ArticlePDF Available

Integration of Services for Victims of Child Sexual Abuse at the University Teaching Hospital One-Stop Centre

Authors:

Abstract and Figures

Objective. To improve care of sexually abused children by establishment of a “One Stop Centre” at the University Teaching Hospital. Methodology. Prior to opening of the One Stop Centre, a management team comprising of clinical departmental heads and a technical group of professionals (health workers, police, psychosocial counselors lawyers and media) were put in place. The team evaluated and identified gaps and weaknesses on the management of sexually abused children prevailing in Zambia. A manual was produced which would be used to train all professionals manning a One Stop Centre. A team of consultants from abroad were identified to offer need based training activities and a database was developed. Results. A multidisciplinary team comprising of health workers, police and psychosocial counselors now man the centre. The centre is assisted by lawyers as and when required. UTH is offering training to other areas of the country to establish similar services by using a Trainer of Trainers model. A comprehensive database has been established for Lusaka province. Conclusion. For establishment of a One Stop Centre, there needs to be a core group comprising of managers as well as a technical team committed to the management and protection of sexually abused children.
No caption available
… 
No caption available
… 
Content may be subject to copyright.
Hindawi Publishing Corporation
Journal of Tropical Medicine
Volume 2010, Article ID 864760, 7pages
doi:10.1155/2010/864760
Review Article
Integration of Services for Victims of Child Sexual Abuse at
the University Teaching Hospital One-Stop Centre
Elwyn Chomba,1Laura Murray,2Michele Kautzman,3Alan Haworth,1Mwaba Kasese-Bota,4
Chipepo Kankasa,1Kaunda Mwansa,1Mia Amaya,5Don Thea,6and Katherine Semrau6
1Department of Pediatrics and Child Health, University Teaching Hospital, Nationalist Road, Lusaka 10101, Zambia
2Johns Hopkins University Research, 600 North Wolfe Street, Baltimore, MD 21287-0005, USA
3Baylor College Of Medicine Children’s Foundation. P.Bag B397, Lilongwe 3, Lilongwe, Malawi
4United Nations Children’s Fund, Alick Nkhata Road, Lusaka 10101, Zambia
5University of Alabama in Birmingham, Birmingham, AL 35233, USA
6School of Public Health, Boston University, 715 Albany Street, Boston, MA 02118, USA
Correspondence should be addressed to Elwyn Chomba, echomba@zamnet.zm
Received 25 February 2010; Revised 19 May 2010; Accepted 1 June 2010
Academic Editor: Marcel Tanner
Copyright © 2010 Elwyn Chomba et al. This is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly
cited.
Objective. To improve care of sexually abused children by establishment of a “One Stop Centre” at the University Teaching Hospital.
Methodology. Prior to opening of the One Stop Centre, a management team comprising of clinical departmental heads and
a technical group of professionals (health workers, police, psychosocial counselors lawyers and media) were put in place. The
team evaluated and identified gaps and weaknesses on the management of sexually abused children prevailing in Zambia. A
manual was produced which would be used to train all professionals manning a One Stop Centre. A team of consultants from
abroad were identified to oer need based training activities and a database was developed. Results. A multidisciplinary team
comprising of health workers, police and psychosocial counselors now man the centre. The centre is assisted by lawyers as and
when required. UTH is oering training to other areas of the country to establish similar services by using a Trainer of Trainers
model. A comprehensive database has been established for Lusaka province. Conclusion. For establishment of a One Stop Centre,
there needs to be a core group comprising of managers as well as a technical team committed to the management and protection
of sexually abused children.
1. Introduction
Zambia is a landlocked country located in Southern Africa
with a population of about 10.8 million. Fifty one percent
of the population is made up of women and children. Over
70% of the population lives below the poverty datum line
[1]. The Gross Per Capita Income is $630, and 13% of central
government expenditure is allocated to health care (UNICEF
Zambia Statistics). According to the Zambia Demographics
and Health Survey in 2007, it is estimated that 14.3% of
the sexually active age group (15–49) is living with Human
Immunodeficiency Virus (HIV) [2], 12.3% males and 16.1%
females.
Children have been much aected by the HIV/AIDS
epidemic in Zambia, where over 30,000 children are HIV
positive [3]. While perinatal transmission accounts for the
majority of new pediatric HIV infections, in countries such
as Zambia, where HIV prevalance is high, sexual exposure
remains an important risk factor in children in the post-
weaning period. While HIV transmission rates attributable
to sexual abuse are unknown, pediatric victims of sexual
abuse are at a higher risk of HIV transmission due to physical
trauma and due to the fact that multiple exposures often
occur prior to discovery of the abuse [4] In a pilot study
conducted at the University Teaching Hospital (UTH) in
Lusaka, Zambia in 2003, 99% of sexually abused children
Hindawi Publishing Corporation
Journal of Tropical Medicine
Volume 2010, Article ID 864760, 7 pages
http://dx.doi.org/10.1155/2010/864760
2Journal of Tropical Medicine
reporting to the gynecology ward were females, which also
places them at a higher risk for HIV acquisition [5].
Although epidemiologic data for the prevalence of child
sexual abuse (CSA) in Zambia is not available [6], Murray
et al. found that CSA is a significant concern in the
community in Lusaka. Defilement was mentioned by 40% of
women and 30% of children asked to list problems aecting
children in the community [7]. Among the children inter-
viewed, this was the most frequently mentioned problem. In
2007, Slonim-Nevo and Mukuka surveyed 3,360 adolescents
(defined as age 10 to 19 years) and found that 9% of
adolescents reported a family member touching their breasts
or genitals, 3% reported sexual intercourse, 2% reported oral
sex, and 1% reported anal sex by a family member. Females
were more likely to have been touched sexually than their
male counterparts, but males were more likely than females
to have had sexual intercourse or oral sex with a family
member.
Literature from countries surrounding Zambia docu-
ments the existence of a CSA epidemic in the region.
Prevalence studies rely on cross-sectional study design, most
often surveying school children about their experiences of
sexual abuse. In a review article of child sexual abuse in
subsaharan Africa, Lalor et al. report that between 3.2 and
7.1% of all respondents report unwanted or forced sexual
intercourse before the age of 18 years [8]. Jewkes et al.
surveyed 11, 735 South African women between the ages of
15 and 49 years about their history of rape during childhood.
