Postrape care services to minors in Kenya: are the services healing or hurting survivors?

Wangamati, Cynthia Khamala; Thorsen, Viva Combs; Gele, Abdi; Sundby, Johanne

doi:10.2147/ijwh.s108316

Cited by 15 publications

(29 citation statements)

References 29 publications

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“…While treatment for survivors is generally similar for adults and children, the dynamics of dealing with children and adolescents and their needs are vastly different from adults [ 37 ]. A recently published case study found that healthcare providers in Kenya lacked the basic skills necessary to deliver quality services to minors such as obtaining informed consent, maintaining confidentiality, conducting a physical examination that maintains the dignity of the child and collecting specimens [ 38 ]. Our qualitative interviews found that none of the healthcare providers in these facilities had received any training on dealing with children and adolescents.…”

Section: Discussionmentioning

confidence: 99%

Missed treatment opportunities and barriers to comprehensive treatment for sexual violence survivors in Kenya: a mixed methods study

et al. 2018

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BackgroundIn Kenya, most sexual violence survivors either do not access healthcare, access healthcare late or do not complete treatment. To design interventions that ensure optimal healthcare for survivors, it is important to understand the characteristics of those who do and do not access healthcare. In this paper, we aim to: compare the characteristics of survivors who present for healthcare to those of survivors reporting violence on national surveys; understand the healthcare services provided to survivors; and, identify barriers to treatment.MethodsA mixed methods approach was used. Hospital records for survivors from two referral hospitals were compared with national-level data from the Kenya Demographic and Health Survey 2014, and the Violence Against Children Survey 2010. Descriptive summaries were calculated and differences in characteristics of the survivors assessed using chi-square tests. Qualitative data from six in-depth interviews with healthcare providers were analysed thematically.ResultsAmong the 543 hospital respondents, 93.2% were female; 69.5% single; 71.9% knew the perpetrator; and 69.2% were children below 18 years. Compared to respondents disclosing sexual violence in nationally representative datasets, those who presented at hospital were less likely to be partnered, male, or assaulted by an intimate partner. Data suggest missed opportunities for treatment among those who did present to hospital: HIV PEP and other STI prophylaxis was not given to 30 and 16% of survivors respectively; 43% of eligible women did not receive emergency contraceptive; and, laboratory results were missing in more than 40% of the records. Those aged 18 years or below and those assaulted by known perpetrators were more likely to miss being put on HIV PEP. Qualitative data highlighted challenges in accessing and providing healthcare that included stigma, lack of staff training, missing equipment and poor coordination of services.ConclusionsNationally, survivors at higher risk of not accessing healthcare include older survivors; partnered or ever partnered survivors; survivors experiencing sexual violence from intimate partners; children experiencing violence in schools; and men. Interventions at the community level should target survivors who are unlikely to access healthcare and address barriers to early access to care. Staff training and specific clinical guidelines/protocols for treating children are urgently needed.

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Section: Discussionmentioning

confidence: 99%

Missed treatment opportunities and barriers to comprehensive treatment for sexual violence survivors in Kenya: a mixed methods study

et al. 2018

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“…Survivors of CSA are either threatened or their parents are given small tokens to settle the cases out of court. 24 Consequently, survivors of CSA tend to disappear from the locality or refuse to testify in law courts. 24 Bail applications need to be evaluated carefully to ensure that state witnesses (CSA survivors and their families) are not intimidated or persuaded into dropping charges.…”

Section: Resultsmentioning

confidence: 99%

“…33 Psychosocial support is poorly administered due to the lack of professionals to offer counselling services. 17 , 24 There is need for Kenyan government commitment to facilitating psychosocial support for survivors of CSA by either training more service providers or contracting services from the private sector.…”

Section: Resultsmentioning

confidence: 99%

“… 17 In addition, she followed up two girls as they interacted with the health system and law enforcement officers, held informal conversations with their parents and service providers and reviewed their health records. 24 Findings from these studies revealed that most of the health providers were not conversant with the guidelines on management of sexual violence; the health facility was ill equipped and poorly staffed. We also found that health providers showed little regard for informed assent, confidentiality, and privacy while offering post-rape care (post-sexual assault care).…”

