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)
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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.
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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.
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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.
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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.
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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
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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
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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
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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
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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
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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
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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.
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Conclusion/Recommendations: Comprehensive reproductive health education, female education, open discussions about sexuality and reproductive health matters with adolescents at family level are recommended.
Keywords: Sexual abuse, adolescents, slums, non-slums.
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DEFINITION OF TERMS
Extra-familial member- anyone who has no blood related union to the sexual abuse victim
(friends, acquaintances, neighbors, etc…)
Intra-familial member- blood related union to the victim (father, mother, brother, uncle, aunt, nephew, etc…)
Sexual exploitation is the act of rendering assistance (physical or moral) to an adolescent with the purpose of taking sexual advantage of an adolescent.
Sexual abuse is any form of unacceptable sexual contact expressed to an adolescent which may be in form of Sexual harassment (verbal/nonverbal), sexual exploitation, pornography, etc.
Verbal Sexual Harassment is any act of unacceptable comments of a sexual nature which may or may not be accompanied by threat or force expressed toward an adolescent.
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CHAPTER ONE
INTRODUCTION 1.0 Background
Sexual abuse is a hideous crime. For the vast majority of people, the idea of violating, hurting and abusing a child/adolescent is intolerable, deplorable and despicable. Nonetheless, these crimes are not as rare as we would like to think or imagine. Every day, countless children and adolescents around the world are sexually abused and exploited, to the extent that sexual abuse is increasingly being recognised as a major public health concern globally.1 The sexual abuse of adolescents is as pervasive in Sub-Saharan Africa as it is in other parts of the world. As elsewhere, it is most commonly perpetuated by family members, relatives, neighbours and others known to the adolescent victim.1 The special circumstances in which adolescents especially girls find themselves in Nigeria expose them to possible risks of sexual abuse which in turn increases their vulnerability to early pregnancy, Sexually transmitted Infections and
HIV/AIDS.2
According to the Convention of the Rights of a Child (CRC) in Geneva 1989, a child is “a human being below the age of 18 years unless under the law applicable to the child, majority is attained earlier”.3 The World Health Organization (WHO) defines adolescents as those people between 10 and 19 years of age. The great majority of adolescents are, therefore, included in the age-based definition of “child”, adopted by the CRC.3 Child sexual abuse is defined as the involvement of a child in sexual activity that he or she does not fully comprehend, is unable to give informed consent to, or for which the child is not developmentally prepared and cannot give consent, or that violates the laws or social taboos of society.4
Sexual abuse in adolescents is activity between an adolescent and a person who by age or development is in a relationship of responsibility, trust or power, the activity being intended to 4 gratify or satisfy the needs of such person. This may include but not limited to the inducement or coercion to engage in any unlawful sexual activity, the exploitative use in prostitution, pornographic performance and materials or other unlawful sexual practices.4
Sexual abuse is a violation perpetrated by a person who holds, or is perceived to hold, power over someone who is vulnerable. The abuse may have physical, verbal and emotional components. It includes such sexual violations as rape, sexual assault, sexual harassment, incest, and sexual molestation. The victim experiences sexual activity that is neither wanted nor agreed to. Sexual abuse is a pervasive public health problem that affects us all directly or indirectly. It is not peculiar to any particular race or socio-economic class. The actual rates of child and adolescent sexual abuse may not be fully known because of significant barriers victims and community leaders face in reporting cases. This low rate of reporting cases leads to a cycle of reduced public awareness and limited preventive and intervention measures which further emboldens perpetrators thereby making the rates of sexual abuse high. Sexual abuse can cause many short and long-term struggles for victims, offenders, families, communities, and the larger society.2
1.1 STATEMENT OF THE PROBLEM
A World Health Organization review of research estimated the global prevalence of sexual abuse to be about 27% among girls and around 14% among boys.5 The WHO reports that one in every five women has been a victim of sexual assault and globally, 35% of women have experienced either physical and/or sexual violence in childhood.5,6 The regions of the world with the highest reported rates of sexual abuse are Africa, the Middle East and Southeast Asia.5
In 2009, another study estimated the global prevalence of sexual abuse to be 19.7% for females and 7.9% for males.7
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In Africa, 5–15% of the females report a forced or coerced sexual experience.8 In South Africa, prevalence of forced sexual intercourse, from community based reports show a figure of 2070 per 100,000 per year.9 Ethiopia reported that out of 367 high school girls, 11.4% of them had started having intercourse and 33.3% of this group was rape.10 Reports have also shown that adolescents have the highest rates of rape and other sexual assaults of any age group.11
Similarly in West Africa, Ghana reports that 1 in 3 women had been fondled or touched against their will with most cases of sexual abuse occurring between the ages of 10 – 18 years.5
Sexual abuse of young people is a problem in Nigeria, the true extent of its prevalence remains unknown because much of it goes unreported.2 The reported incidence of sexual abuse varies depending on study design and methodology. A study in Ibadan showed that 15% of young females reported forced penetrative sexual experience, while 13.8% prevalence rate was found in female students in Maiduguri.12,13 True incidences are largely inaccurate and often underestimated since most cases of sexual abuse are under-reported by the victims because of the associated stigma.13
Sexual abuse experienced in childhood or adolescence is a developmental stressor that can have profound, long term physiologic and psychosocial effects. The violence involved in an attempted sexual assault can have the same impact on the survivor as a completed one. The impact can be immediate or delayed with long-term health consequences for survivors.
Significant social and economic consequences can also occur. Health consequences include physical injuries, unwanted pregnancies, unsafe abortions and sexually transmitted diseases, including HIV. Immediate psychological reactions such as shock, shame, guilt and anger may be exhibited while long-term psychological outcome include depression, post-traumatic stress disorder, suicidal ideation, lack of sexual enjoyment, and fear.14 Adolescents are particularly susceptible to HIV transmission through forced and unforced sex because their vaginal mucous
6 membranes have not yet acquired cellular density significant to provide an effective barrier that develop in later teenage years.6 In Nigeria, cases of sexual assault are increasingly being reported. Lagos, like other megacities in the world over predisposes its women population to higher risks of sexual violence amongst other crimes.15 Despite this, many Nigerian researchers have not given adequate attention to this subject.
1.2 JUSTIFICATION OF THE STUDY
Nearly one third of Nigeria’s total population is between the ages of 10 and 24 i.e about fifty million. With an estimated population of over 30million, Nigerian adolescents’ sizeable share of the population makes them integral to the country’s social, political and economic development.16 Nigeria’s development is therefore severely compromised by the sexual and reproductive health issues afflicting its youth. Young people face numerous health challenges during their transition to adulthood. These challenges include, among others, limited access to
Sexual and Reproductive Health (SRH) information and services. Unmet SRH needs among adolescents may contribute to Sexually Transmitted Infections (STIs), including HIV, and unintended pregnancies. Adolescent pregnancies are associated with several adverse outcomes, such as miscarriage, unsafe abortion, obstructed labour, and other complications, which can result in long-term morbidity and even death.17 Adolescents and young adults are the most at risk group of sexual violence. The vulnerability of this group is thought in part to be related to low socioeconomic status and inexperience in matters of sexuality as reported in several studies.18-20
More than 50% of the world’s population live in urban areas.16 The new face of rapid urbanization is the presence of urban slums which are settlements with inadequate social, environmental and societal care facilities. While Asia has the largest number of urban slum residents, Africa is urbanizing faster than any other continent and according to 2007 report by
7 the United Nations Population Fund, 72% of city residents in sub-Saharan Africa live in slums.21 With the increasing population which inhabit slums in sub-Saharan Africa, health issues of the urban poor are intensified and brought to fore. Since human settlement is now overwhelmingly urban and urbanization is likely to persist and intensify, cities commonly seen as potential drivers of sustainable development can also be the same barriers to it.22 The increasing dominance of urbanization impacts across all dimensions of global change and makes intervention at the urban scale imperative to achieve sustainable development.
The United Nations projected that in 2017, rural population will begin to decrease such that more population will be in urban areas with increased development of slums.21 Sadly, the proliferation of slums is a phenomenon with which Nigeria has struggled for some time. In
Nigeria, adolescents make up a considerable proportion of urban populations, and many of them live in the numerous informal settlements or slums.16,21 Adolescents living in the slums face a distinct set of challenges as they develop into adulthood in a hostile environment characterized by high levels of unemployment, crime, poor sanitation, substance abuse, poor education facilities, and lack of recreational facilities. Unmarried adolescent girls also experience multiple forms of violence at home, in romantic relationships and in the community. Circumstances in the slums have begun to shift to allow girls to become important contributors to family income, girls have become more mobile and independent. Unfortunately, these new roles have advanced more quickly than the traditional, patriarchal ideology that condones the control of girls through further restrictions and violence. While much has been done to provide insights into adolescents’ SRH outcomes in the country, little attention has been paid to understanding and meeting the SRH challenges and needs specific to adolescents living in resource-poor urban settings, such as the slums of Lagos Nigeria.
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This is a priority area for research, as the wellbeing of the urban poor will increasingly drive national development indicators, including health and poverty, in Nigeria. Furthermore, the
International conference on population and development beyond 2014 report clearly posits the need to focus on slums that “as Urbanization progresses, the conventional stratification of rural or urban may no longer offer adequate analytical insight to health differentials” Research data should include more detailed information to define urban categories such as slum and non- slums to enable planners identify intra city and intergroup commonalities and develop targeted interventions.22 Studies available on sexual abuse have shown disparities in urban and rural areas but only a few have attempted to compare the differences of adolescents residing in urban slum and non-slum areas. It is in recognition of the challenges posed by the proliferation of slums that Target 7.d of the Millennium Development Goals (MDGs) sought to improve the lives of at least 100 million slum dwellers by the year 2020. The goal was to focus on empowering inclusive, productive and resilient cities with focus on slums and urban violence.23
One of the targets (goal 4) of the SDGs is to prevent and eliminate violence against women and children by closely monitoring percentage of referred cases of sexual and gender based violence against women and children that are investigated and sentenced.24 It is clear that a lot of attention needs to be paid to adolescents in slum areas, but do adolescents resident in slums differ from their counterparts in non-slum communities in terms of exposure to sexual abuse?
Socioeconomic hardship in slum areas may predispose adolescents more to sexual abuse than those in non-slum communities. Further research is needed to unravel this.
Adolescent sexual abuse might appear to occur more frequently among underprivileged families because of the disproportionate number of Sexual Abuse cases that come from lower socioeconomic classes.25 In terms of the presupposed impact of socioeconomic status and ethnic background, the existing literature has many weaknesses and obvious contradictions.
Overall, while low family or neighbourhood socioeconomic status is a great risk factor for
9 physical abuse and neglect, its impact on sexual abuse is not as proven. Some recent population-based studies are showing that, amongst other factors, living in poverty is a predictive factor for children and Adolescents to be subjected to both physical and sexual abusive experiences.26
This study focuses on adolescents who reside in slum and non-slum communities. The study compared the prevalence, pattern and determinants of sexual abuse amongst adolescents dwelling in slum and non-slum communities and highlighted possible differences in risk and the challenges of disclosing sexual violence and seeking services. The findings generated from this study will contribute to the design and implementation of appropriate SRH intervention programs that will respond to the unique needs of adolescent boys and girls especially those living in poor urban settings.
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RESEARCH QUESTION
Is there a difference in the prevalence, pattern and determinants of sexual abuse amongst adolescents who reside in slums compared to those who live in non-slum communities?
Hypotheses Null (Ho) -There is no difference in the prevalence, pattern and determinant of sexual abuse amongst adolescents in slum communities compared to those living in non-slum communities.
Alternative (H1) - There is a difference in the prevalence, pattern and determinants of sexual abuse amongst adolescents in slum communities compared to those who do not live in slums.
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1.3 OBJECTIVES
1.3.1 GENERAL OBJECTIVE
To compare the prevalence, pattern and determinants of sexual abuse amongst adolescents residing in slum and non-slum communities of Lagos state.
1.3.2 SPECIFIC OBJECTIVES
1. To determine and compare the prevalence of sexual abuse amongst adolescents in the
slums and non-slum communities.
2. To determine and compare the patterns of sexual abuse amongst adolescents residing
in the slum and non-slum communities.
3. To identify factors associated with sexual abuse amongst adolescents who reside in the
slum and non-slum communities.
4. To determine the consequences of sexual abuse on the mental health status of the
adolescents.
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CHAPTER TWO
LITERATURE REVIEW
2.1 HISTORY OF SEXUAL ABUSE
Child/Adolescent sexual abuse has gained public attention in the past few decades and has become one of the most high-profile crimes. Since the 1970s the sexual abuse of children and
Adolescents has increasingly been recognized as deeply damaging and thus unacceptable for society as a whole. While sexual use of children by adults has been present throughout history, it has only become the object of significant public attention in recent times.27 The first published work dedicated specifically to sexual abuse appeared in France in 1857 was published in the Medical-Legal Studies of Sexual Assault by a notable French pathologist and pioneer of forensic medicine.27 By the 1970s and 1980s, sexual abuse became a public issue.
Prior to this point in time, sexual abuse remained rather secretive and socially unspeakable.
With the adoption of the Convention on the Rights of the Child on 20 November 1989 by the
United Nations, sexual abuse is outlawed nearly everywhere in the world, generally with severe criminal penalties, including in some jurisdictions, life imprisonment or capital punishment.28
The United Nations CRC is an international treaty that legally obliges countries to protect children's rights. Articles 34 and 35 of the CRC require States to protect children from all forms of sexual exploitation and sexual abuse. This includes outlawing the coercion of a child to perform sexual activity, the prostitution of children, and the exploitation of children in creating pornography.
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2.2 DEFINITIONS OF SEXUAL ABUSE
There is currently no widely accepted definition of sexual abuse. Some have used sexual violence and abuse interchangeably. Multiple definitions and terms co-exist in a number of contexts, for example, within the criminal and civil law, in the area of child protection and in applied and academic research. In recent years, the term ‘sexual abuse’ has become widely associated with the sexual assault of children.29 Sexual abuse against adolescents is defined as a situation in which adolescents are used for the sexual pleasure of an adult or older adolescent,
(legally responsible for them or who has some family relationship, either current or previous),which ranges from petting, fondling of genitalia, breasts or anus, sexual exploitation, voyeurism, pornography, exhibitionism, to the act of sexual intercourse itself, with or without penetration.30
Sexual abuse is also defined as any sexual act, attempt to obtain a sexual act, unwanted sexual comments or advances, or acts to traffic, or otherwise directed, against a person’s sexuality using coercion, by any person regardless of their relationship to the victim, in any setting, including but not limited to home and work.31 The WHO consultation on child abuse prevention defines Sexual abuse as the involvement of a child or adolescent in sexual activity that he or she does not fully comprehend and is unable to give informed consent or that violates the laws or social taboos of society.4 It further states that sexual abuse is evidenced by sexual activity between a child and adolescent and an adult or another adolescent who by age or development is in a relationship of responsibility, trust or power, the activity being intended to gratify or satisfy the needs of the other person. This may include but not limited to: the inducement or coercion of an adolescent to engage in any unlawful sexual activity, the exploitative use of a child and adolescent in prostitution or other unlawful sexual practices and their exploitative use in pornographic performance and materials.
14
On the other hand, the American Academy of Paediatricians (AAP) has defined Sexual abuse as the engagement of a child and adolescent in sexual activities that he/she cannot comprehend and is developmentally unprepared for and cannot give informed consent to.32 Also, sexual abuse is defined by the Child Abuse Prevention and Treatment Act of the United States of
America as the employment, use of persuasion, inducement, enticement, coercion to engage in, or assist any other person to engage in, any sexually explicit conduct or simulation of such conduct for the purpose of producing a visual depiction of such conduct.33 In Nigeria, there is no clearly elaborate definition of sexual abuse in the national legislation. However, Section 34 of the 1999 Constitution prohibits all forms of torture, inhuman or degrading treatment, and slavery, forced or compulsory labour and ensures the child’s right to dignity of his/her person.34
2.3 SEXUAL ABUSE IN ADOLESCENTS
The WHO identifies adolescence as the period in human growth and development that occurs after childhood and before adulthood, from ages 10 to19 and defines a child according to the convention of the rights of a child as any human being below 18 years of age.3 The Child Right's
Act 2003 of the Federal Republic of Nigeria also defines a child as a person who has not attained the age of eighteen years.35 The great majority of adolescents are, therefore, included in the age-based definition of “child”, adopted by the CRC, as a person under the age of 18 years.
Adolescence is considered a developmental period with high vulnerability to physical and psychosocial risks.36 Sexual abuse is a violation of basic human rights and is the outcome of a set of interrelated familial, social, psychological, and economic factors. The problem of sexual abuse and human rights violations is one of the most critical matters on the international human rights agenda.37 Sexual abuse of children and adolescents exists across cultural and societal boundaries, despite variations in its prevalence, form, and definition. Its wide-spread presence
15 in both developing and developed countries is well documented.17-20,38 Available data suggest that in some countries nearly one in four women may experience sexual violence by an intimate partner, and up to one-third of adolescent girls report their first sexual experience as being forced.
Sexual abuse in children and adolescents includes any activity before the age of legal consent, that is for the sexual gratification of an adult or a significantly older child.20 It is a serious breach of basic human rights and is responsible for numerous adverse sequelae. These sequelae include depression, anxiety eating disorders, poor self-esteem, post-traumatic stress disorder, school/learning problems, behaviour problems including substance abuse, destructive behaviour, criminality in adulthood, and suicide.39 Sexual activities may include all forms of oral-genital, genital, or anal contact, or sexual abuse that does not involve contact such as exhibitionism, voyeurism, or using the child in the production of pornography.31 Injury from sexual abuse ranges depending on the age and size of the child/ adolescent and the degree of force used. Sexual abuse may cause internal lacerations and bleeding in severe cases, and damage to internal organs that, in some cases, may cause death.40 Sexual abuse can also profoundly affect the social wellbeing of victims; individuals may be stigmatized and ostracized by their families.
Evaluation of sexually abused children and adolescents must therefore be accurate to ensure legal validity and should be performed with diligence. Diagnosis of Sexual abuse still depends mainly on the child’s and adolescent’s allegation of abuse, while anogenital examination yields minimal medical evidence of sexual abuse. Legally confirmed cases of sexual abuse, mostly children do not have physical findings diagnostic of sexual abuse. Therefore, disclosure is often the most important piece of information in determining abuse.32 A wide range of activities occur in sexual abuse, including contact and noncontact activities. The World Health
16
Organization definition of childhood sexual abuse captures the penetrative and non-penetrative forms of sexual abuse.41
Contact sexual abuse can be penetrative or non-penetrative. Non penetrative abuse includes sexualized kissing, fondling, masturbation while the penetrative includes digital and/or object penetration of the vagina and/or anus, as well as oral-genital, genital-genital, and anal-genital contact.42 Noncontact activities include exhibitionism, inappropriate observation of a child,
(while the child is dressing, using the toilet, bathing), the production or viewing of pornography, or involvement of children in prostitution. The sexual activities are imposed on the child and represent an abuse of the caregiver's power over the child. The sequence of activities often progresses from noncontact to contact over a period of time during which the child's trust in the caregiver is misused and betrayed.42
Sexual abuse is a serious problem that transcend racial, economic, social and regional lines.
Violence is frequently directed toward females and youth, who lack the economic and social status to resist or avoid it. Accurately estimating the prevalence of sexual abuse and violence in the developing world is difficult due to the limited amount of research done on the subject.
Cultural mores against reporting abuse make it difficult to assess accurately, and few adolescent health programs in sub-Saharan African address these critical issues.
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2.4 PREVALENCE OF CHILD AND ADOLESCENT SEXUAL ABUSE
A 2009 Meta-analysis study from the University of Barcelona analysed 65 research studies across 22 countries to estimate an overall international figure for sexual abuse. An estimated
7.9% of men and 19.7% of women globally experienced sexual abuse prior to age of 18. In the
US, rates were 7.5% for males and 25.3% for females. The highest prevalence rate of child sexual abuse geographically was found in Africa (34.4%). Europe showed the lowest prevalence rate (9.2%) while America and Asia had prevalence rates between 10.1% and
23.9%. South Africa has the highest prevalence rates for both men and women (60.9%) and
(43.7%) respectively.7 Jordan presents the second highest prevalence rate for men (27%) followed by Tanzania (25%). The prevalence of sexual abuse in other parts of Africa is varied between 16% in Cameroun, 23% in Sierra Leone, 34.4% in Ethiopia, 49% in Ghana to 65.6% in Zimbabwe, and 67% in Botswana.43,44
Studies in Nigeria showed that the prevalence of sexual abuse ranges 2.1% to77.7%.45,46
This very wide disparity could have been due to the differences in the definition of sexual abuse, study designs and study population in the different studies. A community based study in the south-eastern geopolitical zone of Nigeria which studied only penetrative exposure reported a slightly lower prevalence of 21.3%.47 This is unlike a community based study in an urban area in the south-western geopolitical zone of Nigeria which reported a sexual abuse prevalence of 38% and 28% occurring in female and male respondents respectively.7 This study included all the forms of sexual abuse as outlined in the WHO’s definition.
A study on penetrative abuse conducted amongst out of school adolescents (female apprentices) in Ibadan found a prevalence of 19% which was quite lower than that conducted amongst school going adolescents in an urban area of south western Nigeria (55%).48,49 This high prevalence amongst school going adolescents is also found in a study among urban
18 secondary school students in Zimbabwe with a prevalence of 56.3%.50 The high prevalence among school-going adolescents may be attributed to the perceived low supervision of parents over children/wards, especially in urban population.49 Also those who had ever been to school have had greater interaction with men since going to and returning from school offers the opportunity to be away from adult supervision. Therefore, such girls may meet their sexual partners either on their way to school or from school. Those who had never been to school on the other hand may not have a reason good enough to be away from home.
Another possible reason for the disparity is that the latter study considered all the forms of CSA while the former was limited to penetrative form. A study in north-eastern Nigeria revealed a female CSA prevalence rate of 77.7%.51 The population studied consisted mostly of female hawkers and shop-helps who worked for an average of 8.5 hours a day. However, two studies in Anambra state, south-eastern Nigeria and Oyo State, south-western Nigeria found a prevalence of 60.9% and 55% respectively among female street hawkers.48,52 The lower prevalence seen in Oyo State could have been due to the fact that it was conducted in a single motor park compared to that in Anambra where a larger population involving two cities was studied. Another study in Kwara State, north-central part of Nigeria had a CSA prevalence of
50% among female prostitutes similar to that found in the Oyo study.53
A study among school-going adolescents in north-central Nigeria recorded a lower prevalence of 26%.54 This could probably be as a result of the cultural and religious factors encouraging early marriage, commonly occurring in the northern part of Nigeria, which may not be classified as CSA. Also, a study among Nigerian undergraduates reported a lower CSA prevalence of 13.3%.55 Unlike other studies, this study defined the age limit of CSA as 15 years, this may contribute to the seemingly lower prevalence noted.
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Lower prevalence rates have also been recorded where parents had to give information about sexual abuse exposure in their children. A study in south-western Nigeria showed that 2.1% of parents reported that their children were sexually abused.49 This result is similar to a study in north-central Nigeria in which 2.7% of parents reported that their children were sexually abused.56 This low prevalence could have resulted from withheld information by the parents or due to the fact that the affected children did not disclose their sexual experiences to their parents.56 Some studies have reported higher prevalence rates in clinical settings. Studies based on clinical records reported that 94% and 95.1% of all reported cases of sexual abuse occurred in children in Kano and Suleja respectively.57,58 Similar studies using clinical records in Benin and Jos noted that 56.6% and 63.8% of all sexual abuse cases occurred in children respectively.8,59 This differs from another health facility based study on prevalence of sexual abuse where a low prevalence of sexual abuse was obtained in most of the health facility based studies ranging from 0.06% in Zaria, 0.76% in Lagos, 2.1% in Calabar, to 5.2% of all gynecological emergencies in Ile-Ife.60, 61 The study setting, design and period may have accounted for the observed difference. In the Zaria study, the small sample size and issues with incomplete documentation could have accounted for the low prevalence. Generally, prevalence of sexual abuse in community based studies have been found to be higher than Health facility based studies. This could be due to the fact that penetrative type of sexual abuse was usually reported in the health facilities compared to other forms of sexual abuse. This high prevalence of sexual abuse in the community based study may not be unconnected with the fact that most cases of sexual abuse are unreported in health facilities by the victims out of fear of stigmatization, rejection by the society, and safety concerns, coupled with the fact that even for cases that are reported, the perpetrators are rarely prosecuted. Other forces believed to be responsible for the high prevalence of sexual assault in Nigerian include the enduring culture
20 of male dominance, female social and economic disempowerment, and lack of synergy in civil society initiatives.62
While the Nigerian Demographic Health Survey documented a 6.6% prevalence rate of experience of sexual violence among girls (ages 15 -19 years), a study conducted amongst out of school adolescents in Iwaya, Lagos, Nigeria showed that about 18% of out-of-school adolescent girls in the study population had experienced forced sex.63,64 In addition, about 45% of those girls had experienced statutory rape. The observations suggested that out-of-school girls might run a greater risk of being sexually abused than other members of the society.63
However, most studies in Nigeria haven’t compared slums and non-slum areas and how place and socioeconomic factors influence sexual abuse exposure. Only a few studies have been able to show that prevalence of child sexual abuse is more in boys in low resource areas compared to their counterparts in high resource areas whereas for girls, prevalence was not dependent on socioeconomic status.65
2.5 SEXUAL ABUSE CHARACTERISTICS: CHILDREN AND ADULT SURVIVORS
2.5.1 Age of Childhood Sexual Abuse
Young people are vulnerable to sexual abuse but there is some discrepancy in the available data about teenagers at higher risk or whether the risk is uniformly distributed. Some studies show a relatively uniform risk for children after age three while other studies find that older children are more likely to be abused.66 One study found that over half of the children who were sexually victimized were between 15-17 years old.67 Worldwide, 40-47% of sexual assaults are perpetrated against girls 15 years or younger.68
In a study in a South African hospital of children under age 15 in whom a diagnosis of child abuse was considered, 45% of the children reported having been the target of sexual abuse.69
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Thirty-one percent reported being physically abused, and sexual abuse was suspected but not confirmed in another 14 percent of the children.69 A study in Uganda revealed that 49% of sexually active primary school girls say they had been forced to have sexual intercourse.70
Abuse takes place in both urban and rural environments. A study in a rural population of South
Africa found that 51% of children between six months and 15 years of age receiving medical treatment for sexual abuse have been abused by a neighbour, an acquaintance, a lodger or a stranger.71 Studies conducted in a city in Zimbabwe found that half of reported rape cases involve girls less than 15 years of age and that girls are most vulnerable to sexual abuse by male relatives, neighbours and school teachers.72 Young girls frequently report that their early sexual experiences were coerced. In a study in South Africa, 30% of girls report that their first sexual intercourse was forced.73 In rural Malawi, 55% of adolescent girls surveyed report that they were often forced to have sex.74
Sexual exploitation of young people is frequently facilitated by their lack of economic power and job opportunities. In Addis-Ababa, Ethiopia, an estimated 30% (about 30,000) of prostitutes are women ranging from 12-26 years of age.75 The number of adolescent females engaged in informal prostitution may be far greater.75 Young girls are vulnerable to coercion into sexual relationships with older men. "Sugar daddies" take advantage of girls' lack of economic resources by promising to help with their expenses in exchange for sex.76,77 A study of female adolescents in Kenya revealed that 50% of the girls admit receiving gifts in the form of money, ornaments and clothes from their partners when they engaged in sex for the first time.78 In Uganda, 22% of primary school girls anticipate receiving gifts or money in exchange for sex.70 In a hospital study on abortion in Tanzania, nearly one third of adolescents receiving abortion were impregnated by men 45 years or older.79
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In villages in Ghana, 70% of mothers interviewed said they had encouraged young girls into premarital sexual relationships. Many older women felt that receiving gifts in exchange for sex was not regarded as prostitution but evidence of a man's love.80 Forced marriage of young girls to older males leaves girls with little or no economic or social power. In rural Northern
Ethiopia, the mean age for first marriage is 13.5 years for girls and 19.5 years for boys.81 While the average age at marriage is rising, twelve of sixteen countries included in the Demographic
Health Survey have an average age at first marriage of between 16 and 21.82
A study in North-Western Nigeria stated that the age group mostly exposed to sexual abuse was 3-5 years and this was followed by 11-15 years.58 However, a study in Enugu, South-
Eastern Nigeria noted that the highest incidence of sexual abuse occurred between ages 13-14 years followed by 15-16 years.52 This is in keeping with most studies that have reported that adolescent-age groups were mostly affected by sexual abuse.67,83,84 This finding among adolescents may be due to rapid growth and development associated with this phase; making them preys of sexual abuse. Contrasting with the above, some studies have reported a mean age of nine years for sexual abuse exposure.57,58,85 While another study revealed a mean age of
10 years for sexual abuse with about 20% of the children being less than five years.86 In the same light, another study in Maiduguri stated that girls below the age of 12 years were significantly more likely to be sexually abused than those above 12 years.51 This lower age of onset of sexual abuse exposure may be attributed to the poor supervision of parents and/or guardians.
