|Year : 2021 | Volume
| Issue : 1 | Page : 76-82
Knowledge, attitude, and experience of master degree dental students toward child physical abuse in Egypt: A cross-sectional study
Randa Youssef Abd Al Gawad, Sara Ahmed Mahmoud
Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Cairo University, Giza, Egypt
|Date of Submission||14-Apr-2020|
|Date of Decision||15-Apr-2020|
|Date of Acceptance||15-Oct-2020|
|Date of Web Publication||28-Jan-2021|
Dr. Sara Ahmed Mahmoud
Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Cairo University, 13 Solder Building, El Haram, Giza.
Source of Support: None, Conflict of Interest: None
Aim: Identification of child physical abuse (CPA) cases is a global worldwide concern nowadays due to its serious lifelong consequences. The aim of this study was to assess knowledge, attitude, and experience of pediatric dentistry master’s degree students and other master’s degree students toward CPA. Materials and Methods: A cross-sectional study with convenient consecutive sampling was conducted on 124 Master Degree dental students at Cairo University, during the academic year (2018–2019). The sample was divided into Group I: 53 Pediatric Dentistry Master Degree students and Group II: 71 Other Master Degree students, where data regarding their knowledge, attitude, and experiences toward CPA were collected using a structured, self-administered questionnaire. Collected data were tabulated and statistically analyzed. Comparisons between the two groups were performed using chi-square test (P < 0.05). Results: Only11.4% of Group I and 9.9% of Group II received previous training about CPA. Regarding knowledge, there was no statistically significant difference between both groups, except for Qs 12 and Q15 where Group I showed statistically significant higher positive responses (52.8% and 79.2%, respectively). When assessing attitude, there was no statistically significant difference between both groups, except for Q 21, where Group I showed a statistically significant higher positive response (92.5%). Regarding experience, Group I reported more suspicions toward physical abuse cases (56.6%); however, Group II reported more cases (76.7%). Conclusion: Both groups had nearly equivalent positive knowledge, attitude, and experience toward CPA; however, the number of suspected cases was far beyond the worldwide records. Training courses and data available at workplaces are still not sufficient.
Keywords: Abuse, Child, Dentist, Egypt, KAP
|How to cite this article:|
Abd Al Gawad RY, Mahmoud SA. Knowledge, attitude, and experience of master degree dental students toward child physical abuse in Egypt: A cross-sectional study. J Int Oral Health 2021;13:76-82
|How to cite this URL:|
Abd Al Gawad RY, Mahmoud SA. Knowledge, attitude, and experience of master degree dental students toward child physical abuse in Egypt: A cross-sectional study. J Int Oral Health [serial online] 2021 [cited 2021 Apr 17];13:76-82. Available from: https://www.jioh.org/text.asp?2021/13/1/76/308345
| Introduction|| |
Child abuse and neglect (CAN) is a global worldwide problem. CAN is defined by World Health Organization (WHO) as, “Any kind of physical, sexual, emotional abuse, neglect or negligent treatment, commercial or other exploitation resulting in actual or potential harm to the child’s health, survival, development or dignity in the context of a relationship of responsibility, trust or power.”
Child physical abuse (CPA) results from deliberated physical force against the child with subsequent physical injury, which leads to vulnerable and harmful effects for children, societies, and countries.,,,
In Egypt, children face different types of abuse far beyond the world wide records. In 2014 the Demographic Health Survey (DHS) announced that 93% of Egyptian children aged in the age range (1–14) years had been exposed to a diversity of violence, including psychological aggression and physical punishment.
Dentists are in a unique position in the identification and reporting of CPA, they may be in a pioneer situation to remark physical abuse cases, which are often reported in the orofacial region (50%–77% of physically abused children). Therefore, their knowledge and attitudes are important to fulfill their commitments.,,,
Al-Dabaan et al. conducted a study to analyze the experience and knowledge of dental practitioners in Saudi Arabia regarding the identification of CAN. A self-administered, web-based questionnaire was emailed to all of the members of the Saudi Dental Society (n = 7352). The respondents (n = 122) showed good knowledge of the forms and indicators of CAN. Moreover, a large proportion (59%) had experienced a case of child abuse or neglect in their practice over the previous 5 years.
A cross-sectional survey was performed in Jeddah, Saudi Arabia to assess knowledge, attitudes, and behaviors of dentists regarding CPA using a self-administered questionnaire. This research explored that participants had deficient knowledge about CPA but positive attitudes in detecting and counting it.
