Child Sexual Abuse

Predictors of physical violence against children in Rwanda: findings from a National Cross-Sectional Survey

BACKGROUND

To address the challenges of limited national data on the prevalence and nature of violence experienced by children, Rwanda conducted, in 2015-2016, the first National Survey on Violence among female and male children and youth aged 13-24 years. To further contribute to these efforts to fill existing data gaps, we used the Rwanda survey data to assess the prevalence and predictors of physical violence (PV) in children aged 13-17.

METHODS

A nationally representative sample of 618 male and 492 female children were analysed. Nationally representative weighted descriptive statistics were used to analyse the prevalence of PV self-reported by children, and logistic regression models were applied to investigate its predictors.

RESULTS

Sixty percent of all children, including 36.53% of male and 23.38% of female children, reported having experienced any form of PV in their lifetime. Additionally, 21.81% of male children and 12.73% of female children reported experiences of PV within twelve months before the survey date. Older children (OR: 0.53 [0.40-0.72]), female children (OR: 0.43 [0.31-0.58]), and children not attending school (OR: 0.48 [0.31-0.73]) were less likely to be physically abused. However, sexually active children (OR: 1.66 [1.05-2.63]), children in households from the middle wealth quintile (OR: 1.63 [1.08-2.47]), children living in a larger family (OR: 1.55 [1.07-2.26]), and children who reported not feel close to both biological parents (OR: 2.14 [1.31-3.49]) had increased odds of reporting physical violence.

CONCLUSION

Higher rates of PV in children attending school were the key finding. There is an urgent need to design and implement particular national interventions to prevent and reduce the incidence of PV in schools in Rwanda. PV was also associated with poor parent-child relations. Parents and other adult caregivers should be sensitised to the consequences of PV on children and be urged to adopt positive parenting practices.

Sexual Inviolability of Minors in Central Kazakhstan: A Forensic Medical Analysis

Abstract Child sexual abuse is a social phenomenon that requires special attention from society, as it leads to the suffering of the most vulnerable part of the world's population. Child sexual abuse around the world not only persists, but also continues to grow, despite the active measures of the world community against it. Taking into account the high latency of crimes against sexual inviolability and sexual freedom of the person, measures for their detection and prevention are of particular relevance. All this requires constant monitoring of the current situation not only in the world or in the country, but also in each region of the country separately. Forensic medical examination of victims of sexual violence plays an important role in the analysis of the situation on this problem, not only in the legal, but also in the medical aspect.  Research aim: Analysis of quantitative and qualitative indicators of crimes against the sexual inviolability of minors on the territory of Central Kazakhstan for the formation of indicators for assessing the current situation in the region and recommendations for the prevention of these types of crimes. Methods A retrospective analysis of the situation on the number and structure of sexual crimes committed against children from 2018 to 2021 was carried out, and their dynamics was studied. There were investigated 1252 forensic medical examinations on cases of sexual crimes against the sexual inviolability of the person on the territory of Central Kazakhstan. Methods of applied statistical analysis were used to analyz obtained results. Results A detailed analysis made it possible to assess the structure and peculiarities of sexual crimes committed against children on the territory of Central Kazakhstan over the specified period of time. The number of sexual crimes against minors in the region is increasing every year. Statistically significant age characteristics of victims and specific indicators characterizing the socio-psychological aspects of sexual crimes in the region were revealed. It has been established that in most cases the aggressor is part of the victim's family or is very close to it. The analysis of the age structure of children showed that boys from 6 to 14 years old and girls over 14 are more likely to become victims. In the studied territory, the number of sexual harassment of children is more often committed by one person, often known to them, and in most cases occurs in enclosed spaces than on the street. Conclusion The progressive growth of crimes against the sexual inviolability of children in the region requires strengthening measures to improve legal means of countering sexual crimes against minors. A detailed study of the issue made it possible to identify lacks (organizational, tactical, diagnostic) and give the forensic medical examination of sexual conditions a qualitatively new level. The strategy of combating sexual crimes against minors should be based on active preventive work. Key words: forensic medical examination, sexual violence, Central Kazakhstan, children, minors.