2.5.2 Gender and Childhood Sexual Abuse
Both boys and girls can be victims of sexual abuse but it is well known that many more girls than boys are the victims of sexual abuse. Across different types of research, all reliable studies conclude that girls experience more sexual abuse than do boys.87 Females generally have been
23 reported to be more vulnerable to sexual abuse due to their being used more often as domestic servants and for child labour.61 In terms of risk factors, being female is considered a major risk factor for Sexual abuse as girls are about two times more likely to be victims than males.88,89
Several authors do, however, point out that there is a strong likelihood that boys are more frequently abused than the ratio of reported cases would suggest given their probable reluctance to report the abuse.90 A recent Canadian population-based study confirmed this assumption by showing that among CSA survivors, 16% of female victims had never disclosed the abuse, whereas this proportion rose to 30% for male victims.91
The WHO estimates that 1 in 4 girls and 1 in 6 boys experience sexual abuse.41 This finding by WHO agrees with other studies in Nigeria; which shows that the girl-child is more commonly sexually abused.82,92 Furthermore, one study reported that Sexual abuse is experienced by 15–30% of girls and 5–15% of boys while another one reported that Sexual abuse occurred in 71.3% of females and 26.3% of males.93,94 Additionally, some retrospective studies reviewing hospital records reported that the identified cases of Sexual abuse occurred only in females.57,58 This is unlike the other studies above where both genders were identified as victims.
Some studies have been able to show that prevalence of Sexual abuse is more in boys in low resource areas compared to their counterparts in high resource areas whereas for girls, prevalence was not dependent on socioeconomic status.65
2.5.3 Race and sexual abuse
Findings about race are inconclusive. Several studies have found that blacks and white children experienced near equal levels of sexual abuse.67 Other studies however have found that both
Blacks and Latinos have an increased risk for sexual victimization.95
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2.5.4 Family characteristics
Regarding family characteristics and sexual abuse, a study found more cases of sexual abuse among children from lower income backgrounds.67 Among cases coming to the attention of authorities, however, sexual abuse is less related to low income than other forms of child maltreatment. Studies have also found that sexual abuse is associated with other family problems, such as parental alcoholism, parental rejection and parental marital conflict.96
2.6 SEVERITY OF ADOLESCENT SEXUAL ABUSE
2.6.1 Frequency of abuse
The frequency of exposure to child sexual abuse is a measure of the severity of abuse.97 Studies have shown that experiencing one episode of Sexual abuse is often associated with further sexual victimization. A study on sexual abuse and mental illness noted that 63% of victims with mental illness had sexual abuse frequency of more than once while another study reported that 84% of all sexual abuse victims were abused more than once.98 Studies have shown that frequent abuses predisposes to greater severity of psychological disorder such as suicide and this is similar to another study which reported a significant association between mental illness in adult life and experiencing a Sexual abuse frequency of greater than five times.99,100
2.6.2 Type of abuse
The WHO definition of Sexual abuse captures the penetrative and non-penetrative forms of sexual abuse.41The non-penetrative or non-contact form varies from child pornography to all forms of sexual touch while the penetrative or contact involves vaginal, anal or oral penetration.41 The non-penetrative abuse may be difficult to attest because of the lack of clinical signs of abuse, unlike the penetrative forms. Nonetheless, research has shown that victims of abuse, whether penetrative or non-penetrative are unlikely to falsify claim of being abused and
25 thus should receive appropriate medical and psychological treatment.32 Even though, some studies have associated penetrative forms of abuse with mental illness in adulthood, it has been noted that all forms of abuse hampers on the child’s right and adversely affect their psychological development.85,99
Literature supports that sexual abuse involving contact or intercourse is more severe and associated with a more negative outcome in adulthood than the non-contact type of abuse.101
Several studies have shown that women with a history of CSA were more likely to experience rape as an adult and to be victims of domestic violence which raises the question as to whether
CSA is a vulnerability factor to further sexual abuse in and of itself. Studies have reported that not only is re-abuse common, it is also associated with poorer outcomes.102
2.6.3 Relationship of offender to child
Studies have associated severity of sexual abuse to the type of perpetrator, stressing that perpetrators within the family are associated with higher frequency of sexual abuse and thus more traumatizing.103,104 Girls sexually abused by family members, including victims of multiple perpetrators, had significantly higher levels of dissociation.105 Similarly, victims of father-daughter incest presented higher levels of disturbances across domains, including internalized (e.g. depression) and externalized (e.g. delinquency) behaviours.106
2.6.4 Duration of abuse
Severity of abuse can also be measured with the duration of abuse. The greater the duration of abuse, the more negative effects in the victim. Cumulative trauma has been found to have a more substantial effect than a single or less frequent abusive event.
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2.7 PERPETRATORS OF ADOLESCENT SEXUAL ABUSE
Just as it is difficult to create a simple profile of who will become victims of sexual abuse, it is equally difficult to create a profile of who will perpetrate sexual crimes. a. Gender: The perpetrators of sexual abuse are overwhelmingly males. Studies using the
law enforcement as well as victim self-report data found that more than 90% of
perpetrators of sexual offences against children were males.107 Most studies have
reported a predominance of male sexual abuse perpetrators, while a few others reported
only males as sexual abuse perpetrators.51,52,57 The studies that reported only males were
hospital based and the finding of only male perpetrators in these studies may not be
surprising as the study populations were sexual abuse victims being managed in the
hospital. Male-perpetrated abuse often induces perineal injuries, thus necessitating
hospital care for the child victim.103 On the other hand, female preponderance as
perpetrators has been documented in another study.84 This latter study contrasts with
the general notion that perpetrators are mainly males. Generally, these studies showed
that sexual abuse perpetrators were commonly people known to the victims.
b. Intra-familial and extra-familial perpetrators: Intra-familial sexual abuse (incest)
has been associated with more traumatic experiences, predisposing victim to mental
illness in later life. This is in keeping with studies that have reported higher prevalence
of incest-perpetrated abuse among subjects with mental disorders.98,99 However,
another study reported no significant association between the type of sexual abuse
perpetrator and mental illness in adulthood.45 It further opined that irrespective of the
type of perpetrator, intra-familial or extra-familial, exposure to sexual abuse is
associated with mental disorders. Extra-familial abuse, on the other hand has been
reported to have higher prevalence in some studies.55 Interestingly, majority of
Child/adolescent sexual abuse perpetrators were people the victim and their families
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had trusted. Despite this, research has shown that the abuse from stranger- higher
prevalence of incest-perpetrated abuse among subjects with mental disorders.98
However, another study reported no significant association between the type of
perpetrator and mental illness in adulthood.45 It further opined that irrespective of the
type of perpetrator, intra-familial or extra-familial, exposure to sexual abuse is
associated with mental disorders. Extra-familial abuse, on the other hand has been
reported to have higher prevalence in some studies.55,104 Interestingly, majority of
sexual abuse perpetrators were people the victim and their families had trusted. Despite
this, research has shown that the abuse from stranger-perpetrators is also not rare,
revealing a prevalence rate range from 3% to 20%.87 This herald the call for greater
watchfulness over children.
c. Age: Juveniles themselves commit a considerable proportion of sexual offences against
children, with estimates indicating about a third (ranging from 29-41%) are juveniles.
Among adult perpetrators, young adults, under the age of 30, are over represented.105
2.8 DISCLOSURE OF SEXUAL ABUSE BY VICTIMS
Disclosing sexual abuse is a complex process and when young people disclose sexual abuse, friends of their own age seem to be the most important receivers of the information. Young people’s difficulties to disclose are associated with both abuse factors such as severity and frequency, with the relation to the perpetrator and with family background factors such as family structure and living in a caring environment.
The fear of retribution and feeling of embarrassment, guilt and shame inhibit or delay disclosure of CSA by victims. A model of delay of sexual abuse disclosure posits three exogenous variables: child’s age at exposure, child’s gender and the category of abuse
28 perpetrator (intra-familial versus extra-familial).108 According to the model, younger children, females and victims of intra-familial perpetrated abuse were predicted to feel more responsible for the abuse and thus conceal it. Also, it further predicts that older children as well as victims of intra-familial abuse conceal abuse due to their greater awareness on the potential negative consequences of disclosure. Noteworthy, the failure or delay in the disclosure of CSA has been linked to mental illness in adulthood.98,99
The legal reporting that should promptly occur following disclosure by victims has been shown to be unacceptably low. While a study in Benin reported that only 7.1% of CSA victims legally report abuse, a similar study in Calabar noted that none of the victims reported legally.59,103
Interestingly, low prevalence of legal reporting of CSA victims has also been documented in developed countries.94, 101 However, the rates are even much lower in African setting. This is not surprising as the cultural practice in most African settings extols the virtue of a virgin bride and a court case would thus publicize the victim’s violation and bring shame.102
In a study in Sweden, most of the participants who reported sexual abuse and answered the question about disclosure had talked to somebody about the abuse (girls: 81.4%, boys: 69.1%).
Multivariate analyses showed that girls were less likely to disclose when they had been exposed to contact or penetrating abuse compared to non-contact abuse, being exposed to a single abuse occasion compared to more than five abuse occasions. This happens if the offender at first/only abuse occasion had been a family member/relative or friend/acquaintance compared to a stranger and if they had perceived their parents as non-caring when growing up. Boys were less likely to disclose when they participated in a vocational educational programme, they were living with both mom and dad and if they had perceived their parents as either caring and overprotective or non-caring and not overprotective.42
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2.9 DETERMINANTS AND FACTORS CONTRIBUTING TO SEXUAL ABUSE
The Ecological model of human development proposed by in 1979 has been used by several studies investigating risk and protective factors for sexual abuse.109 This framework places children/adolescents at the center of multiple interacting spheres of influence. Closest to the child/adolescent are relationships with caregivers and family. More distal are the ways in which child and family are influenced by school, community, society, and culture. The cumulative and counterbalancing effects of risk and protective factors within and across spheres, depending on their severity and strength, may lead to or prevent sexual abuse. This ecological theory provides a valuable framework to examine risk and protective factors for sexual abuse in Africa. Risk and protective influences on child/adolescent sexual abuse in Africa takes place within varied cultural contexts and highly constrained child protective services. Determinants of sexual abuse range from socio-demographic, economic, cultural and environmental factors.
Figure 1: Ecological Model describing the environmental influences on a child109
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2.9.1 Sociodemographic factors
Correlates of sexual abuse associations between child/adolescent sexual abuse and sociodemographic variables such as parent’s socioeconomic status, ethnicity/immigration, and family structure have been studied with contradictory results. In the literature, there is substantial agreement concerning family structure in that not living with both biological parents places a child/adolescent at higher risk for sexual abuse.110 Nevertheless, another study found no association between sexual abuse and living together with both, one, or no parent while some found weak or no associations between sexual abuse and parent’s socioeconomic class in most community studies. Associations between male sexual abuse and parental unemployment or unskilled labour have been identified but regarding community size, some studies have found no association with sexual abuse.42
2.9.2 Cultural factors
The social environment within a community is usually more important than the physical surrounding. Community beliefs in male superiority and male entitlement to sex greatly affects the likelihood of sexual violence taking place and the general tolerance in the community of child marriage. Childhood environments that are physically violent have been associated with sexual abuse. Sexually aggressive behaviour in young men has been linked to witnessing family sexual violence and having emotionally distant and uncaring fathers. Moreover, men raised in families with strongly patriarchal structures are likely to become violent, rapist and use sexual coercion against women.42 Some researchers have investigated factors responsible for sexual abuse. A study argued that patriarchy is a major socio-cultural factor that underlies the occurrence of sexual abuse in Nigeria. Yet it is clear that within the broad patriarchal social structure found in the Nigerian society, there are variations across specific sociodemographic boundaries.
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How deeply entrenched a community belief in male superiority and male entitlement to sex, will greatly affect the likelihood of sexual violence taking place, as will the general tolerance in the community of sexual abuse and sanctions for perpetrators. While various factors operate largely at local level, within families, schools, workplaces and communities, there are also influences from the laws and norms working at national and even international level. Weak laws for perpetrators of sexual abuse is a contributing factor to the repetition of such a crime.
Factors such as weak community sanctions, lack of institutional support from police and judicial systems, dysfunctional and unhealthy relationships characterized by inequality, power imbalance and conflict are associated with sexual abuse.111
2.9.3 Poverty
Poverty is linked to both the perpetration of sexual abuse and the risk of being a victim of it.
Several authors have argued that the relationship between poverty and perpetration of sexual abuse is mediated through forms of crisis of masculine identity. Poor women and girls may be more at risk of sexual abuse in the course of their daily tasks than those who are better off, when they walk home on their own from work late at night, or work in the fields or collect firewood alone. Children of poor women may have less parental supervision when not in school, since their mothers may be at work and unable to afford child care. The children themselves may, in fact, be working and thus vulnerable to sexual exploitation.112 Poverty forces many women and girls into occupations that carry a relatively high risk of sexual violence particularly sex work. Poverty, economic stress and unemployment are linked to both the perpetration of sexual violence and the risk of being a survivor. Early forced or arranged marriages are also associated with poverty. In addition, poor girls may engage in transactional sex with teachers, school staff or other adults to financially support their education with some parents turning a blind eye in their children’s sexual relations with teachers or other adults to mitigate lack of cash to support their schooling.113
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2.9.4 Substance/drug abuse
Studies have shown that individuals who abused drugs were more likely to be perpetrators of sexual abuse. Perpetrator use of alcohol or marijuana was found to be significantly associated with penetrative sexual abuse.110 Alcohol and other drugs consumption/abuse may increase vulnerability to sexual violence. Consuming alcohol or drugs by women makes it difficult for them to protect themselves by interpreting and effectively acting on warning signs. It may also place women in settings where chances of encountering a potential offender are greater.
2.10 CONSEQUENCES OF SEXUAL ABUSE
The health consequences of sexual abuse are numerous and varied, and include physical and psychological effects, both in the short-term and in the long-term. Most significantly perhaps, sexual abuse can have devastating long-term psychological effects, influencing and radically altering a person’s entire life course.
2.10.1 Psychological /mental effects
Child/Adolescent sexual abuse can result in both short-term and long-term harm, including psychopathology in later life. Indicators and effects include depression, anxiety, eating disorder, poor self-esteem, sleep disturbances and dissociative and anxiety disorders including post-traumatic stress disorder. While children may exhibit regressive behaviours such as thumb sucking or bedwetting, the strongest indicator of sexual abuse is sexual acting out and inappropriate sexual knowledge and interest.114 Victims may withdraw from school and social activities and exhibit various learning and behavioural problems including cruelty to animals,
Attention Deficit/hyperactivity Disorder (ADHD), conduct disorder, and Oppositional Defiant
Disorder (ODD). Teenage pregnancy and risky sexual behaviours may appear in adolescence.
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A well-documented, long-term negative effect is the repeated or additional victimization in adolescence and adulthood. A causal relationship has been found between childhood sexual abuse and various adult psychopathologies, including crime and suicide, in addition to alcoholism and drug abuse. Males who were sexually abused as children more frequently appear in the criminal justice system than in a clinical mental health setting. A study comparing middle-aged women who were abused as children with non-abused counterparts found significantly higher health care costs for the former. Intergenerational effects have been noted, with the children of victims of child sexual abuse exhibiting more conduct problems, peer problems, and emotional problems than their peers.115
Studies have found that sexually abused children exhibit psychological symptoms. The risk of harm is greater if the abuser is a relative, if the abuse involves intercourse or attempted intercourse, or if threats or force are used. The level of harm may also be affected by various factors such as penetration, duration and frequency of abuse, and use of force. The social stigma of child sexual abuse may compound the psychological harm to children, and adverse outcomes are less likely for abused children who have supportive family environments.116
2.10.2 Dissociation and posttraumatic stress disorder (PTSD)
Sexual abuse starting at early ages, has been found to be related to the development of high levels of dissociative symptoms, which includes amnesia for abuse memories. Some therapists believe that sexual abuse can cause enough trauma that the victim forgets or represses the experience as a coping mechanism. When severe sexual abuse (penetration, several perpetrators, lasting more than one year) had occurred, dissociative symptoms were even more prominent. Besides Dissociative Identity Disorder (DID) and Posttraumatic Stress Disorder
(PTSD), sexual abuse survivors may present Borderline Personality Disorder (BPD) and eating disorders such as bulimia nervosa.116
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2.10.3 Neurological damage
Research has shown that traumatic stress, including stress caused by sexual abuse, causes notable changes in brain functioning and development. Various studies have suggested that severe sexual abuse may have a deleterious effect on brain development.115
2.10.4 Other effects a. Injury: Depending on the age and size of the adolescent, and the degree of force used, sexual abuse may cause internal lacerations and bleeding. In severe cases, damage to internal organs may occur, which, in some cases, may cause death.114
b. Infections: Sexual abuse may cause infections and sexually transmitted diseases including
HIV/AIDS.114 Due to a lack of sufficient vaginal fluid, chances of infections may be higher depending on the age and size of the adolescent. Vaginitis has also been reported. c. Reproductive health problems: Sexual abuse may result in Unwanted pregnancy, unsafe abortion, Sexually Transmitted Infections (STIs), sexual dysfunction, infertility, pelvic pain, pelvic inflammatory disease and urinary tract infections. d. Social problems
Survivors of sexual abuse may experience difficulty in establishing interpersonal relationships.
Symptoms correlated with childhood sexual abuse may hinder the development and growth of relationships. Common relationship difficulties that survivors may experience are difficulties with trust, fear of intimacy, fear of being different or weird, difficulty establishing interpersonal boundaries, passive behaviours, and getting involved in abusive relationships. Some studies have examined the relationship between a person’s ability to adjust to an intimate relationship, depression, and level of severity of childhood abuse. Their study revealed that as the severity of abuse increased, the scores measuring the ability to adjust to intimate relationships decreased.123 Sexual abuse often is initiated by someone the child/adolescent loves and trusts,
35 which breaks trust and may result in him/her believing that people they love will hurt them.
Many survivors experience sexual difficulties.
The long-term effects of the abuse that the survivor experiences, such as, depression and dissociative patterns, affect the survivors sexual functioning. The top ten sexual symptoms that often result from experiences of sexual abuse are avoiding, fearing, or lacking interest in sex; approaching sex as an obligation; experiencing negative feelings such as anger, disgust, or guilt with touch; having difficulty becoming aroused or feeling sensation; feeling emotionally distant or not present during sex; experiencing intrusive or disturbing sexual thoughts and images; engaging in compulsive or inappropriate sexual behaviours; experiencing difficulty establishing or maintaining an intimate relationship; experiencing vaginal pain or orgasmic difficulties and experiencing erectile, ejaculatory, or orgasmic difficulties.117 Male victims of sexual abuse may experience erectile dysfunction, premature ejaculation, and low sexual desire.116
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CHAPTER THREE
METHODOLOGY
3.1 STUDY AREA
The study was conducted in Lagos State which is an administrative division of Nigeria, located in the south western part of Nigeria and lies approximately on longitude 20 420E and 30 220E respectively and between latitude 600220N and 600 42N. Lagos State was created on May 27,
1967 and took off as an administrative entity in 1968 with Lagos Island serving the dual role of being the State and Federal Capital. However, with the creation of the Federal Capital
Territory of Abuja in 1976, Lagos Island ceased to be the capital of the State which was moved to Ikeja. With the formal relocation of the seat of the Federal Government to Abuja on 12
December 1991, Lagos Island ceased to be Nigeria’s political capital. Nevertheless, Lagos remains the centre of commerce for the country. Lagos has always been Nigeria’s largest city but its rapid growth began in the 1980s and has continued to this day.118
Lagos state reached a mega city status (cities over 10 million) by 1995 and the State Bureau of statistics estimated that its population in 2011 was over 20 million. It was estimated that Lagos will be ranked as the third largest city in the world after Tokyo and Mumbai. Current assumptions indicate that Lagos should be planning for a city of just over 28 million by 2020.119
This represents an additional 7 million people living in Lagos state during the plan period.
Lagos state has historically been challenged by rapid urbanization and natural population growth. With its coastal location limiting expansion, the availability of land is a major issue.
After Cairo, Lagos is the fastest growing city in Africa – with a population, according to UN estimates, that will rise to 25 million by 2025.119 Adolescents make up 23% of the general population and a minimum of two out of three people in Lagos live in some form of slum accommodation with little access to clean water, electricity, waste disposal and other essential services.119
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According to the Lagos State Urban Renewal Agency (LASURA), Lagos is said to have 42 blighted/slum areas. This stratification is based on the availability of social amenities and infrastructure such as pipe borne water, electricity and good road networks.118 Though new slum areas are rapidly evolving, data collection, collation and documentation of the newly evolving slums are still ongoing. There are several Government agencies and Non-
Governmental Organizations (NGOs) in Lagos that focus on supporting survivors of sexual abuse such as the Mirabel centre in Lagos State University Teaching Hospital, Ikeja, Media concern for women and children in Lagos state, the Lagos state Ministry of women affairs,
Women advocate research and documentation centre, Office of the public defender and Project alert on violence against women.
3.1.1 Slum Communities in Lagos State
There are fourty two slum communities in Lagos state distributed across 17 LGAs (See appendix V) and are overcrowded with a population of over 250,000 living in substandard houses that lack basic facilities. These areas have been described as irregular or informal settlements with unhealthy living conditions.120 Five of these slums were selected for this study.
a. Ajegunle slum
Ajegunle, popularly known as the ghetto city has a population of 46,487. It is located in the south of Lagos and situated in Ajeromi Ifelodun LGA which is bordered on the west by Apapa
Wharf and Tincan, two of Nigeria's biggest sea ports from where over 70 percent of imported goods come into the country. Ajegunle is divided into two parts by the popular Ayeke bridge.
One part of Ajegunle is situated on heaps of refuse and swamp, and mostly inhabited by yorubas, urhobo, ijaw, bini, Isoko while the other part mostly inhabited by the Ibos is relatively cleaner but with poor road network. Most of the residents are traders, drivers, and conductors.121
38 b. Makoko Slum
The official record of people living in Makoko as at June 2016, is 71,909, as obtained from the
LGA but the Local Head of the community (Baale) says it is approximately 400,000. Makoko is situated on the Lagos mainland LGA and is a large low income community with half of the population on water and half on land. The area known to outsiders as Makoko is actually six distinct villages/clusters spread across land and water: Oko Agbon, Adogbo, Migbewhe,
Yanshiwhe, Sogunro and Apollo. The first four are the floating communities, known as
Makoko on water/Makoko waterfront, the rest are based on land. Almost every house in
Makoko waterfront has a canoe and the predominant occupation is fishing. More than 80% rent their rooms from landlords and an average of 6 to 10 people sleep in one room. Communal latrines are shared by about 15 households and waste water, excreta, kitchen waste go straight into the water.122
c. Badia Slum
Badia is located in the Apapa LGA and has 32 settlements. Most of these settlements are situated on heaps of refuse and swamp. Total population in Badia is 21,478. There is no predominant occupation in Badia unlike Makoko where the residents are into fishing. What thrives here mostly is merchandising, particularly domestic products like soap, buckets, drinks, food stuff, soup condiments and clothes. Only one public primary school exists in Badia but there are several privately owned substandard schools in Badia.
d. Ilaje Slum
Ilaje is one of the suburbs of Bariga in Somolu Local Government Area of Lagos state. It is bounded to the north by Gbagada, to the south by Akoka, to the west by Bariga and to the east by the 3rd mainland bridge. It is a sprawling slum located along the Bariga axis in Lagos, situated by the Lagoon characterised by substandard housing and lack of basic amenities. Total
39 population in Ilaje is 29,798 and it has a total of 30 streets. The predominant occupation of residents in Ilaje is fishing.120
e. Mushin Slum
Mushin slum is located in Mushin Local Government Area situated in the heart of Lagos. It is bounded in the North by Oshodi-Isolo Local Government to East by Shomolu Local
Government and in the South by Mainland Local Government. Mushin/Idiaraba has a population of 50,461 with 70 registered streets and is inhabited by Hausas, Yorubas and Igbos.
It is characterised by poor roads and overcrowding.120
Non Slum Communities
Lagos mainland is a local government area in the Lagos Division of Lagos State, Nigeria.
Eight Non slum communities were identified in Lagos Mainland, out of which Oyadiran estate was selected for the study. Oyadiran estate has a population of 24,616.
Ajeromi LGA: Six non-slum communities were identified out of which Wilmer was selected.
Wilmer is a non-slum area in Ajeromi Ifelodun with a population of 55,430.
Apapa LGA: A total of 10 non-slum communities were identified in Apapa LGA, out of which
Tincan was selected for the study. Tincan has a population of 9,812.
Mushin LGA: Papa Ajao was selected from a total of 11 non-slum communities identified in
Mushin LGA. Papa Ajao has 51 streets with a population of 42,829.
Somolu LGA: Eleven non-slums were identified, out of which Igbobi/Fadeyi was picked which has a population of 24,144.
These non-slum areas differ from slum areas because they are characterized by good road networks, presence of basic facilities such as pipe borne water and adequate security and basic amenities and these areas are not as crowded as the slums. High and Middle income earners reside predominantly in such communities.120
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3.2 STUDY DESIGN
It was a comparative descriptive cross-sectional study on the prevalence, pattern and determinants of sexual abuse amongst adolescents in selected slum and non-slum communities in Lagos state.
3.3 STUDY POPULATION
The study population comprised adolescents (10-19 years) residing in slum and non-slum communities in Lagos State.
Exclusion criteria:
1. Adolescents who had not lived up to 1 year in the community or were temporary visitors
in study area.
2. Adolescents who were ill at time of study.
3.4 SAMPLE SIZE ESTIMATION
In determining the sample size, the formula for the comparison of proportions of two independent groups was used. The level of significance (α) and the power of the study (1-β) was set at 5% and 80% respectively.123
n = (Zα + Zβ)2 {P1 (1-P1) + P2 (1-P2)}
(P1 – P2)
Where:
n = Minimum required sample size in each group.
Zα = Standard normal deviate corresponding to the probability of type
41
1 error (α) at 5% (95% confidence interval) = 1.96
Zβ = Standard normal deviate (at 80% power) corresponding to
probability of making a type II error (β) of 20%, power at 80% = 0.84
P1 = Prevalence of sexual abuse amongst adolescents in slum area 55%
or 0.5548
P2 = Prevalence of sexual abuse amongst adolescent in a non-slum area.
40% or 0.40124
P1-P2 = minimum expected difference between the prevalence of sexual
abuse in slums and non-slum communities.
= (1.96+0.84)2 {(0.55(1-0.55) +0.40 (1-0.40)} = 169 (0.55-0.40)2
The calculated sample size was increased by 10% to compensate for non-response and incompletely filled questionnaires, 169 × 0.1=16.9
Thus the desired sample size, n= 169 + 17=186
One hundred and eighty-six adolescents should be interviewed for each group. However, to make up for loss of randomness, a design effect of 2 was used because some of the respondents in the slum communities were picked in clusters.
Sample size calculated was 372 per group. However, this was rounded up to 400 respondents per group to make a total of 800 respondents.
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3.5 SAMPLING TECHNIQUE Slum communities
A multistage sampling technique was used to select the communities.
