Child sexual abuse and disclosure in South Western Nigeria: a community based study

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.

Histories of violence among clients seeking substance use disorder treatment: a systematic mapping review

Introduction

There is a limited literature base regarding the intersection of drug and alcohol treatment, violence, and trauma. While research substantiates that exposure to violence and trauma impacts the propensity to misuse substances, the conceptualization in clinical trials and practice has largely been narrow and gendered, referring only to intimate partner or domestic violence. Our systematic mapping review explored a more inclusive and expansive review of survivors of and perpetrators of violence and trauma (e.g., intimate partner violence, sexual assault, stalking, child abuse, political and community violence, criminal violence, micro violence, structural violence, and oppression) to establish: 1) the types of treatment settings included in intervention studies, 2) the common indicators of success or common outcomes recorded, and 3) understanding who is seeking treatment for drug and alcohol use with histories of violence.

Methods

A systematic mapping review was conducted to identify any peer-reviewed articles published from 2011 to 2022. The Web of Science database was searched using a broad set of Boolean search terms related to violence, substance use disorders, and treatment. Over 8,800 records were identified from the systematic review with a total of 48 articles meeting inclusion criteria.

Results

Most studies in this review included populations reporting perpetration of violence (n=23, 48%) versus participants reporting survival of trauma/violence (n=17, 35%). Results also indicated female identifying populations (n=19; 40%) were predominantly served, were treated in the US (n=33; 69%) and seen in an outpatient setting (n=24; 50%). Authors also were attentive to studies that included sexual and gender minorities and discovered only three studies (6%) explicitly acknowledging inclusion of transgender participants or participants in relationship with partners of the same sex; three more studies (6%) were focused on participants with histories of or engaging in sex work.

Discussion

This review outlines treatment and research implications directly situated in the gap of service delivery found in this review. Specifically, the results elucidate the impact on minoritized and excluded identities based on gender, sexual preference, criminal legal status and directions for research and treatment to increase inclusion, representation, and equity across research and treatment settings.

Ecological factors associated with child sexual abuse among 15- to 17-year-old adolescents in mainland China: implications for intervention

Background

Child sexual abuse is a major public health problem with adverse consequences for victims' physical, mental, and reproductive health. This cross-sectional study aimed to determine the prevalence of child sexual abuse and its associated factors among 15- to 17-year-old adolescents in mainland China.

Methods

From September 8, 2019 to January 17, 2020, a total of 48,660 participants were recruited by 58 colleges and universities across the whole country to complete the self-administered, structured, online questionnaire. This analysis was restricted to 3,215 adolescents aged between 15 and 17 years in mainland China. Chi-square tests and multivariate Logistic regression analyses were performed to identify individual, relationship, and community factors associated with child sexual abuse.

Results

The overall prevalence of child sexual abuse was 12.0%. More specifically, 13.0% of girls and 10.6% of boys reported that they were sexually abused prior to 18 years of age. At the individual level, being female, sexual minority identity, younger age, and higher levels of knowledge, skills and self-efficacy regarding condom use were significantly related to increased odds of reporting sexual abuse. At the relationship and community level, adolescents from disrupted families and those entering into a marriage, having casual sexual partners, and having first intercourse at a younger age were more likely to report sexual abuse. On the contrary, those who had never discussed sex-related topics with their family members at home and were offered school-based sexuality education later (vs. earlier) were less likely to report sexual abuse.

Conclusion

Multilevel prevention programs and strategies, including targeting adolescents with high-risk characteristics, educating young children and their parents about child sexual abuse prevention and optimizing the involvement of parents, school, community, society and government in comprehensive sexuality education, should be taken to reduce child sexual abuse among 15- to 17-year-old adolescents.

Sexual violence among young women in Nigeria: a cross-sectional study of prevalence, reporting and care-seeking behaviours

BACKGROUND

Only a few studies, mostly hospital-based, have examined sexual violence among young people women in Nigeria. We examined the prevalence, correlates, perpetrators, reporting of and health-seeking behaviour for sexual violence using data of 395 young women (aged 17-24) obtained from a Nigerian university.

METHODS

We selected participants using stratified sampling and defined sexual violence as sexual acts or attempts to obtain sexual acts by violence or coercion by any person irrespective of their relationship to the victim. Descriptive and inferential statistics were used to summarise the data obtained.

RESULTS

Our analysis shows that 39.5% of the respondents had experienced some form of sexual violence. Adequate family financial support was protective against sexual violence after adjusting for all background characteristics (AOR: 0.60 95% CI: 0.39-0.93). However, young women who use alcohol had higher odds of reporting sexual violence experience than those who never used alcohol. In most cases (78.5%), perpetrators were well known to the victims. Only 3.3% of sexual violence cases were reported to law enforcement agencies and just 13.1% of victims sought care from health providers.

