PAGE 1

An overview of child sexual abuse

research conducted in low- and
middle-income countries between
2011-2021

MAY 2022
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Table of Contents
ACKNOWLEDGEMENTS 3
ABBREVIATIONS 3
EXECUTIVE SUMMARY 4
I. BACKGROUND 5
II. METHODOLOGY 5
Search strategy and study selection 5
Criteria for inclusion and exclusion 5
III. OVERVIEW OF STUDIES 7
IV. RESEARCH KEY FINDINGS 8
A.Epidemiology Studies 8
B.Intervention Studies 11
C.Methodology and Ethics Studies 15
D.Theory and Framework Studies 16
V. COMMENTARY 17
Geographical Representation in CSA Research 17
Methodological Gaps: Defining and Measuring CSA 18
Intersectional Research 18
Feminist Perspective 18
Gaps 19
VI. CONCLUDING REMARKS 20
REFERENCES 21
APPENDIX I 35
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Acknowledgements
This report is part of a project on strengthening and clarifying SVRI’s work on violence against
children and child sexual abuse that has been made possible by the generous support of the
Oak Foundation.

Thank you to Ayesha Mago for her inputs into this review.

Authors
Nicole Gonzalez, Anik Gevers, and Elizabeth Dartnall.

Citation
Gonzalez, N., Gevers, A, & Dartnall, E. (2022) An overview of child sexual abuse research
conducted in low and middle income countries between 2011-2021. Sexual Violence Research
Initiative. Pretoria, South Africa.

Abbreviations
CSA Child Sexual Abuse

LMIC Low and Middle Income Country

SVRI Sexual Violence Research Initiative

VAC Violence Against Children

VAW Violence Against Women

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Executive Summary
To strengthen our understanding of what kinds of child sexual abuse research is coming from
low and middle income countries we conducted a brief scoping review of studies published over
the past 10 years.

One hundred and ninety four studies were included in this review based on a search of the
MEDLINE (PubMed) database. The majority of articles were epidemiological studies (n=146) and
the remaining articles included intervention studies, methodology and ethics work, and theory
and frameworks articles. Most publications were based on research conducted in the Sub-
Saharan Africa region (n=98) and the fewest publications were from the East Asia and Pacific
region.

The review revealed that there is no cohesive body of evidence and that there seems little
connection between, for example, epidemiological research and intervention research. Further,
very little of the epidemiological research focused on identifying the risk and protective factors
for child sexual abuse including the drivers of perpetration and more analysis of the norms,
systems, and social structures that impact and influence child sexual abuse. The review found
several methodological gaps in the evidence base as studies utilized different definitions of child
sexual abuse, a variety of measurements for child sexual abuse, and at times grounding in ethics
was not clear. Few studies were intersectional (n=25).

More priority-driven child sexual abuse research is needed from low and middle income
countries with clear links to policy and practice. A clear, shared research agenda is needed to
guide the field toward building a cohesive evidence base as well as capacity strengthening to
address methodological and ethics issues of this research. This research should be
intersectional in order to build a nuanced understanding of child sexual abuse across diverse
and particularly marginalised or vulnerabilised groups. There is evidence on the mental health
impact of child sexual abuse but few studies evaluated interventions that addressed these
outcomes among survivors. Research that will improve our understanding of the drivers, risk
factors, and protective factors for different forms of child sexual abuse – including perpetration
of this violence – is needed to inform prevention intervention strategies.
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I. Background
The child sexual abuse (CSA) evidence base is dominated by research from high income
countries (HICs) [1]. One of SVRI’s priorities is to strengthen research in low- and middle-
income countries (LMICs). Therefore, to strengthen our understanding of what kinds of CSA
research is coming from LMICs we conducted a scoping review of literature published over
the past 10 years.

II. Methodology
Search strategy and study selection
The search terms included keywords for child sexual abuse, LMIC names, and language
parameters (abstracts in English, Spanish, French, or Arabic were included). Keywords were
combined into a phrase including Boolean (AND, OR) terms as illustrated in Appendix I.

Criteria for inclusion and exclusion

The following inclusion and exclusion criteria were used to screen search results and select
studies for the review.

