Skip to main content

Child Abuse Evaluations at the Centre Hospitalier Universitaire de Kigali (CHUK): Medical Education and Experience


Child maltreatment is a poorly recognized phenomenon worldwide, and many pediatric healthcare professionals do not receive adequate training in child abuse and neglect evaluations. In response to the paucity of child maltreatment literature on low- to middle-income countries, this study aims to determine the education and training needs of medical professionals at the Centre Hospitalier Universitaire de Kigali (CHUK) with respect to child abuse and neglect identification, investigation, evaluation, and case management. Data collection took place in July and August 2019 at CHUK in Kigali, Rwanda. A mixed-methods approach was employed, including semi-structured qualitative interviews with sixteen healthcare professionals (3 pediatricians, 7 pediatric residents, 2 nurses, and 4 social workers) at CHUK and a systematic chart review of child maltreatment cases evaluated at the hospital from July 2015 to July 2019. Interviews with professionals revealed perceived gaps in training regarding child maltreatment case evaluation, reporting, and management. Study participants noted the need for standardized, hospital-wide protocols for the handling of confirmed abuse and neglect cases as well as expanded curriculum on the topic throughout professional education. Chart reviews demonstrated inconsistent and sparse documentation of maltreatment cases in hospital records. In conjunction with our findings, we provide informant-based suggestions for the improvement of child abuse and neglect case management at CHUK,  including consistent training modules, inter-departmental collaboration, and systematic documentation. Beyond the hospital, participants widely agreed that child maltreatment awareness and prevention measures should be implemented at the community level with professionals from CHUK getting involved in local efforts.

This is a preview of subscription content, access via your institution.

Data Availability

Not applicable.

Code Availability

Not applicable.


  • Agathonos-Georgopoulou, H. (1992). Cross-cultural perspectives in child abuse and neglect. Child Abuse Review, 1(2), 80–88.

    Article  Google Scholar 

  • Al Odhayani, A., Watson, W. J., & Watson, L. (2013). Behavioural consequences of child abuse. Canadian Family Physician, 59(8), 831–836.

    Google Scholar 

  • Ards, S., Myers, S., Malkis, A., Sugrue, E., & Zhou, L. (2003). Racial disproportionality in reported and substantiated child abuse and neglect: An examination of systematic bias. Children and Youth Services Review, 25(5/6), 375–392.

    Article  Google Scholar 

  • Argent, A. C., Bass, D. H., & Lachman, P. I. (1995). Child abuse services at a children’s hospital in Cape Town. South Africa. Child Abuse & Neglect, 19(11), 1313–1321.

    Article  Google Scholar 

  • Badoe, E. (2017). A critical review of child abuse and its management in Africa. African Journal of Emergency Medicine, 7, S32–S35.

    Article  Google Scholar 

  • Bottoms, B. L., Nielsen, M., Murray, R., & Filipas, H. (2004). Religion-related child physical abuse: Characteristics and psychological outcomes. Journal of Aggression, Maltreatment & Trauma, 8(1–2), 87–114.

    Article  Google Scholar 

  • Clarke, V., & Braun, V. (2014). Thematic analysis. In Encyclopedia of critical psychology (pp. 1947–1952). Springer, New York, NY.

  • Cluver, L. D., Meinck, F., Steinert, J. I., Shenderovich, Y., Doubt, J., Herrero, R. R., & Gardner, F. (2018). Parenting for lifelong health: A pragmatic cluster randomised controlled trial of a non-commercialised parenting programme for adolescents and their families in South Africa. Bmj Global Health, 3(1), 000539.

    Article  Google Scholar 

  • Coore Desai, C., Reece, J. A., & Shakespeare-Pellington, S. (2017). The prevention of violence in childhood through parenting programmes: A global review. Psychology, Health & Medicine, 22(sup1), 166–186.

    Article  Google Scholar 

  • Currie, J., & Widom, C. S. (2010). Long-term consequences of child abuse and neglect on adult economic well-being. Child Maltreatment, 15(2), 111–120.

    Article  Google Scholar 

  • Dako-Gyeke, M. (2018). Perspectives of key informants on child abuse: Qualitative evidence from northern Ghana. Child and Adolescent Social Work Journal, 36(2), 155–169.

    Article  Google Scholar 

  • Finkelhor, D. (1994). The international epidemiology of child sexual abuse. Child Abuse & Neglect, 18(5), 409–417.

    Article  Google Scholar 

  • Flaherty, E. G., Sege, R. D., Griffith, J., Price, L. L., Wasserman, R., Slora, E., & Binns, H. J. (2008). From suspicion of physical child abuse to reporting: Primary care clinician decision-making. Pediatrics, 122(3), 611–619.

    Article  Google Scholar 

  • Hay, T., & Jones, L. (1994). Societal interventions to prevent child abuse and neglect. Child Welfare, 73(5), 379–403.

    Google Scholar 

  • Levi, B. H., & Brown, G. (2005). Reasonable suspicion: A study of Pennsylvania pediatricians regarding child abuse. Pediatrics, 116(1), e5-e12.

  • Levi, B. H., & Portwood, S. G. (2011). Reasonable suspicion of child abuse: Finding a common language. The Journal of Law, Medicine & Ethics, 39(1), 62–69.