CONCLUSION

Sexual violence occurs at a tragically high frequency, and victims rarely report incidents to law enforcement agencies or access the much-needed care. The findings suggest a need for interventions that address why victims of sexual violence rarely report to law enforcement or seek care.

Child sexual abuse in Kaduna State, Northwestern Nigeria: A review of 420 police-reported cases

Child sexual abuse affects millions of children globally but in Nigeria, hospital-based studies continue to report few cases, making it difficult to assess the magnitude and quality of care. This study aimed to overcome this challenge by reviewing police medical reports instead of hospital records. A total of 420 reports were retrieved from one police area command in Kaduna State, Northwestern Nigeria, between 2018 and 2021. The majority of the victims were females (65.5%), 5-14 years (70.2%), and familiar with their assailants (71.4%). Most of the assailants were men (99.0%), 20-40 years (29.1%), who acted alone (86.7%). Most of the reports contained history (79.3%), physical examination (49.6%), and laboratory results (>90%). Among female victims, the commonest genital findings were absent hymen (25.6%) and normal findings (17.6%). Among male victims, the commonest anal findings were normal findings (41.7%) and anal dilatation (23.6%). The victims tested positive for HIV (0.5%), hepatitis B (4.7%), hepatitis C (1.0%), and syphilis (0.8%). Higher positivity rates were noted among assailants. Treatments offered to the victims included antibiotics (30.2%), analgesics (11.9%), emergency contraception (6.7%), and psychotherapy (67.4%). The review calls for improved reporting, use of comprehensive treatment guideline, and training of service providers to improve the quality of care.

Knowledge and Experience of Sexual Violence among Female Adolescents in Public Schools in Enugu State during the Covid-19 Pandemic

Sexual violence among female adolescents is a pervasive problem. This is even worse in periods of unrest such as the COVID-19 pandemic, which heighten the vulnerability of these female adolescents' victims to the potential perpetrators of sexual violence. This study assessed the knowledge and experience of sexual violence amongst female adolescents in public schools in Enugu State, Nigeria, during the COVID-19 pandemic. Three hundred twenty-five adolescents (aged 10-19 years with a mean age of 12.8 ±2.8) female school students were purposively recruited in this cross-sectional study to complete a scale designed to measure the knowledge and experience of sexual violence among female adolescents. Findings showed a high (90.8%) knowledge level of sexual violence among adolescents. The majority of the perpetrators were their uncles (40.4%) and cousins (28.6%). Among 9.8% of the participants who had forced to have sex, about two-thirds (65.6%) have been raped 2 to 5 times. A significant difference was noted only between the respondent's class levels and their knowledge of sexual violence (p < .05) with higher classes having better knowledge. Female adolescents showed a good knowledge level about sexual violence, which might explain the low prevalence of sexual violence in the sample population. The study also provides evidence that females are most at risk of sexual violence from closer relations during times of crisis. Thus, these study findings add evidence to the literature that would guide policymakers, health, and social workers toward making campaigns and interventions that would prevent female adolescent sexual violence.

Prevalence of Child Contact Sexual Abuse in the Spanish Region of Andalusia

The aim of this study was to analyze the prevalence and characteristics of child sexual abuse (CSA) in Andalusia, Spain's most populated region. A sample of 817 adults (281 male; M age = 34.7; SD = 13.86) completed the Child Sexual Abuse Experiences Questionnaire. Because the sample was unbalanced, we performed post-stratification by gender, resulting in 562 participants (50% male). Overall, 38.8% of the sample reported at least one type of contact abuse experience, with prevalence ranging from 22% for being fondled to 3.9% for being forced to perform a sexual act involving penetration. The first episode of CSA most commonly occurred between age 6 and 11 years, except for penetration. The majority of reported experiences were repeated and perpetrated by a male. More than half of the victims did not label their experience as sexual abuse, and this apparent lack of awareness about what constitutes abuse was particularly evident among male victims. The prevalence of CSA in Andalusia is higher than for Spain as a whole, highlighting the need to raise public awareness through prevention programs.

Associations Among Age of First Experience of Violence, Type of Victimization, Polyvictimization, and Mental Distress in Nigerian Females

This study explored associations of age of first victimization, sexual violence (SV), physical violence (PV), polyvictimization, and mental distress among females in Nigeria (n = 1,766, 13-24 years old) using the nationally representative 2014 Nigeria Violence Against Children Survey. Multinomial logistic regressions were performed. Nigerian females reporting SV victimization and polyvictimization were more likely to experience higher mental distress. The older the female was at the time of PV victimization, the greater the risk for mental distress. Violence is prevalent in Nigeria and its impact on youth's health is severe. However, evidence-based and data-driven policies and programs can reduce and prevent violence.