Inclusion criteria:
• Articles published in English, French, Spanish, Arabic
• Articles published between January 2011- January 2021 (in the last 10 years)
• Studies that included children: ages 0-18 years old (all person's age 0 to 18 years
(including infants, toddlers, young children, children, adolescents, teenagers) of all
gender and sexuality identities (girls, boys, non-binary, intersex, LGBTQI+, etc.) and from
any population group within a (or several) LMIC(s)
• Studies about child sexual abuse: all types of sexual abuse, sexual violence, sexual
exploitation, sexual harassment, grooming
• Research conducted in LMIC(s) - utilizing World Bank Group’s criteria of LMIC(s)

Exclusion criteria:
• Articles published in languages other than English, French, Spanish, or Arabic.
• Articles published before January 2011
• Studies that do not include any form of CSA
• Studies where CSA was not disaggregated in reporting from other forms of violence
• Studies conducted in HIC(s)
• Studies where data from children were grouped together with adults who experienced
sexual violence during adulthood without disaggregating the data by age (such as VAWG)
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Figure 1. Abstract Review

Search Yielded 635 Results

Title Screening:
Excluded 386, Included 249

• Excluded:
• 221 focused on populations in HIC (57%)
• 165 were not about CSA (43%)

Abstract Screening:
Excluded 55, Included 194

• Excluded:
• 33 did not disagregate data between
adults and children who experienced
sexual violence (60%)
• 18 did not disagregate data between type
of violence experienced (33%)
• 2 included both HIC and LMICs without
disagregating data (3,5%)
• 2 were not a study (3,5%)

194 Articles Included in Review

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Limitations
An optimal systematic review would include a search of multiple databases including Embase,
MEDLINE, Web of Science Core Collection, and Google Scholar[2]. This study was not designed
to be a systematic review of the state of evidence of CSA but rather a scoping review to enable
the extraction of some key trends in published CSA research from LMICs. Given the time and
resources available to conduct this scoping review, only MEDLINE (PubMed) was searched for
this review. The results of the review should be read with these limitations in mind.

III. Overview of Studies

194 articles were included in the scoping review. Overall, most studies (~76%) were
epidemiological, focusing on understanding the nature, extent, risks or impact of CSA. Within
the interventions theme, there were a similar number of response intervention studies (22) and
prevention intervention studies (14). There were some methodological/ethics studies (10), and
two theory/framework studies. Studies included in the methodology and ethics theme focused
on improving or testing methodology regarding CSA research while studies characterized under
theory/framework theme utilized new theories to study cases of CSA and/or analyzed current
frameworks to prevent or respond to CSA. Table 1 summarises the number of papers according
to the type of study and its region.

Table 1: Number of Articles per Region and Theme

Epidemiology Interventions Methodology Theory and N (%)
and Ethics Frameworks
Sub-Saharan 71 22 2 1 96 (49%)
Africa
Middle East and 40 9 6 0 55 (28%)
North Africa
South Asia 13 2 2 0 17 (9%)

Latin America and 13 0 0 0 13 (7%)

Caribbean
Europe and 2 3 0 1 6 (3%)
Central Asia
East Asia and the 3 0 0 0 3 (2%)
Pacific
Multi-regional 4 0 0 0 4 (2%)

N (%) Total 147 (76%) 36 (18%) 10 (5%) 2 (1%) 194 (100%)

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IV. Research Key Findings

A. Epidemiology Studies
Research in this theme focused on understanding the extent, nature and consequences of CSA
(impact, risk and protective factors, prevalence, and incidence studies). As mentioned earlier,
epidemiology focused studies were by far the largest theme. Studies in this theme were further
subcategorized into the following groups:
• impact/consequences
• risk and protective factors
• prevalence and incidence.

The majority of the studies were based on impact of CSA on study participants (n=73) followed
by risk and protective factor studies (n=48) which focused on participant characteristics that
increased or decreased the risk of experiencing CSA.

