Missed treatment opportunities and barriers to comprehensive treatment for sexual violence survivors in Kenya: a mixed methods study
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...
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| Format: | Article |
| Language: | English |
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BMC
2018-06-01
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| Series: | BMC Public Health |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12889-018-5681-5 |
| _version_ | 1811278036613464064 |
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| author | Anne Gatuguta Katherine G. Merrill Manuela Colombini Seyi Soremekun Janet Seeley Isaac Mwanzo Karen Devries |
| author_facet | Anne Gatuguta Katherine G. Merrill Manuela Colombini Seyi Soremekun Janet Seeley Isaac Mwanzo Karen Devries |
| author_sort | Anne Gatuguta |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-13T00:27:30Z |
| format | Article |
| id | doaj.art-198d27ebea4d4899bef292eefa1637bc |
| institution | Directory Open Access Journal |
| issn | 1471-2458 |
| language | English |
| last_indexed | 2024-04-13T00:27:30Z |
| publishDate | 2018-06-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Public Health |
| spelling | doaj.art-198d27ebea4d4899bef292eefa1637bc2022-12-22T03:10:33ZengBMCBMC Public Health1471-24582018-06-0118111810.1186/s12889-018-5681-5Missed treatment opportunities and barriers to comprehensive treatment for sexual violence survivors in Kenya: a mixed methods studyAnne Gatuguta0Katherine G. Merrill1Manuela Colombini2Seyi Soremekun3Janet Seeley4Isaac Mwanzo5Karen Devries6Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical MedicineDepartment of International Health, Johns Hopkins Bloomberg School of Public HealthDepartment of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical MedicineFaculty of Epidemiology and Public Health, London School of Hygiene and Tropical MedicineDepartment of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical MedicineDepartment of Community Health, School of Public Health, Kenyatta UniversityDepartment of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical MedicineAbstract 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.http://link.springer.com/article/10.1186/s12889-018-5681-5Sexual violenceHealthcareHIV PEP-Kenya |
| spellingShingle | Anne Gatuguta Katherine G. Merrill Manuela Colombini Seyi Soremekun Janet Seeley Isaac Mwanzo Karen Devries Missed treatment opportunities and barriers to comprehensive treatment for sexual violence survivors in Kenya: a mixed methods study BMC Public Health Sexual violence Healthcare HIV PEP-Kenya |
| title | Missed treatment opportunities and barriers to comprehensive treatment for sexual violence survivors in Kenya: a mixed methods study |
| title_full | Missed treatment opportunities and barriers to comprehensive treatment for sexual violence survivors in Kenya: a mixed methods study |
| title_fullStr | Missed treatment opportunities and barriers to comprehensive treatment for sexual violence survivors in Kenya: a mixed methods study |
| title_full_unstemmed | Missed treatment opportunities and barriers to comprehensive treatment for sexual violence survivors in Kenya: a mixed methods study |
| title_short | Missed treatment opportunities and barriers to comprehensive treatment for sexual violence survivors in Kenya: a mixed methods study |
| title_sort | missed treatment opportunities and barriers to comprehensive treatment for sexual violence survivors in kenya a mixed methods study |
| topic | Sexual violence Healthcare HIV PEP-Kenya |
| url | http://link.springer.com/article/10.1186/s12889-018-5681-5 |
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