Patterns of Sexual Assault victims presenting to the University Teaching Hospital in Lusaka, Zambia: a Cross-Sectional Study

Background: Sexual assault, which encompasses defilement and rape, is a public health and public safety problem with the majority of victims being women and children. The consequences of sexual assault include physical injuries, psychological trauma, depression, suicide or suicide attempt and post-traumatic stress disorder (PTSD) as a long-term consequence. Others are unwanted pregnancies and risk of acquiring sexually transmitted infections including the Human Immunodeficiency Virus (HIV). There is little information about the conditions under which sexual assault occurs. The aim of this study was to determine the patterns of sexual assault victims presenting to the University Teaching Hospital (UTH). Materials and Methods: This was a cross-sectional study that was carried out on sexual assault victims who presented to UTH over a period of four months from December 2013 to April 2014. A total of 160 participants were recruited, 59 from the Gynaecology admission ward (C03) and 101 from the Paediatric Centre of Excellence Child Sexual Assault (PCOE-CSA). Participants were interviewed using an interviewer-administered questionnaire while some data was extracted from victims’ files including documented HIV status. Frequency tables were constructed and characteristics of sexual assault were compared between victims aged below 16 years and those aged 16 years and above. Data analysis was done using SPSS version 20. Results: The age of 160 victims ranged from 2 to 34 years and the most affected age group was 11-15 years (n=91; 56.9%). Victims were mostly single (n=149; 93.1%), had attained primary education or none (n=102; 63.8%) were unemployed (n=149; 93.1%) and resided in high-density areas (n=144; 90%). Only 7.5% (n=12) of victims tested HIV positive. A positive HIV test occurred 14 times more frequently in victims aged 16 years and above (OR = 14.32, CI = 2.35 – 87.22, P-value < 0.01). Majority of the incidents took place in residential homes (n=110; 68.8%) and these were significantly less common among victims aged 16 years and above (OR = 0.33, CI = 0.11 – 0.98, P-value = 0.05). The majority of perpetrators were known to the victims (n= 119; 74.4%). Sexual assault perpetrated by strangers affected victims aged 16 years and above more than those aged below 16 years (50.0% versus 17.5%; P <0.01). About half of victims (n=84; 52.5%) reported to UTH within 72 hours of assault and these were 4.5 times more likely to be aged 16 years and above (OR = 4.53, CI = 1.23 - 16.73, P-value = 0.02). Genital injuries were present in 70% of victims. The absence of genital injuries was 8 times more in victims aged 16 years and above (OR = 8.46, CI = 2.78 – 25.77, P-value <0.01). Conclusion: The majority of sexual assault victims were younger (<16 years). Younger victims were mostly assaulted by perpetrators known to them, mainly in residential homes while older victims were mostly assaulted by strangers in isolated places. Compared to older victims, younger victims presented more to UTH later than 72 hours the following the assault and sustained genital injuries more. Patters of sexual assault are therefore different in younger victims compared to adults.