Studies focusing on Impact and Consequence: Impact studies largely focused on consequences
or impacts of CSA on study participants who experienced CSA. The majority of these studies
looked at the associations between mental health and CSA, with exposure to CSA linked with
higher rates of PTSD, depression and anxiety [3-30]. The relationship between CSA and risky or
maladaptive behaviors among children and adults who experienced CSA was the focus of the
next largest group of studies [31-49], including studies on the risk of contracting HIV in
childhood or adulthood [35, 39, 40, 48, 50], developing an eating disorder [36, 38], and
engaging in substance use after experiencing CSA [42-45]. Studies on the physiological impacts
of CSA exposure was the third largest group [51-61]. Four of these studies looked at cortisol
levels in individuals who experienced CSA [51, 55, 60, 61]. A select number of studies researched
the impact on community and support systems [62-68], coping strategies [69], and pregnancy
outcomes of women who experienced CSA [59]. Lastly, a few studies described specific cases,
their characteristics, and their outcomes [70-75]. Two articles included involved incest as a form
of CSA [43, 73].

Risk and Protective Factors Studies: Studies on risk and protective factors for CSA victimization
formed the second largest sub-theme within the epidemiology theme. This subtheme referred
to studies that looked at factors that increased children’s risk of experiencing CSA or at factors
that protected children from experiencing CSA. Overall, more studies that focused on the risk
factors rather than protective factors for CSA. Common topics found within this sub-theme
included: familial and gender factors, school environments, common risk and protective factors
associated with CSA victimisation, and social norms that deter reporting. Most of these studies
investigated familial, gendered factors including [76-85]: lack of adequate parental care,
community patriarchal attitudes, biological parental separation and remarriage, and alcohol
abuse within the family. Studies on child sexual exploitation including online sexual abuse were
also part of this group [86-91] as were studies which discussed the associations between the
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family’s socio-economic status and CSA [88, 89, 92, 93]. A multi-country study found no
association between socio-economic status and CSA; they reported that adolescents
experienced CSA regardless of socio-economic status [93].

Additionally, two studies looked at lifetime prevalence of CSA [94, 95]. While both studies found
that girls were more likely to experience violence throughout their lifetime, one study found
that younger girls are at greater risk of experiencing sexual violence compared to older girls /
young women [95]. Another study found that boys who had previously experienced CSA had a
higher likelihood of experiencing CSA again [91]. In a cross-sectional study, many adolescent
girls and young women reported that their first sexual experience was forced sex and that this
experience was often associated with emotional violence [96]. Another study looked at
children’s own feelings of self-efficacy and how this impacts their risk of experiencing CSA, the
study found that children with lower feelings of self-efficacy were more at risk of experiencing
CSA compared to those with higher self-efficacy [97]. Lastly, two studies looked at the potential
of specific styles of caregiving as protective factors [98, 99]. In these studies, one found that
positive, supervisory caregiving and food security served as protective factors [98] while the
other found that there was in increase in communication about sex by youth to mothers who
previously experienced CSA that could also serve as a protective factor [99]. Three studies
looked at associations between CSA and early forced marriages [100-102]. One study applied
environmental criminology to CSA by studying the location of victims, crime scenes, and
distances among them to predict possible future offences of CSA [103]. Other studies looking
at characteristics of CSA also found that the majority of cases were perpetrated by an adult
male [104, 105]. Similarly, a nationally representative study looked at the characteristics of
pedophiles in Turkey and found that 97,4% of perpetrators were male [106].

The second largest sub-theme within the epidemiological studies were studies investigating the
risks of CSA among high risk or marginalized groups (e.g. orphaned children living in residential
facilities and/or street-living children). Studies found that girl children were more likely to be
orphaned [107-109] and orphaned children were at higher risk of experiencing CSA [107-111].
However, a systematic review found no statistically significant risk of experiencing CSA between
children who had been orphaned compared to non-orphaned counterparts in sub-Saharan
Africa. The authors note that due to inconsistent data reporting and quality, these findings
should be interpreted with caution [112]. One of these studies on orphaned children included
the experiences of feminised men in Pakistan [111]. The majority of these interviews described
experiencing sexual abuse as a child and moving into sex work to find financial and extra-familial
support [111]. Three studies focused on children with disabilities and their risk of experiencing
CSA and found that children with intellectual disabilities were more at risk of experiencing
penetrative abuse and more frequent abuse than children without intellectual disabilities [113-
115].

