child abuse profiles in a soweto abuse centre

145 Pages·2013·3.46 MB·English

CHILD ABUSE PROFILES IN A SOWETO
ABUSE CENTRE
Nobulembu Babalwa M * ida
A research report submitted to the Faculty of Medicine, University of the Witwatersrand,
in partial fulfilment of the requirements for the degree of Master of Science in Medicine,
Community Paediatrics
Johannesburg, 1999
Supervisor: Prof. J. Pettifor
DECLARATION
I, Nobulembu Babalwa Mwanda declare that this research report is my own work. It is
being submitted for the degree of Master of Science in Medicine in the University of the
Witwatersrand, Johannesburg, It has not been submitted before for any degree or
examination at this or any other University.
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DEDICATION
In loving memory of my father
Barrington Phumelele Mwanda
1928-1990.
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PUBLICATIONS AND PRESENTATIONS ARISING FROM THE THESIS
1. “Should genital examination be routine for all children presenting to a general
practitioner ?” - a poster presentation at the 12til International Congress on Child
Abuse & Neglect, Auckland, New Zealand, September 6-9, 1998.
2. “Should genital examination be routine for all children presenting to a general
practitioner?” - an oral paper presentation at the 13th annual San Diego Conference
on responding to child maltreatment, 25-29 January 1999.
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ABSTRACT
The aim of this study was to examine the profiles of child abuse in Zamokuhle Child
Centre, a child abuse referral Centre serving black children in Soweto. It was
hypothesised that these profiles are different from those described in the Western
communities.
A retrospective analysis of all 1995 patient records was done. The data was extracted by
the way of a data collection form. A total of 372 children were seen over a ten-month
period in which the Centre was operational. Of these records all but four could be traced.
Of the 368 records, 357 were related to sexually abuse. There were very few cases of
other forms of abuse. The average age of these children was 8.1 ±3.6 years and 97%
were females. Only in about a third of these children was abuse purposefully disclosed,
either to mother (29.7%) or teacher (17.8%). Most of the children (61.3%) were
incidentally found to be abused by either a clinician (57.1%) or a parent (27.9%). Most
children presented with signs and symptoms that raised enough suspicion of sexual
abuse.
An overwhelming majority (278 out of 357) had physical signs highly suggestive of
penetration beyond the hymen, on examination. Only in about a third o* the cases was
the abuse intra-familial, in the majority it was extra-familial. STDs were diagnosed in
about 12% of the children.
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In conclusion it is apparent from the above that the patterns abuse as seen in Zamokuhle
are different from those described in the Western communities. Because this study was
facility-based, f is however, difficult to generalise to the general population.
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ACKNOWLEDGEMENTS
My sincere gratitude to my supervisor, Professor John Pettifor for his guidance.
A word of thanks to the following: Soweto Community Health Centres for allowing me
to view such confidential and sensitive records for the purposes of this research; the staff
at Zamokuhle, for keeping such comprehensive and meticulous records, making it easy to
do the research; the mothers and children of Soweto for sharing their stories with us at the
Centre; to all those people who spurred me on as it became increasingly difficult to finish
this task, the more I delayed, Jonathan Levine and Shireen Mothi from MRC for helping
me with the statistics and Professor Lucy Wagstaff for her support.
Many thanks to my husband Trevor for his continued support and constructive criticism;
my children who seem to ‘understand’ when Mommy said she was busy and my
colleague, Dr Ama Ilunga for being such a friend.
Lastly, and certainly not least to The Almighty, for the strength He gave me.
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PREFACE
South Africa has just recently emerged from an unremitting and unprecedented political
strife, which saw the youth and children at the helm. The townships were th< hotbed of
this violence, while the suburbs were protected and safe.
With the change of the political climate and the realisation of a new democracy, the focus
of violence seems to have shifted to the two most vulnerable groups in any society,
children and women. There seems to be a rapid spread of this violence beyond the
borders of the tow nships as attested to by the daily news, leaving no safe havens for the
children in our country.
This research not only wants to highlight the problem of vhild abuse in Soweto, but also
seeks to draw attention to the tremendous amount of violence that seems to underpin it.
Even more ominous is the threat of HIV/AIDS death sentence that these children are
likely to get as HIV infection reaches epidemic levels in our country.
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TABLE OF CONTENTS
DECLARATION ii
DEDICATION iii
PUBLICATIONS AND PRESENTATIONS iv
ABSTRACT V
ACKNOWLEDGEMENTS vii
PREFACE viii
TABLE OF CONTENTS ix
LIST OF FIGURES xii
LIST OF TABLES xiii
1. INTRODUCTION 1
1.1 Background about Zamokuhie Child Centre 4
1.2 Objectives 6
1.3 Hypothesis 6
1.4 Limitations 6
1.5 Literature review 7
1.5.1 Definition of child abuse 8
1.5.2 Sexual abuse 10
1.5.2.1 Definition 10
1.5.2.2 Epidemiology - Western society 14
1.5.2.2.1 Incidence 14
1.5.2.2.2 Age distribution 17
1.5.2.3 Developing countries 19
1.5.2.3.1 Perpetrator 20
1.5.2.3.2 Age distribution 23
1.5.2.4 Sexually transmitted diseases 24
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1.5.2.4.1 Prevalence of STDs 25
1.5.2.4.2 Modes of transmission 28
1.5.2.4.3 Guidelines for screening 31
1.5.2.5 Clinical findings 34
1.5.2.6 Reporting of the abuse 34
1.5.3 Physical abuse 39
1.5.3.1 Definition 39
1.5.3.2 Culture/religion or abuse? 41
1.5.3.3 Corporal pun'shment or abuse? 44
1.5.3.4 Incidence and prevalence 46
1.5.3.5 Age & sex distribution 48
1.5.3.6 Risk factors 49
1.5.3.7 Perpetrators 49
1.5.4 Physical Neglect 50
1.5.4.1 Definition 51
1.5.4.2 Incidence and prevalence 52
1.5.4.3 Clinical presentation 53
1.5.5 Emotional abuse 53
1.5.5.1 Definition 53
1.5.5.2 Incidence and prevalence 55
1.5.5.3 Clinical presentation 56
MATERIALS AND METHODS 57
2.1 Statistics 58
RESULTS 59
3.1 Sexual Abuse 59
3.1.1 Demographics 59
3.1.2 Background information 60
3 1.3 Educational status of the parents 64
3.1.4 Housing 64
3.1.5 Disclosure of abuse 64
31.6 Signs and symptoms 66
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