preva lance of child abuse and associated psychological and pysical health problems

403 Pages·2010·1.22 MB·English

PREVA LANCE OF CHILD ABUSE AND ASSOCIATED
PSYCHOLOGICAL AND PYSICAL HEALTH
PROBLEMS : OMDURMAN LOCALITY, KHARTOUM
STATE, SUDAN

A thesis submitted for the award of the degree

OF PhD IN PSYCHOLOGY

Submitted by

Manal Abdelrahim Mohammed Omer
B.A, Psychology & Pre-school education, Ahfad University
Post graduate Diploma, Clinical Psychology, Khartoum University
M.A, Clinical Psychology, Indianapolis University, USA

Supervised by

Professor Alzubair Bashir Taha

Department of Psychology

Faculty of Art

October 2009
DECLARATION

"I hereby declare that this submission is my own work and that, to the
best of my knowledge and belief ,it has not been submitted previously
for the award of any degree to Khartoum University or any other
academic institute.

Manal Abd Elrahim Mohammed Omer
Khartoum November ,2009

II
Key Words

Child abuse/maltreatment1
Child sexual abuse/maltreatment
Child physical abuse/maltreatment
Child emotional abuse/maltreatment
Child neglect
Health risk behaviours
Co-occurrence of child maltreatment
Multiple-type/form maltreatment
Poly-victimization2
Community-based research
Prevalence
Associations
Mental and physical health
Cumulative effect
1
In this study, the usage of child abuse and child maltreatment terms is exchangeable (WHO, 1999).
2
In this study, multiple-type maltreatment and poly-victimization terms are exchangeable.
III
ACKNOWLEDGMENT
I would like to express my gratitude to my supervisor, Professor Alzubair Bashir
Taha, for his invaluable support and encouragement. His moral support and
continuous guidance enabled me to complete my work successfully.
Special thank goes out for Dr. Khalid Alkurdi and Dr Osama Aljyli for taking time
out from their busy schedule to provide me with valuable advices and suggestions.
To the schools and students who participated as anonymous volunteers, for their time,
openness and eagerness for this study that made the research possible.
To my friend Sheila Fellows from UNCEF, for providing me with materials related to
my thesis and for her assistance in data analysis and statistical advice, from which I
have learnt so much.
Sincere appreciation to my friends Osman Shaiba from UNICEF and Kholoud Yousif
for their help and support.
Finally I would like to thank my family for the support they provided me through my
entire life and in particular, I must acknowledge my husband and best friend, Alfatih
Almalik, without whose love, encouragement and editing assistance, I would not have
finished the challenging journey .

