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

Abstract

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.

Full text

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 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.
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 affected 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 affecting
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 offered 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 offender. 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, efforts 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 officer, 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
staffing 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 effects 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 effects and PEP compliance. Give remaining 14
days of PEP
Visit 2 (week 4)
Assess side effects 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
offenders, 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 staffing 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 offer 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 offer
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 traffic 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 officers 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
officer 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 officer is supported by a director who is a senior
pediatrician and a middle-grade doctor. The clinical officer
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 staffed by one police
officer 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 officers.
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 Difficulties 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 officer 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
staff, 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 officer. The police
officer 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 effective [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 difficult 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-effective 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-
effective, but also efficacious 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 effects. Upon review, if the child
has taken the medication and has had no adverse effects,
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 effective 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 effective in improving
the management of sexually abused children [20–22]. 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.
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