Attached
Introduction
Patterns of child sexual abuse are different
from country to country and also from area
to area within a country. Further, the
management should not be confined to
medico-legal aspects but ensure psychosocial management o f child and family as
a whole. Therefore, this study was
conducted to identify and describe the
patterns of child sexual abuse and
management strategies in a District of Sri
Lanka.
Methods
Retrospective descriptive study was
conducted on the victims of child sexual
abuse reported to the Base Hospital,
Puttalam, Sri Lanka over 20 months from
November 2014 to June 2016.
Demographic factors, injuries sustained,
the abusers" correlates and the
management strategies were studied.
Results
There were 183 victims of Child sexual
abuse reported and 168 (91.8%) were
females and 15 (8.2%) were males. Ages
ranged from 3-18 years and mean age was
12.65 years with SD+/- 3.462. O f them.
123 (67.2%) belonged to 11 -15 years. The
distribution of age is shown in Table 1.
Forty two (23%) were less than 10 years of
age and remaining 141 (77%) were 11-18
years.
Table 1. Distribution of Age
Age groups Frequency Percent
0-5 10 5.5
6-10 32 17.5
11-15 123 67.2
16-18 18 9.8
Total 183 100.0
There were 164 (89.6%) Sinhalese, 16
(8.7%) Muslims and 3 (1.6%) Tamils. 64
(35%) lived in Urban areas and remaining
119 (65%) belonged to rural areas. At the
time of the incident, 53 (29%) had studied
up to 5th standard, 127 (69.4%) up to 11th
standard and 3 had gone up to Advance
Level.
In 62 (33.9%) incidents, mother had
complaint to police, in 10 the relatives^ in
3 the father and in 4 instances the victim
himself.
Ninety six (52.5%) incidents had taken
place at home and the remaining incidents
at places outside home. 37.1% (n=39) of
non-relatives and 80% (n=48) of relatives
abused their victims at the victinv's home
and this difference was significant
(x2=28.136, df=l, p=0.000<0.05). But the
place of occurrence was not significantly
associated with urban or rural living
(p=0.317>0.05). |
8.
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Regarding the time of the incident, 21
(11.5%) in the morning, 40 (21.9%) in the
afternoon, 30 (16.4%) in the night, one
case in dawn and 91 (49.7%) could not
remember the time of the incident.
None of them were abused by strangers;
62 (33.9) were relatives and 121 (66.1%)
were known non-relatives. Abuser was the
father in one instance. All the abusers were
male. In 7% (n=l) of male victims and
36% (n=61) of female victims were abused
by relatives and this difference was
significant (x2=5.402, df=l, p=0.02<0.05).
Almost all male children (93%, n=14)
were abused by non-relatives. Whereas,
one third o f female children (36%, n=61)
were abused by relatives. In 52% (n=50)
of incidents occurred at home and 14%
(n=l2) of incidents occurred at outside
were committed by relatives and this
difference was significant (x2=29.87,
df=l, p=0.000<0.01)
Among girls, 94 (51.4%) had crescentic
hymen, 36 (19.7%) had annular hymen, 35
(19.1%) had fimbriated hymen and 3 had
attenuated hymen. Among less than 10
years girls, most (91%, n=32) had nonfimbriated hymens such as crescentic
hymens. In 82% (n=28) o f less than 10
years of age and 50% (n=66) o f over 10
years of age had crescentic hymens and
this difference was significant (x2= 11.256,
df= 1, p=0.001 <0.05).
Among girls, 74(40%) had complete tears,
40(23.8%) had partial tears,5 had notches,
4 had attenuation and 45(26.8%) had no
hymenal tears. Three tears were in the
anterior half of the hymen and 114
(36.1%) were posterior tears. In 45%
(n=16) of less than 10 years of age and
80% (n=107) o f more than 10 years o f age
had tears and this difference was
significant (x2= 17.049, df=l,
p=0.000<0.01 ).Both home (73%, n=66)
and outside (73%, n=57) incidents caused
tears in hymen.
Among all the victims, 92 (50%) had
evidence of genital penetration, 51 (28%)
had been subjected to both genital and anal
penetration, 12had evidence of anal
penetration, and 27 (15%) did not have
any evidence of penetration. Only one had
fresh injuries. Three female victims were
pregnant. In 33% (n=5) of males and 34%
(n=58) of females had evidence of anal
penetration and the difference was not
significant (p=0.926>0.05).
Five (2.7%) had associated physical abuse
as well.
Regarding further referrals, 146 (79.8%)
were referred to STD clinic and 154
(84.2%) were referred to the psychiatrist.
In 37 (20.2%), case conference was
organized. Case conferences were not
organized in 92% (n=58) of cases with
anal penetration. Both, 20% (n=24) of
victims with hymenal tears and 18% (n=8)
of victims with no hymenal tears were
considered for case conference
(p=0.800>0.05).
Conclusions
Physical abuse was rarely associated
with child sexual abuse. Majority- of
incidents that occurred at home were
committed by male relatives. Known
non-relatives are the most potential
abusers. Girls more than 10 years are
most vulnerable for penetration. None
were given STI prophylactic treatment.
Mere presence of injuries were not
indications for case conference.
However, the follow-up reports of
psycho-social managements were not
available.
