Unpacking Forms, Causes and Effects of Abuse on Child Development in Southern Malawi Communities

This paper unpacked forms, causes and effects of abuse on child development in Southern Malawi communities. It further examined the role of guidance and counselling in mitigating effects of abuse on child development. A two stage sampling procedure was employed to select a total of 400 individuals from Southern Malawi communities to participate in the study. The study found a number of forms of abuse on child development. Some of these are physical, emotional, negligence, sexual and verbal. It found that these abuse are commonly affected by factors such as lack of or week policy on child abuse, poverty and past abusive experience of the perpetrator. It was noted that abuse on child development have several consequences such as mental illness, post traumatic disorders, behavioural problems, infectious diseases and early marriages. Worrisome, the paper found that victim of abuse may never forget the abusive experience for the rest of their lives. On a positive note, the paper found guidance and counselling as central to mitigating effects of child abuse especially through policy lobbying and providing counselling for mental stability, self-worthiness and esteem. The paper recommends that child programmes should refocus on proactive policies that ensure child care and protection.


The Study Context
Child abuse is endemic in most communities in Sub-Sahara Africa [1]. It cuts across class, gender, age, religion and national boundaries [2]. Exposure to child abuse significantly increases girls' and boys' chances of several forms of abuses such as early sexual intercourse, forced marriage, marital rape, battering and others. Like other developing countries, Malawi is not exempted from child abuse which rampant in areas of socioeconomic and child development programming [1,3] reports that more than 40 percent of boys, girls and women are victims of abuses. Girls, boys and young-adult females are the most visible survivors and they far much suffer from the consequences of child abuse. Following the negative impacts of child abuse on girls' and boys' physical, sexual, psychosocial and economic development in the society, a number of programs are designed to bring awareness campaign against child abuse in Malawi [3]. However, programs lack data that would unravel forms and causes of child abuse, their implications, how to addressed and mainstream them in child development programs across the country.
Krupinski et al. [4] define child abuse as an action or series of actions inflicted upon a child that causes harm and leaves scars. In other countries, studies have indicated that abuse on child development is facilitated by family, parental, environmental, social, cultural and economic factors [5][6][7] argued that such abuses may have various consequences that may range from physical, psychosocial, behavioural, sexual, verbal, negligence and others. Like other countries, various institutions have been formed to abolish both prevailing and effects of various forms of abuse on child development. In spite of latest report on various institutions working on child abuse in Malawi, studies have not clearly unpacked the role that institutions play in mitigating effects of abuse [1].
Accordingly, studies have acknowledged that there are many cases of child abuse in Malawi. Nonetheless, few have been recorded [1]. Some of known cases include sexual abuse, child labour just to mention a few, which their effects are long term [3]. This paper acknowledges background information that other studies [1] have provided. On the other hand, most existing literatures on Malawi have not unpacked causes and effects of child abuse on the victims [1]. It is against this context that this paper would like to identify forms, causes and examine implications of child abuse on children. This paper further investigate roles of guidance and counselling in mitigating effects of child abuse on in Malawi.

The Problem and Rationale
Child abuse has detrimental impacts on child development [1]. A girl or boy child who has been abused does not become a responsible citizen during adulthood [2]. Abused children are highly exposed to physical injuries or infectious diseases such as HIV and AIDS. On one hand, they are likely to drop out of school due to negative emotions, low self -esteem and lack of direction in their day to day activities. On the other hand, much as it has been recognised that some cases of child abuse are being reported to relevant authorities, most reports have been on physical abuse and less on psychological and emotional abuse to children [1]. This undermines treatments towards effects of psychosocial abuse to victims. Physical treatment is essential for physical recovery; it is, nevertheless, a short term on one hand while implications of psychological or emotional abuse are long term.
Limited information on comprehensive abusive actions encourages long term effects of psychosocial abuse among children. Most recent studies have presented scanty informational at national level and without any at district and community levels [1]. In addition, these studies have not inclusively approached child abuse from psychosocial dimensions. This implies that no data exist to unpack forms, causes and effects of abuse on child development in Malawi. This negates psychosocial abuse on child development and associated implications [8]. This paper will therefore examine forms, causes and implications of abuse on child development. The paper understands the role that information plays in the entire program life cycle of child development.
It believes that provision of information on forms, causes and implications of child abuse is important for designing of both national and community level programs. In addition, this paper also reveals the effects of neglected abuse on child development such as psychosocial abuse. Therefore, this investigation is valid in Malawi because it brings awareness and theory of change to different stakeholders such as health practioners, faith based institutions and other private organizations. It is for this reason that this paper believes to make a contribution knowledge and information available on catalysing child development in Malawi. It is to this effect that our children will be cared, protected and find justice as they grow and become citizens.