Stage one: Selection of Five Local Government Areas from Seventeen LGAs with the designated slum areas. Five local government areas, were selected by simple random sampling through balloting from a list of seventeen LGAs which had the designated slums. These were
Lagos Mainland LGA, Ajeromi- Ifelodun LGA, Apapa LGA, Mushin LGA and Somolu LGA.
Stage two: Selection of slums
Lagos mainland LGA has 4 slum areas: Iwaya, Makoko, Oko baba, Otto/ Iddo.
Ajeromi- Ifelodun LGA has 2 slum areas: Amukoko, Ajegunle
Apapa LGA has 3 slum areas: Badia, Ijora-Oloye, Marine beach.
Mushin LGA has 2 slum areas: Ijeshatedo/Itire, Mushin- Idi-Araba
Somolu LGA has 2 slum areas: Ilaje, Somolu.
One slum area was then selected from each of the 5 selected LGAs by simple random sampling through balloting and they are: Makoko, Ajegunle, Badia, Mushin- Idiaraba, and Ilaje. A total of 5 slums were selected.
Proportionate Sampling Method
Population of adolescents (identified to be 23% of the total population) was estimated based on the total population in these area.125
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Population by Estimated population of Proportionate Nos of respondent LGA Adolescents Sampling Calculation to be studied (10-19 years) Makoko 71,909 16,539 16539/ 50,269 ×400 131
Badia- 21,478 4,939 4,939 / 50,629 ×400 40
Mushin - 50,461 11,606 11,606/50,629×400 91
Ilaje - 29,798 6,853 6,853/50,629 ×400 54
Ajegunle – 46,487 10,692 10,692/50,629×400 84
Total 50,629 400
Stage three: Sampling of streets and settlements.
An estimate of 6-8 adolescents were expected in each street and this was an estimate gotten during the pre-test. Therefore, selection of number of streets was done using information on number of respondents from each community.
Mushin Slum
A total of thirteen streets were selected by simple random sampling through balloting from a total of seventy streets.
Ilaje Slum
Nine streets were selected by simple random sampling through balloting from a total of thirty streets.
Badia Slum
From a total of thirty-two settlements, two settlements were selected randomly by balloting.
Makoko Slum
Makoko slum has two parts. Makoko and Makoko waterfront.
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At Makoko waterfront, four cluster settlements were identified from which one was randomly selected by balloting while at Makoko on land, one cluster settlement was randomly selected through balloting from two settlements.
Ajegunle Slum
Ajegunle slum also has two distinct cluster settlements. Sample size of eighty four respondents was divided equally amongst the two settlements. Forty two respondents were interviewed per settlement.
Stage Four: Selection of houses
The first house in each settlement was selected as the starting point and subsequent houses following an anticlockwise manner were selected consecutively.
Stage Five: Selection of respondents
Only one adolescent (age 10-19yrs) was selected by simple random sampling through balloting in each house regardless of the number of households. Where there was only one adolescent in a house, he or she automatically qualified to participate in the study but when there was no adolescent in a selected house, the next house to it was considered. This was repeated for different streets and clusters till the total number of respondents for each community was achieved. Seven adolescents were selected per street at Mushin LGA to achieve a sample of ninety one respondents. In Ilaje, Six adolescents were selected in each of the nine streets to achieve a total of fifty four respondents. At Badia, the sample size of forty respondents was divided equally amongst these two settlements since they had no designated streets. The sample size of one hundred and thirty one was divided equally for the Makoko waterfront and Makoko on land. Sixty six respondents were interviewed at Makoko on land while sixty five adolescents were interviewed at Makoko waterfront.
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NON-SLUM COMMUNITIES
The five LGAs that were previously selected from seventeen LGAs by simple random sampling through balloting were also used to select the non-slum communities. These 5 LGAs are Lagos
Mainland LGA, Ajeromi-Ifelodun LGA, Apapa LGA, Mushin LGA and Somolu LGA.
Lagos mainland non slum areas are:
Apapa road, Olaleye village, Oyingbo market, Glover, Oyadiran Estate / Abule Oja, Alagomeji,
Yaba/ Igbobi Sabe.
Ajeromi ifelodun non slum areas: Ibafon/Wilmer, Olodi, Tolu, Temidire 1, Ojo road, Layeni,
Alaba oro, Mosafejo, Temidire 2.
Apapa: Apapa 1 (Marine Road and environs), Apapa 2 (Liverpool road and environs), Apapa
3(Creek Road, Tin Can and Snake Island), Apapa 4 (Pelewura crescent and environs), Gashiya and environs, Malu road and environs.
Mushin LGA:
Alakara, Idi-oro, baba olosa, ojuwoye, Ilupeju, Olateju, Kayode/ fadeyi, Mushin/ atewolara,
Papa Ajao, Ilasamaja, Ilupeju industrial estate.
Somolu LGA: Onipanu, Palmgroove, Alade, Bajulaiye, Mafowoku/ Pedro, lady lak, Igbobi fadeyi, folagoro, Gbagada phase 1/Obanikoro, Gbagada phase 2.
Stage One: Selection of the non-slum areas
By simple random sampling through balloting, one slum area was picked from each of the 5
LGAs.
Lagos mainland LGA: Oyadiran estate.
Ajeromi –Ifelodun LGA: Wilmer
Apapa LGA: Tincan
Mushin LGA: Papa Ajao
Somolu LGA: Igbobi Fadeyi
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Population By LGA Estimated population Proportionate Nos of respondent of Adolescents Sampling to be studied (10-19 years) Calculation
Oyadiran -24,616 5,661 5,661/36,068×400 63
Tincan -9,812 2,256 2,256/36,068×400 25
PapaAjao -42,829 9,850 9,850/36,068 ×400 109
Igbobi/fadeyi- 24,144 5,553 5,553/36,068×400 62
Ibafon/Wilmer-55,430 12,748 12,748/36,068×400 41
36,068 400
Stage two: Selection of streets
Using an estimate of 6-8 adolescents per street which was an estimate gotten during pretest, number of streets to be selected for each community was calculated using information on number of respondents from each community.
Papa Ajao - 14 streets were selected by simple random sampling from 51 streets through balloting.
Igbobi/Fadeyi - 9 streets were selected by simple random sampling through balloting from
25streets.
Ibafon/Wilmer – 17 streets were randomly selected by balloting from 35 streets. A total of 141 respondents were interviewed.
Tincan- 4 streets out of 12 were selected by simple random sampling through balloting.
Oyadiran estate- 9 streets were randomly selected by balloting from a total of 24 streets.
Stage three: Selection of houses
The first house in each street was the starting point. Subsequent houses were then selected consecutively till the desired number of eligible respondents was achieved.
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Stage four: Selection of respondents
Only one adolescent (age 10-19yrs) was studied per house and this was selected by a simple random sampling technique carried out by balloting to choose an adolescent from a house where there were more than one adolescent even in selected houses with multiple households.
Where there was only one adolescent in a house, he or she automatically qualified to participate in the study. When there was no adolescent in a selected house, then the next house to it was considered.
This was repeated for different streets till the total number of respondents for each community was achieved.
3.6 DATA COLLECTION TOOL AND TECHNIQUE
Data was collected using both qualitative and quantitative methods.
3.6.1 Quantitative data collection
An interviewer-administered questionnaire adapted from three sources was used:
Questionnaire on Prevalence of sexual abuse amongst adolescents in Geneva, Measuring violence against children by UNICEF and that used for a cross sectional study in northwest
Ethiopia.111,126,127
The questionnaire consisted of 5 sections labelled 1-5.
Section 1: Comprised of questions on socio-demographic characteristics of respondents such as age at last birthday, sex, religion, marital status, education status, occupation (Question 1-9)
Section 2: Comprised questions on living arrangement and social history such as family size, type of residential accommodation, whom the respondents live with, parent’s occupation, smoking and alcohol history. (Questions 10-28).
Section 3: Comprised of questions on prevalence and pattern of sexual abuse. These included type of sexual abuse (verbal harassment, breast caressing, unwelcomed kissing, genital touch,
48 vaginal touch, anal sex, oral sex), disclosure of sexual abuse and discussion with parents on sexual abuse (Questions 29-45).
Section 4: Sought information on relationship of perpetrator to victim (intrafamilial/ extrafamilial perpetrators). Questions 46-47
Section 5: Consisted questions to assess outcome of sexual abuse (reproductive health outcomes, injuries, mental health outcomes).
The questionnaire was in the two predominant languages in the state, Yoruba and English. It was translated to Yoruba and back translated into English to ensure original meanings were retained before translation by an expert in linguistics.
3.6.2 SCORING AND GRADING METHOD
Mental effects of sexual abuse
This was assessed with the post-traumatic stress disorder scale for Questions 50- 59).
The post-traumatic stress disorder scale, provides a quick assessment of whether an adolescent shows signs and symptoms of possible Post-Traumatic Stress Disorder (PTSD). Each question has a yes or no answer. A score of 1 point was assigned to each YES answer. A score of greater than 5 is a predictor of post-traumatic stress disorder. The scale is sensitive to predict distressing PTSD symptoms with a sensitivity of 85%, and a specificity of 75%.129
Rosenberg self-esteem scale
It is a self-report measure of self-esteem and this was used to assess the self-esteem of the adolescents. Has a validity of 0.55, internal consistency for the RSE range from 0.77 to 0.88 and Test-retest reliability for the RSE range from 0.82 to 0.85.130, 131
For the items marked with (R), the scoring was reversed (0=3, 1=2, 2= 1, 3=0)
49
For those items without an (R) next to them, the scores were simply added. Typical scores on the Rosenberg scale are around 22, with most people scoring between 15 and 25. Those with scores less than 15 were classified as having low self-esteem.
Strongly agree Agree Disagree Strongly
disagree
Items a,b,d,f,g 3 2 1 0
Items c,e,h,I,j 0 1 2 3
3.6.3 Pretesting of data collection tool
The questionnaire was pretested before the main study. This was conducted amongst 40 adolescent’s resident in Isolo Local Government, Lagos state. Amendments were made to aspects of the instrument that were found ambiguous or lacked clarity.
3.6.4 Training of research assistants and data collection
Sexual abuse is a very sensitive issue and obtaining information of such an issue requires adequate training and preparation. Five experienced research assistants who are students from
Lagos state college of health technology were trained by the principal investigator. The trainings were done over three days in sessions of three hours each, two weeks prior to commencement of data collection. After the pre-test of the questionnaire, a one-day refresher training was also done considering the changes that were made on the questionnaire. The training included an overview of sexual abuse, aims and objectives of the study, the sensitivity of the topic and style of interview. Using the sample of the questionnaire, a detailed explanation of each question was made. Practice interviews were also done and the principal investigator emphasized the need for privacy and confidentiality. An understanding of the survey procedure, methodology, coordination of the project, logistics and standardization of the
50 process was emphasized during the training. The research assistants had a minimum qualification of Ordinary National Diploma and were able to speak English and Yoruba language fluently.
The research assistants and the principal investigator collected data with the use of the questionnaire. Data was collected mostly in the evenings on week days and during weekends, over a 3-month period, between May and September 2016. The completed questionnaires were reviewed by the researcher and research assistants. Errors and wrong entries were corrected before leaving each venue. Completed questionnaires were stored in locked up folders to further ensure confidentiality.
3.6.5 Qualitative data collection
Qualitative data was collected using a FGD guide to complement the findings of the quantitative study and explore the perception of the community towards sexual abuse, depth of exposure to sexual abuse and its associated factors. The FGD guide was adapted from a sexual violence assessment tool and FGD guide by the UNFPA and a qualitative study on sexual abuse experiences of high school students in Ethiopia.111,128
Eight FGD, four each in the slum and non-slum communities were conducted with adolescent males and females and with adult men and women who were purposively recruited by the help of a link person in the community. Inclusion criteria was willingness to take part in the study and being a community member who had lived in the community for a minimum of 1 year.
There were a total of seventy eight participants in the slum and non-slums. Adolescents recruited were between ages 10-19yrs while the adult men and women recruited were between ages 35-60yrs and they were a mix of religious leaders, traders, professionals, skilled and unskilled workers and house wives. Each FGD consisted 8-10 participants and a total of eight focus group discussions all of single gender was conducted to make four FGD per community.
51
These participants got SMS and phone call reminders 2 days prior and on the day of the discussion to enable full attendance. However, 2 female adolescents in the slums did not show up because one had to run errands for her parents while the other went for a family function.
SLUM and NON-SLUM
FGD 1: Men in the community (adults) 10 participants
FGD 2: Women in the community (adults) 10 participants
FGD3: Male adolescents 10 participants
FGD4: Female adolescents 8/ 10 participants
Due to the sensitivity of the topic, FGDs were conducted in a small hall that allowed privacy in the discussions without interruptions. This space was provided by the communities at no cost. Written informed consent was obtained from participants and permission was sought from all participants to record the discussion on a smart recorder and the FGDs were conducted in
English and Yoruba. Participants were seated in a semicircle and discussions lasted between
60minutes to 90minutes using an FGD guide (Appendix 4). The discussion assessed community perception to sexual abuse and discussions were centred on causes of sexual abuse, help-seeking and reporting, and gathered suggestions on measures for improvement. Probes were used to enable participants expatiate on their discussion This was conducted by the principal researcher who served as the facilitator while three research assistants took notes, assisted with time keeping and audio recording.
Discussions in Yoruba were translated back to English. At the end of the discussion, participants were given refreshments and a little token for their transport.
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3.6 DATA MANAGEMENT
The questionnaires for the quantitative data were collated and entered into Statistical Package for the Social Sciences statistics version twenty (SPSS Inc., Chicago, USA) spreadsheet. Data was cleaned and analyzed using the same software and Winpepi version 11.30. Data was presented using frequency tables and charts. Data was summarized with percentages and proportions and Pearson chi-square was used to test for associations between categorical variables such as sociodemographic and socioeconomic characteristics of parents, living arrangement, and sexual abuse. and Fischer’s exact was used wherever the cell content was less than 5. The independent t-test was used to test for difference between means of quantitative variables in the slums and non-slums. Values of p≤0.05 were considered as statistically significant. The Independent variables that were fed into multiple logistic regression were those factors found to be statistically significant in the bivariate analysis which are age, sex, level of education, mothers education, fathers occupation. The predictor variables were entered into the logistic regression model as a single block entry to control for possible confounders between the predictor variables. The magnitude and direction of the relationship between the variables were expressed as odd’s ratios. The outcome/dependent variable in this study was sexual abuse and the prevalence of sexual abuse was the proportion of adolescents who reported experience of one or more acts of sexual abuse at any point in their lives in the selected communities.
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Outcome indicators
Proportion of adolescents who experienced sexual abuse (forced or threatened).
Proportion of adolescents who were abused by intra-familial and extra-familial members
Proportion of adolescents who reported the case and sought help.
Proportion of adolescents who experienced contact and non-contact forms of sexual abuse.
Proportion of adolescents who encountered reproductive problems after sexual abuse.
The independent variables were respondent’s age, sex, educational status, life style arrangement and social habits, living arrangement with parents, type of parents’ marriage, educational status of parents, etc.
Alcohol consumption and cigarette smoking refers to the frequency of alcohol and cigarette consumption by the respondent. This was classified as rarely (less than once a month), often
(more than 3-4 times a week) and occasionally (less than 3-4 times a week)
Occupational status of parents was classified as unskilled, manually skilled, non-manually skilled and professional using the Register General Classification.159
Professional: Civil servants, Bankers, Architects, Doctors, Nurses
Manually skilled: Carpenters, Hairdressers, Caterers, Tailors, Vulcanizer, Welder, Mechanic.
Non manually skilled: Teacher, Police, Security, etc
Unskilled: Petty traders, Messengers, Bus drivers, Fishermen, Subsistence farmer, etc
Educational status was classified as: No formal education, Primary, Secondary and Post- secondary education.
Focus Group Discussions (FGDs) were analysed using Framework analysis method
The first stage was familiarization which began with transcription and translation of the data.
Discussions were transcribed verbatim from the audio recordings, translated to English language and was reconciled with the notes taken. This was achieved by listening to tapes, and reading the observational notes taken during the interview. The Microsoft word 2013 software
54 was the main tool used to organise the transcripts. Transcripts were then read and re-read for a general overview, and comprehension. The next stage involved identifying a thematic framework, themes were developed from the research questions and narratives of research participants. The next stage was indexing/coding which was done by assigning codes and numbers to each statements/ texts corresponding to the theme they belonged. Thereafter each coded data was rearranged and grouped under each theme (Charting). This was done by lifting statements belonging to a specific theme and adding corresponding statements within each family next to each other. Comparisons in the statements were then made and a word cloud done to identify frequently occurring words. Descriptive statements were formed and interpretation of data was done.
3.7 ETHICAL CONSIDERATION
Ethical approval for this study was obtained from the Health Research and Ethics Committee
(HREC) of the Lagos University Teaching Hospital. (Appendix I).
Permission was sought from the Chairman of the Local Government Areas where the study sites are situated. Permission was also sought from the CDA chairmen of the selected areas. A written informed consent was obtained from the parents and assent from the respondents before the interview. Appendix II.
Confidentiality was maintained by ensuring that respondents were interviewed privately and away from where passers-by could hear their responses.
The nature of the study, participation status, benefits of the study and confidentiality issues were made clear to the respondents before obtaining their consent. Respondents were assured of the highest level of confidentiality on information given. Following the appropriate approvals, questionnaires were administered. Names and addresses were not included in the
55 data collection instrument and respondents were informed of their right to decline or withdraw from the study at any time without any consequences.
At the end of the study, respondents were given information on how to keep safe and prevent sexual abuse. They were also informed on where to seek help in cases of sexual abuse and where to get information and counselling on sexual and reproductive health issues.
Respondents who had been victims of sexual abuse were referred to Mirabel Centre in
LASUTH and Action Health Incorporated Yaba, a Non-Governmental Organization which promotes adolescent sexual health and rights for counselling and information on their sexual health.
3.8 LIMITATION OF THE STUDY
Due to the nature of the study, it assesses personal and sensitive issues related to sexuality which might have caused underreporting experiences of sexual abuse.
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CHAPTER FOUR
RESULTS
A total of 800 questionnaires were administered to the respondents. 400 in the slum and 400 in the non-slum communities. All were fully completed without omissions and errors.
Table 1: Socio-demographic characteristics of respondents
Variable Frequency (%) χ2 df p-value Fisher Slum Non-slum exact p n=400 n=400 Age (year) 10 – 14 111 (27.8) 146 (36.5) 7.014 1 0.008* 15 – 19 289 (72.2) 254 (63.5) Mean age 15.9 ± 2.3 15.2 ± 2.2 Student’s t = 4.450; p-value < 0.001* Gender Male 124 (31.0) 174 (43.5) 13.369 1 < 0.001* Female 276 (69.0) 226 (56.5) Religion Christianity 243 (60.8) 286 (71.5) 13.023 2 0.001 0.001* Islam 157 (39.3) 112 (28.0) Others 0 (0.0) 2 (0.5) Ethnicity Yoruba 271 (67.8) 191 (47.8) 44.164 3 < 0.001* Igbo 60 (15.0) 113 (28.2) Hausa 3 (0.8) 21 (5.2) Others ( Togo, Ghana, 66 (16.5) 75 (18.8) Calabar, Edo, Delta) Marital status Never married 391 (97.8) 396 (99.0) 1.955 1 0.162 Currently married 9 (2.2) 4 (1.0) Level of Education No formal 25 (6.3) 15 (3.8) 3.034 3 0.386 0.383 Primary 149 (37.3) 160 (40.0) Secondary 222 (55.5) 222 (55.5) Postsecondary 4 (1.0) 3 (0.8) Still schooling Yes 279 (69.8) 324 (81.0) 13.637 1 < 0.001* No 121 (30.2) 76 (19.0)
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Currently working/paid job Yes 123 (30.8) 86 (21.5) 8.867 1 0.003* No 277 (69.2) 314 (78.5) The majority of respondents in the slum 289 (72.2%) and non-slums 254 (63.5%) were in the late stage of Adolescence between 15-19 years. Mean age in both settings was 15.9 ± 2.3 and
15.2 ± 2.2 in the slum and non- slum, respectively. The difference in age was statistically significant (p= 0.008).
There were more females than males in both groups with the slum category having 276 (69.0%) females and the non-slum having 226 (56.5%). The difference in sex distribution was statistically significant with a p value <0.001. A larger proportion of the respondents in both settings were Christians and this was statistically significant p= 0.001. Majority of respondents were of the yoruba ethnic group in both the slum 271(67.8%) and the non-slum 191(47.8%) while the Igbo tribe was the second commonest ethnic group 60(15.0%) and 113(28.2%) slum and non-slum respectively. (p<0.001).
Majority of the respondents had never been married 391(97.8%), 396(99%) slums and non- slum respectively. More than two thirds of respondents in both the slum 279(69.8%) and the non-slum 324(81%) were still in school. This finding was statistically significant as there were more in-school adolescents in the non-slum communities. (p <0.001).
A large proportion of the respondents had one form of education with majority reporting highest level of education to be secondary school in both slums 222 (55.5%) and non-slums
222 (55.5%) p value 0.383. More respondents 121(30.2%) in the slums were out of school compared to 76 (19.0%) in non-slums. This finding was statistically significant with a p value
< 0.001.
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In both groups, most of the adolescents 277 (69.2%) in the slum and 314 (78.5%) in the non- slum were not in a paid job. Adolescents who were in a paid job were more in the slums 123 (
30.8% ) than in the non-slum areas 86 (21.5%). This difference was statistically significant.
Table 2: Respondents source of income and living arrangement Variable Frequency (%) χ2 df p-value Fisher Slum Non-slum exact p n = 400 n = 400 Source of subsistence Self (work) 18 (4.5) 12 (3.0) 2.646 6 0.754 0.758 Parents 335(83.7) 345(86.2) Relatives 37 (9.2) 36 (9.0) Friends 1 (0.3) 1 (0.3) Spouse 5 (1.3) 2 (0.5) Others(Boss, religious leader) 4 (1.0) 4 (1.0) Born in index community Yes 328 (82.0) 301 (75.2) 5.422 1 0.020* No 72 (18.0) 99 (12.8) Duration of stay in community (year) ≤ 5 108 (27.0) 123 (30.8) 16.193 3 0.001* 6 – 10 86 (21.5) 79 (19.8) 11 – 15 105 (26.2) 138 (34.4) 16 – 20 101 (25.3) 60 (15.0) Mean duration in community 10.3 ± 5.8 9.7 ± 5.4 Student’s t = 1.572; p-value = 0.116 Parents living together Yes 315 (78.8) 328 (82.0) 1.339 1 0.247 No 85 (21.2) 72 (18.0) Reason for not living together n = 85 n = 72 Divorce 34 (40.0) 24 (33.3) 6.944 4 0.139 Father is dead 14 (16.5) 20 (27.8) Mother is dead 8 (9.4) 10 (13.9) Both are dead 4 (4.7) 6 (8.3) Don’t know 25 (29.4) 12 (16.7) Other reasons n = 10 n = 7 Due to polygamy 1 (10.0) 0 (0.0) 3.695 5 0.594 0.879 Father lives in the village 1 (10.0) 1 (14.3) Live separately 5 (50.0) 4 (57.1) Father is outside the country 1 (10.0) 1 (14.3) Separation 2 (20.0) 0 (0) Business trip 0 (0) 1 (14.3) Type of parents’ marriage Monogamy 290 (72.5) 347 (86.8) 25.033 1 < 0.001* Polygamy 110 (27.5) 53 (13.2)
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Whom respondents live with Both parents 264 (66.0) 299 (74.8) 13.219 8 0.105 Father only 18 (4.5) 12 (3.0) Mother only 55 (13.8) 30 (7.5) Brother 9 (2.3) 9 (2.3) Sister 5 (1.3) 6 (1.5) Relative 18(4.5) 20(5.0) Friend 2(0.5) 1(0.3) Alone 0(0) 1(0.3) Others (Family friend, boss) 29(7.3) 22(5.5)
Parents were the main source of subsistence for the adolescents in both the slum (82.5%) and non-slums (85.8%). Over three quarters of respondents were born in Lagos in both groups and about half of the respondents had lived in the community for more than 10 years 206(51.5%) slum and 198 (49.4%) non-slum). The mean duration of stay in the community was
10.3±5.8years and 9.7±5.4 years for slum and non-slum respectively.
The majority of parents of respondents in both groups were living together with only about a fifth of the parents 85(21.2%) in the slums and 72(18%) in the non-slum communities not living together. There was a statistically significant difference in type of marriage in the slums and non-slums p value < 0.001. Monogamy was the commonest type of marriage in both slum and non-slums. 290(72.5%) and 347(86.8%) respectively. However, a higher proportion of respondents whose parents were in polygamous marriages were more in the slums. 110(27.5%)
Most respondents were living with both parents (66% slum and 74.8% non-slum) though this was more with adolescents in the non-slum communities. Adolescents who lived with single parents were more in the slums with a larger proportion of slum residents living with their mothers only.
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Table 3: Socio-economic characteristics of respondents parents
Variable Frequency (%) χ2 df p-value Fisher Slum Non-slum exact p n = 400 n = 400 Type of accommodation Single room with shared amenities 275 (68.8) 119 (29.8) 123.534 2 < 0.001* Single room self-contained 69 (17.2) 133 (33.2) Bedroom flat 56 (14.0) 148 (37.0) Who pays for accommodation Self 1 (0.2) 3 (0.8) 6053 5 0.301 0.320 Friend 6 (1.5) 11 (2.8) Relative 44 (11.0) 41 (10.2) Parents 337 (84.3) 335 (83.7) Spouse 7 (1.8) 2 (0.5) Others 5 (1.2) 8 (2.0) Father’s education No formal education 20 (5.0) 5 (1.3) 33.174 3 < 0.001* Primary school 73 (18.2) 34 (8.5) Secondary school 206 (51.5) 210 (52.5) Postsecondary 101 (25.3) 151 (37.7) Mother’s education No formal education 29 (7.2) 15 (3.8) 21.801 3 < 0.001* Primary school 83 (20.8) 58 (14.5) Secondary 225 (56.2) 217 (54.2) Postsecondary 63 (15.8) 110 (27.5) Father’s occupation Unskilled 93 (23.2) 83 (20.7) 0.988 3 0.803 Manually skilled 140 (35.0) 151 (37.8) Non-manually skilled 129 (32.3) 128 (32.0) Professional 38 (9.5) 38 (9.5) Mother’s occupation Unskilled 288 (72.0) 266 (66.5) 25.304 3 < 0.001 < 0.001* Manually skilled 69 (17.3) 42 (10.5) Non-manually skilled 42 (10.5) 89 (22.2) Professional 1 (0.3) 3 (0.8) Family size < 5 137 (34.2) 110 (27.5) 4.181 2 0.124 5 – 9 256 (64.0) 281 (70.3) ≥ 10 7 (1.8) 9 (2.2) Mean family size 5.3 ± 1.7 5.5 ± 1.7 Student’s t = 1.729; p-value = 0.084 Shares room with others Yes 96 (24.0) 83 (20.8) 1.216 1 0.270 No 304 (76.0) 317 (79.2) Shares amenities, toilet & bath Yes 303 (75.8) 184 (46.0) 74.321 1 < 0.001* No 97 (24.2) 216 (54.0)
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A higher proportion of respondents from slums resided in single rooms 275(68.8%) while
148(37%) of respondents from non-slums lived in a self-contained flat. This difference was statistically significant. (p= <0.001).
In more than three quarters of respondents, the parents paid for accommodation of the respondents while friends were responsible in 6(1.5%) of slums respondents and 11(2.8%) of non-slum respondents.
There was a statistically significant difference in level of education of fathers in slum and non- slums. Fathers with no form of education were more in the slums 20(5%) compared to 5(1.2%) in non-slums. However, about half of fathers of respondents in both slum 206(51.5%) and non- slums 210 (52.5%) had completed secondary school level of education. There was a statistically significant difference in level of education of mothers in both communities. (p<0.001) Mothers who had no formal education were more in the slums 29(7.3%) than non-slum 15(3.8%). A larger proportion of the mothers in the slums 288(72%) and non-slums 266(66.5%) were unskilled with more unskilled women in the slums. This difference was statistically significant.