In Egypt, there are no available data about knowledge, attitude, and experience of postgraduate dentists regarding the issue of CPA identification and reporting; therefore, the aim of this research was to assess the knowledge, attitude, and experience of Pediatric Dentistry Master Degree Students (PDMDS) and Other Master Degree Students (OMDS) toward CPA. In this study a null hypothesis was suggested; both groups have the same knowledge, attitude, and practice toward CPA.
| Materials and Methods|| |
Study design, and participants
This cross-sectional study was conducted in Pediatric Dentistry and Dental Public Health Department, Faculty of Dentistry, Cairo University during the educational year 2018–2019 (from September 2018 to May 2019). The research protocol was approved by the department research board. The target participants were PDMDS (Group I, n = 53): those were master degree students studying pediatric dentistry master degree courses and other subsidiary courses at Pediatric Dentistry and Dental Public Health Department, and OMDS (Group II, n = 71): those were master degree students of other clinical departments studying master degree subsidiary courses at Pediatric Dentistry and Dental Public Health Department.
Master’s degree dental students enrolled in this study should fulfill the following inclusion criteria. They were all Clinical Based Master’s degree specialties studying at Pediatric Dentistry and Dental Public Health Department, Faculty of Dentistry, Cairo University and Master’s degree dental students studying during the educational year 2018–2019. Both sexes and all nationalities were included. Exclusion criteria were Master’s degree dental students refused to sign the informed consent and Master’s degree dental students whose Master degree thesis is about CPA or CAN.
Sample size calculation
Convenient consecutive sampling was applied; it included 124 master’s degree students, 53 PDMDS (Group I), and 71 OMDS (Group II) studying at Pediatric Dentistry and Dental Public Health Department, Faculty of Dentistry, Cairo University during the educational year 2018–2019. All answered questionnaires were included in the study analysis, where no questionnaires were lost or excluded due to inaccurate responding.
Data were collected from participants using a structured, self-administered questionnaire written in English (Appendix I). The questionnaire was based on previously published studies,, and more questions were added in the first section (Personal History) to cover all the required information. Russell et al. developed the questionnaire, which was validated by Marengo et al.
The questionnaire was composed of four sections. The first section included eight questions (Q1-8) that were planned to survey the baseline characteristics and demographics of the participants. The second section consisted of eleven questions (Q9-19) designed to assess their knowledge about the CPA. The third section (Q21-26) cared about the participants’ personal views (attitude) regarding the importance of detecting, reporting, and documentation of the CPA. The fourth section of the questionnaire was designed to address the respondents’ professional experience, their reporting behaviors, and the actions that they would have taken if a suspected case of CPA was recognized. (kappa test showed 100% intra-examiner consistencies for clarifying and explaining 30 questionnaires before the initiation of the study).
Questionnaires were distributed by one researcher to the master’s degree students during their existence in their classrooms and 20 min were given to them to answer all the questions. During answering the questionnaire, both investigators supervised the classroom, where no students were allowed to leave or enter the classroom until all present students delivered the answered questionnaires.
To ensure the accuracy of their beliefs and opinions, participants answered the questionnaire independently; where they were not allowed to discuss items with, or consult their classroom mates. Throughout the whole study, only one researcher dealt with participants’ questions either to clarify any part of the questionnaire or explain anything about the survey; however, the researcher was not allowed to help the participants in answering the questions. The researcher dealt with the participant personally, so there was no risk of the same participant to fill more than one questionnaire. After the participants finished answering the whole questionnaires, they were collected by the other investigator. All participants responded in an appropriate manner to the study questionnaire. No questionnaires were excluded. So, the response rate was 100%.
Selection bias was avoided as all Master’s degree students studying at Pediatric Dentistry and Dental Public Health Department, Faculty of Dentistry, Cairo University during the educational year 2018–2019 were included. One well trained and expert researcher provided the same explanations with a standardized procedure to participants to avoid Performance bias. A high quality, self-administrated questionnaire with close-ended questions in addition, interviewer allowed sufficient time for adequate recall of long-term memory needed questions were implemented to overcome information bias, recall bias and Social desirability bias. Finally, all collected data had been accurately recorded and reported to avoid detection and reporting bias.
