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Odontoestomatología

versão impressa ISSN 0797-0374versão On-line ISSN 1688-9339

Odontoestomatología vol.20 no.32 Montevideo dez. 2018

http://dx.doi.org/10.22592/ode2018n32a4 

Research

Prevalence of children victims of violence in the city of Porto Alegre and impact of its variables on dentistry

Márcia Cançado Figueiredo1 
http://orcid.org/0000-0002-4279-5417

Rossana Malmaceda Da Rocha

Ximena Concha Melgar3 
http://orcid.org/0000-0002-9139-218X

1 Facultad de Odontología, Universidad Federal de Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brasil. mcf1958@gmail.com

2 Facultad de Odontología. Universidad Federal do Rio Grande do Sul. Porto Alegre, Brasil.

3 Facultad de Odontología, Universidad Federal de Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brasil

Abstract

Porto Alegre, capital of the state of Rio Grande do Sul, Brazil, is considered a violent city.

Objective:

to evaluate the main characteristics and variants of violence against children aged between 0 and 12 as reported at the General Office of Health Surveillance of Porto Alegre between 2010 and 2016.

Methods:

descriptive exploratory study that analyzed the data of 6,493 cases of violence against children recorded by the SINAN and published on the Porto Alegre Municipality website.

Results:

2015 recorded the highest prevalence of violence against children; 57.46% of the victims were female. The most frequent type of violence was negligence (36.25%). It was the mother who was mainly responsible for the aggressions.

Conclusion:

Child violence is high in Porto Alegre, and to ensure that health professionals treat children victims of violence appropriately, it is necessary to address these cases in their academic education.

Keywords: violence against children; abuse reporting; aggression; dentistry.

Introduction

According to the World Health Organization(¹), the term violence means “the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment or deprivation”.

Violence is more likely to exist in places where there is inequality, specifically in the case of violence against children, where an adult is superior to a child, both physically and emotionally. Violence against children is a highly debated topic nowadays. In Brazil, this violence is considered a serious public health issue given its magnitude and impact on health and quality of life, as it affects children’s physical, mental and/or emotional integrity. It causes serious damage and has dangerous consequences on development, such as mental health problems and aggressive behavior. It also affects the children’s inclusion in society, having short or mid-term consequences (2-4.

For children to develop properly, they should have an education based on a humanized model, through healthy and non-punitive learning, without the use of aggression or physical strength. Therefore, the Statute of Children and Adolescents (ECA) 5 was created in 1990 through Law 8.069 to regulate their rights and duties, to protect them from abuse and to create opportunities to punish those responsible for the violence. The ECA considers children those under the age of 12, and adolescents those aged between 12 and 18.

On 25 January 2011, ordinance No. 104 6 determined that domestic, sexual and other types of violence must be notified. Article 7 states that all health professionals, heads of organizations and public and private institutions in the fields of health and education must cooperate in this regard. To facilitate this, in 2006, the Ministry of Health implemented the System of Information on the Notification of Complaints (SINAN), which is the notification mechanism of the General Office of Health Surveillance (CGVS) and an epidemiological tool.

Despite the existence of this regulation, there are still 10 to 20 unreported cases of violence against children per case reported, given its difficult diagnosis (7. This reinforces the need for health professionals, in particular dentists (60% of the injuries caused in the violent attacks affect the face), to diagnose, notify and report cases of suspected or confirmed violence to the competent bodies 8-9.

In March 2018, the NGO Security, Justice and Peace from Mexico City reported that Porto Alegre, the capital of the state of Rio Grande do Sul, Brazil, is among the 50 most violent cities in the world (position 39). It also stated that the city has the necessary premises and resources for violence against children to be reported. Therefore, there is a significant number of cases reported, including the cities in the metropolitan region 10).

In light of the above, this work aimed to determine the socio-demographic and epidemiological profile of children victims of violence, as reported in the General Office of Health Surveillance of Porto Alegre between January 1, 2010 and December 31, 2016.

Methodology

Descriptive study focused on the quantitative paradigm developed from the analysis of violence reports filed with the SINAN, at the General Office of Health Surveillance of Porto Alegre between January 1, 2010 and December 31, 2016. The files were published by the Department for the Surveillance of Accidents and Violence (VIVA) 11-12 of the Municipal Health Secretariat (SMS) of the city and are available on the website of the Municipality of Porto Alegre. We obtained a total of 6,493 cases of violence against children of both sexes under the age of 12.

The variables analyzed were: age, sex, skin color, type of violence, means of aggression, place of occurrence, relationship/degree of kinship with the victim, sex of the aggressor, drug use by the aggressor, recurrence of the event, outcome.

After data collection, the information was recorded in an Excel 2013 spreadsheet. The responses were analyzed quantitatively in terms of percentages, and presented in absolute relative frequency.

