broadcasted on internet via google form link which was completed by 1145 Pakistani residents. The outcome variable was Internet addiction and was assessed using the "Young's Internet Addiction Test" (IAT). In addition, symptoms of depression, anxiety, and stress were evaluated using the "Depression, Anxiety, and Stress Scale-21" (DASS-21). The multinomial logistic regression was applied, and adjusted odds ratio along with 95% confidence intervals were reported for significant factors associated with Internet addiction. Results The majority of participants were females and youth (between ages 20–24 years). The prevalence of problematic-internet-users (PIU) and addictive-internet-users (AIU) was 27.3% and 11.3%, respectively. The odds of extremely severe anxiety among AIU were approximately three times (Adj OR: 2.6 (1.1–7.1) followed by the odds of having extremely severe depression was 3.14 (95% C.I.: 1.53–6.44) times greater among PIUand odds of extremely severe stress being about five times higher among AIU (Adj OR: 5.42 (1.66–17.68)) as compared to normal-internet-user (NIU). Conclusion Amid Covid 19, the burden of internet addiction was discovered to have surged among the Pakistani populace. This study found that gender, marital status, depression, stress, anxiety, work situation, and mood changes amidst the pandemic are significantly associated with problematic and addictive internet use.

Background The effect of childhood maltreatment in the developmental pathway of panic symptoms was not well documented specifically in Pakistan. Therefore, this study aimed to examine the association between child maltreatment and the risk of developing Panic symptoms among adolescents aged 11–17 years in Karachi, Pakistan. Methods The sample of this study comprised of 800 adolescents aged 11–17 years from 32 systematically selected urban and peri-urban clusters of Karachi. The symptoms of panic (significant somatic symptoms) were assessed using a validated tool “SCARED” and the association between childhood maltreatment and panic symptoms was measured using a cox-proportional algorithm. Results Sixty-three percent of severely maltreated children developed Panic symptoms compared to nineteen percent of non-maltreated children. Severely maltreated Female children had approximately four times (95% CI: 2.11–6.35) the risk of panic symptoms and severely maltreated male children were three times (95% CI: 2.27–5.99) more likely to develop panic symptoms. Conclusion The current study provided evidence that maltreated children are at increased risk of developing panic symptoms later in adolescence. Interventions and policies to reduce childhood maltreatment and professional support and counseling to the victims may be an effective strategy to reduce the burden of panic symptoms to some extent.

Background Self-Harm (SH) is a major global public health problem under-researched in Pakistan due to religious and legal implications. This study aims to identify the characteristics and patterns among patients with SH and factors associated with the intent to die. Method This retrospective descriptive study where SH cases presented to private tertiary care teaching hospital in Karachi, Pakistan, from January 2013 to December 2017 were extracted from HIMS records. Details related to demography, history, associated factors, access to methods used, and intent to die were collected on a structured proforma and analysed using STATA version 14. Results A total of 350 cases were analysed. More than half of the reported cases were in the age group 20–39 years. Though only one-fourth of the SH cases had a past psychiatric history, it was found to be significantly (P-value Conclusion This paper provides recent data on the characteristics and patterns associated with the intent to die of individuals who have self-harmed. In most cases of SH, past psychiatric history was not evident. Current psychiatric diagnosis and young adults were favoured in this study. The data from this study has limited representation for all demographic representation of SH cases from Pakistan as being from a single private hospital. There is a need for further research on SH in Pakistan.

Background Parent-to-child maltreatment is considered one of the risk factors for Generalized Anxiety Disorder (GAD) symptoms, but this hypothesis has not been adequately tested in Pakistani settings. Aim This study aimed to examine the association between parent-to-child maltreatment and the risk of developing GAD symptoms among adolescents. Methods The association of none to rare, occasionally, and frequently parent-to-child maltreatment with the incidence of GAD symptoms was investigated in a sample of 800 adolescents aged 11–17 years who were followed for two years. Parent-to-child maltreatment was assessed using ICAST-C (International child abuse screening tool). GAD Symptoms were determined by SCARED (Screen for children anxiety-related disorders). Cox Proportional Algorithm was used to estimate risk ratios. Results Among children with both uneducated parents, frequently maltreatment was associated with 7.31 (2.20–24.04) times the risk of GAD symptoms compared to none to rare maltreatment. In contrast, the risk of GAD symptoms in frequently maltreated children was 5.58 times (1.40–21.97) than negligibly maltreated children with either educated parent. Conclusion The frequency of parent-to-child maltreatment is significantly associated with an increased risk of developing GAD symptoms in which parental education plays a crucial role. Parents should be imparted with the awareness of the consequences of child maltreatment. In Pakistani settings the need to have this awareness is even more necessary due to the culturally acceptable disciplinary measures used by parents.

