Home Print this page Email this page Small font sizeDefault font sizeIncrease font size
Users Online: 192

 

Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Advertise Contacts Login 
     

  Table of Contents  
ORIGINAL ARTICLE
Year : 2014  |  Volume : 55  |  Issue : 3  |  Page : 254-259  

Sexual assault in Ile-Ife, Nigeria


1 Department of Obstetrics; Obstetrics and Gynaecology, Gynaecology and Perinatology, Ile-Ife, Nigeria
2 Department of Pediatrics and Child Health, Obafemi Awolowo University; Pediatrics, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
3 Department of Pediatrics, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria

Date of Web Publication7-May-2014

Correspondence Address:
Olusegun Olalekan Badejoko
Department of Obstetrics, Gynaecology and Perinatology, Obafemi Awolowo University, Ile-Ife
Nigeria
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0300-1652.132065

Rights and Permissions
   Abstract 

Background: Sexual assault (SA) is a shattering malevolence against women. This study determined the burden, periodicity, presentation and management of SA in Ile-Ife, Nigeria. Materials and Methods: Retrospective analysis of the hospital records of 76 SA survivors managed over a 5-year period (2007-2011) in Obafemi Awolowo University Teaching Hospitals complex (OAUTHC), Ile-Ife. Results: Sexual assault accounted for 0.69% of all female and 5.2% of all gynaecological emergencies in OAUTHC, Ile-Ife. The survivors' ages ranged from 4 to 50 years (mean = 17.7 ± 8.8years) and adolescents made up for 48%. The peak prevalence of SA was in February and December and among adults and under-16-year-old survivors, respectively. Daytime and weekday SA were significantly more common among the under-16-year-old survivors (P = 0.008). Majority of the survivors (62%) knew their assailant(s). Neighbours were the commonest perpetrators identified (28.2%) and the assailants' house was the commonest location (39.4%). Weapons were involved in 29.6% of cases and various injuries were identified in 28.2% of the survivors. Hospital presentation was within 24 hours in majority (76.1%) of the survivors, but rape kit examinations were not performed as the kits were not available. Although appropriate medical management was routinely commenced, only 12.7% of survivors returned for follow-up. Conclusions: Seasonal and diurnal patterns exist in the prevalence of SA in Ile-Ife and most survivors that reported in the hospital presented early. Rape kit examinations were, however, not executed, due to non-availability. Personnel training, protocol development, provision of rape kits and free treatment of SA survivors are, therefore, recommended. Public enlightenment on preventive strategies based on the observed periodicity and age patterns is also suggested.

Keywords: Child sexual abuse, rape kit, rape, sexual assault, sexual violence


How to cite this article:
Badejoko OO, Anyabolu HC, Badejoko BO, Ijarotimi AO, Kuti O, Adejuyigbe EA. Sexual assault in Ile-Ife, Nigeria. Niger Med J 2014;55:254-9

How to cite this URL:
Badejoko OO, Anyabolu HC, Badejoko BO, Ijarotimi AO, Kuti O, Adejuyigbe EA. Sexual assault in Ile-Ife, Nigeria. Niger Med J [serial online] 2014 [cited 2017 May 26];55:254-9. Available from: http://www.nigeriamedj.com/text.asp?2014/55/3/254/132065


   Introduction Top


Sexual assault (SA) is an umbrella terminology which encompasses a wide range of sexual offenses extending to actual or attempted unlawful sexual penetration also called rape. [1] It is a pandemic crime that is characteristically underreported worldwide. However, it is known to have a high prevalence in Nigeria and this has been variously attributed to the enduring culture of male dominance, female social and economic disempowerment and poor or non-prosecution of sex offenders. [2] Its magnitude in Nigeria was again brought to the fore in September 2011, when a video appeared on the internet showing a south-eastern Nigerian woman being gang-raped. This incident sparked a global outrage and drew the attention of the Nigerian authorities to the alarming status of rape in the country. [3]

Although it is known that studies relying on hospital-based data might only capture the tip of the iceberg as far as SA is concerned, [4],[5] such studies remain relevant. These studies are capable of providing important details about the acute phase such as the pattern of injury-both physical and psychological, as well as the obtainability of forensic evidence, which could aid in the identification and prosecution of the perpetrator(s). The quality of medical care given to SA survivors can also be objectively evaluated in such studies. In addition, these studies enable the scrutiny of special groups such as children, which might be virtually impossible using conventional community-based survey techniques.

