Research Article - Journal of Child and Adolescent Health (2020) Volume 4, Issue 1

Prevalence and pattern of child sexual abuse: A cross-sectional study among male secondary school adolescents in Ibadan, Nigeria

¹University College Hospital, Ibadan, Nigeria

²Institute of Child Health, College of Medicine, University of Ibadan, Ibadan, Nigeria

*Corresponding Author:

Adenowuro OE
Institute of Child Health,
College of Medicine,
University of Ibadan,
Ibadan, Nigeria
Tel: +2348060009030
E-mail: adelamide2008@gmail.com

Accepted Date: May 04, 2020

Citation: Balogun FM, Adenowuro OE. Prevalence and pattern of child sexual abuse: A cross-sectional study among male secondary school adolescents in Ibadan, Nigeria. J Child Adolesc Health 2020;4(1):1-8.

Abstract

Objective: The aim of this study was to determine the prevalence of sexual abuse among male children and ascertain its circumstance of occurrence, perpetrators, risk factors and predictors. Research methodology: A cross-sectional approach and three-stage sampling technique were adopted. Two out of five local government areas in Ibadan metropolis were randomly selected; seven and five secondary schools were proportionately selected from each of the local government areas; thus twelve schools were included. Study participants were proportionally recruited based on the male student population of each school. In total, 472 male adolescents were included in this study. Interviewer-assisted semi-structured questionnaires were administered to collect data on the socio-demographic characteristics of respondents, risk factors, prevalence and details of sexual abuse occurrence. The data were analyzed on SPSS Statistics 20, using descriptive statistics, Chi-square and Logistic Regression with the significance level set at p ≤ 0.05. Results: The overall prevalence of sexual abuse was 29.0%. The most prevalent non-contact sexual abuse was being made to watch pornography (18.9%) while the commonest contact sexual abuse was being touched or fondled sexually (8.1%). Over half (54.1%) of the victims were abused at the house of the perpetrator. More victims (51.4%) had been sexually abused in the afternoon between 12:00 p.m. and 4:00 p.m. than in the evening or night (40.5%). The commonest perpetrators of non-contact sexual abuse were friends (55.5%), neighbors (22.7%) and family members (20.9%), while most perpetrators of contact sexual abuse were friends (47.3%), neighbors (25.7%) and strangers to the victims (12.2%). Sportive respondents were less likely to have experienced contact sexual abuse than those who had less frequent or no sport participation. Other factors associated with sexual abuse were coming from a polygamous home, having separated or unmarried parents, hawking, and assisting trading parents in the shop. Conclusion: This study shows the high burden of sexual abuse and its vicious pattern among male in-school adolescents. That considerable sexual abuse occurred in homes and during the afternoon shows there is a need for parents and other care givers to be educated about its occurrence and prevention among male adolescents. Mechanisms should be put in place to make adolescents safe outdoors and encourage their participation in activities that are protective against sexual abuse.

Keywords

Child sexual abuse, Adolescents, Prevalence, Pattern, Risk factors

Introduction

Sexual abuse is a detrimental act that bares its victims to diverse short and long term consequences which can adversely affect their wellbeing physically, socially and economically. The yet to be met need to eliminate this menace in the society has increased quest on the pattern of occurrence especially among its most vulnerable victims, children. The World Health Organization (WHO) and International Society for Prevention of Child Abuse and Neglect (ISPCAN) define child sexual abuse 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, or else that violates the laws or social taboos of society” [1]. Acts that constitute CSA include erotic talk, tricking or forcing a child to look at sexually explicit materials or acts, voyeurism, involving a child in the production of pornography, encouraging or forcing a child to masturbate, sexual touching, kissing, or fondling of body parts, as well as any act of attempted or executed oral, vaginal or anal penetration with the penis, finger(s) or other objects for sexual gratification [2,3].

Studies in industrialized nations have shown that about one in six male children experience sexual abuse [4,5]. The statistics have been equally worrisome if not worse in developing countries as up to 55% sexual abuse prevalence has been recorded among male adolescent populations [6]. Male child sexual abuse has not been given much attention until recently probably due to the underdevelopment of many societies or low rate of disclosure. However, with globalization which has enhanced socialization, sexual abuse has clearly become a societal menace to which no age group or gender is immune.

