Child maltreatment in Nepal: prevalence and associated factors.

OBJECTIVES: Child maltreatment is a global public health problem. There is limited information about this problem in low-income countries. We aimed to document the prevalence and factors associated with physical punishment of children less than 14 years of age in Nepal.

STUDY DESIGN: Population-based cross-sectional study.

METHODS: We conducted an in-depth analysis using data from the Nepal Multiple Indicator Cluster Survey, a nationally representative multi-stage-stratified cluster sampling survey. Data were collected from 13,000 households in 520 sample enumeration areas. We assessed prevalence of physical punishment and different child violence related acts on 5081 children aged 3-14 years for whom complete information on all acts and attitude towards violence was available. Logistic regression was used to investigate the association between physical punishment of child and factors such as household and maternal demographics.

RESULTS: Our results suggested violence is common across Nepal, with data showing one in every second child is physically punished. One in every third (33%) of children were spanked, hit or slapped on the bottom, 25% were hit or slapped on the face and approximately 3% were beaten up hard. Odds of facing physical punishment were higher among children aged 3-5 years (odds ratio [OR] 2.9, 95% confidence interval [CI]: 2.0-4.3), aged 6-8 years (OR 2.8, 95% CI: 2.2-3.7), engaged in child labour activities (OR 1.4, 95% CI: 1.1-1.7), with mother that accepted wife beating by husband is justified (OR 1.2, 95% CI: 1.1-1.4), whose father is currently abroad (OR 1.5, 95% CI: 1.2-1.9) and whose father is away from home but in the same country (OR 1.60, 95% CI: 1.1-2.3). The risk was also higher among children living in households that believe physical punishment of children is necessary (OR 3.5, 95% CI: 2.9-4.3) and from lower caste/indigenous (dalit/janajati) ethnicity (OR 1.3, 95% CI: 1.1-1.7). Those less likely to experience physical punishment included female children (OR 0.7, 95% CI: 0.6-0.9) and children with an older mother (34-49 years; OR 0.5, 95% CI: 0.3-0.9).

CONCLUSIONS: Our results suggest that physical punishment of children is common across Nepal with varying severity. Prevention efforts should focus on designing and promoting interventions that support parents to adapt alternative forms of parenting practices.