Background: The COVID-19 pandemic has paved the way for psychological crises, especially in resource-limited settings where mental health infrastructure is already crippled. This study aims to determine the prevalence and factors associated with perceived-stress in the Pakistani population during the Covid-19 pandemic. Methods: A web-based cross-sectional survey was conducted on 1679 Pakistani residents who received the study questionnaire's Google form link. A validated tool of perceived-stress scale-10 was used to screen perceived stress levels. Multiple Ordinal Regression was used to identify the factors associated perceived stress and the results are reported as adjusted odds ratios with 95% confidence intervals. Results: The mean score of perceived stress was 19.32 (SD=+6.67). Most of the participants screened positive for moderate (69%) and high levels (14%) of stress, respectively. A significant interaction was seen between generalized-anxiety and the phase of the lockdown. During the complete lockdown, the odds of high-perceived stress among severely anxious participants were 44.67(95% CI: 21.33, 93.53) times than participants with no/minimal generalized anxiety. Moreover, the odds of high levels of perceived-stress among moderately anxious respondents were 15.79(95% CI: 10.19-24.28) times compared to participants with no/minimal anxiety during the smart lockdown. Conclusion: This study evidences that the pandemic was extremely distressing for the Pakistani population causing the maximum level of perceived-stress in more than half of the population. Adequate and timely interventions are needed before high-stress levels culminate into psychological disorders.

Background Psychological impact of the COVID 19 pandemic has been expected and widely predicted, but its associated factors are not measured predominantly in low- and middle-income countries. This study aims to determine the burden and factors associated with generalized-anxiety-disorder in the Pakistani population amidst the COVID 19 pandemic Methods We conducted a web-based cross-sectional survey on 1679 Pakistani residents who had access to the study questionnaire broadcasted via the Google form. Generalized-anxiety-disorder was screened through a validated tool of the Generalized-Anxiety-Disorder 7 scale. Multiple Ordinal Regression was used to identify the factors associated generalized anxiety disorder and the results were reported as adjusted odds ratios with 95% confidence intervals. Results Most of the participants (70.8%; n = 1189) were screened positive for generalized-anxiety-disorder, out of which moderate and severe symptoms were seen in 22% (n = 365) and 18% (n = 301) of them, respectively. The mean score for generalized-anxiety was 8.57(SD = ± 5.88). A significant interaction was seen between gender and perceived stress, indicating that females with high perceived stress had 30 times greater odds of generalized-anxiety as compared to females with low perceived stress (95% CI: 20.02, 44.46). Additionally, during the complete down, the odds of generalized-anxiety among respondents who frequently watched news were 1.72(95% CI: 1.06, 2.77) times compared to participants who rarely watched the news. Furthermore, participant’s current psychiatric illness, anxiousness about uncertainty, fear of getting infected from COVID, fear of loved one getting infected from COVID 19, worrying when the first case of COVID 19 was reported, indulgence in recreational activities, and current health status were found to be significantly associated with generalized-anxiety. Conclusion Study findings indicate an alarming increase in generalized anxiety adversely affecting the psychological well-being of respondents. Immediate interventions for offering psychological support need to be implemented to curtail the rapidly increasing morbidity due to anxiety related to the pandemic.

To assess the effectiveness of intervention in improving knowledge, attitude and perception regarding smokeless tobacco (SLT) use and its harmful effects and intention to quit SLT among school going adolescents. A school-based cluster randomized control trial was carried out in 18 secondary schools targeting male and female students from grades 6 to 10 in Karachi. Primary outcome was knowledge about hazards of smokeless tobacco (SLT) and secondary outcomes were attitude and Perception about hazards of SLT, and intention to quit SLT. We enrolled 738 participants in intervention group and 589 in the control group. Mean score of knowledge significantly improved in intervention as compared to control group (P value

