Abstract
BackgroundChildren are vulnerable to abuse and violence because their level of development makes them unable to protect themselves. Such adversities during early childhood may have a negative impact on the future lives of the victims.This study was done to determine the delay to hospital presentation, clinical manifestations and immediate health effects of child sexual abuse in two tertiary care hospitals in Ethiopia.MethodsWe reviewed records of all cases of child sexual and physical abuse between January 2011 and December 2012. Bivariate and multivariate logistic regression models were used to test the presence and strength of association between time to reporting to hospital and, age and sex of the victim, place of residence and relation of the victim to the perpetrator. Odds ratio and 95% confidence intervals were generated. Significance was taken as p-value < 0.05.ResultsDuring the study period, we identified records of 275 children who were seen for alleged physical and sexual abuse; they accounted for 0.6% of the outpatient department (OPD) visits. The majority of the victims were cases of sexual abuse (97.3%) and most of them were female (75.7%). The mean age of the victims was 9.5 years (standard deviation (SD) = 4.2 years). The majority of the abusers were known to the victim (73.0%) and male (98.8%). Neighbors (38.95%), teachers (7.9%) and relatives (13.4%) were the most commonly reported perpetrators. The median length of time taken to present to hospital after the abuse incident was 4 days (range = 2 hours to 3 years). Male victims were 2.4 times more likely to have a delay of greater than one week to present to hospital (Adjusted Odds Ratio (AOR), 2.40; 95% Confidence interval (CI), 1.34-4.31; P-value = 0.002). Sexual abuse was associated with various immediate health effects, for example, hymenal tear, urinary tract infection and, perineal laceration or tear.ConclusionPresentation for care was often delayed. Male sex was independently associated with a delayed presentation to care. We recommend that further studies are carried out to identify the reasons for delay to reporting and design mechanisms to address them.
Highlights
Children are vulnerable to abuse and violence because their level of development makes them unable to protect themselves
Tikur Anbessa specialized Hospital (TASH) and Yekatit 12 Hospital (Y12H) are among the largest hospitals in terms of capacity in the country. Both hospitals provide a structured service with Pediatrics Emergency and Intensive Care departments, regular outpatient department (OPD), Inpatient services and all specialty follow up clinic services
Out of a total of 45, 834 outpatient visits to the two tertiary hospitals between January 2011 and December 2012, we identified a total of 275 children who presented for alleged child abuse
Summary
Children are vulnerable to abuse and violence because their level of development makes them unable to protect themselves. Based on the International Child Abuse Network (ICAN), child abuse is defined as the bad treatment of a child under the age of 18. Children, because of their age and level of development, are the least able to protect themselves; they are vulnerable to abuse and violence. Numerous studies from Africa and the rest of the world had shown that child sexual abuse (CSA) is a considerable public health problem [4]. In South Africa, between 3.2% and 7.1% of all the respondents reported experiencing unwanted or forced sexual intercourse as a child [6]
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