The present study was therefore undertaken to determine the burden, periodicity, clinical presentation and management of SA in the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Nigeria.


   Materials and methods Top


This study was carried out in the Ife Hospital Unit of the Obafemi Awolowo University Teaching Hospitals complex (OAUTHC), Ile-Ife, southwestern Nigeria. The hospital is a referral centre providing tertiary healthcare services for an up-take area spanning the whole of Osun Sate and parts of Ondo and Ekiti States of southwestern Nigeria. It has a Children's Emergency unit where all emergencies in persons below 16 years are managed, while its Adult Emergency unit attends to emergencies in individuals who are 16 years or older. All cases of SA presenting in these emergency units are initially resuscitated by the emergency room team who then invite the gynaecologists to take over the management. Up till the time of this review, the hospital did not have an institutional rape management protocol, nor had rape kits become available.

A retrospective analysis of the hospital records of SA cases managed over a 5-year period from 1 st of January 2007 to 31 st of December 2011 in OAUTHC, Ile-Ife was performed. Cases were identified through the accident and emergency registers of both emergency units of the hospital and the case notes were recovered from the medical records library. Five out of the 76 case notes (6.6%) could not be located. Further analysis was therefore based on the 71 cases (93.4%) with complete data. The reported date and time of incidence of each case was also obtained to identify any periodicity in the occurrence of SA in Ile-Ife, Nigeria.

The data obtained was analyzed using SPSS version 15.0 and P-value of < 0.05 was accepted as significant. This study was conducted in conformity to the standards of the international code of medical ethics [6] and ethical approval was obtained from the Research and Ethics Committee of OAUTHC, Ile-Ife (IRB Number: ERC/2012/04/01).


   Results Top


There were 76 cases of SA over the 5-year period from January 2007 to December 2011. Thirty-one (40.8%) and 45 (59.2%) of them were managed in the Children's and Adult Emergency units, respectively. All the 76 survivors of SA seen were females. There were 24,575 emergency cases in the two emergency units over the 5-year period. Out of this number 11,038 (44.9%) were females. Thus, SA accounted for 0.69% of all female emergency room admissions in OAUTHC, Ile-Ife. Separately, it made up 0.94% of emergencies in girls below 16 years and 0.58% of emergencies in those 16 years or older. Sexual assault also accounted for 45 (3.2%) of the 1,409 adult gynaecological emergencies and 31 (72.1%) of the 43 gynaecological emergencies in girls below 16 years. Overall, SA accounted for 5.2% of all gynaecological emergencies.

The ages of the survivors ranged from 4 to 50years with a mean 17.7 ± 8.8 years. This and other sociodemographic characteristics of the survivors are shown in [Table 1]. Most of the survivors (81.7%) were either students or pre-school age children. Among those who worked, there were secretaries, pub-operators, hairdressers, salesgirls, a nurse and a housemaid.
Table 1: Socio-demographic characteristics of sexual assault survivors in Ile-Ife

Click here to view


The peak month of occurrence of SA was February for adults and December for children. This is shown in [Figure 1]. Overall, Friday and Sunday were the days with the highest prevalence of SA, while Monday had the lowest prevalence. Adult-SA cases were the major contributors to the Friday and Sunday peaks. This is shown in [Figure 2]. A comparison of the prevalence of child-SA versus adult-SA on weekdays (Monday-Thursday) versus weekends (Friday-Sunday) revealed a statistically significant difference (X [2] = 7.00; df = 1; P = 0.008); with child-SA cases occurring more on weekdays and adult-SA on weekends
Figure 1: Bar chart showing the month of occurrence of sexual assault in Ile-Ife, Nigeria

