Alleged child sexual abuse in Alexandria Governorate, Egypt, in 2020

INTRODUCTION

Child sexual abuse (CSA) is a significant public health and social justice concern harming lives of millions of individuals.¹

Collin-Vezinaet et al.,² emphasizedthatCSA is a major issue affecting more than one out of five females and one in 10 males globally.

One of the most frequent human rights breaches that exposes children at danger is sexual abuse. In addition, abuse frequently takes place in a person's home where the abusers are the children's guardians. The incapacity of the abused children to report the abuse leaves them vulnerable to additional assaults.³

Our study included and targeted children who claimed sexual abuse and to detect and analyze features of those cases in Alexandria Governorate in Arab republic of Egypt during the year 2020.

PATIENTS AND METHODS

Our work is a cross-sectional study that gathered prospectively 139 alleged child sexual abuse cases referred to the Forensic Medicine Authority, Alexandria Governorate in Egypt for one year. The approach included history and medico-legal examination of assault which was documented.  The study complied with the codes of the Egyptian Forensic Medicine Authority (EFMA) and Ethics Committee of the Faculty of Medicine of Al-Azhar University Cairo, Egypt. An assent of all children and informed consent of their guardians were obtained.

- Medicolegal examination:

1- History: The alleged cases were questioned regarding the assault's circumstances, including the type of violence used, the number of suspects involved and their relationships with the children, the location of the assault, and the frequency of assaults. Before examination, a brief explanation of the necessary examination positions and techniques were given.⁴

2- General body examination: All alleged cases were comprehensively examined for general signs of violence. Any visible injuries were documented appropriately.

3-Local examination:-Examination of the genitalia and anal region

-In females, a careful genital examination was conducted in lithotomy and knee-chest positions for detection of any recent or old injuries.

-In Males, male genitalia were properly inspected for the presence of recent or old injuries.

-Anal region was examined in the knee-chest and left lateral position for the presence of any injuries. Also, anal sphincter tone and reflex were assessed.

- All important injuries were reported.

Medicolegal findings:

1-Positive findings: The existence of recent or ancient injuries that are consistent with the provided history is evidence of child abuse. However, the appearance of any injuries related to the alleged sexual conduct serves as proof of sexual abuse of children.

2-Negative findings: in absence of any evidence that supporting sexual offenses.

Statistical analysis:

The documented data were collected and statistically studied, tabulated and analyzed and graphically represented. The data were analyzed through SPSS for Windows version 10. Nominal variables were reported as frequency and percentages, and p ≤0.05 was considered significant.

RESULTS

The present work included 139 alleged child sexual abuse cases.

Age: Preschool group (

Fig. 1: Age grouping of study cases

Sex in relation to age:  Male victims in preschool and school age were higher than females while in adolescent age females predominate (62.5%) (Table 1)

Table 1: sex distribution in relation to age

Demographic distribution: cases of Second Almontazah and East districts showed a high incidence of sexual assault than other district, while Borg- Alarab district showed the lowest percentage of cases (Figure 2).

Fig. 2: Demographic distribution of study cases

Place of assault: assailant home was the most used place for sexual offences as they were the most chosen place for to offend  (in 63; 45.3% of cases) followed by outdoor in 54; 38.9%, while victim home was least mentioned place for sexual assault 22; 15.8% (Figure 2).

Fig. 3: Place of sexual assault

Age of assailant: data of allegations displayed that the most prevalent age of offenders was of third and fourth decades 58 and 41 while those of age less than 20 years were 34 and 5^th decade were 18 while, the least numbers were over 50 years to be 3 cases (Table 2).

Table 2: age of assailant

Sexual abuse findings in relation to age groups

As demonstrated in (table 13), as age increase more findings were obvious, adolescents more than 12 years old then those between 6-12 years old and those with least findings were those in preschool age (Table 3).

