Relationship Between Violence Against Women, Social Support, Self-Esteem, and Mental Health in Riyadh, Saudi Arabia.

The objectives of this study were to measure the prevalence of mental distress and to explore the relationship between violence against women (VAW), social support, self-esteem, and mental distress in women in Riyadh, Saudi Arabia. A questionnaire-guided, cross-sectional, interview-based study was conducted with 1,932 women, in primary healthcare centers. Around 29% reported moderate to severe distress levels, whereas 40% of women reported lifetime exposure to at least one type of violence. Linear regression analysis found that VAW was positively associated with mental distress with a unit increase associated with a 0.13 (0.58, 1.15) increase in distress level, whereas, for both social support and self-esteem, a unit increase in violence was associated with -0.23 (-0.47, -0.32) and -0.22 (-0.49, -0.33) unit decrease in the mental distress. Structural equation modeling found that violence had direct significant negative effects on social support (ß = -.156, p < .001) and self-esteem (ß = -.135, p < .001). Both social support (ß = -.266, p < .001) and self-esteem (ß = -.183, p < .001) had direct significant negative effects on distress. VAW exerted a direct significant positive effect on distress (ß = .171, p < .001) as well as an indirect effect (ß = .068, p < .001). Both social support (ß = .044, p < .001) and self-esteem (ß = .025, p < .001) were significant mediators of the effect of violence on mental distress. VAW can lead to mental distress and low self-esteem. Identification, counseling, and social support for women are important to improve their self-confidence and reduce the adverse effects of violence.

Determining the Prevalence of Child Maltreatment Among Young Adults in Saudi Arabia Using ISPCAN Child Abuse Screening Tool.

Background Child maltreatment is an important public health issue, thus determining its prevalence is critical to recognize the extent of the problem and mandate efforts to combat child abuse. We aimed to investigate child maltreatment prevalence among special populations of young adults in Riyadh, Saudi Arabia. Methods We used the retrospective version of the International Society for Prevention of Child Abuse and Neglect (ISPCAN) Child Abuse Screening Tool (ICAST-R). The survey included Saudi students of both genders aged between 18 to 24 years old and attending King Saud bin Abdulaziz University for Health Sciences (KSAU-HS). The questionnaire was provided electronically using Survey Monkey (Momentive Global Inc., San Mateo, CA, USA). Results A total of 713 students completed all sections of the questionnaire. The prevalence of any type of child maltreatment was estimated to be 42%. Physical abuse was the most prevalent (51.1%), followed by emotional abuse (49.9%), lack of protection and safety (38%), and sexual abuse (29.6%). The most common form of physical abuse was being hit or punched at 77.5% followed by 'beaten very hard with an object' at 58.8% while touching was the most common form of sexual abuse at 68.7%, and only 13.7% encountered penetrating form of sexual abuse. In comparison to female victims, male victims were more likely to be physically abused (odds ratio (OR)=1.5; confidence interval (CI)=1.1-2.0). Participants who lived with a single parent were more likely to be victims of a lack of protection and safety than those who lived with both parents (OR=1.9; CI=1.0-3.7). Most participants reported the abuse to occur after the age of nine years, and the perpetrator was the parents in 17.5% of cases.  Conclusion Our findings demonstrated a high prevalence of child maltreatment among the young adult population in Saudi Arabia. It is vital to obtain more information on the prevalence and risk factors of child maltreatment in various populations and regions of Saudi Arabia to raise awareness and improve services for the victims of abuse.

Factitious Hypoglycemia in an Infant With Undetectable Exogenous Insulin by a Commercial Insulin Immunoassay: A Diagnostic Pitfall.