Study conceptual and empirical framework
The paper adopts Cognitive Behavioural Therapy Theory as a guiding therapy in identifying and mitigating effects of physical, psychological, emotional and social abuse on child development [9]. It is based on the principle that a person's emotional and behavioural reactions are determined by the relationship between his or her cognitions and subsequent behaviours. It addresses the effects of abuse and exposure to domestic violence and other traumatic events by integrating several therapeutic approaches and treating the victim in a comprehensive manner. [9] states children are at risk of developing significant emotional and behavioural difficulties ( Figure 1). Figure 1: Conceptual framework of the paper [9]. Dziegielewski (2010) argues that Cognitive Behavioural Therapy Theory identify and mitigate effects of child abuse through: (a) reducing negative emotional and behavioural responses to the trauma and (b) correcting maladaptive beliefs and attributions related to the traumatic experiences. In addition, the therapy is grounded on the following fundamental principles:-(i) Identify the negative thinking pattern; (ii) replace negative thinking with positive thinking and (iii) behaviour modification. This is diagrammatically presented as in Figure 1. Empirically, the therapy would help in facilitating effects of abuse on child development.
This paper employs a two stage sampling procedure. First, the paper adopts a cluster sampling technique where communities in Southern Malawi are heterogeneously grouped and selected randomly. The second procedure involved simple random sampling technique where individuals are selected. A total of 400 individuals are randomly selected for the study. A semi structured questionnaire was use to collect data and that was entered in SPSS and data analysis was done in Stata. In terms of age, Figure 3 displays percentage distribution of respondents by age group in the study area. It shows that 73 percent of study respondents aged between 20 and 40 years. Respondents aged above 50 years and below 60 years represented 10 percent of the total sample size in the study area. In general, a slightly higher percent of respondents aged between 310 and 400 were part of the study sample size than other age groups. The participants were asked common forms of abuse on child development. Questions were related to whether respondents have experienced, have knowledge or been aware of and if they have dealt with in helping survivors or victims of child abuse. Table 1 shows that frequency distribution of forms of abuse that respondents have experienced, are aware of and have dealt with in the study area. The paper findings show that about 90 percent of respondents (n=360) reported to have either experienced or been aware of physical abuse. This was followed by verbal abuse where about 80 percent of respondents (n=320) reported on the same. On the other hand, less than half of respondents (n=190) in the study area reported emotional abuse as a form of abuse that they have either experienced, heard or been aware of.

Socioeconomic characteristics
In terms of dealing with abuse, Table 1 shows that 40 percent of respondents (n=160) indicated negligence abuse as one of the form that they deal with. This was seconded by sexual abuse where about 28 percent of respondents (n=110) reported to be dealing with. A very marginal percentage of respondents (n=20) indicated to deal with physical abuse in the study area.

