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A Comparative Study on Prevalence, Pattern and Determinants of Sexual Abuse Amongst Adolescents in Selected Slum and Non-Slum Communities In

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A Comparative Study on Prevalence, Pattern and Determinants of Sexual Abuse Amongst Adolescents in Selected Slum and Non-Slum Communities In A COMPARATIVE STUDY ON PREVALENCE, PATTERN AND DETERMINANTS OF SEXUAL ABUSE AMONGST ADOLESCENTS IN SELECTED SLUM AND NON-SLUM COMMUNITIES IN LAGOS STATE. SUBMITTED BY DR. AKINSULIRE OLUWADAMILOLA OLABISI DEPARTMENT OF COMMUNITY HEALTH LAGOS UNIVERSITY TEACHING HOSPITAL IDI-ARABA, LAGOS STATE TO THE NATIONAL POSTGRADUATE MEDICAL COLLEGE OF NIGERIA IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE AWARD OF THE FELLOWSHIP OF THE MEDICAL COLLEGE IN PUBLIC HEALTH (FMCPH) MAY, 2017. i DECLARATION I hereby declare that this Part II Dissertation titled “A comparative study on prevalence, pattern and determinants of sexual abuse amongst adolescents in selected slum and non- slum communities in Lagos.” is my original and individual work. It has not been submitted in part or in full for any other examination. It was done under the supervision of DR KA ODEYEMI (MBBS, MPH, FMCPH, FWACP) ii DEDICATION This work is dedicated to the Almighty God, who has brought me this far. It is also dedicated to my everlasting treasures, Adewole, David and Adejola. iii CERTIFICATION This is to certify that Akinsulire Oluwadamilola Olabisi of the Department of Community Health and Primary Care, carried out this project titled “A Comparative Study on Prevalence Pattern and Determinants of Sexual Abuse amongst Adolescents in Selected Slums and Non-Slums Communities in Lagos” under my supervision. iv ATTESTATION I attest that this work “A COMPARATIVE STUDY ON PREVALENCE, PATTERN AND DETERMINANTS OF SEXUAL ABUSE AMONGST ADOLESCENTS IN SELECTED SLUM AND NON-SLUM COMMUNITIES IN LAGOS” was done by Dr. (Mrs.) Akinsulire Oluwadamilola Olabisi under the supervision of Dr. K.A. Odeyemi and it was presented to the Department of Community Health, LUTH on Wednesday, November 30th, 2016 in accordance with the requirements of the National Postgraduate Medical College of Nigeria. v ACKNOWLEDGEMENT I am indeed most grateful to God Almighty who has brought me to this very point in my Residency training. Sincere appreciation goes to my Supervisor, Associate Prof K.A Odeyemi who has been most patient and supportive. Your continuous scrutiny and drive for excellence has propelled me to higher heights. Thank you for believing and bringing out the best in me. I wish to thank Professor Onajole, Dr IP Okafor, Dr Roberts and Dr Ogunnowo for their encouraging words and support all through my Residency programme. To Olajumoke Olufemi, thank you for being a supportive friend. Many thanks to my parents who have always believed in me and supported me. To my siblings Deji, Demilade and Damola, thanks for believing in your Big Sis. To David and Adejola – you are the best gifts of God to me To my Rock and pillar of support “Adewole” What could I have done without you? Thank you for the love we share. vi TABLE OF CONTENTS Page Title Page… … … … … … … … … … … i Declaration… … … … … … … … … … … ii Dedication… … … … … … … … … … … iii Certification… … … … … … … … … … iv Attestation … … … … … … … … … … v Acknowledgement… … … … … … … … … … vi Table of Contents… … … … … … … … … … vii List of Tables… … … … … … … … … … ix List of Figures… … … … … … … … … … xi List of Abbreviations… … … … … … … … … xii Summary… … … … … … … … … … … 1 Definition of terms… … … … … … … … … … 3 Chapter One: Introduction… … … … … … … … … … … 4 Objectives… … … … … … … … … … … 12 Chapter Two: Literature Review… … … … … … … … 13 Chapter Three: Methodology… … … … … … … … 37 vii Chapter Four: Result… … … … … … … … … 57 Chapter Five: Discussion… … … … … … … … … 103 Conclusion. … … … … … … … … … … 117 Recommendations… … … … … … … … … … 118 References… … … … … … … … … … … 121 Appendix I: Ethical clearance from LUTH ethical board … … … … 140 Appendix II: Parents/caregivers Informed consent form… … … … … 141 Appendix III: Respondents consent form and questionnaire … … … 143 Appendix IV: Questionnaire on Prevalence, Pattern and Determinants of Sexual Abuse Amongst adolescents in Slum and Non Slum communities of Lagos State … … … … … … … … 145 Appendix V: Thematic guide for focus group discussion… … … … 173 Appendix VI: List of designated slums and their corresponding LGAs… … … 175 Appendix VII: Sample Pictures during questionnaire administration … … … 177 Appendix IX : Map of Lagos state … … … … … … … 179 Appendix VIII: FGD Report … … … … … … … … 180 viii LIST OF TABLES Page Table 1: Socio-demographic characteristics of respondents 57 Table 2: Respondents source of income and living arrangement 59 Table 3: Socio-economic characteristics of respondents parents 61 Table 4: Respondents lifestyle and social habit 63 Table 5: Respondents experience of sexual abuse and perpetrator characteristic 64 Table 6: Pattern of sexual abuse amongst adolescents in slums and non-slums 67 Table 7: Respondents experience of threat to sexual abuse and perpetrators age. 71 Table 8: Location of abuse and respondent’s disclosure of sexual abuse experience. 