Factitious hypoglycemia in infancy is a rare, life-threatening manifestation of Munchausen syndrome by proxy (MSBP). The hallmark of such presentation is the detection of low c-peptide combined with high insulin at the time of hypoglycemia. We report the case of a male infant who presented with recurrent severe unexplained hypoglycemic episodes since the age of six months. Two of his siblings had similar unexplained hypoglycemia episodes at a young age. He was extensively investigated, and all were normal, for endocrine and metabolic etiologies. He underwent fundoplication and insertion of a gastrostomy tube with multiple lengthy hospital admissions. His mother had diabetes and was on insulin treatment; she also had mental health issues with family-related social stressors. His hypoglycemic attacks resolved once separated briefly from his mother on the ward, raising our suspicion of MSBP. The exogenous administration of insulin was only confirmed following a scheduled change of our local Insulin assay in our laboratory when his insulin was detectable with low C-peptide on one of his typical attacks. Apparently, our previous insulin immunoassay lacked sensitivity for his mother's long-acting insulin. We are reporting this case to raise awareness about this potential diagnostic pitfall.

Adverse Childhood Experiences and Chronic Diseases: Identifying a Cut-Point for ACE Scores.

Adverse Childhood Experiences (ACEs) contribute to many negative physiological, psychological, and behavioral health consequences. However, a cut-point for adverse childhood experience (ACE) scores, as it pertains to health outcomes, has not been clearly identified. This ambiguity has led to the use of different cut-points to define high scores. The aim of this study is to clarify a cut-point at which ACEs are significantly associated with negative chronic health outcomes. To accomplish this aim, a secondary analysis using data from a cross-sectional study was conducted. The Adverse Childhood Experiences-International Questionnaire (ACE-IQ) was used for data collection. Descriptive statistics, nonparametric regression, and logistic regression analyses were performed on a sample of 10,047 adults. Data from demographic and self-report health measures were included. The results showed that a cut-point of four or more ACEs was significantly associated with increased rates of chronic disease. Participants with at least one chronic disease were almost 3 times more likely (OR = 2.8) to be in the high ACE group. A standardized cut-point for ACE scores will assist in future research examining the impact of high ACEs across cultures to study the effect of childhood experiences on health.

Child health advocacy in Saudi Arabia: Traditional medicine as a model.

Objective: The purpose of this work is to describe the opportunities and challenges faced by health advocates in Kingdon of Saudi Arabia (KSA) regarding traditional medicine practices, which commonly result in health issues affecting children in the community. Method: A literature review was conducted of all articles identified in PubMed with the following keywords: alternative medicine, traditional medicine, KSA, and advocacy. No articles from other countries with similar cultural backgrounds were excluded, and recommendation from authors were listed at the end of the article. Results: Traditional medicine, traditional herbal medications, and spiritual treatments, which are common practices in the community, present major opportunities for advocacy in KSA. Because these practices are conducted without appropriate supervision, many adverse events result, thus affecting children and families. Many challenges are described herein, such as use of these practices in treating benign self-limited conditions; the surrounding culture and beliefs; and the dilemma of achieving child protection. At the system level, national policies and legislation, as well as research, are lacking. Moreover, health care facilities have longer waiting lists than traditional medicine facilities. Conclusion: Recommendations include improving knowledge, facilitating behavioral changes, data collection, bylaw enactment, and providing better access to health care facilities, all of which are supported by Saudi Vision 2030.

Paecilomyces/Purpureocillium Infection in Children, Case Report, and Review of the Literature.

Paecilomyces/Purpureocillium has recently been recognized as an emerging human pathogen, causing serious infection in immunocompromised and immunocompetent patients. Several predisposing factors have been reported, including foreign body implants, previous surgery, or trauma. Treatment with antifungal drugs often fails as species-specific differences in antifungal susceptibilities are one of the management challenges. Surgical debridement with or without antifungal therapy was sufficient to cure the infection in a few reported cases. Nonetheless, the surgical approach has been found to decrease the chance of dissemination and recurrence. Here, we report the first pediatric patient with chronic osteomyelitis of the femur secondary to Paecilomyces species, with no predisposing risk factors. Our case was successfully treated with a combination of antifungal therapy and surgical debridement. Additionally, we describe the first extensive literature review of previously reported Paecilomyces/Purpureocillium species infections in pediatric age groups.

Child neglect in Saudi Arabia: The neglected form of child maltreatment.

