Prevalence and factors associated with psychological aggression and physical punishment among children aged 12 to 59 months in Malaysia: findings from the National Health and Morbidity Survey 2022

INTRODUCTION: Psychological aggression and physical punishment remain common disciplinary practices globally, despite evidence of their adverse effects on child development. This study investigated the prevalence and associated factors of these practices among children aged 12 to 59 months in Malaysia. METHOD: Data were obtained from the National Health and Morbidity Survey (NHMS) 2022, a nationally representative cross-sectional study employing a two-stage stratified random sampling design. The primary respondents were caregivers of children aged 12-59 months. Psychological aggression was defined as being scolded in a harsh tone or using hurtful names, while physical punishment was defined as actions intended to cause pain, such as shaking the child, spanking, or hitting them with a hand or object like a cane. These actions were measured based on occurrences within the past month intended to correct behaviour. Disciplinary practice data were collected through face-to-face interviews using a validated questionnaire adapted from the Multiple Indicator Cluster Survey (MICS). Prevalence estimates with 95% confidence intervals (CI) were generated, and adjusted prevalence ratios (aPR) with 95% CI were obtained using design-adjusted Poisson regression with robust variance. RESULTS: Among the 13,288 respondents, the prevalence of psychological aggression was 58.3% (95% CI: 55.9-60.6) and of physical punishment was 40.7% (95% CI: 38.4-43.0). Older children were significantly more likely to experience both forms of discipline. In adjusted models, compared with children aged 12-23 months, children aged 48-59 months had higher prevalence of psychological aggression (aPR 1.44, 95% CI: 1.33-1.56) and physical punishment (aPR 1.48, 95% CI: 1.31-1.69). Boys had higher adjusted prevalence of physical punishment than girls (aPR 1.13, 95% CI: 1.05-1.21). CONCLUSION: Harsh disciplinary practices remain common. Integration of evidence-based positive parenting programmes into maternal and child health services and community-based support platforms is recommended.