Violences sexuelles à l'hôpital Donka (Guinée)

Introduction. L'objectif de ce travail était de déterminer la prévalence, le profi l épidémiologique et clinique des victimes de violences sexuelles prises en charge au Centre Hospitalo-universitaire de Donka. Méthodes. Il s'agissait d'une étude rétrospective de type descriptif qui s'est déroulée du 01 Janvier2015 au 31 Décembre 2017à l'unité de médecine légale. Résultats. Sur un total de 1937 cas constituant l'ensemble des consultations en victimologie, 16% étaient descas de violence sexuelle.L'âge moyen des victimes était de 8 ansavec des extrêmes de 5 et 56ans et un écart type de 10,79.Dans la majorité des cas, l'agresseur était connu de la victime mais ne faisait pas partie de l'entourage familial direct (52,6%). Les victimes ont consulté majoritairement au cours des 5 premiers jours (55,8%) avec des extrêmes de 8heures et 30jours.Il s'agissait dans la majorité des cas des défl orations anciennes (54,2%). Conclusion : Nos résultats ne sauraient refl éter exactement l'ampleur du phénomène car la majorité des victimes préfère pour une raison ou une autre taire leur drame

Preparedness of civil society in Botswana to advance disability inclusion in programmes addressing gender-based and other forms of violence against women and girls with disabilities

Background: In low-income and middle-income countries women and girls with disabilities are more likely to experience violence than those without disabilities. Non-governmental organisations (NGOs) and disabled people's organisations (DPOs) can help to address this. However, in countries like Botswana we know little about the preparedness of NGOs and DPOs to increase inclusion in and access to programmes addressing violence. Objectives: To explore the capacity and preparedness of NGOs and DPOs to ensure that women and girls with disabilities can participate in and access programmes addressing violence. Methods: A qualitative study was undertaken using interviews with 17 NGOs and DPOs in Botswana to understand the organisations' level of and ability to deliver programmes addressing violence against women and girls. Results: Both NGOs and DPOs lack elements of universal design and reasonable accommodation, and thus are inaccessible to some people with disabilities. Some programmes address violence against women but lack skills and resources to accommodate people with disabilities. In contrast, DPOs work with people with disabilities, but lack focus on violence against women with disabilities. Participants identified opportunities to fill these gaps, including adaptation of policies and structural changes, training, approaches to mainstream disability across programmes, development of disability-specific interventions and improved networking. Conclusions: Botswana's NGOs and DPOs are well positioned to address violence against women and girls with disabilities, but need to increase their accessibility, staff knowledge and skills and disability inclusion. Training, resource allocation and participation of women with disabilities in NGOs and DPOs is needed to drive this change

Major interpersonal violence cases seen in a Pretoria academic hospital over a one-year period, with emphasis on community assault cases

Introduction: Interpersonal violence cases make up a significant portion of the trauma cases seen in emergency centres in South Africa. Community assaults are extremely violent attacks on suspected perpetrators by members of the community aimed at inflicting serious injury. The aim of this study was to profile the major interpersonal violence cases at Kalafong Hospital with emphasis on the community assaults and how this group compares with non- community assaults regarding demographics, surgical intervention and mortality. Methods: A retrospective analysis was conducted of the major interpersonal violence cases seen over a one-year period (1 January 2016 to 31 December 2016) at Kalafong Hospital, Pretoria, South Africa. Data was manually collected and entered into a Microsoft Excel spreadsheet. The Stata 13 statistical program was used for data analysis. Results: During the study period, a total of 578 cases were analysed. Penetrating trauma accounted for 446 (77.2%) cases and blunt trauma for 132 (22.8%) cases. The number of community assault cases was 75 (12.9%). A total of 28 deaths were recorded during this period. Community assaults accounted for 13 (46.4%) of these deaths. Community assault cases had a significantly higher mortality compared to non-community assault cases with 17.3% versus 3%; Odds ratio 6.82 (95% CI 3.04­15.33, p < 0.001). The community assault group also showed a statistically significant difference in the intensive care admission rate with 15.3% compared to 6.9% in the interpersonal violence cases; Odds ratio 2.41 (CI 1.07­5.43, p = 0.028). Conclusion: Community assault cases may present with similar demographics when compared to non-community assault cases, but the difference in disposition and outcome was highlighted in this study with a higher intensive care unit admission rate and a higher mortality rate. A multi-centre follow-up study is recommended to compare demographics across Pretoria and to monitor trends in this subgroup of interpersonal violence cases

