Predictors of Health Services Utilization in Child and Adolescent Ethiopian Male Sexual Assault Survivors Público

Abstract

Background: Sexual violence against children is a global problem that impacts over 150 million children in the world. While rates of sexual violence against children are particularly high in sub-Saharan Africa, there is a dearth of research on the subject. In Ethiopia, sexual violence against male children is particularly understudied due to issues of underreporting, stigmatization, and legal consequences.

Objectives: This study examined descriptive characteristics of pediatric male patients of sexual assault one-stop centers in Hawassa and Adama, Ethiopia. It also explored the differences between child and adolescent male patients. In addition, it explored the predictors of health services utilization of this population by using the Behavioral Theory for Vulnerable Populations.

Methods: A quantitative codebook was created based on national Ethiopian standards of care for sexual assault survivors. Data were collected through a medical chart review, and 83 male patients between the ages of 2 and 19 were identified. Demographics were examined using univariate analyses (mean, standard deviation), and correlations of categorical variables were examined using chi-squared analysis.

Results: The average patient age was 9.58 years, with a standard deviation of 4.06. The only statistically different finding between the child and adolescent groups was in the reporting of extra-genital injury: three children reported extra-genital injury, while no adolescents did (χ² = 6.60, p = 0.04). None of the population characteristics significantly predicted whether patients would present to clinic within one week of assault; however, the highest correlation for presenting to clinic within a week was the presence of genital or anal injury (χ² = 5.79, p = 0.06).

Conclusions: The medical charts were missing significant amounts of documentation, which may have contributed to the lack of statistical significance between groups on most variables. The best predictor for whether a male patient would go to a one-stop center clinic and seek care within one week was presence of genital or anal injury. Recommendations for Ethiopian practitioners include providing a medical chart template specific to male patients, utilizing standardized chart templates on every patient, and adding in other demographic and assault characteristic variables that could help predict health services utilization.

Table of Contents

Chapter 1: Introduction

Problem Description and Justification

Development of ESOG Clinics

One-Stop Center Model

Study Purpose

Definitions of Terms

Chapter 2: Literature Review

Sexual Abuse and Adverse Health Outcomes

Effects by Abuse-Specific Variables

Age

Relationship to Offender

Type of Abuse

Male Sexual Abuse

Underreporting of Sexual Abuse Among Males

Male Sexual Abuse in Ethiopia

Theoretical Framework

Chapter 3: Methods

Study Design

2014 Codebook Creation

2015 Codebook Update

Data Extraction and Coding

Study PopulationMeasures

Data Analysis

Chapter 4: Results

Chapter 5: Discussion

Findings

Limitations

Implications and Recommendations

Conclusion

ReferencesAppendix A: Quantitative Codebook Developed by 2014 Team

Appendix B: Quantitative Codebook Developed by 2015 Team

Appendix C: ESOG Sexual Evaluation Certificate

Appendix D: Institutional Review Board Expedited Approval

Appendix E: Recommendations for ESOG

List of Figures

Figure 1:Study Participants Flow ChartList of Tables

Table 1: OSC Services Provided

Table 2: Variables Present in 2014 and 2015 Codebooks

Table 3: Variables Organized by Constructs of the Behavioral Model for Vulnerable Populations

Table 4: Patient Demographics

Table 5: Characteristics of Patient Presentation to Clinic

Table 6: Characteristics of Assault

Table 7: Physical Findings and Test Results from Physician Examination

Table 8: Record of Patient Treatments Given Per ESOG Guidelines

Table 9: Time to Presentation to Clinic Based on Behavioral Model for Vulnerable Population Constructs

About this Master's Thesis

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School	Rollins School of Public Health
Department	Behavioral Sciences and Health Education
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Palavra-chave	Ethiopia sexual violence adolescent male sexual assault children
Committee Chair / Thesis Advisor	Comeau, Dawn L, Emory University
Committee Members	Krause, Kathleen Helen, Emory University Goedken, Jennifer, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs International Non-governmental organization (e.g., CARE, Inc.) Hospital or other health care provider

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