Effect of Physical Abuse on Academic Achievement among Secondary School Female Students in Jeddah

Background : Physical abuse is defined as the intentional use of physical force against a child that can lead to harm for the child’s health, survival and development. Hitting, beating, kicking, shaking, biting, burning, poisoning and suffocating are forms of physical abuse. Physical abuse was predicted to negatively affect children’s academic and behavioral adjustment. Physically abused school age children continued to function more poorly than their non-maltreated peers on a variety of academic and socio-emotional measures. They having lower grades, showed less academic engagement, more social skills deficits, and lower ego resiliency than non-maltreated comparison children. Aim of the study: The aim of the study is to investigate the effect of physical abuse on academic achievement among secondary school female students in Jeddah.


Background
One of the major worldwide health issues among children is child maltreatment. It is not only having immediate affects but also long term consequences and it cost extremely burden on society for prevention, treatment, develop policies and programs [1]. It takes different forms, including neglect, emotional abuse, physical abuse and sexual abuse. Physical abuse is defined as "the intentional use of physical force against a child that results in -or has a high likelihood of resulting in -harm for the child's health, survival, development or dignity. This includes hitting, beating, kicking, shaking, biting, strangling, scalding, burning, poisoning and suffocating" [2]. Every year, there are an estimated 000 41 homicide deaths in children under 15. This number underestimates the actuality extent of the problem, as a significant proportion of deaths due to child maltreatment are incorrectly attributed to other causes rather than physical abuse [3]. Studies from several countries in all regions of the world suggest that up to 80 to %98 of children suffer physical punishment in their homes, with a third or more experiencing severe punishment resulting from the use of implements [4]. Furthermore, international studies revealed that a quarter of all adults report having been physically abused as children [3].
Many studies have been aimed at identifying factors which may be associated with or are predictors of physical abuse. The presence of these factors does not always mean that physical abuse will occur however they will be at high risk. There are factors related to the child such as been unwanted, failing to fulfill the parents› expectations, crying continuously, having abnormal physical features or being disabled. Other factors related to the parents or caregiver includes parent who has difficulty bonding with a new-born; was an abused child; displays a lack of awareness of child development; approves of physical punishment as a method of disciplining children, suffers from physical or mental health problems, shows a lack of self-control when angry; misuses alcohol or drugs, depressed; and experiences financial difficulties [2]. Child maltreatment has been recognized also in the Arabic centuries. The first case in Saudi Arabia was reported in 1990. A total of 188 cases from January 2000 to December 2008 were reported to the Suspected Child Abuse and Neglect (SCAN) team. Physical abuse was the most common form of abuse in the first  period at %61 and second  period at %76 and in the third  period. In November 2005, the National Family Safety Program (NFSP) was founded as an example of a specialized quasi-governmental agency dedicated to the prevention of child abuse and domestic violence [5].
There has been a growing amount of research into the consequences of child maltreatment. It has immediate and lifelong physical and mental health impairment. Poor school performance and educational achievement are among the consequences of child abuse and neglect. Physical abuse was predicted to negatively affect children›s academic and behavioral adjustment through the creation of deficits in academic engagement, social competencies, ego resiliency, and ego control [6,7]. Furthermore, stress caused by maltreatment is associated with disruption in early brain development. Extreme stress can impair the development of the nervous and immune systems. Consequently, as adults, maltreated children are at increased risk for behavioural, physical and mental health problems [3].
Physically abused school age children continued to function more poorly than their non-maltreated peers on a variety of academic and socio-emotional measures, Maltreated children, having lower grades, more suspensions, and more grade repetitions, showed less academic engagement, more social skills deficits and lower ego resiliency than non-maltreated comparison children. Maltreated children manifested multiple forms of academic risk and showed more externalizing and internalizing behavior problems [6]. Kurtz et al. [7] reported that abused children had a greater incidence of problems with school than children in a matched control group. More studies of the impact of physical abuse on academic achievement are in need specially in Arabic countries, So, the aim of the current study is to investigate effect of physical abuse on academic achievement among secondary school female students in Jeddah.

Aim of the Study
The aim of the study to investigate the effect of physical abuse on academic achievement among secondary school female students in Jeddah.

Specific Objectives
• To assess the prevalence of physical abuse in the last 6 months among secondary school female students.
• To correlate the relationship between physical abuse and academic achievement among secondary school female students.

Research Questions
Is there relationship between physical abuse and academic achievement among secondary school female students?