Prevalence and Factors Associated with Sexual Violence against Children in a Brazilian State

Sexual violence is one of the forms of violence against children worldwide. Understanding its magnitude and its associated factors is essential to promote effective protection policies to childhood. The objective was to verify the prevalence and analyze the factors associated with sexual violence against children in a Brazilian state. This is a cross-sectional study analyzing data from reported cases of violence against children in the state of Espírito Santo, Brazil, between 2011 and 2018. The characteristics of the victim, perpetrator and aggression were studied, and the associations were analyzed using Poisson regression. The frequency of sexual violence was 41.8% and was more prevalent in girls, in the age groups 3 to 5 and 6 to 9 years old, in white ethnicity/color and in the urban area. The offenders were mainly men, known to the victim and occurred mainly in the residence. Sexual violence was the most reported violence among children in Espírito Santo, occurring within their circle of trust, demonstrating the need to provide support for families and to advance public policies to guarantee children's rights.

Child sexual abuse detection in the pediatric emergency room

BACKGROUND

Children who report sexual abuse are often first evaluated in a Pediatric Emergency Room (ER).

OBJECTIVE

This study aims to describe clinical characteristics and management among these children.

PARTICIPANTS AND METHODS

A retrospective review of child sexual abuse (CSA) cases in the ER of a tertiary hospital in Madrid over a 9-year period (January 2011 to April 2020) was conducted. 213 children up to 16 years old were included. Descriptive statistics were performed.

RESULTS

An 83% of victims were girls, of whom 97.7% reported physical contact. The mean age was 8.5 ± 4.4 years, with two peaks of incidence at ages of 3 and 13. Aggressors were known by the victim in 77.8% of cases. Anogenital lesions were present in 39.9% of children who described physical contact, of which 31.7% were suspicious or specific of CSA. We obtained positive microbiological samples in 41 patients, with 14.6% specific findings for sexually transmitted infections (STIs). 23,9% received prophylaxis for bacterial STIs and 13.6% against HIV. 59.6% were followed-up in outpatient clinics. Since our protocol renovation in 2019, we observe a statistically significant increase in microbiological detection (p < .005) and outpatient follow-up (p < .001).

CONCLUSIONS

STIs screening should always be done when physical contact is reported for eventual treatment and perpetrator prosecution, as physical lesions are frequently not found. The optimal treatment of CSA requires the use of renewed specific protocols and the involvement of multidisciplinary trained teams to ensure adequate medical and personal care.

Pediatric Emergency Department Testing for Gonorrhea and Chlamydia in Children

OBJECTIVE

This study aimed to describe trends in the utilization of nucleic acid amplification (NAAT) testing for gonorrhea and chlamydia in US pediatric emergency departments. Nucleic acid amplification has been recommended over genital culture by the American Academy of Pediatrics and Centers for Disease Control and Prevention for children evaluated for sexual abuse.

METHODS

We conducted a multicenter study of children aged 12 months to 11 years tested for gonorrhea and chlamydia between 2004 and 2018 at 22 hospitals in the Pediatric Health Information System. We included patients diagnosed with maltreatment concerns and/or genitourinary (GU) symptoms. The primary outcome was prevalence of testing with NAAT, culture, or both. We analyzed groups based on patient sex, as well as diagnoses of maltreatment versus GU symptoms.

RESULTS

A total of 36,312 visits were analyzed. Visits were 73.4% girls and 26.6% boys. During the study period, there was an increase in use of NAAT-only testing for girls (49.3% to 94.3%; P < 0.001) and boys (54.5% to 96.1%; P < 0.001). There was a decrease in use of culture alone for girls (40% to 1.6%; P < 0.001) and boys (38.7% to 0.8%; P < 0.001). Use of both tests in the same encounter was higher among children diagnosed with maltreatment than GU symptoms, regardless of sex (P < 0.001).

CONCLUSIONS

Over a 14-year period, downtrend of culture use with increase in NAAT was observed, suggesting general adherence to evidence-based guidelines. Almost 10% of children diagnosed with maltreatment continued to be tested with culture. This could indicate provider concerns regarding test accuracy, legal admissibility, or lack of test availability.

Brazilian Protocol for Sexually Transmitted Infections 2020: sexual violence

This article addresses sexual violence, as part of the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health. Guidance is provided in programmatic and operational management, focusing on the service network for people in situation of sexual violence, recommendations to health staff about pregnancy and viral and non-viral sexually transmitted infections prophylactic measures, in addition to surveillance action strategies. Sexual violence is an encompassing issue that includes wider areas than the health field. It involves conceptual and programmatic challenges for health staff, at the forefront of care for affected people and also to the implementation of prevention strategies addressed to the whole society. Sexual violence is one of the principal forms of human rights violation, affecting the right to life, health, and bodily integrity.

