Abstract
BACKGROUND: Child maltreatment is becoming predominantly multi-type in nature. Studies report that multi-type child maltreatment is associated with low self-esteem in adolescence and adulthood. There is a lack of published studies in Tanzania regarding multi-type child maltreatment and its relationship with self-esteem in adolescence. This study investigates the prevalence of multi-type child maltreatment and its relationship with self-esteem among secondary school students in Tanzania. METHODS: A cross-sectional, community-based study of secondary school students was conducted in randomly selected secondary schools in Tanzania. A multistage cluster sampling technique was employed to obtain the required number of study participants. The Rosenberg Self-Esteem Scale and the Adverse Childhood Experiences (ACE) questionnaire were used to measure the variables under investigation in the study. A total of 1000 participants (M: F ratio = 1.2:1) were studied. The mean age at presentation was 16.24 ± 7.36 years. The modal age group was 16-18 years (54.2%). RESULTS: The prevalence of multi-type child maltreatment was 97.6%. The prevalence of physical abuse, physical neglect, emotional neglect emotional abuse and sexual abuse was 82.1, 26.2, 51.9, 21.8 and 24.7%, respectively. Females reported a higher prevalence of physical abuse (84.3%), physical neglect (28.0%) and sexual abuse (26.2%) than their male counterparts. Emotional abuse (53.3%) was reported more often by males. In terms of ACE, participants were classified as having zero (2.4%), one (22.4%), two (20.3%), three (18.2%), four (14.7%), five (12.8%) and over five (9.2%) types of maltreatment. With regard to multi-type child maltreatment, emotional abuse (X(2) = 2.925, p = 0.001), emotional neglect (X(2) = 2.329, p = 0.032), physical neglect (X(2) = 22.508, p < 0.001) and physical abuse (X(2) = 6.722, p = 0.036) were significantly associated with low self-esteem. CONCLUSION: The current study demonstrates that multi-type child maltreatment exists in Tanzania and has adversely affected self-esteem among secondary school students. We believe that this study has significantly added to the body of literature on child maltreatment by investigating exposure to 10 types of ACEs as opposed to single types, as the majority of previous studies have investigated.