1
12
transmitted infections. Five (25%) children were
referred to the gynaecologist, while only nine (45%)
presented just once for follow up visit. No patient was
referred/received psychotherapy or psychiatric evalua-
tion/psychologic intervention.
reasons such as taboo, protection of family name and
family influence. In addition, inadequate training of
health personnel in the detection, inadequate support
system and channels for reporting may account for the
low prevalence.
There was scanty information obtained about the assail-
ants, although all those identified were males. At least
two of the assailants were known to be married, while
two were said to be recently divorced, and they all had
children of their own. The age range of the assailants
was 20-60years with a mean of 49 years. In all the cases
that the suspected assailant was identified, they were
neighbours or household members (houseboys, guard-
man/ security guard, and live-in relatives), with the ex-
ception of one case that involved a total stranger. Eleven
Most of the children were aged 10 years and below and
attending school.4,1T2,h13e reason for this is not clear though
previous studies
have shown similar trend. It may
be speculated that young children are less likely to re-
port such attacks due to fear. The low number of adoles-
cents in this study is due to the fact that the institute ca-
ters specifically for children under 15years of age.
5
According to an analysis by Grossin et al, in Paris, vic-
tims of abuse younger than 15 years are more likely to
present to hospital after 72 hours of the assault. This
corroborates our own findings, but may just be a
(
55%) of the assailants had been previously suspected of
committing abuse in the past, but it was not documented
whether any of them had been convicted before.
reflection of the fact that children depend on others to
make their health decisions. It may also be probably due
to their being too scared to inform parents until they
develop obvious disturbing features such as painful gait,
discomforting sensations at the external genitalia or foul
smelling discharge. Three boys were victims of sexual
abuse in this study, all under 10years and two had obvi-
Four (20%) of the victims had just one assailant and just
one event, 12 (60%) had one assailant on several occa-
sions, while two (10%) had more than one assailant on
several occasions. None of the victims had more than
one assailant on a single event. The number of assailants
and events were not recorded in two (10%) cases. The
legal outcome was not documented in any of the cases,
although in 12 (60%) of the cases the police were in-
volved.
8
ous peri-anal trauma. Holmes and Slap in USA reported
that boys at risk of abuse are less than 13 years, of low
socio-economic background, assailants known but fre-
quently unrelated to the victim and abuse typically in-
volves penetration. Although the number is too small, it
highlights the existence of male sexual abuse in the
community which has hitherto been considered to occur
mainly in developed countries. Thus sexual abuse of
boys may not be uncommon, but perhaps under recog-
nized and therefore under reported.
Table 2: Presenting clinical features
Presenting features (n=20)
Number (%)
Trauma
Genitourinary findings
Absent hymen
Miscellaneous
Normal genital findings
5
16
12
3
(25)
(80)
(60)
(15)
(20)
In this study we found a very high proportion of repeti-
tive child sexual abuse in contrast to other report,1s2 that
5
documented single abuse in most of their cases. The
4
study from Maiduguri however, also showed that 48%
of the victims suffered two or more episodes of sexual
4
Many had multiple presenting features
abuse. It may be postulated that lack of reporting, and
lack of punitive/rehabilitative/protective mechanisms
could be contributory.
We found 60% of patients with evidence of genital
trauma in this study, whi2ch mirrors the high percentage
Discussion
1
obtained by Omorodion in Benin-city, Chesshyre and
1
4
This study has shown that child sexual abuse is not as
uncommon as previously thought. The prevalence rate
of 0.06% is low compared to a similar hospital based
study in Dakar, Senegal where a rate of 0.4% was ob-
tained. The study setting, design and period may account
for the observed difference. While our study was in chil-
Molyneux in Blantyre, Malawi. This contrasts the
5
19.5% documen3ted by Grossin et al, in Paris and 31%
1
by Santos et al, in Lisbon, Portugal, although the latter
6
studies had much larger sample sizes. The incidence of
trauma could also be related to the degree of resistance
put up by the victim, which in turn could be determined
by a variety of factors, such as physical force in trying to
6
dren Faye et al’s study was prospective and involved
mainly adolescents. Although, pr1evalence rates of child
7
keep the child quiet or threat to avoid disclosures. In
1
4
sexual abuse as high as 69.9% and 77% have been
reported in studies from some parts of Nigeria, these
figures were from vulnerable groups consisting of street
hawkers and girls in paid employment. The difference
between hospital based and community based studies
may not be surprising as non-penetrative forms of sexual
abuse are not likely to be reported to hospital for various
some assailant, the association of sexual arousal with
aggression coupled with the need to maintain the level
of arousal through escalating7 violence, results in serious
injury or death of the victim.
A study from Zaria suggested that accidental trauma,
either from road traffic accidents or falls on a sharp