IV
Abstract
PREVA LANCE OF CHILD ABUSE AND ASSOCIATED
PSYCHOLOGICAL AND PYSICAL HEALTH PROBLEMS :
OMDURMAN LOCALITY, KHARTOUM STATE, SUDAN
Manal Abdelrahim Mohammed Omer
The primary objective of this research was to examine the nature and co-
occurrence of four forms of child maltreatment including sexual,
physical, emotional maltreatment and neglect among Sudanese basic and
high school adolescents in both urban and rural settings, and determine
the extent to which such adverse experiences impact on self-reported
health risk behaviours and physical and mental health.
The study participant are school-based population from Sudanese basic
education schools, Khartoum state, Omdurman locality (grade 7 and 8)
and secondary high schools (grade 1 to3). The student’s age generally
ranges from12 to17. The study conducted between 2007 and 2009.
A descriptive method including qualitative 16 in-depth interviews, 8
focused group discussions and across-sectional survey of 2,591 was
employed in this study ,as well as a pilot study of 299 adolescents. A
two-stage cluster sampling technique was employed. In which the areas
were purposely selected, schools within sites were randomly selected,
then classes within schools were randomly chosen. Data were collected
by self-administered questionnaires in class rooms. Key information
included demographics, family characteristics and environment, and four
scales measuring sexual abuse, emotional and physical maltreatment and
neglect as well as health risk behaviours scale and mental health scales
which included anxiety, depression, and self-esteem and physical health
problem scale . Appropriate statistical analysis was performed using
Survey Data Analysis – SUDAAN 7.5.2a to estimate sample size for the
major survey; Statistical Package for Social Sciences- SPSS (version
14).As well as AMOS 5.0 .
V
The main findings of the study were : the experiences of different forms
and co-occurrence of child maltreatment among school adolescents were
prevalent in Sudan. The prevalence estimates of at least one type of
physical and emotional maltreatment, neglect and sexual abuse were
47.5%, 39.5%, 29.3% and 19.7% respectively. A significant proportion of
respondents (41.6%) were exposed to more than one form of child
maltreatment. the prevalence of child physical and emotional
maltreatment and neglect among adolescents was not statistically
different between urban and rural areas.
There was no significant gender difference in reports of adverse sexual
experiences. In contrast, girls were more likely to report emotional
maltreatment and neglect whereas boys were more likely to experience
physical maltreatment. In general, the pattern of correlations between
child maltreatment and health risk behaviours was similar for females and
males. Emotional maltreatment significantly correlated with most
behaviours examined. Clearly, co-occurrence of child maltreatment was
significantly associated with almost all examined health risk behaviours
and a dose-response relationship was observed in most of the dependent
variables.
multivariate regression analyses revealed that presence of four types of
child maltreatment explained a small but significant proportion of
variance (from 5% to 9%). Additionally, while each form of child
maltreatment had independent effects on depression, anxiety problems,
low self-esteem and poor physical health, emotional maltreatment
appeared to be the strongest influence on mental and physical health of
both female and male adolescents. Analysis of variance also clearly
suggested that exposure to increasing numbers of maltreatment forms
significantly increased the risk of mental and physical health problems in
a dose-response fashion.
There is a significant independent associations between various types of
child maltreatment, as well as the cumulative effects of poly-
victimization on a wide range of health risk behaviours, depression,
anxiety, self-esteem, and general physical health. The study concluded
with the recommendations.