Click here to view
Figure 2: Bar chart showing the day of occurrence of sexual assault in Ile-Ife, Nigeria

Click here to view


Forty-seven (66.2%) of the 71 SA cases occurred during the daytime (between 7:00 am and 7:00 pm), while the remaining 24 (33.8%) occurred at night (between 7:00 pm and 7:00 am). The peak hour of SA was 8:00 pm. A comparison of child- and adult-SA also revealed a significant difference in diurnal pattern between the two groups. Whereas children (<16 years) made up 25 (53.2%) of the 47 cases of SA which occurred during the daytime, they constituted only five (20.8%) of the 24 cases that occurred at night (X [2] = 6.82; df = 1; P = 0.009).

In 44 out of the 71 cases (62%) in this review, the assailant was somebody known to the survivor. The relationships between the survivors and the assailants are shown in [Table 2]. The table also shows the reported number of assailants, which ranged from one to four. Furthermore, the assailant's house was found to be the commonest venue (39.4%) of reported SA, while forced peno-vaginal intercourse (94.4%) was the predominant act. Other acts reported included forced oral sex, forced anal sex, insertion of finger into the vagina, and vaginal impalement with a foreign body (a twig).
Table 2: Pattern of sexual assault and its perpetrators in Ile-Ife, Nigeria

Click here to view


Fifty six (78.9%) of the 71 survivors reported the use of verbal threats by their assailant(s) and 42 (59.2%) reported the actual use of force by the perpetrator(s). Enticement and inducement was reported in 24 cases (33.8%). Although 35 (49.3%) of the survivors reported struggling with their assailants, none of them reported injuring the assailant in the process. Weapons were involved in 21 cases (29.6%) and the different types of weapons along with their mode of usage are as presented in [Table 3]. Firearms were the most common weapons reported, but fortunately, none of the affected women was shot. In all the nine cases involving firearms, the perpetrators were armed robbers.
Table 3: Types of weapons involved and their mode of usage in sexual assault in Ile-Ife

Click here to view


Some relevant forensic history and examination findings are presented in [Table 4]. Many of the survivors had already bathed, douched or washed the clothes in which the SA occurred, before presenting at the hospital. In majority (69%) of cases, the incident had also been reported to the police before presentation. Indeed, in 33.8% of cases, arrest of the suspected perpetrator(s) had been effected prior to the survivor's presentation in the hospital. The reported time intervals between SA and presentation at the emergency unit are also shown in [Table 4], with the majority (76.2%) of survivors presenting within 24 hours of the SA. The SA-Presentation intervals actually ranged from 90 minutes to 42 days, with a median of 8 hours. However, none of the survivors had a rape kit examination, neither was there preservation of forensic evidence in any of the cases. The pattern of injuries documented during the survivors' emergency room examinations is also shown in [Table 4].
Table 4: Forensic history and examination of sexual assault survivors in Ile-Ife

Click here to view


A summary of the investigations and treatment of the survivors is presented in [Table 5]. Two out of the 60 survivors who had HIV screening were HIV-positive at presentation (3.3%). Neither of them had been previously diagnosed. Microscopy of vaginal wet preparation was performed in 24 survivors and spermatozoa were seen in nine of them (37.5%). Also, four of the survivors (5.6%) were pregnant at the time of the SA and these were confirmed by urine pregnancy test and pelvic ultrasound scan. Their gestational ages ranged from 9 to 14 weeks at the time of the assault. The various treatments given to the survivors are also summarised in [Table 5].
Table 5: Investigations and treatment of sexual assault survivors in Ile-Ife

Click here to view


Overall, although the requisite counseling and medical care were routinely provided as appropriate, only nine (12.7%) of the 71 survivors returned for follow-up and all nine were subsequently lost to follow-up (seven after the first visit and two after a second visit).