Setting
The study was conducted in two governmental female secondary schools in Jeddah -Saudi Arabia.

Study subjects
The sample included 200 female students in governmental secondary school in Jeddah (100/school) who were willing to participate at the study.

Study design
A descriptive -correlational design study design was utilized in this study as it fits its nature. It useful to exam the relationship between physical abuse and academic achievement of secondary school female students and it is an efficient and effective method of collecting a large amount of data [8].

Sample size
A total of 200 female students were recruited from two governmental female secondary schools.

Sampling technique
Non probability "convenience" sampling was used. It is the most readily accessible persons or objects as subjects in a study.

Data collection methods, instruments used, measurements
A questionnaire was developed by the researchers, after reviewing of literature. It includes three parts: Part 1: includes socio-demographic characteristics such as age, father's education and occupation, mother's education and occupation, level in Secondary School… etc.).
Part 2: includes questions related to participants' point of view about the physical abuse and its effect in the academic achievement and they will response by yes or no scale. Part 3: includes statements related to forms of physical abuse using 3 items scale (Never, rarely and usually) and the secondary female student will response to each statement.
The questionnaire was tested for validity by asking the experts in the field to assess relevance and necessary modifications were done. Reliability for part 3 was 0.813 by using Cronbach's Alpha test.
The researcher informed head master of the schools the purpose of the study to obtain their approval.
The researcher distributed the questionnaire to the participants who were willing to participate after asking them to sign the informed consent. To minimize the possibility of bias the researcher was ensure that the respondents received standardized instructions on how to complete the questionnaire.

Data management and analysis plan
Data were fed to the computer and analyzed using IBM SPSS software package version 20.0. Qualitative data were described using number and percent. Quantitative data were described using minimum and maximum, mean and standard deviation. Comparison between different groups regarding categorical variables was tested using Chisquare test. When more than 20% of the cells have expected count less than 5, correction for chi-square was conducted using Monte Carlo correction. For normally distributed data, comparison between two independent populations was done using independent t-test. Reliability Statistics was assessed using Cronbach's Alpha test. Significance of the obtained results was judged at the 5% level [9].

Ethical Consideration
The researcher submitted the research proposal and questionnaire to the Research Committees of the College of Nursing -Jeddah for review and to obtain a permission to conduct the study. All participants were fully informed about the research purpose, the nature of the study. All participants were required to indicate their willingness to participate in the study by signing a consent form and their right to withdraw from the study at any time. Confidentiality was ensured in this study by using code names rather than respondents' real names during data collection and analysis. The questionnaire used for data collection was handled by only the research team Table 1 illustrates participants' distribution according to their demographic characteristics. Two hundred female students were participated in the study; their age ranged from 15 to 20 years with mean age of 17 Majority of them (88%) were living with their parents. About half of them (49%) having more than 5 siblings with mean of 6. Less than one third (29.5 %) of their Parents have health problems. Regarding to parents' education, 7% of their fathers are illiterate and 44%of them have university graduation while 16.5 % of their mothers are illiterate and 34% have university graduation as presented in Figure  1. Most of fathers are working 74%, while about 73% of their mothers are house wife as presented in Figure 2.

Results
Participants' perception on the effect of physical abuse on academic performance. Majority of participants reported that physical abuse affects student's academic achievement in forms of lack of concentration in the class, having problems in learning and solving homework in addition to increase absenteeism (94.5%, 86.5%, 81% and 92% respectively) as illustrated in Figure 3. The results revealed that 29% of participates reported that they experienced at least one form of physical abuse as illustrated in Figure 4. Experiences of physical abuse among participates was illustrated in Figure 5. The highest percent was for biting as reported by participates (29% for rarely and 15% for usually) followed by spanking/pinching (23.5% for rarely and 13.5% for usually).    While hitting, slapping, or punching by parents causing no injury were reported by 13.5% for rarely and 12.5% usually. Furthermore, pulling the hair was experienced by 13% of participants rarely and usually by 4.5% of them. While hitting with hard objects was reported rarely by 11.5% and usually by 3% of them.
Relationship between physical abuses with academic achievement is presented in Table 2. The participates who reported any forms of physical abuse (62.1%) get GPA less than 85% compared with who reported that they never been abused (32.4%) and the differences was statistically significant (P=0.001). Furthermore, the mean GPA of physically abused participants was 83.07 ± 8.02 while the mean GPA of non-physically abused participants was 88.19 ± 9.13 and the differences was statistically significant (P=0.001). As regards the GPA and forms of physical abuse, statistical significant differences were found between GPA and experiences of biting, hitting, slapping, pulling hair and presence of bruises after experience of physical abuse as presented in Table 3.
Believe of abused participants about being abused illustrates in Figure 6, 70.7% of abused believed that they weren't abused and 29.3% of them believed they were physically abused. No statistical significant differences were found between physical abuse and participants' sociodemographic characteristic using Chi square test, Monte Carlo test and student t-test as presented in Table 4.