This study was approved by the Research Committee of the School of Dentistry at Universidad Federal de Rio Grande do Sul (UFRGS) and by the Ethics and Research Committee (CEP) of the Municipal Health Secretariat of of the Municipality of Porto Alegre, Record No. 617.

Results

There were 6,493 violence reports against children under the age of 12: 10.66% in 2010; 10.73% in 2011: 11.46% in 2012; 11.57% in 2013; 15.05% in 2014; 21.70% in 2015 and 18.83% in 2016 (Table 1).

Table 1: Number of reports of violence against children between 2010 and 2016 

Source: Municipality of Porto Alegre/SINAN - Adaptaded from VIVA Continuo and VIVA (11-12

Of the 6,493 cases reported: 57.46% were male and 42.54% female; the age group most reported was 0 to 3 (39.64%), followed by 4 to 7 (30.88%) and 8 to 12 (29.48%). There was a uniform distribution of the reports in the different age groups of females; however, the percentage was slightly higher in girls aged between 8 and 12 (19.82%). In males, there were more reports in the 0 to 3 group (20.14%); the percentage decreased significantly as age increased (Table 2).

Table 2: Reported cases of violence according to the child’s sex and age group 

Source: Municipality of Porto Alegre/SINAN - Adaptaded from VIVA Continuo and VIVA (11-12

Children of white skin color showed the highest number of violence reports (74.78%), followed by children of brown skin (10.09%), black skin (9.75%), not applicable/no answer (5.07%), yellow skin (0.23%), indigenous skin (0.08%) (Table 3).

Table 3: Reported cases of violence according to the child’s skin color 

Source: Municipality of Porto Alegre/SINAN - Adaptaded from VIVA Continuo and VIVA (11-12

We found 8,803 reports regarding type of violence, a number higher than the cases of violence found because some children endured more than one type of violence in the reporting story. The most prevalent types of violence were negligence (36.25%), sexual (32.28%), psychological (19.48%), physical (10.88%) and others (1.11%) (Table 4).

Table 4: Reported types of violence according to the child’s age group 

Source: Municipality of Porto Alegre/SINAN - Adaptaded from VIVA Continuo and VIVA (11-12

In this study, we identified 6,320 reports regarding means of aggression, the most prevalent being physical strength (25.86%), followed by threats (17.99%), poisoning (2.2%), blunt object (1.12%), hot substance (0.98%), firearm (0.97%), perforation/cutting (0.93%), others (49.95%) (Table 5).

Table 5: Means of aggression cited in reports of violence against children 

Source: Municipality of Porto Alegre/SINAN - Adaptaded from VIVA Continuo and VIVA (11-12

The main place of occurrence was the child’s own residence (71.07%), followed by shops/services (15.65%), public roads (3.02%), school (1.74%), others (2.16%), not applicable (6.36%) (Table 6).

Table 6: Places of occurrence of violence against children 

Source: Municipality of Porto Alegre/SINAN - Adaptaded from VIVA Continuo and VIVA (11-12)

As for the victim’s relationship with the aggressor, there were 7,124 aggressors in the reports, as in some cases there was more than one aggressor per victim. The mother, regardless of the age group, was mainly responsible for the violence (38.63%), followed by the father (19.86%), a friend (12.24%), stepfather (7.36%), uncle (4.67%), grandfather (4.01%), unknown (1.73%), others (11.50%) (Table 7).

Table 7: Victim’s relationship with the aggressor by age group 

Source: Municipality of Porto Alegre/SINAN - Adaptaded from VIVA Continuo and VIVA (11-12

Regarding the sex of the aggressors, most aggressors are males in the general reports: males (46.35%), females (32.19%), both (13.46%) and not applicable (8%) (Table 8).

Table 8: Sex of the child’s aggressors 

Source: Municipality of Porto Alegre/SINAN - Adaptaded from VIVA Continuo and VIVA (11-12

The use of alcohol/drugs was left as not applicable in 53.04% of the reports, followed by non-use (34.47%) and use (12.49%) (Table 9).

Table 9: Use of alcohol/drugs by the aggressor 

Source: Municipality of Porto Alegre/SINAN - Adaptaded from VIVA Continuo and VIVA (11-12

Recurrence of violence was present in 31.55% of cases; 24.76% had no recurrence, 43.60% of cases were left as not applicable and 0.09% were left with no answer. Of the total number of reported cases of recurrent violence, 21.05% were against females and 10.49% against males (Table 10).

Table 10: Recurrence of violence according to the child’s sex 

Source: Municipality of Porto Alegre/SINAN - Adaptaded from VIVA Continuo and VIVA (11-12

The cases of violence in the city of Porto Alegre were referred to the health sector (31.72%), the Guardianship Council (31.26%), the Legal Medical Institute (14.18%), the Reference Center for Social Assistance (9.50%), the Public Prosecutor's Office (5.07%), the Institution of Children and Adolescents (2.98%), the Court of Children and Adolescents (1.60%), other institutions (1.03%), a shelter (0.92%) and others (1.74%) (Table 11).