   Discussion Top


The burden of SA obtained from the present study is comparable to the findings of some previous studies in Nigeria. [7],[8],[9] Also, as in some other Nigerian studies; there was no male SA survivor in the present study. This is perhaps due to the well known fact that male SA survivors are less likely to report the incident. [10],[11],[12] Abdulkadir et al., [8] however, discovered two males (7%) among 29 survivors of child-SA in Suleja, Nigeria thus demonstrating the existence of male SA in the country.

The present study clearly demonstrated the existence of seasonal and diurnal patterns in the occurrence of SA in Ile-Ife. Although the reasons behind the observed patterns may not be very clear, the February peak which consisted predominantly of adult SA cases may not be unconnected with the annual Valentine's Day celebration which is a huge phenomenon especially among university students, and Ile-Ife being a university town. Similarly, the December peak comprising mostly child-SA cases could be related to the Christmas holiday season which generally enables more unsupervised contact between children and an increased number of familiar adults other than their parents and teachers. [13]

The Friday and Sunday peaks were largely accounted for by adult-SA cases. This is not surprising, considering that the assailant's or victim's home is the commonest location for SA and both days are widely favoured for visiting. [14],[15] Typically, weekends are periods of heightened, informal interpersonal contact and increased alcohol consumption, both recognised as significant contributors to SA among adults. [16]

Children on the other hand were more likely to be sexually assaulted on weekdays and this may be because they are likely to spend less time under parental supervision during the week, as parents are usually out working. Moreover, children usually return home from school earlier than their parents get home from work, thus exposing them to the danger of SA by familiar or trusted people, especially neighbours. This probably also explains the diurnal pattern observed in this study with most child-SA occurring during the daytime, while most adult-SA occurred at night.

Similar to other studies, children and adolescents constituted the majority of SA survivors. [9],[17],[18] This reaffirms SA as a major adolescent reproductive health problem and uncovers the stark reality of child sexual abuse in Ile-Ife. It is quite disturbing that most children were assaulted by well known persons trusted by both the children and their parents. All parents, therefore, need to be mindful of this risk when leaving their children alone with anyone, however, well known or trusted the individual might be.

On the whole, most survivors were assaulted by people who were well known to them. This is similar to the findings of several other workers. [9],[18],[19],[20],[21] Women should, therefore, be advised to avoid vulnerable positions such as being alone with males of questionable intent, or paying unguarded visits to any males no matter their relationship. Adults were generally more likely than children to be sexually assaulted by strangers and such sexual assaults tended to be opportunistic. For example, while rape by commercial motorcyclists mostly occurred in the bush, that by commercial bus drivers occurred inside the bus. Women, therefore, need to be mindful of these risks when patronising commercial motorcyclists in secluded areas or boarding buses as sole passengers, especially at night. General security measures against armed robbery attacks should also be strengthened as a means of rape prevention in Ile-Ife.

The rate of involvement of weapons in the present study was comparable to that reported in a US study. [20] Actual use was, however, limited to the less lethal weapons. This corroborates the observation from other studies and is thought to be due to the fact that a woman is less likely to struggle with an assailant wielding a gun than with one brandishing a less lethal weapon. [21] Indeed, physical resistance by the survivor has been linked with a reduction in completion of rape especially by known assailants. [22],[23] It is, however, also associated with a slightly increased risk of injury. [22]

In the present study, more survivors sustained genital trauma than body injuries. This pattern is the reverse of the findings reported by Ullman et al.,[22] in the US. This may be due to the higher proportion of child-SA cases in Ile-Ife. For obvious anatomical reasons, children are more likely to suffer genital trauma from SA. Furthermore, body injuries are less likely in child-SA because the perpetrators seldom recourse to the use of force since children are less capable of physical resistance.

