2
30
lower incidence over a 3-year period, with a total of 16
cases, all but one of which were children below the age
of 17 years. The low prevalence in this study could be
due to the fact that this was a retrospectively collected
hospital data and most likely involved the violent
crimes, thus minor forms of abuse were most likely un-
der-reported. More so in this environment, it is stigma-
tizing and dehumanizing to report cases of sexual abuse
and thus the low1p1revalent result. This corroborates well
with other study.
study was executed in the perpetrator’s home and mode
of sexual abuse was genital. These adults were trusted
by these children who will then fall into the arms of the
perpetrators that could offer any little care.
It is noted with interest that 3% of the sexually abused
and 9.1% of perpetrators tested positive to HIV infection
12 weeks after sexual abuse. Sexual transmission of
HIV infection among sexually abused children, although
not usually reported is probably under recognized, a9nd
1
Children younger than 10 years were most the fre-
quently abused in this study. Some data from both
agency cases and adult retrospective reports sho8w,13a rela-
may constitute an important public health problem . It
is critical that health care providers should screen
abused children and the perpetrators for HIV and Hepa-
titis B, and where positive a post exposure prophylactic
programme can be instituted early. Unfortunately in this
series only 42% of the victims and 9% of the perpetra-
tors were screened for HIV, while only 3% of the vic-
tims had a repeat 12 weeks later. This is an indictment
of the quality of care that these patients receive. This
lapse is confirmed by the positive status of the only
child that had a repeat screen. It also very important to
point out here that none of the sexually abused children
was referred to a gynaecologist and none had pregnancy
test done. The reason for this could be that some parents
and care givers would not want to visit any health insti-
tution to seek medical care because of the stigma that
follows the victim and so will prefer to conceal and later
abort any pregnancy secretly. This could also account
for the low turn up of the victims during follow up.
Similarly psychiatrists were not involved in the manage-
ment of sexually abused children in this study. Referral
to psychiatrist is relevant because sexually abuse chil-
dren are at risk of developing p2sychiatric problems or a
tively uniform risk for children after age three.
How-
ever, the predominance of these young children among
the abused could be because like in most violent crimes,
the vulnerable and defenceless are always victims.
From our study, females are more commonly abused
while males are more accused. It is well known that
many more girls th8 an boys are the victims of sexual
14
abuse. Olusanyan and Omorodion , in separate stud-
ies, have also found that females are more often abused.
It is noted in this study that the perpetrators of sexual
abuse are overwhelmingly male. Studies using the law
enforcement as well as victim self-report data found that
more than 90% of the perpetrators of sexual offenses
1
5
against minors were males. From our study, we found
that males are also sexually abused though not as much
as females. The type of abuse is usually anal and perpe-
trators are males and none of them sustaining physical
injuries. It is reported that 5% to 15%8,o14f men were sexu-
ally abused when they were children.
2
The commonest age of the perpetrators of this abuse in
this study is 13-18 years followed by 24-29 years. Juve-
niles themselves commit a considerable proportion of
sexual offenses against children, with estimates indicat-
disorganized attachment style. From our study major-
ity of the perpetrators are from poor socioeconomic
background as they are peasants and neither had any
form of education.
1
6
ing about a third (ranging from 29-41%) are involved.
Among adult perpetrato1r7s, young adults, under the age
of 30, are been reported.
It has been found in this present study that most of the
reports on the sexually abused were made by the victims
themselves and victim’s parents .This is surprising as
the victim of the abused are often overwhelmed with
fear and shame and so could not report the case.
Conclusion
The prevalence or sexual abuse in EBSUTH is
0
.9%.This low prevalence could be due to under-
reporting. Females are mainly abused and some come
down with HIV infections. Parents and caregivers
should be encouraged to report cases of sexual abuse
promptly to the hospital while health workers should be
trained on the management of such cases to avoid its
complications.
Limitation: We could not ascertain the socioeconomic
statuses of the families of the victims. It is also impor-
tant to know the relationship between the perpetrators
and the families of the abused children. Unfortunately,
these facts are unavailable because of the retrospective
nature of the study.
Notwithstanding, There is always a tendency for under-
reporting sexual abuse. The reas1o8ns for non-reporting
are complex and multi-faceted.
These reasons may
include a number of factors such as the age of the
abused child at the time of the event, the relationship
between the perpetrator and the abused, the gender of
the abused, the severity of the abuse, developmental and
cognitive variables related to the17abused, and the likely
consequences of the disclosure.
Regrettably, we did
not ascertain if there are any relationship between the
victims and the perpetrators due to lack of data. We
noted that female victims report episodes of sexual
abuse than males. Girls are more likely to report sexual
abuse than boys and more importantly when the perpe-
trator is7 a relative, there are fewer tendencies to report
Conflict of interest: None
Funding: None
1
abuse. Majority of the episodes of sexual abuse in this