Prevalence of Post-Traumatic Stress Disorder Among Sexually Abused Children of the Child Abuse Centre at the University Teaching Hospital,Zambia

Abstract

Child Sexual Abuse (CSA) is a problem in many countries in the world including Zambia with various studies pegging the prevalence at 3 to 17% for boys and 8 to 31% for girls (Barth, Bermetz, Heim, Trelle & Tonia, 2013). The effects of CSA are both physical (genital trauma, contraction of infections, pregnancy, etc) and psychosocial (emotional dysregulation, bed wetting, regression of milestones, relational problems, poor self-esteem and other psychiatric diagnosis such as depression, eating disorders, substance misuse disorders, dissociative anxiety disorders, anxiety disorders, posttraumatic stress disorder (PTSD), etc). However, physical effects which often heal without any further sequel are often given more attention than psychosocial effects which may last up to several years (Bernard, Peters and Makoroff, 2006; Cohen, Deblinger, Mannarino & Steer, 2004; Fossati, Madeddu, & Maffei, 1999; Hevey & Kenward, 1989; Maniglio, R., 2009). Aim: This study was done to determine the prevalence of posttraumatic stress disorder among sexually abused children from the child sexual abuse centre at University Teaching Hospital and to describe relevant aspects of it. Materials and Methods: Children aged 4 to 15 years were recruited at their one month reviews. Demographic details and abuse characteristics were obtained from the centre records while the Child PTSD Symptom Scale (CPSS) was used to assess for PTSD (Foa, Johnson, Feeny & Treadwell, 1999). Two way analysis and multivariate analysis were used to analyse association. Results and Discussion: There were 192 participants in the study with only 3 boys. Teenagers constituted almost half the study population with median age = 13, mean age = 11, mean age for boys = 11. Ninety eight percent of the referrals were from the Police. All the abusers were males with neighbours, boyfriends and non-relative adults constituting over 50% of the abusers in the study. Sexual abuse by boyfriends was significantly high although the abuse by the neighbour scored the highest. Penile penetration was the main feature of the abuse with only one in twenty abusers being reported to have used condoms. Physical Force was the main mode of engagement used on the children. The prevalence of PTSD was 33.3 % with 9 % of vi the children presenting with severe impairment. There was an association between PTSD diagnosis and functional impairment and re-experiencing and hyper-arousal cluster of PTSD symptoms. There was no association between the type of coercion used (force, playful coaxing, etc) to lure the children and the development of PTSD. Conclusion and Recommendations: Prevalence of PTSD is high among sexually abused children. Most of the sexual abuse involves unprotected penetrative sex. The police should be included in planned care for CSA victims.