The pattern and characteristics of sexual assault perpetrators and survivors managed at a sexual assault referral centre in Lagos

Child Sexual Abuse in Nigeria: A Systematic Review

Child sexual abuse (CSA) is a major social and public health issue that creates short- and long-lasting impacts on victims, families, and society. While global researchers have considered the topic of CSA since the 19th century, the Nigerian context has been largely ignored. Yet, without sufficient evidence and understanding, making changes to practices and policies becomes almost impossible. The review aimed to gain insights into the nature and extent of CSA and identify areas for improvement in practice and research in Nigeria. This article presents the findings of a systematic review of 31 empirical articles related to CSA in Nigeria. Using key search terms along Boolean operators and truncation, PubMed, PsycINFO, CINAHL, ASSIA, PILOTS, African Journals Online, and Google Scholar were searched. A total of 1,325 studies were found, and 31 empirical studies, including 20 quantitative, 9 qualitative, and 2 mixed methods studies, were included. The review findings reveal the discourse on CSA and delve into various aspects such as its prevalence, manifestation patterns, root causes, management, and consequential impact on victims and societal domains. The gaps in the existing literature are identified and explored to identify areas for improvement in victim services, societal awareness, and healthcare practices and relevant policies. The sociocultural norms not only heightened children's vulnerability to sexual abuse but also posed significant barriers to them disclosing such abuse. Survivors of CSA often receive inadequate care, indicating a pressing need for improvements in this area. Implications for research, policy, and conclusion were discussed.

Sexual assault cases managed at a referral hospital in Western Ethiopia: A retrospective cross-sectional study

Objectives:

Sexual assault is the most prevalent and hidden global problem. The condition is worse in developing countries like Ethiopia. Therefore, this study described the survivors’ characteristics, clinical profiles, and management of cases of sexual assault at the One-Stop Service Center for survivors of sexual assault at a referral hospital in Western Ethiopia.

Methods:

A facility-based retrospective cross-sectional descriptive study was conducted to assess 203 cases of sexual assault managed at the One-Stop Service Center for survivors of sexual assault in Wollega University Referral Hospital from January 2019 to March 2022. Data were collected using a pre-tested structured checklist. Data were organized using Epidata version 3.1, cleaned, and exported to SPSS version 25 for analysis. The results were presented in tables.

Results:

Of 203 cases of alleged sexual assaults during the study period, 142 (70%) and 61 (30%) of survivors were raped and attempted rape, respectively. The age of survivors ranges from 3 to 28 years with a mean age of 15.7 ± 4.7 years. One hundred ninety-four (95.6%) were females. Seventy percent of them were students. Most of the survivors, 173 (85.2%), were assaulted by a person known to them. Only 74 (36.5%) present to the hospital within 72 h. Genital injuries were documented in 153 (75.4%). More than half, 112 (55.2%), were brought to the hospital by the police officers. In this study, 34 (16.7%) of survivors were admitted and 10 (4.9%) needed surgical procedures. Serology for syphilis, hepatitis B virus and HIV were reactive in 5 (7.1%), 1 (0.5%), and 1 (0.5%) respectively. The pregnancy test was positive in 12 (7.1%) of survivors. One (0.5%) study participant died in the intensive care unit.

Conclusion:

In this study, children and adolescents were the most vulnerable group, and survivors’ presentation to the hospital was delayed. They presented to the hospital with variable complications, including minor genital and/or extra-genital injuries, sexually transmitted infections, unwanted pregnancy, fractures, and multiple organ failures leading to death. Therefore, it is recommended that all concerned stakeholders work on the prevention of sexual assault in the study area. Legal protection for these survivors and students should also be strengthened. It is also recommended to evaluate the execution of existing national and international policies and programs toward sexual assault to develop contextual policies and guidelines.