(P < 0.001) In comparison to the men, a larger number of the men had some form of skill.
307(76.7%) and 317(79.3%) in slums and non-slums respectively. This difference was however not statistically significant.
Regarding family size, there was no statistically significant difference in the slums compared to the non-slums as both settings had a mean family size of 5. Majority of respondents in both settings did not share rooms 304(76.0) and 317(79.2) however, more respondents 303(75.8%) in the slum communities shared amenities, toilets and baths with other community members compared to the non-slum 184(46%). This difference was found to be statistically significant.
(p<0.001).
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Table 4: Respondents lifestyle and social habit Variable Frequency (%) χ2 df p-value Fisher Slum Non-slum exact p
Ever smoked cigarette n = 400 n = 400 Yes 4 (1.0) 7 (1.8) 0.830 1 0.362 No 396 (99.0) 393 (98.2) Currently smoking cigarette n=400 n=400 Yes 2 (0.5) 2 (0.5) 0.000 1 1.000 1.000 No 398 (99.5) 398 (99.5) How often smokes n = 2 n = 2 Occasionally 1 (50.0) 1 (50.0) 0.000 1 1.000 1.000 Often 1 (50.0) 1 (50.0) Ever drunk alcohol n= 400 n=400 Yes 39 (9.8) 43 (10.8) 0.217 1 0.641 No 361 (90.2) 357 (89.2) Currently drinking alcohol Yes 33 (8.2) 38 (9.5) 0.386 1 0.534 No 367 (91.8) 362 (90.5) How often drinks n = 33 n = 38 Rarely 2 (6.1) 8 (2.1) 3.784 2 0.151 Occasionally 26 (78.8) 23 (60.5) Often 5 (15.2) 7 (18.4)
Almost all the respondents in slum 396(99%) and non-slum 393(98.2%) had never smoked.
Only a tenth of respondents had ever drank alcohol 39(9.8%) slum and 43(10.8%) non-slum with similar percentage as current drinkers of alcohol 33(8.2%) and 38(9.5%) in slums and non-slums respectively.
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Table 5: Respondents experience of sexual abuse and perpetrator characteristic
Variable Frequency (%) χ2 df p-value Fisher Slum Non-slum exact p
Ever had sexual intercourse n = 400 n = 400 Yes 155 (38.8) 102 (25.5) 16.103 1 < 0.001* No 245 (61.2) 298 (74.5) Age at first intercourse (year) n = 155 n = 102 10 – 14 54 (34.8) 29 (28.4) 0.011 1 0.916 15 – 19 101 (65.2) 73 (71.6) Mean age at first intercourse 15.1 ± 2.1 15.1 ± 2.0 Student’s t = 0.176; p-value = 0.860 Consent given to sex n = 155 n = 102 Yes 78 (50.3) 40 (39.2) 3.056 1 0.080 No 77 (49.7) 62 (60.8) Ever had unwanted sexual experience Yes 307 (76.8) 233 (58.3) 31.202 1 < 0.001* No 93 (23.2) 167 (41.7) Type of perpetrator n = 307 n = 233 Intrafamilial 24 (7.8) 28 (12.0) 11.136 7 0.133 Unrecognized person 12 (3.9) 9 (3.9) School mate 78 (25.4) 43 (18.5) School teacher 3 (1.0) 4 (1.7) Neighbour 83 (27.0) 53 (22.7) Known person- choir master, street 56 (18.2) 46 (19.7) person, religious leader) Boyfriend/Girl friend 19 (6.2) 21 (9.0) Others(boss, househelp) 32 (10.5) 29 (12.5) If intrafamilial, relationship n = 24 n = 28 Brother 3 (12.5) 3 (10.7) 5.608 4 0.230 0.207 Sister 2 (8.3) 0 (0) Step father 0 (0) 1 (3.6) Uncle 6 (25.0) 3 (10.7) Others (aunt, aunts husband, cousin) 13 (54.2) 21 (75.0)
Regarding exposure to sexual intercourse, a larger proportion of adolescents 155(38.8%) who resided in the slums had been exposed to sexual intercourse compared to their counterparts in the non-slum communities 102(25.5%). This difference was statistically significant <0.001.
Mean age at sexual debut was similar in the slums and non-slums (15.1 ± 2.1 and 15.1 ± 2.0.1)
A higher proportion of respondents in the slums and non-slums had their first exposure to sex at age 15-19 years. (65.2%, 71.6%). More adolescents in the slums were found to have consented to sex compared to those in the non-slums however this difference was not
64 statistically significant. Regarding unwanted sexual experience, more respondents in the slums
307(76.8%) had had unwanted sexual experience when compared to non-slums 233(58.3%).
The commonest perpetrator of the unwanted sexual experience was the neighbour in slums
(27%) and non-slums (22.7%) while 24(7.8%) and 28(12%) of unwanted sexual experiences were perpetrated by family members. Most intrafamilial experiences were perpetrated by distant relations (aunt, aunt’s husband, (54.2% slum and 75% non-slum).
65
100
90
80 76.8
70 58.3 60
50
40
30 Prevalence of sexual (%)anuse 20
10
0 Slum Non-slum Community
Figure 1: Bar diagram of prevalence of sexual abuse in the slum and non-slum communities
Figure 2: Prevalence of sexual abuse disaggregated by community
The community with the highest prevalence rate of sexual abuse include Ilaje (89.8%) in the slum while in the non-slum communities it was Mushin urban (71.1%).
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Table 6: Pattern of sexual abuse amongst adolescents in slums and non-slums
Variable Frequency (%) χ2 p-value Fisher Slum Non-slum exact p n = 307 n = 233 Type of unwanted sexual experience Verbal sexual harassment 193 (62.9) 96 (41.2) 24.993 < 0.001* Breast caressing 125 (40.7) 85 (36.5) 1.000 0.317 Unwelcomed kissing 145 (47.2) 129 (55.4) 3.506 0.061 Genital touch 47 (15.3) 56 (24.0) 6.533 0.011* Vaginal intercourse 91 (29.6) 62 (26.6) 0.600 0.439 Anal sex 4 (1.3) 8 (3.4) 2.767 0.096 Oral sex 12 (5.5) 21 (9.0) 2.446 0.118 Multiple responses
Ever forced to do the followings: Look at pornographic picture 105 (34.2) 84 (36.1) 1.99 0.655 Look at his/her genitals 35 (11.4) 27 (11.6) 0.005 0.946 Watch him masturbate 17 (5.5) 13 (5.6) - - Be naked & expose genitals to picture 7 (2.3) 1 (0.4) 3.109 0.078 0.146 Undress and show him/her genitals 21 (6.8) 19 (8.2) 0.334 0.564 Undress with another child & touch 21 (6.8) 10 (4.3) 1.590 0.207 Fondle or touch him/her 221 (72.0) 180 (77.3) 1.922 0.166 Made you have sexual intercourse 97 (31.6) 63 (27.0) 1.320 0.251 Made you have anal sex 1 (0.3) 5 (2.1) 3.994 0.046 0.090 Made you have oral sex 7 (2.3) 3 (1.3) 0.718 0.397 0.526 Received money/reward for sex 17 (5.5) 21 (9.0) 2.446 0.118
Multiple responses * Statistically significant
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There was a statistically significant difference in the pattern of sexual abuse experienced by respondents. Adolescents in the slums, experienced verbal harassment as a type of sexual abuse
193 (62.9%) while their counterparts in the non-slums experienced more of unwelcomed kissing 129 (55.4%). Many of the adolescents in both settings had been forced to fondle/touch someone else 221 (72%) and 180 (77.3%) slums non-slums respectively. Regarding forced pornography viewing, a larger proportion of the respondents were from the slums 105(34.2%) compared to 84(36.1%) in non-slums. This difference was however not statistically significant. p value 0.655. There was also no statistically significant difference in forceful exposure to sexual intercourse in both settings p value 0.251 though more respondents who had been victims were from the slums. 97 (31.6%) compared to 63(27%) non-slum.
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Non-contact Contact (non-penetrative) (Verbal sexual harassment) Breast caressing Unwelcome kissing Genital touch
78 61
61
10 44 26
16
16
Contact (Penetrative sexual abuse)
Vaginal intercourse Anal sex
Oral sex
Figure 3: Venn diagram of type of sexual abuse experienced in the slum communities
In the slums, a higher proportion of the respondents 78(25%) respondents were exposed to non- contact and non-penetrative types followed by 61(19%) adolescents who experienced verbal harassment alone and another 61(19%) who had experienced the non-penetrative types of sexual abuse. A smaller proportion 10(3%) were exposed to contact and penetrative types of abuse. A total of 44(14%) respondents out of the 307 abused victims had been exposed to all forms of sexual abuse as shown in the Venn diagram. (Figure 3).
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Non-contact Contact (Non penetrative) (Verbal sexual harassment) Breast caressing Unwelcome kissing Genital touch
48 83 25
9 14 35
6
6
Contact (Penetrative sexual abuse) Vaginal intercourse Anal sex Oral sex
Figure 4: Venn diagram of type of sexual abuse experienced in the non-slum communities
In the non-slums, a total of 14(6%) respondents out of the 233 abused victims had been exposed to all forms of sexual abuse while 83(36%) respondents were exposed to the contact (non- penetrative) forms while 6(3%) experienced only the penetrative type of abuse.
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Table 7: Respondents experience of threat to sexual abuse and perpetrators age. Variable Frequency (%) χ2 df p-value Fisher exact p Slum Non-slum
Ever been threatened n=307 n=233 Yes 106 (34.5) 84 (36.1) 0.135 1 0.713 No 201 (65.5) 149 (63.9) What did you do n = 106 n = 84 Unable to say no 49 (46.2) 41 (48.8) 3.279 2 0.194 0.229 Forced to go along with act 43 (40.6) 33 (39.3) Others 7 (6.6) 1 (1.2) Non response 7 (6.6) 9 (10.7) Age of the perpetrator n = 106 n = 84 More than 10 years older 29 (27.4) 14 (16.7) 6.955 4 0.138 5-10 years older than victim 32 (30.2) 31 (36.9) 1-5 years older 27 (25.4) 20 (23.8) Equal to my age 18 (17.0) 16 (19.0) Can’t guess 0 (0) 3 (3.6)
More than a third of respondents who reported being victims of sexual abuse were threatened about it. 106 (34.5%) slum and 84(36.1%) non-slum. When threatened most of the respondents were either unable to say no or were forced to go along with the act 92(86.8%) slum and
74(88.1%) non-slum. In more than half of the times the respondents were threatened, the perpetrator was usually older than the respondent by more than 5 years 61(57.6%) slum and
45(53.6%) non-slum.
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Table 8: Location of abuse and respondent’s disclosure of sexual abuse experience. Variable Frequency (%) χ2 df p-value Fisher Slum Non-slum exact p n = 307 n = 233 At time of abuse, respondent was living with: Both parents 225 (73.3) 171 (73.4) 1.111 4 0.893 Friends 3 (1.0) 4 (1.7) Relatives 42 (13.7) 32 (13.7) Mother only 31 (10.0) 20 (8.6) Father only 6 (2.0) 6 (2.6) Where the abuse occurred Victim’s house 67 (21.8) 58 (24.9) 4.508 4 0.342 Perpetrator’s house 121 (39.4) 102 (43.8) At school 66 (21.5) 43 (18.5) Hotel 2 (0.7) 0 (0) Others 51 (16.6) 30 (12.9) Reported the problem after Yes 182 (59.3) 136 (58.4) 0.046 1 0.831 No 125 (40.7) 97 (41.6) Who did you report to n = 182 n = 136 Friends 73 (40.1) 58 (42.7) 6.431 5 0.266 0.285 Family member 88 (48.4) 65 (47.8) School teacher 10 (5.5) 10 (7.4) Parents 4 (2.2) 0 (0) Police 0 (0) 1 (0.7) Others 7 (3.8) 2 (1.5) What happened when disclosed n = 182 n = 136 You were helped 56 (30.8) 49 (36.0) 6.784 5 0.237 Not believed 2 (1.1) 5 (3.7) Nothing changed 38 (20.9) 30 (22.1) It was kept secret 46 (25.3) 31 (22.8) The person involved was punished 33 (18.1) 14 (10.3) Others 7 (3.8) 7 (5.1) Reason for not reporting n = 125 n = 97 Do not know what to do 18 (14.4) 4 (4.1) 10.071 4 0.039* Afraid of perpetrator 12 (9.6) 15 (15.5) Afraid of parent 47 (37.6) 30 (30.9) Fear of stigma 6 (4.8) 4 (4.1) Felt it won’t change anything 42 (33.6) 44 (45.4)
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The commonest location for sexual abuse was in the perpetrator’s house (39.4% slum and
43.8% non-slum) while a sizeable number happened at victims house 67(21.8%) slum and
58(24.9%) non-slum. Half of the respondents were bold enough to report the abuse.
182(59.3%) slum and 136(58.4%) non-slum. There was no statistically significant difference in the slums and non-slums regarding disclosure of abuse and perpetrators characteristic. For the adolescents who did not disclose their experience, a higher proportion of respondents in the slums refused disclosure because they were afraid of their parent’s reactions while in the non- slums, a higher proportion felt disclosure wouldn’t change anything. This difference was statistically significant. P value 0.039.
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Table 9: Reporting pattern following sexual abuse
Variable Frequency (%) χ2 df p-value Fisher Slum Non-slum exact p n = 68 n = 59 Whom sexual abuse was reported to Friends 24 (35.3) 23 (39.0) 1.993 4 0.737 0.836 Family member 36 (52.9) 28 (47.5) School teacher 4 (5.9) 6 (10.2) Parents 1 (1.5) 0 (0) Others ( religious leader) 3 (4.4) 2 (3.4) Outcome of disclosure You were helped 24 (35.3) 21 (35.6) 2.524 5 0.773 0.770 Not believed 1 (1.5) 1 (1.7) Nothing changed 11 (16.2) 15 (25.4) It was kept secret 17 (25.0) 13 (22.0) The person involved was punished 13 (19.1) 7 (12.3) Others 2 (2.9) 2 (3.4) Action taken on perpetrator Sentenced to jail 2 (2.9) 0 (0) 2.240 3 0.524 0.697 Financial penalty 1 (1.5) 1 (1.7) Forced to marry 1 (1.5) 2 (3.4) Warned 64 (94.1) 56 (94.9) Reason for not reporting n = 38 n = 25 Do not know what to do 8 (21.1) 2 (8.0) 3.722 4 0.445 0.496 Afraid of perpetrator 7 (18.4) 8 (32.0) Afraid of parent 10 (26.3) 7 (28.0) Fear of stigma 4 (10.5) 1 (4.0) Felt it won’t change anything 9 (23.7) 7 (28.0)
A significant number of the respondents who had been sexually abused reported the incident to other family members other than their parents. 36(52.9%) slum and 28(47.5%) non-slum.
Less than half of those who reported received help (35.3% and 39.0%) in slum and non-slums respectively. More respondents in the non-slums did not report for fear of the perpetrator while more adolescents in the slums did not report for fear of their parents. This difference was however not statistically significant (p =0.496).
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Table 10: Respondents discussion with parents/ guardians on issues related to sexual abuse
Variable Frequency (%) χ2 p-value Slum Non-slum n = 400 n = 400 Came across / heard about sexually abused children Yes 232 (58.0) 242 (60.5) 0.518 0.472 No 168 (42.0) 158(39.5) Discussed with parents/guardians on sexual abuse and its reporting Yes 196 (49.0) 180 (45.0) 1.285 0.257 No 204 (51.0) 220 (55.0) df = 1
More than half of the respondents had come across/ heard about sexually abused children (58% slums and 60.5% non-slums). Almost an equal proportion of respondents in both slums (49%) and non-slums (45%) already had discussions on sexual abuse with parents or guardians. There was no statistically significant difference on discussions about sexual abuse in the two settings. p = 0.257.
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Table 11: Effect of sexual abuse
Variable Frequency (%) χ2 df p-value Slum Non-slum n = 307 n = 233 Encountered problem after the abuse Yes 37 (12.1) 35 (15.0) 1.011 1 0.315 No 270 (87.9) 198 (85.0) Reproductive health problems n = 37 n = 35 encountered Unwanted pregnancy/birth 11 (29.7) 5 (14.3) 2.812 3 0.422 Abortion 9 (24.3) 9 (25.7 STI 6 (16.3) 6 (17.1) Others(Felt unwell, genital laceration) 11 (29.7) 15 (42.9) Mental health effects of sexual abuse Have thought/memories about the event 210 (68.4) 176 (75.5) 3.306 1 0.069 Have bad dreams about the event 123 (40.1) 76 (32.6) 3.157 1 0.076 Feels as if it will happen again 121 (39.4) 104 (44.6) 1.486 1 0.223 bodily reactions when reminded 84 (27.4) 70 (30.0) 0.467 1 0.494 Have trouble falling or staying asleep 47 (15.3) 43 (18.5) 0.944 1 0.331 Feels grumpy or lose temper 85 (27.7) 64 (27.5) 0.003 1 0.955 Feels upset by reminders of the event 134 (43.6) 135 (57.9) 10.823 1 0.001* Have a hard time paying attention 45 (14.7) 45 (19.3) 2.067 1 0.151 On look-out for possible danger 144 (46.9) 121 (51.9) 1.339 1 0.247 Sudden happenings makes you jump 136 (44.3) 120 (51.5) 2.756 1 0.097 Multiple responses
Post-traumatic stress score 0 – 5 210 (68.4) 158 (67.8) 0.021 1 0.884 6 – 10 (Post-traumatic stress disorder) 97 (31.6) 75 (32.2) Mean score 3.8 ± 2.9 4.2 ± 2.6 Student’s t = 1.643; p-value = 0.101 * Statistically significant
Though a majority of the respondents didn’t encounter any problem following the abuse
270(87.9%) slum and 198(85%) non-slum. For those that did, a large majority in the non-slums were generally unwell after the incident. Unwanted pregnancy (29.7% and 14.3%), abortion
(24.3% and 25.7%) and STI (16.2% and 17.1%) were experienced by slum and non-slum dwelling respondents respectively. This difference was however not statistically significant.
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Mental health effects were however much commoner with a large number of respondents in both settings having memories about the event (68.4% slum and 75.5% non-slum) while more than a third of them (39.4% slum and 44.6% non-slum) feel the act might happen again. Also a significant number of respondents who were abused have bad dreams at night (40.1% slum and 32.6% non-slum).
There was no statistically significant difference in the post-traumatic stress score of adolescents who resided in the slums compared to non-slums. However, close to a third of the respondents had some form of Post-traumatic stress disorder 97(31.6%) slum and 75(32.2%) non-slum.
This difference was not statistically significant. p= 0.884.
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Table 12: Rosenberg self-esteem scale of respondents who had been victims of sexual abuse
Variable Frequency (%) χ2 p-value Fisher Slum Non-slum exact p n = 307 n = 233 Feels a person of worth Strongly disagree 2 (0.6) 8 (3.4) 11.848 0.008* Disagree 14 (4.6) 19 (8.2) Agree 86 (28.0) 76 (32.6) Strongly agree 205 (66.8) 130 (55.8) Feels that I have good qualities Strongly disagree 2 (0.7) 3 (1.3) 9.779 0.021 0.016 Disagree 4 (1.3) 14 (6.0) Agree 169 (55.0) 122 (52.4) Strongly agree 132 (43.0) 94 (40.3) Inclined to feel that I am a failure Strongly disagree 148 (48.2) 88 (37.8) 6.041 0.110 Disagree 115 (37.4) 103 (44.2) Agree 30 (9.8) 30 (12.9) Strongly agree 14 (4.6) 12 (5.1) Able to do things as most people Strongly disagree 3 (1.0) 3 (1.3) 0.983 0.805 0.793 Disagree 21 (6.8) 20 (8.6) Agree 174 (56.7) 134 (57.5) Strongly agree 109 (35.5) 76 (32.6) Feels do not have much to be proud Strongly disagree 46 (15.0) 30 (12.9) 0.897 0.826 Disagree 116 (37.8) 96 (41.2) Agree 111 (36.2) 83 (35.6) Strongly agree 34 (11.0) 24 (10.3) * Statistically significant df = 3
There was a statistically significant difference in one of the components of self-esteem measured. p = 0.008. More adolescents in the slums 205(66.8%) strongly agreed to being a person of worth and having good qualities 130(55.8%) compared to their counterparts in the non-slums.
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Table 13: Rosenberg self-esteem scale of victims of sexual abuse 2
Variable Frequency (%) χ2 p-value Fisher Slum Non-slum exact p n = 307 n = 233 Takes a positive attitude toward self Strongly disagree 5 (1.6) 1 (0.4) 3.115 0.374 0.390 Disagree 14 (4.6) 14 (6.0) Agree 156 (50.8) 109 (46.8) Strongly agree 132 (43.0) 109 (46.8) On the whole, satisfied with self Strongly disagree 3 (1.0) 11 (4.7) 16.210 0.001* Disagree 22 (7.2) 34 (14.6) Agree 199 (64.8) 130 (55.8) Strongly agree 83 (27.0) 58 (24.9) Wish could have more respect for self Strongly disagree 5 (1.6) 1 (0.4) 1.855 0.605 0.674 Disagree 12 (3.9) 8 (3.4) Agree 173 (56.4) 135 (57.9) Strongly agree 117 (38.1) 89 (38.2) Certainly feels useless at times Strongly disagree 91 (29.7) 66 (28.3) 1.726 0.631 Disagree 98 (31.9) 86 (36.9) Agree 99 (32.2) 66 (28.3) Strongly agree 19 (6.2) 15 (6.5)
Thinks that I am no good at all Strongly disagree 99 (32.2) 66 (28.3) 1.759 0.624 Disagree 100 (32.6) 88 (37.8) Agree 96 (31.3) 70 (30.0) Strongly agree 12 (3.9) 9 (3.9)
* Statistically sig df = 3
More respondents in the slum communities 199(64.8%) strongly agreed to being satisfied about themselves compared to the non-slums 130(55.8%). P<0.001
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Table 14: Rosenberg self-esteem score of victims of sexual abuse in the selected slums and non-slums
Table 14: Rosenberg self-esteem score Variable Frequency (%) χ2 df p-value Slum Non-slum n = 307 n = 233 0 – 14 (Low self-esteem) 28 (9.1) 29 (12.4) 15 – 30 (High self-esteem) 279 (90.9) 204 (87.6) Mean self-esteem score 18.8 ± 3.3 18.5 ± 3.4 Student’s t = 1.054; p-value = 0.292
There was no statistically significant difference in the overall self-esteem score of adolescents residing in the slum compared to those in the non-slum communities. P= 0.292. A higher proportion of the respondents had a good self-esteem.
Table 14b: Rosenberg self-esteem score for the non-sexually abused participants
Variable Frequency (%) χ2 df p-value Slum Non-slum n = 93 n = 167 0 – 14 (Low self-esteem) 13 (14.0) 19 (11.4) 0.375 1 0.541 15 – 30 (High self-esteem) 80 (86.0) 148 (88.6) Mean self-esteem score 18.5 ± 3.4 18.8 ± 3.2 Student’s t = 0.804; p-value = 0.422
Most respondents who were not victims of sexual abuse had a high self-esteem score. The high self-esteem scores in this group is similar to that found amongst those who had been victims of sexual abuse though a higher self-esteem score (18.8) was recorded in the non-slums compared to the slums (18.5).
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Table 15: Association between socio-demographic characteristics and sexual abuse
Variable Slum Non-slum Unwanted sexual experience Unwanted sexual experience Yes No Yes No Total n = 307 n = 93 n = 233 n = 167 n = 400 Age (year) 10 – 14 74 (66.7) 37 (33.3) 58 (39.7) 88 (60.3) 146 15 – 19 233 (80.6) 56 (19.4) 175 (68.9) 79 (31.1) 254 χ2, df, p-value 8.754, 1, 0.003* 32.441, 1, <0.001* Sex Male 81 (65.3) 43 (34.7) 84 (48.3) 90 (51.7) 174 Female 226 (81.9) 50 (18.1) 149 (65.9) 77 (34.1) 226 χ2, df, p-value 13.151, 1, < 0.001* 12.598, 1, < 0.001* Religion Christianity 192 (79.0) 51 (21.0) 171 (59.8) 115 (40.2) 286 Islam 115 (73.2) 42 (26.8) 60 (53.6) 52 (46.4) 112 Others 0 0 2 (100) 0 (0) 2 χ2, df, p-value, Fisher exact p 1.776, 1, 0.183 2.721, 2, 0.257, 0.348 Ethnicity Yoruba 201 (74.2) 70 (25.8) 109 (57.1) 82 (42.9) 191 Igbo 48 (80.0) 12 (20.0) 70 (61.9) 43 (38.1) 113 Hausa 2 (66.7) 1 (33.3) 12 (57.1) 9 (42.9) 21 Others 56 (84.8) 10 (15.2) 42 (56.0) 33 (44.0) 75 χ2, df, p-value, Fisher exact p 3.983, 3, 0.256, 0.209 0.911, 3, 0.823 Marital status Never married 300 (76.7) 91 (23.3) 231 (58.3) 165 (41.7) 396 Currently married 7 (77.8) 2 (22.2) 2 (50.0) 2 (50.0) 4 χ2, df, p-value 0.005, 1, 0.941 0.113, 1, 0.737 Level of Education No formal 14 (56.0) 11 (44.0) 4 (26.7) 11 (73.3) 15 Primary 108 (72.5) 41 (27.5) 82 (51.2) 78 (48.8) 160 Secondary 183 (82.4) 39 (17.6) 144 (64.9) 78 (35.1) 222 Post-secondary 2 (50.0) 2 (50.0) 3 (100) 0 (0) 3 χ2, df, p-value, Fisher exact p 13.174, 3, 0.004, 0.003* 15.521, 3, 0.001, 0.001* Still schooling Yes 205 (73.5) 74 (26.5) 176 (54.3) 148 (45.7) 324 No 102 (84.3) 19 (15.7) 57 (75.0) 19 (25.0) 76 χ2, df, p-value 5.538, 1, 0.019* 10.824, 1, 0.001* Currently working Yes 99 (80.5) 24 (19.5) 53 (61.6) 33 (38.4) 86 No 208 (75.1) 69 (24.9) 180 (57.3) 134 (42.7) 314 χ2, df, p-value 1.391, 1, 0.239 0.514, 1, 0.473
There was a statistically significant association between age and exposure to sexual abuse in
the slum (p value 0.003) and non-slum communities (p value < 0.001).
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In the slum and non-slum communities, a higher proportion of respondents in the 15-19 age group 233(80.6%), 175(68.9%) had experienced sexual abuse compared to those in the 10-14 age group 74(66.7%), 58(39.7%). A higher proportion of females in the slums 226(81.9%) and
149(65.9%) non-slums had experienced sexual abuse compared to the males 81(65.3%) slums and 84(48.3%) non slums. This difference was statistically significant with p value <0.001 for the slum and non-slums.
In the slums, a higher proportion 183(82.4%) of respondents with secondary level of education had experienced sexual abuse compared to those with primary 108(72.5%) or no formal education 14(56%). The association between level of education and sexual abuse in the slums was found to be statistically significant with a p value 0.003.
Similarly, in the non-slums, there was a statistically significant association between level of
Education and sexual abuse (p value 0.001). In the non-slums, the higher the educational status of respondents, the higher the chances of being sexually abused. A higher proportion
144(64.9%) of the respondents with secondary level of education experienced sexual abuse compared to 4(26.7%) with no formal education.
A higher proportion of the respondents in the slums who gave information on experience of sexual abuse were no longer in school 102(84.3%) compared to those that were out of school
205(73.5%). The association between schooling status and sexual abuse was statistically significant with a p value 0.019.
In the non-slums, association between schooling status and sexual abuse was also found to be statistically significant with a p value 0.001. A larger proportion 57(75%) of respondents who had experienced sexual abuse were those that were out of school.
A higher proportion of respondents who were working or in a paid job reported being sexually abused for the slum 9(80.5%) and 53(61.6%) non slum communities compared to 208(75.1%) slum and 180(57.3%) that weren’t working. This association was however not statistically significant. There was no statistically significant association between religion, ethnicity, marital status and sexual abuse.
