WHO initiative on violence against children in low- and middle-income countries

Background/Purpose. Violence is a global issue, one of public health without borders. WHO has convened United Nations agencies and international nongovernmental organizations concerned about the health and rights of children to develop health-sector indicators of violence against children in low- and middle-income countries. The purpose of this talk is to present information from the background paper that WHO commissioned for a November 2008 meeting in Geneva for these stakeholders.

Methods. The English-language literature was reviewed to identify relevant materials about violence against children and about the use of health indicators in low- and middle-income countries. The review focused mainly on U.S. work, the primary source of current knowledge about the nature and occurrence of violence against children.

Results/Outcomes. A framework that employs two key concepts - child development and victim-assailant relationship - was used to describe patterns of risk in violence against children. Ethical issues in monitoring the experiences and exposures of children were identified as were special considerations pertaining to establishing health indicators in low- and middle-income countries. Suggested indicators are based on a combination of administrative record surveillance and self-report surveys.

Conclusions. Monitoring violence against children is not a priority compared to highly visible and urgent health problems (e.g., starvation, HIV) in low- and middle-income countries. Basic record-keeping (e.g., birth and death certificates) is lacking in many locales. Possible indicators of outcome (injury), behavior, and exposure will be presented for feedback and discussion. Process indicators are suggested as an interim step to guide prevention and population-based intervention.