Sexual Assault: Pattern and Related Complications among Cases Managed in Jimma University Specialized Hospital

Background

Sexual assault affects one out of every five women, and it is a substantial public health and human rights problem in developing countries including Ethiopia. There has not been a study which documented the extent of the problem in the study area; hence the objective of this study was to assess the pattern of sexual assault and related complications in cases which were treated at Jimma University Specialized Hospital from November 1, 2011 – October 31, 2012.

Methods

A hospital based cross-sectional descriptive study was conducted with the aim of assessing sexual assault patterns and related complications on 99 sexual assault cases which were managed at the Gynecology Out-patient Department of the Hospital. Data on circumstances of sexual assault, survivor specific demographic characteristics and information on complications and interventions provided were collected by trained third year residents in obstetrics and gynecology using pretested questionnaire after respondent consent was taken. The collected data was cleaned, edited, fed into computer and analyzed using SPSS for windows version 16.0.

Results

The mean (±SD) of the survivors' age was 14 (±5) years; 57.5% of the survivors were children and 68.7% were from rural areas. Three percent of the clients visited the Gynecology Outpatient Department for sexual assault where rape accounted for 78.8%. The majority (76.8%) of the assailants was known to the survivors, 91% were assaulted by one assailant and 5.1% of the rape cases were gang rape. The mean time of presentation after sexual assault to the hospital was 15 days. Survivors had pregnancy test, HIV test and screening for sexually transmitted infections in 76.8%, 99%, 93% respectively of which 17.1%, 5.1%, 14.1% tested positive for pregnancy, HIV, and some STIs respectively. All HIV positive survivors were children under fifteen years of age. Forty percent of the survivors were provided with emergency contraception. In addition, 60.5%, 63%, and 91.9% of them were provided with post-exposure prophylaxis for HIV, STIs prophylaxis and were given counseling respectively.

Conclusion

It has been revealed that sexual assault is a major problem of women and children of less than fifteen years. There were gaps in providing and receiving packages of care and justice system to protect survivors indicating the needs for community intervention and providing quality of care by health care staff.

Table 1

Demographic Characteristics of survivors of sexual assault managed in JUSH, Oct 2011–Nove 2012.

Variables		Number (99)	Percentage
Age in years	≤ 5	6	6.1
	6–10	15	15.2
	11–15	36	36.4
	16–20	40	40.4
	≥21	2	2.0
Address	Urban	31	31.3
	Rural	68	68.7
Ethnicity	Oromo	69	69.7
	Amhara	16	16.2
	Tgrie	1	1.0
	Guragie	7	7.1
	Dawuro	4	4.0
	Others	2	2.0
Occupation	Students	72	72.7
	Maids	4	4.0
	Dependent	14	14.1
	Preschool	5	5.1
	Others	4	4.0
Educational status	illiterate	16	16.2
	kindergarten	1	1.0
	preschool	8	8.1
	grade 1–8	68	68.7
	grade 9–12	6	6.1
Religion	Orthodox Christian	30	30.3
	Protestant	22	22.2
	Muslim	47	47.5
Personal/family income in Birr	≤500	43	43.4
	600–1000	36	36.4
	≥1001	20	20.2
Current survivors relationship status	Married and or steady boy friend	3	3.0
	No male partner	10	10.1
	Living with mother and father	69	69.7
	Living with relatives	17	17.2

Table 2

Circumstances of survivors of sexual assault managed in JUSH, Oct 2011–Nov 2012.

variables		Number (99)	Percentage
Type of sexual assault	Rape	78	78.8
	attempted rape	14	14.1
	sexual abuse	7	7.1
Brought to the hospital by	Her own	7	7.1
	Family	48	48.5
	Police	40	40.4
	Others	4	4.0
Alcohol use by assailant	Yes	4	4.0
	No	95	96.0
Time of assault	Day	70	70.7
	Night	29	29.3
Number of assailants	1	90	90.9
	2	4	4.0
	≥3	5	5.1
Number of times assaulted	1	69	69.7
	2	12	12.1
	3	10	10.1
	≥4	8	8.1
Perpetrators relationship with survivors	Stranger	24	24.2
	Acquaintance	41	41.4
	Employer	1	1.0
	Neighbor	22	22.2
	Relative	5	5.1
	Others	6	6.1
Place of assault	Own home	23	23.2
	Assailant's home	33	33.3
	School	3	3.0
	Garden	14	14.1
	Bush	20	20.2
	Others*	6	6.1
First institution reported to	Health institution	22	22.2
	Police	75	75.8
	Others	2	2.0

*survivor's friend home =3, Office=1, assailant' friend home by a boyfriend = 2

Table 3

The first time of presentation of survivors of sexual assault and related injuries managed in JUSH, Oct 2011–Nov 2012.

Variables		Number (99)	Percentage
Time of presentation to the Hospital after assault	1 day	21	21.2
	2–3 days	17	17.2
	4–5 days	16	16.2
	≥6 days	45	45.5
Genital injuries	Hymenal tear	75	75.8
	Perineal tear	3	3.0
	Rectovaginal fistula	1	1.0
	Other genital lesions	1	1.0
	None	19	19.2
Non-genital injuries	Bruise	9	9.1
	Abrasion	7	7.1
	Echymoses	4	4.0
	Laceration	6	6.1
	Fracture	1	1.0
	None	72	72.7

Table 4

Laboratory tests performed and medico-legal issues of survivors of sexual assault managed in JUSH, Oct 2011– Nov 2012.

Variables		Number (99)	Percent
Pregnancy test	Positive	13	13.1
	Negative	63	63.6
	Not done	23	23.2
Screening done for STIs	VDRL	84	84.8
	VDRL and Gram stain	2	2.0
	VDRL and HBSAg	6	6.1
	Nothing done	7	7.1
HIV test	Positive	5	5.1
	Negative	93	93.9
	Not done	1	1.0
Vaginal swab for sperm analysis	Motile sperm detected	4	4.0
	Dead sperm detected	7	7.1
	Negative	14	14.1
	Not done	74	74.8
Screening test positive for STI	VDRL	3	3.0
	Gram stain	3	3.0
	Saline mount	2	2.0
	HBSAg	5	5.1
	None	86	86.9
Medico-legal certificate given to	Police	78	78.8
	Survivor	4	4.0
	Family	12	12.1
	Not given	5	5.1
Legal measures taken against perpetrators	Under investigation	78	78.8
	Pending trail	3	3.0
	Denied, pending trail	10	10.1
	No information	8	8.1

Below:  Sexual Assault and total Gym OPD visit, Oct 2011 – Nov 2012

Full article at:   http://goo.gl/LnXEKZ

By:   Demisew Amenu1 and Desta Hiko2

¹Department of Gynecology and Obstetrics, Jimma University, Jimma, Ethiopia

²Department of Epidemiology, Jimma University, Jimma, Ethiopia

Corresponding Author: Demisew Amenu, Email: te.de.uj@unema.wesimed

 

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