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Table 16: Association between living arrangement of respondent’s parents, and sexual abuse
Variable Slum Non-slum Unwanted sexual experience Unwanted sexual experience Yes No Yes No Total n = 307 n = 93 n = 233 n = 167 n = 400 Duration of stay in community ≤ 5 90 (83.3) 18 (16.7) 67 (54.5) 56 (45.5) 123 6 – 10 66 (76.7) 20 (23.3) 55 (69.6) 24 (30.4) 79 11 – 15 71 (67.6) 34 (32.4) 69 (50.0) 69 (50.0) 138 16 – 20 80 (79.2) 21 (20.8) 42 (70.0) 18 (30.0) 60 χ2, df, p-value 7.871, 3, 0.049* 12.190, 1, 0.007* Parents living together Yes 238 (75.6) 77 (24.4) 178 (54.3) 150 (45.7) 328 No 69 (81.2) 16 (18.8) 55 (76.4) 17 (23.6) 72 χ2, df, p-value 1.185, 1, 0.276 11.879, 1, 0.001* Parents’ marriage Monogamy 227 (78.3) 63 (21.7) 192 (55.3) 155 (44.7) 347 Polygamy 80 (72.7) 30 (27.3) 41 (77.4) 12 (22.6) 53 χ2, df, p-value 1.372, 1, 0.241 9.173,1, 0.002* Discussed about Sexual Abuse with parents/ guardians Yes 171 (87.2) 25 (12.8) 126 (70.0) 54 (30.0) 180 No 136 (66.7) 68 (33.3) 107 (48.6) 113 (51.4) 220 χ2, df, p-value 23.721,1, < 0.001* 18.579, 1, < 0001*
There was a statistically significant association between duration of stay in the slum community
and sexual abuse. P value 0.049. A higher proportion of respondents who had lived in the slums
for less than 5 years 90(83.3%) in the slums reported experience of sexual abuse compared to
those who had lived longer in the slum communities.
Conversely, in the non-slums, a larger proportion 42(70%) of respondents who had stayed as
long as 16 years reported experience of sexual abuse compared to those who lived less than 16
years. This association between duration of stay in the non-slum community and sexual abuse
was found to be statistically significant with a p value 0.007.
In the slums, a higher proportion 69(81.2%) of adolescents whose parents where not living
together reported experience of sexual abuse compared to those whose parents were together
55(76.4%). The association between parents living status and experience of sexual abuse was
83 not statistically significant in the slums. In the non-slums, a higher proportion 55(76.4%) of adolescents whose parents were not living together reported experience of sexual abuse compared to 178 (54.3%) whose parents lived together. This association was found to be statistically significant for the non-slums with a p value of 0.001.
Regarding type of parent’s marriage in the slums, a higher proportion 227(78.3%) of respondents whose parents were in monogamous marriages reported experience of sexual abuse compared to those in polygamous marriages 80(72.7%). This association, however was not statistically significant. P value 0.241.
In the non-slums, there was a statistically significant association between type of marriage and sexual abuse. P value 0.002. A higher proportion of respondents 41(77.4) whose parents were in a polygamous marriage reported experience of sexual abuse compared to those whose parents were in a monogamous marriage 192(55.3%).
Interestingly, for the slums and non-slums, respondents who had discussions with their parents or guardians on issues relating to sexual abuse reported experiencing sexual abuse compared to those who had no discussions on sexual abuse. The association between discussions on sexual abuse and experience of sexual abuse in itself was found to be statistically significant in both settings with p value < 0.001.
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Table 17: Association between living arrangements, social habits of respondents and sexual abuse Variable Slum Non-slum Unwanted sexual experience Unwanted sexual experience Yes No Yes No Total n = 307 n =93 n = 233 n = 167 n = 400 Type of accommodation Single room with shared amenities 213 (77.5) 62 (22.5) 71 (59.7) 48 (40.3) 119 Single room self-contained 55 (79.7) 14 (30.3) 82 (61.7) 51 (38.3) 133 Bedroom flat 39 (69.6) 17 (30.4) 80 (54.1) 68 (45.9) 148 χ2, df, p-value 2.000, 2, 0.368 1.803, 2, 0.406 Family size < 5 109 (79.6) 28 (20.4) 68 (61.8) 42 (38.2) 110 5 – 9 193 (75.4) 63 (24.6) 160 (56.9) 121 (43.1) 281 ≥ 10 5 (71.4) 2 (28.6) 5 (55.6) 4 (44.4) 9 χ2, df, p-value 0.983, 2, 0.612 0.801, 2, 0.670 Shares room with others Yes 68 (70.8) 28 (29.2) 47 (56.6) 36 (43.4) 83 No 239 (78.6) 65 (21.4) 186 (58.7) 131 (41.3) 317 χ2, df, p-value 2.478, 1, 0.115 0.114, 1, 0.736 Shares amenities/toilet/bath Yes 230 (75.9) 73 (24.1) 107 (58.2) 77 (41.8) 184 No 77 (79.4) 20 (20.6) 126 (58.3) 90 (41.7) 216 χ2, df, p-value 0.497, 1, 0.481 0.001, 1, 0.971 Ever smoked cigarette Yes 3 (75.0) 1 (25.0) 6 (85.7) 1 (14.3) 7 No 304 (76.8) 92 (23.2) 227 (57.8) 166 (42.2) 393 χ2, df, p-value 0.007, 1, 0.934 2.210, 1, 0.137 Ever drunk alcohol Yes 35 (89.7) 4 (10.3) 29 (67.4) 14 (32.6) 43 No 272 (75.3) 89 (24.7) 204 (57.1) 153 (42.9) 357 χ2, df, p-value 4.089, 1, 0.043* 1.674, 1, 0.196
In the slums, a higher proportion 55(79.7%) of the respondents living in single room self-
contained apartments reported experience of sexual abuse compared to their counterparts who
lived in flats. This association was however not statistically significant with p value 0.368.
Type of accommodation was also not associated with experience of sexual abuse in the non-
slums (p value 0.406). 82 (61.7%) of respondents in single room self-contained flats
experienced sexual abuse compared to a lower proportion 80(54.1%) who lived in flats.
There was no statistically significant association between sharing of amenities and sexual
abuse. Neither was there an association with family size in the slums and non- slums.
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There was however a statistically significant association with alcohol intake in the adolescents.
(P value 0.043). A higher proportion 35(89.7%) of adolescents in the slums who had ever drunk alcohol reported sexual abuse. In the non-slums, alcohol was not associated with sexual abuse p value 0.196, though a larger proportion 29(67.4%) who reported sexual abuse experience were those who had ever drunk alcohol.
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Table 18: Association between socio-economic characteristics of respondent’s parents and sexual abuse
Variable Slum Non-slum Unwanted sexual experience Unwanted sexual experience Yes No Yes No Total n = 307 n =93 n = 233 n = 167 n = 400
Father’s education No formal 15 (75.0) 5 (25.0) 5 (100) 0 (0) 5 Primary 53 (72.6) 20 (27.4) 26 (76.5) 8 (23.5) 34 Secondary 159 (77.2) 47 (22.8) 126 (60.0) 84 (40.0) 210 Post-secondary 80 (79.2) 21 (20.8) 76 (50.3) 75 (49.7) 151 χ2, df, p-value, Fisher exact p 1.102, 3, 0.777 12.383, 3, 0.006, 0.005* Mother’s education No formal 22 (75.9) 7 (24.1) 14 (93.3) 1 (6.7) 15 Primary 57 (68.7) 26 (31.3) 46 (79.3) 12 (20.7) 58 Secondary 173 (76.9) 52 (23.1) 117 (53.9) 100 (46.1) 217 Post-secondary 55 (87.3) 8 (12.7) 56 (50.9) 54 (49.1) 110 χ2, df, p-value 6.979, 3, 0.073 22.283, 3, < 0.001* Father’s occupation Unskilled 62 (66.7) 31 (33.3) 49 (59.0) 34 (41.0) 83 Manually skilled 116 (82.9) 24 (17.1) 89 (58.9) 62 (41.1) 151 Non-manually skilled 95 (73.6) 34 (26.4) 70 (54.7) 58 (45.3) 128 Professional 34 (89.5) 4 (10.5) 25 (65.8) 13 (34.2) 38 χ2, df, p-value 12.370, 3, 0.006* 1.607, 3, 0.658 Mother’s occupation Unskilled 229 (79.5) 59 (20.5) 151 (56.8) 115 (43.2) 266 Manually skilled 47 (68.1) 22 (31.9) 26 (61.9) 16 (38.1) 42 Non-manually skilled 30 (71.4) 12 (28.6) 54 (60.7) 35 (39.3) 89 Professional 1 (100) 0 (0) 2 (66.7) 1 (33.3) 3 χ2, df, p-value, Fisher exact p 5.085, 3, 0.166, 0.137 0.774, 3, 0.856
In the slums, the highest proportion of respondents 80(79.2%) that experienced sexual abuse
were those whose fathers had post-secondary education. The association between father’s
87 educational status and experience of sexual abuse by the adolescent was not statistically significant p value 0.777.
Interestingly, in the non-slums, there was a statistically significant association between father’s educational status and sexual abuse experience in the adolescent. P value 0.005
A larger proportion (100%) of adolescents who experienced sexual abuse in the non-slums were those whose fathers had no formal education compared to those whose fathers had post- secondary education (50.3%) or some form of education.
With respect to mother’s education in the slums, a larger proportion 55(87.3%) of adolescents who had been sexually abused had mothers with post-secondary education compared to
57(68.7%) whose mothers had primary education. The association between mother’s education and sexual abuse was not statistically significant. P value 0.073.
In the non-slums, a larger proportion 46(79.3%) of adolescents whose mothers had no formal education reported experience of sexual abuse compared to those whose mothers had some form of education. This association was found to be statistically significant with p value
<0.001.
A higher proportion 34(89.5%) of adolescents whose fathers were professionals reported sexual abuse. This association was found to be statistically significant P value 0.006
In the non-slums, there was no statistically significant association between father’s occupation and sexual abuse. However, a larger proportion 25(65.8%) of adolescents who reported sexual abuse experience were those whose fathers were professionals.
Mother’s occupation was not statistically associated with sexual abuse in the slums and non- slums. Though a larger proportion of adolescents who had been sexually abused in the slums and non-slums were those whose mothers were professionals.
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Table 19: Simple and multiple logistic regressions of experience of sexual abuse on associated factors in slum
Predictor variable Simple logistic regression Multiple logistic regression β SE Wald p- Crd. 95% CI β SE Wald p- Adj. 95% CI value OR Lower Upper value OR Lower Upper Age (year) 0.17 0.05 10.73 0.001* 1.19 1.07 1.31 .135 0.08 2.90 0.088 1.14 0.98 1.34 Sex (Female/Male) 0.88 0.25 12.76 0.001* 2.40 1.48 3.88 .905 0.26 11.75 0.001* 2.47 1.47 4.15
Level of education Primary/No formal 0.73 .443 2.70 0.100 2.07 0.87 4.93 0.75 0.50 2.29 0.130 2.12 0.80 5.60 Secondary/No formal 1.31 .440 8.80 0.003* 3.69 1.56 8.73 0.85 0.55 2.40 0.121 2.35 0.80 6.91 Post-secondary/No formal -0.24 1.08 0.05 0.823 0.79 0.10 6.50 -1.19 1.19 1.01 0.314 0.30 0.03 3.10
Out of schooling (Yes/No) 0.66 0.28 5.42 0.020* 1.94 1.11 3.38 0.37 0.34 1.23 0.267 1.45 0.75 2.81 How long in community (year) -0.03 0.02 1.75 0.186 0.97 0.94 1.01
Mother’s education No formal /Post-secondary -0.78 0.58 1.85 0.174 0.46 0.15 1.41 -0.88 0.63 1.93 0.165 0.42 0.12 1.44 Primary /Post-secondary -1.14 0.45 6.56 0.010* 0.32 0.13 0.77 -1.20 0.47 6.44 0.011* 0.30 0.12 0.76 secondary /Post-secondary -0.73 0.41 3.13 0.077 0.48 0.22 1.08 -0.97 0.44 4.88 0.027* 0.38 0.16 0.90 Father’s occupation Manually skilled/Unskilled 0.88 0.31 7.89 0.005* 2.42 1.31 4.47 0.90 0.34 7.16 0.007* 2.46 1.27 4.74 Non-Manually skilled/Unskilled 0.33 0.30 1.27 0.261 1.40 0.78 2.50 0.27 0.32 0.71 0.400 1.31 0.70 2.45 Professional/Unskilled 1.45 0.57 6.39 0.011* 4.25 1.38 13.05 1.31 0.59 4.88 0.027* 3.70 1.16 11.80
Eve drank alcohol (Yes/No) 1.05 0.54 3.77 0.052 2.86 0.99 8.28 Constant -1.90 1.23 2.39 *Statistically significant Crd.=Crude Adj.=Adjusted
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Significant associations with sexual abuse in the slums are:
Age 15- 19 years OR 1.19, 95% CI 1.07- 1.31, p value 0.001.
Female sex OR 2.40, 95% CI 1.48- 3.88, p value 0.001
Out of school OR 1.94, 95% CI 1.11-3.38, p value 0.020
Secondary level of Education in adolescent OR 3.69, 95% CI 1.56-8.73, p value 0.003
Mother’s education (primary) OR 0.32, 95% CI 0.13- 0.77, p value 0.010
Multi variate analysis confirmed that the most significant determinant/predictors of sexual abuse in the slum were
Female sex OR 2.47, 95% CI 1.47- 4.15, p value 0.001
Mother’s education (primary) OR 0.30, 95% CI 0.12-0.76, p value 0.011
Mothers education (secondary) OR 0.38, CI 0.16-0.90, p value 0.027
Father’s occupation: manually skilled OR 2.46, CI 1.27-4.74, P value 0.007
Professional OR 3.7, CI 1.16-11.80, P value 0.027
The above has therefore shown that in the slum, Females were 3 times more likely to be sexually abused than males in the slum communities.
Adolescents whose mothers had only primary education were 3 times less likely to be sexually abused compared to adolescents whose mothers had post-secondary level of education.
Secondary level of education in the mother made an adolescent 3 times less likely to be sexually abused than those whose mothers had post-secondary education. Adolescents whose fathers were manually skilled were about 3 times more likely to be sexually abused. The odds of sexual abuse experience were 4 times more likely in adolescents whose fathers were professionals compared to the unskilled fathers.
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Table 20: Simple and multiple logistic regressions of experience of sexual abuse on associated factors – Non-slum Predictor variable Simple logistic regression Multiple logistic regression β SE Wald p-value Crd. 95% CI β SE Wald p- Adj. 95% CI OR Lowe Uppe value OR Lower Upper r r Age (year) 0.25 0.05 25.34 < 1.29 1.17 1.42 0.14 0.07 3.99 0.046* 1.15 1.00 1.33 0.001* Sex (Female/Male) 0.73 0.21 12.45 < 2.07 1.38 3.11 0.72 0.23 9.72 0.002* 2.05 1.31 3.21 0.001* Level of education Primary/No formal 1.06 .605 3.08 0.079 2.89 .883 9.46 0.821 0.69 1.40 0.237 2.27 0.58 8.86 Secondary/No formal 1.63 .601 7.32 0.007* 5.08 1.57 16.47 1.23 0.71 2.98 0.085 3.41 0.85 13.71 Post-secondary/No formal 22.21 2.3 ˄4 0.00 0.999 4.4 ˄9 0.00 Infini 21.39 2.3 ˄4 0.00 0.999 1.9 ˄9 0.00 Infinit ty y
Out of schooling (Yes/No) 0.93 0.29 10.37 0.001* 2.52 1.44 4.43 0.39 0.35 1.27 0.259 1.48 0.75 2.90 How long in community 0.01 0.02 0.40 0.526 1.01 0.98 1.05 (year) Parents not together 1.00 0.30 11.27 0.001* 2.73 1.52 4.90 0.73 0.34 4.71 0.030* 2.07 1.07 4.01 (Yes/No) Polygamous marriage 1.02 0.35 8.62 0.003* 2.76 1.40 5.43 0.61 0.38 2.48 0.115 1.83 0.86 3.89 (Yes/No) Father’s education No formal /Post-secondary 21.19 1.8 ˄4 .000 0.99 9 1.6˄10 0.00 Infini 18.93 1.7 ˄4 0.00 0.999 1.7 ˄8 0.00 Infinit ty y Primary /Post-secondary 1.17 .436 7.150 0.007* 3.21 1.37 7.54 0.18 0.54 0.11 0.746 1.19 0.41 3.45 Secondary /Post-secondary 0.39 .215 3.32 0.068 1.48 0.97 2.26 0.16 0.29 0.29 0.592 1.17 0.66 2.06 Mother’s education No formal /Post-secondary 2.60 1.05 6.12 0.013* 13.50 1.72 10.62 2.05 1.13 3.27 0.071 7.77 0.84 71.78 Primary /Post-secondary 1.31 0.38 12.08 0.001* 3.70 1.77 7.73 1.10 0.47 5.52 0.019* 2.99 1.20 7.46 Secondary /Post-secondary 0.12 0.23 0.27 0.607 1.12 0.71 1.79 -0.04 0.31 0.02 0.893 0.96 0.53 1.75 Constant -3.77 1.20 9.94
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Significant associations with sexual abuse in non-slum communities were
Age (OR =1.29, 95% CI 1.17- 1.42, p value < 0.001)
Female sex (OR =2.07, 95% CI 1.38-3.11, p value < 0.001)
Secondary level of education (OR = 5.08, 95% CI 1.57-16.47, p value 0.007)
Out of school (OR = 2.52, 95% CI 1.44 – 4.43, p value 0.001)
Parents not together (OR= 2.73, 95% CI 1.52- 4.90, p value 0.001)
Polygamous marriage (OR= 2.76, 95%CI 1.40-5.43, p value 0.003)
Fathers education (primary) (OR = 3.21, 95% CI 1.37-7.54, p value 0.007)
Mothers education (no formal education) (OR = 13.50 95% CI 1.72-10.62, p value 0.013)
Mothers education (primary) (OR 3.70, CI=1.77-7.73, p value 0.001)
Multi variate analysis confirmed that the most significant determinant of sexual abuse in the non-slum community was Age, sex, parents not together and mother’s education.
Age (15-19 years) (OR =1.15, 95% CI 1.00- 1.33, p value 0.046)
Female sex (OR =2.05, 95% CI 1.31-3.21, p value 0.002)
Parents not together (OR= 2.07, 95% CI 1.07- 4.01, p value 0.030
Mothers level of education (primary) (OR = 2.99, 95% CI 1.20-7.46, p value 0.019
The above therefore shows that adolescents 15-19 years in the non- slums are more likely to be sexually abused than those aged 10-14 years while the odds of sexual abuse was 2 times higher in females. Adolescents whose parents did not live together were 2 times more likely to be sexually abused in the non-slum communities.
Mother’s education was a significant determinant of sexual abuse. In the non-slums adolescents whose mothers had only primary level of education, were 3 times more likely to be sexually abused compared to those whose mothers had higher levels of education.
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4.1 RESULTS OF FOCUS GROUP DISCUSSION
The main findings that emerged from the focus group discussions were centred on five major themes which include:
1. Perceived prevalence of sexual abuse.
2. What respondents perceived constitutes sexual abuse.
3. Determinants/ factors contributing to sexual abuse in their community.
4. Perceived consequences of sexual abuse to adolescents.
5. Support system for sexual abuse and what they should do when they perceive sexual
abuse.
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Table 21: Perceived prevalence of sexual abuse
Theme Subtheme Age/ Location Response Sex How Common 17yrs/ NON- “It is getting rampant nowadays. It is common is in schools F SLUM everywhere, even teachers are forcing sexual students to sleep with them”. abuse in this area? 18yrs/ SLUM “My teacher punished me and said I should M sit under her table and opened her legs wide open for me to see. Each time I take my head away, she shouts that I look straight. Is that not part of abuse?”
Religious 50yrs/ SLUM “A particular man of God used to call young homes F girls on phone and tell them to pray at midnight with one finger in their private part. He then later sleeps with them. He has been caught now and chased away from the church. He said my children were strong spiritually. If not he would have called them”. 40yrs/ SLUM “An alfa in our area calls 2-3 year olds and F give them sweets then he touch their private part. I think he is using it for juju .sighs!”
Families 53yrs/ NON- “It is very common. Even husband and wife. M SLUM If the man is frustrated he can rape his wife”. “I have heard stories of men sleeping with 45yrs/ NON- house helps. Its frustration of life. If the wife M SLUM is not pleasing him sexually”.
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16yrs/ SLUM “It is very common but people are still hiding F and not voicing it out because of shame”.
17yrs/ NON- “See ehn… when we talk about sexual abuse, M SLUM is not just about the girls but even boys. Afterall, it was my aunty that showed me the way there. Now I enjoy it and I am an expert. She is married now with 3 children”. 19yrs/ NON- “It happens in the home now. Uncle’s father M SLUM and brother sleep with their children and sister”.
50yrs/ SLUM “When we were younger, we used to play a M game daddy and mummy. That’s sexual abuse because we copied what adults were doing. It has been in existence for so long…. Sings a Yoruba folksong”.
45yrs/F SLUM “Aunty do you even see this area; I can’t send my child on errand at night. Sexual abuse is too much here. Sighs….”
Participants in both settings thought that sexual abuse was very common and condoned by communities. They also perceived that these acts were seldom reported due to several barriers that favour the acceptance and non-disclosure of sexual abuse. Some discussants also cited examples of this abuse going on in religious homes.
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Table 22: Perception of what constitutes sexual abuse
Theme Subtheme Age/sex Location Statement/Response Perception of Forceful 38yrs/F NON- “Sexual abuse is what you have no what sex/rape SLUM interest and someone force you”. constitutes sexual abuse 17yrs/F SLUM “A girl in my school who was raped at age 10years and since then she keeps having urge to have sex but now she is getting better with prayers”.
50yrs/F SLUM “What I see is that it does-not matters if you dress in front of them because after bath you cannot tell your child to go out but all we have to do is to cover small. Let them see my body at least I did not draw any tattoo on my body so they too have no reason to draw tattoo”.
All participants had similar views on what constitutes sexual abuse. They agreed that forceful sex/ rape was sexual abuse. They perceived that boys, girls, women, men could experience sexual abuse. Some of the participants echoed that sexual abuse was exposure to sex at an early age whether consensual or not. Many of the adolescent males agreed that exposure of a child to pornography by an adult is a serious form of sexual abuse. Majority of the respondents were unaware that parents dressing in front of their children was a form of sexual abuse. Some respondents attributed sexual abuse to prostitution.
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Table: 23 Factors contributing to sexual abuse
Theme Subtheme Age/ Locatio Statement/ Response sex n Factors Pornography 16yrs/ SLUM “Sexual abuse is doing what you ought not contributing to F to do like 10-12 years watching blue film on sexual abuse phone”. 45yrs/ NON- “Film is very common. It is those shameless F SLUM adults that allow children watch it. Phone sef is a big wahala. Where I have not reached on my phone, my children get there”. 19yrs/ NON- “All this WhatsApp and facebook and M SLUM internet. It is causing problem I tell you. Any small thing you will see naked woman. That alone can make men want to rape”.
Housing 49yrs/ SLUM “Some children will know when their daddy F want to meet mummy and pretend they are sleeping. What can we do. Its only one room we can afford”. 18yrs/ SLUM “See, do you think I don’t know what M happens with my parents. Afterall its only one room nah”. 55yrs/ NON- “It’s the women that are fond of dressing M SLUM infront of their children. Some of them will even bathe with their kids. So what are you saying?”
Alcohol 43yrs/ SLUM “When men take too much alcohol. For F example, you know “skunshii” that one they mix cough syrup in their hot drinks. you can buy the mixture for 500 naira. When they take it, their senses are never complete and they do and undo”. 15yrs/ NON- “Some men rape girls that they have toasted F SLUM and she didn’t agree. Most of these boys are always high”. 55yrs/ NON- “Those girls called “olosho” do you think M SLUM they don’t drink too. They can even rape a man” 58yr/ NON- “There is too much freedom in this country. M SLUM Let there be sharia everywhere. Let Government control selling of alcohol. This alcohol doesn’t make them think straight”.
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Parental 51yrs/ SLUM “Is it not some mothers that will be asking factor F their girls what they brought home and how much they have. Tell me. Where are they supposed to get the money from”. 49yrs/ NON- “Some children will leave the house with one F SLUM cloth and change to a bad one outside. I pieces my child’s clothe one day. She dares not try me. You have to monitor them well”. 49yrs/ SLUM “Parents and even the church should start F teaching this children about sex education and how to keep safe”. 17yrs/ NON- “Our parents should also draw us close and F SLUM stop shouting at every little thing”. 18yrs/ SLUM “I have one friend the mother did not know F when she started menstruating. If anything happens she won’t talk now”. 46yrs/ NON- “If we shout on them they won’t be free with M SLUM us”. 52yrs/ NON- “Imagine a parent that goes in the morning M SLUM and comes back late at night very tired. How will you monitor”. 49yrs/ SLUM “Please ooo. We women have a role to play. F Don’t blame the men. Its in our hands to help them”. 50yrs/ SLUM “Parents should stop taking the children up F and down to different pastors for prayers. That’s where they miss it. Going up and down looking for vision”. 42yrs/ SLUM “Shebi, some women have boyfriend and M their children know. What do you expect We need to show them the right way”. 46yrs/ NON- “The first friends of the child is the parent. M SLUM Let us draw them close”. 40yrs/ SLUM “Fathers that sleep with their children are F using it for juju”. Education 16yrs/ NON- “Let them make education compulsory F SLUM especially those boys who smoke Indian hemp”. 19yrs/ NON- “It is the people that don’t go to school that F SLUM are raped. Like me now, I still want to read but I’m doing hairdresser”. 18yrs/ SLUM “Sex education is good but not at unripe age F atleast from 20 years”.
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48yrs/ SLUM “We should teach them parts of their body F and tell them not to allow any man or uncle carry them on their lap” Culture 53yrs/ NON- “My religion says once they have started M SLUM menstruating, they should marry so that they don’t sleep around but it is not a by force rule. At least, I can take up a child and take care of her till she is ready for me to sleep with her. We are in modern age now. We can’t force them till they are ready”. 55yrs/ NON- “The girls are the ones pushing themselves M SLUM on us now. Before in the olden days it wasn’t like that. People do things the proper way. But our culture have changed”. SLUM “The environment and what is rampant in that area matters. If there are many bad people, the child will be exposed to raping girls. Even if the parents monitor, the bad boys will mount pressure”. Indecent 19yrs/ NON- “If a woman wears skimpy things, dressing M SLUM automatically people will look and talk. Even a baby will talk. Of course she will be raped”. 57yrs SLUM “Their mode of dressing nowadays is terrible. Advertising themselves for everybody to see”. 40yrs/ SLUM “My husband likes me dressing like that. So F it depends”
Participants attributed increase in sexual abuse to a number of factors, such as technology, indecent dressing, and lack of parental care as a major contributor. They also identified financial hardship and poor housing as a major problem.
Some of the respondents felt that there was too much emphasis on the girl child and less attention on the boys who also get sexually abused. Alcohol and drug abuse was echoed by majority of the respondents. Respondents unanimously agreed that Lack of parental care was a factor. They identified overworking parents, careless, uncaring and non chalant parents to be contributors to sexual abuse.
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In all the FGDS, participants expressed deep concerns about poverty and poor parental care that make children vulnerable to several risks including sexual abuse. Some participants reported that parent’s poor economic status might force girls to engage in risky sexual activities in order to solicit financial support from boyfriends or engage in prostitution. Participants across all age groups and of both genders expressed that there was poor parental monitoring with children especially when they have attained puberty. For parents who monitor and take time to educate their kids, the information wasn’t sufficient
Table 24: Consequences of sexual abuse
Theme Subtheme Age/yrs Location Statement/ response Consequences of HIV 17yrs/M NON- “The child cannot be normal again. sexual abuse SLUM Can have HIV”.
Emotional 18yrs/F SLUM “It can affect their schooling and the trauma girl will be depressed. And it will show. She won’t dress well and interact with people like before”.