Attitudes toward violence against women and the factors that affect them in Kutahya, Turkey

This cross-sectional descriptive study was conducted to determine the attitudes of women and men living in Kutahya, Turkey towards violence against women, and the factors that affect them. The data were collected using an Information Form for Women, an Information Form for Men, and the Attitude towards Violence Scale. The study was completed with 2959 participants; 1481 women and 1478 men. In the study, 41.3% of the women and 22.6% of the men reported being subject to violence. The mean score of the attitude towards violence scale was 41.57±11.83 for women and 49.38±11.52 for men (p<0.001). The mean scores on the attitude towards violence scale were found to be statistically significantly related to gender, education status, occupation, income status, co-educational status, co-occupation, marital age, family type, and subjection to violence (p<0.05). Socio-demographic and socio-cultural factors were found to influence the attitudes of women and men towards violence against women. The attitudes towards violence against women were found to be more positive in women. The rate of accepting violence as natural (acceptable) phenomena was found to be higher among men. That is, the attitudes of men towards violence against women are closer to the traditional approach, away from the modern approach

Cost analysis of violence-related medical imaging in a Free State tertiary trauma unit

Background: Violence is a leading public health problem worldwide. Beyond the pain and suffering, violence has a significant economic impact on a country's health, policing and judicial services. Because of the lack of current and comprehensive data in South Africa, local violence-related economic impact studies are largely estimations. Violence-related imaging expenditure, as a component of a public hospital's expenditure, is yet to be determined. Objectives: The goals of this study were to measure the violence-related patient burden on Pelonomi Tertiary Hospital's (PTH) trauma and radiology services, determine the imaging-component cost of violence-related injuries and calculate the financial burden violence has on the hospital's expenditures. Method: From the PTH's trauma unit patient registry, 1380 patients with violence-related injuries were consecutively sampled for 6 months ending 31 December 2017. Imaging investigations were documented and categorised according to the South African National Department of Health's 2017 Uniform Patient Fee Schedule (UPFS). Descriptive analysis and cost calculations were performed using the 2017 UPFS tariff schedule and hospital-specific health efficiency indicators ­ patient-day equivalent and expenditure per patient-day equivalent. Results: Violence-related injuries accounted for 50.64% of all trauma department visits and received a total of 5475 imaging investigations. Violence-related imaging investigations represented 14.81% of all investigations performed by the radiology department in the study period. Overall violence-related admission costs amounted to R35 410 241.85 (8.33% of the hospital's total expenditure), of which 20.08% (R7 108 845.00) was attributed to imaging investigations. Conclusion: Violence-related admissions had a high patient and financial burden on PTH. The pinnacle of healthcare cost saving is violence prevention; however, the cost-conscious radiologist could assist with cost saving if responsible and ethical imaging practices are followed

Expectations of youth victims of violence regarding health care professionals leading them to wellness in South Africa

Background: Many youth victims of violence report for treatment at the health care facilities in the Western Cape Province of South Africa. It was unclear what the youth expected regarding how they could be led towards wellness by health care professionals following an incident of violence (R1.1). Objectives: This study sought to explore and describe the expectations of the youth victims of violence with regards to health care professionals (R1.2) leading them to wellness in a selected rural community. Method: A qualitative; exploratory; descriptive and contextual design was used. Nine focus group discussions were conducted with 58 (23 males; 35 females) purposefully selected youth victims of violence between the ages of 15 and 19. Data analysis was done through open coding. Ethics clearance was received from the University Ethics Committee prior to the study being conducted. Results: Findings indicated that the youth victims of violence expect the health care professionals (professional nurses; doctors and social workers) working in their community to act as role models; demonstrate a professional attitude; provide health education; provide confidential counselling services; and establish school and community outreach programmes. Conclusion: This study provides evidence that youth victims of violence have important expectations from health care professionals concerning their wellness. Hence; health care professionals should focus on designing and implementing interventions targeting these expectations

