ORIGINAL�ARTICLE ABSTRACT Place and Duration of Study: The study was conducted on people living in cities of Islamabad and Rawalpindi, Pakistan during March-June 2018. Study Design: . Observational cross-section study Results: p p Majority (94.7%) of the participants, irrespective of their gender ( -value=0.19) and marital status ( - value=0.08), were in favour of educating children about sexual abuse prevention. Around 42% participants tried themselves to educate children on this topic and males' participation in it was observed to be less than females ( -value=0.005). Optimal age to educate children was considered between 5-9 years. A positive p response was shown by participants, when the extent and ways of child sexual abuse prevention education were discussed. Conclusion: Majority of the adults are in favour of educating children to protect themselves from sexual abuse so they are able to recognize and react effectively to potentially dangerous situations. Materials and Methods: Data was collected from 228 people by non-probability convenient sampling. People of both genders with any marital status, above 18 years of age and with minimum high school education or above were considered eligible for this study. A self-designed structured questionnaire was used to collect data which was analysed using SPSS version 23. P value ≤ 0.05 was considered significant. Key Words: Child Abuse, Educational Activities, Preventive Measures, Public Health, Sexual Abuse. Objective: This research was planned to assess attitude of adults towards educating children about sexual abuse prevention. 4 are relatives and only 10 % are strangers. The highest vulnerable age group among both genders is reported to be the children between the ages of 11 to 5 15 years and then 6 to 10 years. Like other countries of the world, CSA is a serious problem in Pakistan as well and has recently gained lot of attention. According to a data collected by a non-governmental organization, Sahil, about 11 cases of CSA are reported from across the Pakistan 7 every day. Almost 17,862 cases of CSA have been 8 reported in the country from 2013 to 2017 and still many remains undisclosed due to the feeling of guilt and shame, fear of perpetrator's threats, lack of trusted confidante, or to maintain the reputation of family. Worldwide hild abuse prevention programs are c created to provide knowledge to children to recognize abuse, teach skills that decrease the risk for abuse, normalize the disclosure process and CSA has an adverse effect on child's physical, social, spiritual and mental health. Health consequences includes depression, anxiety, post-traumatic stress disorder, unwanted pregnancy, HIV acquisition, 1,6 sexual disorientation, and drug addiction. The estimated global prevalence of CSA is 19.7% for 3 females and 7.9% for males. About 60% of the child sexual abusers are non-relative acquaintances, 30% Introduction Worldwide, child sexual abuse (CSA) is a massive challenge for public health, human rights and social 1 justice. The World Health Organization (WHO) defines it as: "The involvement of child in a sexual activity that he or she does not fully comprehend, is unable to give informed consent to, or for which the child is not developmentally prepared “or else that 2 violate the laws or social taboos of society”. Attitude of Adults towards Educating Children to Protect Themselves from Sexual Abuse in Pakistan 1 2 3 Haddaya Umar , Wardah Umar , Sidra Hamid Correspondence: Haddaya Umar nd 2 Year MBBS Student E-mail: haddayaumar@gmail.com 1 Student Rawalpindi Medical University, Rawalpindi 2 Student Al-Nafees Medical College Isra University, Islamabad 3 Department of Physiology Rawalpindi Medical University, Rawalpindi Funding Source: NIL; Conflict of Interest: NIL Received: December 17, 2018; Revised: October 29, 2019 Accepted: October 30, 2019 JIIMC 2019 Vol. 14, No.4 212 Attitude towards Child Sexual Abuse Education In order to know the age at which children should be given CSA education different age groups were made. Among them the most favored group by participants was children between the ages of 5 to 7 years (by 27% participants), followed by children between 7 to 9 years (24.9%), 9 to 11 years (16.90%), 3 to 5 years (15.60%) and above 11 years (15.50%). Few questions were planned to assess adults' participation in trying to aware their children (or other children having close relation with them) about CSA by their own. Self-participation of 222 out of 228 participants could be assessed. Only 93 (42%) tried it and among them 77 were satisfied by their way of counseling with majority being females. It was observed that males' participation in giving children CSA awareness was less (p-value= 0.005) as compared to females as only 28 male participants tried to educate children on their own. Adults' views regarding extent of educating children are shown in Table I. about a CSA case around them. About 94.7% of the participants agreed that the child must be given education about CSA prevention and among them 75.2% approved CSA awareness through public programs like television shows, school based programs, activities at public places, etc. Both males and females, irrespective of their gender, approve educating children about CSA prevention as p-value of 0.08 was obtained after applying Chi-square test. Similarly there is an insignificant association between marital status and approval of CSA prevention education (p-value of 0.19) stating that both married and unmarried participants favored it equally. Unmarried females favored educating children the most as 98.7% agreed to it. Whereas, 94.4% of married females, 93.1% of unmarried males, and 89.7% of married males were in its favour. Different ways were suggested to prevent CSA and among them the most favored