Families where parents had childhood history of victimization may likely to abuse their children; hence contributing as an important predictor of child emotional maltreatment (CEM). This study aimed to determine the relationship of intergenerational abuse with CEM among 11-17 years old children residing in peri-urban and urban communities of Karachi, Pakistan.Structured interviews were conducted with 800 children and parents-pair using validated questionnaire "International Child Abuse Screening Tool for Child (ICAST-C)" comprised of 4 domains. Domain of child emotional maltreatment was considered as outcome (CEM-score). The relationship between Parental history of childhood victimization and CEM-Score was measured using linear regression.The average CEM-score was came to be 19+5.2 among children whom parental history of childhood victimization was present (P 0.001). The estimated mean CEM-score increased by 5.59 units (95% CI= {2.61, 8.51}) among children whom parents had a history of childhood victimization (Intergenerational abuse) with severe physical familial abuse.The current study provided evidence on intergenerational transmission of maltreatment suggesting early prevention to break the cycle of child maltreatment through generations. Preventive measures can be taken, once a parental history of childhood victimization has been identified, by providing appropriate services to those families who belong to lower socioeconomic status, where mothers are young, presence of siblings' rivalry/ bullying and/or violence among family members. However, these factors do not explain a complete causality of the intergenerational transmission therefore additional factors, for instance parenting styles must be taken into consideration.

In many developing countries, physical child maltreatment is considered as an acceptable disciplinary strategy. The aim of this study was to identify factors associated with physical maltreatment among adolescents in Karachi, Pakistan. A survey of 800 adolescents was done using a structured questionnaire adopted by The International Society for the Prevention of Child Abuse and Neglect. Multiple linear regression methods were used to measure the factors associated with child physical maltreatment. The mean physical score was 17.5 ± 4.9, whereas the minimum and maximum score was 11 and 40, respectively. The total variability in physical scores was found to be 42% explained by child’s gender, child’s age, sibling abuse, verbal abuse/ quarreling within family, child’s height, socioeconomic wealth index, marital status, interaction between parental exposure to childhood abuse and physical fighting using hard object, interaction between parental education and age of mother, and interaction between parental history of psychiatric illness and physical fighting by parents.

This study examined the effect of a mental well-being module on undergraduate nursing students' knowledge and beliefs regarding causes and treatment of mental health and illness, and explored the relationship between these variables and depression and anxiety. The one group design incorporated pre-intervention, intervention and post-intervention phases, in a consecutive sample of 246 students in a 4-year BScN programme in Pakistan. A culturally sensitive, interactive mental well-being module of four hours length was delivered to three groups of approximately 40 students per group. Repeated measures ANOVA was performed to assess the difference in the mean knowledge scores. Paired t-tests investigated between-group differences on the factor scores. A total of 112 students screened positive for anxiety and depression symptoms. Repeated measures ANOVA showed a significant difference in the mean knowledge scores regarding mental illness (P < 0.001). Factor analysis resulted in four factors for the aetiology items. Paired t-test showed significant differences (P < 0.001) between psycho-social and environmental factors, supernatural and religious beliefs, and neuro-genetics. For treatment, significant differences (P < 0.001) were found between all factors - Professional and Help from others, Religiosity and Socialization, and Alternative and Medical Treatment. There was a significant and positive change in students' mental health knowledge, beliefs and mental health-seeking behaviour and diminished stigmatized beliefs. Based on the findings, it is highly recommended to incorporate the mental well-being program in the curriculum.

Data from the Global School-based Student Health Survey (GSHS) conducted in 2009 consisting of 5192 Pakistani school-going adolescents was used to assess the association between parent-child-relationship and physical-aggression. A multilevel-weighted-cox-proportional-algorithm was performed. The overall prevalence of physical-aggression was 41% of which 27% had a poor parent-child relationship. Male adolescents who have a poor bond with their parents had two times the prevalence of physical-aggression (95% CI: 1.82, 3.00) than those female adolescents with the strong parent-child-bonding. The findings of this study implicated that the poor parental bond and the role of gender as potential factors in physically aggressive adolescents.