Discussion
Physical abuse has wide and variously effect on child's development and functioning domains. Child's academic achievement is one of the aspect that can be affected by child maltreatment [10,11]. Still more researches are needed to assess the impact of physical abuse on students' academic achievement. Therefore, the aim of the study was to investigate the effect of physical abuse on academic achievement among secondary school female students in Jeddah [12].  70.7%

29.3%
No Yes    According to WHO Global status report on violence prevention 2014, nearly a quarter of adults (22.6%) worldwide suffered from physical abuse as a child with no significant differences between boys and girls [3]. Ba-Saddik and Hattab [13] found that 55.7% of pupils out of 1066 pupils in basic-education schools in Aden reported physical abuse experience at least once in their school lifetime and Daral et al. [14] found that 42.6% out of 1060 adolescent girls experienced physical abuse while the prevalence of physical abuse among participants of the current study is 29%. The current study included only female students but based on WHO report no significant differences between boys and girls.
The results of the current study revealed that the common forms of physical abuse among participants are biting then spanking/pinching, hitting and slapping. On the other hands, Daral et al. [14] found that the most common forms of physical abuse faced by the adolescent girls in his study was slapping or hitting.
Previous researches indicate that child maltreatment can affect the academic achievement [10,11]. Experience of physical abuse can negatively affect brain development and cause alteration in brain maturation and leads to impair in cognitive, language and academic abilities [12,15]. In addition, Leiter [16] investigated the school performance among a random sample of the reported maltreated children. He found that a worse maltreatment effect on absenteeism from schools than on grades especially after the first report. Comparing with the current results, majority of the participants reported that physical abuse affects student's achievement such as concentrated at the class, learning in school, solving homework, and school absenteeism. When comparing the GPA between physically abused participants with non-abused participants, physically abused participants have lower GPA which shows evidence of adverse effect of physical abuse on academic achievement. This is in the same line with the results of Ifeyinwa and Ncheta [17] who assessed the effect of physical abuse and neglect among 3125 pupils and revealed that there is a significant influence of physical abuse on pupils' academic achievement. The findings also supported by studies of Hildyard et al. [18], Slade et al. [12], Leiter [16], Adejobi et al. [11] and Adigeb and Mbua [20]. However, it is contrast with Fantuzzo et al. [19] who reported in his study that physical abuse has only impact on poor learning behaviors but has no effect on academic achievement outcomes. Furthermore, a study by Bosede and Comfort [21] revealed a significant relationship between child abuse and children's attention span in class as reported by 200 teachers from 10 schools [21][22][23][24][25][26][27][28][29][30].
One of the surprising results is most of the abused children were not aware about being abused. This may be attributed to culturally accept the abuse as a method of child rearing discipline in addition to lack of knowledge and awareness about the proper way of modifying the children behavior rather than using physical abuse.
Child maltreatment usually occurs due to interaction of several risk factors either from child, parents or/and environment. A study by Ba-Saddik and Hattab [13] found a statistically significant association between prevalence of physical abuse and extended family and father's education. While the results of the current study revealed no significant relationship between physical abuse with demographic characteristics of children as age, number of sibling or parents' education or health problems [31][32][33][34][35][36][37][38][39][40].

Conclusion and Recommendation
In summary, physical abuse is a worldwide problem that needs action from all community sectors. The findings of the current study support that there is a negative impact of physical abuse on children's academic achievement. Identify and support abused children with poor academic achievement are needed. Awareness about rearing practices without using physical abuse is the key for prevention of the problem and should be one of health education topic by pediatric nurse and school nurse. Furthermore, pediatric nurse and school nurse should be trained about identification of physically abused children. Children's rights in Islam and convention on the rights of children should be included in the school curriculum

Limitation of the Study
The study applied only in females' schools and needs to be in repeated in include more schools and to involve male and females' adolescents