Overall, 1.6% reported unwanted sexual intercourse before
the age of 15 years of age. 85% of child rape occurred between
the age of 10 and 14 years and 15% between the ages of 5
and 9 years [9]. In a study in Zimbabwe, Birdthistle reports
that among unmarried, sexually active adolescents, 52.2%
had experienced forced intercourse at least one time. 37.4%
of first sexual intercourse acts were forced [10]. In a study
of 487 university students in Tanzania, 11.2% of women
and 8.2% of men reported unwanted sexual intercourse.
The average age at the time of abuse was 13.6 years [11].
Collings and madu [6] surveyed a sample of 640 female
university students in South Africa and found that 34.8%
had experienced contact sexual abuse before the age of 18
years. Another study among high-school students in South
Africa [12], found that almost 20% were victims of parental
or guardian sexual abuse. Additional research suggests that
the prevalence of child sexual abuse in subsaharan Africa is
similar to other countries across the world [8].
In the second quarter of 2003, Zambian police handled
300 cases of child rape, and some experts believe that for
every case reported another 10 go unreported [13]. The
number of reported cases and the realization that these
cases were likely to be the tip of iceberg, in combination
with high HIV prevalence led to the identification of the
need to establish a comprehensive multidisciplinary centre
to increase public awareness of child sexual abuse and to
improve management of sexually abused children with an
emphasis on preventing HIV acquisition.
In Zambia, most reported Child Sexual Abuse (CSA)
cases come to the attention of medical personnel because of
symptomatic Sexually Transmitted Diseases (STDs). Limited
services were oered for sexually abused youth and no
postexposure prophylaxis (PEP) was available in the public
sector. In 2003, a pilot study was conducted at the University
Teaching Hospital (UTH) to investigate the feasibility of
giving PEP to sexually abused children in Zambia. The
study was done within the department of Obstetrics and
Gynaecology. In this study, 23% of eligible children were able
to complete a 28-day course of PEP [5]. Prior to this study,
there was a lack of awareness of child sexual abuse and a
lack of recognition of child sexual abuse cases. No specific
points of service for child sexual abuse were available. There
were no protocols for how to address the needs of victims,
and there was poor or no coordination between the various
professionals involved in the management of sexually abused
children.
UTH is situated in Lusaka, the capital of Zambia with
a population close to 2 million [1]. UTH houses the
only medical school in the country and the schools of
Registered Nurses and Midwifery. Most of the professionals
in Zambia; medical personnel, social workers, psychiatrists,
psychologists, lawyers, and magistrate, are found in Lusaka.
It was therefore important that a One Stop Centre with a
multidisciplinary approach be established in Lusaka. The
One Stop Centre would then act as a centre for developing
appropriate protocols for the management of child sexual
abuse in Zambia as well as become a training institution for
the rest of the country.
The diagram below (Figure 1) depicts the previous
system for management of a child who had been sexually
abused, along with some of the associated flaws and potential
delays due to the lack of a centralized, coordinated service.
When a child had been sexually or physically abused, the
majority are reported either to the victim support unit within
the police or, if the child had been physically injured or
had a medical symptom, for example a genital discharge,
or to a local health facility. A few children presented to a
nongovernmental organization such as the Young Womens
Christian Association (YWCA). The processing goals of a
child sexual abuse case involved care and protection of the
child, investigation of the background to the abuse, and
apprehension and prosecution of the oender. As a result, the
child was likely to have been interviewed (and even examined
or “inspected”) on more than one occasion, often by people
without the requisite skills. All too often the result was that
the child was further traumatized, and the guardian and child
were put much inconvenience when both were already highly
distressed. The need to visit multiple sites for evaluation also
led to critical delays in the administration of PEP as well as
an increased risk of loss-to-follow-up.
Clearly, eorts towards the development of systems and
training of professionals to more adequately work with
sexually abused youth were in need. The literature suggests
that one stop centres decrease the trauma experienced by the
child and the caregiver [14,15]. Developing a centre that
encompasses all aspects of care required for sexually abused
children is likely to reduce the strain of reporting on families
and assure proper follow-up care. The University Teaching
Hospital in Lusaka undertook the mission to develop a
One-Stop Centre to address the multidisciplinary needs of
Journal of Tropical Medicine 3
Police
Child unfriendlly system
Interviews (more than once)
Caretaker takes police report to hospital
Hospital
Child unfriendlly system
Interviews (more than once)
Forensic sample
Medical treatment
Caretaker takes medical report to police
Child
sexually
abused
No follow up
Reports to ···Reports to ···
Figure 1
sexually abused youth. This paper will present the process of
implementing such a center in a low-resource environment,
and discuss the challenges and lessons learned.
2. Methodology
The UTH proposed an intervention with a multidisciplinary
approach to increase and improve case reporting, manage-
ment and services for child sexual abuse patients with special
emphasis on HIV prevention. A management team was put
in place composed of clinical heads from the departments
of pediatrics, obstetrics and gynecology, and surgery. The
team evaluated the management of sexually abused children
prevailing in Zambia and identified gaps and weaknesses
in the medical management, legal framework, and media
reporting. A technical team composed of members of the
Zambia Society for the Prevention of Child Abuse and
Neglect (ZASPCAN) comprising a doctor, a psychiatrist,
a psychologist, a lawyer, a police ocer, and a journalist
was tasked to review Zambian laws pertaining to child
sexual abuse, review the existing protocols on the medical
management of child sexual abuse, review the literature on
management of traumatized children, and lastly, to review
the reporting on child sexual abuse in both electronic and
print media. After a comprehensive consultative process with
local and international professionals, strengths and weakness
of the existing system were identified. In order to address
many of the problems identified with the system, the One-
Stop Centre, a multidisciplinary clinic where families could
access all necessary services in one child-friendly location,
was proposed.
It was established that in order to implement the One-
Stop Centre, there needed to be identification and training
of the professionals who manage sexually abused children. A
manual for the management of sexually abused children [16]
was produced which will be used to train all professionals
stang a One-Stop Centre. The team reviewed available
literature locally, regionally, and internationally. The draft
manual was circulated to key personnel in the medical,
psychosocial, police, legal, and media communities to review
and validate the various components to see that that they
were in compliance with both the social norms and standards
of care as well as provided protection to the children.
Contents of the manual included the following.
2.1. Medical. In this section, the medical interview and the
physical examination of a sexually abused child were covered,
as well as how to complete medical legal forms and the
collection of forensic specimens. HIV testing and counseling,
treatment and management of STIs, medical complica-
tions seen with CSA, and Post-Exposure Prophylaxis (PEP)
administration were also included. Emphasis was placed on
rapid HIV identification and testing and counseling of those
presenting within 72 hours of the abuse in order to provide
prompt Post-Exposure Prophylaxis (PEP) (Figure 2).