Factors influencing disclosure of CSA were explored by three studies. These studies found that
half of the children delayed disclosing their abuse due to fear of their caregiver’s reaction [116-
118].
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Only one study looked at the risk of CSA in schools [119]. This study found that the majority of
CSA experienced in schools was perpetrated by an adult [119]. As for research on protective
factors, studies investigated schools as a protective factor especially for girls, and found that
girls who had previously experienced CSA and were not in school were most at risk of
experiencing CSA [120].

Three studies investigated adolescent boys’ and girls’ knowledge, attitudes and risk behaviour
related to CSA. One study found that adolescent girls reported higher levels of forced sex than
adolescent boys and that related risk behaviours were also high; the authors suggested that
interventions within the school system should be strengthened to address these issue [121].
Another study found that adolescent boys reported more positive views about forced sex than
girls associating it with a variety of constructs including signs of love, a way to satisfy sexual
desires, an expectation if a female partner is financially dependent on a male partner, and as a
way to punish a female partner [122]. These boys also had less knowledge on the consequences
of forced sex. One study looked at sex trafficking knowledge and attitudes among adolescent
girls and found that while most were aware of sex trafficking from media sources (e.g.: radio,
television), not all understood the various risk factors associated with sex trafficking [123].

Prevalence and incidence of CSA: The third largest subtheme of epidemiology studies focused
on prevalence of CSA (n=26). The largest topic of interest within these studies included a
comparison of the prevalence of CSA between the sexes [124-128]. Some of these studies
reported that girls experienced more sexual victimization than boys [129], whereas other
studies reported that boy children experienced more forced touch or were forced to touch or
look at an abuser’s private parts more than girl children [128, 130]. The next largest topic among
prevalence studies were multi-country studies comparing the prevalence of CSA [131-135].
While all of these studies (n=4) utilized questionnaires to measure lifetime prevalence, the
definitions of CSA and tools used varied. Two of these studies use a broad definition of CSA
including both contact abuse (i.e. physical contact between the child and the abuser) and
exposure abuse (e.g. exposure to pornography) [131, 133]. The other two studies defined CSA
solely as unwanted intercourse during childhood [134, 135] with one making a distinction
between unwanted intercourse from a partner and non-partner [135]. Lastly, one of the studies
defined CSA as any unwanted contact abuse [133]. One study investigated experiences of CSA
across socio-economic status and found no significant association and concluded that CSA
occurred across wealth groups, education status, and area of settlement (urban vs rural) [134].

There were three nationally representative studies from South Africa, Zimbabwe, and Vietnam
[136-138]. All three studies used a household questionnaire for data collection and the studies
in South Africa and Vietnam defined CSA as both contact abuse and exposure abuse [136, 138]
while the study in Zimbabwe defined CSA as only contact abuse [137]. The studies in South
Africa and Zimbabwe both asked about lifetime experience of CSA and past year CSA while the
Vietnam study compared the experience of CSA over 10 years by comparing data from 2004
and 2014. The South Africa study surveyed 5,631 households and found that 9,99% of boys and
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14,61% of girls reported some lifetime sexual victimization [136]. The Zimbabwe study surveyed
7,797 households and included 567 women and 589 men: 32,5% and 8,9% respectively reported
experiencing CSA [137]. Lastly, the study in Vietnam concluded an increase in CSA prevalence
from the year 2004 to 2014 among older adolescents [138].

Two studies looked at cases in smaller populations and recommended further studies to
calculate the prevalence of CSA in their countries [139, 140]. There was one study that
compared the differences in past year incidence of CSA in five countries (Cambodia, Haiti,
Kenya, Malawi, and Tanzania) based on age and gender [141]. The study found that female
adolescents experienced CSA at higher rates than male adolescents in every country. Risk of
sexual violence increased with age for males in Kenya (OR=1.332, p<0.01) and Tanzania
(OR=1.81, p<0.05). In Haiti, the odds of experiencing sexual violence increased with age similarly
for males and females [141].

There were two studies that looked at incestuous cases of CSA [142, 143]. One of these studies
focused on high school students and found that more than half of the incidents occurred in the
home, involved penetration, and children knew their abuser [143].

The other articles within this sub-theme studied the prevalence of reporting for children who
experienced CSA [144] as well as the services available to CSA victims [145]. Others studied the
prevalence of CSA during armed conflict [146], compared experiences of sexual violence during
trafficking (children vs older women) [147], measured the prevalence of physical and or sexual
abuse among street-living children [148].

