An Appraisal of Surveillance Gaps and Underreporting of Adverse Childhood Experiences with Evidence from the Hill Districts of Manipur.

Abstract

Adverse Childhood Experiences have emerged as a major public health concern and important determinants of physical and mental health outcomes across the life course. Despite their significance, accurately estimating their prevalence remains challenging due to limitations in existing surveillance systems, barriers to disclosure, and the resulting underreporting of childhood adversity. This study critically appraised the prevailing surveillance system by reviewing existing literature, policy documents, and government records. It complemented this appraisal with empirical evidence from the student community in the hill districts of Manipur. A cross-sectional descriptive-analytical research design was adopted. A total of 557 participants aged 18 – 30 years were selected from eight colleges using a multistage cluster random sampling technique. Using descriptive statistics such as frequencies and percentages, the prevalence estimate of overall and individual exposure, as well as their reporting to authorities, was estimated, while a Chi-square test was employed to examine gender differences. The results indicate that 95.5% of overall participants had experienced at least one childhood adversity, with community violence as the most prevalent adversity (73.8%), and physical neglect as the least prevalent (4.3%). Further, a significant gender differences were observed only for sexual abuse, emotional neglect, and physical neglect, while reporting of exposure to authorities remained infrequent. The findings highlight important gaps in the identification and documentation of childhood adversities and underscore the need to strengthen surveillance systems for detection and prevention alongside evidence-informed intervention strategies.