Child Maltreatment in Lebanon: Prevalence, Screening and Upgrade of ESCAPE

Jules Joel Bakhos; Ghassan Sleilaty; Bernard Gerbaka; Carole Nehme; Rouba Hamzeh; Charles Chammas; Walid Kheireddine; Gerard Elie Bakhos; Elie Saliba

doi:doi:10.11648/j.wjph.20220701.13

Child Maltreatment in Lebanon: Prevalence, Screening and Upgrade of ESCAPE

Jules Joel Bakhos, Ghassan Sleilaty, Bernard Gerbaka, Carole Nehme, Rouba Hamzeh, Charles Chammas, Walid Kheireddine, Gerard Elie Bakhos, Elie Saliba

Published in World Journal of Public Health (Volume 7, Issue 1)

Received: 25 January 2021 Accepted: 2 February 2021 Published: 25 February 2022

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Abstract

Child maltreatment is a violation of human rights and includes all forms of abuse against children under 18 years of age. It is the second cause of death in children after accidental trauma and remains an active problem worldwide. In Lebanon, little work is being done nationwide to provide and explain the available screening and reporting tools for child maltreatment. In this study, we assess the diagnostic accuracy of the ESCAPE instrument and its modified version (including one additional question “Did parents/caregivers take adequate measures?”) in screening child maltreatment in emergency departments, and calculate the prevalence of child abuse in Lebanon. The present diagnostic accuracy study is performed over 16 months using a convenience sampling on children under the age of 18 who presented to Lebanese emergency departments. Confirmation of maltreatment by the child protection team was considered as the cornerstone to diagnosis. Screening performance characteristics of ESCAPE and ESCAPE-modified were calculated using GPower v3.1 and SPSS v22 soft wares. 411 children with the mean age of 5.7 years were screened (38% girls). 47 children were suspected victims of child abuse (11.4%). 13 children (3.2%) were confirmed victims of child maltreatment. Sensitivity, specificity, positive and negative predictive values of this test, with 95% confidence intervals, were 100% (82.7 – 100), 91.5% (88.4 – 93.9), 27.7% (16.5 – 41.5), and 100% (99.3 – 100) respectively. The additional question added to ESCAPE did not alter the diagnostic performance of the test but was superior in terms of positive predictive value without losing in terms of negative predictive value. In this study, ESCAPE was proven to be an appropriate screening instrument for identifying children at high risk of child abuse, with excellent accuracy. The additional question of “Did parents/caregivers take adequate measures?” represents a simpler tool with a higher positive predictive value, to be used after a positive ESCAPE screening to help confirm or reject the diagnosis of child maltreatment in case of doubt.

Published in	World Journal of Public Health (Volume 7, Issue 1)
DOI	10.11648/j.wjph.20220701.13
Page(s)	14-21
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Child Maltreatment, Child Abuse Screening, Lebanon, Middle East, ESCAPE Questionnaire

