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  • Title: Sexual abuse of minors: emerging medical and social problem in Malawi.
    Author: Lema VM.
    Journal: East Afr Med J; 1997 Nov; 74(11):743-6. PubMed ID: 9557452.
    Abstract:
    Sexual abuse is one of the most dehumanising human offenses. There has been an increasing public concern and outcry regarding the escalating wave of sexual abuse of young girls in Malawi, in the recent past. Four young girls, aged between two and seven years who were sexually abused by adult males aged between 20 and 70 years seen and managed in the department within the past two years, are presented to illustrate the problem. Their physical injuries, varied reactions and those of their immediate families to the abuse; possible predisposing factors to the abuses; the related medical, psychosocial as well as legal management of such incidents, in the light of limited public awareness, and lack of adequately and appropriately trained personnel and facilities in Malawi are discussed. With the scare of AIDS and an increasing disintegration of the traditional family fabric, there is a high potential for an increase, not only of the prevalence of sexual abuse of minors in Malawi, but also the variety and severity of sequelae. It is therefore recommended that there is need to create public awareness about sexual abuse, train and equip the relevant personnel to appropriately manage such cases, as well as enact and enforce the relevant legal provisions, so as to curb the menace, for the well-being of the society. Although the magnitude of child sexual abuse (CSA) in sub-Saharan Africa remains unknown, this problem has become a focus of increasing public concern and outcry. Presented in this article are 4 of the 20 CSA cases treated at the Department of Obstetrics and Gynecology at the University of Malawi Hospital (Blantyre) in a recent 2-year period. The 4 girls, aged 2-7 years, were molested by men 20-70 years old well known to the families. Physical injuries included extensive third-degree perineal tears, lacerations of the lateral vaginal wall and vestibule, bruised labia majora, and torn hymen. In all 4 cases, the caretakers refused to report the assault to the police because of fear of social stigma and the likelihood of a hostile response on the part of authorities. Despite instructions to return to the unit for follow-up, none of the children were seen after their injuries had been treated. Thus, no information is available on long-term medical or psychological sequelae of the abuse. The guardians of 2 of the girls refused to authorize HIV testing; 1 of the 2 tested children had a positive result, but infection may have been acquired prenatally. In 2 cases, the child was living with her grandmother; in the remaining 2, both parents worked in the city and the children were in the care of a houseboy. Continued disintegration of traditional family structures is expected to contribute to increases in the prevalence of CSA in sub-Saharan Africa. Also of concern are cultural practices, such as the belief that sex with a virgin child can cure sexually transmitted diseases or bring riches, as well as a tendency for adult males to attempt to avoid HIV infection through sex with children. Prevention and management of CSA require public awareness campaigns, the design of protocols for the treatment of child victims, guidelines for the management of immediate families and assailants, health personnel training, and enforcement of appropriate legal provisions.
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