VI
ﺺﻠﺨﺘﺴﻤﻟا
، مﻮﻃﺮﺨﻟا ﺔﻳﻻو ، نﺎﻣرﺪﻣا ﺔﻴﻠﺤﻣ: ﺎﻬﺑ ﺔﻄﺒﺗﺮﻤﻟا ﺔﻳﺪﺴﺠﻟاو ﺔﻴﺴﻔﻨﻟا ﻞآﺎﺸﻤﻟاو ﻞﻔﻄﻟا ﺔﻠﻣﺎﻌﻣ ءﻮﺳ
نادﻮﺴﻟا
ﺮﻤﻋ ﺪﻤﺤﻣ ﻢﻴﺣﺮﻟا ﺪﺒﻋ لﺎﻨﻣ
ﺔﻌﺒﺭﻷﺍ ﻉﺍﻭﻨﻷﺍ ﺔﻌﻴﺒﻁﻭ ﺭﺎﺸﺘﻨﺍ ﻯﺩﻤ ﻲﺼﻘﺘﻭ ﺹﺤﻓ ﻲﻓ ﺔﺴﺍﺭﺩﻟﺍ ﻩﺫﻬﻟ ﻲﺴﻴﺌﺭﻟﺍ ﻑﺩﻬﻟﺍ لﺜﻤﺘﻴ
ﺱﺎـﺴﻷﺍ ﻲـﺘﻠﺤﺭﻤﻟ ﺫﻴﻤﻼﺘﻟﺍ ﻲﻓ "لﺎﻤﻫﻹﺍﻭ ﺔﻴﻔﻁﺎﻌﻟﺍ ،ﺔﻴﻨﺩﺒﻟﺍ ،ﺔﻴﺴﻨﺠﻟﺍ " لﻔﻁﻟﺍ ﺔﻠﻤﺎﻌﻤ ﺓﺀﺎﺴﻹ
ﺔﺤﺼﻟﺍ ﻰﻠﻋ ﻲﺒﻠﺴﻟﺍ ﺭﻴﺜﺄﺘﻟﺍ ﻯﺩﻤ ﺩﻴﺩﺤﺘﻭ ﻡﻭﻁﺭﺨﻟﺍ ﺔﻴﻻﻭﺒ ﺔﻴﻔﻴﺭﻭ ﺔﻴﺭﻀﺤ ﻕﻁﺎﻨﻤ ﻲﻓ ﻱﻭﻨﺎﺜﻟﺍﻭ
.ﺔﺤﺼﻠﻟ ﺓﺩﺩﻬﻤﻟﺍ ﺕﺎﻴﻜﻭﻠﺴﻟﺍﻭ ﺔﻴﻠﻘﻌﻟﺍ ،ﺔﻴﻨﺩﺒﻟﺍ
ﻑـﺼﻟﺍ)ﻱﻭﻨﺎﺜﻟﺍ ﻭ ( ﻥﻤﺎﺜﻟﺍﻭ ﻊﺒﺎﺴﻟﺍ ﻑﺼﻟﺍ)ﺱﺎﺴﻷﺍ ﻲﺘﻠﺤﺭﻤ ﺫﻴﻤﻼﺘ ﻲﻓ ﺔﺴﺍﺭﺩﻟﺍ ﺔﻨﻴﻋ ﺕﻠﺜﻤﺘ
18 12
( ﻰﻟﺍ ﻥﻴﺒ ﻡﻫﺭﺎﻤﻋﺃ ﺡﻭﺍﺭﺘﺘ) .ﻥﺎﻤﺭﺩﻤﺍ ﺔﻴﻠﺤﻤ، ﻡﻭﻁﺭﺨﻟﺍ ﺔﻴﻻﻭ ﻲﻓ (ﺙﻟﺎﺜﻟﻭ ﻲﻨﺎﺜﻟﺍ،لﻭﻷﺍ
2009 2007
ﺯ ﻲﻟﺍ ﻥﻴﺒ ﺓﺭﺘﻔﻟﺍ ﻲﻓ ﺔﺴﺍﺭﺩﻟﺍ ﺕﻘﺒﻁ ﺎﻤﻜ