References

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[3]	Hillis S, Mercy J, Amobi A, et al. Global prevalence of past-year violence against children: a systematic review and minimum estimates. Pediatrics. 2016; 137 (3): e20154079.
[4]	Fortson B, Klevens J, Merrick M, Gilbert L, Alexander S. (2016). Preventing Child Abuse and Neglect: A Technical Package for Policy, Norm, and Programmatic Activities. Atlanta, GA: National Center for Injury Prevention and Control.
[5]	Preventing child maltreatment: a guide to taking action and generating evidence. http://apps.who.int/iris/bitstream/10665/43499/1/9241594365_eng.pdf.
[6]	Svevo-cianci, K. A., Hart, S. N., &Rubinson, C. (2010). Child Abuse & Neglect: protecting children from violence and maltreatment: a qualitative comparative analysis assessing the implementation of U. N. CRC Article 19. Child Abuse & Neglect, 34 (1), 45-56.
[7]	Child abuse and neglect: Risk and protective factors. Centers for Disease Control and Prevention. https://www.cdc.gov/violenceprevention/childabuseandneglect/riskprotectivefactors.html. Accessed Aug. 7, 2018.
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[15]	Louwers EC, Affourtit MJ, Moll HA, de Koning HJ, Korfage IJ. Screening for child abuse at emergency departments: a systematic review. Archives of disease in childhood. 2010; 95 (3): 214–8.
[16]	Louwers EC, Korfage IJ, Affourtit MJ, Ruige M, van den Elzen AP, de Koning HJ, et al. Accuracy of a screening instrument to identify potential child abuse in emergency departments. Child abuse & neglect. 2014; 38 (7): 1275–81.
[17]	Dinpanah H, Pasha AA. Potential Child Abuse Screening in Emergency Department; a Diagnostic Accuracy Study. Emerg (Tehran). 2017; 5 (1): e8.
[18]	Hidden in plain sight: a statistical analysis of violence against children. New York: United Nations Children’s Fund; 2014.
[19]	Stoltenborgh MA, van Ijzendoorn MH, Euser E, Bakerman-Kranenburg MJ. A global perspective on child sexual abuse: Meta-analysis of prevalence around the world. Child Maltreatment. 2011; 16: 79–101.
[20]	Stoltenborgh MA, Bakermans-Kranenburg MJ, van Ljzendoorn MH, Alink LR. Culturalgeographical differences in the occurrence of child physical abuse? A meta-analysis of global prevalence. International Journal of Psychology. 2013; 48: 81–94.

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APA Style

Jules Joel Bakhos, Ghassan Sleilaty, Bernard Gerbaka, Carole Nehme, Rouba Hamzeh, et al. (2022). Child Maltreatment in Lebanon: Prevalence, Screening and Upgrade of ESCAPE. World Journal of Public Health, 7(1), 14-21. https://doi.org/10.11648/j.wjph.20220701.13

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ACS Style

Jules Joel Bakhos; Ghassan Sleilaty; Bernard Gerbaka; Carole Nehme; Rouba Hamzeh, et al. Child Maltreatment in Lebanon: Prevalence, Screening and Upgrade of ESCAPE. World J. Public Health 2022, 7(1), 14-21. doi: 10.11648/j.wjph.20220701.13

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AMA Style

Jules Joel Bakhos, Ghassan Sleilaty, Bernard Gerbaka, Carole Nehme, Rouba Hamzeh, et al. Child Maltreatment in Lebanon: Prevalence, Screening and Upgrade of ESCAPE. World J Public Health. 2022;7(1):14-21. doi: 10.11648/j.wjph.20220701.13

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@article{10.11648/j.wjph.20220701.13,
  author = {Jules Joel Bakhos and Ghassan Sleilaty and Bernard Gerbaka and Carole Nehme and Rouba Hamzeh and Charles Chammas and Walid Kheireddine and Gerard Elie Bakhos and Elie Saliba},
  title = {Child Maltreatment in Lebanon: Prevalence, Screening and Upgrade of ESCAPE},
  journal = {World Journal of Public Health},
  volume = {7},
  number = {1},
  pages = {14-21},
  doi = {10.11648/j.wjph.20220701.13},
  url = {https://doi.org/10.11648/j.wjph.20220701.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.wjph.20220701.13},
  abstract = {Child maltreatment is a violation of human rights and includes all forms of abuse against children under 18 years of age. It is the second cause of death in children after accidental trauma and remains an active problem worldwide. In Lebanon, little work is being done nationwide to provide and explain the available screening and reporting tools for child maltreatment. In this study, we assess the diagnostic accuracy of the ESCAPE instrument and its modified version (including one additional question “Did parents/caregivers take adequate measures?”) in screening child maltreatment in emergency departments, and calculate the prevalence of child abuse in Lebanon. The present diagnostic accuracy study is performed over 16 months using a convenience sampling on children under the age of 18 who presented to Lebanese emergency departments. Confirmation of maltreatment by the child protection team was considered as the cornerstone to diagnosis. Screening performance characteristics of ESCAPE and ESCAPE-modified were calculated using GPower v3.1 and SPSS v22 soft wares. 411 children with the mean age of 5.7 years were screened (38% girls). 47 children were suspected victims of child abuse (11.4%). 13 children (3.2%) were confirmed victims of child maltreatment. Sensitivity, specificity, positive and negative predictive values of this test, with 95% confidence intervals, were 100% (82.7 – 100), 91.5% (88.4 – 93.9), 27.7% (16.5 – 41.5), and 100% (99.3 – 100) respectively. The additional question added to ESCAPE did not alter the diagnostic performance of the test but was superior in terms of positive predictive value without losing in terms of negative predictive value. In this study, ESCAPE was proven to be an appropriate screening instrument for identifying children at high risk of child abuse, with excellent accuracy. The additional question of “Did parents/caregivers take adequate measures?” represents a simpler tool with a higher positive predictive value, to be used after a positive ESCAPE screening to help confirm or reject the diagnosis of child maltreatment in case of doubt.},
 year = {2022}
}

