Cisse C T, Niang M M, Sy A K, Faye E H O, Moreau J-C
Service de gynécologie-obstétrique, hôpital institut d'hygiène sociale, Dakar, Sénégal.
Service de gynécologie-obstétrique, hôpital institut d'hygiène sociale, Dakar, Sénégal.
J Gynecol Obstet Biol Reprod (Paris). 2015 Nov;44(9):825-31. doi: 10.1016/j.jgyn.2014.10.010. Epub 2015 Feb 25.
Specify epidemioclinical and legal aspects of sexual abuse among minors and evaluate the cost of care in Dakar.
This is a retrospective multicenter cross-sectional study on sexual abuse among minors over a period of four years from 1st January 2006 to 31st December 2009. Four maternities were targeted: the Social Hygiene Institute of Medina, health center Roi-Baudouin Guédiawaye, the Pikine hospital and health center Youssou-Mbargane-Diop of Rufisque.
During the study period, 252 child victims of sexual abuse were supported at four health facilities on a total of 272 sexual abuses of all ages, a frequency of 92.64%. The epidemiological profile of our patients was a child of 11 years old on average, female (100%) and living in the suburbs of Dakar (68.1%). Children were often abused during working hours (31.7%), outside the family environment and often by someone known to the victim (72.6%). Genito-genital contact was the most common mode of sexual contact (80.9%) with vaginal penetration in 61% of cases. Almost all of the victims (92.1%) came to consult, accompanied by their parents, between the 1st and 4th day after the sexual abuse (70%). The examination usually revealed a hymenal trauma (59.9%) of which nearly half (49%) consisted of old lesions. 56.9% of victims had a post-traumatic stress disorder and 31.1%, mutism. We recorded six (6) pregnancies, 2% of our sample. A case of HIV infection was recorded on a sample taken 72hours after sexual abuse. Control of three months HIV serology was requested in 7.1% of cases and only 20% of children had received antiretroviral prophylaxis. Antibiotic prophylaxis had been performed in 13.7% of cases using doxycycline as drug of choice (75%). Only 29% of our patients had received emergency contraception progestin and psychological care concerned only 22% of children. On the legal aspects, 46% of our patients had filed a complaint. Prosecutions were 38%, 45% of which were convicted and 21% were acquitted. The rate of out-of-court settlement was 35% and the time limit for settlement by the justice was on average 6 months with extremes of one month and 24 months. The average cost of care was estimated at 17,010 CFA francs (26 euros) taking into account the consumables used for clinical examination (sterile gloves, catheter, syringe), analysis and prescription drugs.
The sexual abuse of minors is a disturbing reality that raises rightly universal reprobation. In Senegal, this mainly affects children and its magnitude is increasing over the years. Improved support for victims necessarily involves raising public awareness through the media and the development of specialized structures in the management of sexual abuse.
明确未成年人遭受性虐待的流行病学临床特征及法律问题，并评估达喀尔地区的护理成本。
这是一项回顾性多中心横断面研究，研究对象为2006年1月1日至2009年12月31日这四年间遭受性虐待的未成年人。选取了四家妇产科机构：麦地那社会卫生研究所、鲁菲斯克的尤素夫 - 姆巴加内 - 迪奥普健康中心、皮金医院以及鲁菲斯克的罗伊 - 鲍杜因·盖迪亚韦健康中心。
在研究期间，四家医疗机构共接待了252名遭受性虐待的儿童受害者，在所有年龄段的272起性虐待事件中占比92.64%。我们患者的流行病学特征为平均年龄11岁的女童（100%），居住在达喀尔郊区（68.1%）。儿童遭受性虐待多发生在工作时间（31.7%），在家庭环境之外，且施虐者多为受害者认识的人（72.6%）。生殖器 - 生殖器接触是最常见的性接触方式（80.9%），其中61%的案例存在阴道插入。几乎所有受害者（92.1%）在遭受性虐待后的第1至4天（70%）在父母陪同下前来咨询。检查通常发现处女膜创伤（59.9%），其中近一半（49%）为陈旧性损伤。56.9%的受害者患有创伤后应激障碍，31.1%的受害者出现缄默症。我们记录到6例（6）怀孕案例，占样本的2%。在性虐待72小时后采集的样本中记录到1例HIV感染病例。7.1%的案例要求进行三个月的HIV血清学检测，只有20%的儿童接受了抗逆转录病毒预防治疗。13.7%的案例使用强力霉素作为首选药物（75%）进行了抗生素预防治疗。只有29%的患者接受了紧急避孕孕激素治疗，仅有22%的儿童接受了心理护理。在法律方面，46%的患者提出了投诉。起诉率为38%，其中45%被定罪，21%被无罪释放。庭外和解率为35%，司法解决的平均时限为6个月，最短1个月，最长24个月。考虑到临床检查（无菌手套、导管、注射器）、分析和处方药所使用的耗材，护理的平均成本估计为17,010非洲法郎（26欧元）。
未成年人遭受性虐待是一个令人不安的现实，理所当然地引起了全球的谴责。在塞内加尔，这主要影响儿童，且多年来其规模在不断扩大。改善对受害者的支持必然需要通过媒体提高公众意识，并发展性虐待管理方面的专业机构。
