Sexual abuse of children as seen at Kenyatta National Hospital

Abstract

A retrospective study of 21 sexually abused children admitted to the Kenyatta National Hospital, Nairobi, Kenya, between January 1984 and December 1985 is presented. The peak incidence of sexual abuse was in the age group of 10-15 years (38.1%) followed by the 5-9 years age group (28.6%). Strangers and people familiar to the child were equally implicated as assailants. Fourteen out of the twenty one (66.7%) victims, presented with injuries ranging from perineal tears (19%), vaginal tears (19%), recto-vaginal fistulae (RVP) (4.8%) and vesico-vaginal-fistulae (VVF) and abdominal haematoma (4.8%). The victims presented to hospital within two days of the event usually accompanied by their mothers.

PIP: American studies report that 15% of reported child abuse case involve sexual abuse. Sexual abuse can be sexual molestation, sexual intercourse, and/or family related rape. Sexual abuse cases frequently come to the attention of hospital emergency care departments. Few reports appear in the medical literature on sexual abuse in Africa, although the media reports on its occurrence. This retrospective study provides information on the incidence and demographic characteristics of children admitted to Kenyatta National Hospital in Nairobi, Kenya, for sexual abuse. Records were obtained on rape or sexual abuse diagnosis cases between 1984 and 1988 for the following variables: age and sex of victim, time lapse before medical treatment, perpetrators relationship to victim, type of injury to victim, and person accompanying child to the hospital. The results reveal that 21 cases of children ranging from 4 months to 18 years were reported. In 19 cases, information on the assailant's character was unavailable. 66.7% of the victims were 5-15 years, and all were females. 15 (71.4%) were admitted within 2 days of the incident. 10 (47%) were sexually abused by strangers, and 11 (53%) by someone known such as a friend or relative. 19 incidents occurred after dark while on as parent-motivated errand. The place of victimization was usually close to the victim's home in cases where the assailant was known. The youngest children sustained the most severe injuries. Injuries included RVF and VVF, labial and perineal lacerations, hymenal tears, vaginal and perineal tears, abdominal injuries, and genital infection. Three children aged 4 6, and 7 showed evidence of previous coital experience. 5 children were without injuries. 19 patients stayed for 3 days or less; the other 2 with severe injuries stayed longer. 11 cases were brought by the mother. Case studies of the 4-month-old and the 9-year-old are presented. Discussion focuses on the nature of incestuous relationships and the character of the assailant. Prospective studies are needed, and prevention involves a massive public education effort.