16yrs/F SLUM “The men are lucky. I don’t think it affects them. They will be better at it”.
Responses regarding consequence of sexual abuse ranged from low self-esteem to prostitution, unwanted pregnancies, HIV/AIDS, emotional trauma and mental problems.
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Table 25: Support system for sexual abuse
Theme Subtheme Age Location Statement/response /sex Support Lack of 44yrs/F SLUM “There is one strong man in our area system for quality that rapes girls. He goes to the prison a sexual abuse services lot but they keep releasing him. What can we do. We fear him…sighs” 52yrs/F NON- “The government should help us deal SLUM with criminals”. 18yrs/F SLUM “We need counselling in this area. We need people we can talk to for advice. Like you now, you can help us with a place where we can come and get advice and share our problems”. 18yrs/F SLUM “The Baale settles some cases but at the end it is still the girl that face the shame and all the problem”.
Participants agreed that the fear of being stigmatized prevents reporting. When reports are made, the victims are often times not believed.
Cost, corruption, distance, limited services, lack of quality care services were seen by participants as barrier to appropriate help seeking behaviour. Participants echoed that police usually responds slowly and eventually allow the perpetrator go free. They believed that reporting does more harm than good and that the Government had not done enough regarding punishment of perpetrators. Corruption was echoed has a hindrance to justice for victims.
Participants agreed that the fear of being stigmatized prevents reporting. When reports are made, the victims are often times not believed.
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Figure 7: Word Cloud Generated from analysis of Focus Group Discussion
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CHAPTER FIVE
DISCUSSION
Sexual abuse is a serious problem faced by children and adolescents. Sadly, many of these cases are under reported due to fear of stigma. Studies on sexual abuse have given differing prevalence rates due to the various definitions of sexual abuse captured. This study included the broad definition of sexual abuse by WHO which includes the contact and non-contact type of sexual abuse.41
This study compared the prevalence, pattern and determinants of sexual abuse amongst 800 adolescents in selected slum and non-slum communities in Lagos State. The ages of adolescents in the study ranged 10 to 19 years with a higher proportion of older adolescents.
The adolescents differed significantly in terms of their sex distribution as there were more females in the slums compared to the non-slums. Adolescents in the slums and non-slums were quite similar in terms of level of education as a majority had secondary level of education but were dissimilar with respect to schooling status. A higher proportion of adolescents in the slums were out of school compared to the non-slums. Being out of school is thought to increase vulnerability to sexual abuse though there have been differing results on the association between schooling status and sexual abuse.50,63 Source of subsistence for the adolescents in the slums and non-slums was quite similar, as a large proportion of the adolescents’ source of money was from their parents.
Regarding type of marriage amongst respondent’s parents, majority were from monogamous marriages though a higher proportion of the polygamous marriages were in the slums. An explanation for polygamy in the slum could be due to the fact that women in the slums face formidable challenges for their daily survival and so depend on men who can meet their needs.
The deteriorating socioeconomic conditions of slum dwellers is a major cause of unstable and
103 fragile life of married women. The implication of type of parents’ marriage on sexual abuse is that it may increase vulnerability of adolescents to sexual abuse due to the negative psychological effects of polygamy and reduced parental monitoring. However, this study found no association with type of marriage and sexual abuse and this finding is in contrast with the
Ethiopian study where adolescents from polygamous homes were found to be more vulnerable to sexual abuse.127
This study also found that most of the respondents lived with their parents though a larger proportion of respondents in the slums lived with single parents. The implication of this is that adolescents with single parents may be more likely to experience sexual abuse as corroborated by the focus group discussion where participants emphasized the role of both parents in protecting the adolescent. Single parent homes are a risk factor for sexual abuse in adolescents as reported in a Ghana study where single mothers were found to have encouraged young girls into premarital sexual relationships.80 Similarly, the WHO report on sexual abuse clearly states the relationship of single parents and sexual abuse in their adolescents.4 Surprisingly, in this study, more than two-thirds of adolescents who experienced sexual abuse were actually living with both parents and this was found to be in contrast to another study where respondents living alone and those living with their friends were at higher risk of experiencing sexual abuse.127
This finding is also in contrast with the Lagos and Enugu study that proved living with both parents had a protective effect on experiencing sexual abuse.63,147 However, this finding is in keeping with results from the FGDs where a larger proportion of the adolescents complained about the lack of quality time with their parents and even when the parents are back from work, they are too tired to discuss with them. The possible explanation for this worrisome finding may be due to the fact that parents in Urban areas (slum or not) hardly have time for their kids due to stress of work and long hours in traffic before getting home after close of work. The direct monitoring and follow up that is expected by parents over their wards is gradually getting
104 minimized and may increase chances of exposure of their adolescents to opportunistic predators.
A larger proportion of the adolescents in slum communities, lived in single rooms sharing amenities like toilets, bathrooms and kitchen with other neighbors compared to the non-slums where a higher proportion lived in self-contained apartments and flats. The poor living condition in the slums may be due to their low socioeconomic status and this clearly agrees with the Kenyan and Iwaya studies which were conducted in slums.63,132 Low incomes
(poverty) force families into poor housing conditions. This is an issue raised in the focus group discussions. Housing problem was perceived to be severe in recent times and this may reflect deteriorating housing standards and overcrowding which is characteristic of the slums.
In the slum and non-slum communities, most of the fathers had secondary level of education, however, a larger proportion of the fathers in the slums had no formal education. Similarly, for the mothers, more than half had secondary education in both settings (54.2 and 56.2%) but a higher proportion of the mothers in the slums had no formal education which is expected as the low socioeconomic status in the slums may be responsible for this finding of no formal education.
A disparity however existed regarding level of education and occupation. Despite the fact that more than half of the mothers had at least secondary education, majority were unskilled. This calls for concern because an unskilled woman is likely to earn less and be in poverty, making her children vulnerable to sexual abuse.133
This study reported a high prevalence of sexual abuse 76.8% and 58.3% for the slum and non- slum communities respectively. The high prevalence rates in both communities is comparable to studies from some parts of Nigeria with prevalence rates of sexual abuse as high as 69.9%and
77% from vulnerable groups consisting of street hawkers and girls in paid employment.51,52
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The prevalence observed in the non-slum, is similar to a study conducted in Anambra and Oyo state where a prevalence of 60.9% and 55% were found. This prevalence is higher than what was obtained in two studies from Northern Nigeria (13.8%, 22.2%)13,134. However, there have been some studies with lower prevalence rates far from that seen in this study. Lower prevalence rates were found in studies where parents had to give information about sexual abuse in their children as seen in studies conducted in south western Nigeria 2.1% and
2.7%.49,56 This low prevalence could have been due to withheld information by parents or due to the fact that affected children did not disclose their experiences to their parents.
Lower Prevalence rates have been reported in Europe (9.2%), America (10.1%) and Asia
(23.9%) probably due to the high socioeconomic status and social support enjoyed by their citizens.7 The most frequent explanations for the sexual abuse of children in sub-Saharan Africa
(SSA) include rapid social change and the patriarchal nature of society.1 Generally, studies on sexual abuse have had differing prevalence rates probably due to their definitions of sexual abuse as some studies did not capture the penetrative and non-penetrative definitions of sexual abuse. The difference in the reported prevalence of 76.8% and 58.3% for sexual abuse in the slum and non-slum communities was statistically significant (P < 0.05). This higher prevalence in the slums could be due to the cramped living conditions in the urban slums which limits privacy, as parents are often forced to share sleeping space with children, thus exposing children to sexual activity early on in life. This was reflected in the focus group discussions where many of the respondents in the slum communities emphasized living conditions as a predisposing factor to sexual abuse. Furthermore, exposure to parental sexual activity may weaken adult control over their children’s sexual behaviour. Space constraints may also force young people to move out of parental homes to their own dwellings prematurely, providing them with opportunities to engage in risk behaviour away from parental supervision.132 Studies have been able to demonstrate that empowerment and self-defence are simple and effective
106 tools to decrease the incidence of sexual abuse and this is sadly lacking in urban slums which are on the average poorer than non-slum.135,136 Generally, urban lifestyles stimulate higher stress levels in the daily lives of parents/guardians in the urban population making them away at work and having less time to monitor their children. This explanation may be responsible for the high prevalence rates recorded in both settings. The high prevalence rates may also be attributed to westernization that has caused shifts in values and practices. The high prevalence obtained in this study indicates that sexual abuse is occurring and is relatively common in our environment as corroborated by the FGDs conducted in this study. However, this is only a tip of the iceberg as it is possible that many of the respondents could have withheld information during the interview. This high prevalence is a pointer to the need to pay adequate attention to protection of the sexual rights of all adolescents whether residing in slum or not.
In this study, more respondents in the slums 38.8% had engaged in sexual intercourse compared to 25.5% in the non-slums. This finding was statistically significant (p <0.05). Majority of respondents in both slums and non-slums who have had sexual intercourse, first had intercourse between the ages of 15 and 19 years. This finding is similar to a study amongst out of school adolescents in Lagos, where most of the respondents had their first exposure to intercourse at age 15-19 years and also similar to another study where age at sexual debut was 15 years.63,137
The Federal Ministry of Health of Nigeria reports that almost half (43%) of adolescent females in Nigeria are sexually active, with 20.3% of them having engaged in sexual intercourse by the age of 15 years.138 This finding is much lower than that found in this study. 65.2% of adolescents in the slums and 71.6% in non-slums aged 15-19years reported engaging in sexual intercourse as against the 20.3% quoted by the ministry of health.
This study observed that a higher proportion (34.8%) of adolescents living in the slum areas initiated sexual activity about five years earlier than their non-slum counterparts (28.4%). This
107 finding is consistent with the Nairobi study which showed that slum dwellers fare much worse in terms of risky sexual behaviour than their peers living outside slums.132
The perpetrators of sexual abuse in this study were mostly neighbours (extra familial), Out of the 307 victims of sexual abuse in the slums, 283(92%) were abused by extra familial members which is similar to the Ethiopian study where a majority of the adolescents were abused by their neighbours, friends, teachers, etc.127 Similarly in the non-slums, a larger proportion (88%) of the respondents were abused by extra-familial members. The main extra familial perpetrators in this study were neighbours 83(27%), 53% (22.7%) in slum and non-slum respectively.
However, with respect to forced oral sex, forceful looking of perpetrators genitals, forced undressing and showing perpetrator genitals, the main perpetrators in the non-slums were distant relations (aunt’s husband) which is a reflection that intra-familial abuses do occur. Some studies have been able to show that prevalence of intra-familial sexual abuse is higher than extra-familial and associated with worse outcomes.98,99
The findings in this study reflecting more extra-familial perpetrators may be due to the fact that respondents were more willing to talk about perpetrators outside their families. Respondents who are abused by their family members experience the severe forms of sexual abuse and tend to withhold information regarding their experiences with family members.
Regarding the pattern of sexual abuse, the most common forms reported in this study were forced fondling, unwelcomed kissing, verbal harassment, forced pornographic viewing and forced sexual intercourse in both communities. A higher prevalence of non-contact sexual abuse (verbal sexual harassment) was reported in the slum (62.9%) than the non-slum (41.2%) and this difference was statistically significant. The high prevalence of verbal sexual harassment noted in this study is similar to the Ijesha study where 55% of respondents had experienced verbal sexual harasssment.139 Contact non-penetrative type of abuse (genital
108 touch) was more in the non-slums 56(24%) and this finding is in contrast to what was found in a previous study in Egypt where kissing was the most reported non-penetrative type of sexual abuse in the non-slums.140 This may be due to socio cultural differences. The prevalence of genital touch (15.3% slums and 24% non-slums) found in this study is far lower than the Port
Harcourt study where 33.7% reported fondling/grabbing of sensitive body parts.141
Breast caressing was higher in the slums 125(40.7%) compared to the non-slums 85(36.5%).
The prevalence of breast caressing (contact non penetrative) recorded in this study is far higher than the North Eastern Nigerian study where only 9% of the respondents reported breast caressing.142 The sociocultural and religious differences in the North and Southern Nigeria may have been responsible for this finding.
The prevalence and pattern of the penetrative type of sexual abuse (vaginal, oral and anal) was quite similar in the slums and non-slums. This study has shown that with respect to the severe forms of sexual abuse (penetrative type), the slums and non-slums do not differ much.
Regarding, forced sexual experiences, many of the adolescents in both settings had been forced to fondle/touch someone else 221(72%) and 180(77.3%). Forced pornography viewing was commoner in the slums, 105(34.2%) compared to 84(36.1%) in non-slums but the difference was not statistically significant (p >0.05). There was also no statistically significant difference in forceful exposure to sexual intercourse in both settings (p value >0.05) though more respondents who had been victims were from the slums. 97 (31.6%) compared to 63(27%) non- slum. A significantly higher proportion of female perpetrators were in the non-slums while there were more male perpetrators in the slums (p <0.05).
The high rates of forced sexual intercourse (31.6% and 27% for slums and non-slums) is similar to population-based studies conducted in diverse locations as Cameroon, the Caribbean, Peru,
New Zealand, South Africa, and Tanzania. According to these studies, “between 9% and 37%
109 of adolescent females, have reported sexual coercion at the hands of family members, teachers, boyfriends or strangers.143-145 This finding in the slums and non-slums is higher than 14% or more reported in Bangladesh, Ethiopia, provincial Peru, and the United Republic of
Tanzania.143,146
The wide variation in the prevalence of forced sexual intercourse, may be a reflection of social attitudes toward female sexuality or real cultural differences. This is very important because, studies have shown a strong association between forced sexual experiences and subsequent sexual risky behaviours.
In this study, a higher proportion of the adolescents in both settings were abused in the perpetrators house. Previous reports on settings for sexual abuse in Nigeria have indicated the bush tract, nearby cemetery, and motor parks as common places of abuse of girls.103,148 These settings have also been reported in the Bangladesh and Kampala study.149,150 However, it appears that the settings for committing these heinous acts have shifted to the house of the perpetrators as reflected in this study. This finding is similar to a South Western Nigerian study which indicated that sexual abuse mostly occurred at the perpetrator's residence and that a familiar person is the perpetrator. The reports of some Nigerian newspapers on reported cases of sexual abuse of young girls showed that the abuse occurred in the houses of the perpetrators.151-153 It is therefore inferred that perpetrators in both communities devise means of luring victims into their homes to violate them. This finding is corroborated by the FGD where a participant narrated an incident where a street hawker was sexually abused in the home of the perpetrator while trying to sell her wares. Regarding disclosure, more than half of the respondents in the slums 182(59.3%) and non-slums 136(58.4%) disclosed the incident and the most common recipient of disclosure was their family member followed by their friends. This is in keeping with the Ife/Ijesha study where majority of the adolescents were comfortable disclosing the incident to other people (peers) besides their parents.139 In this study, reason for
110 non-reporting was due to fear of their parents similar to the reason given in the Ijesha study where respondents reasons for nondisclosure to parents were lack of trust, or not wanting to burden the parents. The lack of parent child connectedness may have been responsible for this finding and this explains why only 49% slums and 45% non-slums had discussed issues relating to sexual abuse with their parents.
With respect to health problems encountered following sexual abuse, the least was sexually transmitted infections while one third of the respondents had post-traumatic stress disorder following the abuse. This was similar for both the slums and non-slums. Of the respondents who had been sexually abused, only one third in slums and non-slums (31.6% and 32.2%) had low self-esteem. The self-esteem score of the sexually abused victims and non-victims were similar as the two groups had a high self-esteem score. This is in contrast to findings and negates the assumption that sexual abuse victims may have low self-esteem from the traumatic effect of the abuse. The explanation of this finding may be that the victims had gotten over the trauma or that there were other factors responsible for the high self-esteem seen in both groups.
Several factors have been found to be associated with the experience of sexual abuse. Sexual abuse among the slum and non-slum respondents was found to be associated with age. More adolescents aged 15- 19 years were found to have experienced sexual abuse. This finding is similar to the Sangrouse/Sura study where a higher proportion of the victims were aged 15-
19years. This is in keeping with the WHO report which found adolescents aged 15-19 years to be more vulnerable to sexual abuse than their counterparts.5 This is in contrast with the
Maiduguri study which reported younger adolescent’s less than 15 to be the vulnerable group for abuse.51 This could be due to cultural differences in the Northern part of Nigeria which encourages early marriage. Another explanation for this could be due to the fact that adolescent’s especially girl’s aged 15-19years have already attained puberty and have physical features that may make them appear attractive and vulnerable.
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This study found an association between gender and sexual abuse for both settings. A higher proportion of respondents who had been abused were mostly females. A study in Zaria found that females were more vulnerable to sexual abuse than the males due to them being used as domestic servants and child labour.61 The findings of this study is similar to the Finkelhor study where females were found to be two times more likely to be victims of sexual abuse than males.
Similarly, another WHO report and several other studies have identified being female as a risk factor for sexual abuse.41,82,92-94
The findings concur with a South African study where a higher proportion of females were sexual abuse victims.154 Early sexual maturation in females compared to males increases their susceptibility to unwanted advances, seduction by often older, more experienced males, earlier sex debut and early marriage. Moreover, men may also take advantage of the reduced female physical ability. An interesting finding in this study was that a higher proportion of adolescents with secondary level of Education reported experiencing sexual abuse in both settings. This is similar to the Zambian and Nigerian study where those with higher level of education
(secondary) were victims of sexual abuse.133 This is contrary to reports from other studies where it is expected that highly educated adolescents are less likely to be sexually abused. The results in this study showed that the adolescents with low educational status were less abused.
This finding was statistically significant with a p value < 0.05. The explanation for this finding could be that adolescents who were not well educated withheld information about their experiences compared to the well-educated who were more comfortable and willing to communicate about experiences. In this study respondents were asked about their present schooling status regardless of their highest level of Education. With this, a higher proportion of those who were out of school, regardless of their highest level of education were found to have experienced sexual abuse. This finding was statistically significant in the slums and non- slums with a p value < 0.05. Out of school adolescents are vulnerable to sexual abuse because
112 they may lack skills to resist pressure and have limited access to credible reproductive health information.137
Another factor associated with sexual abuse was duration of stay in the community. In the slums, a higher proportion of adolescents who had lived in the slums for less than 5 years were found to have been sexually abused compared to those in the non-slums where a larger proportion lived far longer than 15 years. The development of slums is as a result of rapid urbanization. The majority of slum dwellers are migrants from rural areas who moved to urban areas for greener pastures. Therefore, Children who change residence frequently as seen in slum dwellers may be more exposed to sexual abuse because as a way of coping with the loss of familiar environment, friends and other social capital, the adolescent may engage in sexual activity soon after in-migration to compensate for the loss and as a way of forming new bonds or fitting into the new environment.133 Also, in the bid to fit in the environment, they become vulnerable and easily lured by the perpetrators of sexual abuse.
In the slums, parents living together or type of marriage of the parents was not associated with sexual abuse compared to the non-slums. In the non-slums, a higher proportion of respondents whose parents were separated or from polygamous marriages were found to have been sexually abused. This finding is similar to the Ethiopian study which established that adolescents from polygamous homes were more likely to be sexually abused.127 However, the finding in the slum may be due to the fact that other factors beyond parental control were responsible for the vulnerability of slum dwellers to sexual abuse.
Regarding discussions about sexual abuse, in the slums and non-slums, adolescents who reported that they had discussions relating to sexual abuse with their parents/ guardians were found to have experienced sexual abuse compared to those who had no discussions. This finding is by far different from other studies where discussions on sexual abuse made the adolescent less likely to be a victim.127,155 The explanation for the finding in the slums and non-
113 slums, may be that those that were actually sexually abused received their discussions /counsel after the incidence since this study is unable to say at what point the adolescents received such counsel.
Another finding associated with sexual abuse is fathers and mother’s education. The educational status of respondent’s parents was associated with sexual abuse in the non-slums but not in the slums. A higher proportion of respondents whose parents had no formal education or primary education were sexually abused. This finding is in line with a study conducted in
Ambo University in Eastern Ethiopia where achieving secondary education by the father was associated with decreased sexual abuse.156 However, the finding was inconsistent with other studies.155 In this study, the possible reason for this finding could be that as parents educational level is higher, they may have better reproductive health information and skills to communicate effectively with their adolescents. Educated parents may give more attention to their adolescents, understand their needs, discuss reproductive and sexual issues freely thereby transferring life skills which strengthens the decision making capacity of their adolescents against sexually abusive advances. In the slums, association between parent’s educational status and sexual abuse in the adolescents was not statistically significant (p >0.05) indicating that educational status of parents was not enough to be a factor to protect/predispose adolescents to sexual abuse.
However, the occupation of the father was associated with adolescent sexual abuse in the slums. A higher proportion of adolescents whose fathers were professionals were more likely to be abused. The explanation for this could be that professionals are less likely to be at home but at their work place and so are unable to effectively monitor their children while away at work. This finding may mean that the presence of a father at home is very important especially in the slums.
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After logistic regression of the significant factors of sexual abuse in the slums and non-slums, the determinants of sexual abuse in the slums were, female sex, mother’s education and father’s occupation.
Females in the slums were 3 times more likely to be sexually abused than their male counterparts. The odds of experiencing sexual abuse were greater among respondents whose mothers had achieved higher levels of education (post-secondary education) compared to those whose mothers had minimal education. The finding of maternal education in the slums is surprising as it contradicts previous studies that have reported that mothers of those sexually abused are less likely to have finished secondary school and that little parental education predisposes children to sexual abuse.55
One possible explanation for this finding could be that, mothers with post-secondary education had better employment opportunities compared with those with no education or with primary education alone. In this regard, their working outside the family could have exposed their children to sexual abuse through lack of maternal protection and supervision, thereby diminishing maternal availability.
Regarding father’s occupation, adolescents whose fathers were manually skilled or professionals were 3-4 times more likely to be sexually abused. The explanation for the father’s occupation could be due to the fact that fathers who were skilled had better employment opportunities and so were away from home.
The determinants of sexual abuse in the non-slums were older age (15-19years), female sex, parents not living together and maternal education.
Older adolescents were found to be 2 times more likely to be sexually abused than those aged
10-14 years, while females were 2 times more likely to be sexually than males. This is in keeping with other studies and the WHO report on sexual abuse. Adolescents whose parents
115 were not living together in the non-slums were 2 times more likely to be sexually abused.
Explanation may be that adolescents in the non-slums exposed themselves to sexual abuse by being more adventurous in the absence of parental monitoring and supervision. This finding is similar to a study where respondents who did not stay with both parents especially their fathers had greater odds of experiencing sexual abuse compared to those who stayed with their fathers.
While this finding is consistent with available research concerning the vulnerability of children in this age group, it also buttresses the protective role of fathers against sexual abuse. As reported in a South African study, parental figures especially fathers can play an important role by providing greater control and restrictions on youth risk behaviour, which may lead to a lesser likelihood of incest and increased protection from potential perpetrators.9
Regarding maternal education in the non-slums, adolescents whose mothers had lower levels of education were 3 times more likely to be sexually abused than those with post-secondary education. This study established that parental occupation was not a risk factor of sexual abuse in the non-slums. While this finding is consistent with some studies it is contrary to others.157,158
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5.1 CONCLUSION
The prevalence of sexual abuse was significantly higher in the slums 76.8% than the non-slum communities 58.3% (p<0.05). Forced fondling, verbal sexual harassment and forced sexual intercourse were the common forms of sexual abuse reported in the slums while unwelcomed kissing, forced fondling and pornography were common in the non-slums. Anal and oral sex were the least reported form of sexual abuse in both groups. One third of the adolescents who were sexually abused in the slum and non-slums had post-traumatic stress disorder while only one tenth of the victims had low self-esteem. Perception of what constitutes sexual abuse includes forceful sex/ rape, nonconsensual sex and exposing a child to pornography.
Technology, indecent dressing, poor housing conditions, alcohol abuse, parental negligence were mentioned as perceived causes of sexual abuse. The effects of sexual abuse reported were emotional trauma, HIV/AIDS, unwanted pregnancies and low self-esteem. Determinants of sexual abuse in the slum areas were female sex, mother’s education and father’s occupation. In the non-slums, predictors of sexual abuse were older age of adolescent, female sex, parents not living together and maternal education.
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5.2 RECOMMENDATIONS
Government a. Awareness about sexual abuse should be increased among different groups in the
community through various media such as radio and television programs and
community meetings by Local Governments, Community Development Associations,
Religious organizations and Non-Governmental Organizations with a view to prevent
the occurrence of sexual abuse by community and family members. b. Opportunities should be created for social interaction of Adolescents in the community
through the establishment of culturally appropriate social clubs suitable for the
adolescents by the Local Governments, Community Developmental Associations, and
Non-Governmental Organizations. c. The government should improve socioeconomic and developmental conditions in the
slum areas which may in turn help improve the family support available to the
adolescents. d. The government should initiate packages such as reducing the cost of services and
social amenities and making free and quality health care services available. e. Government agents and law enforcers should strictly enforce laws regarding public
drunkenness and ensure alcohol and other drug substances are not easily available to
young people.
118
Communities a. Communities should stimulate advocacy efforts for increased political will and resource
allocation for young people's health and development programs and interventions. b. Communities should support victims of sexual abuse and during community meetings,
issues relating to keeping children and adolescents safe should be raised and
implemented. c. Community members as well as the survivors should be bold to report any case of
sexual abuse occurring anywhere including those perpetrated by the family members. d. Social support groups should be formed by community members to help build their
social networks. It will also provide opportunities for the adolescents to share
experiences about their situation and foster solutions. e. Details of sexual health clinics should be advertised in areas that adolescents frequent
such as school toilets, shopping centres, town halls, clubs etc.
Families a. Parents should monitor and give due attention to adolescents and children. As far as
possible, female children should attend their school living with their family or
responsible caretaker rather than left alone or with their friends. b. The importance of open discussions about sexuality and reproductive health with
adolescence is paramount. Therefore, parents have to break their silence against sexual
abuse and discuss all about the nature and its negative consequences. c. Sex education by parents should be more positive with less emphasis on anatomy and
scare tactics but should focus on negotiation skills in sexual relationships. d. Young people should be taught life-saving skills through enhanced reproductive health
knowledge so as to protect themselves from sexual abuse.
119
Adolescents
Should seek information and have counsellors or mentors that they can trust. They should be vigilant and avoid situations that can increase their risks to sexual abuse.
Public Health Physicians
Should be advocates for change. Be involved in more research relating to sexual abuse as the prevalence in this study is only a tip of the iceberg of the happenings relating to sexual abuse.
Interventions to help adolescents learn about healthy sexual relationships need to be designed and evaluations of these interventions that follow the adolescents into adulthood should be done.
120
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141. Mezie-Okoye M-MI, Alamina F. Sexual violence among female undergraduates in a
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associated factors in four secondary institutions in Enugu, Southeast Nigeria. European
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rape victim The Punch Newspaper 2015;7278:30-31.
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violence among private college female students in Bahir Dar city, North Western
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female students of Ambo University in Ethiopia. Sci J Public Health. 2014;2(6):532-
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APPENDIX I
140
APPENDIX II
PARENTS OR CAREGIVER INFORMED CONSENT FORM
TITLE OF RESEARCH – Prevalence, pattern and Determinants of Sexual Abuse Amongst adolescents in Slum and Non Slum communities of Lagos State.
NAME AND AFFILIATION OF RESEARCHER – This study is being conducted by Dr
O.O Akinsulire, a Senior Registrar in the Department of Community Health and primary care,
Lagos University Teaching Hospital.
INTRODUCTION - Sexual abuse is the involvement of a child in sexual activity that he or she does not fully comprehend and is unable to give informed consent to, or for which the child is not developmentally prepared and cannot give consent, or that violates the laws or social taboos of the society.
PURPOSE OF THE RESEARCH - The study is to compare the prevalence, pattern and determinants of sexual abuse amongst out of school adolescents who reside in slums and non- slum areas of Lagos state.
PROCEDURE OF THE RESEARCH - Your adolescent’s opinion about sexual abuse will be tapped with a validated, interviewer administered questionnaire. You are expected to answer based on your opinion and past experiences.
POTENTIAL BENEFITS - This study gives each participant a unique opportunity to express their opinion about sexual abuse. Participants will be given an information leaflet on sexual abuse and prevention and this will also include contact address of where to seek help and support following exposure to sexual abuse.