Collected data were analyzed using IBM SPSS advanced statistics (Statistical Package for the Social Sciences), version 21.0 (SPSS, Chicago, Illinois). Categorical data were described as numbers and percentages. Comparisons between the two groups were performed by chi-square test (P < 0.05).
| Results|| |
The study included 53 PDMDS (Group I) and 71 OMDS (Group II). Group I consisted of 44 (83%) females and 9 (17%) males; and Group II consisted of 52 (73%) females and 19 (27%) males. Group I consisted of 46 (86.8%) Egyptians, 4 (7.5%) Sudanese, 1 (1.9%) Iraqi, 1 (1.9%) Palestinian and 1 (1.9%) Yemeni, whereas Group II consisted of 67(94.4%) Egyptians, 2 (2.8%) Sudanese, and 2 (2.8%) Yemeni. Among Group I, 27 (50.9%), 3(5.7%), 17 (32.2%), 3 (5.7%), and 3 (5.7%) and among Group II, (57.8%), 3 (4.2%), 22 (31%), 4 (5.6%) and 1 (1.4%) got their Bachelor degree from Cairo University, other governmental universities, private universities in Egypt, Arab universities, and nonspecified, respectively. In Group I, 12 (22.9%), 14 (26.4%), 23 (43.4%), and 4 (7.5%) and in Group II, 19 (26.8%), 29 (40.8%), 21 (29.6%) and 2 (2.8%) work in: private institutes, governmental institutes, both and nonspecified, respectively. In Group I, 25 (47.2%) and 28 (52.8%), and in Group II 43 (60.6%) and 28 (39.4%) worked for: <= 5 years and >5 years, respectively. 9 (17%),12 (22.6%), 12 (22.6%),15 (28.3%), and 5 (9.5%); whereas in Group II, 21 (29.6%), 12 (7%), 6 (8.4%), 5 (7%), and 27 (38%) treated: (1–5 child/week), (6–10), >20, and nonspecified, respectively. Among Group I, 6 (11.4%) and 47 (88.6%), and among Group II, 7 (9.9%) and 64 (90.1%) received previous training and were not trained, respectively.
No statistically significant difference was observed between both groups, except for Qs 12 which was concerned about the way to deal with suspected cases of CPA and Q15 (Burns are associated with many child abuse cases). In Q12, Group I recorded a significantly higher “False” response. In Q15, Group I reported a significantly higher “True” response [Table 1].
|Table 1: Descriptive statistics and comparison between both groups regarding knowledge about CPA (chi-square test)|
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No statistically significant difference was observed between both groups, except for Q21 which was aimed in the role of detecting and reporting CPA where Group II recorded a significantly higher “Neutral” response [Table 2].
|Table 2: Descriptive statistics and comparison between both groups regarding personal attitude about CPA (chi-square test)|
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Thirty participants (56.6%) Group I and 30 (42.3%) Group II responded “Yes” to Q27 which was interested in suspecting CPA cases; among whom Group II reported a significantly higher yes response regarding reporting the suspected abuse. Moreover, both groups differed significantly regarding the cause that hindered them from taking a positive action regarding the suspected physical abuse. However, the number of children suspected to be subjected to violence was very little in both groups not matching the worldwide records. Among those who responded “No” to Q 27, there was no significant difference between groups regarding the question “Does workplace provide you with procedures to be followed in case a child is suspected to be physically abused?” [Table 3].
|Table 3: Descriptive statistics and comparison between both groups regarding experience about CPA (chi-square test)|
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| Discussion|| |
Unfortunately, a quite large number of CPA cases escape reporting in developing countries; even though there is a high prevalence of CPA. Countries rely mainly on reports from social services, police, hospitals, and education and health care sectors. Anyone who is in direct contact with children such as health care providers (pediatricians and pediatric dentists), teachers, and caregivers are ought to report any doubted cases to the authorized authorities.
Dentists, especially pedodontics, play an essential role in the identification and reporting of CPA cases. They may be the first person to notice signs of violence; where the areas they routinely examine are frequently affected. So, their knowledge, attitudes, and experience regarding CPA are crucial.,,,
Self-administered questionnaires are the best applicable method to investigate dentists’ knowledge, attitudes, and experience toward CPA.,,
This study included 53 PDMDS and 71 OMDS. Unfortunately, the first section of the questionnaire (Baseline data) showed that most of the participants did not receive previous training regarding CPA; however, Group I was more trained. Lack of training programs is previously reported by Cukovic-Bagic et al., who observed that 80% of respondents require further training and, Markovic et al., who observed that dentists were very rarely provided with training (80%). Also, Malapni et al. observed that only 4.1% of dentists received previous training. Lack of training programs affects, to a great extent, the dentists’ practice and actions toward CPA cases, this was previously clarified by Büyük, who stressed on the importance of training programs for better identification and improvement of reporting; minimizing the deleterious effects on children’s farewell.