The association between sexual abuse and socio-demographic characteristics often varies with gender [4,7]. As such, risk factors of male sexual abuse may be masked in studies that do not analyze sexual abuse by gender, especially when male victims are scarcely represented. Gender roles and activities vary amongst ethnic groups and are sometimes more defined in some societies than others. For instance, Nigerian male youths engage more in sports than their female counterparts. Genderspecific studies on sexual abuse are thus important tools with which gender differences could be explored in analyzing the factors associated with sexual abuse.

Research has established that males constitute the majority of child sexual abuse perpetrators [8,9]. It is not uncommon to record 100% male perpetration in hospital-based studies with female victim preponderance [10,11]. Nevertheless, a United States study has shown that boys are significantly more likely to be abused by female perpetrators [9]. More data on the gender of perpetrators of male child sexual abuse, especially in developing countries could help gain more insight on the gender of perpetrators of child sexual abuse.

Reports on the time of occurrence and location of sexual abuse are important as they could help provide clues on where more resources should be focused for efficient prevention of sexual abuse. Studies show that majority of sexual abuse incidents involving mostly female victims take place in the day time [12,13]. However, there is dearth of data on the timing of sexual abuse of male children.

The relative dearth of literature on male children and adolescents has rendered studies on child sexual abuse very inadequate. Studies that give detailed accounts on the risk factors of sexual abuse, gender of perpetrators, timing and location of sexual abuse among male children and adolescents are crucial in exterminating the menace. This study was therefore aimed at determining the prevalence and pattern of sexual abuse, including sports and extracurricular activities as plausible risk factors among male secondary school adolescents in Ibadan, Nigeria. This research is the first of its kind to investigate sexual abuse against sports among adolescents in Nigeria.

Operational definitions

CSA: this refers to the illicit exposure of a child to sexual activity or sexual concept with or without body contact, by one or more persons. A child in this study refers to anyone between the ages of 0 and 19 years, thus including adolescents (10-19 years).

Acts that constitute CSA: These were grouped into noncontact and contact forms of CSA.

Non-contact CSA

• Making a child draw or watch an image of intimate/ private parts of the body or sexual activities.

• Making a child participate in taking a picture or video of private parts of the body or sexual activities.

• Making a child show his private body part or watch the intimate/private body part of another person.

• Making fun of a child’s private part.

Contact CSA

• Forceful kissing

• Sexual touching, fondling or rubbing of the body.

• Making a child masturbate

• Attempted or actualized sexual penetration

Research Methodology

Study area

This study was carried out in Ibadan North-East and North- West Local Government Areas which were randomly selected in the centre of Ibadan. Ibadan, the capital of Oyo State, is a multicultural city which has five centrally located local government areas and six local governments in its suburbs [14]. Ibadan North-West Local Government has its headquarters in Onireke, while the headquarters of Ibadan North-East is in Iwo- Road, a principal transportation hub in Ibadan. There are 24 and 18 registered private secondary schools in Ibadan North-East and North-West Local Government Areas respectively [14].

Study population

Male junior and senior secondary school students within the age range of 10 and 18 years were included in the study. Senior Secondary Three (S. S. 3) students were not included as they had just completed their final examination and were no longer in school at the time of the study. Public secondary school students were also not in school due to industrial action during the course of the research. Hence, male adolescents attending private secondary schools registered in Ibadan North-East and North- West Local Government Areas were enrolled for the study.

Sampling technique

The study was cross-sectional. Simple random sampling was employed in selecting Ibadan North-East and North-West Local Governments Areas in the centre of Ibadan. Using the list of secondary schools obtained from the Oyo State Ministry of Education, Science and Technology, seven and five schools were proportionally selected from Ibadan North-East and North-West Local Government Areas respectively. The male student population in each school was made a fraction of the total number of male students in all schools selected. Hence, the number of male students recruited from each school was proportionate to the school’s male student population. The number of students to be selected from each class was also allocated proportionally. Selection of the research participants from each class was done via systematic random sampling, using the class registers as a sampling frame.

Data collection instrument

Data was obtained using interviewer-assisted semi-structured questionnaires which were administered by the research participants. The questionnaire was stated in simple English Language and translated into Yoruba Language to enhance comprehension of the respondents. The questionnaire contained sections on: socio-demographic variables; predisposing factors to sexual abuse; prevalence and details on sexual abuse; disclosure of sexual abuse; and sexual risk behaviors.