2.2. Psychosocial/Mental Trauma. Thepsychosocialcompo-
nent of the manual included safety/confidentiality proce-
dures, psychosocial manifestations of sexual abuse, short-
and long-term eects of the abuse, posttraumatic stress
disorder (PTSD), disclosure and reasons for refusal to
disclose the sexual abuse, and challenges in child counseling.
2.3. Legal and Police Component. Included in this section
were; definitions of CSA, definition of a child, children’s
4Journal of Tropical Medicine
Sexually abused child
Post exposure prophylaxis (PEP) flowchart
HIV +
Refer to HIV
clinic for
further
evaluation
HIV
72 hours
urgent PEP
treatment
medical
conditions
Give7day
course of PEP
+72 hours
treatment medical
conditions
Visit1(day14)
Assess side eects and PEP compliance. Give remaining 14
days of PEP
Visit 2 (week 4)
Assess side eects and PEP compliance.
Visit 3 (3 months)
Repeat HIV test.
Figure 2
rights, how to treat child witnesses, ratification and domes-
tication of international law instruments, dealing with child
oenders, and how to preserve evidence.
2.4. Media Component. Prior to the development of the
manual, child sexual abuse was reported in the media
without following any guidelines. Children’s names and
photographs were frequently included in the mass media.
The manual provided guidelines on accurate reporting and
principles on ethical reporting of children. Though in
other countries reporters do not form part of the team in
Child Advocacy Centres (CAC), they were included in the
technical team as hostile reporting was damaging children
both physically and mentally. Media representatives were also
considered important in increasing public awareness of child
sexual abuse to increase the number of cases that were being
reported.
2.5. Trainings. Once the manual was completed, trainings
utilizing the new manual were conducted for the profession-
als who would be stang the One-Stop Centre.
2.6. Public Sensitization. As CSA is widely believed to be
underreported and most cases presented only after symp-
toms or complications developed, a series of public sensiti-
zation activities, including school debates, were conducted
to increase public awareness of child sexual abuse and to
increase awareness of the importance of early reporting and
where to report.
2.7. Setting Up the One Stop Centre. In most western
countries, Child Advocacy Centers (CACs) are not located
within medical institutions and oer a more comprehensive
package to include physical abuse as well as child neglect
[17,18]. We chose to establish the multidisciplinary centre
within the pediatric department because most of the sexually
abused children came to the attention of the health workers
because of medical complications [5] and in order to oer
PEP to abused children, which was only available at the UTH.
The centre would not provide services for isolated physical
abuse cases nor neglected children.
The One-Stop Centre was established in the pediatric
department on 26th April 2006. A location was selected
where there is minimal foot trac and there are no con-
spicuous notices indicating its function to help preserve the
Journal of Tropical Medicine 5
confidentiality of the children and their guardians attending
the center. The Centre included a physical examination room
and several interview rooms including one with a two-way
mirror, microphone, and speakers which allows one person
to interview (usually a medical person) the child whilst
the police ocers and counselors take notes from another
room. Special care was taken to provide comfortable and
child-friendly waiting facilities (TV set, toys, and educational
materials).
Since there is an extreme shortage of doctors, the clinical
ocer trained in forensic and medical examination abroad
was appointed to coordinate the medical management at
the centre. In western countries, a pediatrician or equivalent
would have the responsibility of examining these children.
The clinical ocer is supported by a director who is a senior
pediatrician and a middle-grade doctor. The clinical ocer
examines the child, prescribes medications as indicated for
the sexually abused children, and refers to the consultant if
assistance is needed. The Centre is also staed by one police
ocer from the Victim Support Unit section of the local
police, one social worker, and three nurses.
To round out the multidisciplinary vision of the One-
Stop centre, the director and psychiatrist began working with
Boston University to add a range of psychosocial assessment
tools to strive for comprehensive, multidisciplinary assess-
ments as documented in the literature as the “gold-standard”
in childs sexual abuse care. The assessments were chosen
based on results from a local qualitative study conducted [7]
in Lusaka as well as local input from psychiatrists, mental
health professionals, nurses, and clinical ocers.
Intake interviews are conducted with the caregiver and
child separately (if the child is able). Information on
demographic characteristics and abuse history is collected.
A medical/laboratory panel includes the following tests:
rapid HIV antibody tests, Rapid Plasma Reagin, pregnancy,
Hepatitis B, and forensic specimens (High vaginal swab for
wet prep, gram stain and culture to identify gonorrhea,
trichomonas, and spermatozoa). Mental health assessments
for the youth include the Post-traumatic stress disorder
Reaction Index, the Strengths and Diculties Questionnaire,
and My Feelings About the Abuse. This last measure specifi-
cally examines the construct of shame, which is considered
to be critical in the Zambian culture. The mental health
assessment administered to the caregivers about the abused
child is the Child Behavior Checklist.
Asystematicflowhasbeendesignedtopromoteexcel-
lence in the care of sexually abused youth.
(1) Family registers at UTH main desk and receives a
treatment form
(2) The family is then directed to the One Stop Centre
where they are greeted by the social worker and/or
nurses counselors. Youth and their caregivers are
immediately asked if the abuse happened within the
last 72 hours. If the abuse occurred within 72 hours
of presentation and the child is HIVnegative on rapid
test, the child is eligible for PEP.
(a) If abuse occurred within 72 hours, the child
is immediately brought to a nurse to take the
necessary blood tests, and administer PEP if
appropriate. If the child is pubertal, in addition
to PEP, they are given emergency contracep-
tion. After blood tests and PEP administration,
the intake forms and the questionnaire for
assessment of level of trauma are completed
by the nurse or social worker. A physical exam
is completed by the clinical ocer and/or the
consultant, and the UTH treatment form and
police medical forms are completed.
(b) If abuse did NOT occur within 72 hours, the
child/care-giver is interviewed by one of the
sta, blood tests are performed, a physical
exam of the child is conducted and the UTH
treatment and police form (issued at the centre)
are completed by the clinical ocer. The police
ocer stationed at the centre also completes the
relevant potion of the police form.
(c) If a child is HIV positive, they are referred
to the Paediatric Antiretroviral Therapy (ART)
Clinic for further assessment, management, and
follow up.
(d) If a child is found to be pregnant, she is referred
to the Antenatal and/or Prevention of Mother
to Child HIV Transmission (PMTCT) clinic for
further assessment, management, and follow
up.
Drugs used for PEP were Zidovudine 240 mgs/m2in
combination with Lamivudine 4 mg/kg (Combivir) twice
daily for 28 days. No syrups were available initially leaving
the very young children without any PEP options until
later when syrup formulations were made available. Initially,
a two-drug regimen was recommended as eective [19]
though currently a 3-drug regimen is in place in accordance
with current guidelines.