Child maltreatment is considered as a global social issue and results as combined effect of parental background, socioeconomic environment, family structure, and child characteristics. The aim of this study was to determine factors associated with child maltreatment among children aged 11 to 17 years in Karachi, Pakistan. A cross-sectional survey of 800 pairs (children ranging from 11 to 17 years old and their parents) was randomly selected from 32 clusters of Karachi, using multistage cluster sampling. A structured questionnaire was adopted from the International Society for the Prevention of Child Abuse and Neglect (International Child Abuse Screening Tool for Parent [ICAST-P] and for Child [ICAST-C]). Multiple linear regression technique was used to assess the association of factors with child maltreatment score, by using STATA software. Our study found that children who always get bullied and mistreated by their siblings are at increased risk of getting maltreatment by parents (adjusted β: 10.78, 95% CI = [8.5, 13.05]).The mean estimated ICAST-C score increases by 9.86 (95% CI = [6.17, 13.55]) for children with exposure of verbal abuse and quarrel within family members. The mean estimated ICAST-C score increases by 5.09 among male children as compared with female children (95% CI = [3.65, 6.52]). Among children whose family always fight with each other and whose parents have exposure to childhood maltreatment, the mean estimated ICAST-C score increases by 22.25 (95% CI = [16.53, 27.98]). This study reflects the potential factors of child maltreatment in Karachi. Our findings provide evidence to raise awareness about child maltreatment.

Introduction Neonatal jaundice is a common cause of concern in immediate newborn period for parents as well as for the caregivers. Babies with visible jaundice are identified by the healthcare provider, and blood samples are sent for confirmation. Clinical expertise varies from person to person and may lead to sending excessive blood sampling. Obtaining blood bilirubin samples is a painful procedure; it predisposes the baby to infections and requires skilled health personnel. Moreover, laboratory tests are costly and time consuming, leading to unnecessary delays in commencing phototherapy and discharge from hospital. Transcutaneous bilirubinometer has been in use for a long time as screening tool in postnatal wards. With passage of time, its accuracy and validity have improved tremendously. Methodology We aim to implement a quality improvement initiative to reduce the number of blood bilirubin samples using transcutaneous bilirubin (TcBR) nomogram in full-term, low-risk babies who are born at our hospital and are admitted in postnatal ward after birth. Using preanalysis and postanalysis study design, this study will be performed in two phases of 6 months each. Data regarding total number of admissions in postnatal wards, demographics, serum bilirubin(TSBR) samplings and need for phototherapy will be recorded in both phases. TcBR will be done and recorded in postimplementation phase. Analysis and results Comparisons between the two groups will be made. Primary outcome will be reduction in blood bilirubin samples for TSBR after the implementation of TcBr protocol. The proportion of infants having TSBR performed in both periods will be compared. Crude sampling cost of TSBR will be obtained from laboratory, and cost comparison between two phases will be done to look for difference.

The dynamics of child abuse have been recognised as a global emerging social issue which is highly associated with child humiliation. The Government of Pakistan has taken many initiatives for addressing issues regarding child abuse and neglect and has designed laws to protect children against exploitation, abuse and violence; however, most of them are not enforced at all or poorly implemented due to lack of proper definition of child abuse and related terms, and different ways of reporting child abuse cases. Most of the non-governmental organisations (NGOs) in Pakistan target extreme cases of child sexual abuse such as child rape or commercial sexual exploitation of children, but cases of physical and psychological abuse are under-reported by the NGOs most of the time. A proper surveillance system is therefore required to identify the hidden cases of all types of child abuse that can lead to effective policy formulation and implementation.

BackgroundScreening for neonatal hyperbilirubinaemia in the postnatal ward has traditionally been performed using serum bilirubin sampling, but this has significant drawbacks such as risk of infection and slower reporting time.ObjectiveWe aimed to assess the impact of introducing transcutaneous bilirubin (TcBR) testing using TcBR nomogram on the number of serum bilirubin samples sent.MethodsA before-and-after study was performed following the introduction of a protocol integrating the use of the Dragger JM-105 transcutaneous bilirubinometer in the postnatal ward. Only babies born at ≥37 weeks of gestation, weighing ≥2500 g who presented with jaundice after the first 24 hours and within the first 7 days of life were included in the study. The number of total serum bilirubin samples (TSBRs) sent were compared for the 6-month periods before and after (a total of 12 months) implementation of the new protocol.ResultsIn the pre-implementation phase, a total of 882 (49%) out of 1815 babies had at least one serum bilirubin sample taken as opposed to a total of 236 (17%) out of 1394 babies in the post-implementation phase. The odds of performing TSBRs at least one time among babies in post-implementation phase were 79% lower than in pre-implementation phase (OR 0.21, 95% CI 0.18 to 0.25). We also estimated a significant cost saving of approximately US$1800 over a period of 6 monthsConclusionTcBR testing used in conjunction with our proposed nomogram significantly reduces the need for serum bilirubin sampling.

