Physical, emotional and sexual child abuse victimisation in South Africa: Findings from a prospective cohort study

Background: Child abuse in South Africa is a significant public health concern with severe negative outcomes for children; however, little is known about risk and protective factors for child abuse victimisation. This thesis investigates prevalence rates, perpetrators, and locations as well as predictors of physical, emotional and sexual child abuse victimisation. It also examines the influence of potential mediating and moderating variables on the relationships between risk factors and child abuse.
Methods: In the first study, a systematic review of correlates of physical, emotional and sexual child abuse victimisation in Africa was conducted. The review synthesised evidence from 23 quantitative studies and was used to inform the epidemiological study. For study two to four, anonymous self-report questionnaires were completed by children aged 10-17 (n=3515, 57% female) using random door-to-door sampling in rural and urban areas in two provinces in South Africa. Children were followed-up a year later (97% retention rate). Abuse was measured using internationally recognised scales. Data were analysed using descriptive statistics, multivariate logistic regressions, and mediator and moderator analyses.
Results: The first study, the systematic review, identified high prevalence rates of abuse across all African countries. It identified a number of correlates which were further examined using the study data from South Africa. The second study found lifetime prevalence of abuse to be 54.5% for physical abuse, 35.5% for emotional abuse, 14% for sexual harassment and 9% for contact sexual abuse. Past year prevalence of abuse was found to be 37.9% for physical abuse, 31.6% for emotional abuse, 12% for sexual harassment and 5.9% for contact sexual abuse. A large number of children experienced frequent (monthly or more regular) abuse victimisation with 16% for physical abuse, 22% for emotional abuse, 8.1% for sexual harassment and 2.8% for contact sexual abuse. Incidence for frequent abuse victimisation at follow-up was 12% for physical abuse, 10% for emotional abuse and 3% for contact sexual abuse. Perpetrators of physical and emotional abuse were mostly caregivers; perpetrators of sexual abuse were mostly girlfriends/boyfriends or other peers.
The third study found a direct effect of baseline household AIDS-illness on physical and emotional abuse at follow-up. This relationship was mediated by poverty. Poverty and the ill-person’s disability fully mediated the relationship between household other chronic illnesses and physical and emotional abuse, therefore placing children in families with chronic illnesses and high levels of poverty and disability at higher risk of abuse.
The fourth study found that contact sexual abuse in girls at follow-up was predicted by baseline school drop-out, physical assault in the community and prior sexual abuse victimisation. Peer social support acted as a protective factor. It also moderated the relationship between baseline physical assault in the community and sexual abuse at follow-up, lowering the risk for sexual abuse victimisation in girls who had been physically assaulted from 2.5/1000 to 1/1000.
Conclusion: This thesis shows clear evidence of high levels of physical, emotional and sexual child abuse victimisation in South Africa. It also identified risk and protective factors for child abuse victimisation which can be used to inform evidence-based child abuse prevention interventions.

Keywords: systematic review
risk factors
HIV
South Africa
prevalence
predictors
incidence
adolescents
child maltreatment
child abuse
sub-Saharan Africa
correlates
children
Advisor: Cluver, L
Boyes, M