POTENTIAL RISKS - The study is a questionnaire based survey. Therefore, no harm whatsoever is anticipated concerning any of the participants.
CONFIDENTIALITY - All information obtained in this study will be given code numbers and no name will be recorded. This cannot be linked to you in any way and your name will not
141 be used in any publication or reports from this study. The information you will give me will not be raised with any other person.
WILLINGNESS TO PARTICIPATE - Participation in this research is entirely voluntary and if you choose not to participate, no punishment will be attached to your decision. You will not be paid any fees for participation in this research. Your adolescent can choose to withdraw from the research at any time.
WHAT HAPPENS TO RESEARCH PARTICIPANTS AND COMMUNITIES WHEN
THE RESEARCH IS OVER - The researcher will inform you of the outcomes of the research through the Ministry of health, and Ministry of women affairs of Lagos state. There is no conflict of interest whatsoever.
STATEMENT OF PERSON OBTAINING INFORMED CONSENT - I have fully explained this research to the respondent and given sufficient information including the risks and benefits to make an informed decision.
If you agree that your child/adolescent should participate in the study, kindly sign this form.
Date...... Signature......
For further enquiry, please contact:
Researcher
DR O.O AKINSULIRE Mobile contact: 08033914357 [email protected] Dept. Of Community Health and Primary care, Lagos University Teaching Hospital, Idi-Araba, Lagos. For further enquiry, please contact: LUTH Room 107, Health Research and Ethics Committee, Lagos University Teaching Hospital, Idi- Araba, Lagos.
142
APPENDIX III
RESPONDENTS INFORMED CONSENT FORM
TITLE OF RESEARCH – Prevalence, pattern and Determinants of Sexual Abuse Amongst adolescents in Slum and Non Slum communities of Lagos
State.
NAME AND AFFILIATION OF RESEARCHER – This study is being conducted by Dr
O.O Akinsulire, a Senior Registrar in the Department of Community Health and primary care,
Lagos University Teaching Hospital.
INTRODUCTION - Sexual abuse is the involvement of a child in sexual activity that he or she does not fully comprehend and is unable to give informed consent to, or for which the child is not developmentally prepared and cannot give consent, or that violates the laws or social taboos of the society.
PURPOSE OF THE RESEARCH - The study is to compare the prevalence, pattern and determinants of sexual abuse amongst out of school adolescents who reside in slums and non- slum areas of Lagos state.
PROCEDURE OF THE RESEARCH - Your opinion about sexual abuse will be tapped with a validated, interviewer administered questionnaire. You are expected to answer based on your opinion and past experiences.
POTENTIAL BENEFITS - This study gives each participant a unique opportunity to express their opinion about sexual abuse. Participants will be given an information leaflet on sexual abuse and prevention and this will also include contact address of where to seek help and support following exposure to sexual abuse.
POTENTIAL RISKS - The study is a questionnaire based survey. Therefore, no harm whatsoever is anticipated concerning any of the participants.
143
CONFIDENTIALITY - All information obtained in this study will be given code numbers and no name will be recorded. This cannot be linked to you in any way and your name will not be used in any publication or reports from this study. The information you will give me will not be raised to your parents, friends or any other person.
WILLINGNESS TO PARTICIPATE - Your participation in this research is entirely voluntary and if you choose not to participate, no punishment will be attached to your decision.
You will not be paid any fees for participation in this research. However, if you wish to seek counselling and support, you will be linked with organizations and appropriate authorities who promote sexual and reproductive health of Adolescents.
You can choose to withdraw from the research at any time.
WHAT HAPPENS TO RESEARCH PARTICIPANTS AND COMMUNITIES WHEN
THE RESEARCH IS OVER - The researcher will inform you of the outcomes of the research through the Ministry of health, and Ministry of women affairs of Lagos state. There is no conflict of interest whatsoever.
STATEMENT OF PERSON OBTAINING INFORMED CONSENT - I have fully explained this research to the respondent and given sufficient information including the risks and benefits to make an informed decision. If you agree to participate in the study, kindly sign this form.
Date...... Signature......
For further enquiry, please contact:
144
APPENDIX IV
TITLE: PREVALENCE, PATTERN AND DETERMINANTS OF SEXUAL ABUSE
AMONGST ADOLESCENTS IN SLUM AND NON SLUM COMMUNITIES OF
LAGOS STATE.
Introduction
Dear Miss/Mr,
Good day, I am (mention your name). I am here to ask some questions about yourself and community. This will assist us to get information on how to render help concerning things related to your health and development. Please answer the questions you will be asked as sincerely as possible and be assured that the information you give will be treated with utmost confidentiality. Thank you.
Section 1: Respondents Socio-demographic information
S/No Questions Response
1. Age at last birthday?
2. Sex
3. To which religion do you belong? 1. Christianity
2. Islam
3. Traditional
4. Others ………..
4. To which ethnic group do you belong? 1. Yoruba
2. Igbo
3. Hausa
4. Others…….
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5. Marital status 1. Never married
2. Currently married
3.Divorced
4. Separated
5. Widowed
6. What is your highest level of education? No formal schooling…..
Less than primary school…
Primary school completed..
Secondary completed…
Postsecondary completed.
Quranic….
7. Are you still in school? Yes….
No…..
8. If NO to QUE 7, what is your occupation? Private sector employee…
Trading…..
Farming ……
Artisan…….
Fisherman…..
Housewife…..
Unemployed …..
Others ( specify)
9. What is your current source of income and Self
feeding? Parents
Relatives
Section 3: Prevalence and pattern of sexual abuse 146
Friends
Spouse
Work
Others please specify
Section 2: Living arrangement and social history
10. Were you born in Lagos? 1.Yes
2.No
11. If you were born in Lagos, how long have you
been in Lagos?
12. How long have you been living in this
community?
13. Do your father and mother live together? Yes
No
14. If No to Que 9 what was the reason? 1. Divorce
2. One of them alive
a, father
b, mother
3. Both of them not alive
4. Other, specify______
15. Who are you currently living with? Both parents
Friends
Alone
Relatives
Mother only
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Father only
Sisters
Brothers
Others specify__
16. What type of residential accommodation do you 1. Single room
live in? 2. Self-contained flat
3. Face to face house
4. Others specify
17. Who pays for the accommodation or rent? Self
Friend
Relative
Parents
Others specify
18. What is your father’s occupation?
19. What is your fathers educational status
20. What is your mother’s occupation?
21. What is your mothers’ educational status?
22. Your family size
23. Do you share rooms with other family members Yes
other than your relatives? No
If yes, who?......
24. Do you share amenities such as toilet, kitchen Yes
bath with other family? No
If yes, who?......
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25. Have you ever smoked cigarette? Yes
No
If yes, do you still smoke?....
26. If yes, how often do you smoke? Rarely
Occasionally
Often
27. Have you ever drank alcohol? Yes
No
If yes, do you still drink?..
28. If yes, how often do you drink? Rarely
Occasionally
Often
s.no Questions Alternatives/choices
29. Have you ever had sexual intercourse? Yes
No
30. If yes, at what age did you start having sex?
31. Did you consent to it? Yes
No
32. Have you ever had any unwanted sexual 1. Yes
Experiences? 2. No
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33. If yes ,what type of sexual abuse did you 1. Verbal harassment
experience ?( more than one answer can be 2. Breasts caressed
chosen) 3. Unwelcomed kissing
4. Genitals touched
5. Vaginal intercourse
6. Anal sex
7. Oral sex
8. Other, specify------
34. Since you have been living in this environment,
has anyone ever forced you or demanded that Yes
you do the following No
a. Look at pornographic pictures, drawings, If yes, who?...... and how old were
films, videotapes/ magazines. you when it happened?...... How
many times did it happen?...... what
b. Look at his/her genitals? was the gender of this person?......
Yes
No
If yes, who?...... and how old were
you when it happened………..?
How many times did it happen?......
What was the gender of this
person?......
c. Watch him/her masturbate Yes
No
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If Yes, who? …….and how old were
you when it happened………..?
How many times did it
happen?......
What was the gender of this
person?...... d. be naked and expose your genitals to picture Yes taking? No
If Yes, who? …….and how old were
you when it happened………..?
How many times did it
happen?......
What was the gender of this
person?..... e. Undress and show him/her your genitals? Yes
No
If Yes, who?...... and how old were
you when it happened?......
How many times did it happen?......
What was the gender of this person?.... f. Undress with another child/adolescent and Yes touch/ fondle each other in his/her presence No
If Yes, who? ...... and how old
were you when it happened?
How many times did it happen?
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What was the gender of this person?
......
g. Fondle or touch him/her(caresses, kisses on Yes……..
the whole body and his/her genitals)? No………
If Yes, who? ...... and how old
were you when it happened? ......
How many times did it happen? ......
What was the gender of this person?
.....
h. Made you have sexual intercourse? Yes……….
No………….
If Yes, who? ...... and how old
were you when it happened? ......
How many times did it happen? ......
What was the gender of this person? . i. Made you have anal sex Yes……….
No………….
If Yes, who? ...... and how old
were you when it happened? ......
How many times did it happen? ......
What was the gender of this person? .
j. Made you have oral sex with perpetrator? Yes……….
No………….
If Yes, who? ...... and how old
were you when it happened? ......
152
How many times did it happen? ......
What was the gender of this person? .
k. Received money or reward in exchange of Yes….
sexual acts? No……..
If yes, who?...... and how old were you
when it happened?......
How many times did it happen?......
What was the gender of this person?
35. Was there any time you were threatened for any Yes………
of these things mentioned? No………
If yes, what did you do?
a. Unable to say no out of
embarrassment /shame/fear
b. Forced to go along with the act
c. Others specify……….
36. How old was the perpetrator(estimation) 1. More than 10 years
compared to yours 2. More than 5-10 years
3. More than 1-5years
4. Equal to my age
5. I can’t guess
37. With whom were you living, when the abuse 1. Both parents
happened? 2. Friends
3. Alone
4. Relatives
153
5. Mother only
6. Father only
38. Where was the place of the act occurring? 1. In the victim’s house
2. In the perpetrators house
3. At school
4. Hotel
5. Other, specify______
39. After the attack did you share the problem to 1. Yes
anyone else? 2. No
40. For Q.no 31, if your answer is ‘yes’ to whom did Friends
you report? Family member
School teacher/director
Police
Other, specify------
41. What happened when you disclosed the Yes No
incident? You were helped
You weren’t believed
Nothing changed
It was kept secret
The person involved was punished
154
42. What action was taken on the perpetrator Sentenced to jail
Yes….. Financial penalty
No…. Forced to marry
Other /Specify/------
43. For Q. no 31, if your answer is ‘no’ 1. Do not know what to do
What was the reason of not reporting? 2. Afraid of perpetrators
3. Afraid of parents
4. fearing of stigma
5. other, specify______
44. Have you ever come across or heard about other 1. Yes
children who had been sexually abused? 2. No
45. Have you had any discussion with your parents 1.Yes
or guardians regarding sexual abuse and 2. No
reporting it?
Section 4: The relationship of the perpetrator to the victim
S. No Question Alternatives/choices
46. Who was the perpetrator? 1. Interfamilial
2. Unrecognized person
3. School mate
4. School teacher
5. Neighbour
6. Known person on street
7. Other , specify______
155
47. For the above question if your answer is 1. Father
‘interfamilial’ what was the relationship of the 2. Brother
perpetrator? 3. mother
4. Sister
5. Step father
6. Uncle
7. Other, specify------
Section 5 - Outcomes of sexual abuse
S. No Question Response
48. Did you encounter any problem after the sexual 1. Yes
abuse? 2. No
If for Q. no 39, your answer is yes answer go to Q
40.
49. What reproductive problems did you face? (more 1. Unwanted Pregnancy/birth
than one answer is possible) 2. Abortion
3. STI (Genital lesion, Genital
discharge)
4. HIV/AIDS
5. Other, specify------
Mental health effects of sexual abuse
( post-traumatic stress disorder)
50. Do you have lots of thoughts or memories about the Yes
event that you don’t want to have? No
156
51. Do you have bad dreams about the event? Yes
No
52. Do you feel or act as if the event is about to happen
again?
53. Do you have bodily reactions such as fast beating
heart, stomach churning, sweating and feeling dizzy
when reminded of the event?
54. Do you have trouble falling or staying asleep?
55. Do you feel grumpy or lose your temper?
56. Do you feel upset by reminders of the event?
57. Do you have a hard time paying attention
58. Are you on the lookout for possible dangerous
things that might happen to yourself and others?
59. When things happen by surprise or all of a sudden,
does it make you jump?
157
60. Rosenberg self-esteem scale
3 2 1 0
STRONGLY AGREE AGREE DISAGREE STRONGLY DISAGREE a. I feel that I am a person of worth, at least on an equal plane with others b. I feel that I have a number of good qualities c. All in all, I am inclined to feel that I am a failure(R) d. I am able to do things as well as most people e. I feel I do not have much to be proud of (R) f. I take a positive attitude toward myself g. On the whole, I am satisfied with myself h. I wish I could have more respect for myself(R) i. I certainly feel useless at times. (R) j. At times I think that I am no good at all. (R)
158
ÌWÁDÌÍ LÓRÍ ÀWỌN OHUN TÍ Ó NṢE OKÙNFÀ ÌBÁLÒPỌ̀ L’Ọ́ NÀ ÀÌTỌ́ ÀTI BÍ Ó ṢE
W’Ọ́ PỌ̀ SÍ LÁÀÁRÍN ÀWỌN Ọ̀ DỌ́ TÍ Ó TI BÀLÁGÀ TÍ WỌ́ N FI ...... ṢE IBÙGBÉ
ÌPELE KINNÍ: Ìbéèrè nípa olùdáhùn àti agbègbèe rẹ̀
Nọ́ mbà Ìbéèrè Ìdáhùn
1 Ọmọ ọdún mélòó ni o jẹ́ báyìí
2 Ọkùnrin tàbí Obìrin Ọkùnrin Obìrin
3 Ẹ̀ sin wo ni ò ńṣe? (a) Krìstìẹ́nì
(b) Mùsùlùmí
(c) Ìṣẹ̀nbáyé
(d) Oríṣi mìíràn (sọ ni pàtó) ......
4 Ẹ̀ yà wo ni o ti wá (a) Yorùbá
(b) Ìgbò
(c) Haúsa
(d) Oríṣi mìíràn (sọ ni pàtó) ......
5 Ǹjẹ́ o ti ṣe ìgbéyàwó? (a) Mi ò ṣe ìgbéyàwó rí
(b) Mo wà nínú ìgbéyàwó
lọ́wọ́lọ́wọ́
(c) Mo ti já ìwé kọ ọkọ/ìyàwó sílẹ̀
(d) Mi ò gbé pọ̀ pẹ̀lú ọkọ/ìyàwo mi
(e) Opó ni mí
6 Ǹjẹ́ o ṣì ńlọ sí ilé ìwé (a) Bẹ́ẹ̀ni
(b) Bẹ́ẹ̀kọ́
7 Ìpele ẹ̀kọ́ tí mo kà ìwé dé (a) Mi ò lọ sí ilé-ìwé kankan
(b) Mi ò kà tó ìpele alákọ̀ọ́bẹ̀rẹ̀
159
(c) Mo ka ìwé alakọ̀ọ́bẹ̀rẹ̀ yanjú
(d) Mo lọ sí ilé ẹ̀kọ́ girama (ìpele
kinní)
(e) Mo lọ sí ilé ẹ̀kọ́ girama (ìpele
kejì
(f) Mo ka ìwé ẹ̀kọ́ girama yanjú
(g) Mo ka ìwé mẹ́wàá (ẹ̀kọ́ gíga)
yanjú
(h) Ẹ̀ kọ́ ilé kéwú (Àlkùránì)
8 Ǹjé o ní iṣẹ́ àṣejẹ tí ò ńṣe lọ́wọ́lọ́wọ́ (a) Bẹ́ẹ̀ni
(b) Bẹ́ẹ̀kọ́
9 Tí ìdáhùn sí ìbéèrè kẹ́jọ (8) bá jẹ́ bẹ́ẹ̀ni,
ǹjẹ́ o lè sọ pàtó irú iṣẹ́ wo?
10 Ònà wo ni ò ńgbà rí owó fún àtijẹ-àtimu (a) Láti ipasẹ̀ ara à mi
àti fún ìtọ́jú ara à rẹ? (b) Láti ipasẹ̀ àwọn òbí mi
(c) Láti ipasẹ̀ àwọn mọ̀lẹ́bí yòókù
(d) Láti ipasẹ̀ àwọn ọ̀rẹ́
(e) Láti ipasẹ̀ ọkọ/ìyàwó
(f) Láti ipasẹ̀ iṣẹ́ ṣíṣe
(g) Irúfẹ́ ònà mìíràn (sọ ní pàtó)
11 Ǹjẹ́ ìlú Èkó ni wọ́n bí ọ sí (a) Bẹ́ẹ̀ni
(b) Bẹ́ẹ̀kọ́
12 Tí kìí bá ṣe ìlú ÈKó ni wọ́n bí ọ sí, ó ti tó
ìgbàwo tí o ti tẹ̀dó sí ìlú Èkó?
160
13 Ó ti tó ìgbàwo tí o tí ngbé àwùjọ/agbègbè
yìí?
14 Ǹjẹ́ bàbá àti ìyá à rẹ jọ ńgbẹ́ papọ̀? (a) Bẹ́ẹ̀ni
(b) Bẹ́ẹ̀kọ́
15 Tí ìdáhùn sí ìbéèrè (14) ìkẹrìnlá bá jẹ̀ (a) Ìpínyà láàárín àwọn méjèèjì
bẹ́ẹ̀kọ́, kíni ìdí tí ó fi rí bẹ́ẹ̀? (b) Ọ̀ kan nìnú àwọn méjèèjì ti ṣe
aláìsí
i. Bàbá
ii. Ìyá
(c) Àwọn méjèèjì ti ṣe aláìsí
(d) Ìdí mìíràn (sọ ni pàtó) ......
16 Irúfẹ́ ìgbéyàwó wo ni ó wà láàárín àwọn (a) Ìgbéyàwó ọlọ́kọ-kan-aya-kan
òbíì rẹ (b) Ìgbéyàwó aláya púpọ̀
17 Tani ò ńbá gbépọ̀ pẹ̀lú lọ́wọ́lọ́wọ́? (a) Pẹ̀lú àwọn òbí méjèèjì
(b) Pẹ̀lú bàbá nìkan
(c) Pèlú Ìyá nìkan
(d) Pẹ̀lú ẹ̀gbọ́n/àbúrò okùnrin
(e) Pẹ̀lú ẹ̀gbọ́n/àbúrò obìrin
(f) Pẹ̀lú àwọn mọ̀lẹ́bí mìíràn
(g) Pèlú àwọn ọ̀rẹ́
(h) Àdánìkàngbé
(i) Àwọn mìíràn (sọ ní
pàtó)......
161
18 Irúfẹ́ ilé wo ni ò ńgbé? (a) Ilé oní yàrá kan (b) Ojúlé tí ó ní ilé ìdáná àti ilé
ìwẹ̀/ìgbọ̀nsẹ̀ tirẹ̀ (self-contained) (c) Ojúlé aládojúkọra (face to face house)
(d) Irúfẹ́ ilé mìíràn (sọ ní pàtó ...... 19 Tani ó ń sanwó ilé tí ò ńgbé? (a) Èmi fúnrami
(b) Ọ̀ rẹ́ (c) Mọ̀lẹ́bí (d) Àwọn òbí (e) Àwọn mìíràn (sọ ní pàtó)
20 Irú iṣẹ́ wo ni bàbáà rẹ ńṣe?
21 Ìwé mélòó ni bàbáà rẹ kà?
22 Irú iṣẹ́ wo ni ìyáà rẹ ńṣe?
23 Ìwé mélòó ni ìyáà rẹ kà?
24 Báwo ni ẹ ṣe pọ́ tó nínú ẹbíi yín?
25 Ǹjẹ́ o ma ń pín yàrá pọ̀ pẹ̀lú àwọn Bẹ́ẹ̀ni Bẹ́ẹ̀kọ́
elòmíràn yàtọ̀ sí áwọn ẹbíì rẹ Tí ó bá jẹ́ bẹ́ẹ̀ni, tani ẹni náà?
26 Ǹjẹ́ o ma ń pín lílò ilé ìdáná, ilé ìwẹ̀ tàbí Bẹ́ẹ̀ni Bẹ́ẹ̀kọ́
ilé ìgbọ̀nsẹ̀ pẹ̀lú ẹbí rẹ yòókù? Tí ó bá jẹ́ bẹ́ẹ̀ni, àwọn wo?
27 Ǹjẹ́ o ti mu sìgá rí? Bẹ́ẹ̀ni Bẹ́ẹ̀kọ̀
Tí ó bá jẹ́ bẹ́ẹ̀ni, ǹjẹ́ o ṣì ń muú
lọ́wọ́lọ́wọ́
28 Tí o bá ṣì ń muú lọ́wọ́lọ́wọ́, báwo ni o ṣe (a) Ó ṣọ̀wọ́n
ń muú sí ní ìgbà dé ìgbà? (b) Lẹ́ẹ̀kọ̀ọ̀kan
(c) Nígbàgbogbo
162
29 Ǹjẹ́ o ti mu ọtí rí? Bẹ́ẹ̀ni Bẹ́ẹkọ́
Tí ó bá jẹ́ bẹ́ẹ̀ni, ǹjẹ́ o ṣì ń muú
lọ́wọ́lọ́wọ́
30 Tí o bá ṣì ń mu ọtí lọ́wọ́lọ́wọ́, báwo ni o ṣe (a) Ó ṣọ̀wọ́n
ń muú sí ní ìgbà dé ìgbà? (b) Lẹ́ẹ̀kòọ̀kan
(c) Nígbàgbogb
ÌPELE KEJÌ: Ìbéèrè nípa àwọn Irúfẹ́ ìbálòpọ̀ lónà àìtọ́ àti bí wọ́ n ṣe wọ́ pọ̀ sí
Nọ́ mbà Ìbéèrè Ìdáhùn aláṣàyàn
31 Ǹjẹ́ o ti ní ìbálòpọ̀ rí? Bẹ́ẹ̀ni Bẹ́ẹ̀kọ́
32 Tí ìdáhùn sí ìbéèrè kọkànlélọ́gbọ̀n (31) bá
jẹ́ bẹ́ẹ̀ni, kíni ọjọ́ oríì rẹ nígbàtí o ní
ìbálòpọ̀ fún ìgbà àkọ́kọ́
33 Ǹjẹ́ ìbálòpọ̀ náà jẹ́ àtọkàn wá? Bẹ́ẹ̀ni Bẹ́ẹ̀kọ́
34 Ǹjẹ́ o ti ní ìrírí ìbálòpọ̀ tí o kò ní ìfẹ́ sí ní Bẹ́ẹ̀ni Bẹ́ẹ̀kọ́
ìgbà kankan
35 Tí ó bá jẹ́ bẹ́ẹ̀ni, irú ìbálòpọ̀ lónà àìtọ́ wo (a) Ìsọ̀rọ̀síni nípa ìbálòpọ̀ l’ọ́nà tó
ni o ṣẹlẹ̀ sí ọ? lòdì tàbí mú ipá dání0-pp-9
(O lè mú ju ọkan nínú àwọn àṣàyan (b) Fífọwọ́ pani l’ọ́yàn
ìdáhùn wọ̀ nyí gẹ́ gẹ́ bí ó ti tọ́ ) (c) Ìfẹnukonu ní tipá
(d) Fífọwọ́ pani l’ójú ara/l’ábẹ́
(e) Ìbálòpọ̀ nípasẹ̀ gbígba ojú òbò
w’ọlé
163
(f) Ìbálòpọ̀ nípasẹ̀ gbígba ihò-ìdí
w’ọlé
(g) Ibálòpọ̀ nípasẹ̀ fífi ẹnu lá ǹkan
ọmọkùnrin tàbi ǹkan ọmọbìrin
(h) Ìbálòpọ̀ nípasẹ̀ ọ̀nà mìíràn (sọ
ní pàtó) ......
36 Ǹjẹ́ ẹnikẹ́ni ti fi ipá mú ọ tàbí béèrè wípé
kí o ṣe èyíkéyìí nínú àwọn ǹkan ọw ̀nyí:
(a) Mú ọ wo àwòrán, fọ́rán Bẹ́ẹ̀ni Bẹ́ẹ̀kọ́
(video)¸tàbí ìwé ìròhìn tí ó ṣe Tí ó bá jẹ́ bẹ́ẹ̀ni, Tani ẹni
àfihàn ìbálòpọ̀ tàbí wíwà ní ìhòòhò. náà?...... ọmọ ọdún mélòó ni ọ́
nígbàtí ó ṣẹlẹ̀?......
Ó tó ìgbà mélòó tí ó ṣẹlẹ̀?......
Ṣé ọkùnrin ni ẹni náà tàbí obìrin
(b) Mú ọ wo ǹkan ọmọkùnrin tàbí Bẹ̀ẹ̀ni Bẹ́ẹ̀kọ́
ǹkan ọmọbìrin rẹ̀? Tí ó bá jẹ́ bẹ́ẹ̀ni, Tani ẹni
náà?...... ọmọ ọdún mélòó ni ọ́
nígbàtí ó ṣẹlẹ̀?......
Ó tó ìgbà mélòó tí ó ṣẹlẹ̀?......
Ṣé ọkùnrin ni ẹni náà tàbí obìrin
(c) Mú ọ wòran bí ó ti ńfi ọwọ́ tàbí Bẹ̀ẹ̀ni Bẹ́ẹ̀kọ́
ohun èlò wọ́ okó rè Tí ó bá jẹ́ bẹ́ẹ̀ni, Tani ẹni
náà?...... ọmọ ọdún mélòó ni ọ́
nígbàtí ó ṣẹlẹ̀?......
164
Ó tó ìgbà mélòó tí ó ṣẹlẹ̀?......
Ṣé ọkùnrin ni ẹni náà tàbí obìrin
(d) Mú ọ bọ́ra sílẹ̀ láti ya àwòrán Bẹ̀ẹ̀ni Bẹ́ẹ̀kọ́
ìhòòhò rẹ Tí ó bá jẹ́ bẹ́ẹ̀ni, Tani ẹni
náà?...... ọmọ ọdún mélòó ni ọ́
nígbàtí ó ṣẹlẹ̀?......
Ó tó ìgbà mélòó tí ó ṣẹlẹ̀?......
Ṣé ọkùnrin ni ẹni náà tàbí obìrin
(e) Mú ọ bọ́ra sílẹ̀ láti ṣe àfihàn ìhòòhò Bẹ̀ẹ̀ni Bẹ́ẹ̀kọ́
rẹ fún ẹni náà Tí ó bá jẹ́ bẹ́ẹ̀ni, Tani ẹni
náà?...... ọmọ ọdún mélòó ni ọ́
nígbàtí ó ṣẹlẹ̀?......
Ó tó ìgbà mélòó tí ó ṣẹlẹ̀?......
Ṣé ọkùnrin ni ẹni náà tàbí obìrin
(f) Mú ọ bọ́ra sílẹ̀ pẹ̀lú ọmọdé mìíràn Bẹ̀ẹ̀ni Bẹ́ẹ̀kọ́
kí ẹ ma f’ọwọ́ para yín lára ní ìṣojú Tí ó bá jẹ́ bẹ́ẹ̀ni, Tani ẹni
ẹni náà fún àwògbádùn ara rẹ̀ náà?...... ọmọ ọdún mélòó ni ọ́
nígbàtí ó ṣẹlẹ̀?......
Ó tó ìgbà mélòó tí ó ṣẹlẹ̀?......
Ṣé ọkùnrin ni ẹni náà tàbí obìrin
(g) Mú ọ fi ọwọ́ paá l’ára tàbí f’ẹnu Bẹ́ẹ̀ni Bẹ́ẹ̀kọ́
kòó ní gbogbo ara dé’bi ǹkan Tí ó bá jẹ́ bẹ́ẹ̀ni, Tani ẹni
ọmọkùnrin/ọmọbìrin rẹ̀ náà?...... ọmọ ọdún mélòó ni ọ́
nígbàtí ó ṣẹlẹ̀?......
