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Knowledge, attitudes and practices of diagnostic radiographers regarding non-accidental injuries in Zambia
Osward Bwanga1, Leon-Say Mudadi2, Brian Mubanga3
1Midland University Hospital Tullamore, Radiology Department, Ireland.
Insights
Zambian radiographers have moderate knowledge of non-accidental injuries (NAI) but lack adequate practices due to insufficient training and protocols. Enhancing training and guidelines is crucial for child protection in medical imaging.
Area of Science:
- Medical Imaging and Diagnostics
- Child Protection
- Radiography Education
Background:
- Non-accidental injuries (NAI) pose significant risks to children's health and lives.
- Diagnostic radiographers are vital in identifying and reporting suspected child abuse.
- Limited data exists on radiographers' preparedness for managing NAI in Zambia.
Purpose of the Study:
- To assess the knowledge, attitudes, and practices (KAP) of diagnostic radiographers in Zambia concerning NAI.
- To identify gaps in radiographers' understanding and management of NAI.
- To inform strategies for improving child protection in diagnostic imaging.
Main Methods:
- A cross-sectional online KAP survey was conducted among 165 practicing diagnostic radiographers in Zambia.
- Data collected via a 44-item questionnaire, analyzed using descriptive and inferential statistics.
- Qualitative responses analyzed using thematic analysis.
Main Results:
- Most radiographers (81.1%) lacked formal NAI training, yet knowledge scores were generally above average.
- Significant gaps identified in recognizing specific injuries (e.g., rib fractures) and in the use of imaging protocols.
- Attitudes towards child protection were positive, but practices were inadequate, with few reporting suspected cases.
Conclusions:
- Zambian radiographers show moderate NAI knowledge and positive attitudes but deficient practices.
- Inadequate training, lack of protocols, and unclear reporting pathways hinder effective NAI management.
- Recommendations include integrating child protection training and developing national NAI imaging guidelines.
Introduction:
Non-accidental injuries (NAI) are a significant cause of morbidity and mortality among children and require early recognition by frontline healthcare professionals, including diagnostic radiographers. In Zambia, where children constitute over half of the population, radiographers play a critical role in imaging, safeguarding, and reporting suspected abuse. However, evidence on radiographers' preparedness to manage NAI is limited. This study aimed to assess the knowledge, attitudes, and practices (KAP) of diagnostic radiographers regarding NAI in Zambia.
Methods:
After ethical approval, a cross-sectional online KAP survey was conducted among practising diagnostic radiographers in Zambia between October and November 2025. Convenience and snowball sampling were used. Data were collected using a validated 44-item questionnaire covering demographics, knowledge, attitudes, practices, and suggestions. Quantitative data were analysed using descriptive and inferential statistics, and qualitative free-text responses were analysed using the Braun and Clarke thematic analysis framework.
Results:
A total of 165 radiographers participated in this survey. Most respondents (81.1%) had no formal training in NAI. Knowledge scores were generally above average (median [IQR] 65% [55-75]). Nevertheless, notable gaps were identified, particularly regarding rib fractures, the use of babygrams, and the erroneous belief that a normal skeletal survey excludes NAI. Attitudes toward child protection were largely positive, with higher education level and work experience significantly associated with more positive attitudes (p < 0.05). Practices were inadequate: 90.9% lacked written NAI imaging protocols, 25.8% documented discrepancies, and only 12.3% reported suspected cases to the appropriate authorities.
Conclusion:
Zambian diagnostic radiographers demonstrated moderate knowledge and positive attitudes toward NAI, but their practices were inadequate, attributed by respondents to limited training, the absence of imaging protocols and clear reporting pathways. Incorporating child protection training into radiography curricula and developing national NAI imaging and reporting guidelines are recommended.
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