2.8. Support. To g a i n s u p p o r t f r o m l o c a l p o l i c y m a ke r s
(parliamentarians, Ministry of Health, local and interna-
tional organizations) several meetings were held to explain
the concept of a One-Stop Centre to emphasize the need
for multidisciplinary care for sexually abused youth and to
request financial support for such a centre.
2.9. Monitoring and Evaluation. A data collection and
management system was developed with help from Boston
University, and a Monitoring and Evaluation Specialist was
put in place. Monthly reports are provided to the UTH as
well as biannually to funders.
In the period between January 2006 and December 2008
2863 children attended the One-Stop Centre. The One-
Stop Centre has improved the followup of children, with
52% of eligible children completing a 28-day course of PEP,
compared to 23% in the pilot study conducted in Zambia in
2004-2005 (Tabl e 1 )[5].
6Journal of Tropical Medicine
Tab le 1
Year 2006 2007 2008
No. Defilement Cases 829 955 1079
No. Eligible for PEP 220 368 435
No. Completed PEP 92 (41.8%) 208 (56.5%) 239 (54.9%)
No. Did not Complete
PEP 128 160 196
The drop in number completing PEP in 2008 is attributed to erratic
availability of Antiretrovirals (ARVs) within the public sector
3. Continuing Challenges
Considering that one-stop centres do not exist in most
poorly-resourced countries [8], the first step was to look at
centres established in developed countries and see how they
could be adapted to suit the local needs the environment
and the limited resources available. Unlike most, One-Stop
Centres in developed countries, which are located away
from hospitals [17,18], the center was established within
the hospital where most senior medical professionals are
found. However, most often, they have to deal with the
acutely ill and have little time to audit the performance
of the centre. The most significant challenge continues to
bealackofbothmonetaryandhumanresourcesinthe
setting of numerous competing demands. Because of the
gaps in the Zambian medical training curriculum which
does not include child sexual abuse topics, there was a
lack of experienced local medical professionals available to
conduct the trainings. For this purpose, consultants with
clinical experience in managing sexually abused children
were recruited from abroad to come and train the medical
team, and selected members of the local team were sent for
training abroad. The most dicult task was to find a team
which was prepared to allocate time not only to training
but also to spearheading the implementation process. These
professionals were already overburdened with treating the
severely ill due to the HIV/AIDS pandemic and had little time
to take on other equally important duties. It is hoped that
as the number of medical professionals increase and once a
critical number of professionals have been trained, abused
children will be able to receive services in the primary health
centres, and the UTH centre will assume a coordinating and
training role and act as a referral centre for complicated cases.
The establishment and training of the team would not
have been possible without collaboration, funding, and
technical assistance from international organizations and
individuals. With their assistance, protocols to guide the
operations of the One-Stop Centre were developed. For this,
the local team reviewed available data, and with technical
assistance from outside sources, adapted it to meet the local
needs.
The main goal of the One-Stop Centre was to protect
sexually abused children from acquiring HIV infection. The
drugs used for PEP are those used in the treatment of HIV
and AIDS. The budget for ART is limited to treatment rather
than prophylaxis. This is a huge challenge as currently there
is a shortage of drugs for those who require treatment.
It is therefore important that the National Drug Budget
takes into account drugs for PEP as this is an important
strategy to prevent HIV infection. Future research will need
to explore other, more cost-eective regimens of drugs to be
used for PEP in poor resource settings, as was done in the
PMTCT program. Single-dose nevirapine and short-course
zidovudine regimens were identified which were more cost-
eective, but also ecacious at preventing maternal to child
HIV transmission.
Follow up of children to ensure their completion of a
28-day course of PEP is a great challenge. Currently, when
a child qualifies for PEP, a 7-day course of drugs is given,
and the child is advised to come for review a week later or
earlier if there are any side eects. Upon review, if the child
has taken the medication and has had no adverse eects,
he/she is given the remaining 21-day course of drugs and
scheduled for review again at the completion of treatment.
Even though followup improved from 23% to 52% with the
establishment of the One-Stop Centre, few children report
back on day 28, and negligible numbers return at 3, 6, and
12 months to repeat HIV testing as per protocol. Various
methods have been used to encourage the initial 7- and 28-
day reviews, such as reminder phone calls and diary cards,
with limited improvement (Tabl e 1). One potential barrier to
followup is lack of money for transport to the UTH, which is
often far from the child’s home. It is hoped that once services
have been decentralized to the primary health centres which
are based in the community, follow up will improve as it will
reduce transport costs to and from UTH.
Police and legal services are grossly limited by shortage
of transport and resources, including human resources,
required for eective forensic investigations. The legal system
is hostile to an abused child in that there are no child-friendly
courts, most prosecutors are not familiar with CSA, and
doctors are not keen to give expert opinion in court. The
One Stop Centre has been trying to address these issues by
conducting trainings and seminars for all those involved in
the prosecution of child sexual abuse.
4. Conclusions and Recommendations
One stop centres have proved to be eective in improving
the management of sexually abused children [2022]. This
paper demonstrated a process used to develop such a centre
in a low-resource environment. In order to establish a One
Stop Centre in a developing country, it is important to get the
support of the relevant stakeholders (policy makers, lawyers,
magistrates, police, health workers, and influential networks
in the communities). Mobilization of financial resources is
essential in the initial stages as most medical systems in
developing countries are overburdened with acute illnesses
with no resources to invest in preventative strategies such
as HIV/AIDS. The one-stop centres should be established
within a health institution where the majority of patients
initially present, and the concentration of senior health
care providers is based, who would then be responsible for
developing and modifying protocols, training health care
workers based in rural areas, and maintaining a database
Journal of Tropical Medicine 7
which would help guide future policies and identify areas
where future CSA related research may be needed.
It is not feasible to establish one-stop centers in all
places in Zambia as in the present format they would be
extremely expensive. In order to create a sustainable program
throughout Zambia, the multidisciplinary concept should
be adapted to work within the current health care system.
In the future, once there is a cadre of health care workers
trained in the identification and treatment of child sexual
abuse available, the services should be established as close
to the community as possible. This is especially important
in poorly resourced countries where caretakers may fail to
report abuse or be adherent to the followup regimen because
of lack of transport funds.
Curricula at the health institutions need to be adapted
to include child sexual abuse to ensure professionals are
equipped with the knowledge and skills to care for children
who have been sexually abused at graduation.