OBJECTIVES: To shed light on types, family profiles, risk factors, and outcomes of child neglect in Saudi Arabia. METHODS: A retrospective chart review was carried out at King Abdullah Specialized Children's Hospital, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia. Cases of child neglect diagnosed by the Suspected Child Abuse and Neglect (SCAN) team were reviewed. Data were extracted from patients' electronic charts and SCAN team records. RESULTS: A total of 309 cases of child neglect were diagnosed between 2015-2019. Mean age of victims was 4.4±4.1 years, and 51.8% were male gender.Supervisory neglect was the most common form (63.1%), followed by medical neglect (39.2%), emotional neglect (6.8%), physical neglect (5.5%), and educational neglect (3.2%). Children between the ages of one and 3 years were 3.3 times more likely to be victims of supervisory neglect and girls were 4.5 times more likely to be victims of educational neglect. Children living with ≥4 siblings were 7 times more likely to be victims of physical neglect and 1.9 times of medical neglect. With regard to emotional neglect, children of unemployed fathers were 3.5 times more likely to be parentally neglected than children of employed fathers. Worsening of the underlying disease (30%) and internal injuries (23.5%) were the most common consequences of neglect. Mortality attributed to neglect was documented in 8 (2.6%) children. CONCLUSION: Although child neglect is common in Saudi Arabia, it has not been recognized as an important cause of morbidity and mortality of children. This implies the need for a national protocol that would help identify high-risk families for early detection and implementation of prevention programs.

Childhood vaccination hesitancy in Saudi Arabia: A time for action.

OBJECTIVES: This study aims to assess the health care provider (HCP) perception and knowledge about vaccination and to determine the presence of hesitancy toward it. METHODS: An observational study on HCPs was conducted in King Abdullah Specialized Children's Hospital (KASCH), Saudi Arabia using a questionnaire. The HCPs were categorized as physicians, nurses, and allied health care specialists with total participants of 344. RESULTS: 24% expressed disagreement with the vaccination schedule required by the Saudi Ministry of Health and 17% expressed reluctance in recommending or receiving vaccines in general. There was an apparent reluctance toward the influenza vaccination among allied health care specialists compared to nurses and physicians (42.5% vs 6% vs 11.8% respectively, p = <0.0001). Furthermore, 6% of the HCPs stated they believe of a strong correlation between GBS and the seasonal influenza vaccine, and 8% expressed an association between measles vaccine and autism. Years of experience significantly implicated HCP perceived confidence in explaining vaccine safety and efficacy. HCPs with less experience expressed a lack of confidence in the matter compared to their colleagues with more experience (20.9% vs. 10.7%, respectively, p = 0.0262). CONCLUSIONS: HCPs' confidence in vaccination are essential in influencing their patients. Therefore, it is essential to improve the knowledge and awareness of vaccination among HCPs.

Child maltreatment prevention readiness in Bahrain.

BACKGROUND AND OBJECTIVES: Child maltreatment (CM) is a major public health problem worldwide. Despite the well-documented cases of all forms of CM and the improvement of the national response to CM in Bahrain, efforts on the prevention of CM are still limited. The objective of this study was to assess the readiness to implement a national evidence-based CM prevention (CMP) program in Bahrain. METHODS: The cross-sectional study was conducted with 45 key informants who had influence and decision-making power over CMP. RESULTS: The overall score indicated low to moderate readiness. The key informants scored the highest on legislation, mandates, and policies (7.9), which was followed by the knowledge of CM prevention (7.2), institutional resources and links (5.2), and informal social resources (noninstitutional) (5.2). However, the lowest scores were the human and technical resources (1.2), attitudes toward CM prevention (3.3), will to address the problem, and material resources (3.8), current programs implementation and evaluation, and scientific data on CM prevention (4.5). CONCLUSION: This research has identified strengths and gaps in the country that needs to be addressed to develop programs that are responsive to the needs of the community. The development of a comprehensive well-resourced CMP program requires the collaborative efforts of legislators, political leaders, and professionals.