When compared to the findings of Lakew [18] in Addis-Ababa where a mean delay of 15.4 days before presentation in hospital was reported, SA survivors in Ile-Ife presented early. Similar observations have been reported in several Nigerian studies. [5],[7],[8],[9] This inclination towards early presentation in hospital has many advantages, one of which is the high yield obtainable from a timely forensic medical (rape kit) examination. Unfortunately, SA survivors in Nigeria are largely deprived of this benefit because rape kits are yet to be introduced into SA management in the country. [24] This potentially hinders successful prosecution of SA cases.


   Conclusions Top


Overall, the management of SA survivors in Ile-Ife should be improved upon. The development of a standardised rape management protocol, elimination of out-of-pocket payments for care, as well as provision of rape kits are necessary steps in the right direction. Training of relevant personnel in OAUTHC, Ile-Ife on counseling and forensic management of the SA survivor is also recommended. On the preventive side, public enlightenment on preventive strategies based on the observed periodicity and age patterns is also suggested.

 
   References Top

1.The law of the Federation of Nigeria and Lagos. Code 42 (2), 1958; Section 357 and 358.  Back to cited text no. 1
    
2.Akinade E, Adewuyi T, Sulaiman A. Socio-legal factors that influence the perpetuation of rape in Nigeria. Procedia - social and behavioral sciences 2010;5:1760-4.  Back to cited text no. 2
    
3.Okoli A. Abia gang-rape case: Suspects are husband's cousins-Police. Vanguard Newspapers. March 22, 2013. Available from: http://www.vanguardngr.com/2013/03/abia-gang-rape-case-suspects-are-husbands-cousins-police/. [Last accessed on 2013 Nov 14].  Back to cited text no. 3
    
4.Sable MR, Danis F, Mauzy DL, Gallagher SK. Barriers to reporting sexual assault for women and men: Perspectives of college students. J Am Coll Health 2006;55:157-62.  Back to cited text no. 4
    
5.Binder RL. Why women don't report sexual assault. J Clin Psych 1981;42:437-8.  Back to cited text no. 5
    
6.Rickham P. Human experimentation. Code of Ethics of the World Medical Association. Declaration of Helsinki. Br Med J 1964;2:177.  Back to cited text no. 6
    
7.Tukur J, Omale E, Abubakar I. Increasing incidence of sexual assault on children: Report from a tertiary health facility in Kano. J Med Rehabil 2007;1:19-21.  Back to cited text no. 7
    
8.Abdulkadir MI, Umar LW, Musa HH, Oyeniyi OA, Ayoola-Williams OM, Okeniyi L. Child sexual abuse: A review of cases seen at General Hospital Suleja, Niger State. Ann Niger Med 2011;5:15-9.  Back to cited text no. 8
    
9.Daru PH, Osagie EO, Pam IC, Mutihir JT, Silas OA, Ekwempu CC. Analysis of cases of rape as seen at the Jos University Teaching Hospital, Jos, North Central Nigeria. Niger J Clin Pract 2011;14:47-51.  Back to cited text no. 9
[PUBMED]  Medknow Journal  
10.Davies M. Male sexual assault victims: A selective review of the literature and implications for support services. Aggress Violent Behav 2002;7:203-14.  Back to cited text no. 10
    
11.Elliott DM, Mok DS, Briere J. Adult sexual assault: Prevalence, symptomatology, and sex differences in the general population. J Trauma Stress 2004;17:203-11.  Back to cited text no. 11
    
12.Pino NW, Meier RF. Gender differences in rape reporting. Sex Roles 1999;40:979-90.  Back to cited text no. 12
    
13.Macdowall W, Wellings K, Stephenson J, Glasier A. Summer nights: A review of the evidence of seasonal variations in sexual health indicators among young people. Health Educ 2007;108:40-53.  Back to cited text no. 13
    
14.Read KM, Kufera JA, Jackson MC, Dischinger PC. Population-based study of police-reported sexual assault in Baltimore, Maryland. Am J Emerg Med 2005;23:273-8.  Back to cited text no. 14
    