It remains critical for the UTH Centre as well as other
large tertiary institutions where the centres are established
to gain the support from the government to sustain these
necessary services and reduce reliance on external funding.
Acknowledgments
This paper was supported by Centre for Disease Control and
Prevention (CDC) Zambia. Special thanks to Zambia Society
for the Prevention of Child Abuse and Neglect (ZASPCAN),
Zambia Victim Support Unit, and UNICEF Zambia.
References
[1] Zambia Demographic and Health Survey 2001-2002
February 2003, http://www.unicef.org/infobycountry/zambia
statistics.html#48.
[2] Zambia: HIV/AIDS Prevalence Reduces highlights
of Zambia Demographic and Health Survey, 2007,
http://allafrica.com/stories/200805280428.html.
[3] Government Republic of Zambia, “Zambia Country Report:
Monitoring the Declaration of Commitment on HIV and
AIDs and the Universal Access Biennial Report,” April 2010,
http://www.unaids.org/en/CountryResponses/Countries/
zambia.asp.
[4] M. L. Lindegren, I. C. Hanson, T. A. Hammett, J. Beil,
P. L. Fleming, and J. W. Ward, “Sexual abuse of children:
intersection with the HIV epidemic,Pediatrics, vol. 102, no.
4, p. e46, 1998.
[5] E. Chomba, M. Kasese-Bota, A. Haworth, B. Fuller, and M.
Amaya, “Circumstances of child abuse in a cohort of children
eligibleto receive post-exposure prophylaxis at the University
of Zambia Teaching Hospital: a descriptive study,” in
Proceedings of the International AIDS Conference, August 2006,
http://www.iasociety.org/Default.aspx?pageId=11&abstractId
=2197011.
[6] S. J. Collings and S. N. Madu, “The prevalence and charac-
teristics of child sexual abuse among South African university
students: Comments on S.N. Madu,South African Journal of
Psychology, vol. 32, no. 3, pp. 62–63, 2002.
[7] L. K. Murray, A. Haworth, K. Semrau et al., “Violence and
abuse among HIV-infected women and their children in
Zambia: a qualitative study,Journal of Nervous and Mental
Disease, vol. 194, no. 8, pp. 610–615, 2006.
[8] K. Lalor, “Child sexual abuse in sub-Saharan Africa: a
literature review,ChildAbuseandNeglect,vol.28,no.4,pp.
439–460, 2004.
[9] R. Jewkes, J. Levin, N. Mbananga, and D. Bradshaw, “Rape of
girls in South Africa,Lancet, vol. 359, no. 9303, pp. 319–320,
2002.
[10] I. J. Birdthistle, S. Floyd, A. MacHingura, N. Mudziwapasi,
S. Gregson, and J. R. Glynn, “From aected to infected?
Orphanhood and HIV risk among female adolescents in urban
Zimbabwe,AIDS, vol. 22, no. 6, pp. 759–766, 2008.
[11] D. McCrann, K. Lalor, and J. K. Katabaro, “Childhood sexual
abuse among university students in Tanzania,” Child Abuse
and Neglect, vol. 30, no. 12, pp. 1343–1351, 2006.
[12] S. N. Madu, “The relationship between perceived parental
physical availability and child sexual, physical and emotional
abuse among high school students in the Northern Province,
South Africa,Social Science Journal, vol. 39, no. 4, pp. 639–
645, 2002.
[13] Agence France-Press, Sexual Abuse of young girls rife in
Zambia, September 2003.
[14] B. S. Newman, P. L. Dannenfelser, and D. Pendleton, “Child
abuse investigations: reasons for using child advocacy centers
and suggestions for improvement,Child and Adolescent Social
Work Journal, vol. 22, no. 2, pp. 165–181, 2005.
[15] L. Snell, “Child Advocacy Centers: One Stop on the Road to
Performance- Based Child Protection,” February 2009.
[16] Zambia Society for the Prevention of Child Abuse and
Neglect (ZAPCAN), “Multi-Disciplinary Training Manual
First Edition,” December 2007.
[17] M. Downing., Once is Enough: A Unique Sex Abuse Centre
Ensures that Tender Young Lives Aren’t Torn Apart by the
System, Huston Press, Houston, Tex, USA, 2000.
[18] H. Jennifer, Srpingdale Centre, Police Unite to Protect Abused
Children, The Arkansas Democreat-Gazette, p. B6, August
1998.
[19] WHO, Clinical Management of Sexual abuse Survivors
by World Health Organisation, Geneva, - Reproductive
Health and Research and UNHCR—Health and Community
Development Section, May 2010, http://www.searo.who
.int/LinkFiles/Publications clinical mngt rape survivors.pdf.
[20] H. Dubowitz, M. Black, and D. Harrington, “The diagnosis of
child sexual abuse,American Journal of Diseases of Children,
vol. 146, no. 6, pp. 342–355, 1992.
[21] M. E. Abrams, “Adolescent sexual abuse: clinical discussion
of a community treatment response,Seminars in Adolescent
Medicine, vol. 3, no. 1, pp. 67–78, 1987.
[22] M. L. Blumberg, “Depression in abused and neglected chil-
dren,American Journal of Psychotherapy,vol.35,no.3,pp.
342–355, 1981.
... To effectively provide the support services required by victims of sexual molestation calls for the participation of several professions, including social workers, doctors, nurses, police officers, magistrates, prosecutors, counsellors, and psychologists (Muridzo et al., 2018). In view of the range of services the survivors need, the support for recovery, rehabilitation, and reintegration, requires the establishment of multidisciplinary teams of professionals including social workers, health workers, counsellors, psychologists, police, lawyers, and so on housed under one roof such as a university teaching hospital (Chomba et al., 2010). For survivors to remain safe while recuperating, they deserve the collaborative intervention of educators, social workers, and youth justice workers among others (GOV.UK, 2020). ...
Article
This article provides a case study of child sex tourism (CST) in Surabaya, Indonesia. CST cases are difficult to surface because the victims of CST are such vulnerable human beings. Victims of CST need a variety of forms of support for their recovery and reintegration. This article contends that social, economic, political, technological, and individual factors cause CST. It examines the negative impacts of CST, which are medical, social, psychological, and physical in nature. It also reveals that the techniques used for CST recruitment are fake promises, debt bondage, emotional abuse, counterfeit love, drug addiction, physical abuse, and gifts and favors. The elimination of CST calls for ending certain depraved cultural practices and beliefs, rehabilitation and reintegration of the victims, proactive anti-CST government policies and programs, enactment and effective enforcement of tough laws prohibiting CST, prosecution of the offenders, raising public awareness about the ills of CST, providing education for all children, the provision of national identification documents to all children, and strict border controls to prevent the trafficking of children for sex tourism.
