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Discipline Gone Wrong: A Global Prospective on Non-Accidental Trauma
*Anna E. Ssentongo1, Paddy Ssentongo1, Emily S. Heilbrunn1, Dan Lin1, Kathryn M. McCans1, Joceyln A. Asibe2, Vernon M. Chinchilli1, Joshua P. Hazelton1, John S. Oh1
1Penn State University, Hershey, PA; 2Eastern Reginal Hospital, Koforidua, Ghana

Background: Non-accidental trauma (NAT) is a leading cause of morbidity and mortality globally. Disciplinary strategies employed by caregivers vary widely across the globe. In developing countries, for children older than 5, pediatric trauma, is the leading cause of death. The purpose of this meta-regression analysis was to identify predictors of NAT and to look for hot-spots. Methods: Poisson meta-regression analysis on 260,025 individuals (demographic health survey data) across 12 developing countries. Hot spot analysis using the Getis-ORD Gi approach at the sub-regional level. Results: Of 260,025 participants (83% women), children of parents with no education were 34% more likely have experienced severe physical punishment and 33% less likely to have experienced non-violent discipline compared to those whose parents had higher education (risk ratio: RR=1.34, 95%CI 1.33-1.36 and RR=0.77 95%CI 0.75-0.78). Children from households of lower wealth index were more likely to experience severe physical punishment compared to those of higher wealth index (RR =1.15 95%CI 1.14-1.16). Children between 5 and 9years were the most likely to experience severe physical punishment and the least likely to experience only non-violent discipline (RR=1.14 95%CI, 1.13-1.16 and RR= 0.66 95%CI=0.65-0.67). No hot or cold spots were identified. Conclusions: Interventions to prevent NAT should be tailored towards households oh lower social economic status, with children aged 5-9 and parents without a formal education.


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