The other articles within this sub-theme studied the prevalence of reporting for children who
experienced CSA [144] as well as the services available to CSA victims [145]. Others studied
the prevalence of CSA during armed conflict [146], compared experiences of sexual violence
during trafficking (children vs older women) [147], measured the prevalence of physical and
or sexual abuse among street-living children [148].

B. Intervention Studies
Intervention studies were the second largest theme accounting for approximately 18% (n=36)
of studies in this review. There were slightly more response intervention studies than there
were prevention intervention studies.

• Response Interventions
The majority of response intervention studies analyzed the effectiveness of current or recent
CSA response services and many evaluations indicated that current CSA services were
inadequate. Various types of response services were the subject of research, including:

• Mental health services [149-151]

• Justice sector responses: law enforcement [152, 153] and legal systems [154-157]
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• Health sector responses: physician education [158-160] and attitudes of medical

professionals [161]
• Integration of and access to CSA services [162-166]
• Reponse interventions: guidelines [167, 168], recommendations [169], and methods to
increase disclosure [170]

Mental health services: Studies on current mental health services found that mental health
services do not satisfactorily support children’s recovery and care after CSA [149-151]. One
study looked at mental health services provided to children after reporting CSA in South Africa
and found that the current services are not sufficient for adequate recovery [151]. Other
studies in Turkey and South Africa evaluated receiving immediate psychiatric help after report
of CSA as well as therapy before trial respectively. Both found that immediate psychiatric
health and pre-trial therapy were necessary for an adequate recovery after report of CSA [149,
150].

Justice sector responses: Two studies that assessed law enforcement responses to CSA reports
found that they did not meet families’ needs [152, 153]. Other studies explored current laws
and screening processes to identify cases of non-violent CSA (cases that are thought of as
consensual but involve a child and a perpetrator over the age of 18 years) [155], protective and
supportive legal injunctions for children exposed to CSA [154], and the legal criteria used to
decide punishment for perpetrators of CSA [156]. Another study analyzed current government
frameworks in Zimbabwe, specifically the Victim Friendly Courts, to understand the
management of intrafamilial CSA cases [157].

Health sector responses: Two studies noted the need for physicians to receive additional
training to adequately identify CSA [158, 159]. One of these studies, however, found that only
one third of physicians were interested in receiving more training [159]. A study on medical and
non-medical students’ attitudes towards survivors of sexual violence found that many (abut
two thirds) had negative attitudes about survivors (would not want them to supervise or marry
their [students’] child or be friends with a survivor) [161]. Lastly, a study from Pakistan provided
examples for practitioners to create strong doctor-patient relationships as well as tactics to
encourage the CSA survivor (child) and non-offending accompanying adult caregiver to continue
treatment, specifically for cases where the father is the perpetrator and the mother is financially
dependent on the father. Such tactics included encouraging the inclusion of another trusted
family member to bring the child to treatment when the mother is not able to or discussing the
addition of a lock to the child’s bedroom door [160].

Integration of and access to CSA services: There were two interventions that integrated
support for CSA survivors, preventing HIV, and connecting participants to sexual and
reproductive health services [162, 163]. Additional studies categorized in this sub-theme
included a comparison of care requirements for children who were raped vs children who
consented to sex [164], an expression through art intervention for adoelscent girls who
experienced CSA where intervention value was measured [165], and a third study conducted
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an analysis of families’ utilization of coping mechanisms (both internal and external) in dealing
with their child’s experience of CSA [166].

Intervention guidelines and recommendations: Two studies provided a set of guidelines [167,
168]. The first provided suggestions for other aspects to consider when expert medical
examination does not confirm CSA [168]. These examples are meant to reduce the discomfort
of medical witnesses and improve quality of expert medical testimony [168]. The second
provided guidelines for stakeholders working with mothers of sexually abused children [167].
Guidelines included: a social-ecological model (SEM) detailing factors that affect mothers of
children who experience CSA as well as details in each level explaining the factors and what is
recommended to help mothers [167]. Intervention recommendations based on a previous CSA
case perpetrated by a religious leader included providing intervention after CSA as soon as
possible and a longer follow-up period as psychological consequences can carry on into
adulthood [169].