... Thus, it demands the participation of several professionals including social workers, doctors, nurses, police officers, magistrates, prosecutors, counsellors; and psychologists (Muridzo et al., 2018). In this regards, the establishment of multidisciplinary team of professionals including social workers, health workers, counsellors, psychologists, police, lawyers, etc. housed under one roof especially in a university teaching hospital would be ideal (Chomba et al., 2010). ...
Article
Full-text available
Daily, in almost every part of the world, series of maltreatment are meted on the children. Because of their vulnerability, the time has come to take serious actions and unreserved measures to end this inhumane treatment and support the victims and their communities. Children are innocent beings and are the last hope of every community and nation and deserve a decent and safe environment to grow to the fullest. This is a fundamental human right as capsulated in the United Nations Convention on the Rights of the Child (UNCRC), an international legal instrument of universal significance. A systematic review of the works of literature using information collected from different sources was actuated. Google search engine, google scholar, web of science, and Scopus database were used to search for these articles. During the search, combinations of words and phrases were used to ensure articles reflected the most current knowledge and scholarly works. The systematic searches beget varied and voluminous articles that had to be sieved not only to meet the inclusion and exclusion criteria but also to ensure the fundamental objectives of the study are wrangled. In summary, the potentials of web-counseling include but are not restricted to unlimited access and improved seeking behavior, affordability, convenience, limited pressure, permanent record availability, anonymity, independence and autonomy, empowerment, geographical barriers elimination, less feeling shy, freedom of expression, confidentiality, and privacy, efficiency and effectiveness improvement, all-time access to multiple therapists, resources with no transport cost and hassle, and client-driven therapy sessions
... Again, very few studies examined outcomes related to medical referral and improvement in symptoms, but all those that did found that a multi-disciplinary team was significantly more likely to be associated with the receipt of medical services than comparison conditions (Chomba et al., 2010;Edinburgh et al., 2008;Smith et al., 2006;Walsh et al., 2007). ...
Technical Report
Full-text available
This report summarises the findings of the evaluation of the Multiagency Investigation and Support Team (MIST), a pilot response developed by WA Police (Child Abuse Squad); Department for Child Protection & Family Support (Child First, Armadale & Cannington Districts); WA Department of Health (Princess Margaret Hospital); Department of the Attorney General (Child Witness Service); and Parkerville Children and Youth Care Inc.
... Again, very few studies examined outcomes related to medical referral and improvement in symptoms, but all those that did found that a multi-disciplinary team was significantly more likely to be associated with the receipt of medical services than comparison conditions (Chomba et al., 2010;Edinburgh et al., 2008;Smith et al., 2006;Walsh et al., 2007). ...
Technical Report
Full-text available
This report summarises the interim findings of the evaluation of the Multi-Agency Investigation and Support Team (MIST), a pilot cross-agency response to cases of severe child abuse in Perth, Western Australia. The evaluation presents the findings of three studies: worker perceptions of MIST, an administrative data study of MIST, and a quasi-experimental comparison of MIST with Practice as Usual at the time. This interim report covers the first 5 months of the intervention. While further research is needed, the interim report suggests that the MIST is operating well, and certainly resolving cases in the criminal justice system faster. Changes to the methodology for the quasi-experimental comparison were identified in order to better present a reliable comparison between the two conditions.
... Adolescents 10-19 years old are especially affected by the AIDS epidemic in Zambia, with about 68,000 (60,000 -80,000) estimated to be infected by end of 2015 [1]. With increasing access to antiretroviral (ARV) treatment, many more perinatally infected children are now reaching adolescence [4][5][6]. ...
Article
Full-text available
Introduction As HIV infected adolescents mature into adulthood, they are confronted with issues related to sexuality and sexual reproductive health (SRH). An estimated 68,000 adolescents aged 10-19 years are living with HIV in Zambia. The current study explores their sexuality and SRH experience and needs. Methods This was a mixed method analytical cross-sectional study. Adolescents at a tertiary hospital were surveyed on their sexuality and SRH experiences. Bivariate analyses on SPSS were used to assess factors associated with selected behaviors. Emerging themes from open-ended questions qualitative data were explored using content analysis. Results A total of 148 adolescents (63.5% females) aged 15-19 years were surveyed. Majority (77.0%) had secondary education; 77.2% currently in school; 40.1 % had a boy or girlfriend; 15.1% have ever had sex, of whom only 61.1 % reported consistent condom use. About 68.9 % expressed intention to have children; 2.1% of girls had been pregnant before. Of 52 respondents, 19.2% had a sexually transmitted infection (STI) before. Not being in school was a significant predictor, for knowing where to access information about sex (OR= 2.53; 95% CI:1.10-5.82; p=0.02), and also for ever gone there (OR=2.61; 95% CI:1.04-6.58; p=0.03). Conclusion The survey of HIV infected adolescents attending a tertiary hospital in Zambia found that their sexuality and SRH needs remain similar to those of the general adolescent population in terms of counseling in sexual matters, family planning and STI services. More efforts are needed to provide for adolescent health care needs, especially those living with HIV.
... Relatively few studies included outcomes related to medical care (n ¼ 5) and improvement in symptoms (n ¼ 1). Primarily studies examined whether children received a physical examination as part of the response (Chomba et al., 2010;Edinburgh, Saewyc, & Levitt, 2008;Smith, Witte, & Fricker-Elhai, 2006;Walsh et al., 2007). ...
Article
Full-text available
Multi-Disciplinary teams (MDTs) have often been presented as the key to dealing with a number of intractable problems associated with responding to allegations of physical and sexual child abuse. While these approaches have proliferated internationally, researchers have complained of the lack of a specific evidence base identifying the processes and structures supporting multi-disciplinary work and how these contribute to high-level outcomes. This systematic search of the literature aims to synthesize the existing state of knowledge on the effectiveness of MDTs. This review found that overall there is reasonable evidence to support the idea that MDTs are effective in improving criminal justice and mental health responses compared to standard agency practices. The next step toward developing a viable evidence base to inform these types of approaches seems to be to more clearly identify the mechanisms associated with effective MDTs in order to better inform how they are planned and implemented.