Table 3: Sexual abuse findings in relation to age groups

Local injuries finding in relation to sex: vaginal assault was the most common site of injury among female victims. Female anal injuries were seen in 10 cases. While in male cases, local anal injuries were seen in 16 cases (figure 4)

Fig. 4: Local Injury findings in relation to sex

DISCUSSION

The involvement of children and adolescents in sexual activities that they are unable to completely understand and consent to as a fully equal, self-determining participant due to their early stages of development constitutes child sexual abuse. Social taboos are broken, and the offenders use verbal and/or physical coercion to take advantage of their adulthood and power. The main characteristic of child sexual abuse is the intention of adults to utilize children for their own sexual arousal and fulfilment.⁵

Physical abuse of children was shown to be far less common in Egypt than child sexual abuse. This result confirms a research by the United Nations Entity for Gender Equality and the Empowerment of Women (UNEGEEW) that found a trend toward rising sexual abuse and harassment.⁶

Our present work included 139 cases of prospectively studied alleged child sexual abuse examined for medicolegal evaluation in Forensic Medicine Authority in Alexandria Governorate of Arab Republic of Egypt during 2020.

Preschool group () were the least sexual abused children followed by school and preschool age groups (45.7%, 30.7% and 23.6% respectively).

 In agreement with Essabar et al., ⁷ who stated that approximately 15% of victims were between ages 0 and 5 years. Between ages 6 and 10 years, the percentage almost tripled (48%). Ages 11 to 15 years accounted for a quarter (26%) of cases, with children 16 years and older accounting for the remaining 11 % of cases. Before the age of 16 years boys were at about two times higher risk than girls, with a percentage of 68 %. Victims 16 years and older were female in 82% of cases.

In contrast, Sobh and Menessi's, ⁸ study in Alexandria, Egypt, found that 55 children (82%) with ages ranging from 2.5 to 11.75 were believed to have experienced sexual abuse. Nearly three-quarters (71.64%) of these children were male. Additionally, Carvalho et al. ⁹ demonstrated that there were more male victims when they were younger. The age groups (11–18 years) (56%) and (5–10 years) (39%) constituted the majority of cases of CSA, respectively, while the age group (1-4 years) (%) represented the least frequency of age groups subjected to sexual abuse among the cases included.

As regards place of assault, our study showed that assailant home was the most used place for sexual offences (in 63; 45.3% of cases) followed by outdoor in 54; 38.9%, while victim home was least mentioned place for sexual assault (22; 15.8% of  cases).

Our findings are consistent with Kaushik et al., ¹⁰ study who reported that the home of the offender was the common site of the offense in (33.33 %) of cases and the victim's home was the site of the crime in (16.90 percent) of cases. According to Kumar-Pal et al., ¹¹ the victim's home was the common site of the offence in 20.0% of cases, followed by the home of the offender in 31.42 percent of cases.

According to Metwaly et al., ¹² the majority of sexual assaults took place away from the victim's house (55%) whereas the crime scene was nearby in (45%) of the cases.

Data of our cases of allegations displayed that the most prevalent age of offenders was of third and fourth decades 58 and 41, while those of age less than 20 years to be the 34 and those in 5th decade to be 18 while the least number were over 50 years 3.  

According to Jones et al., ¹³ the average age at which abuse began was 9 years, and the average estimated age of the abuser was 30 years.

Dube et al., ¹⁴ showed that the majority of sexual abuse victims were men between the ages of 20 and 40.

Wolf, ¹⁵, reported in his study that a large fraction of child sexual abuse seemed to be committed by minors. Using a variety of victim samples, his studies estimated that between 40 and 51 percent of child sexual abuse was committed by individuals under the age of 20, and between 13 and 18 percent was committed by young children.

In the present study as regard local examination vaginal assault was the most common site of injury among victims (52.4 %).

In agreement to Maqsood et al., ¹⁶ and Sarkar et al., ¹⁷, studies that found the majority of local injuries among abused children involved the vagina.

Contrary to Elgazzar et al., ¹⁸ study, which reported that the most common form of sexual abuse during the course of the study was anal assault, which included anal sex only (36.6%) and mixed anal-vaginal sex (4.5%). Also Abo-Seria et al., study reported that Cairo governorate had a greater frequency of anal sex (55.0%).

CONCLUSION

Female were assaulted more than males and the most assaulted victims were of adolescent age and second Almontazah and East districts showed a high incidence of sexual assault than other districts.