European and international integration of Ukraine requires intensification of socio-legal, medical and social work on child protection, with special attention to vulnerable groups [1, ñ. 198].
The aim of the study was to identify the frequency and causes of neglect among children with overweight and obesity based on the analysis of personal experience of respondents – children and their parents.
Materials and methods
The study was performed on the outpatient department and endocrinology department of the Odesa Regional Children's Clinical Hospital from 2011 to 2021, taking into account all standards of Good Clinical Practice and the requirements of the Helsinki Declaration of the World Medical Association “Ethical principles for medical research involving human subjects”.
An anonymous survey of 948 children aged 6 to 18 years was conducted. The first group included 328 children with overweight, the second group – 364 obese children, the control group – 256 children. Signs and analysis of the causes of neglect were identified by survey and anonymous questioning of children (948) and their parents (1286). Statistical processing of the received data was performed using programs Excel 2010, Statistica 10, Internet-calculator SISA (Simple Interactive Statistical Analysis).
The results of the study and their discussion.
Surveys and questionnaires of respondents allowed to establish a statistically significant predominance of neglect among children with overweight and obesity: deprivation of medical care (odds ratio (OR) in overweight girls was 3.00 (95% CI 1.81–5.00%), in obese girls – 11.16 (95% CI 6.61–18.86%), in overweight boys – 1.69 (95% CI 1.03–2.77%), in obese boys – 7.54 (95% CI 4.45–12.77%)), untimely seeking of medical care (OR in overweight girls was 1.86 (95% CI 1.13–3.06%), in obese girls – 11.22 (95% CI 6.67–18.88%), in overweight boys – 1.64 (95% CI 0.99–2.72%), in obese boys – 17.40 (95% CI 9.53–31.78%)), inconsistent medical care (OR in overweight girls was 3.53 (95% CI 2.09–5.95%), in obese girls – 28.41 (95% CI 15.60–51.75%), in overweight boys – 2.82 (95% CI 1.67–4.76%), in obese boys – 25.15 (95% CI 13.34–47.40%)), insufficient adherence to treatment (OR in overweight girls was 1.76 (95% CI 1.08–2.86%), in obese girls – 15.73 (95% CI 9.07–27.29%), in overweight boys – 2.45 (95% CI 1.47–4.11%), in obese boys – 13.50 (95% CI 7.66–23.82%)), failure to provide healthy food (non-healthy nutrition) (OR in overweight girls was 2.23 (95% CI 1.41–3.55%), in obese girls – 2.78 (95% CI 1.76–4.39%), in overweight boys – 2.74 (95% CI 1.68–4.46%), in obese boys – 3.84 (95% CI 2.34–6.29%)), failure to ensure healthy lifestyle (OR in overweight girls was 1.66 (95% CI 1.05–2.61%), in obese girls – 2.52 (95% CI 1.61–3.96%), in overweight boys – 2.38 (95% CI 1.46–3.87%), in obese boys – 4.10 (95% CI 2.50–6.72%)), and the refusal of vaccination as a child abuse did not have statistical differences in overweight and obese children compared with the control group.
Analysis of the causes of child abuse with overweight and obese children allowed us to identify the most significant socio-economic, family and personal factors. The significance of socio-economic factors has been detected for poverty (OR in overweight girls was 1.95 (95% CI 1.05–3.64%), in obese girls – 3.66 (95% CI 2.03–6.58%), in overweight boys – 1.48 (95% CI 0.80–2.71%), in obese boys – 2.76 (95% CI 1.55–4.90%)) and isolation (OR in obese girls was 5.84 (95% CI 2.67–12.75%), in obese boys – 6.57 (95% CI 2.86–15.12%)). The unemployment, unsatisfactory living condition, and insufficient social support had no statistically significant differences. The significance of family factors has been established for single-parent (incomplete) families (OR in overweight girls was 2.60 (95% CI 1.60–4.22%), in obese girls – 3.71 (95% CI 2.30–5.96%), for boys, no statistical difference was found), conflictive families (OR in overweight girls was 1.87 (95% CI 1.13–3.11%), in obese girls – 2.60 (95% CI 1.59–4.24%), in overweight boys – 1.45 (95% CI 0.86–2.44%), in obese boys – 1.96 (95% CI 1.18–3.26%)), overload of parents (OR in overweight girls was 1.72 (95% CI 1.07–2.75%), in obese girls – 4.80 (95% CI 2.99–7.70%), in overweight boys – 1.35 (95% CI 0.83–2.18%), in obese boys – 3.39 (95% CI 2.08–5.53%)), low cultural level (OR in overweight girls was 1.59 (95% CI 0.97–2.62%), in obese girls – 1.79 (95% CI 1.11–2.90%), in overweight boys – 1.39 (95% CI 0.83–2.33%), in obese boys – 1.66 (95% CI 1.00–2.75%)). The mental illness of parents, drug/alcohol addictions, and violence during childhood had no statistical differences in overweight and obese children compared with the control group. Among personal factors, the significance of inflated expectations from the child was revealed only in obese children: OR in obese girls was 3.73 (95% CI 1.86–7.48%), in obese boys – 4.73 (95% CI 2.22–10.11%). The child rejection (unwanted child) and the adopted child did not have statistically significant differences.
Conclusions.
The obtained data testify to the incomplete detection and registration of neglect among children in Ukraine. Children with overweight and obesity are potentially vulnerable to violence, stigma, social isolation, are at risk of neglect and need close monitoring.
References:
1.Risk factors for child neglect: A meta-analytic review / T. M. Mulder et al. Child Abuse Negl. 2018. Mar. (Vol. 77). P. 198-210. PMID: 29358122.
DOI: https://doi.org/10.1016/j.chiabu.2018.01.006.
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