Sexual Violence Against Children

Sexual violence against children is a gross violation of children's rights during their formative years and will likely interfere with their developmental trajectory and long-term quality of life. As a result, this form of violence includes commercial sexual exploitation of children, sexual abuse, child marriages, and female genital mutilation. The evidence shows that violence prevention is worth the investment; however, prioritizing this agenda to ensure funding through government spending remains low. Despite funding realities, research and advocacy efforts need to continue, with a focus on promoting effective practices for mitigation.

[Brazilian Protocol for Sexually Transmitted Infections 2020: sexual violence]

This article addresses sexual violence, a topic that makes up the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Ministry of Health of Brazil. Guidance is given to managers in programmatic and operational management with a focus on the service network for people in situations of sexual violence, recommendations to health professionals about prophylactic measures of pregnancy and viral and non-viral sexually transmitted infections, in addition to strategies for surveillance actions. Sexual violence is a broad problem that goes beyond the health field and involves conceptual and programmatic challenges for both health professionals, who are at the forefront of care for affected people, and for society, in terms of possible forms of prevention.

Perceived Skill and Willingness to Address Child Sexual Abuse: Assessing Serbian and Montenegrin Pediatricians

Most research on pediatricians' reporting of child sexual abuse (CSA) is based in western countries. Only recently have studies focused on low-income countries. We are the first to survey pediatricians in Serbia and Montenegro on their encounters, competence and beliefs regarding CSA. Pediatricians in Serbia (n = 358) were recruited during a professional conference; pediatricians in Montenegro (n = 121) were sent an online survey. Demographic information was not obtained. Frequencies and percentages were calculated. A quarter of pediatricians in both countries felt competent detecting medical evidence of CSA. Twenty-seven percent in Serbia and 7% in Montenegro felt adequately trained to assess and diagnose CSA. Forty percent believed that CSA occurs predominately in poor, unstable or disorganized families. Twenty-nine percent in Montenegro and 15% in Serbia believed that complete strangers perpetrate CSA. Both Serbian (23%) and Montenegrin (30%) pediatricians were uncomfortable asking questions about possible abuse. One third of pediatricians in both countries were interested in further training. CSA is underreported at a concerning rate in Serbia and Montenegro, yet only a third of pediatricians in both countries were interested in further training. Future studies should focus on barriers to reporting in these regions, to increase awareness and competencies related to CSA.

Recognizing, diagnosing, and preventing child maltreatment: an update for pediatric clinicians

PURPOSE OF REVIEW

Despite an increasing understanding of the impact of emotional trauma and physical abuse on children, clinicians and hospitals still sometimes miss the diagnosis of abuse. The literature in 2017 focused on creating standardized approaches to recognition and diagnosis of physical abuse and occult injury, including using the electronic medical record to provide triggers for consultation of the hospital Child Protection Program. The American College of Radiology updated their standardized approach to the evaluation of physical abuse in the child, and other authors gave us screening tools for commercial exploitation, as well as guidance about how to recognize risks for emotional abuse in families. The opioid epidemic and legalization of marijuana are both impacting children, and providers are searching for ways to provide support for parents with substance use disorders whilst considering the safety of children.This article reviews relevant publications during the past year about issues of child maltreatment. It is intended to guide those providers in primary care or other medical disciplines who care for children and families.

RECENT FINDINGS

Child maltreatment cases are still not always diagnosed, either because of provider bias (leading to under evaluation), or because clinicians lack experience or understanding of proper evaluation approaches. There are many new tools to assist in recognition of abuse, including screening instruments and flags that can be used in the electronic medical record to trigger a consult with the Child Protection Program. The evaluation and diagnosis of sexual abuse continues to evolve, with the literature providing advice about what is or is not normal on physical exam, as well as advice for providers who work with adolescent sexual assault victims. The debate about the validity of abusive head trauma (AHT) diagnoses continues, with sweden being the most recent center of controversy. With the opioid epidemic having such a significant effect on families and children, clinicians are struggling to support parents with substance use disorder while protecting children from the impact of their parents' disease.

SUMMARY

The past year in child abuse literature has yielded increased clarity in screening and diagnostic recommendations across the fields of physical abuse, AHT, sexual abuse, and commercial sexual exploitation of children (CSEC). The body of literature surrounding emotional abuse and neglect continues to grow, especially in light of the burgeoning opioid epidemic. Critically, the year's research reflects an evolving understanding of effective prevention and intervention initiatives to address child maltreatment.