Mistreatment among Undergraduate Medical Trainees: A Case Study of a Nigerian Medical School

Background: Several international studies have shown that abuse or mistreatment is a regular phenomenon faced by medical students. However; there is limited information on medical student abuse/mistreatment in Nigeria. The study was therefore conducted to assess the prevalence and patterns of mistreatment experienced by Medical Students in the University of Calabar. Materials and Methods: A descriptive cross-sectional study was conducted among 451 undergraduate medical trainees in the University of Calabar. Systematic sampling was used in recruiting participants into the study. A self-administered questionnaire was then employed to obtain information on patterns of mistreatment experienced by medical undergraduates. Data were analyzed using Statistical Package for Social Scientists version 19 and level of significance set at 0.05. Results: More than a third (35.5) of all respondents interviewed had experienced one or more forms of mistreatment during their training; with 38.5 of them experiencing it weekly. The most common form of mistreatment experienced was verbal abuse (52.5); and the main perpetrators of these incidents were medical consultants; (18.6) other cadre of doctors (17.3) and lecturers (14.4). Being in the clinical level of study and aged above 25 years were significantly associated with experiencing mistreatment in this study (P 0.05). However; only 8.8 reported these incidents. Conclusion: With more than a third of undergraduate medical trainees experiencing mistreatment; development of appropriate strategies for the prevention and reduction of these incidents are strongly recommended

Alcohol Consumption and High Risk Sexual Behaviour among Female Sex Workers in Uganda

Alcohol consumption has been associated with high risk sexual behaviour among key populations such as female sex workers. We explored the drivers of alcohol consumption and its relationship to high risk sexual behaviour. Participants were drawn from a cohort of 1 027 women selected from 'hot spots' in the suburbs of Kampala city. We conducted 3 in-depth interviews with 40 female sex workers between 2010 and 2011. Data were analysed thematically; focusing on alcohol use within the context of sex work. Alcohol consumption was very high with only seven women reporting that they did not drink. Alcohol consumption was driven by the emotional and economic needs of the participants; but also promoted by clients who encouraged consumption. Many sex workers only started drinking alcohol when they joined sex work on the advice of more experienced peers; as a way to cope with the job. Alcohol was blamed for unsafe sex; acts of violence and poor decision making which increased sexual and physical violence. Alcohol was reported to affect medication adherence for HIV-positive women who forgot to take medicine. The findings suggest that the drivers of alcohol consumption are multifaceted in this group and require both individual and structural interventions. Alcohol reduction counselling can be supportive at the individual level and should be an integral part of HIV prevention programmes for female sex workers and others such as patrons in bars. The counselling should be addressed in a sensitive manner to bar owners and managers

Association between Intimate Partner Violence and Utilisation of Maternal Health Services in Nigeria

This study examines the relationship between intimate partner violence and utilisation of maternal healthcare services. Data was extracted from the 2008 Nigeria Demographic and Health Survey. Data were analysed using the STATA. Results show that: 15.6 of the women have ever of the women have ever experienced at least one type of sexual violence; and 22.4experienced at least one type of physical violence; 4.1 of the women have ever experienced at least one type of emotional violence. The logistic regression show that women who have ever experienced emotional violence were: 24.2 less likely to utilise skilled antenatal care (OR=0.7578;p0.001); 36.0 less likely to have facility delivery (OR

Political and Socio-Economic Instability: does it have a Role in the HIV/AIDS Epidemic in Sub-Saharan Africa?