،ﺔﻘﻤﻌﺘﻤ ﺔﻠﺒﺎﻘﻤ ﺭﺸﻋ ﺔﺘﺴ ﺎﹰﻨﻤﻀﺘﻤ ﺙﺤﺒﻟﺍ ﺕﻼﻜﺸﻤ ﺔﺠﻟﺎﻌﻤ ﻲﻓ ﻲﻔﺼﻭﻟﺍ ﺞﻬﻨﻤﻟﺍ ﻡﺍﺩﺨﺘﺴﺍ ﻡﺘ
591 299
ﻲﻋﺎﻁﻗ ﺢﺴﻤ ﻡﺘ ﺎﻤﻜ ، ﻥﻤ ﺔﻴﻋﻼﻁﺘﺴﺍ ﺔﻨﻴﻋ ﻙﻟﺫﻜﻭ ﺓﺯﻜﺭﻤ ﺔﻴﻋﺎﻤﺠ ﺕﺍﺭﺍﻭﺤ ﺔﻴﻨﺎﻤﺜ
لﻭـﺼﻔﻟﺍ، ﺏﻼـﻁﻟﺍ ﺭﺎﻴﺘﺨﺍ ﻯﺭﺠ .ﻥﻭﻌﺴﺘﻭ ﺩﺤﺍﻭﻭ ﺔﺌﺎﻤﺴﻤﺨﻭ ﻥﺎﻔﻟﺃ ﻥﻤ ﺔﻨﻭﻜﻤﻟﺍ ﺙﺤﺒﻟﺍ ﺔﻨﻴﻌﻟ
ﻊـﻤﺠ ﻡـﺘﻭ . ﺓﺩﺩﺤﻤ ﺏﺎﺒﺴﻷ ﺔﺴﺍﺭﺩﻟﺍ ﻊﻗﺍﻭﻤ ﺭﺎﻴﺘﺨﺍ ﻡﺘ ﺎﻤﻜ ﺔﻴﺌﺍﻭﺸﻌﻟﺍ ﺔﻨﻴﻌﻟﺎﺒ ﺱﺭﺍﺩﻤﻟﺍ ﻙﻟﺫﻜﻭ
ﻥﻤـﻀﺘﺘ ﺔﻴﺴﻴﺌﺭ ﺕﺎﻤﻭﻠﻌﻤ ﻥﺎﻴﺒﺘﺴﻻﺍ لﻤﺸﻴﻭ ﺔﻴﺴﺍﺭﺩﻟﺍ لﻭﺼﻔﻟﺍ ﻲﻓ ﻥﺎﻴﺒﺘﺴﻻﺍ لﻼﺨ ﻥﻤ ﺕﺎﻨﺎﻴﺒﻟﺍ
ﺕﺎـﺠﺭﺩ ﻊﺒﺭﺃ ﻥﻤﻀﺘﺘ ﺎﻤﻜ ﺔﺴﺍﺭﺩﻟﺍ ﺔﻨﻴﻌﻟ ﺔﻴﺌﻴﺒﻟﺍﻭ ﺔﻴﺭﺴﻷﺍ ﺹﺌﺎﺼﺨﻟﺍﻭ ﺔﻴﻓﺍﺭﻏﻭﻤﻴﺩﻟﺍ ﺕﺎﻨﺎﻴﺒﻟﺍ
ﺕﺎﻴﻜﻭﻠﺴﻟﺍ ﺱﺎﻴﻘﻤ ﻰﻟﺇ ﺔﻓﺎﻀﻹﺎﺒ ،لﺎﻤﻫﻹﺍﻭ ﺔﻴﻨﺩﺒﻟﺍ، ﺔﻴﻔﻁﺎﻌﻟﺍ ﺓﺀﺎﺴﻹﺍ، ﻲﺴﻨﺠﻟﺍ لﻼﻐﺘﺴﻻﺍ ﺱﺎﻴﻘﻟ
ﻕـﻠﻘﻟﺍ، ﺏ ﺎـﺌﺘﻜﻻﺍ ﺕﺍﺭﻴﻐﺘﻤ ﺔﺜﻼﺜ ﺱﺎﻴﻗ ﻥﻤﻀﺘ ،ﻱﺫﻟﺍ ﺔﻴﻠﻘﻌﻟﺍ ﺔﺤﺼﻟﺍ ﺱﺎﻴﻘﻤﻭ ﺔﺤﺼﻠﻟ ﺓﺩﺩﻬﻤﻟﺍ