    Article  Google Scholar 

  • Levi, B. H., Crowell, K., Walsh, K., & Dellasega, C. (2015). How childcare providers interpret ‘reasonable suspicion’ of child abuse. In Child & Youth Care Forum (Vol. 44, No. 6, pp. 875–891). Springer US.

  • Mathews, B., & Kenny, M. C. (2008). Mandatory reporting legislation in the United States, Canada, and Australia: A cross-jurisdictional review of key features, differences, and issues. Child Maltreatment, 13(1), 50–63.

    Article  Google Scholar 

  • May-Chahal, C., & Cawson, P. (2005). Measuring child maltreatment in the United Kingdom: A study of the prevalence of child abuse and neglect. Child Abuse & Neglect, 29(9), 969–984.

    Article  Google Scholar 

  • Meinck, F., Cluver, L. D., Boyes, M. E., & Loening-Voysey, H. (2016). Physical, emotional and sexual adolescent abuse victimisation in South Africa: Prevalence, incidence, perpetrators and locations. Journal of Epidemiology and Community Health, 70(9), 910–916.

    Article  Google Scholar 

  • Mikton, C., Mehra, R., Butchart, A., Addiss, D., Almuneef, M., Cardia, N., & Raleva, M. (2011). A multidimensional model for child maltreatment prevention readiness in low-and middle-income countries. Journal of Community Psychology, 39(7), 826–843.

    Article  Google Scholar 

  • Moen, K., & Middelthon, A. L. (2015). Qualitative research methods. In Research in medical and biological sciences (pp. 321–378). Academic Press.

  • Morantz, G., Cole, D. C., Ayaya, S., Ayuku, D., & Braitstein, P. (2013). Maltreatment experiences and associated factors prior to admission to residential care: A sample of institutionalized children and youth in western Kenya. Child Abuse & Neglect, 37(10), 778–787.

    Article  Google Scholar 

  • Muhire, H. B., Tuyisenge, L., Hakizimana, F. X. B., Ball, A., & Cartledge, P. (2020). Reporting child abuse in Rwanda: Attitudes and practices of physicians—A cross-sectional survey. PAMJ-Clinical Medicine, 3(131).

  • Norman, R. E., Byambaa, M., De, R., Butchart, A., Scott, J., & Vos, T. (2012). The long-term health consequences of child physical abuse, emotional abuse, and neglect: A systematic review and meta-analysis. PLoS Medicine, 9(11), e1001349.

    Article  Google Scholar 

  • QSR International Pty Ltd. (2020) NVivo (released in March 2020),

  • Putnam-Hornstein, E., Wood, J. N., Fluke, J., Yoshioka-Maxwell, A., & Berger, R. P. (2013). Preventing severe and fatal child maltreatment: Making the case for the expanded use and integration of data. Child Welfare, 92(2), 59.

    Google Scholar 

  • Rwandan Ministry of Health. (2017). Violence against children and youth survey in Rwanda: Findings from a national survey, 2015–2016. Rwanda: Kigali.

  • Sargeant, J. (2012). Qualitative research part II: Participants, analysis, and quality assurance. Journal of Graduate Medical Education, 4(1), 1–3.

    Article  Google Scholar 

  • Southall, D., & MacDonald, R. (2013). Protecting children from abuse: A neglected but crucial priority for the international child health agenda. Paediatrics and International Child Health, 33(4), 199–206. Epub 2013 Sep 24.

    Article  Google Scholar 

  • Speizer, I. S., Goodwin, M., Whittle, L., Clyde, M., & Rogers, J. (2008). Dimensions of child sexual abuse before age 15 in three Central American countries: Honduras, El Salvador, and Guatemala. Child Abuse & Neglect, 32(4), 455–462.

    Article  Google Scholar 

  • M Stoltenborgh MJ Bakermans-Kranenburg LR Alink van IJzendoorn MH 2015 The prevalence of child maltreatment across the globe: Review of a series of meta-analyses Child Abuse Review 24 1 37 50

  • Van, H. A. R., Dadds, M., & Armstrong, K. L. (1998). The child abuse lottery—Will the doctor suspect and report? Physician attitudes towards and reporting of suspected child abuse and neglect. Child Abuse & Neglect, 22(3), 159–169.

    Article  Google Scholar 

  • World Health Organization. (‎2004)‎. ICD-10 : International statistical classification of diseases and related health problems: Tenth revision, 2nd ed. World Health Organization.

  • World Health Organization & International Society for Prevention of Child Abuse and Neglect. (2006). Preventing child maltreatment: A guide to taking action and generating evidence. Retrieved July 12, 2020, from

Download references


This work was supported by McGill Global Health Programs and the Global Health Scholars Program (McGill University, Montréal, QC, Canada).

Author information

Authors and Affiliations


Corresponding author

Correspondence to Gil Grunfeld.

Ethics declarations

Ethics Approval

Approval was obtained from the McGill University Faculty of Medicine and Health Sciences Institutional Review Board and the University of Rwanda College of Medicine and Health Sciences Institutional Review Board.

Consent to Participate

Informed consent was obtained from all individual participants included in the study.

Consent for Publication

Not applicable.

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Grunfeld, G., Akingeneye, P., Muhire, H.B. et al. Child Abuse Evaluations at the Centre Hospitalier Universitaire de Kigali (CHUK): Medical Education and Experience. Int. Journal on Child Malt. 5, 257–279 (2022).

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Child maltreatment
  • Child abuse
  • Child neglect
  • Rwanda
  • Child protection
  • Child welfare system