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TY - JOUR
T1 - Child Maltreatment in Lebanon: Prevalence, Screening and Upgrade of ESCAPE
AU - Jules Joel Bakhos
AU - Ghassan Sleilaty
AU - Bernard Gerbaka
AU - Carole Nehme
AU - Rouba Hamzeh
AU - Charles Chammas
AU - Walid Kheireddine
AU - Gerard Elie Bakhos
AU - Elie Saliba
Y1 - 2022/02/25
PY - 2022
N1 - https://doi.org/10.11648/j.wjph.20220701.13
DO - 10.11648/j.wjph.20220701.13
T2 - World Journal of Public Health
JF - World Journal of Public Health
JO - World Journal of Public Health
SP - 14
EP - 21
PB - Science Publishing Group
SN - 2637-6059
UR - https://doi.org/10.11648/j.wjph.20220701.13
AB - Child maltreatment is a violation of human rights and includes all forms of abuse against children under 18 years of age. It is the second cause of death in children after accidental trauma and remains an active problem worldwide. In Lebanon, little work is being done nationwide to provide and explain the available screening and reporting tools for child maltreatment. In this study, we assess the diagnostic accuracy of the ESCAPE instrument and its modified version (including one additional question “Did parents/caregivers take adequate measures?”) in screening child maltreatment in emergency departments, and calculate the prevalence of child abuse in Lebanon. The present diagnostic accuracy study is performed over 16 months using a convenience sampling on children under the age of 18 who presented to Lebanese emergency departments. Confirmation of maltreatment by the child protection team was considered as the cornerstone to diagnosis. Screening performance characteristics of ESCAPE and ESCAPE-modified were calculated using GPower v3.1 and SPSS v22 soft wares. 411 children with the mean age of 5.7 years were screened (38% girls). 47 children were suspected victims of child abuse (11.4%). 13 children (3.2%) were confirmed victims of child maltreatment. Sensitivity, specificity, positive and negative predictive values of this test, with 95% confidence intervals, were 100% (82.7 – 100), 91.5% (88.4 – 93.9), 27.7% (16.5 – 41.5), and 100% (99.3 – 100) respectively. The additional question added to ESCAPE did not alter the diagnostic performance of the test but was superior in terms of positive predictive value without losing in terms of negative predictive value. In this study, ESCAPE was proven to be an appropriate screening instrument for identifying children at high risk of child abuse, with excellent accuracy. The additional question of “Did parents/caregivers take adequate measures?” represents a simpler tool with a higher positive predictive value, to be used after a positive ESCAPE screening to help confirm or reject the diagnosis of child maltreatment in case of doubt.
VL - 7
IS - 1
ER -