Forms of child abuse Experienced, Knowledge or Aware of Dealt
Physical abuse 360 20 Verbal abuse 320 70 Sexual abuse 290 110 Negligence abuse 290 160 Emotional abuse 190 90 Table 1: Frequency distribution of common forms of abuse experienced or aware of and dealt with by respondents

Least common form of abuse on child development
Furthermore, the paper asked respondents to indicate least common form of abuse they have dealt with or heard of. Table 2 shows frequency distribution of least common form of abuse by respondents in the study area. The paper found negligence abuse as the least case of abuse where about 300 out 400 respondents indicated it as a least common form of abuse. This was followed by emotional abuse. In terms of dealing with the abuse, most respondents have directly or indirectly dealt abuses associated with physical, verbal and sexual forms of abuse (

Causes of Child Abuse
On the possible causes of child abuse, the researcher asked the participants to respond by indicating their answers in form of a scale. Respondents based their scale-choices on statements that the study provided to them such as 5 indicated Strongly Agree (SA), 4 indicated Agree (A), 3 indicated Don't Know (DK), 2 indicated Disagree (D) and 1 indicated Strongly Disagree (SD). Table 3 shows frequency distribution of causes of child abuse by respondents in the study area. Almost half of the respondents (n=200) strongly agreed that lack of policies or legislations on abolishing or mitigating abuse was a major cause of child abuse in the study area. This was followed by poverty, depression and cultural and customs. Approximately 30 percent of respondents (n=120) strongly disagreed that child abuse if caused by lack of perpetrator's knowledge and as a form of child discipline. Interestingly, the study found that 65 percent (n=260) of child abuse are caused by abusers who are also victims of child abuse. This agrees with literature that victimised children are likely to abuse others when they grow up [7,8].

The effects of abuse on child development
The study also solicited information on effects of abuse on child development. Respondents based their scale-choices on statements that the study provided to them such as 5 indicated Strongly Agree (SA), 4 indicated Agree (A), 3 indicated Don't Know (DK), 2 indicated Disagree (D) and 1 indicated Strongly Disagree (SD). Table 4 displays frequency distribution of effects of abuse on child development by respondents. About 70 percent of respondents (n=280) agreed that victims of child abuse will often have flashbacks and this was followed by victims of child abuse becoming abusers when they grow up (Table  4). Worrisomely, 50 percent of respondents (n=200) strongly reported that victims of abuse will never forget about the abuse they underwent. In other words, Table 4 indicates that most respondents agree that child abuse has consequences on the victim. Figure 4 validates that effects could range from mental illness, post traumatic disorders, behavioural problems, infectious diseases and early marriages.

The role of guidance and counselling
The paper asked respondents on how would guidance and counselling help in minimizing or mitigating the effects of abuse on child development. Table 5 shows frequency distribution of roles of guidance and counselling in mitigating effects of child abuse on child development by respondents in the study area. Approximately 88 percent of respondents (n=35) mentioned guidance and counselling to focus on ensuring self-worthiness. Just half of respondents mentioned that guidance and counselling to target on policy making and lobbying. One in every four respondents urged guidance and counselling to concentrate on emotional stability of the victimised.

ROLES
Frequency Proportions (%)  Table 5: Frequency distribution and proportions of roles, mechanisms and other ways of guidance and counselling in mitigating effects of child abuse by respondents.
In general, respondents reported that guidance and counselling could provide emotional stability, mental stability, self worthness, improve relationships, policy making and can help victims of abuse chose career path in their lives. In addition, the study asked the respondents on other best ways of helping the victims of abuse. Above 50 percent of respondents outlined counselling, helpline to report abuse and social support as best mechanisms in helping the victim of abuse (Table 5).
Furthermore, Table 5 shows civic education, abuse being part of education in schools, punishment to abusers, clear policies and laws on child abuse as some of key means through which effects of abuse can be mitigated. About 83 percent of respondents indicated that civil eductaion on abuse could effectively help in mitigative effects of child abuse above half of the respondents highlighted the importance of clear legislations on child care and protection to mitigate effects of abuse on child development.