Data collection technique

The school halls were used as data collection venue. Male research assistants who had at least one post-secondary school certificate were recruited for the data collection and trained on ethical and scientific conduct of the study. A secondary school was selected in Ibadan North Local Government to pre-test the questionnaire for the clarity of questions and enhance the efficiency of the research.

The purpose and procedure of the research were communicated to the school principals and parents of the research participants and their consents were obtained ahead of the data collection. Consents of the respondents were also obtained after the purpose and details of the research had been clearly explained to them before they were allowed to fill the questionnaires.

Data analysis

The questionnaires were checked to ensure completeness and entered using the Statistical Package for Social Sciences (SPSS) for Windows, Version 20. The Chi-square test was used to test for associations between sexual abuse and categorical variables. Statistically significant associations were further analyzed using the Logistic Regression model, thereby identifying the predictors of sexual abuse.

Ethical considerations

Ethical approval for the study was sought at the Oyo State Research Ethical Review committee at the Ministry of Health, Oyo State Secretariat, Ibadan.

The seats at the school halls were widely spaced to ensure privacy during the data collection. The research participants were also given plain sheets of paper to cover their responses. Each participant had the liberty to withdraw his assent or consent at any point in the course of the data collection without any penalty. The research participants were counseled during and after the data collection to reduce any distress that might have been incurred in the course of the research.

Results

Socio-demographic characteristics

The mean age of the respondents was 13.4±1.9 years. More than half (55.9%) of the respondents were junior students and 44.1% were senior students. About three in four respondents were Christians, one in four respondents were Muslims while few (0.8%) practiced traditional religion. Majority (84.5%) of the respondents were Yoruba, 11.9% were Ibo while 1.7% were Hausa by ethnicity. Most (94.7%) of the respondents lived with their parents while 4.9% lived with extended family members. About nine in ten respondents (90.5%) had parents who were married while 89.0% indicated that they came from monogamous families. Socio-demographic characteristics of the respondents are as presented in Table 1.

Table 1. Socio-demographic characteristics of respondents.

Extracurricular activities

About 45.1% of the respondents worked or engaged in extracurricular activities. The commonest types of extracurricular activity indicated were assisting trading parents in the shop (23.7%) and engaging in religious activities (15.7%). Other extracurricular activities included artisan work or skill acquisition (4.9%), hawking (1.9%), and motorcycling (0.8%).

Sports participation

About 86.0% of the respondents indicated that they participated in sports on a daily or weekly basis, 11.0% indicated that they engaged in sports less often while 3.0% did not partake in any sport. The types of sports mostly indicated by the respondents were football (78.0%), table tennis (34.5%), sprint (26.1%), basketball (17.8%), swimming (11.4%), and snooker (1.9%). Other forms of sports included volleyball (1.5%), cycling (1.1%), Handball (0.2%), skating (0.2%), acrobatics (0.2%), and taekwondo (0.2%).

Prevalence of sexual abuse

The overall prevalence of sexual abuse was 29.0%; 13.3% had experienced only non-contact sexual abuse, 5.7% had experienced only contact sexual abuse, while 10% had experienced both. The prevalence of sexual abuse is as shown in Table 2.

Table 2. Prevalence of sexual abuse.

Timing of sexual abuse

The average ages of onset were 10.2±2.0 and 10.9±2.4 years for non-contact and contact sexual abuse respectively. One in three (33.7%) victims of non-contact sexual abuse and 31.1% victims of contact sexual abuse had been abused within the last one year.

About half (51.4%) of the victims of contact sexual abuse had experienced the abuse in the afternoon between 12:00 pm and 4:00 p.m., 40.5% had experienced it between 4:00 p.m. and 5:00 a.m., while 13.5% had been abused in the morning between 5:00 a.m. and 12:00 pm.

Location of contact sexual abuse

Over half (54.1%) of the victims of contact sexual abuse were abused at the house of the perpetrator. Respondents’ homes (23.0%) and school premises (16.2%) were also common sites of contact sexual abuse. Other locations of contact sexual abuse included market (4.1%), shopping mall (2.7%), car park (2.7%), deserted building (1.4%), nightclub (1.4%), office or business centre (1.4%), and school bus (1.4%).

Perpetrators of sexual abuse

Most of the victims of both non-contact (71.7%) and contact sexual abuse (57.8%) indicated that their abusers were adolescents. About 39.8% and 22.5% victims of contact and non-contact sexual abuse respectively had been abused by adults aged 20 years or older. The commonest perpetrators of non-contact sexual abuse were friends (55.5%), neighbors (22.7%) and family members of the victims (20.9%), while most perpetrators of contact sexual abuse were friends (47.3%), neighbors (25.7%) and strangers to the victims (12.2%). The perpetrators of non-contact and contact sexual abuse are as shown in Table 3.

