Characteristics, medical management and outcomes of survivors of sexual gender-based violence, Nairobi, Kenya

Buard,; R, Van den Bergh; Tayler-Smith, K.; Godia, Pamela; Sobry, Agnès; Rj, Kosgei; Szumilin, Elisabeth; Ad, Harries; Pujades-Rodríguez, Mar

doi:10.5588/pha.13.0012

Cited by 14 publications

(18 citation statements)

References 7 publications

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“…Although national survey data show that reporting of violence increases with age and older survivors are more likely to report sexual violence [ 17 ], our hospital data seems to contradicts this. Together with multiple other studies in Kenya [ 15 , 19 – 21 , 24 ], our data show that children are more likely to present for treatment in hospitals. Moreover, the proportion of male survivors presenting for care is low compared to the proportion reporting violence, indicating that the vast majority of men who experience sexual violence do not seek healthcare.…”

Section: Discussionsupporting

confidence: 83%

Missed treatment opportunities and barriers to comprehensive treatment for sexual violence survivors in Kenya: a mixed methods study

et al. 2018

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BackgroundIn 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.MethodsA 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.ResultsAmong 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.ConclusionsNationally, 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.

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Section: Discussionsupporting

confidence: 83%

Missed treatment opportunities and barriers to comprehensive treatment for sexual violence survivors in Kenya: a mixed methods study

et al. 2018

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“…3,4 The article by Buard et al in this issue of Public Health Action on the characteristics, management and outcomes of survivors of gender-based violence in Nairobi, describes the successful implementation of a comprehensive medical program for survivors of SGBV. 5 The demographics of the sexual violence survivors presenting to their program were similar to those described by other providers in Kenya. 6 In the program by Buard et al, many of the barriers to high quality post-assault medical care were overcome.…”

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confidence: 65%

Sexual and gender-based violence [Editorial]

Bartels¹

2013

public health action

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likely contributed to it being well known within the community.Within the SGBV program offered by Buard et al., there was good uptake of HIV PEP, prophylactic antibiotics and emergency contraception, similar to reports by others. 6 Although the attrition rates for subsequent hepatitis B and tetanus vaccination were high, they are within the realm of what might be expected given the setting and context. The authors make reasonable recommendations for addressing this high attrition, including digital tracking or reminders using mobile phones.Buard et al. are to be commended for the high quality medical services they are providing to survivors of SGBV in Nairobi, and their program should serve as a model for other programs in similar urban settings. In circumstances where a survivor has been violated (often by someone known to him/her) and in the context of a judicial system that often fails the survivor either by re-traumatization and/or by failure to bring the perpetrator to justice, it is important that the health care system do right by these individuals by offering the best possible protection for their current and future health. S exual and gender-based violence (SGBV) continues to be a pervasive problem for women, men and children around the world. Many survivors are understandably concerned about the potential health sequelae of being sexually assaulted, primarily about unwanted pregnancies and transmission of sexually transmitted infections (STIs), including the human immunodefi ciency virus (HIV). There has been much emphasis on prompt referral to medical care, as it has been shown that post-exposure prophylaxis (PEP) for STIs and HIV as well as emergency contraception are signifi cantly more likely to be effective if taken within the fi rst 72 hours following the assault. 1 Historically, provision of post-assault care has been challenging in developing countries such as Kenya. 2 Survivors may not be aware of the benefi ts of early medical care, post-assault medical protocols may not be in widespread use, confi dentially may be poorly maintained and the required medicines may not be available at local clinics. Furthermore, there are often signifi cant delays to seeking medical care, far beyond the recommended 72 hours, thus rendering prophylactic medical interventions almost useless. 3,4 The article by Buard et al. in this issue of Public Health Action on the characteristics, management and outcomes of survivors of gender-based violence in Nairobi, describes the successful implementation of a comprehensive medical program for survivors of SGBV. 5 The demographics of the sexual violence survivors presenting to their program were similar to those described by other providers in Kenya. 6 In the program by Buard et al., many of the barriers to high quality post-assault medical care were overcome. Because it was an urban setting, lengthy travel times to access medical care were not a problem and, in fact, almost three quarters of the survivors sought medical attention within the recommended 72 hours. Being op...

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“…A total of eight studies with quantitative data had findings relevant to the review 18–25. Meta-analysis was not possible due to wide variations in study designs, measures and outcomes.…”

Section: Resultsmentioning

confidence: 99%

“…The implementation of many SOPs faced significant challenges due to lack of content, contextualisation, availability or visibility within the facility (MC) 10–12 15 16 30 31. Conversely, OSCs with SOPs found they enhanced clarity of staff roles, patient flow and referral pathways (MC) 10 14 15 19 22 28 31–33…”

Section: Resultsmentioning

confidence: 99%

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The implementation and effectiveness of the one stop centre model for intimate partner and sexual violence in low- and middle-income countries: a systematic review of barriers and enablers

2020

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IntroductionMany low- and middle-income countries have implemented health-system based one stop centres to respond to intimate partner violence (IPV) and sexual violence. Despite its growing popularity in low- and middle-income countries and among donors, no studies have systematically reviewed the one stop centre. Using a thematic synthesis approach, this systematic review aims to identify enablers and barriers to implementation of the one stop centre (OSC) model and to achieving its intended results for women survivors of violence in low- and middle-income countries.MethodsWe searched PubMed, CINAHL and Embase databases and grey literature using a predetermined search strategy to identify all relevant qualitative, quantitative and mixed methods studies. Overall, 42 studies were included from 24 low- and middle-income countries. We used a three-stage thematic synthesis methodology to synthesise the qualitative evidence, and we used the CERQual (Confidence in the Evidence from Reviews of Qualitative Research) approach to assess confidence in the qualitative research. Meta-analysis could not be performed due heterogeneity in results and outcome measures. Quantitative data are presented by individual study characteristics and outcomes, and key findings are incorporated into the qualitative thematic framework.ResultsThe review found 15 barriers with high-confidence evidence and identified seven enablers with moderate-confidence evidence. These include barriers to implementation such as lack of multisectoral staff and private consultation space as well as barriers to achieving the intended result of multisectoral coordination due to fragmented services and unclear responsibilities of implementing partners. There were also differences between enablers and barriers of various OSC models such as the hospital-based OSC, the stand-alone OSC and the NGO-run OSC.ConclusionThis review demonstrates that there are several barriers that have often prevented the OSC model from being implemented as designed and achieving the intended result of providing high quality, accessible, acceptable, multisectoral care. Existing OSCs will likely require strategic investment to address these specific barriers before they can achieve their ultimate goal of reducing survivor retraumatisation when seeking care. More rigorous and systematic evaluation of the OSC model is needed to better understand whether the OSC model of care is improving support for survivors of IPV and sexual violence.The systematic review protocol was registered and is available online (PROSPERO: CRD42018083988).

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Characteristics, medical management and outcomes of survivors of sexual gender-based violence, Nairobi, Kenya

Abstract: Acceptable, good quality SGBV medical care can be provided in large cities of sub-Saharan Africa, although further work is needed to improve follow-up interventions.

Cited by 14 publications

References 7 publications

Missed treatment opportunities and barriers to comprehensive treatment for sexual violence survivors in Kenya: a mixed methods study

Missed treatment opportunities and barriers to comprehensive treatment for sexual violence survivors in Kenya: a mixed methods study

Sexual and gender-based violence [Editorial]

The implementation and effectiveness of the one stop centre model for intimate partner and sexual violence in low- and middle-income countries: a systematic review of barriers and enablers

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