Background Harsh disciplinary practices are considered common in developing countries. However, scientific evidence lacks to support this. Primary aim of this study was to determine the prevalence of different forms (physical, emotional maltreatment and neglect) of child abuse in Karachi, Pakistan. Methods A cross sectional survey of 800 dyads (children ranging from 11–17 years old and their parent) were selected from 32 clusters of Karachi, using multistage cluster sampling between December 2014 to March 2015. A structured questionnaire adopted from International society of child abuse and neglect (International child abuse screening tool for parent and child). Prevalence of child maltreatment was estimated by mean child abuse score. Results Mean score were 51.7 + 11.9 (child), 77.9 + 20.2 (mother) and 63.6 + 17.3 (father). Both parent and child responses revealed similar prevalence (43%) of child maltreatment. The mother’s responses showed a prevalence of physical (42%), emotional (50%) maltreatment and neglect (5.4%) whereas, father’s responses showed a prevalence of physical (39%), emotional (46%) maltreatment and neglect (9.7%). The child’s experiences showed a prevalence of physical (49%), emotional (50%) maltreatment and neglect (57%). A substantial proportion of participants were exposed to at-least one form of maltreatment on mother (58%), father (54%) and child (74%) responses, of which all three maltreatment forms experienced by children were 4%, 9% and 31% on mother, father and child responses respectively. Conclusions This study reflects hidden extent of child maltreatment and poly-victimisation in Karachi. Our findings provide evidence to raise public awareness about malpractices and highlight the need to develop positive parenting program.

Background Harsh disciplinary practices are considered common in developing countries. However, scientific evidence lacks to support this. Primary aim of this study was to determine the prevalence of different forms (physical, emotional maltreatment and neglect) of child abuse in Karachi, Pakistan. Methods A cross sectional survey of 800 dyads (children ranging from 11–17 years old and their parent) were selected from 32 clusters of Karachi, using multistage cluster sampling between December 2014 to March 2015. A structured questionnaire adopted from International society of child abuse and neglect (International child abuse screening tool for parent and child). Prevalence of child maltreatment was estimated by mean child abuse score. MLR was used to assess the association of factors with outcome. Results Mean score were 51.7 + 11.9 (child), 77.9 + 20.2 (mother) and 63.6 + 17.3 (father). Both parent and child responses revealed similar prevalence (43%) of child maltreatment. There is an interaction between parental exposures to childhood abuse and physical fighting with hard object among family members. Among children whom family always fight with each other and parents have exposure to childhood maltreatment, the mean estimated ICAST-Child score increases by 13.746 (95% CI: 7.193, 20.298). There is an interaction between age of mother and parental education. The estimated mean of ICAST-Child score increases 2.169 times for every 10 years increase in age of mother among children whom both formal have no formal school education as compared to children whom both parents have formal education. Conclusions This study reflects hidden extent of child maltreatment and poly-victimisation in Karachi. Our findings provide evidence to raise public awareness about malpractices and highlight the need to develop positive parenting program.

Aims Child abuse is a global problem and pervades all cultures and socio-economic strata. The effects of abuse can be profound and life altering for both victims and the victims’ own children. There is substantial literature from High Income Countries about signs of abuse but a dearth of data from Low and Middle Income Countries like Pakistan To intervene, the first step is earlier identification. Healthcare professionals (HCPs) are ideally placed to detect abuse, but, before designing interventions to enhance services, it is necessary to understand professionals’ experiences, training needs and cultural beliefs. We sought to (1) Explore the challenges that health professionals’ face when managing cases of abuse; (2) Explore their cultural beliefs and to understand how these shape practise and (3) Identify their training needs. Methods Qualitative research design using standard methodology and analysis. In-depth tape-recorded interviews were conducted in Urdu with doctors, nurses and security staff in the emergency department (ED) of a large private hospital in Pakistan. Interviews were transcribed and translated into English for thematic analysis using AtlasTi software Results Challenges were identified at multiple levels from acknowledging to identifying to reporting abuse. HCPs offered a number of personal experiences in which they had identified abuse but considered that cases are often missed. The process of referral to legal services was poorly understood and further training and a guideline was suggested by participants. As the legal system in Pakistan does not currently allow HCPs to keep potentially abused patients in their custody, they felt restricted in their ability to act in the best interests of such children. Conclusion HCPs have great potential for the early detection of child abuse. However, without strong social organisations, the form that their intervention should take is unclear and, even where serious cases of abuse are encountered, there are major barriers preventing the escalation of concerns. This study highlights a need to support HCPs at an institutional level through a combination of training, senior and legal support and a hospital guideline to which they can refer.