Child mortality in Saudi Arabia: Time for action at all levels.

BACKGROUND AND OBJECTIVES: Although child mortality is declining in Saudi Arabia, new trends and causes are emerging. The objective of the study is to determine the causes of child death in a tertiary care hospital in Saudi Arabia and to identify its preventable causes and associated risk factors. METHODS: A modified UNICEF Multiple Indicator Cluster Survey (MICS) was used to analyze all deaths among children under the age of 18 which occurred at the King Abdullah Specialized Children's Hospital (KASCH) between 2010 and 2016. RESULTS: After reviewing all the death charts of 1138 children, the team determined that 15% (172) of all deaths could have been prevented and the preventability increased with age. Only 2% of the neonates died of preventable causes, while 53% of the children of 6 years of age or older died of preventable causes. The highest percentage of preventable deaths occurred in children aged 13-18 years (39.3%), followed by the age group of 6-12 years (32.4%) and the age group of 29 days to 5 years (13.9%). All 966 (85%) deaths from biological causes were considered to be unpreventable. Among the preventable causes, 142 (82.5%) had injuries and 30 (17.4%) were sudden unexpected infant death (SUID) with no documented autopsy or death scene investigation, and thus it was considered preventable by the researchers. The 5 major causes of deaths secondary to injuries were motor vehicle accidents (MVA) accounting for 86 deaths (60.6%), followed by drowning accounting for 19 deaths (13.4%), child maltreatment accounting for 13 deaths (9.2%), fire and weapon accounting for 12 deaths (8.5%), and finally home accident (fall, poisoning, suffocation) accounting for 12 deaths (8.5%). CONCLUSION: The State Child Death Reviews Board should thoroughly investigate deaths due to SUID and injuries by identifying the factors that contribute to the implementation of preventive strategies.

Social Determinants of Domestic Violence Among Saudi Married Women in Riyadh, Kingdom of Saudi Arabia.

Intimate partner violence is a worldwide public health problem. The objectives of this study were to measure the prevalence and types of domestic violence, and to explore the association between social determinants (sociodemographic factors, husband-related factors, and social support) and violence against women by their intimate partner (husband). We conducted a cross-sectional survey in 18 randomly selected primary health care centers and 13 private institutions (teaching institutes, government offices, social welfare organizations) in Riyadh, Saudi Arabia. Female data collectors took interview from 1,883 married Saudi females aged 30 to 75 years. Interviews included sociodemographic information, reproductive health variables, and social support questionnaire. Violence was measured using modified Intimate Partner Violence Against Women questionnaire developed by the World Health Organization. Multivariate logistic regression analysis was conducted. The lifetime prevalence for any type of violence was 43.0% (n = 810). The most frequent type was controlling behavior (36.8%), followed by emotional violence (22%), sexual violence (12.7%), and physical violence (9.0%). Multivariate logistic regression analysis revealed that the following were associated with greater odds of reporting domestic violence: younger age 30 to 40 years (adjusted odds ratio [aOR] = 1.9, 95% confidence interval [CI] = [1.3, 3.0]), 41 to 50 years (aOR = 1.6, 95% CI = [1.1, 2.5]); lack of emotional support (aOR = 1.7, 95% CI = [1.2, 2.5]); lack of tangible support (aOR = 1.4, 95% CI = [1.1, 1.9]); and perceived poor self-health (aOR = 1.7, 95% CI = [1.0, 3.0]), husbands' poor health (aOR = 1.9, 95% CI = [1.2, 2.0]), and polygamy (aOR = 1.6, 95% CI = [1.5, 2.6]). Domestic violence occurs frequently in Saudi Arabia. Both social conditions and social relations are significantly associated with domestic violence against Saudi women. Furthermore, improvement in implementation of the local policies and multisectoral protection services can prevent women from domestic violence.

Long term consequences of child sexual abuse in Saudi Arabia: A report from national study.

