Household illness, poverty and physical and emotional child abuse victimisation: findings from South Africa's first prospective cohort study.
BACKGROUND
Physical and emotional abuse of children is a large scale problem in South Africa, with severe negative outcomes for survivors. Although chronic household illness has shown to be a predictor for physical and emotional abuse, no research has thus far investigated the different pathways from household chronic illness to child abuse victimisation in South Africa.


METHODS
Confidential self-report questionnaires using internationally utilised measures were completed by children aged 10-17 (n = 3515, 56.7% female) using door-to-door sampling in randomly selected areas in rural and urban locations of South Africa. Follow-up surveys were conducted a year later (96.7% retention rate). Using multiple mediation analyses, this study investigated direct and indirect effects of chronic household illness (AIDS or other illness) on frequent (monthly) physical and emotional abuse victimisation with poverty and extent of the ill person's disability as hypothesised mediators.


RESULTS
For children in AIDS-ill families, a positive direct effect on physical abuse was obtained. In addition, positive indirect effects through poverty and disability were established. For boys, a positive direct and indirect effect of AIDS-illness on emotional abuse through poverty were detected. For girls, a positive indirect effect through poverty was observed. For children in households with other chronic illness, a negative indirect effect on physical abuse was obtained. In addition, a negative indirect effect through poverty and positive indirect effect through disability was established. For boys, positive and negative indirect effects through poverty and disability were found respectively. For girls, a negative indirect effect through poverty was observed.


CONCLUSIONS
These results indicate that children in families affected by AIDS-illness are at higher risk of child abuse victimisation, and this risk is mediated by higher levels of poverty and disability. Children affected by other chronic illness are at lower risk for abuse victimisation unless they are subject to higher levels of household disability. Interventions aiming to reduce poverty and increase family support may help prevent child abuse in families experiencing illness in South Africa.
Centre for Evidence-Based Intervention, Department of Social Policy & Intervention, University of Oxford, Barnett House, 32 Wellington Square, Oxford, OX1 2ER, UK. Franziska.Meinck@spi.ox.ac.uk.
Franziska
F
Meinck
Centre for Evidence-Based Intervention, Department of Social Policy & Intervention, University of Oxford, Barnett House, 32 Wellington Square, Oxford, OX1 2ER, UK. Lucie.Cluver@spi.ox.ac.uk.|Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa. Lucie.Cluver@spi.ox.ac.uk.|Health Economics and HIV/AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa. Lucie.Cluver@spi.ox.ac.uk.
Lucie D
LD
Cluver
Centre for Evidence-Based Intervention, Department of Social Policy & Intervention, University of Oxford, Barnett House, 32 Wellington Square, Oxford, OX1 2ER, UK. Mark.Boyes@curtin.edu.au.|Health Psychology and Behavioural Medicine Research Group, School of Psychology and Speech Pathology, Curtin University, Perth, Australia. Mark.Boyes@curtin.edu.au.
Mark E
ME
Boyes
D000293:Adolescent; D002648:Child; D002649:Child Abuse / Q000523:psychology* / Q000706:statistics & numerical data*; D002908:Chronic Disease / Q000523:psychology*; D015331:Cohort Studies; D019548:Crime Victims / Q000523:psychology* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D011203:Poverty / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012737:Sex Factors; D013019:South Africa; D011795:Surveys and Questionnaires