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Author Information

Jules Joel Bakhos

Hô
Ghassan Sleilaty

Hô
Bernard Gerbaka

Hô
Carole Nehme

Hô
Rouba Hamzeh

Hô
Charles Chammas

Bellevue Medical Center, Beirut, Lebanon
Walid Kheireddine

Saint-Georges Hospital, Beirut, Lebanon
Gerard Elie Bakhos

Hô
Elie Saliba

Hô

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Plain Text BibTeX RIS

APA Style

Jules Joel Bakhos, Ghassan Sleilaty, Bernard Gerbaka, Carole Nehme, Rouba Hamzeh, et al. (2022). Child Maltreatment in Lebanon: Prevalence, Screening and Upgrade of ESCAPE. World Journal of Public Health, 7(1), 14-21. https://doi.org/10.11648/j.wjph.20220701.13

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ACS Style

Jules Joel Bakhos; Ghassan Sleilaty; Bernard Gerbaka; Carole Nehme; Rouba Hamzeh, et al. Child Maltreatment in Lebanon: Prevalence, Screening and Upgrade of ESCAPE. World J. Public Health 2022, 7(1), 14-21. doi: 10.11648/j.wjph.20220701.13

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AMA Style

Jules Joel Bakhos, Ghassan Sleilaty, Bernard Gerbaka, Carole Nehme, Rouba Hamzeh, et al. Child Maltreatment in Lebanon: Prevalence, Screening and Upgrade of ESCAPE. World J Public Health. 2022;7(1):14-21. doi: 10.11648/j.wjph.20220701.13

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@article{10.11648/j.wjph.20220701.13,
  author = {Jules Joel Bakhos and Ghassan Sleilaty and Bernard Gerbaka and Carole Nehme and Rouba Hamzeh and Charles Chammas and Walid Kheireddine and Gerard Elie Bakhos and Elie Saliba},
  title = {Child Maltreatment in Lebanon: Prevalence, Screening and Upgrade of ESCAPE},
  journal = {World Journal of Public Health},
  volume = {7},
  number = {1},
  pages = {14-21},
  doi = {10.11648/j.wjph.20220701.13},
  url = {https://doi.org/10.11648/j.wjph.20220701.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.wjph.20220701.13},
  abstract = {Child maltreatment is a violation of human rights and includes all forms of abuse against children under 18 years of age. It is the second cause of death in children after accidental trauma and remains an active problem worldwide. In Lebanon, little work is being done nationwide to provide and explain the available screening and reporting tools for child maltreatment. In this study, we assess the diagnostic accuracy of the ESCAPE instrument and its modified version (including one additional question “Did parents/caregivers take adequate measures?”) in screening child maltreatment in emergency departments, and calculate the prevalence of child abuse in Lebanon. The present diagnostic accuracy study is performed over 16 months using a convenience sampling on children under the age of 18 who presented to Lebanese emergency departments. Confirmation of maltreatment by the child protection team was considered as the cornerstone to diagnosis. Screening performance characteristics of ESCAPE and ESCAPE-modified were calculated using GPower v3.1 and SPSS v22 soft wares. 411 children with the mean age of 5.7 years were screened (38% girls). 47 children were suspected victims of child abuse (11.4%). 13 children (3.2%) were confirmed victims of child maltreatment. Sensitivity, specificity, positive and negative predictive values of this test, with 95% confidence intervals, were 100% (82.7 – 100), 91.5% (88.4 – 93.9), 27.7% (16.5 – 41.5), and 100% (99.3 – 100) respectively. The additional question added to ESCAPE did not alter the diagnostic performance of the test but was superior in terms of positive predictive value without losing in terms of negative predictive value. In this study, ESCAPE was proven to be an appropriate screening instrument for identifying children at high risk of child abuse, with excellent accuracy. The additional question of “Did parents/caregivers take adequate measures?” represents a simpler tool with a higher positive predictive value, to be used after a positive ESCAPE screening to help confirm or reject the diagnosis of child maltreatment in case of doubt.},
 year = {2022}
}

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