Child Abuse in Health Centers Affiliated with Jundishapur University of Medical Sciences: Prevalence and Associated Factors

Abstract

Background: Child abuse is a major public health and social concern with potentially long-lasting effects on children’s physical, psychological, and social development. It encompasses physical and emotional abuse, sexual abuse, neglect, and exploitation, and its occurrence is influenced by familial, socioeconomic, and caregiver-related factors. Despite growing evidence on child maltreatment, comprehensive data on its prevalence and associated factors in Iran remain limited, particularly in primary healthcare settings. Health centers offer an important opportunity for the early identification of at-risk children and families. Objectives: This study aimed to determine the prevalence of child abuse and identify its key contributing factors among children attending health service centers affiliated with Jundishapur University of Medical Sciences in Ahvaz, using validated psychometric instruments. Methods: This cross-sectional analytical study included 782 children and their guardians. Indicators of child abuse were assessed using the Dundee Abuse and Care Scale (DACAS) and the Social Health Questionnaire (SHQ). The internal consistency of the DACAS was acceptable (Cronbach's alpha = 0.82). Data were analyzed using SPSS version 26.0. Chi-square tests were used to examine bivariate associations, and multivariable logistic regression was conducted to estimate adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Results: The overall prevalence of identified child abuse was 18.5% (n = 145/782). Emotional neglect (44.8%) and emotional abuse (38.6%) were the most commonly reported forms. The prevalence of abuse was 41.2% in the 5 - 10-year age group, consistent with bivariate analysis (χ2 = 15.98, P = 0.003). Multivariable analysis identified low maternal education (aOR = 3.85, P = 0.001), single-parent family structure (aOR = 2.15, P = 0.003), and emotional neglect (aOR = 15.20, P < 0.001) as significant independent predictors. No statistically significant association was found with parental substance use (P = 0.217) or psychological distress (P = 0.184). Conclusions: Child abuse remains a substantial public health concern in Ahvaz and is strongly associated with low maternal education, unstable family structure, and emotional neglect. These findings underscore the need for integrated health policies that prioritize parenting education, provide targeted economic support, and implement school-based screening to reduce child maltreatment effectively.