ﺔﻴﺌﺎـﺼﺤﻹﺍ ﺞﻤﺍﺭـﺒﻟﺍ ﻡﺍﺩﺨﺘـﺴﺍ ﻡـﺘ. ﺔﺤـﺼﻟﺍ لﻜﺎـﺸﻤ ﺱﺎـﻴﻘﻤﻟ ﺔﻓﺎﻀﻹﺎﺒ ﺕﺍﺫﻟﺍ ﻡﺍﺭﺘﺤﺍﻭ
SPSS, SUDAAN 7.5 ,AMOS5.
.ﺕﺎﻨﺎﻴﺒﻟﺍ لﻴﻠﺤﺘﻟ :ﺔﻴﻟﺎﺘﻟﺍ
ﻪﻟﻼﻐﺘﺴﺍﻭ لﻔﻁﻟﺍ ﺔﻠﻤﺎﻌﻤ ﺓﺀﺎﺴﻹ ﺔﻔﻠﺘﺨﻤﻟﺍ ﺔﻌﺒﺭﻷﺍ ﻉﺍﻭﻨﻷﺍ ﺭﺎﺸﺘﻨﺍ : ﺕﻨﻤﻀﺘ ﺔﺴﺍﺭﺩﻟﺍ ﺞﺌﺎﺘﻨ ﻡﻫﺃ
ﺓﺀﺎـﺴﻹﺍ ﻉﺍﻭـﻨﺃ ﻥﻤ لﻗﻷﺍ ﻰﻠﻋ ﺩﺤﺍﻭ ﻉﻭﻨ ﺭﺎﺸﺘﻨﺍ ﺕﺍﺭﻴﺩﻘﺘ ﺕﻠﺼﻭﻭ .ﺙﺤﺒﻟﺍ ﻊﻤﺘﺠﻤ ﺔﻨﻴﻋ ﻲﻓ
29,3 39,5 47,5
ﻭ % ﻭ % ﻭ % ﺔﺒـﺴﻨ ﻰـﻟﺇ ﺔﻴﺴﻨﺠﻟﺍﻭ لﺎﻤﻫﻹﺍ ،ﺔﻴﻔﻁﺎﻌﻟﺍ ،ﺔﻴﺩﺴﺠﻟﺍ ﺔﻌﺒﺭﻷﺍ
41 6% . 19,7
ﺀﻭـﺴ ﻥـﻤ ﻉﻭـﻨ ﻥﻤ ﺭﺜﻜﻷ ﺍﻭﻀﺭﻌﺘ ﺔﺴﺍﺭﺩﻟﺍ ﺔﻨﻴﻋ ﻥﻤ . ﻲﻟﺍﻭﺘﻟﺍ ﻰﻠﻋ %
ﻭ ﺔـﻴﻔﻁﺎﻌﻟﺍ ، ﺔﻴﺩـﺴﺠﻟﺍ ﺓﺀﺎـﺴﻺﻟ ﺽﺭﻌﺘﻟﺍ ﻲﻓ ﺔﻴﺌﺎﺼﺤﺇ ﺔﻟﻻﺩ ﺕﺍﺫ ﻕﻭﺭﻓ ﺩﺠﻭﺘ ﻻ . ﺔﻠﻤﺎﻌﻤﻟﺍ
ﺔﻴـﺴﻨﺠﻟﺍ ﻡﻬﺒﺭﺎﺠﺘﺒ ﺔﻴﻔﻴﺭﻟﺍ ﺱﺭﺍﺩﻤﻟﺍ لﺎﻔﻁﺃ ﺡﺭﺼﻴ ﺎﻤ ﺎﹰﺒﻟﺎﻏ ﻥﻜﻟ ،ﺭﻀﺤﻟﺍﻭ ﻑﻴﺭﻟﺍ ﻥﻴﺒ لﺎﻤﻫﻹﺍ
ﻯﺯـﻌ ﻴ ﺔﻴـﺴﻨﺠﻟﺍ ﺔﻠﻤﺎﻌﻤﻟﺍ ﺀﻭﺴ ﻲﻓ ﻕﻭﺭﻓ ﺩﺠﻨ ﻡﻟﻭ .ﺔﻴﺭﻀﺤﻟﺍ ﺱﺭﺍﺩﻤﻟﺍ ﻲﻓ ﻡﻬﻨﺍﺭﻗﺃ ﻥﻤ ﺭﺜﻜﺃ