"I just became like a log of wood … I was paralyzed all over my body": women's lived experiences of tonic immobility following rape

Tonic immobility is considered the last involuntary self-protecting act/mechanism experienced by victims of rape when they are under attack. It is associated with trauma related mental health risks post-rape. Despite this, tonic immobility has not received priority as an area of research on Nigerian female victims of rape. As a result, little has been known about this phenomenon by nurses and other professionals who are involved in the care and management of rape survivors in Nigeria. The limited knowledge about tonic immobility as a phenomenon might have resulted in mismanagement and secondary victimization of rape victims experiencing manifestations suggestive of tonic immobility during or after rape. This study was a qualitative narrative inquiry that explored, analysed, and interpreted the lived experiences suggestive of tonic immobility, and the meaning attached to such experiences by victims. A sample of fourteen Nigerian women who self-identified as rape victims was utilized. Individual semi-structured, in-depth interviews were conducted to generate data. Thematic data analysis revealed four overarching themes: namely (i) Tonic immobility as an Altered Physical State, (ii) Tonic Immobility as Mental Paralysis, (iii) Painful Loss of Self-defence, and (iv) Constant Self-blame. The findings provided an insight into the traumatic experience of raped women and the psychological implication of tonic immobility as extreme defence mechanism. This study will prove invaluable to nurses and other professionals/stakeholders involved in the care and management of rape victims; to help them develop and use appropriate strategies for management and prevention of secondary victimisation.

Epidemiological Profile of the Victims of Sexual Violence Treated at a Referral Center in Southern Brazil

OBJECTIVE

 To characterize the sociodemographic profile of women victims of sexual violence treated at a university hospital in southern Brazil.

METHOD

 The present cross-sectional study included all female victims of sexual violence who attended the sexual violence unit at the Hospital de Clínicas de Porto Alegre (HCPA, in the Portuguese acronym) from April 18, 2000 to December 31, 2017. Data were extracted from the electronic record of the patients and stored in a standardized questionnaire database with epidemiological aspects of the victim, the perpetrators and the type of aggression. Statistical analysis was performed using the chi-squared test for trend and descriptive statistics with 95% confidence interval (CI).

RESULTS

 During the length of the study, 711 women victims of sexual violence were treated. The mean age of the patients was 24.4 (±10) years old (range from 11 to 69 years old) and most of the victims were white (77.4%), single (75.9%) and sought care at the unit within 72 hours after the occurrence (80.7%). In most cases, violence was exerted by a single perpetrator (87.1%), who was unknown in 67.2% of cases. Victims < 19 years old showed a higher risk of not using contraception (relative risk [RR] = 2.7; 95% CI = 1.9-3.6).

CONCLUSION

 Most victims of sexual violence were treated within 72 hours of the occurrence. The majority of these victims were white and young, and those < 19 years old had a higher risk of not using contraception and to know the sexual perpetrator.

Effect of sexual violence on planned, mistimed and unwanted pregnancies among women of reproductive age in sub-Saharan Africa: A multi-country analysis of Demographic and Health Surveys

Introduction

Sexual violence plays a key role in women's pregnancy intention. We investigated the influence of sexual violence on planned, mistimed, and unwanted pregnancies in sub-Saharan Africa (SSA).

Materials and methods

Data from the Demographic and Health Survey (DHS) of 22 countries in SSA were used in this study. Both descriptive and inferential analyses were conducted. We carried out a multinomial logistic regression analysis to examine the effect of sexual violence on planned, mistimed, and unwanted pregnancies. STATA version 14.2 was used to carry out all analyses. Statistical significance was declared at p<0.05.

Results

At the descriptive level, we found that 74.1% of women of reproductive age in SSA had planned pregnancies, with the remaining 25.9% having either mistimed (20.4%) or unwanted (5.5%) pregnancies. Women in Nigeria had the lowest proportion of mistimed pregnancies (7.5%) whereas those in Burundi had the greatest percentage of unwanted pregnancies (12.4%). Women who had history of sexual violence had increased risk of mistimed [ARRR = 1.5, CI = 1.3–1.7] and unwanted pregnancies [ARRR = 1.6, CI = 1.3–2.0], compared to those with no history of sexual violence. Women aged 40–44 [ARRR = 3.3, CI = 1.4–7.6] and 45–49 [ARRR = 4.4, CI = 1.7–11.2] had higher risk of unwanted pregnancies, compared to women aged 15–19. Women who were cohabiting had higher risk of mistimed [ARRR = 1.3, CI = 1.1–1.4] and unwanted pregnancies [ARRR = 1.6, CI = 1.3–2.1], compared to married women.

Conclusion

Sexual violence plays a key role in mistimed and unwanted pregnancies. It is, therefore, prudent to develop various assessment techniques to detect sexual violence in unions and refer victims to appropriate services to diminish the risk of mistimed and unwanted pregnancies. Our findings provide a basis for developing and implementing policies and interventions aimed at reducing mistimed and unwanted pregnancies.

