B15. Improving the care of children who are sexually abused in Malawi
Jane C Ellis, S Shafique Ahmad, Elizabeth M Molyneux
Department of Paediatrics, College of Medicine, University of Malawi, Blantyre, Malawi
Child sexual abuse (CSA) is a global problem. The actual incidence is difficult to quantify and data from sub-Saharan Africa is scarcer than that from resource rich settings, but the incidence is probably similar world-wide. The consequences of child sexual abuse include physical and psychological damage, sexually transmitted diseases and pregnancy. In areas with a high HIV infection prevalence rate there is the additional risk of acquiring HIV infection. This can potentially be prevented by HIV post-exposure prophylaxis (PEP) with antiretroviral therapy (ART).
To improve the care of children who are victims of CSA by routinely offering HIV PEP and to assess the feasibility, safety and efficacy of such treatment started in a paediatric emergency department in Malawi.
Method and setting
Children presenting to the Paediatric Emergency Department, Queen Elizabeth Central Hospital, Blantyre between January 1st 2004 and December 31st 2004 with a history of alleged CSA were all assessed for eligibility for HIV PEP and followed prospectively.
The number of children presenting with a history of CSA in the 12-month period was 64. There were 63 girls and 1 boy. The mean age was 83 months. The perpetrator was a family member in 9.4% of cases, a known person in 62.5%, and an unknown person in 28.1%.
Of the 64 children seen, 17 (26.5%) were offered PEP. The reasons for the remaining children not being offered PEP were: absence of physical signs of abuse in 20 cases (31.3%); delay in presentation beyond 72 hours from assault in 11 (17.2%); previous sexual abuse by the same assailant in 15 (23.4%); and one child (1.6%) was found to be HIV-infected on initial testing. No family refused an HIV test. No side effects due to ARV therapy were reported. Of the 17 children commenced on PEP, 11 returned for review after 1 month (64.7%), 7 returned at 3 months (41.2%) and 2 of 10 (20%) returned at 6 months post assault. None have seroconverted.
Conclusions and recommendations
HIV PEP is an important part of the care of sexually abused children in an area with high HIV prevalence and is acceptable, safe and feasible in our setting.