Many sub-Saharan African countries are confronted by the HIV/AIDS epidemic. This article reviews academic literature in the social sciences and health to discover why HIV/AIDS has become an epidemic in sub-Saharan Africa and not in other parts of the world. This was studied by examining the social determinants of diminishment of tradition and social cohesion in terms of political; social and economic problems. Four countries in this region were selected for this case study; namely South Africa; Botswana; Uganda and Zimbabwe. The findings showed that instability in socio-economic and political aspects in these nations was responsible for creating a suitable environment for the spread of HIV/AIDS infection. This paper concludes by using the theories of collective action/responsibility and social cohesion to hypothesise that the breakdown of social ties due to various kinds of conflicts and unrest is one of the main contributors to the HIV/AIDS epidemic

Experiences of Violence among Pregnant Women Attending Ante-Natal Clinics in Selected Hospitals in Abuja; Nigeria

Anecdotal records have shown that there is increasing prevalence of gender based violence in Nigeria. Little is known about the extent and magnitude of this phenomenon as it affects pregnant women. This study described the experiences of violence among pregnant women attending ante-natal clinics in Abuja; Nigeria using a cross-sectional design. A three-stage sampling technique was used to select 300 participants from six hospitals in the three out of the six Local Government Areas in the region. Data was collected using a pretested semi-structured questionnaire and analysed using descriptive statistics and chi-square tests. Forty three percent of the respondents had experienced at least one form of violence and 15.0 were experiencing violence in their current relationships. Main forms of violence ever experienced were psychological (38.0) and physical (36.4). Partners/husbands (70.2) and partner/husband relatives (29.8) were the perpetrators. Of the partner/husband's relatives; sisters-in-law (57.1) and partners' cousins (21.5) were the main perpetrators of the forms of violence experienced. Strategies employed to resolve violence conflict included dialogue with spouse (46.7); ignoring the experience (30.3); making up with sex (16.7); providing gifts and special dishes (5.0) and mediation by family members (1.3). Health promotion and education intervention strategies such as counselling; male involvement in sexual and reproductive health programs; advocacy for the promotion of women's health and right as well as use of appropriate culturally sensitive conflict resolution strategies are needed to ameliorate the situation

Views of Adolescents on Addressing Violence in Semi-Rural Secondary Schools in Mafikeng; North West Province

Background: Violence is a public health problem and often an issue of criminal justice.Violence in schools is a worldwide phenomenon and exposes adolescents to premature death. Purpose: The purpose of this study was to explore and describe adolescents' views on addressing violence in semi-rural secondary schools in Mafikeng. Research design and method: A qualitative; explorative; descriptive and contextual research design was utilised. Purposive sampling was used to select adolescents from semi-rural secondary schools in Mafikeng who fell between the ages of 13 and 20 years and who were involved in community youth groups or associations. In-depth focus group discussion using audiotape; reflexive notes and naive sketches were used for data collection. The central question which was asked was 'What are the adolescents' views on addressing violence in semi-rural secondary schools?' Data were analysed by means of open coding. Results: The results showed that adolescents understood the complexities associated with violence in this country; and they suggested multiple approaches and interventions. The adolescents were of the opinion that responsible communication patterns in the school environment could build healthy relationships between learners and educators and lead to a decrease in violence in the school setting. They also felt that enforcement of a secure teaching environment through encouragement of behavioural and attitudinal change guided by school codes of conduct and provision of firm security will help reduce violence in schools

Depression and exposure to violence among Venda and Northern Sotho adolescents in South Africa

Objective: Despite the high levels of violence in South Africa; a lacunae in research exists regarding the influence of violence exposure on children. This study investigated the correlation between children's exposure to violence and the development of psychological problems such as depression. Method: 186 Venda and 151 Northern Sotho adolescents were studied in a questionnaire survey to determine this relationship. Two measuring instruments were used: The Children's Depression Inventory and the Child Exposure to Violence Form. Results: When comparing gender; no significant differences were found in terms of overall exposure to violence between males and females. For depression; the total group of girls had a remarkably higher prevalence of depression. Regarding ethnic comparison; no significant differences were found in terms of overall exposure to violence or for witnessed events. However; the Venda adolescents had been victims significantly more often. Venda and Northern Sotho females had a similar prevalence of depression; but Northern Sotho boys had a higher depression rate than Venda boys. The correlation between victimisation and total group depression was relatively low for the Northern Sotho group; and non-existent for the Venda group. A significant correlation was found between total exposure to violence and depression for the overall group. Conclusion: This study indicates that adolescents' exposure to violence and subsequent mental health is an area of concern. However; adolescents could be taught effective coping and problem-solving techniques in schools to help empower them against stressors they might encounter

