Disclosure, reporting and help seeking among child survivors of violence: a cross-country analysis.

BACKGROUND: Violence against children is a pervasive public health issue, with limited data available across multiple contexts. This study explores the rarely studied prevalence and dynamics around disclosure, reporting and help-seeking behaviours of children who ever experienced physical and/or sexual violence. METHODS: Using nationally-representative Violence Against Children Surveys in six countries: Cambodia, Haiti, Kenya, Malawi, Nigeria and Tanzania, we present descriptive statistics for prevalence of four outcomes among children aged 13-17 years: informal disclosure, knowledge of where to seek formal help, formal disclosure/help seeking and receipt of formal help. We ran country-specific multivariate logistic regressions predicting outcomes on factors at the individual, household and community levels. RESULTS: The prevalence of help-seeking behaviours ranged from 23 to 54% for informal disclosure, 16 to 28% for knowledge of where to seek formal help, under 1 to 25% for formal disclosure or help seeking, and 1 to 11% for receipt of formal help. Factors consistently correlated with promoting help-seeking behaviours included household number of adult females and absence of biological father, while those correlated with reduced help-seeking behaviours included being male and living in a female-headed household. Primary reasons for not seeking help varied by country, including self-blame, apathy and not needing or wanting services. CONCLUSIONS: Across countries examined, help-seeking and receipt of formal services is low for children experiencing physical and/or sexual violence, with few consistent factors identified which facilitated help-seeking. Further understanding of help seeking, alongside improved data quality and availability will aid prevention responses, including the ability to assist child survivors in a timely manner.

Child-Sensitive WASH Composite Score and the Nutritional Status in Cambodian Children.

Progress in health has occurred in the past decades in Cambodia, in terms of health service access and interventions, but several indicators, including the prevalence of malnourished children, remain alarming. The causes of undernutrition are often linked to inadequate access to water, sanitation and hygiene services but limited evidence exists on the direct association between poor WASH practices and children's' nutritional statuses. This study investigates the relationship between water, sanitation and hygiene practices, defined as the child-sensitive composite score, and the nutritional status of children under five years old, measured as the weight-for-height z-score, mid-upper arm circumference or height-for-age z-score in six districts of Cambodia. The analysis used data from a longitudinal study, comprising extensive data collection on anthropometry, health, nutrition, WASH, and cognitive development. Chronological trends in wasting and stunting were described cross-sectionally, whereas the effect of WASH practices on the nutritional status of children over up to three consecutive study visits was examined with a linear mixed-effects model. The prevalence of wasting decreased during the study while stunting prevalence increased. A small, but significant, association was found between the WASH child-sensitive composite scores and the wasting child anthropometry indicators: weight-for-height z-score or mid-upper arm circumference. Evidence for an association with height-for-age z-score, detecting stunted children, was found when the independent variable was quantified according to global, but not national, guidelines. This study reinforces discordant existing evidence towards a direct association between WASH practices and children's nutritional status, suggesting the need to align nutrition and WASH programmes.

Risk factors for childhood violence and polyvictimization: A cross-country analysis from three regions.

Understanding risk factors is important to ending childhood violence and meeting Sustainable Development Goal 16.2. To date, no study has examined patterns of risk factors across countries comprehensively for different types of childhood violence, and there is a dearth of evidence of polyvictimization in lower- and middle-income settings. We analyse risk factors of childhood emotional (EV), physical (PV), sexual violence (SV) and polyvictimization for children aged 13-17 from nationally-representative Violence Against Children Surveys across six countries. We examine risk factors at the community-, household-, and individual- levels for each violence type, stratified by gender using multivariable logistic regression models. Across countries, school enrolment increased violence risk among females and males (three countries), but was protective against violence among females (one country), and among males (three countries). Among females, increasing age was associated with increased risk of SV (five countries) and polyvictimization (three countries); among males this relationship was less salient. Non-residence with a biological father emerged as a risk factor for SV among girls. Few or inconsistent associations were found with other factors, including number of household members, wealth, and urban residence. These results underscore on the one hand, the need for country-specific research on risk factors to inform prevention strategies, as well as increased investment in data collection to provide a more complete and robust basis for evidence generation. High levels of polyvictimization highlight overlapping vulnerabilities children face, and may provide insights for policymakers and practitioners in designing strategies to protect children at greatest risk of abuse.

Assessment of the chemical quality of drinking water in Cambodia.

Most water supply programmes in Cambodia have focused on providing access to bacteriologically safe water, an approach which has led to an increasing reliance on ground water, especially in rural areas. However, there have been very few data collected on the chemical quality of the nation's drinking water sources, and few water supply programmes have the capacity to assess chemical quality. The study was designed to address this data gap by conducting a low-cost, rapid assessment of drinking water sources nationwide to determine whether there were any chemicals of concern in Cambodian water supply sources. Results of the assessment confirm that there are several parameters of health and aesthetic concern; dissolved arsenic is the most significant. Elevated arsenic levels (some exceeding 500 microgl(-1)) were detected in aquifers of moderate depth in several highly populated areas, confirming that further investigation of the occurrence of arsenic contamination in Cambodia is warranted. Other chemicals of health concern include nitrate, nitrite, fluoride and manganese. Additionally, many ground water sources are negatively impacted by parameters of aesthetic concern, such as iron, manganese, hardness and total dissolved solids. Elevated levels of these parameters have caused consumers to reject newly installed water supplies, often in favour of surface water sources that are bacteriologically unsafe.