In the second section (knowledge); Most of the two groups answered favorably regarding knowledge related to child confessions, related socio-economic factors, parental facing, signs, and symptoms of violence, reporting legal authority, with no statistically significant difference, except for Q12 and Q15.
In Q12, the answer was significantly higher “False” response in Group I. These may be attributed to previous educational programs regarding parental psychology, behavior, and attitude toward their children which was not evident in Group.
In Q15 (Burns are associated with CPA), Group I reported a significantly higher “True” response; where the educational curriculum might have guided Pediatric dentists to answer more readily. Unfortunately, both groups recorded that they don’t know the reporting hotline number.
The previous results are comparable to Owais et al., who previously reported that 97% of Jordanian dentists were able to identify CPA but their knowledge regarding the legal authority––to report to––was deficient and another study, who recorded that most Brazilian dentists could identify CPA cases, but there was great defect regarding reporting issues. These may be attributed to the lack of the spread of reporting data to the medical professionals.
Regarding the personal attitude toward CPA (third section), both groups expressed a positive attitude and willingness toward their role in the recognition and reporting process. These findings are similar to others’ studies,, who found that the majority of dentists agreed with their valuable position in detecting and reporting cases of CPA. This positive attitude was explained by El-Tantawi et al. based on the planned behavior theory where a high sense of responsibility toward victims is always expressed by medical professionals.
In section four (Experience), 56.6% of participants from Group I and 42.3% from Group II responded “Yes” to Q 27. However, the majority recorded that they suspected (1–3 cases) during their working years (very low number in comparison to the worldwide records). Moreover, a considerable number of participants didn’t report the cases, this was in accordance with Qwais et al., who reported that only 20% of respondents reported the cases, although 42% suspected them and Azevedo et al., who reported that only 20% of respondents reported the cases, although 42% of dentists suspected them and Azevedo et al., who stated that among those dentists who suspected the cases 76.0% did not report them. Surprisingly, among the minority who reported cases in this study, Group II reported a significantly higher “Yes” response.
Moreover, both groups differed significantly regarding the cause that hindered them from taking a positive action; denoting multifactorial reasons, one of them was fear of parental anger. Among those who responded “No” to Q 27, the reason was mostly that workplaces do not provide them with reporting procedures.
The previous findings were in concordance with Hashim and Al-Dallal, Olubukola et al., and Özgür et al., who observed that the most common barriers hindering the reporting process were uncertainty about the diagnosis, lack of knowledge about referral procedures, and fear of parental violence toward the child. This was explained by Mathews et al., who stressed on the importance of mandatory legalization of the reporting process.
The study was conducted on Master's degree students studying at Cairo University, and it does not include the other dental schools. Not all participants responded properly to the complex question (Q27), where some answers were inconvenient. Criticism and comparison with previous literature were somehow not objective due to lack of universal assessment measures and the target populations were different. For this study, the Null hypothesis was accepted where there was no group better than the other regarding knowledge, attitude, and experience toward CPA.
Physical child abuse is considered a serious public health issue and a problem of interdisciplinary interest involving child social protection services, law enforcement institutions, forensic physicians, and medical teams. Although, Training regarding CPA is still insufficient. Master’s degree students expressed great knowledge and a positive attitude toward their role in the recognition and reporting of violence. Regarding experience, PDMDS suspected more child abuse cases than OMDS. However, the number of suspected cases were very few. As many factors hindered the reporting process denoting the multifactorial origin.
The concluded data should be addressed to all responsible authorities for developing professional education curriculums, and training programs targeting dentists regarding CPA identification and reporting.
Mandatory legalization of offering required reporting procedures by Medical workplaces.
Follow-up longitudinal study protocol can be designed to the target population after organizing a training program about CPA.
The authors are thankful to all the participants involved in the study for their cooperation and support.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
Randa Youssef Abd Gawad was responsible for the conception and the study design and has been involved in analyzing and interpreting of the data and the scientific writing, as well as, the revising of the manuscript. Sara Ahmed Mahmoud was responsible for constructing the study design, data collection, data acquisition and analysis along with scientific writing, and revising of the manuscript.
Ethical policy and institutional review board statement
Ethical approval ID: 191224.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Data availability statement
The data set used in this study is available on request from corresponding author (Sara Ahmed Mahmoud, e-mail: [email protected]).
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[Table 1], [Table 2], [Table 3]