Risk factors for violence among long-term psychiatric in-patients: a comparison between violent and non-violent patients

Objective: The problem of the prediction of violence in psychiatric patients has led to a proliferation of research over the last decade. This study focuses on enduring patient related risk factors of violence; and investigates which long-term patients in Weskoppies Hospital (a specialist psychiatric hospital) are the most likely to commit violent acts. Method: Nursing statistics on violent incidents and other security breaches were collected for 262 long-term in-patients over a six month period (April - September 2007). The 41 patients who committed violent acts were compared to the 221 non-violent patients in terms of demographic and clinical variables; using two-way tables and Chi-Square or Fisher's Exact Tests. Results: The prevalence of violence among the long-term patients was 16. Fighting among patients was the most common form of violence (58). The most significant risk factors of violence among the long-term patients are: A diagnosis of mental retardation; first hospital admission before the age of 40 years; total hospital stay 12 years; current accommodation in a closed ward; habitual verbal aggression; absence of disorganised behaviour; and being clinically evaluated as unsuitable for community placement. Conclusion: The findings will help to identify those long-term patients most at risk of violence. The subgroup of patients with mental retardation is responsible for a disproportionately large number of violent acts in the hospital. The risk lies not so much in their psychiatric symptoms; but more in their cognitive ability; coping skills and inappropriate admission circumstances. Efforts should be directed - at a provincial level - towards their community placement

Epidemiology of Child Injuries in Uganda: Challenges for Health Policy

Globally; 90 of road crash deaths occur in the developing world. Children in Africa bear the major part of this burden; with the highest unintentional injury rates in the world. Our study aims to better understand injury patterns among children living in Kampala; Uganda and provide evidence that injuries are significant in child health. Trauma registry records of injured children seen at Mulago Hospital in Kampala were analysed. This data was collected when patients were seen initially and included patient condition; demographics; clinical variables; cause; severity; as measured by the Kampala trauma score; and location of injury. Outcomes were captured on discharge from the casualty department and at two weeks for admitted patients. From August 2004 to August 2005; 872 injury visits for children

The Prevalence and Health Implications of Violence in Impoverished Communities in Johannesburg

The experience of violent crime can have a significant impact on the physical and psychological well-being of victims and their families. This paper looks at household experience of violence in five impoverished sites in the city of Johannesburg; South Africa. Five sites were purposefully selected to reflect the prevailing housing profiles in settings of relative impoverishment in Johannesburg. A structured questionnaire was used to obtain information on demographic profiles; socioeconomic data; environmental conditions and health status. Bivariate analyses were conducted to assess the relationship between household experience of violence; and potential risk factors and health/social outcomes. Overall; members of 28of households had been a victim of violence in the year preceding the study. Across sites; experience of violence within households ranged from 21to 36. Perceptions of drug abuse (p=0.01) and drug peddling (p=0.03) as being major problems in the neighbourhood; and living in a house of poor quality (p=0.01); were significantly associated with household experience of crime. In households with experience of violence; fear of crime (p=0.03) and depression (p 0.001) were elevated; and levels of exercise in men were decreased (p

The Prevalence and Health Implications of Violence in Impoverished Communities in Johannesburg

Abstract:The experience of violent crime can have a significant impact on the physical and psychological well-being of victims and their families. This paper looks at household experience of violence in five impoverished sites in the city of Johannesburg; South Africa. Five sites were purposefully selected to reflect the prevailing housing profiles in settings of relative impoverishment in Johannesburg. A structured questionnaire was used to obtain information on demographic profiles; socioeconomic data; environmental conditions and health status. Bivariate analyses were conducted to assess the relationship between household experience of violence; and potential risk factors and health/social outcomes. Overall; members of 28 of households had been a victim of violence in the year preceding the study. Across sites; experience of violence within households ranged from 21 to 36. Perceptions of drug abuse (p=0.01) and drug peddling (p=0.03) as being major problems in the neighbourhood; and living in a house of poor quality (p=0.01); were significantly associated with household experience of crime. In households with experience of violence; fear of crime (p=0.03) and depression (p 0.001) were elevated; and levels of exercise in men were decreased (p