Child Sexual Abuse (CSA) is a global public health problem that has been found to be linked to negative health outcomes. The aim of this study is to examine the prevalence of different forms of CSA and its impact on chronic diseases, mental health disorders, and health-risk behaviors among adults in Saudi Arabia (SA). A cross-sectional, national survey utilizing Adverse Childhood Experiences International Questionnaire (ACE-IQ) was conducted in SA. Adults (N=10,156) aged ≥18 years were invited to participate. The relationship between CSA variables and outcomes were calculated. The prevalence of life time CSA was 20.8%. Participants who reported CSA had 1.7, 2.2, and 3.8 times the odds of diabetes, coronary heart disease, and obesity diagnosis respectively compared to participants with no CSA. Regarding mental health disorders, CSA had 3.0, 2.6, and 4.1 times the odds of a depression, anxiety, and other mental illness diagnosis respectively. Those reported CSA were identified as having 2.0, 5.5, 5.8, 7.9, and 7.2 times the odds of being a smoker, drinking alcohol, using drugs, out of wedlock sexual relations, and suicidal thoughts respectively. In comparing males and females with CSA, males had the highest odd ratio (5.2) for obesity among the physical and mental health disorders and female had the highest OR (10.7) in out of wedlock sexual relations among the health- risk-behaviors. CSA is a common hidden phenomenon in SA, efforts should be strengthened to increase awareness on consequences, and outcomes in order to build prevention programs.

Pathways to a more peaceful and sustainable world: The transformative power of children in families.

This article provides an overview of selected ongoing international efforts that have been inspired by Edward Zigler's vision to improve programs and policies for young children and families in the United States. The efforts presented are in close alignment with three strategies articulated by Edward Zigler: (a) conduct research that will inform policy advocacy; (b) design, implement, and revise quality early childhood development (ECD) programs; and (c) invest in building the next generation of scholars and advocates in child development. The intergenerational legacy left by Edward Zigler has had an impact on young children not only in the United States, but also across the globe. More needs to be done. We need to work together with a full commitment to ensure the optimal development of each child.

Readiness assessment for implementation of a large scale child maltreatment prevention program in Qatar.

BACKGROUND AND OBJECTIVES: Child maltreatment is a worldwide problem, with lifelong consequences for the survivors. The focus is shifting from Child Maltreatment Protection to Child Maltreatment Prevention. The objective of this descriptive study was to assess readiness for child maltreatment among stakeholders before implementation of large-scale prevention programs in Qatar. METHODS: The study involved structured interviews with 45 representatives of various stakeholders in sectors of national and local entities of Qatar. A survey was conducted among these stakeholders, to explore their perception and level of awareness of child maltreatment in Qatar. All of them responded, with a response rate of 100%. A multidimensional tool, developed by WHO and collaborators from several middle and low-income countries, was used to assess ten dimensions of readiness. RESULTS: Child maltreatment prevention readiness in Qatar is low with a total score of 37.8 on a scale of 0-100. The respondents scored high (≥ 5) in knowledge of child maltreatment (5.3), legislation, mandates and policies (6.8) and informal social resources (non-institutional) (5.6). Participants, however, scored low (≤ 5) in their knowledge about current program implementation and evaluation (1.1), human and technical resources (1.7), institutional resources and links (2.3), material resources (2.8), scientific data on child maltreatment prevention (3.1), attitude towards child maltreatment prevention (4.3) and will to address the problem (4.8). CONCLUSION: Child maltreatment prevention readiness in Qatar is low and requires improvement in some of the areas. It highlighted the need for capacity building among organizations across Qatar for a large scale CMP program to be successfully implemented.

Hospital preparedness and management of pediatric population during COVID-19 outbreak.

With the recent pandemic of Coronavirus disease-2019 (COVID-19), there has been a higher number of reported cases in children more than to the prior Corona Virus-related diseases, namely, severe acute respiratory syndrome and the Middle East respiratory syndrome. The rate of COVID-19 in children is lower than adults; however, due to high transmission rate, the number of reported cases in children has been increasing. With the rising numbers among children, it is imperative to develop preparedness plans for the pediatric population at the hospital level, departmental level, and patient care areas. This paper summarizes important considerations for pediatric hospital preparedness at the hospital level that includes workforce, equipment, supply; capacity planning, and infection prevention strategies, it also span over the management of COVID-19 pediatric patients in high-risk areas such as critical care areas, Emergency Department and operative rooms.