ﺓﺀﺎـﺴﻹﺍ ﺏﺭﺎـﺠﺘ ﻥﻤ ﻯﻭﻜﺸﻠﻟ ﺭﺜﻜﺃ ﻥﻠﻤﻴ ﺕﺎﻨﺒﻟﺍ ﻥﺃ ﻙﻟﺫﻟ ﺎﹰﻓﻼﺨ ﺩﺠﻨ ﺎﻨﻨﻜﻟ ،(ﻰﺜﻨﺃ ،ﺭﻜﺫ) ﻉﻭﻨﻠﻟ
.ﻱﺩﺴﺠﻟﺍ ﻑﻨﻌﻠﻟ ﺏﻟﺎﻐﻟﺍ ﻲﻓ ﺭﻭﻜﺫﻟﺍ لﺎﻔﻁﻷﺍ ﺽﺭﻌﺘﻴ ﺎﻤﻨﻴﺒ لﺎﻤﻫﻹﺍﻭ ﺔﻴﻔﻁﺎﻌﻟﺍ
ﺭﻭﻜﺫـﻟﺍ ﻯﺩـﻟ ﺔﺤﺼﻠﻟ ﺓﺩﺩﻬﻤﻟﺍ ﺕﺎﻴﻜﻭﻠﺴﻟﺍﻭ لﻔﻁﻟﺍ ﺔﻠﻤﺎﻌﻤ ﺓﺀﺎﺴﺇ ﻥﻴﺒ ﻪﻴﻁﺎﺒﺘﺭﺍ ﺔﻗﻼﻋ ﺩﺠﻭﺘ
ﻙﻭﻠﺴﻟﺍ ﻁﺎﻤﻨﺃ ﻡﻅﻌﻤﻭ ﺔﻴﻔﻁﺎﻌﻟﺍ ﺓﺀﺎﺴﻹﺍ ﻥﻴﺒ ﺔﻴﺌﺎﺼﺤﺇ ﺔﻟﻻﺩ ﺕﺍﺫ ﻪﻴﻁﺎﺒﺘﺭﺍ ﺔﻗﻼﻋ ﺩﺠﻭﺘ .ﺙﺎﻨﻹﺍﻭ
VII
ﺎﻤﻜ .ﺕﺍﺫ ﺔﻗﻼﻋ ﺩﺠﻭﺘ ﺎﻤﻜ .ﺭﻜﺴ ﻟﺍﻭ لﻭﺤﻜﻟﺍ ﻲﻁﺎﻌﺘﻭ ﻥﻴﺨﺩﺘﻟﺍﻭ ﺩﻴﺩﻬﺘﻟﺍﻭ ﻑﻴﻨﻌﻟﺍ ﺎﻬﺼﺤﻓ ﻡﺘ ﻲﺘﻟﺍ
ﺕﺎﻴﻜﻭﻠﺴﻟﺍ لﻜﺒ ﺔﻴﺌﺎﺼﺤﺇ ﺔﻟﻻﺩ ﺕﺍﺫ ﺎﹰﻁﺎﺒﺘﺭﺍ ﻁﺒﺘﺭﺘ لﻔﻁﻟﺍ ﺔﻠﻤﺎﻌﻤ ﺓﺀﺎﺴﺇ ﻉﺍﻭﻨﺃ ﺭﺍﺭﻜﺘ ﻥﺃ ﺢﻀﺘﺍ
.ﺎﻬﺼﺤﻓ ﻡﺘ ﻲﺘﻟﺍ ﺔﺤﺼﻠﻟ ﺓﺩﺩﻬﻤﻟﺍ
ﺓﺀﺎـﺴﻹ ﺔﻌﺒﺭﻷﺍ ﻉﺍﻭﻨﻷﺍ ﺩﻭﺠﻭ ﻥﺃ ﺓﺩﺩﻌﺘﻤﻟﺍ ﺕﺍﺭﻴﻐﺘﻤﻟﺍ ﻥﻴﺒ ﺔﻗﻼﻌﻠﻟ ﻲﺌﺎﺼﺤﻹﺍ لﻴﻠﺤﺘﻟﺍ ﺭﻬﻅﺃ
9 5