Pattern of Injury among Students of the University of Calabar; Nigeria; Following a Violent Clash with Youths of the Neighbouring Community

Accidental traumatic injuries involving students of the University of Calabar; Nigeria and their neighbouring community were studied. The objectives of this study were to determine the body parts affected and to evaluate the type of injury sustained. The results indicate that most of the injuries were lacerations (open wound) involving the wrist/hand/finger and head; but the severest injuries (fractures and crush injury) were those incurred following assault with the axe. Males were more vulnerable than females in a ratio of 4:1. Committed professional awareness of accidental traumatic injury as a clinical-cum-public health problem; development of institutional/community based injury prevention programmes in requisite settings; and mass casualty coping disposition in health care delivery outfits serving tertiary educational institutions are recommended in the face of increasing youthful restiveness globally

Soft Tissue Injuries of the Face in Port Harcourt; Nigeria

Background: This study was carried out in Port Harcourt the centre of several violent activities in the Niger Delta Region of the South-South GeoPolitical Region in Nigeria. In addition; assaults; road traffic accidents and other causes of injuries are common in this environment. Aim: To determine the pattern of soft tissue injuries to the face as seen in the Accident and Emergency Department of the University of Port Harcourt Teaching Hospital. Methods: A retrospective study of all soft tissue injuries to the face seen and managed in the Accident and Emergency Department of the University of Port Harcourt Teaching Hospital from January to December; 2004. Results: A total of 159 cases were studied during this period. Males were 62.9and females (37.1); a ratio of 1.7: 1. Laceration was the commonest type of injury (44.7). Human bite was the commonest cause of injury (33) and RTA was next (31). The forehead was the most injured part of the face (21). Males had more lacerations (75) and were injured more by road traffic accident (78) while females had more human bite (57). Conclusion: Laceration was found to be the commonest type of injury while human bite was the commonest cause. Injuries to the face are very conspicuous and disfiguring. They should be treated very meticulously and comprehensively by the experts

Lifetime Experience and Management of Cases of Gender-Based Violence in the Health Facilities of Kabarole District; Uganda

Gender-based violence (GBV) is a common problem in many countries; leading to high levels of mortality and morbidity; especially of women. In the health sector; GBV presents in a cryptic manner due to fear by the victims; poor records; culture; inadequate staffing and inadequate equipment. In developing countries; there is also a lack of policies; standards and guidelines for case management. As a result; GBV cases are never recognized and are poorly managed. This study set out to assess the management of GBV victims in health facilities of Kabarole District; western Uganda. It aimed at profiling the common forms of GBV; the lifetime experience of GBV by ordinary residents; the accessibility of health services to GBV victims; the health services rendered to them and to analyse inter-sectoral collaboration on GBV issues. A descriptive cross-sectional study involving 400 respondents; 40 key informants and 2 FGDs was done in May and June 2006. Over 96of the respondents had ever experienced a form of GBV and women were more likely to have experienced it than men. Most were likely to have experienced physical violence. Female respondents were more likely to have abused their victims verbally while the males were more likely to have abused them physically. Most cases of GBV were domestic and were never reported to any authorities or to the health system unless they had led to severe physical injury. This was due to cultural restrictions on discussing domestic matters publicly. GBV survivors also often lacked funds for transport and processing the cases either with the health services; local authorities or police. They reported long waiting times at health facilities; absence of staff; lack of privacy and lack of medicines as the common problems they faced at health facilities. The range of health care services provided to GBV survivors was very narrow and mostly on request by the police. Apart from being insufficient and absent; health workers were not trained in screening for GBV; management of cases and conducting forensic investigations. They did not probe actively for possible history or evidence of GBV and the data were never disaggregated within the HMIS. Intersectoral collaboration on GBV was limited to preparing police dossiers and court testimony. The paper recommends the formulation of a national policy on GBV; and the setting up of standards and guidelines for case management in the health sector. It also recommends adequate equipment of district level facilities for sufficient forensic investigations as well as training of health workers in case management including counseling. It recommends institutionalization of GBV data collection through revision of the HMIS and Continuing Medical Education. Finally; it recommends wider inter-sectoral collaboration in order to enhance prevention of GBV at community level