Ó tó ìgbà mélòó tí ó ṣẹlẹ̀?......
165
Ṣé ọkùnrin ni ẹni náà tàbí obìrin
(h) Mú ọ ní ìbálòpọ̀ pẹ̀lúu rẹ̀ Bẹ́ẹ̀ni Bẹ́ẹ̀kọ́
Tí ó bá jẹ́ bẹ́ẹ̀ni, Tani ẹni
náà?...... ọmọ ọdún mélòó ni ọ́
nígbàtí ó ṣẹlẹ̀?......
Ó tó ìgbà mélòó tí ó ṣẹlẹ̀?......
Ṣé ọkùnrin ni ẹni náà tàbí obìrin
(i) Mú ọ ní ìbálòpọ̀ nípasẹ̀ gbígba ihò- Bẹ́ẹ̀ni Bẹ́ẹ̀kọ́
ìdí w’ọlé Tí ó bá jẹ́ bẹ́ẹ̀ni, Tani ẹni
náà?...... ọmọ ọdún mélòó ni ọ́
nígbàtí ó ṣẹlẹ̀?......
Ó tó ìgbà mélòó tí ó ṣẹlẹ̀?......
Ṣé ọkùnrin ni ẹni náà tàbí obìrin
(j) Mú ọ ní ìbálòpọ̀ nípasẹ̀ fífi ẹnu lá Bẹ́ẹ̀ni Bẹ́ẹ̀kọ́
ǹkan ọmọkùnrin tàbi ǹkan Tí ó bá jẹ́ bẹ́ẹ̀ni, Tani ẹni
ọmọbìrin rẹ̀ náà?...... ọmọ ọdún mélòó ni ọ́
nígbàtí ó ṣẹlẹ̀?......
Ó tó ìgbà mélòó tí ó ṣẹlẹ̀?......
Ṣé ọkùnrin ni ẹni náà tàbí obìrin
(k) Mú ọ gba owó tàbí ẹ̀bùn ní Bẹ́ẹ̀ni Bẹ́ẹ̀kọ́
pàṣípàrọ̀ fún àwọn ìṣe tí ó jẹ mọ́ Tí ó bá jẹ́ bẹ́ẹ̀ni, Tani ẹni
ìbálòpọ̀ náà?...... ọmọ ọdún mélòó ni ọ́
nígbàtí ó ṣẹlẹ̀?......
Ó tó ìgbà mélòó tí ó ṣẹlẹ̀?......
Ṣé ọkùnrin ni ẹni náà tàbí obìrin
166
37 Ǹjẹ́ ẹnikẹ́ni ti halẹ̀ mọ́ ọ tàbí mú ọ nípá Bẹ́ẹ̀ni Bẹ́ẹ̀kọ́
láti ṣe èyíkéyìí nínú àwọn ǹkan ọw ̀nyí ti a Tí ó bá jẹ́ bẹ́ẹ̀ni, kíni ìṣesíì rẹ
ti mẹ́nu bà nígbànáà
(a) O kò lè kọhùn sí ẹni náà nítorí
ìtìjú tàbí ìbẹ̀rù
(b) O tẹ̀síwájú láti ṣe ohun tí ẹni náà
fẹ́ nítorí kò sí ohun tí o lè ṣe si.
(c) Ìṣesí mìíràn (sọ ní pàtó)
38 Bí ọdún mélòó ni ó wà láàárín ọjọ́ orí ẹni (a) Ó ju ọdún mẹ́wàá
tí ó ṣe àṣemáṣe yìí àti tìẹ (b) Ó ju ọdún márùn ún sí mẹ́wàá
(c) Ó ju ọdún kan sí márùn ún
(d) ọjọ́ oríi wa dọ́gba
(e) Mi ò lè sọ dájú
39 Tani ò ń bá gbé nígbàtí àṣemáṣe náà ṣẹlẹ̀ sí (a) Àwọn òbíì rẹ méjèèjì
ẹ (b) Àwọn ọ̀rẹ́
(c) Ò ń dá nìkan gbé
(d) Ìyáà rẹ nìkan
(e) Bàbáà rẹ nìkan
40 Níbo ní pàtó ni àṣemáṣe náà ti ṣẹlẹ̀ (a) Ní ilé ẹni tí a ṣe àṣemáṣe náà sí
(b) Ní ilé ẹni tí ó ṣe àṣemáṣe náà
(c) Ní ilé ìwé
(d) Ní ilé ìgbafẹ́
(e) Ibòmíràn (sọ ní pátó)
167
41 Lẹ́yìn ìṣẹ̀lẹ̀ àṣemáṣe náà, ǹjẹ́ o fi ọ̀rọ̀ náà lọ Bẹ́ẹ̀ni Bẹ́ẹ̀kọ́
ẹnikẹ́ni
42 Tí ìdáhùn sí ìbéèrè 41 bá jẹ́ bẹ́ẹ̀ni, tani o fi (a) Àwọn ọ̀rẹ́
ẹjọ́ sùn? (b) Mọ̀lẹ́bíì rẹ
(c) Olùkọ́ tàbí ọ̀gá ilé-ìwé
(d) Ọlọ́pàá
(e) Ẹlòmíràn (sọ ní pàtó)......
43 Kíni ó ti ẹ̀yìn rẹ̀ yọ nígbàtí o tú ọ̀rọ̀ náà síta (a) O rí ẹni ràn ẹ́ l’ọ́wọ́
(b) Wọn kò gbà ẹ́ gbọ́
(c) Kò sí àyípadà tàbí àtúnṣe kankan
(d) Wọ́n pa ọ̀rọ̀ náà mọ́ ní àṣírí
(e) Wọ́n fi ìyà tí ó tọ́ jẹ ẹni tí ó ṣe
àṣemáṣe náà
44 Irú ìyà wo ni wọ́n fi jẹ ẹni tí ó ṣe àṣemáṣe (a) Wọ́n ran lọ s’ẹ́wọ̀n
náà (b) Wọ́n ní kó sanwó ìtọràn
(c) Wọ́n mu nípá kó ṣe ìgbéyàwó
pẹ̀lúù rẹ
(d) Ìjìyà mìíràn (sọ ní pàtó)
45 Tí ìdáhùn rẹ sí ìbéèrè 41 bá jẹ́ bẹ́ẹ̀kọ́, kíni (a) O kò mọ ohun tí ó yẹ kí o ṣe
ìdíi rẹ̀ tí o kò ṣe fi ẹjọ́ sun ẹnikẹ́ni? (b) Ẹ̀ rù ẹni tí ó ṣe àṣemáṣe náà ńbà ọ́
(c) Ẹ̀ rù àwọn òbíì rẹ ńbà ọ́
(d) ẹ̀rù àbùkù tàbí ìtìjú ńbà ọ́
(e) ìdí mìíràn (sọ ní pàtó)......
168
46 Ǹjẹ́ o ti bá àwọn òbí tàbí alágbàtọ́ọ̀ rẹ Bẹ́ẹ̀ni Bẹ́ẹ̀kọ́
jíròrò rí nípa ìbálòpọ̀ l’ọ́nà àìtọ́ àti fí fi ẹjọ́
sùn nípa rẹ̀
47 Ǹjẹ́ o ti ṣe alábàápàdé àwọn ọmọdé mìíràn Bẹ́ẹ̀ni Bẹ́ẹ̀kọ́
tí wọ́n ti bá lò pọ̀ l’ọ́nà àìtọ́
ÌPELE KẸ́ TA: Ìbéèrè nípa irúfẹ́ àjọṣepọ̀ tí ó wà láàárín ẹni tí ó ṣe àṣemáṣe àti ẹni tí wọ́n
ṣe àṣemáṣe náà sí
Nọ́ mbà Ìbéèrè Ìdáhùn aláṣàyàn
48 Báwo ni ẹni tí ó ṣe àṣemáṣe náà ṣe jẹ́ (a) Ìbátan ni ó jẹ́ sí mi
(b) Mi ò dá ẹni náà mọ̀
(c) Akẹgbẹ́ mi ní ilé-ìwé ni
(d) Olùkọ́ ilé-ìwé mi ni
(e) Aládùúgbò mi ni
(f) Ẹni mímọ̀ mi ni
(g) Ẹlòmíràn (sọ ní pàtó)
49 Sí ìbéèrè 48 tí ó wà lókè, tí ìdáhùn rẹ bá jẹ́ (a) Bàbáà rẹ
“ìbátan”, báwo ni ẹni tí ó ṣe àṣemáṣe náà (b) Ẹ̀ gbọ́n tàbí àbúrò rẹ ọkùnrin
ṣe jẹ́ sí ọ? (c) Ìyáà rẹ
(d) Ẹ̀ gbọ́n tàbí àbúrò rẹ obìrin
(e) Ọkọ ìyáà rẹ tí kìí ṣe bàbáà rẹ
(f) ọmọ ìyá bàbá tàbí ìyáà rẹ tí ó jẹ́
ọkùnrin (ọọnkú)
(g) Ẹlòmíràn (sọ ní pàtó)......
169
ÌPELE KẸ́ RIN: Ìbéèrè nípa ohun tí ó t’ẹ̀yìn ìbálòpọ̀ lọ́ nà àìtọ́ náà yọ
Nọ́ mbà Ìbéèrè Ìdáhùn aláṣàyàn
50 Ǹjẹ́ o dojúkọ ìṣòro kankan lẹ́yin ìbálòpọ̀ Bẹ́ẹ̀ni Bẹ́ẹ̀kọ́
l’ọ́nà àìtọ́ tí ó ṣẹlẹ̀ sí ọ?
51 Tí ìdáhùn sí ìbéèrè 50 bá jẹ́ Bẹ́ẹ̀ni, irú (a) Oyún àìfẹ́/ọmọ bíbí
ìṣòro ìbísí wo ni o dojú kọ (O ṣeéṣe kí o (b) Oyún ṣíṣẹ
mú ju ìdáhùn kan) (c) Àrùn ìbálòpọ̀ (egbò lójú abẹ́,
ǹkan ńdà lójú ara)
(d) Àrùn kògbóògùn (HIV/AIDS)
(e) Ìṣoro mìíràn (sọ ní pàtó)
Ipa tí ìbálòpọ̀ l’ọ́nà àìtọ́ ńkó lórí ìlera
ọpọlọ (ìdààmú ọkàn lẹ́yìn kíkojú ìṣẹ̀lẹ̀ ibi)
52 Ǹjẹ́ o ma ń ní èrò ọkàn tàbí ìrántí nípa Bẹ́ẹ̀ni Bẹ́ẹ̀kọ́
ìṣẹ̀lẹ náà tí o kò fẹ́
53 Ǹjẹ́ o ma ńlá àlákálàá nípa ìṣẹ̀lẹ̀ burúkú Bẹ́ẹ̀ni Bẹ́ẹ̀kọ́
náà
54 Ǹjẹ́ o ma ń ni l’ọ́kàn tàbí ṣe bí ẹni pé ìṣẹ̀lẹ̀
burúkú náà tún fẹ́ ṣẹlẹ̀ sí ẹ?
55 Ǹjẹ́ o ma ń nì àmì ara bíi mímí lókè lókè,
kí inú máa lọ́ ẹ, lílàágùn àti kí òyì máa kọ́
ẹ nígbàtí o bá rántí ìṣẹ̀lẹ̀ náà?
56 Ǹjẹ́ o ma ń ní ìṣòro àìrí oorun sùn?
57 Ǹjẹ́ o ma ń kanra tàbí bínú lódì lódì
58 Ǹjẹ́ àwọn ǹkan tí ó ma ń mu ọ rántí ìṣẹ̀lẹ̀
náà ma ń bà ọ́ nínú jẹ́?
170
59 Ǹjẹ́ ó ma ń ṣòro fún ọ láti fetísílẹ̀ tàbí
fokànsí ohun tí o bá ńṣe?
60 Ǹjẹ́ o ma ń ní ìpayà tàbí fojú ṣọ́nà fún ìṣẹ̀lẹ̀
ewu tí ó lè ṣẹlẹ̀ sí ọ àti àwọn yòókù
61 Tí àwọn ǹkan bá ṣẹlẹ̀ lójijì, ǹjẹ́ ó ma ń mú
ọ fò sókè pẹ̀lú ìpayà?
171
62. Ìwọ̀n Ìdáraẹnilójú ti Rósẹ́nbẹ́ẹ̀gì
Nọ́ mbà Ìwọ̀n Ìdáraẹnilójú ti Rósẹ́nbẹ́ẹ̀gì 3 2 1 0
62a Mo ní l’érò wípé mo níye lórí, mo sì wúlò, ó kéré
jù ní ìdọ́gba pẹ̀lú àwọn yòókù
62b Mo ni l’érò wípé mo ní àwọn ohun ẹ̀ṣọ́ tí
ọmọlúàbí yẹ kó ní
62c Lákòótán, màá fẹ́ gbàgbọ́ wípé ẹni tí kò lè ní
àṣeyorí nínu ohukóhun ni mo jẹ́ (R)
62d Mo ma ń lèṣ e ohunkóhun tí mo ba ń ṣe bákannáà
bí ọ̀pọ̀lọpọ̀ ènìyàn ṣe lè ṣe
62e Mi ò ni l’érò wípé mo ní àwọn ohun àmúyangàn
tó jọjú (R)
62f Mo ní ìṣesí tí ó dára sí ara mi
62g Boríborí ohun gbogbo, ohun tí mo jẹ́ tẹ́milọ́rùn
62h Ó wù mí kí n ní ìbọ̀wọ̀-fùnra-ẹni jù báyìí lọ (R)
62i Dájúdájú mo ma ń rí ara mi ẹg ́gẹ́ bí aláìwúlò
lẹ́ẹ̀kọ̀ọ̀kan (R)
62j Lẹ́ẹ̀kọ̀ọ̀kan, mo ma ń ni l’éro wípé mi o
suwọ̀n/dára rárá (R)
3 = Mo gbà bẹ́ẹ̀ ní gidi gaan 2 = Mo gbà bẹ́ẹ̀ 1= Mi ò gbà bẹ́ẹ̀ 0 = Mi ò gbà bẹ́ẹ̀ rárá rárá
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APPENDIX V
List of designated slums and their corresponding LGAs.113
SLUM AREAS LGA / LCDA
Badia Apapa LGA
Ajegunle Ajeromi/Ifelodun LCDA
Iwaya Lagos Mainland LGA
Makoko Lagos Mainland LGA
Ilaje Shomolu LGA
Amukoko Ajeromi/Ifelodun LCDA
Oko Baba Lagos Mainland LGA
Ijora Oloye Apapa LGA
Sari iganmu Apapa Iganmu LCDA
Ogudu village Kosofe LGA
Agege Agege LGA
Lagos Island (Isaleeko) Lagos Island LGA
Ijeshatedo/Itire Mushin LGA
Ilaje ,Bariga Bariga LCDA
Mile 12 Ikosi – isheri LCDA
Mushin- Idi-Araba Mushin LGA
Agidingbi Ikeja LGA
Olaleye Iponri Surulere LGA
Oworonshoki Kosofe LGA
IpodoIkeja Ikeja LGA
Marine Beach Apapa LGA
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Otto Lagos Mainland LGA
Oshodi Market Area Oshodi - Isolo LGA
Shogunle Oshodi LGA
Obalende Ikoyi – Obalende LCDA
Olusosun Kosofe LGA
Oregun Onigbongbo Opebi LCDA
Orile Agege Agege LGA
Somolu Somolu LGA
Onigbongbo Onigbongbo – Opebi LCDA
Alausa Village Ikeja LGA
Ogba West Ikeja LGA
Iju Agege LGA
Ejigbo Oshodi – Isolo LGA
Lawansonikate Surulere LGA
Abuleijesha Yaba LCDA
Ipaja Alimosho LGA
Non slum communities
Non-slum areas in Ajeromi LGA are Wilmer, Olodi Tolu, Temidire, Ojo road, Layeni,
Mosafejo.
Apapa LGA: Non slum areas identified at Apapa LGA are Tincan, Apapa1, Apapa2, Apapa3,
Apapa4, Olodan/Iganmu, Gashiya, Afolabi, Malu road, Sari and environs.
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Mushin LGA: Papa-ajao, Alakaraidi-oro, Babalosa, Ojuwoye, Ilupeju, Olateju, Kayode,
Mushin/ Atewolara, PapaAjao, Ilasamaja, Babalosa, Ilupeju industrial estate are non-slum areas identified.
Somolu LGA: Onipanu, Palmgrove, Alade, Bajulaiye, Mafowoku, Ladlak, Gbagada1,
Gbagada2, Abule-okuta, Igbobi/Fadeyi, Folagoro are non-slum areas.
Lagos mainland non slum areas are Apapa, Olaleye village, Glover, Oyadiran/Abuleoja,
Alagomeji and Yaba.
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APPENDIX VI
THEMATIC GUIDE FOR FOCUS GROUP DISCUSSION
Title: Community perceptions of sexual abuse
Objectives
• To explore the perceptions of adolescents and older community members on sexual abuse
• To identify factors contributing to sexual abuse
Socio-demographic information
Age as at last birthday: ...... Highest level of education: ......
Religion/Denomination: ...... Ethnicity: ......
Occupation: ...... Living arrangement: …………………
Relationship status (Single, separated, divorced, widow) ……….
Introduction
Thank you for coming. We are from LUTH, Idi-Araba. We are conducting a research on sexual abuse. We have invited you here today to discuss this issue with you. Your responses will be used to help develop materials and services to assist with curbing sexual abuse and provide reproductive health services for adolescents. All of our discussions will be kept strictly secret.
We will be producing a report on our findings, but will not reveal your name if we quote anything you say. If you don’t mind, we will like to tape record our discussion. This is to help us record what has been said. The tape will not be played to anyone. Once notes have been taken from the tape, it will be destroyed.
Is everyone happy to participate in this discussion? Record response yes/ no
Is there anyone who would like to leave now? Record if someone leaves.
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We hope that you will feel free to discuss your opinions openly. There are no right or wrong answers and we would like to hear your honest opinion about the issue. All of your responses will remain confidential.
Notes on background of participants and comments on discussion
To be completed after interview.
Focus group discussion guide
1. Warm up
Tell me something about yourself, your work and the things you like to do.
What worries you these days?
2. What do you understand as the meaning of sexual abuse?
3. What constitutes sexual abuse
4. How prevalent is sexual abuse in your community
5. Where does this occur?
6. What factors contribute to sexual abuse?
7. What are the consequences of sexual abuse?
8. What support systems are in place for victims of sexual abuse.
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APPENDIX VII
Some Pictures taken during questionnaire administration on the field
178
Some Pictures taken during questionnaire administration on the field
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APPENDIX VIII
Map of Lagos state Local Government Areas
180
APPENDIX IX
FGD RESULT WRITTEN IN PROSE FORMAT.
Prevalence of sexual abuse
Participants in both settings thought that sexual abuse was very common and condoned by communities. They also perceived that these acts were seldom reported due to several barriers that favour the acceptance and non-disclosure of sexual abuse.
Prevalent in school - subtheme
It is getting rampant nowadays it is everywhere even teachers are forcing students to sleep with them (M.O 17yrs F non slum)
My teacher punished me and said I should sit under her table and opened her legs wide open for me to see. Each time I take my head away, she shouts that I look straight. Is that not part of abuse? (A.B 18yrs M slum)
Prevalent in religious homes
A particular man of God used to call young girls on phone and tell them to pray at midnight with one finger in their private part. He then later sleeps with them. He has been caught now and chased away from the church. He said my children were strong spiritually. If not he would have called them. (O.A 50yrs F slum)
An alfa in our area calls 2-3 year olds and give them sweets then he touch their private part. I think he is using it for juju….sighs! (B.K 40yrs F slum)
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Prevalent in homes.
It is very common. Even husband and wife. If the man is frustrated, he can rape his wife. (F.O
53yrs M non slum)
I have heard stories of men sleeping with house helps. Its frustration of life. If the wife is not pleasing him sexually. (F.O 53yrs NON SLUM)
It is very common but people are still hiding and not voicing it out because of shame. SLUM)
See ehn… when we talk about sexual abuse, is not just about the girls but even boys. Afterall, it was my aunty that showed me the way there. Now I enjoy it and I am an expert. She is married now with 3 children. (FGD 3 NON SLUM)
It happens in the home now. Uncles father and brother sleep with their children and sister.
When we were younger, we used to play a game daddy and mummy. That’s sexual abuse because we copied what adults were doing. It has been in existence for so long…. Sings a yoruba folksong.
Aunty do you even see this area, I cant send my child on errand at night. Sexual abuse is too much here. Sighs….
Perception of what constitutes sexual abuse
All participants had similar views on what constitutes sexual abuse. They agreed that forceful sex/ rape was sexual abuse. They perceived that boys, girls, women, men could experience sexual abuse. Some of the participants echoed that sexual abuse was exposure to sex at an early age whether consensual or not. Many of the adolescent males agreed that exposure of a child to pornography by an adult is a serious form of sexual abuse. Majority of the respondents were unaware that parents dressing in front of their children was a form of sexual abuse. Some respondents attributed sexual abuse to prostitution.
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Forceful sex- subtheme
Sexual abuse is what you have no interest and someone force you. FGD 4(nonslum)
A girl in my school who was raped at age 10years and since then she keeps having urge to have sex but now she is getting better with prayers. (FGD4 NONSLUM)
Housing - subtheme
What I see is that it does-not matters if you dress in front of them because after bath you cannot tell your child to go out but all we have to do is to cover small. Let them see my body at least
I did not draw any tattoo on my body so they too have no reason to draw tattoo. (FGD 4 SLUM)
Factors contributing to sexual abuse
Participants attributed increase in sexual abuse to a number of factors, such as technology, indescent dressing, lack of parental care was a major contributor. They also identified financial hardship and poor housing as a major problem.
Some of the respondents felt that there was too much emphasis on the girl child and less attention on the boys who also get sexually abused. Alcohol and drug abuse was echoed by majority of the respondents.
Pornography/technology - subtheme
Sexual abuse is doing what you ought not to do like 10- 12 years watching blue film on phone.
FGD 4 NON SLUM
Film is very common. It is those shameless adults that allow children watch it. Phone sef is a big wahala. Where I have not reached on my phone, my children get there. FGD 2 NONSLUM
All this watsapp and facebook and internet. It is causing problem I tell you. Any small thing you will see naked woman. That alone can make men want to rape. (FGD 3 NONSLUM)
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Housing- subtheme
Some children will know when their daddy want to meet mummy and pretend they are sleeping.
What can we do. Its only one room we can afford. FGD 3 SLUM
See, do you think I don’t know what happens with my parents. Afterall is only one room nah.
FGD 3 SLUM
It’s the women that are fond of dressing infront of their children. Some of them will even bathe with their kids. So what are you saying? FGD 1 NONSLUM
Alcohol – subtheme
When men take too much alcohol. For example you know “skunshii” that one they mix cough syrup in their hot drinks. you can buy the mixture for 500 naira. When they take it, their senses are never complete and they do and undo. FGD 3 SLUM
Some men rape girls that they have toasted and she didn’t agree. Most of these boys are always high. FGD 4 NON SLUM
Those girls called “olosho” do you think they don’t drink too. They can even rape a man nicely.
FGD 3 SLUM
There is too much freedom in this country. Let there be sharia everywhere. Let Government control selling of alcohol. This alcohol doesn’t make them think straight. FGD 1 NON SLUM
Respondents unanimously agreed that Lack of parental care was a factor. They identified overworking parents, careless, uncaring and non chalant parents contributing to sexual abuse.
Parental factor- subtheme
In all the FGDS, participants expressed deep concerns about poverty and poor parental care that make children vulnerable to several risks including sexual abuse. Some participants reported that parents poor economic status might force girls to engage in risky sexual activities in order to solicit financial support from boyfriends or engage in prostitution. Participants across all age groups and of both genders expressed that there was poor parental monitoring
184 with children especially when they have attained puberty. For parents who monitor and take time to educate their kids, the information wasn’t sufficient
Is it not some mothers that will be asking their girls what they brought home and how much they have. Tell me. Where are they supposed to get the money from. FGD 2 NON SLUM
Some children will leave the house with one cloth and change to a bad one outside. I pieces my childs clothe one day. She dares not try me. You have to monitor them well. FGD 2 SLUM
Parents and even the church should start teaching this children about sex education and how to keep safe. FGD 2 SLUM
Our parents should also draw us close and stop shouting at every little thing. FGD 4 NON
SLUM
I have one friend the mother did not know when she started menstruating. If anything happens she wont talk now. FGD 4 NONSLUM
If we shout on them they wont be free with us. FGD 1 NON SLUM
Imagine a parent that goes in the morning and comes back late at nighjt very tired. How will you monitor. FGD 1 NON SLUM
Please ooo. We women have a role to play. Don’t blame the men. Its in our hands to help them.
FGD 2 SLUM
Parents should stop taking the children up and down to different pastors for prayers. That’s where they miss it. Going up and down looking for vision. FGD 2 NON SLUM
Shebi, some women have boyfriend and their children know. What do you expect. FGD 1
SLUM
We need to show them the right way. FGD 1 NONSLUM
The first friends of the child is the parent. Let them draw us close. FGD 1 NON SLUM
Fathers that sleep with their children are using it for juju. FGD 2 NON SLUM
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Education – subtheme
Let them make education compulsory especially those boys who smoke indian hemp. FGD 4
NON SLUM
It is the people that don’t go to school that are raped. Like me now, I still want to read but im doing hairdresser. FGD 4 SLUM
Sex education is good but not at unripe age atleast 20 years. FGD 4 NONSLUM
We should teach them parts of their body and tell them not to allow any man or uncle carry them on their lap. FGD 2 NONSLUM
Culture – subtheme
My religion says once they have started menstruating, they should marry so that they don’t sleep around but it is not a by force rule. At least, I can take up a child and take care of her till she is ready for me to sleep with her. We are in modern age now. We cant force them till they are ready. FGD 1 SLUM
The girls are the ones pushing themselves on us now. Before in the olden days it wasn’t like that. People do things the proper way. But our culture have changed. FGD 1 NON SLUM
The environment and what is rampant in that area matters. If there are many bad people, the child will be exposed to raping girls. Even if the parents monitor, the bad boys will mount pressure. FGD 1 SLUM
Indescent dressing- subtheme
If a woman wears skimpy things, automatically people will look and talk. Even a baby will talk.
Ofcourse she will be raped. FGD 3 NON SLUM
Their mode of dressing nowadays is terrible. Advertising themselves for everybody to see. FGD
2 SLUM
My husband likes me dressing like that. So it depends. FGD 2 NON SLUM
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Consequences of sexual abuse
Responses regarding consequence of sexual abuse ranged from low self-esteem to prostitution, unwanted pregnancies, HIV/AIDS, emotional trauma and mental problems.
It can make the girl have HIV. Her future is gone. FGD 3 SLUM
The child cannot be normal again. FGD 3 NON SLUM
The men are lucky. I don’t think it affects them. They will be better at it. FGD 4 SLUM
It can affect their schooling and the girl will be depressed. And it will show. She wont dress well and interact with people like before. FGD 4 NONSLUM
Support system for sexual abuse
Participants agreed that the fear of being stigmatized prevents reporting. When reports are made, the victims are often times not believed.
Cost, corruption, distance, limited services, lack of quality care services were seen by participants as barrier to care seeking behaviour. Participants echoed that police usually responds slowly and eventually allow the perpetrator go free. They believed that reporting does more harm than good and that the Government had not done enough regarding punishment of perpetrators. Corruption was echoed has a hindrance to justice for victims.
There is one strong man in our area that rapes girls. He goes to the prison a lot but they keep releasing him. What can we do. We fear him… sighs FGD 2 SLUM
The government should help us deal with criminals. FGD 2 NON SLUM
We need counselling in this area. We need people we can talk to for advice. Like you now, you can help us with a place where we can come and get advice and share our problems. FGD 3
SLUM
The Baale settles some cases but at the end it is still the girl that face the shame and all the problem. FGD 4 SLUM
Participants agreed that the fear of being stigmatized prevents reporting. When reports are made, the victims are often times not believed.
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