Child Maltreatment Prevention Readiness Assessment in Oman.

OBJECTIVES: This study aimed to evaluate Oman's readiness for implementing large-scale child maltreatment prevention (CMP) programmes. METHODS: This cross-sectional study was conducted between May and August 2016 in Oman. Participants, referred to as key informants, were individuals with influence and decision-making powers over CMP. The multidimensional Readiness Assessment for the Prevention of Child Maltreatment tool, developed by the World Health Organization with the help of collaborators from middle- and low-income countries, was used to assess 10 dimensions of readiness, each with a maximum score of 10. RESULTS: A total of 49 participants were included in this study (response rate = 98%). The mean total score for the 10 dimensions was 50.17 out of 100 possible points. The participants showed high mean readiness scores on legislation, mandates and policies (9.08) followed by knowledge of CMP (7.55), institutional resources and links (6.12), willingness to address the problem (5.35), informal social resources (5.15) and current programme implementation and evaluation (5.10). Participants had low scores in readiness in association with human and technical resources (2.44), attitudes towards CMP (2.90), scientific data on CMP (3.06) and material resources (3.46). CONCLUSION: The results of this study indicate that Oman has a moderate level of readiness to implement large-scale evidence-based prevention programmes against child maltreatment; however, several dimensions still need to be strengthened. It is important to develop a national strategy that outlines a framework for organising and prioritising efforts towards CMP.

Prevalence, pattern and factors of intimate partner violence against Saudi women.

BACKGROUND: This study aimed to assess the prevalence of intimate partner violence (IPV) and its correlates, amongst currently married Saudi women. METHODS: A total of 400 currently married females aged 19-65 years old who attended the outpatient clinics of PHC centres in Riyadh, from 1 November 2015 to 1 February 2016, were screened for the current and previous experiences with IPV, and its correlates, using the previously validated Arabic version of the WHO multi-country instrument on violence against women. Logistic regression analyses were applied to identify the correlates of IPV. RESULTS: The lifetime overall prevalence of IPV was 44.8%, in the form of; physical (18.5%), emotional (25.5%), sexual (19.2%) and economic (25.3%) violence. Wife's experience of child abuse was significantly associated with physical [OR = 3.63, P < 0.001], emotional [OR = 2.2, P = 0.004], sexual [OR = 2.42, P = 0.006], economic [OR = 2.24, P = 0.006] and overall IPV [OR = 2.76, P < 0.001], whilst husband's experience was significantly associated with only the emotional violence [OR = 2.4, P = 0.004]. Physical violence was significantly more prevalent when the woman lived with other wife in same house. CONCLUSION: IPV with its all forms was prevalent amongst Saudi women. Child abuse experience and polygamy were significantly associated with IPV. Designing tailored IPV national prevention programmes is a necessity.

Examining the Relationship Between Witnessing Intimate Partner Violence and Victimization Among Children in Saudi Arabia.

