Child sexual abuse presenting to District General Hospital, Chilaw

Introduction: Incidence of child sexual abuse is increasing worldwide. There is little data on child sexual abuse in the North Western Province of Sri Lanka.

Objectives: To describe the demographic and medico-legal findings of victims of sexual abuse aged less than 16 years and to identify factors associated with positive findings on medical-legal examination.

Methods: This cross-sectional analytical study, analysed 132 victims, referred by authorities to General Hospital,Chilaw, from 2012 to 2014.

Results: Mean age of the victims was 13.1years. Main types abuse were penetrative (61.4%), intra-crural (39.4%) and anal sex (10.6%). The perpetrator was known in 94%. Places of offence were offender’s habitat (55.3%), victim's home (23.5%) and secluded areas (11.4%). A positive history of penetrative sex (OR =15.3; 95% CI 5.6-42), chronic sexual abuse (OR=4.8; 95% CI 2.2-10.5) and time lapse in reporting to authorities (OR=4.4; 95% CI 2.0-9.4) were significantly associated with presence of conclusive medical examinations findings. Children were less likely to be willing partners in intra-familial abuse compared to extra-familial abuse where the child was sometimes a willing partner, (OR=0.2; 95% CI 0.07-0.5). Adverse psychological outcomes were observed in 16.7% (n=22).

Conclusions: Most children were victims of statutory rape and knew the perpetrator. In extra-familial abuse, child was sometimes a willing partner. A positive history of penetrative sex, number of abusive incidents and time lapse for presentation were important factors associated with conclusive medical findings.