Recommendations and Conclusion
The forms of abuse The study shows that there are five forms of abuse discussed. These are physical abuse, verbal abuse, sexual abuse, emotional abuse and negligence abuse. The study has shown that all these are well recognised forms of abuse. On the other hand the study has shown that negligence abuse and emotional abuse are the least common forms of abuse. For instance, the study found that 75 percent of respondents mentioned negligence abuse as the least common form of abuse. However, this could be because there's less knowledge of negligence and some cultural buriers may contribute to limited identification of negligence forms of abuse (Cicchetti, 1989). The study recommends that communities should take part in teaching their communities of abuse and its forms. In addition, Government should also make sure that forms of abuse should also embedded in education syllabus and that policies are in place to curb their incidences. Furthermore, the study recommends that institutions engaged in guidance and counselling should continue lobbying Government to enact most legislations that protect child welfare.

Causes of child abuse
Literature revealed that there are numerous factors related to the causes of abuse ranging from parental, environmental and family factors (Tower, 2008). Likewise, the study found that child abuse are caused by: the abusers were also victims of abuse; People abuse children when they abuse drugs or alcohol; Lack of education or awareness on effects of abuse on child development; Poverty and Serious marital problems. In addition, the study shows that abuse may occur because of cultural practices and customs; some beliefs connected to HIV and AIDS; high expectation on a child and what a child should achieve; violence between family members; acceptance of physical violence as punishment by culture; acceptance parents ownership and their right to treat children as they want; and inequality between men and women may also contribute to child abuse. The study recommends that awareness programmes to be promoted to aim at educating communities about incidences, facilitating causes and effects of abuse on child development.

Effects of abuse on child development
The study shows that child abuse has devastating consequences of abuse on child development. The researcher has summarised and categorised some of the mentioned effects of abuse as mental problems, behavioural problems, and emotional problems as well as permanent physical disabilities due to abuse. The physical effects may include difficulty in walking and sitting, sexual transmitted infections and permanent visible scars due to the impact of physical abuse. Some survivors for example who have been sexually abused show off sexual behaviours that are not expected in a child. They may also withdraw from friends and family. The study also shows that in connection to mental problems, the survivors may also have cognitive distortions. The victims may see the world as dangerous place because of the powerlessness in the past, may also underestimate sense self-efficacy and self-worth in dealing with both real and perceived danger and feel that there is nothing to be done. Cognitive distortions can contribute emotional distress and increase the risk of depression.
Behavioural effects include; unhealthy behaviours such as alcohol and drugs abuse, self-harm or eating problems. These problems are often used to try to hide painful emotions related to the abuse. The study also shows that survivors of child abuse may indulge in crimes ranging from petty crimes to more serious crimes. On the other hand, the study also shows that girls will more likely indulge in prostitution and get married early. Furthermore, children may drop out from school due to lack of family, parental support and motivation. The aggressive behaviour effects will be directed to other children or adults in order to cause pain or revenge. Emotional effects of abuse may involve lack of expression of their feelings and may develop difficulty in regulating their emotions. As adults they may also continue to struggle with their feelings which can lead to depression and anxiety. The study shows that the following are some emotional effects due to child abuse: academic problems in school aged children and adolescent; Difficult in concentration; Withdrawn and difficulty connecting with others; Difficulty sleeping; Increased hyper -vigilance; and Disassociation.
The study recommends development and promotion of policies that encourage child care, protection and justice. It is also proposed that institutions in guidance and counselling should deepen their trainings in dealing with child abuse and related issues. In addition, support and counselling services for abused and their families must be available in all communities. Develop educating programs which include young people to address the effects of abuse and the need of reporting any form of abuse so that victims can receive relevant support and treatment.

The role of guidance and counselling on child abuse
According to the study it shows that guidance and counselling plays central role in mitigating the effects of abuse on child development. Counselling provides emotional and mental stability for child, promote self-worth and increase self-esteem of the child. Guidance and counselling improve personal relationships of the child and create a platform of educating communities about braking the abusive behaviour cycle. However, the study found insufficient networking and coordination between government and non-governmental institutions. In this study, it is recommended that safe homes for abused children where they can get refugee should be made available in most communities. Furthermore, healing centres should be established in all communities that would utilise the skills of trained counsellors. Various institutions should lobby Government to formulate and implement legislations that protect children.