Citation

Lema VM. East Afr. Med. J. 1997; 74(11): 743-746.

Affiliation

Department of Obstetrics and Gynaecology, College of Medicine, University of Malawi, Blantyre, Malawi.

Copyright

(Copyright © 1997, Nairobi Medical Association of East Africa)

DOI

unavailable

PMID

9557452

Abstract

Although the magnitude of child sexual abuse (CSA) in sub-Saharan Africa remains unknown, this problem has become a focus of increasing public concern and outcry. Presented in this article are 4 of the 20 CSA cases treated at the Department of Obstetrics and Gynecology at the University of Malawi Hospital (Blantyre) in a recent 2-year period. The 4 girls, aged 2-7 years, were molested by men 20-70 years old well known to the families. Physical injuries included extensive third-degree perineal tears, lacerations of the lateral vaginal wall and vestibule, bruised labia majora, and torn hymen. In all 4 cases, the caretakers refused to report the assault to the police because of fear of social stigma and the likelihood of a hostile response on the part of authorities. Despite instructions to return to the unit for follow-up, none of the children were seen after their injuries had been treated. Thus, no information is available on long-term medical or psychological sequelae of the abuse. The guardians of 2 of the girls refused to authorize HIV testing; 1 of the 2 tested children had a positive result, but infection may have been acquired prenatally. In 2 cases, the child was living with her grandmother; in the remaining 2, both parents worked in the city and the children were in the care of a houseboy. Continued disintegration of traditional family structures is expected to contribute to increases in the prevalence of CSA in sub-Saharan Africa. Also of concern are cultural practices, such as the belief that sex with a virgin child can cure sexually transmitted diseases or bring riches, as well as a tendency for adult males to attempt to avoid HIV infection through sex with children. Prevention and management of CSA require public awareness campaigns, the design of protocols for the treatment of child victims, guidelines for the management of immediate families and assailants, health personnel training, and enforcement of appropriate legal provisions.

Language: en