Attached
Child sexual abuse (CSA) is a major public health
problem affecting all cultures and social classes. Estimated
global prevalence o f CSA is 11.8% [1]. Retrospective
studies in Sri Lanka have shown prevalence o f sexual
abuse among adolescents to be 21.9% [2].
A retrospective descriptive study was carried
out o f all children referred through courts or Judicial
Medical Officer to a Child Guidance Clinic at Lady
Ridgeway Hospital, from 2010-2014, due to alleged
CSA. Psychological consequences were assessed by a
Consultant Psychiatrist and diagnosis was made according
to the International Classification o f Diseases, 10th edition.
Approval was obtained from Ethics Review Committee
o f The Lady Ridgeway Hospital, Colombo. Data obtained
from case records were suitably altered to maintain
confidentiality.
Thirty-five children presented with alleged CSA,
during 2010-2015, with the highest number referred
in 2013(Table 1). M ajority (57.1% ) were females.
Commonest age group was 12-14 years (9/35). Sixty
percent were from Colombo District. In 9 (25%), parents
were separated. In 5 (14%) the mother was abroad. In all
cases, the perpetrator was male. Majority 29 (83%) were
known to the child. In most (29/35), a single perpetrator
was involved. In 23 (66%), abuse occurred on several
occasions by the same person. Threats or violence was
used in 17 (49%) and rewards were given in 7 (20%). The
commonest form o f sexual abuse was non-penetrative
contact 17 (49%). Co-existing forms of abuse were present
in 13 (37%). Psychological consequences were present in
24 (68%), with post-traumatic stress disorder being the
commonest 7 (20%).
Globally, CSA is commoner in females [ 1 ], which is
compatible with our findings. Similarly, highest rates of
CSA has been reported among adolescents [3]. Mother living abroad has been shown to be a risk factor, which
is supported by the present results [2],
Worldwide, majority of abusers are male and known
to victims [3], In the current study, all perpetrators were
male and 83% were known to the child. However, a
previous Sri Lankan study showed most perpetrators
to be strangers [4], Data from Australia has shown that
commonest place of abuse was at offender's home [5],
However, in our study, most abuse occurred at child's
home (43%). Literature shows that perpetrators gain
compliance of children by “grooming behaviour'', rather
than by threats [5]. In contrast, in the current study, threats
or violence has been used in 17 (48.6%) with rewards
being given only in 20%.
Previous community studies of adolescent boys
in Sri Lanka showed oral and intra-crural sex to be the
commonest forms, with 10.7% being penetrative sex [2].
Percentage of anal penetrative sex in boys was higher
(17.1%) in the present study, possibly due to differences
in sampling. Previous literature has reported that different
forms of child abuse and neglect frequently co-exist [3].
This was supported by our results.
In previous studies psychological consequences
have been reported in up to two-thirds of victims, this
was consistent with our results [3], Previous data show
that post-traumatic stress disorder (PTSD) was present
in 48% [3]. In our study, rate of PTSD was lower (20%).
The most likely reason is that our data included findings
at the first visit following abuse and PTSD may develop
up to six months after the initial abuse.
The sample was derived from referrals to child
guidance clinic and may not represent all children
subjected to CSA as only some make complaints and are
referred for assessment. This is a limitation of our study.
Since a majority of perpetrators were known to
victims, public education programmes should aim at
recognition of the danger that exists at home in addition
to danger from strangers. Since CSA frequently coexists with other forms of abuse, clinicians should be
vigilant about this. All children should be screened
for psychological problems following abuse in order
to minimise adverse outcomes, as majority show
psychological consequences.