15.Sarkar S, Sharma R, Bhardwaj D, Dogra T. A study on victims and accused of sexual offences in South Delhi. Indian J Forensic Med Toxicol 2010;4:90-3.  Back to cited text no. 15
    
16.Bosman IJ, Verschraagen M, Lusthof KJ. Toxicological findings in cases of sexual assault in the Netherlands. J Forensic Sci 2011;56:1562-8.  Back to cited text no. 16
    
17.Bhattacharyya SK, Saha SP, Pal R. Rape among women and girls presenting at a gynecological emergency department, North Bengal Medical College, Darjeeling, India. Int J Gynaecol Obstet 2012;17:186-7.  Back to cited text no. 17
    
18.Lakew Z. Alleged cases of sexual assault reported to two Addis Ababa hospitals. East Afr Med J 2001;78:80-3.  Back to cited text no. 18
[PUBMED]    
19.Chaudhry S, Sangani B, Ojwang S, Khan K. Retrospective study of alleged sexual assault at the Aga Khan Hospital, Nairobi. East Afr Med J 1995;72:200-2.  Back to cited text no. 19
    
20.Riggs N, Houry D, Long G, Markovchick V, Feldhaus KM. Analysis of 1,076 cases of sexual assault. Ann Emerg Med 2000;35:358-62.  Back to cited text no. 20
    
21.Ononge S, Wandabwa J, Kiondo P, Busingye R. Clinical presentation and management of alleged sexually assaulted females at Mulago hospital, Kampala, Uganda. Afr Health Sci 2005;5:50-4.  Back to cited text no. 21
    
22.Ullman SE. A 10-year update of "review and critique of empirical studies of rape avoidance". Crim Justice Behav 2007;34:411-29.  Back to cited text no. 22
    
23.Bachman R. The factors related to rape reporting behavior and arrest. Crim Justice Behav 1998;25:8-29.  Back to cited text no. 23
    
24.Badejoko OO, Kuti O, Ijarotimi AO. Have you seen a Rape Kit? A Snapshot at the Quality of Care of Rape Survivors in Nigerian Tertiary Hospitals. Trop J Obstet Gynaecol 2010;27:23-6.  Back to cited text no. 24
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]


This article has been cited by
1 Sub-Saharan African hospitals have a unique opportunity to address intentional injury to children
Jared R. Gallaher,Elizabeth Molyneux,Anthony G. Charles
African Journal of Emergency Medicine. 2016;
[Pubmed] | [DOI]
2 Intentional injury against children in Sub-Saharan Africa: A tertiary trauma centre experience
Jared R. Gallaher,Benjamin Wildfire,Charles Mabedi,Bruce A. Cairns,Anthony G. Charles
Injury. 2015;
[Pubmed] | [DOI]
3 Pattern of Female Sexual Assault in Qalyubia Governorate, Egypt, During the Period From 2009 to 2013
Abeer A.I. Sharaf El-Din,Shereen M.S. Elkholy,Eslam S. Metwally,Hesham A. Farag
The American Journal of Forensic Medicine and Pathology. 2015; 36(4): 276
[Pubmed] | [DOI]
4 Prevalence and pattern of rape among girls and women attending Enugu State University Teaching Hospital, southeast Nigeria
Robsam S. Ohayi,Euzebus C. Ezugwu,Chibuike O. Chigbu,Susan U. Arinze-Onyia,Chukwuemeka A. Iyoke
International Journal of Gynecology & Obstetrics. 2015; 130(1): 10
[Pubmed] | [DOI]



 

Top
  
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   Introduction
    Materials and me...
   Results
   Discussion
   Conclusions
    References
    Article Figures
    Article Tables

 Article Access Statistics
    Viewed3465    
    Printed16    
    Emailed0    
    PDF Downloaded141    
    Comments [Add]    
    Cited by others 4    

Recommend this journal