Table 11: Referrals to the various public institutions that help victims of violence in the city of Porto Alegre 

Discussion

This study showed that reports of violence against children from Rio Grande do Sul are increasing at alarming rates, as in 2010 there were 692 reports, and in 2016 the figure practically doubled. Violence in general is currently growing. Additionally, according to data from the Secretariat of Public Security, this happened in the entire state of Rio Grande do Sul over the past few years. Therefore, we can state that social violence, in some way or another, reaches families and consequently children (13. Following this same logic, Figueiredo et al., in a 2013 14 study of a population from Rio Grande do Sul in extreme poverty, concluded that there is a potential risk of violence in situations of vulnerability such as poverty, since violence is the direct result of inequality, inequitable distribution of income and the difficulty of access poor people have to consumer goods, all notorious characteristics of Brazil in recent times.

In this study, we found a predominance of reports of violence against girls over the years, although it was boys who were attacked the most in early childhood (0 to 3). This reflects a tragic snapshot of society, due to lack of information and deeply rooted socio-cultural concepts. In 2015, Habigzang et al. 15 justify the linearity of violence against girls with their growth, because the physical violence suffered during sexual abuse encourages victims to remain silent, despite being exposed from preschool age.

According to the latest census conducted by the Brazilian Institute of Geography and Statistics (IBGE) 16, the population from Rio Grande do Sul declared itself white in 79.23% of the sample, which justifies that almost 75% of the reports of violence in this study involved white victims.

This research shows that neglect, sexual, psychological and physical violence were the most frequently reported cases. The number of cases of violence was higher than the reports because some children suffered more than one type of violence, with the reports of violence overlapping. The same situation was observed by Costa et al 17, with a different prevalence order, with secondary data from the records of occurrence of children victims of violence in Guardianship Councils I and II of Feira de Santana in Bahia, Brazil.

It was alarming to observe the situation endured by children from Rio Grande do Sul regarding the negligence of the adults responsible for them. We found that the child-family-society triad was very important, as well as the family as its pillar. Some social issues, such as socioeconomic level, may be decisive in this type of violence. Underweight, poor dental hygiene and extensive and widespread tooth decay are factors that tend to show that the child does not have the proper care and may be the victim of neglect. According to Seger et al. 18, in a study conducted in the city of Porto Alegre, 79% of family neglect is intentional and 7% is not intentional.

Sexual violence was recorded in all age groups, and happens in a very subtle way for children, as they find it difficult to determine if it was inappropriate behavior. In 2001, Figueiredo et al.19 reported that children victims of sexual violence may show altered signs and symptoms, such as atypical behavior in the dental appointment and the appearance of oral lesions, which can facilitate diagnosis. In contrast, according to Abranches and Assis 20, psychological violence or psychological torture is difficult to diagnose, leaves invisible marks, and may be implicit in other types of violence.

Physical violence was considered to be a punitive approach to educate children, and was the most prevalent means of aggression among girls. Additionally, Assis 21, in a study including students in public and private schools in the municipality of Duque de Caxias in Rio de Janeiro, showed that over 50% of children suffered verbal abuse through insults by their parents.

Almost all cases of reports of violence found in this study took place inside the children’s homes, the mother being the main aggressor, mainly in the 0 to 3 age group. In 2014, Nunes and Salles 22 conducted a literature review on violence against children in Brazil. They showed that the aggressor is always a family member and that parents are the greatest perpetrators of violence against children, specially the mother.

Most aggressors were male, which is justified by the power relations inherent in men, which result in inequality and domination over the children. In turn, the use of alcohol and other drugs may trigger situations of violence, because excessive use can alter consciousness, leading to irritability, loss of critical sense and increased libido. In this study, 12% of the aggressors claimed to use such drugs 15-23)

As violence tends to be cyclical and repetitive, we found 35% of reports of recurrence. Furthermore, the reports were proportionally referred to the health sector and the Guardianship Council of Porto Alegre. According to Fonseca 24, in a study conducted with children victims of recurrent violence in the city of Curitiba, this feature is a major factor the health professional must pay attention to, mainly when caring for children who were victims of violence.

Finally, public policies must be urgently implemented, in accordance with current legislation, to ensure the protection of children and their family so that the cycle of victimization and suffering does not perpetuate in future generations. Health professionals should be aware of the issues involved in domestic violence, taking into account the child and family’s social context, in order to have a broader understanding and to provide better quality of care, thus improving the quality of life of these people.

Conclusion

We conclude that there was an increase in the number of children victims of violence as reported to the General Office of Health Surveillance of Porto Alegre between January 1, 2010 and December 31, 2016. This shows the need to promote measures of prevention and protection to safeguard children, as well as the importance of addressing this issue in the academic training of health professionals, in particular, dental surgeons

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Received: July 21, 2018; Accepted: August 29, 2018

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