Psychosocial Outcomes Associated With Sexual Violence Against Children Among Children Seen at the Nairobi Women’s and Kenyatta National Hospital

Abstract

Background: Sexual Violence Against Children has psychological, social, psychiatric and educational negative outcomes that are detrimental to the health of children and society as a whole. This study aimed at determining the psychosocial outcomes associated with Sexual Violence Against Children among children seen at Gender Based Violence Recovery Centres of the Mental Health Department Kenyatta National Hospital and The Nairobi Women’s Hospital. Objectives: To determine the incidence of Post-Traumatic Stress Disorder, the incidence of depression, the effect of SVAC on children’s self-esteem and the effects of Sexual Violence Against children on their performance. Study Design: This was a longitudinal study design using both quantitative and qualitative methods. Methods and Tools: Research and Ethical clearance was obtained from Kenyatta National Hospital/University of Nairobi Research and Ethics Committee. The participants in this study consisted of children aged 7-17 years who had experienced sexual violence and their parent/legal guardians. Six parents/ legal guardians were purposively selected for qualitative narratives and an interview guide was used. Sample size calculation method used in the research was precision of the estimate, on the level of sampling error. The calculated sample size was 205 children who had experienced sexual violence. Study instruments included: Socio-demographic questionnaire for child and the parent, Child Post-Traumatic Stress Disorder Symptom Scale, Child Depression Inventory, Becks Depression Inventory and

Pier-Harris self-concept scale. The instruments were administered at baseline and at 3 follow-ups of 4 months interval for one year. Data analysis: SPSS version 21 was used to analyze quantitative data and Nvivo version 12 was used for qualitative data. Results: One hundred ninety one (191) study participants were recruited into the study of whom 23 (12%) were male and 168 (88%) were female (male: female ratio of 1:7). The mean age of the study participants was 13 years. The incidence of full PTSD was 95.3% and partial PTSD was 4.7% at baseline, at follow up 1, full PTSD was 95% and partial PTSD was 5%, at follow up 2 full PTSD was 60.7% and partial PTSD was 39.3% and at follow up 3 full PTSD was at 60% and partial at 40%. The incidence of moderate-severe depression among the children was 69.5% at baseline and mild at 30.5%, at follow up 1 severe-moderate depression was at 2.3% and mild was at 97.7%. The incidence of high self-esteem was at 18.3%, average self-esteem was at 75.4% and low self-esteem at 6.3% at baseline, at follow up 1 high self-esteem was at 6.3%, average at 92.6% and low at 2%, at follow 2 high self-esteem was at 4.7%, average was at 92.8% and low at 2.5% and at follow up 3 there were no children with high self-esteem, average was at 98.1% and low at 1.9%. Children with moderate to severe depression on CDI/BDI were less likely to perform above average compared to those with minimal to mild depression (p = 0.003). The children with high self-esteem based on Pier Harris self-concept scale were 3.6 times more likely to have above average performance compared to those with low or

average self-esteem. The children performed poorly in school after the sexual violence incidence but improved in subsequent follow ups. Conclusion: Sexual Violence Against Children has negative mental health outcomes as measured by the PTSD, depression and low self-esteem scales. These outcomes have detrimental effect to the normal development of children. Sexual Violence Against Children has also negative effect on the children’s progress in school performance. There is need to minimize risk factors that would lead to poor mental health outcomes after the incidence of sexual violence on children and enhance parenting protective skills