ﻊـﻤ ﺔﻨﺭﺎﻘﻤ % ﻰﻟﺇ % ﻥﻤ ﺔﻤﺎﻫ ﺔﻟﻻﺩ ﺕﺍﺫ ﺎﻬﻨﻜﻟ ﺓﺭﻴﻐﺼ ﺕﻭﺎﻔﺘ ﺔﺒﺴﻨ ﺢﻀﻭﺘ لﻔﻁﻟﺍ ﺔﻠﻤﺎﻌﻤ
لﻼﻐﺘﺴﺍﻭ ﺓﺀﺎﺴﺇ لﺎﻜﺸﺃ ﻥﻤ لﻜﺸ لﻜﻟ ﻥﺃ ﻰﻟﺇ ﺔﻓﺎﻀﻹﺎﺒ ﻱﺭﺴﻷﺍ ﺦﻴﺭﺎﺘﻟﺍ ﺕﺍﺭﻴﻐﺘﻤ ﻥﻤ ﺭﻴﺒﻜ ﺩﺩﻋ
ﺎﻤﻜ .ﺔﻴﻨﺩﺒﻟﺍ ﺔﺤﺼﻟﺍ ﻲﻨﺩﺘﻭ ﺕﺍﺫﻟﺍ ﻡﺍﺭﺘﺤﺍ ﺔﻠﻗ ،ﻕﻠﻘﻟﺍ ،ﺏﺎﺌﺘﻜﻻﺍ ﻰﻠﻋ ﻼﹰ ﻘﺘﺴﻤ ﺍﹰﺭﻴﺜﺄﺘ ﺔﻌﺒﺭﻷﺍ لﻔﻁﻟﺍ
ﻥﻴﻐﻟﺎـﺒﻠﻟ ﺔﻴﻨﺩﺒﻟﺍﻭ ﺔﻴﻠﻘﻌﻟﺍ ﺔﺤﺼﻟﺍ ﻰﻠﻋ ﺔﻴﻭﻗ ﻪﻴﻁﺎﺒﺘﺭﺍ ﺔﻗﻼﻋ ﺎﻬﻟ لﻔﻁﻠﻟ ﺔﻴﻔﻁﺎﻌﻟﺍ ﺓﺀﺎﺴﻹﺍ ﻥﺃ ﺩﺠﻭ
ﺓﺀﺎـﺴﻹﺍ لﺎﻜـﺸﺃ ﻥـﻤ ﺩﻴﺯﻤﻟ ﺽﺭﻌﺘﻟﺍ ﻥﺃ ﺡﻭﻀﻭﺒ ﻥﻴﺎﺒﺘﻟﺍ لﻴﻠﺤﺘ ﺭﻬﻅﺃ .ﺭﻭﻜﺫﻟﺍﻭ ﺙﺎﻨﻹﺍ ﻥﻤ
. ﺔﻴﻨﺩﺒﻟﺍﻭ ﺔﻴﻠﻘﻌﻟﺍ ﺔﺤﺼﻟﺎﺒ ﺭﺍﺭﻀﻹﺍ ﺭﻁﺎﺨﻤ ﻑﻋﺎﻀﻴ
ﺔﻓﺎﻀﻹﺎﺒ ،لﺎﻔﻁﻷﺍ لﻼﻐﺘﺴﺍﻭ ﺓﺀﺎﺴﻹ ﺔﻌﺒﺭﻷﺍ ﻉﺍﻭﻨﻷﺍ ﻑﻠﺘﺨﻤ ﻥﻴﺒ ﺔﻠﻘﺘﺴﻤ ﻪﻴﻁﺎﺒﺘﺭﺍ ﺔﻗﻼﻋ ﺩﺠﻭﺘ
ﺔـﻠﻗ ،ﻕﻠﻘﻟﺍ ،ﺏﺎﺌﺘﻜﻻﺍ ،ﺔﺤﺼﻟﺎﺒ ﺓﺭﺎﻀﻟﺍ ﺕﺎﻴﻜﻭﻠﺴﻟﺍ ﻰﻠﻋ ﺓﺩﺩﻌﺘﻤﻟﺍ ﺓﺀﺎﺴﻺﻟ ﻲﻤﻜﺍﺭﺘﻟﺍ ﺭﻴﺜﺄﺘﻟﺍ ﻰﻟﺇ
. ﺔﻴﻨﺩﺒﻟﺍ ﺔﺤﺼﻟﺍﻭ ﺕﺍﺫﻟﺍ ﻡﺭﺘﺤﺍ