72 Table 9: Reporting pattern following sexual abuse 74 Table 10: Respondents discussion with parents/ guardians on issues related to sexual abuse 75 Table 11: Effect of sexual abuse 76 Table 12: Rosenberg self-esteem scale of respondents who had been victims of sexual abuse 78 Table 13: Rosenberg self-esteem scale of victims of sexual abuse 2 79 Table 14: Rosenberg self-esteem score 80 Table 14b: Rosenberg self-esteem score for the non-sexually abused participants 80 Table 15: Association between socio-demographic characteristics and sexual abuse 81 Table 16: Association between living arrangement of respondent’s parents, and sexual abuse 83 Table 17: Association between living arrangements, social habits of respondents and sexual abuse 85 ix Table 18: Association between socio-economic characteristics of respondent’s parents and sexual abuse 87 Table 19: Simple and multiple logistic regressions of experience of sexual abuse on associated factors in slum 89 Table 20: Simple and multiple logistic regressions of experience of sexual abuse on associated factors – Non-slum 91 Table 21: Perceived prevalence of sexual abuse 94 Table 22: Perception of what constitutes sexual abuse 96 Table: 23: Factors contributing to sexual abuse 97 Table 24: Consequences of sexual abuse 100 Table 25: Support system for sexual abuse 101 x LIST OF FIGURES Figure 1: Prevalence of sexual abuse 66 Figure 2: Prevalence of sexual abuse disaggregated by community 66 Figure 3: Venn diagram of type of sexual abuse experienced in the slum communities 69 Figure 4: Venn diagram of type of sexual abuse experienced in the non-slum communities 70 Figure 5: Type of unwanted experience (sexual abuse) 73 Figure 6: Reproductive problems encountered 91 Figure 7: Word cloud generated from analysis of FGD 102 xi LIST OF ABBREVIATIONS AIDS Acquired immune deficiency syndrome ASRH Adolescent Sexual Reproductive Health CDC Centre for Disease Control and Prevention CRA Child Rights Act CRC Convention on the Rights of the Child CSA Child Sexual Abuse ICPD International Conference on Population and Development LCDA Local Council Development Area LGA Local Government Area MDGS Millennium Development Goal OR Odds ratio SDGS Sustainable Development Goal SRH Sexual and Reproductive Health STD Sexually transmitted Disease UN United Nations UNFPA United Nations Population Fund UNICEF United Nations Children’s Fund WHO World Health Organization xii SUMMARY Background: Sexual abuse of adolescents is a serious public health, social and human rights problem affecting millions of people. This study compared the prevalence, patterns and determinants of sexual abuse amongst adolescents in slums and non-slum communities in Lagos state. Methods: This was a comparative descriptive cross-sectional study. A total of eight hundred adolescents residing in slums and non-slum communities in Lagos state were selected using a multi-stage sampling technique for the study. An adapted, pre-tested, semi-structured interviewer-administered questionnaire was used for quantitative data collection while for the qualitative data, Focus Group Discussions were conducted. Data analysis was with Statistical Package for Social Sciences (IBM SPSS statistics) version 20 and WinPepi 11.30 software. Data was presented using Frequency tables and charts. Chi-Square tests were used to compare proportions; odds ratio and confidence intervals were also computed. Logistic regression was done to determine any associations between studied variables. Associations or differences was considered significant at p≤ 0.05 or if the confidence interval did not cross one. Results: The prevalence rate for sexual abuse among the adolescents was higher in the slums (76.8%) than in non-slum (58.3%) communities. Fondling, verbal harassment, unwelcomed kissing, exposure to pornography and forced sexual intercourse were the most reported type of sexual abuse in both communities. The main perpetrators in both communities were neighbors (27%) in slums and (22.7%) non-slums respectively while the teachers had the least number, 1% and 1.7% for slum and non-slum respectively. In both communities, more than half of the victims (59.3% in slums and 58.4% in non-slum communities) disclosed their sexual abuse experience, to mainly their family members and friends. The least disclosure was to the police and their parents. The predictors of sexual abuse in the slums were female sex, parent’s level of education and type of occupation. In the non-slums, predictors of sexual abuse were older age of adolescent, female sex, parents living together and mothers educational status. 1 Conclusion/Recommendations: Comprehensive reproductive
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