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Sexual violence is a global concern.

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Sexual violence plays a key role in women's pregnancy intentions.

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74% of pregnancies in SSA are planned.

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25.9% are either mistimed (20.4%) or unwanted (5.6%).

The gender-based violence and recovery centre at Coast Provincial General Hospital, Mombasa, Kenya: An integrated care model for survivors of sexual violence

Marleen Temmerman and colleagues describe a model of care for people who have experienced sexual violence, set in Kenya.

[Study of the factors associated with the delay of health consultation of victims of rape in Senegal]

INTRODUCTION

Rape remains one of the most serious forms of sexual violence because of its negative impact on the physical and mental health of victims. The objective of this study is to identify the factors associated with the delay in rape victims seeking medical assistance from healthcare professionals in Senegal.

METHODOLOGY

A retrospective, descriptive and analytical observation study was conducted. The study population consisted of all the court files of girls or women victims of rape recorded by the investigators at the 11 high courts of Senegal during the period from 2006 to 2015. An exhaustive recruitment of the full records of rape victims meeting the inclusion criteria were completed. The uni and multivariate analyses were carried out with Epi Info 2000 and R 2.2.9 software respectively.

RESULTS

At the end of the collection, 1,037 cases of rape were included in the study population. The average age of the victims was 16.3±7.9 years (range 1-72). Minors (<18 years) accounted for 24.8 %. The median time from rape to consultation at a health facility was 24hours. Long delay in consultation (>24hours) was noted for 38.6 % of victims. Risk of late consultation after rape was higher among victims residing in the southern areas (ORaj=4.31 [1.15-16.14]), or northern areas (ORaj=4.22 [1.26-14.14]), who were major (ORaj=1.67 [1.04-2.68]) or married (ORaj=3.44 [1.58-7.5]) or who were pregnant after the aggression (ORaj=34.03 [15.47-74.85]) or had an abortion (ORaj=5.45 [1.04-24.47]).

CONCLUSION

Medical and judicial assistance are more difficult if there is a long delay between the aggression and consultation. Thus, it is important for the health and judicial authorities to raise awareness about the harmful consequences of sexual violence, and to put forward the benefits of therapeutic care, compensation for the harm suffered by rape victims, as well as the availability of holistic care services 24hours a day.

HIV Non-Occupational Post Exposure Prophylaxis in Nigeria: A Systematic Review of Research Evidence and Practice

BACKGROUND

Although non-occupational Human Immunodeficiency Virus (HIV) post-exposure prophylaxis (nPEP) has been proven to be efficacious in preventing HIV, it remains an underutilized prevention strategy in Nigeria. We aimed to conduct an overview of research studies on nPEP and practice in Nigeria from 2002 to 2018 examining: sociodemographic characteristics of study sample, awareness, knowledge and prior use of nPEP, reasons for HIV nPEP, timeliness in presenting for PEP, antiretrovirals (ARVs) used for nPEP, side effects and adherence, monitoring and follow-up visits, adherence to guidelines and recommendations for nPEP by healthcare institutions and the strength of evidence of reviewed studies.

METHODS

An electronic search on PubMed, PubMed Central (PMC), cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, Medline, Embase and Google Scholar for published studies on nPEP from January 2002 to December 2018. We conducted our search using different combinations of the keywords "HIV," "non-occupational," "nonoccupational," "post-exposure," "postexposure," "prophylaxis" and "Nigeria."

RESULTS

Five articles met the inclusion criteria for this study. About 25.4% of college students were aware of PEP.PEP awareness was significantly determined by the following factors ever tested for HIV, nude picture exchanges, sex without condom, and knowledge of partner's HIV status. Across studies, exposed victims who presented for PEP were mostly females (64%-78%). Rape was the most frequently occurring reason for seeking nPEP (25.9%-64.1%). Although most patients presented for nPEP within 72 hours, follow up visits were generally low (0%-2%) across studies assessed, except for one study that reported a high follow up visit of 83.3%. Guidelines adherence by healthcare institutions could not be established due to lack of information on key variables.

CONCLUSION

Our study highlights the paucity of research evidence on nPEP use in Nigeria, the societal and cultural contexts in which non-occupational exposures occur, healthcare providers' roles and the public health and practice implications.