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Individual and community-level socioeconomic position and its association with adolescents experience of childhood sexual abuse: a multilevel analysis of sixcountries in Sub-Saharan Africa
Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Centre for Evidence-Based Global Health, Nigeria.
Division of Social Medicine, Department of Public Health Sciences, Karolinska Institute, Sweden..
Warwick - Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, Warwick Medical School, The University of Warwick, Coven try, CV4 7AL, United Kingdom.
Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Division of Social Medicine, Department of Public Health Sciences, Karolinska Institute, Sweden.ORCID iD: 0000-0001-5221-9504
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2013 (English)In: Journal of Injury and Violence Research, ISSN 2008-2053, E-ISSN 2008-4072, Vol. 6, no 1, 21-30 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Childhood sexual abuse (CSA) is a substantial global health and human rights problem and consequently a growing concern in sub-Saharan Africa. We examined the association between individual and community-level socioeconomic status (SES) and the likelihood of reporting CSA. METHODS: We applied multiple multilevel logistic regression analysis on Demographic and Health Survey data for 6,351female adolescents between the ages of 15 and 18 years from six countries in sub-Saharan Africa, between 2006 and 2008. RESULTS: About 70% of the reported cases of CSA were between 14 and 17 years. Zambia had the highest proportion of reported cases of CSA (5.8%). At the individual and community level, we found that there was no association between CSA and socioeconomic position. This study provides evidence that the likelihood of reporting CSA cut across all individual SES as well as all community socioeconomic strata. CONCLUSIONS: We found no evidence of socioeconomic differentials in adolescents’ experience of CSA, suggesting that adolescents from the six countries studied experienced CSA regardless of their individual- and community-level socioeconomic position. However, we found some evidence of geographical clustering, adolescents in the same community are subject to common contextual influences. Further studies are needed to explore possible effects of countries’ political, social, economic, legal, and cultural impact on Childhood sexual abuse.

Place, publisher, year, edition, pages
2013. Vol. 6, no 1, 21-30 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:miun:diva-19689DOI: 10.5249/jivr.v6i1.316PubMedID: 23797565Scopus ID: 2-s2.0-84906921817OAI: oai:DiVA.org:miun-19689DiVA: diva2:639072
Available from: 2013-08-05 Created: 2013-08-05 Last updated: 2017-12-06Bibliographically approved
In thesis
1. Childhood Sexual Abuse Against Girls in Sub-Saharan Africa: Individual and Contextual Risk Factors
Open this publication in new window or tab >>Childhood Sexual Abuse Against Girls in Sub-Saharan Africa: Individual and Contextual Risk Factors
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background and objectives: Childhood sexual abuse (CSA) is a substantial public health and human rights problem, as well as a growing concern in sub-Saharan Africa (SSA). It has both short and long term effects on girls: physical and psychological, including negative sexual outcomes. Up to one-third of adolescent girls report their first sexual experience as being forced. Despite growing evidence supporting a link between contextual factors and violence, no studies have investigated the connection between CSA and contextual factors. It is therefore important to identify the extent of CSA and understand factors associated with it in SSA in order to develop interventions aimed to address the scale of the problem.

Aim: The overall aim of this thesis is to assess the individual and contextual factors associated with CSA. In addition, the thesis aims to quantify the magnitude of CSA and describe the factors associated with CSA among women from SSA (Study I). This thesis also examines the independent contribution of individual and community socio-economic status on CSA (Study II). Moreover, it scrutinises the effect of social disorganisation on CSA (Study III) and explores the relationship between CSA and sexual risk behaviours as well as potential mediators (Study IV).

Methods: This thesis used the Demographic and Health Survey (DHS) datasets conducted between 2006 and 2008 from six SSA countries. The thesis used multiple logistic regression models to describe and explore factors associated with CSA among 69,977 women (Study I).  It used multivariable multilevel logistic regression analysis to explore the effect of contextual level variables (neighbourhood socio-economic status) on CSA among 6,351 girls (Study II). Neighbourhood socio-economic status was operationalized with a principal component analysis using the proportion of respondents who were unemployed, illiterates, living below poverty level and rural residents. Study III applied multivariable multilevel logistic regression analysis on 6,351 girls and considered five measures of social disorganisation at the community level: neighbourhood poverty, female-headed households, residential mobility, place of residence, population density, and ethnic diversity. In study IV, 12,800 women from the Nigerian DHS were used. Structural equation modelling was applied using a two-step approach. The first step used a confirmatory factor analysis to develop an acceptable measurement model while the second step involved modifying the measurement model to represent the postulated causal model framework.

Results: In study I, the reported prevalence of CSA ranged from 0.3% in Liberia to 4.3% in Zambia when the prevalence was based on all respondents aged between 15 and 49 years and who were present during the survey. None of the socio-economic factors were associated with CSA. In study II, where the data was restricted to permanent residents aged between 15 and 18 years, the prevalence ranged between 1.04% in Liberia to 5.8% in Zambia. At the individual level, there was no significant association between CSA and wealth status while at the community level, there was no significant association between CSA and socio-economic position. However, 22% of the variation in CSA was attributed to the community level factors. In study III, there was significant variation in the odds of reporting CSA across the communities, with community level factors accounting for 18% of the variation. In addition, respondents from communities with a high family disruption rate were 57% more likely to have reported sexual abuse in childhood. Study IV showed that there was a significant association between CSA and sexual risk behaviours and the association was mediated by alcohol and cigarette use.

Conclusions: The study provides evidence that adolescents in the same community were subjected to common contextual influences. It also highlighted the significance of mediators in the relationship between CSA and sexual risk behaviours. It is therefore important that effective preventive strategies are developed and implemented that will cut across all socio-economic spheres in a context that both permits and encourages disclosure as well as identifying predisposing circumstances for recurrence.

Place, publisher, year, edition, pages
Sundsvall: Mid Sweden University, 2014. 66 p.
Series
Mid Sweden University doctoral thesis, ISSN 1652-893X ; 180
Keyword
alcohol, child sexual abuse, demographic and health survey, multilevel, neighbourhood, sexual violence, smoking, social disorganisation, socio-economic status, sub-Saharan Africa
National Category
Health Sciences
Identifiers
urn:nbn:se:miun:diva-21919 (URN)978-91-87557-40-8 (ISBN)
Public defence
2014-05-15, L111, Mid-Sweden University, Sundsvall, 10:00 (English)
Opponent
Supervisors
Available from: 2014-05-12 Created: 2014-05-11 Last updated: 2014-05-23Bibliographically approved

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