Silent screams: Listening to and making meaning from the voices of abused children

BACKGROUND

Sexual violence against children is a major clinical, public health and human rights concern globally. Specifically, child sexual violence (CSV) is one of the world's leading causes of trauma in children. In extreme cases, victims of CSV grow up with a plethora of maladaptive behaviours, which may be salient in the course of growth but later present in adulthood as severe cases of comorbid psychopathologies. It is expected therefore that CSV cases be treated with urgency and policies/laws against perpetrators be translated into visible outcomes. However, many CSV cases go unreported; and where there are attempts at reporting, the manner and approach of handling these cases is discouraging and futile. In this study, we explored the lived experiences of CSV survivors in Nigeria who tried reporting and opening up their experiences.

METHOD

Using the hermeneutic phenomenological approach, responses from 11 girls aged 15 to 17 years at the time of the study and 8 to 16 years at onset of abuse were obtained. Data were gathered through interviews, and the victims' experiences were aggregated using content analysis.

RESULTS

The major findings were summarized under the following themes: (a) silent screams, (b) trauma and the search for a therapeutic ear, (c) stigma and (d) withdrawal: our last resort. Respondents reported crying out and begging perpetrators to stop the act. They also reported experiencing trauma and related physical/mental health issues after the act. As they sought whom to disclose to, they reported feeling stigmatized and eventually having to withdraw and recoil.

CONCLUSIONS

Implications of the study cut across medical practice, social work, therapeutics and policy formation/implementation for the prevention of CSV and attending to CSV victims in hospitals, homes and schools. The importance of empathic therapeutic processes was discussed. The need for a multisectoral and multistakeholder approach in tackling CSV was also highlighted.

Sexual Abuse of Children in Turkey: Psychiatric Evaluation of 1785 Cases

INTRODUCTION

This study aims to investigate the characteristic features of sexual abuse of children with a focus on psychiatric consequences and other associated elements.

METHODS

We evaluated 1785 child sexual abuse cases who were referred to the Ondokuz Mayis University Faculty of Medicine Forensic Medicine Department for examination and forensic reports during the 14-year period between 2006 - 2019. The study involved the examination of the patient files/records of victims of child sexual abuse.

RESULTS

The girls represented 81.8% of victims of sexual abuse, while all perpetrators were male. The mean ages at the time of abuse were 12.7±3.1 (2-17) years in girls and 10.7±3.2 (2-17) years in boys. In vast majority of the cases, perpetrators were found to be acquaintances of the victims (87.2%). 43% of child sexual abuse cases involved penetration. Psychological examination revealed that psychiatric pathology developed in 64.6% of the children who were exposed to sexual abuse. Being female, the presence of penetration and the presence of incest significantly increased the development of any psychiatric pathologies.

CONCLUSION

Sexual abuse of children is a multidimensional public health problem. Additional education services to raise awareness of the children and their relatives, and the establishment of social and legal support schemes for victims and the families for sexual abuse and its consequences are deemed necessary.

Circumstances and Consequences of Violence-Related Injuries Presenting at Hospital. A Study at the Pediatric Emergency and Forensic Medicine Units of Maputo Central Hospital, Mozambique

Rates of violence against children are high in Sub-Saharan Africa and information is scarce on the resulting injuries. This study investigates sex-related differences in the circumstances and consequences of sexual and physical violence in the Mozambican context. Hospital records from 2019 at the pediatric emergency and forensic medicine units of Maputo Central Hospital were scrutinized using a standardized form. Of the 321 cases identified, 60% resulted from sexual violence. Girls represented 86.4% of the victims of sexual violence and boys, 66.1% of those from physical violence. Being injured in a familiar environment and by a parent, a relative, or someone known was strikingly common. The injury pattern varied by form of violence and sex of the child. About half of the injuries sustained by physical violence were minor/superficial. Severe injuries requiring hospitalization (33% in total) and some specialized care (27% in total) were mainly sustained by girl victims of sexual violence. While circumstances and consequences of violence-related injuries have several similarities, being severely injured is more typical of girl victims of sexual violence. Besides medical care, hospital services in Mozambique must be prepared to offer pediatric victims of violence the necessary social care.

Prevalence, Pattern and Predictors of Child Sexual Abuse Among Senior Secondary School Students in Enugu Metropolis

Objective

Child sexual abuse (CSA) is a growing public health concern with health, academic and psychosocial implications. The aim of this study was to determine the prevalence, pattern and predictors of CSA among secondary school students.