Table 3. Perpetrators of non-contact and contact sexual abuse.

Gender of perpetrators

Among the non-contact sexual abuse victims, 60.0% indicated that they had been abused by male perpetrators only, 26.4% had been abused by female perpetrators only while 13.6% had been abused by both. More victims of contact sexual abuse (46.0%) had been abused exclusively by female perpetrators than males (40.5%) or both (13.5%). Information on the gender of perpetrators is as presented in Figure 1.

Figure 1. Gender of perpetrators of non-contact and contact sexual abuse.

Predictors of sexual abuse

Factors associated with sexual abuse were coming from a polygamous home (χ 2= 6.6, p < 0.05), having separated or unmarried parents (χ 2= 14.3, p < 0.01), hawking (Fisher’s Exact Test; p < 0.01), and assisting trading parents in the shop (χ 2= 8.9, p < 0.01).

Discussion

There was no association between sports participation and sexual abuse. However, swimming (χ 2= 9.0, p < 0.05) and infrequent sports participation (χ 2= 4.9, p < 0.05) were risk factors for contact sexual abuse as shown in Table 4. Table tennis was a risk factor for non-contact sexual abuse (χ 2= 4.3, p < 0.05) as shown in Table 5.

Table 4.Association between sports and contact sexual abuse.

Table 5. Association between sports and non-contact sexual abuse.

The predictors of sexual abuse were having separated or unmarried parents (AOR= 2.737, 95%CI: 1.393 - 5.379, p < 0.01), hawking (AOR= 10.279, 95%CI: 2.058 – 51.339, p < 0.01), and assisting trading parents in the shop (AOR= 2.096, 95% CI: 1.324 – 3.318, p < 0.01) as shown in Table 6.

Table 6.Predictors of sexual abuse.

Despite relative silence on male CSA in the society, this study shows that it is not an uncommon phenomenon. The fact that having parents who are unmarried or not living together is one of the predictors of sexual abuse emphasizes not only the significance of parental figures but also that of strong parental partnership in the home. While the extended family network which helps in resolving marital conflicts have become less functional due to urbanization [15], unwanted pregnancies remain a key contributor to child development outside marital harmony. These factors are of importance at family and societal levels and reveal an urgent need to intervene on sexual abuse among male adolescents.

The male CSA prevalence obtained in this study is higher than the 21.2% obtained in an Egyptian study involving university students who are often adults. The relatively younger age of respondents in the current study could have given less room for recall bias, thus resulting in a higher proportion of respondents who indicated that they had been sexually abused. Although a much higher male CSA prevalence (55.0%) had been reported in a Kenyan study, this difference could have been because adolescents in the Kenyan study were drawn from districts listed as vulnerable by virtue of their socio-economic status.

Male CSA was found to be most common in the afternoon and least common in the morning, showing that most cases of sexual abuse occurred when adolescents are likely to be outdoors, away from parental supervision. The peak time of sexual abuse occurring was 12 noon to 4pm in which fall the first few hours after school closure. School premises was mentioned as the most common out of home location where sexual abuse occur which suggests that most of these abuse occur after school. At this period, the adolescents would no longer be under the supervision of school teachers and would likely be in transit, going home. Getting adolescents involved in meaningful after school activities may help in reducing the occurrence of sexual abuse at this time of the day.

A disturbing finding in this study was the adolescent preponderance among perpetrators of CSA. Even though less than one in ten cases (5.8%) involved child perpetrators, the figure could have been higher among preadolescent participants who are likely to have less recall bias on childhood abuse experience. This shows the need to intervene on sexual abuse perpetration across all age groups. Friends, neighbours and family members constituted the majority of CSA perpetrators, thus supporting earlier reports that CSA perpetrators are usually known to the children [10]. This familiarity would not allow any suspicion of sexual abuse by parents or passers-by, making sexual abuse difficult to spot. Due to the societal perception that males are strong, victims may have found it difficult to call for help even if there could have been people around during the abuse. In the same vein, adults in the vicinity could have paid less attention to the possibility of sexual abuse occurring when male adolescents are seen with potential abusers, especially their male peers.