one reflected the importance parents' attitude towards their children which enable them to share things openly with them. The details of other ways are further mentioned in Table II According to 89% (n=203) participants, CSA affects both the mental and physical health of the child and only 11% (n=25) participants believed that it affects his/her mental health only. provide a pathway for children who may be 9 experiencing abuse to report the abuse. Though several attempts have been taken to develop and implement such programs in Pakistan as well but adults' view regarding its need has attracted very little attention from research point of view. Therefore, this study was planned to assess adults' attitudes towards development of such educational programs in order to protect children from sexual abuse. Materials and Methods Data was entered and analyzed using Statistical Package for Social Sciences (SPSS) version 23. Chi- square tests were applied to calculate p values for determining relation between adults approving educating children about CSA prevention on basis of their gender and marital status. P value ≤ 0.05 was considered significant. Descriptive Statistics were used to analyze rest of the data. Results Data was collected by means of a self-designed questionnaire which was distributed online and in- hand. It included demographic profile (i.e. gender, age, marital status, and education) and a set of questions through which adults' opinions towards CSA prevention education and their participation could be observed. Different ways and extent of protecting and educating children about CSA were suggested and the participants were asked to select the most suitable one/s. Out of the 228 participants, 42.5% (n=97) were males and 57.5% (n=131) were females. Only 40.8% (n=93) of the participants were married (39 males and 54 females) and 59.2% (n=135) were unmarried (58 males and 77 females). A cross-sectional study was conducted in the twin cities of Pakistan, Islamabad and Rawalpindi, during March to June 2018. Data from 228 participants was collected using nonprobability convenient sampling after getting approval from ethical committee of Rawalpindi Medical University. Adults of both genders of any marital status above 18 years of age, who were residents of Islamabad or Rawalpindi, were asked to participate in this study voluntarily. Whereas, people with no or less than high school education and those who were reluctant or not comfortable with filling form were excluded. More than 50% of the participants i.e. 115 knew JIIMC 2019 Vol. 14, No.4 Attitude towards Child Sexual Abuse Education 213 potentially abusive situations. About 83% believed that it can lead to considerable decrease in number of cases reported and according to 76.8% CSA prevention education can lead to earlier disclosure of CSA cases by victims. Whereas, adults' concern about CSA education leading to negative impacts are mentioned in table III. This table also explains the concerns of individuals disapproving CSA education. Table I: Extent of Educa�ng Children about CSA Table II: Ways of CSA Preven�on The counseling about CSA prevention education can leave multiple impacts on the child's mind. According to 87.7% participants it enables the child to deal with Table III: Concerns Regarding Impacts of CSA Preven�on Educa�on Discussion The results of the present study shows that majority of participants approve teaching children about CSA prevention especially during the time period when they are attending elementary school i.e. 5 to 11 years old. Their participation in giving CSA prevention education to children on their own, interest in suggesting ways and extent of educating children shows their concern towards contributing to safety of children. A research conducted on mother’s knowledge and perception about CSA in Jordan showed that 74% of mothers who were part of study, stated that 10 educating children about CSA can prevent it. Similarly another study conducted in China also showed that 89.8% of parents supported CSA 11 prevention education for their kids. A randomized controlled trail on elementary students in US These negative impacts could become serious concern, only if the education is done in inappropriate ways. Thus, this sensitive issue of educating the child about sexual abuse must be dealt carefully as it attracts individual, religious, institutional, and societal concern. JIIMC 2019 Vol. 14, No.4 Attitude towards Child Sexual Abuse Education 214 prevention. The knowledge about CSA, attitudes, self-efficacy to take action, and awareness are all key capabilities related to creating conditions of safety for our children. Our study includes educated people as they are more open towards new change and more willing to children about new things as compared to people with little or no education. Thus there is need of further study in which opinions of people with little or no education are considered and compared with those of people who have received higher education. Also the opinions of people belonging to low socioeconomic status should also be assessed as CSA is more prevalent in such areas. 2. World Health Organization. Guidelines for medico-legal care for victims of sexual violence. World Health Organization 2003; 2003. 144 p. Available from: Apps.who.int/iris/bitstream/handle/10665/42788/92415 4628X.pdf;sequence=1. Majority of adults are in favor of educating children about CSA especially during the time period when children are attending elementary school. Adult’s interest in suggesting ways and extent of educating children shows their concern towards contributing to safety of children by preparing them to deal with potentially harmful situations. 4. Julia Whealin, Ph.D. Child Sexual Abuse. 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