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

Gatuguta, Anne, Merrill, Katherine G, Colombini, Manuela, Soremekun, Seyi, Seeley, Janet, Mwanzo, Isaac and Devries, Karen (2018) Missed treatment opportunities and barriers to comprehensive treatment for sexual violence survivors in Kenya: a mixed methods study. BMC Public Health, 18 (769). ISSN 1471-2458

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Background:In Kenya, most sexual violence survivors either do not access healthcare, access healthcare late or donot complete treatment. To design interventions that ensure optimal healthcare for survivors, it is important tounderstand the characteristics of those who do and do not access healthcare. In this paper, we aim to: comparethe characteristics of survivors who present for healthcare to those of survivors reporting violence on nationalsurveys; 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 werecompared with national-level data from the Kenya Demographic and Health Survey 2014, and the Violence AgainstChildren Survey 2010. Descriptive summaries were calculated and differences in characteristics of the survivorsassessed using chi-square tests. Qualitative data from six in-depth interviews with healthcare providers wereanalysed thematically.

Results:Among the 543 hospital respondents, 93.2% were female; 69.5% single; 71.9% knew the perpetrator; and69.2% were children below 18 years. Compared to respondents disclosing sexual violence in nationallyrepresentative datasets, those who presented at hospital were less likely to be partnered, male, or assaulted by anintimate partner. Data suggest missed opportunities for treatment among those who did present to hospital: HIVPEP and other STI prophylaxis was not given to 30 and 16% of survivors respectively; 43% of eligible women didnot receive emergency contraceptive; and, laboratory results were missing in more than 40% of the records. Thoseaged 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 stafftraining, missing equipment and poor coordination of services.

Conclusions:Nationally, survivors at higher risk of not accessing healthcare include older survivors; partnered orever partnered survivors; survivors experiencing sexual violence from intimate partners; children experiencingviolence in schools; and men. Interventions at the community level should target survivors who are unlikely toaccess healthcare and address barriers to early access to care. Staff training and specific clinical guidelines/protocolsfor treating children are urgently needed.

Item Type: Article
Keywords: Sexual violence, Healthcare, HIV PEP-Kenya
Schools and Departments: Brighton and Sussex Medical School > Global Health and Infection
Research Centres and Groups: Wellcome Trust Brighton and Sussex Centre for Global Health Research
Depositing User: emma louise Bertrand
Date Deposited: 28 Jun 2018 11:46
Last Modified: 28 Jun 2018 11:46
URI: http://srodev.sussex.ac.uk/id/eprint/76780

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