Perpetration of sexual abuse by females should not be overlooked. They were responsible for more cases (46.0%) of contact sexual abuse than their male counterparts. While society tends to stereotype males as the perpetrators of sexual abuse, this study has shown that it is not true among male adolescents. This may be as a result of the low disclosure rate among male victims as males are traditionally expected to be stronger and be in control. Reporting sexual abuse by a female may be associated with shame or failure to have these attributes and may have sharpened the perception that perpetrators are males. This study is among male adolescents and may be the reason why the female perpetrators of sexual abuse are being brought to the fore.

Even though the prevalence of male CSA was significantly higher amongst adolescents who came from polygamous families, it could not be concluded that polygamy is a predictor of sexual abuse. The probability for a larger family size is higher in polygamous families and this could mean more children to be cared for. This may reduce the amount of time dedicated to the care of each child, making them more vulnerable to sexual abuse. It could also be that despite coming from polygamous homes, some of the respondents still had few siblings or not more than one step-mother, and as such had relatively adequate supervision from their parents. It is thus sufficient to suggest that parental monitoring and guidance has more important influence in the lives of the respondents than coming from a polygamous home.

There was a significant relationship between having married parents who live together and not experiencing sexual abuse which strongly supports the fact that having both parents around offers more monitoring and supervision for male adolescents and can shield them from sexual abuse. This finding is similar to reports from a study among male Ethiopian high school students aged 18 and above, which showed the prevalence of sexual abuse to be significantly higher among those who were not living with their parents [16]. The absence of parental protection could have been responsible for this as some of the Ethiopian study participants were either living alone or with their peers. None of the current study participants indicated that they had been living alone. Those who were not living with their parents either lived with extended family members, family friends or religious leaders but the protection they enjoyed could have been less compared to those who lived with parents.

Hawking and assisting trading parents in the shop were the types of work that predisposed male children to sexual abuse in this study. Unlike hawking and shop assistance, artisan work and motorcycling were not predictors of sexual abuse among the respondents, despite equal or possibly greater degree of mobility involved in these activities. This implies that some environmental factors may be involved in predisposing working adolescents to sexual abuse. For instance, youths who hawk or engage in shop assistance may be targets for perpetrators who know they are likely to be alone while working and be easy prey. Further research could help to understand the relationship between working and sexual abuse among male in-school adolescents.

It was found that those who engaged in sports on a daily or weekly basis were less likely to have experienced contact sexual abuse than those who did not participate as often. This association supports the perception that sports could protect male adolescents against sexual abuse [17], and perhaps, the scientific evidence that sports offer psychosocial advantages to children [18]. While loneliness or isolation is often required in contact sexual abuse settings, frequent sports participation could drastically reduce the length of time spent alone. In addition, children and adolescents who participate in sports frequently may acquire many friends overtime and as such have more peer support. Support from friends and a sense of satisfaction from doing the sports that they love could have contributed to their physical and psychosocial protection from abusers. However, more research is required to further explain the mechanisms by which sports protect adolescents against sexual abuse.

Although frequent sports participation was shown to be protective against contact sexual abuse in this study, contact sexual abuse was significantly higher among swimmers while non-contact sexual abuse was significantly higher among table tennis players. The victims are less likely to have been abused during swimming as there is a higher chance they visited public pools where they are not likely to have swum alone with the perpetrator. The abuse is likely to have taken place in changing rooms or around hidden pool sides. Most swimming pools in Nigeria are public pools which can bring adolescents in contact with different people of diverse backgrounds, thus increasing the chances of the adolescents meeting with sex abuse perpetrators. Nonetheless, the location of pools visited by adolescents in this study group was not known. Further research, perhaps a qualitative study could explain the finding as well as elaborate on the association between table tennis and non-contact sexual abuse.

Conclusion

The notion that male children are safe with more attention being paid to the safety of the girl child outside the home has been proven untrue in this study. Both genders equally require monitoring and protection within and outside the home. The kinds of activities that male adolescents participate in outside classroom periods have serious implication for their safety. Caregivers should discourage their wards from engaging in activities that predispose them to sexual abuse and if such activities are necessary for their development, measures should be put in place to ensure safety such as choosing relatively safe locations and reducing the length of time of such activities. It is important to monitor who children are with at home, including neighbors, other family members and domestic helps. This is because most cases of sexual abuse occur in home settings. Marital harmony should be encouraged in families and the society at large as this would make the parental task of child monitoring easier and more efficient.

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