Section: Methodsmentioning

confidence: 99%

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Sexualised violence against children: a review of laws and policies in Kenya

Wangamati

Yegon

Sundby

et al. 2019

Sexual and Reproductive Health Matters

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Child sexual abuse (CSA) is a major global health challenge. Extant literature shows that CSA is prevalent in Kenya. As a signatory of the United Nations Convention on the Rights of the Child and the African Charter on the Rights and Welfare of the Child, the Kenyan government is mandated to ensure that children are protected from sexual abuse through sound laws and policies. This paper reviews existing laws and policies on CSA and highlights their strengths and weaknesses. Our findings indicate that laws on child protection exist and are protective to a large extent, as harsh penalties are outlined for sexual offences. Survivors of CSA are entitled to free legal and medical services. However, there are no reparations offered to survivors in criminal proceedings. Moreover, there is no legislation on age-appropriate comprehensive sexuality education which plays an important role in cultivating positive gender norms and describing what constitutes CSA and reporting procedures. The national standard operating procedures for the management of sexual violence against children lack CSA screening procedures. There is urgent need for review of these laws and policies and development of multisectoral protocols at the national and county level, that outline roles and responsibilities for various service providers, supervisory and accountability measures and referral networks.

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“…The inability of providers to collect samples from child survivors could be attributed to the lack of protocols for evidence collection as observed in a study conducted in Uganda where only one out of eight hospitals had standardised protocols (Henttonen et al ., ). Findings of this study resonate with existing evidence (Wangamati et al ., ; Welch and Mason, ), highlighting the need for facilities to be stocked with the requisite equipment, supplies and instructional material to aid providers in the collection and documentation of evidence.…”

Section: Discussionmentioning

confidence: 99%

Health Sector Inadequacies in Attending to Child Survivors of Sexual Abuse in Kenya: An Operations Research

et al. 2018

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In 2015, LVCT Health (a Kenyan non-governmental organisation) conducted an exploratory study to assess the quality and comprehensiveness of services provided to child survivors of sexual violence at two public health facilities in Kenya. Both quantitative and qualitative data collection methods were used, including a retrospective review of 164 child survivor medical records, a health facility staff inventory, in-depth interviews with 31 healthcare providers and 19 exit interviews with 14 child survivors and their caregivers. Ethical approval was obtained from two independent ethics committees. Quantitative data were analysed using SPSS version 22, while qualitative data were analysed using NVivo 10 based on a thematic coding framework. The health facility staff inventory indicated that only two out of 581 providers had undergone previous training on the management of child survivors of sexual violence. Both health facilities lacked the appropriate equipment for the collection of forensic evidence from children and private rooms in which to conduct the clinical examination. Providers cited challenges in offering psychosocial support to children. Only 27 per cent of child survivors were documented to have received trauma counselling. There is a need for health facilities to enhance their human resource and infrastructural capacity to facilitate the delivery of comprehensive care to child survivors. KEY PRACTITIONER MESSAGES:• There is a need to develop child-specific guidelines for healthcare providers in order to ensure that child survivors of sexual violence receive good-quality services at the facility level. • Healthcare providers in public health facilities need competency-based training to enable them to acquire knowledge and skills to identify and respond to child survivors of sexual violence, collect evidence, communicate with the children and offer counselling support to child survivors effectively. • Services for child survivors should be centralised in health facilities to minimise the number of different contact points.

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Postrape care services to minors in Kenya: are the services healing or hurting survivors?

Cited by 15 publications

References 29 publications

Missed treatment opportunities and barriers to comprehensive treatment for sexual violence survivors in Kenya: a mixed methods study

Missed treatment opportunities and barriers to comprehensive treatment for sexual violence survivors in Kenya: a mixed methods study

Sexualised violence against children: a review of laws and policies in Kenya

Health Sector Inadequacies in Attending to Child Survivors of Sexual Abuse in Kenya: An Operations Research

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