Child sexual abuse in Puttalam, Sri Lanka: a medico-legal analysis

Abstract

Introduction: All cases of child sexual abuse (CSA) are expected to be examined by specialists in Forensic Medicine in Sri Lanka. Further, management should not be confined to medico-legal aspects but ensure the psychosocial management of child and family. Therefore, this study was conducted to identify and describe patterns of abuse and strategies of management of children affected with CSA. Methods: Retrospective descriptive study was conducted on all the victims of child sexual abuse reported to Base Hospital, Puttalam, Sri Lanka over 20 months from Nov-2014 to June-2016. Results: There were 183 children affected and of them, 168 (92%) were girls. Out of incidents occurred at home, 52% were committed by relatives (p=0.000). All abusers were male and none were strangers. Known non-relatives abused 64% of females and almost all male victims (p=0.02). In more than 10 years old female victims, 80% had hymenal tears (p=0.000). One-third of both males and females had anal penetration. Only five (05) had associated physical abuse. Eighty percent were referred to STI and 84% to psychiatrist. Institutional case conference was held in 20%. It was held in 8% of anal and 20% of genital penetrations (p=0.8).Conclusions: Physical abuse was rarely associated with child sexual abuse. Majority of incidents were committed by male relatives. Known non-relatives are the most potential abusers. Girls more than 10 years are the most vulnerable for penetration. None were given STI prophylactic treatment. Mere presence of injuries were not indications for case conference. However, the follow-up reports of psycho-social managements were not available.

Child sexual abuse presenting to a teaching hospital in Colombo, Sri Lanka

“…These findings may be due to an increase in the prevalence of CSA or may reflect increased public awareness of CSA. However, the number of cases who presented in our study is much less than that of Northern (352 cases over a 6 year period) and North Western (183 cases over 18 months) areas of the country 11,14,15 . Further studies should be done to identify reasons for variation of the rates of CSA in different parts of the country.…”

“…A higher prevalence has been reported in Northern Sri Lanka, an area which has been affected by the civil war 8 and in areas associated with the tourism industry 9 . Hospital based studies have shown a wide variation in the number presenting to hospitals with alleged abuse, with numbers ranging from 84 cases over 15 years (average 5.6/year) 10 to 183 over 18 months (average 122/year) 11 . Although CSA is prevalent in Sri Lanka, studies examining victim and perpetrator characteristics, risk factors for abuse, pattern of disclosure and psychological impact of abuse are limited in Sri Lanka.…”

A Study on Factors Associated with Child Sexual Abuse and Recognizing the Severity: Special Reference to Galle District

“…In Sri Lanka, many researchers have focused only on the characteristics and descriptive statistics of CSA. There are some studies that detect the key risk factors using chi-square tests and logistic regression Amararatne et al (2016) , Chandrasiri et al (2017) , Sathiadas et al (2018). But none of the studies have used ordinal logistic regression models nor machine learning techniques to detect the key risk factors of CSA and to predict the severity of CSA in Sri Lanka.…”