Article
Full-text available
No child should have to worry about his or her safety and welfare. Unfortunately, research shows that millions of children around the world are at risk for violence, abuse, and exploitation. There are several threats to the safety of children, most of which are interconnected. Therefore, this study focused on the practices of secondary schools in ensuring the protection of their children in Lusaka district of Lusaka province of Zambia. The study was guided by the following objectives: i). Describe the prevalence of cases of violence, exploitation and sexual abuse among children in secondary schools in Lusaka district. ii). Explore the measures taken to protect children from violence, exploitation and sexual abuse in selected secondary schools. iii). Explore gaps in the actions taken to deal with child protection concerns in selected secondary schools in Lusaka district. This study employed a qualitative methodology guided by a case study design in the light of learned helplessness theory. Additionally, the study adopted systematic and purposive sampling techniques to enrol four secondary schools and to enlist thirty-six (36) participants respectively. The findings of the study revealed that violence, exploitation and sexual abuse are very much prevalent in secondary schools. However, it is difficult to ascertain the prevalence because of under-reporting of these cases by the pupils. Cases of sexual abuse were found to be more prevalent among the girls and cases of physical abuse were more pronounced among the boys. The study also revealed that teachers are usually the perpetrators of these cases. Thus, the following were recommendations among others: i). the government through the Ministry of General Education should strengthen the child protection policies in schools, ii). the government through the Ministry of Higher Education should introduce a course in guidance and counselling.
Article
Full-text available
No child should have to worry about his or her safety and welfare. Unfortunately, research shows that millions of children around the world are at risk for violence, abuse, and exploitation. There are several threats to the safety of children, most of which are interconnected. Therefore, this study focused on the practices of secondary schools in ensuring the protection of their children in Lusaka district of Lusaka province of Zambia. The study was guided by the following objectives: i). Describe the prevalence of cases of violence, exploitation and sexual abuse among children in secondary schools in Lusaka district. ii). Explore the measures taken to protect children from violence, exploitation and sexual abuse in selected secondary schools. iii). Explore gaps in the actions taken to deal with child protection concerns in selected secondary schools in Lusaka district. This study employed a qualitative methodology guided by a case study design in the light of learned helplessness theory. Additionally, the study adopted systematic and purposive sampling techniques to enrol four secondary schools and to enlist thirty-six (36) participants respectively. The findings of the study revealed that violence, exploitation and sexual abuse are very much prevalent in secondary schools. However, it is difficult to ascertain the prevalence because of under-reporting of these cases by the pupils. Cases of sexual abuse were found to be more prevalent among the girls and cases of physical abuse were more pronounced among the boys. The study also revealed that teachers are usually the perpetrators of these cases. Thus, the following were recommendations among others: i). the government through the Ministry of General Education should strengthen the child protection policies in schools, ii). the government through the Ministry of Higher Education should introduce a course in guidance and counselling.
Article
Full-text available
Background: Specialist sexual assault services, which collect forensic evidence and offer holistic healthcare to people following sexual assault, have been established internationally. In England, these services are called sexual assault referral centres (SARCs). Mental health and substance misuse problems are common among SARC attendees, but little is known about how SARCs should address these needs. This review aims to seek and synthesise evidence regarding approaches to identification and support for mental health and substance misuse problems in SARCs and corresponding services internationally; empirical evidence regarding effective service models; and stakeholders' views and policy recommendations about optimal SARC practice. Methods: A systematic review was undertaken. PsycINFO, MEDLINE, IBSS and CINAHL were searched from 1975 to August 2018. A web-based search up to December 2018 was also conducted to identify government and expert guidelines on SARCs. Quality assessment and narrative synthesis were conducted. Results: We included 107 papers. We found that identification based on clinical judgement, supportive counselling and referral to other services without active follow-up were the most common approaches. Evaluations of interventions for post-rape psychopathology in attendees of sexual assault services provided mixed evidence of moderate quality. Very little evidence was found regarding interventions or support for substance misuse. Stakeholders emphasised the importance of accessibility, flexibility, continuity of care, in-house psychological support, staff trained in mental health as well as specialist support for LGBT groups and people with learning difficulties. Guidelines suggested that SARCs should assess for mental health and substance misuse and provide in-house emotional support, but the extent and nature of support were not clarified. Both stakeholders and guidelines recommended close partnership between sexual assault services and local counselling services. Conclusions: This review suggests that there is big variation in the mental health and substance misuse provision both across and within different sexual assault service models. We found no robust evidence about how sexual assault services can achieve good mental health and substance misuse outcomes for service users. Clearer guidance for service planners and commissioners, informed by robust evidence about optimal service organisations and pathways, is required. PROSPERO registration number: CRD42018119706.
Article
Full-text available
Child protective service (CPS) and child abuse law enforcement (LE) investigators have been required by the majority of states to work together when investigating criminal cases of child abuse. Child Advocacy Centers (CACs) and other. multidisciplinary models of collaboration have developed across the United States to meet these requirements. This study surveyed 290 CPS and LE investigators who use a CAC in their investigations of criminal cases of child abuse. Reasons given for using, centers, include legal or administrative mandate and protocol, child appropriate environment, support, referrals, capacity for medical exams, expertise of center interviewers and access to video and audio technology. Respondents also identified ways that centers could be more helpful.
Article
Full-text available
Sexual transmission of human immunodeficiency virus (HIV) is the predominant risk exposure among adolescents and adults reported with HIV infection and acquired immunodeficiency syndrome (AIDS). Although perinatal transmission accounts for the majority of HIV infection in children, there have been reports of HIV transmission through sexual abuse of children. We characterized children <13 years of age who may have acquired HIV infection through sexual abuse. All reports by state and local health departments to the national HIV/AIDS surveillance system of children with HIV infection not AIDS (n = 1507) and AIDS (n = 7629) through December 1996 were reviewed for history of sexual abuse. Information was ascertained from data recorded on the case report form as well as investigations of children with no risk for HIV infection reported or identified on initial investigation. For children with a possible history of sexual abuse, additional data were collected, including how sexual abuse was diagnosed; characteristics of the perpetrator(s) (ie, HIV status and HIV risks); and other possible risk factors for the child's HIV infection. Of 9136 children reported with HIV or AIDS, 26 were sexually abused with confirmed (n = 17) or suspected (n = 9) exposure to HIV infection; mean age of these children at diagnosis of HIV infection was 8.8 years (range, 3 to 12 years). There were 14 females and 3 males who had confirmed sexual exposure to an adult male perpetrator at risk for or infected with HIV; of these, 14 had no other risk for HIV infection, and 3 had multiple risks for HIV infection (ie, through sexual abuse, perinatal exposure, and physical abuse through drug injection). The other 9 children (8 females, 1 male) had no other risk factors for HIV infection and were suspected to have been infected through sexual abuse, but the identity, HIV risk, or HIV status of all the perpetrator(s) was not known. All cases of sexual abuse had been reported to local children's protective agencies. Sexual abuse was established on the basis of physician diagnosis or physical examination (n = 20), child disclosure (n = 15), previous or concurrent noncongenital sexually transmitted disease (n = 9), and for confirmed cases, criminal prosecution of the HIV-infected or at-risk perpetrator (n = 8). For the 17 children with confirmed sexual exposure to HIV infection, 19 male perpetrators were identified who were either known to be HIV infected (n = 18) or had risk factors for HIV infection (n = 17), most of whom were a parent or relative. These 26 cases highlight the tragic intersection of child sexual abuse and the HIV epidemic. Although the number of reported cases of sexual transmission of HIV infection among children is small, it is a minimum estimate based on population-based surveillance and is an important and likely underrecognized public health problem. Health care providers should consider sexual abuse as a possible means of HIV transmission, particularly among children whose mothers are HIV-antibody negative and also among older HIV-infected children. The intersection of child abuse with the HIV epidemic highlights the critical need for clinicians and public health professionals to be aware of the risk for HIV transmission among children who have been sexually abused, and of guidelines for HIV testing among sexually abused children, and to evaluate and report such cases.
