Primary health care will address adverse childhood experiences

14 May 2019
A newborn baby is being dressed after bath by a nurse

Skopje, 13 May 2019: UNICEF launched a new pilot initiative to assess the negative effects of adverse childhood experiences on health risk behavior and wellbeing as adults through screening among patients in 10 primary health care settings in Skopje.

Conducted in partnership with the Macedonian Medical Association this initiative will help estimate the prevalence of adverse childhood experiences and will provide evidence for system interventions to strengthen prevention mechanisms of violence against children and provide quality health and social services for those who need support.

Adverse childhood experiences (ACEs) is a broad term describing childhood trauma including abuse, neglect and household disfunction such as addiction of household member, crime, parent-to-parent violence or mental illness. A global research in the last years provides evidence that there is strong correlation between traumatic early life experiences and risky health behavior and wellbeing outcomes throughout the lifecycle. 

 “The issue of adverse childhood experiences remains taboo, difficult to discuss and emotive. And yet it severely affects the health, productivity, life expectancy, attachment and parenting style of victims when they become adults. Helping adults deal with trauma from their own childhood adverse experiences is important to help reduce the intergenerational transmission of violence, abuse and neglect,” said Benjamin Perks, UNICEF Representative.

A recent study in North Macedonia, confirms ACE is linked to risky health behavior, chronic health conditions and low life potential. WHO survey on ACE in our country shows that emotional abuse in childhood doubles the likelihood of drug abuse and triples the likelihood of attempting suicide. Household dysfunction such as substance abuse in the family doubled the likelihood of starting smoking early. The study finds a general trend that as the number of adverse childhood experiences increased, so did health-risk behaviours, implying an association with longer-term poor health outcomes.

UNICEF is working with the Ministry of Health to increase the knowledge and skills of general practitioners, family medicine specialists and patronage nurses on positive parenting and recognition of mothers at risk of child abandonment, neglect and violent discipline and providing support to parents in establishing early attachment with young children. As of this year, activities will be expanded with routine screening for ACEs at primary health care level, aimed at identification of the prevalence and severity of the cases and proper referral of cases in need.

The primary care setting provides several advantages to address some of the barriers in promotion of positive parenting and screening for ACEs: established infrastructure, a non-stigmatizing location, and frequent child visits during the first 3 years of a child’s life. These advantages offer an opportunity to work on prevention of adverse childhood experiences through improved parenting practices.

Media Contacts

Suzie Pappas Capovska
Tel: (02) 3231-244
Irina Ivanovska
Tel: (02) 3231-172


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