Childhood exposure to violence can lead to physical, mental, and emotional harm, whether a child is a direct victim or a witness to violent events. The aim of this study is to examine the relationship between witnessing intimate partner violence (IPV) and victimization among children. A cross-sectional, national study was conducted in secondary high schools in the five main provinces of Saudi Arabia (SA) using International Society for Prevention of Child Abuse and Neglect (ISPCAN) ISPCAN Child Abuse and Neglect Screening Tool-Child: Home version. Boys and girls, public and private schools were selected to participate. Students (N = 16,939) aged 15 to 18 years completed the survey instrument which included demographics, different types of abuse (physical, psychological, and sexual), neglect, and witnessing IPV. Mean age of the participants was 16.8 ± 0.9 years, and 51% were boys. Eighty-one percent lived with both parents, 6% with single parent, and 2% with step-parent. Fifty-two percent of the participants witnessed IPV. Those who witnessed IPV were more likely to be abused compared with those who did not (p < .01). Among those who witnessed physical IPV, girls had a significantly greater likelihood of experiencing psychological abuse (odds ratio [OR] = 3.7, confidence interval [CI] = [1.9, 6.8]), physical abuse (OR = 1.3, CI = [1.0, 1.6]), and neglect (OR = 1.6, CI = [1.4, 1.9]) but less likelihood of experiencing sexual abuse (OR = 0.6, CI = [0.5, 0.7]) than boys. Among those who witnessed psychological IPV, girls had a significantly greater likelihood of experiencing neglect (OR = 1.3, CI = [1.2, 1.5]) but less likelihood of experiencing sexual abuse (OR = 0.5, CI = [0.5, 0.6]) than boys. Boys who witnessed physical IPV and psychological IPV had a significantly greater likelihood of experiencing sexual abuse compared with girls. Witnessing IPV increases the chances of child and adolescent victimization. Multidisciplinary approaches involving social workers, law enforcement personnel, and domestic violence and child protection workers could effectively respond to this problem.

Child maltreatment prevention readiness in Gulf Cooperation Council (GCC) countries.

BACKGROUND AND OBJECTIVES: Child maltreatment (CM) is a global public health problem that has received growing attention over the past five decades. There have been many recent advances in child maltreatment prevention (CMP). The objective of this study is to assess CMP readiness to implement large-scale evidence-based CMP programs in Gulf Cooperation Council (GCC) countries. METHODS: This cross-sectional study (n = 244) was conducted in the GCC countries. Participants were key decision makers and senior managers in the field of CM. The Readiness Assessment for the Prevention of Child Maltreatment (RAP-CM) was used to assess 10 dimensions of CMP readiness. RESULTS: The key informants gave CMP readiness scores of 47.8 out of 100. Four of the dimensions (knowledge of CMP; legislation, mandates, and policies; institutional resources and links; and informal social resources) had high readiness scores (≥5), while six dimensions (attitudes towards CMP; scientific data on CMP; current program implementation and evaluation; will to address the problem; material resources; and human and technical resources) had low readiness scores (<5). CONCLUSION: GCC countries have moderate-to-fair readiness to implement large-scale evidence-based CMP programs. Strengthening their material, human, and technical resources, and improving the quality of scientific data, collaboration, and attitudes towards CMP are required to improve each country's readiness.

Understanding the needs of the Kingdom of Saudi Arabia: Child maltreatment prevention program development.

BACKGROUND: Global efforts are being made to combat child maltreatment (CM); however, in 2011 the Kingdom of Saudi Arabia's (KSA) response to this issue was found to be mediocre. Several developments have been implemented in KSA since then, and reevaluation is now necessary. OBJECTIVE: To assess the CM-prevention readiness (CMPR) of KSA in regard to implementing large-scale, evidence-based CM-prevention programs. PARTICIPANTS AND SETTING: Key informants based in KSA who were decision makers and senior managers in the CM field; face-to-face interviews were conducted in the participants' offices. METHODS: This was a cross-sectional study. We used the multi-dimensional tool "Readiness Assessment for the Prevention of Child Maltreatment - short version," which examines 10 dimensions concerning this topic. Comparison between the results of this study and those of the 2011 examination was performed to determine how the situation in KSA has changed. RESULTS: Sixty informants were interviewed; the majority being females (57%) and from governmental institutions (56%). The average total score for the 10 dimensions was 47.4%, an increase from the 43.7% reported in 2011. The strongest dimensions were legislations and mandates (8.3/10), followed by knowledge (7.1/10) and institutional links and resources (5.8/10). The lowest scores concerned human and technical resources (1.7/10) and attitude towards CM (2.8/10). Compared to the 2011 results, some dimensions showed significant improvements, but the majority had remained consistent. CONCLUSIONS: Time and commitment are necessary to secure CMPR improvement. Periodic assessment of CMPR is required to provide proper recommendations to the government regarding the progress of CM-prevention strategies.