Missed treatment opportunities and barriers to comprehensive treatment for sexual violence survivors in Kenya: a mixed methods study
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Date
2018
Authors
Gatuguta, Anne
Merrill, Katherine G.
Colombini, Manuela
Soremekun, Seyi
Seeley, Janet
Mwanzo, Isaac
Devries, Karen
Journal Title
Journal ISSN
Volume Title
Publisher
BioMed Central
Abstract
Background: In Kenya, most sexual violence survivors either do not access healthcare, access healthcare late or do
not complete treatment. To design interventions that ensure optimal healthcare for survivors, it is important to
understand the characteristics of those who do and do not access healthcare. In this paper, we aim to: compare
the characteristics of survivors who present for healthcare to those of survivors reporting violence on national
surveys; understand the healthcare services provided to survivors; and, identify barriers to treatment.
Methods: A mixed methods approach was used. Hospital records for survivors from two referral hospitals were
compared with national-level data from the Kenya Demographic and Health Survey 2014, and the Violence Against
Children Survey 2010. Descriptive summaries were calculated and differences in characteristics of the survivors
assessed using chi-square tests. Qualitative data from six in-depth interviews with healthcare providers were
analysed thematically.
Results: Among the 543 hospital respondents, 93.2% were female; 69.5% single; 71.9% knew the perpetrator; and
69.2% were children below 18 years. Compared to respondents disclosing sexual violence in nationally
representative datasets, those who presented at hospital were less likely to be partnered, male, or assaulted by an
intimate partner. Data suggest missed opportunities for treatment among those who did present to hospital: HIV
PEP and other STI prophylaxis was not given to 30 and 16% of survivors respectively; 43% of eligible women did
not receive emergency contraceptive; and, laboratory results were missing in more than 40% of the records. Those
aged 18 years or below and those assaulted by known perpetrators were more likely to miss being put on HIV PEP.
Qualitative data highlighted challenges in accessing and providing healthcare that included stigma, lack of staff
training, missing equipment and poor coordination of services.
Conclusions: Nationally, survivors at higher risk of not accessing healthcare include older survivors; partnered or
ever partnered survivors; survivors experiencing sexual violence from intimate partners; children experiencing
violence in schools; and men. Interventions at the community level should target survivors who are unlikely to
access healthcare and address barriers to early access to care. Staff training and specific clinical guidelines/protocols
for treating children are urgently needed.
Description
Research Article
Keywords
Sexual violence, Healthcare, HIV PEP-Kenya
Citation
BMC Public Health (2018) 18:769; https://doi.org/10.1186/s12889-018-5681-5