Methods

This was a cross-sectional study carried out among adolescents in four secondary schools in Enugu Metropolis, Nigeria. A pretested self-administered questionnaire was used to collect information from 325 adolescents and data was analysed with a significance level set at P ≤ 0.05.

Results

The prevalence of CSA in this study was 116 (35.7%). While the majority 20 (40%) of the victims were forced to watch pornography, most of the perpetrators were neighbours 34 (29.3%). A higher proportion of the victims were abused once, 79 (68.1%); when they were between 12 and 18 years old, 62 (53.4%); and at home, 39 (33.6%). Grouped ages, whom the child lived with, father’s and mother’s education, and father’s occupation were statistically significant on bivariate analysis. Predictors of CSA were students in senior secondary school Class 2 (SSS2) and those whose fathers were employed.

Conclusion

Our study revealed a high prevalence of CSA. Comprehensive sexuality education and legislative policies should be implemented to educate adolescents and deter perpetrators.

Victims and Perpetrators of Child Sexual Abuse: Abusive Contact and Penetration Experiences

Child sexual abuse (CSA) includes abusive contact experiences, which habitually impact the victim's whole life. This study aims to analyze the characteristics of six CSA experiences with physical contact, including penetration, in a representative sample of the Spanish population. Participants were 1071 Spanish adults (53% males; M_age: 45.37) who completed the Child Sexual Abuse Experiences Questionnaire. The victim's age at the first episode, the perpetrator's characteristics, and the number of times that each experience occurred were analyzed, taking into account gender differences. Results were reported for every experience independently. The most prevalent age at the first experience was from 6 years old onwards, but with differences in some experiences. The abuses usually happened more than once, committed by the same person. The most prevalent perpetrator is a male, although a female perpetrator is more prevalent in male victims. Most of the abuses were committed by an adult acquaintance, a strange adult, and other minors, with some gender differences. The implications of the results concerning every CSA experience are discussed, highlighting their value for future research and practice, the design of preventive programs, and early detection of CSA.

Associations between a history of sexual abuse and dental anxiety, caries experience and oral hygiene status among adolescents in sub-urban South West Nigeria

INTRODUCTION

Sexual and oral health are important areas of focus for adolescent wellbeing. We assessed for the prevalence of sexual abuse among adolescents, oral health factors associated with this history, and investigated whether sexual abuse was a risk indicator for dental anxiety, caries experience and poor oral hygiene.

METHODS

This was a cross-sectional study conducted between December 2018 and January 2019 among adolescents 10-19 years old in Ile-Ife, Nigeria. Survey data collected included respondents' age, sex, and socioeconomic status, oral health risk factors (dental anxiety, frequency of tooth brushing intake of refined carbohydrates in-between-meals, flossing, dental visits, smoking, alcohol intake, use of psychoactive substances), caries experience, oral hygiene status, history of sexual abuse, and sexual risk behaviors (age of sexual debut, history of transactional sex, last sexual act with or without condom, multiple sex partners). Regression models were constructed to determine the association between outcome variables (dental anxiety, presence of caries experience and poor oral hygiene) and explanatory variables (oral health risk factors and history of sexual abuse).

RESULTS

The prevalence of sexual abuse in our cohort was 5.9%: 4.3% among males and 7.9% among females. A history of sexual abuse was associated with alcohol consumption (p = 0.009), cigarette smoking (p = 0.001), and a history of transactional sex (p = 0.01). High/severe dental anxiety was significantly associated with increased odds of a history of sexual abuse (AOR = 1.81; 95% CI 1.10, 2.98), but not with caries experience (AOR = 0.66; 95% CI 0.15, 2.97) nor poor oral hygiene (AOR = 1.68; 95% CI 0.95, 2.96). Dental anxiety was associated with increased odds of alcohol intake (AOR = 1.74; 95% CI 1.19, 2.56), twice daily tooth brushing (AOR = 1.48; 95% CI 1.01, 2.17) and daily consumption of refined carbohydrates in-between-meals (AOR = 2.01; 95% CI 1.60, 2.54). Caries experience was associated with increased odds of using psychoactive substances (AOR = 4.83; 95% CI 1.49, 15.62) and having low socioeconomic status (AOR = 0.40; 95% CI 0.18, 0.92). Poor oral hygiene was associated with increased odds of having middle socioeconomic status (AOR = 1.43; 95% CI 1.05, 1.93) and daily consumption of refined carbohydrates in-between-meals (AOR = 1.38; 95% CI 1.08, 1.78).

CONCLUSION

Adolescents who are highly dentally anxious need to be screened for a history of sexual abuse to facilitate access to professional care and support.