VIII
Contents
Declaration........................................................................................................... ......II
Key Words …………………………………………………………………....... III
Abstract ……………………………………………………………………........IV
Abstract in Arabic (ﺚﺤﺒﻟا ﺺﻠﺨﺘﺴﻣ)……………………………………………… .....VI
Contents ……………………………………………………………………….... . VIII
List of tables …………………………………………………………………... XI
List of figures ………………………………………………………………….. .. XIV
Abbreviations …………………………………………………………………. XV
Acknowledgements ……………………………………………………………. . XVI

Chapter 1: Introduction …………………………………………………….... . 1
1.1 Background ………………………………………………………... . ..1
1.2 Research problem ........................................................................1
1.3 Research importance..................................................................... ........ 3

1.4 Research aim and objectives ………………………………………. .. .4
1.5 Research hypothesis.......................................................................5
1.6 Methods of data collection &analysis...............................................5
1.7 Study sites &Time line ..................................................................6
1.8 Research definitions.......................................................................6
1.9 Outline of thesis …………………………………………………… ...7
Chapter2:Literature Review …………………………………………………. 10
2.1 Definition of child maltreatment …………………………………... . 10
2.2 International prevalence of child maltreatment ……………………. 13
2.3 Risk factors for child maltreatment ………………………………... 27
2.4 Consequences of child maltreatment ……………………………..… 44
2.5 Child maltreatment in Sudan………………………………….……. 68
2.6 Research on child maltreatment in Sudan………………………….. 73
Chapter3:Research Methods and Pilot Study ………………………………. 78
3.1 Methodological considerations in research on child maltreatment ... 78
3.2 Design of this study ………………………………………………... 83
3.3 Study participants …………………………………………………. 86
3.4 Study sites …………………………………………………………. 86
3.5 Timeline …………………………………………………………… 87
3.6 Instrument development …………………………………………… 88
IX
3.7 Sample selection …………………………………………………... 93
3.8 Data collection …………………………………………………….. 94
3.9 Data management ………………………………………………….. 94
3.10 Data analysis ……………………………………………………... 95
3.11 Ethics approval …………………………………………………… 99
3.12 The qualitative and pilot studies …………………………………. 99
3.13 Implications of the pilot study …………………………………… 116
3.14 Changes to the questionnaire …………………………………….. 117
Chapter4:Findings:Prevalence and Characteristics of Different Forms of Abuse
...............................................................................................................119
4.1 Sample characteristics ……………………………………………... 120
4.2 Adverse experiences and prevalence of four forms of child maltreatment
………………………………………………………….........…............ 127
4.3 Characteristics of child maltreatment ………………………….… 135
4.4 Correlates of child maltreatment …………………………………... 138
4.5 Summary ………………………………………………................... 156
Chapter 5:Finding :Associations between Child Maltreatment and Health
Risk Behaviours …. .......................................................................................... 158
5.1 Prevalence and correlates of health risk behaviours ………………. 158
5.2 Associations between maltreatment types, multiple forms of maltreatment
and health risk behaviours ……………………………………………… 162
5.3 Summary ………………………………………………………….... 190
Chapter 6:Findings :Associations between Child Maltreatment and Mental and
Physical Health .. .................................................................................................. 193
6.1 Descriptive analyses ……………………………………………….. 194
6.2 Bivariate correlations of child maltreatment with mental and physical
health………………………………………………………………........ 197
6.3 Impact of co-occurrence exposure to child maltreatment …………. 199
6.4 Relative influence of each type of child maltreatment …………….. 208
6.5 Summary …………………………………………………………... .220

Chapter 7: Discussion , Conclusion &Recommendations..........................221
7.1 The prevalence of child maltreatment and correlates with background
variables………………………………………………………............… 221
7.2 Correlates of child maltreatment and health risk behaviours ……… 232
7.3 Correlates of child maltreatment and physical and mental health … 240
7.4 Strengths, weaknesses and implications for further research ……… 249
7.5 Conclusion ……………………………………… ………………… 254
X