Article
Full-text available
This article reviews the English-language literature on child sexual abuse in sub-Saharan Africa (SSA). The focus is on the sexual abuse of children in the home/community, as opposed to the commercial sexual exploitation of children. English language, peer-reviewed papers cited in the Social Sciences Citation Index (SSCI) are examined. Reports from international and local NGOs and UN agencies are also examined. Few published studies on the sexual abuse of children have been conducted in the region, with the exception of South Africa. Samples are predominantly clinical or University based. A number of studies report that approximately 5% of the sample reported penetrative sexual abuse during their childhood. No national survey of the general population has been conducted. The most frequent explanations for the sexual abuse of children in SSA include rapid social change, AIDS/HIV avoidance strategies and the patriarchal nature of society. Child sexual abuse is most frequently perpetrated by family members, relatives, neighbors or others known to the child. There is nothing to support the widely held view that child sexual abuse is very rare in SSA-prevalence levels are comparable with studies reported from other regions. The high prevalence levels of AIDS/HIV in the region expose sexually abused children to high risks of infection. It is estimated that, approximately.6-1.8% of all children in high HIV-incidence countries in Southern Africa will experience penetrative sexual abuse by an AIDS/HIV infected perpetrator before 18 years of age.
Article
This is an investigation into the relationship between perceived parental physical availability and child sexual, physical and emotional abuse among high school students in the Northern Province (South Africa). All the secondary school students in standards 9 and 10 in three secondary schools filled in a retrospective self-rating questionnaire in a classroom setting. The questionnaire asked questions about perceived parental physical availability during childhood, and childhood sexual, physical and emotional abuse. Logistic Regression Analysis shows that among all the participants, “haven ever had a stepfather or adoptive father until he or she was at least 16 years old” and again, “haven ever had a stepfather or adoptive father until he or she was at least 16 years old” and “haven lived in a ‘group home’ until he or she was at least 16 years”; and “haven been raised by any other adult” predict child sexual, physical and emotional abuse, respectively. Mental health and social workers, educators and law enforcement agencies dealing with prevention and protection against child abuse in the Province should take note of the above identified predictors while designing programmes for the eradication of child sexual, physical and emotional abuse.
Article
To examine how the history, psychological evaluation, medical examination, and child's response to the examination contributed to a diagnosis of child sexual abuse by an interdisciplinary team. Patient series. Subspecialty clinic for evaluating prepubertal children alleged to have been sexually abused. One hundred thirty-two children alleged to have been sexually abused and their parents or guardian, evaluated consecutively in a subspecialty clinic between September 1989 and June 1990. A social worker interviewed the parents, a psychologist interviewed the child, and a pediatrician obtained a medical history and examined the child. Parents completed a Child Behavior Check list and the child's response to the physical examination was noted. Both a disclosure by the child and abnormal physical findings were significantly and independently associated with the team's diagnosis of sexual abuse, whereas the presence of sexualized behavior, somatic problems, and the child's response to the examination did not make an additional contribution to the diagnosis. The findings support the need for a skilled psychological interview and a medical examination of a child alleged to have been sexually abused to make the diagnosis of sexual abuse. An interdisciplinary team appears to be a valuable approach for evaluating these children and their families.
Article
Adolescent sexual abuse is an overwhelming issue for society and the medical community. Adolescent medicine has only begun to emerge in the mainstream of medical practice. Sexual medicine, adolescent chemical dependency, and abusive medicine are emerging subspecialties of mainstream medicine, with victimization syndromes just beginning to be explored. Adolescent sexual abuse, sexual addiction disorders, family incest, eating disorders, depression, and suicide in adolescents all need to be viewed from epidemiologically regarding family and community orientation. I refer to physician and troubled adolescent relations as the quadruple passivity syndrome. The ego-centered, troubled adolescent denies he or she has problems but no desire for treatment; the physician denies that the adolescent has health problems and has no desire to evaluate them. Physicians need to take an aggressive role in identifying, treating, and preventing the victimization process in children, adolescents, adults, spouses, families, and geriatric patients. Physicians need to be trained to identify these patients and to develop treatment protocols. The victimization syndrome needs more research, publication, and surveillance by all medical associations, but primarily by family physicians and pediatricians. In conclusion this clinical discussion describes four main points: Sexually abused adolescents can be successfully treated by a multidisciplinary advocacy team. A community multidisciplinary team can work in a unified approach for the good of the community by putting an end to future generations of victimized adolescents and families. The medical community has the greatest challenge in training, educating, and becoming more aware about adolescent sexual abuse. The community must provide support for victims of sexual abuse.
Article
Depressive affect of continuing depression do occur in children. Behavioral symptoms can be described as masked depression. Deficient rearing, neglect, and physical and sexual abuse are most significant causes of childhood depression. Suicide and suicide attempts usually result from prolonged depression. Management must be multidisciplinary and aimed at rehabilitating child and family.
Article
Child rape violates human rights and causes immediate and long-term health problems for the child. In the 1998 South Africa Demographic and Health Survey, we assessed frequency of rape in a nationally representative study of 11735 women aged 15-49 years. 153 (1.6%, 95% CI 1.2-1.9%) of these women had been raped (forced or persuaded to have sex against their will) before the age of 15 years. Our results show that younger women were significantly more likely to report rape than older women (p<0.0001). The largest group of perpetrators (33%) were school teachers. Our findings suggest that child rape is becoming more common, and lend support to qualitative research of sexual harassment of female students in schools in Africa.