The management of childhood sexual abuse by midwifery, nursing and medical providers in Tanzania

Ever Mkonyi, Dorkasi L. Mwakawanga, B. R.Simon Rosser, Zobeida E. Bonilla, Gift Gadiel Lukumay, Inari Mohammed, Stella E. Mushy, Lucy R. Mgopa, Michael W. Ross, Agnes F. Massae, Maria Trent, James Wadley

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Child sexual abuse (CSA) is a significant public health problem affecting one billion children aged 2 to 17 globally. The prevalence of CSA in Tanzania is one of the highest; however, how health care providers manage CSA cases has not been studied. Objectives: This study investigated how medical, nursing, and midwifery professionals in Tanzania handle cases of CSA and identified the factors that facilitate or impede the provision of quality care to CSA victims. Methods: Participants were 60 experienced healthcare professionals and 61 health students working in Dar es Salaam, Tanzania. We conducted 18 focus groups stratified by profession (midwifery, nursing, or medicine) and experience (practitioners versus students). Results: Three main themes emerged. First, child abuse management involved using a multi-disciplinary approach, including proper history taking, physical assessment, treatment, and referral. Second, factors that enhanced disclosure of CSA included building rapport, privacy, and confidentiality. Third, factors that impeded care included fear of harm to the child if the abuse was reported, abuse reporting being perceived as a “waste of time” for providers, loss of evidence from the victim, family resistance, poverty, corruption and cultural dynamics. Conclusions: Midwives, nurses and doctors were all experienced in and reported similar challenges in addressing CSA. At a structural level, the ratio of providers to patients in health facilities inhibits quality care. These findings have implications for strengthening CSA policy/guidelines and clinical practice in Tanzania. Mandated CSA training is necessary for midwifery, nursing, and medical students as well as in continuing education courses for more experienced providers.

Original languageEnglish (US)
Article number105268
JournalChild Abuse and Neglect
Volume121
DOIs
StatePublished - Nov 2021

Bibliographical note

Funding Information:
This manuscript was authored as part of the Training for Health Professionals study funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health, Grant number: 1 R01 HD092655 (MPI: Rosser; Mkoka). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. We would like to acknowledge our former co-principal investigator (Dr. Sebalda Leshabari) at the Muhimbili University of Health and Allied Sciences Dar es Salaam who passed away in 2019. Her contribution and leadership to this study remain valuable.

Funding Information:
This manuscript was authored as part of the Training for Health Professionals study funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) , National Institutes of Health , Grant number: 1 R01 HD092655 (MPI: Rosser; Mkoka). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. We would like to acknowledge our former co-principal investigator (Dr. Sebalda Leshabari) at the Muhimbili University of Health and Allied Sciences Dar es Salaam who passed away in 2019. Her contribution and leadership to this study remain valuable.

Publisher Copyright:
© 2021

Keywords

  • Africa
  • Child sexual abuse
  • Healthcare professionals
  • Practitioners
  • Tanzania

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