CSA disclosure interventions: Among studies that reviewed methods to increase reporting, one
study tested two methods of disclosure among primary school children: the face-to-face-
interview (FTFI) method and the sealed-envelope method (SEM). The study found that the SEM
method was superior to FTFIs in identifying cases of forced sex, particularly for boys [170].

• Prevention Interventions
Prevention intervention included family-based interventions [171-173], school-based
interventions [174-178] and community-based interventions [179]. Some studies evaluated
current prevention interventions [180, 181] or provided implications for future prevention
interventions [182, 183].

Family-based interventions: Three family-based interventions were included in this review.

These interventions focused on parents, caregivers, and mothers in preventing and responding
to CSA [170-172]. One of these interventions focused on training caregivers to teach children
about CSA prevention and found that children who received CSA prevention education from
their parents demonstrated improved knowledge about private parts and what to do if they
suspect they have experienced sexual abuse [172]. In another study, after finding out that
mothers have inaccurate information about preventing CSA, a short-term training was provided
to mothers which improved their knowledge and they then supported disseminating CSA
prevention trainings in preschools [170].

School-based interventions: Five school-based interventions were included in this review.

Three of these interventions worked with adolescents [175-177]. In one intervention,
adolescent boys learned about healthy gender norms and adolescent girls learned
empowerment, gender relations, and self-defense [175]. The intervention resulted in an
increase in self-efficacy and a reduction in the rate of sexual assault among girls [175]. In
another intervention primary and secondary school-aged girls were the target group and the
study found effective results in reduction in sexual violence victimization [176]. An intervention
 PAGE 14

called Let Us Protect Our Future Intervention (an HIV/ STD risk risk-reduction intervention)
sought to prevent perpetration and experience of forced sex among adolescents [177]. Of the
other two interventions that worked with younger children, one focused on providing
information to children about their body and developing self-protection skills [178]. The other
focused on preventing CSA among children with mild intellectual disabilities through increasing
their awareness of sexual abuse [174].

Community-based interventions: There is one community-based interventions included in this

review. This intervention employed empowerment and self-defence to prevent sexual assault
among adolescent girls. This intervention found a reduction in sexual assault rates among
adolescent girls and an increase in disclosure of assaults and care seeking [179].

Social determinants: Four studies looked at policies to address social determinants associated
with CSA such as laws and a regulatory framework, social services, improving access to schools,
and securing basic needs [180, 181, 184]. One of these studies, based in Zimbabwe, found that
while the country has well-established legal and regulatory frameworks to protect children from
CSA, implementation of these policies is weak [180]. The study stated that the lack of financial,
human, and material resources explain the lack of CSA prevention interventions and
recommended implementing existing legislation, targeting school children, and getting the
community involved [180]. The study also mentioned the impact of a dedicated budget but
argued that benefits can still be achieved without such a budget [180]. Another study looked at
anti-child trafficking strategies put in place by South and Southeast Asian governments and non-
governmental organizations and whether they target all 21 social determinants of child
trafficking [181]. The study found that government and NGO anti child-trafficking strategies
addressed 15 and 12 social determinants respectively and failed to address organizational level
determinants [181]. The two other studies focused on low-income settings and noted the need
to address underlying social and economic determinants to prevent transactional CSA including
reduction of gender inequalities, accessing school, and securing basic needs [184].

The last subgroup included studies that focused on sharing implications for future prevention
interventions. A South African study found that youth’s pursuits were most directed by safety
issues rather than by what should be fun and healthy for this developmental period. The
authors recommended that any health promotion activity first had to provide safe spaces for
youth and also opportunities to critically question patriarchal norms that drove much of the
violence they face [183]. The study also delved into multi-layered issues including poverty,
prevalence of crime, dysfunctional education systems, and limited or absent leisure facilitators
that all negatively impacted on youth’s wellbeing and risks for experiencing violence, including
CSA [183]. A literature review provided guidelines for preventing CSA in the family including:
defining CSA, describing types of CSA, discussing actions to take when a child experiences CSA,
describing risk factors for CSA, discussing rights of children especially care and protection,
describing the impact of CSA, discussing the importance of communication within the family
system, discussing the importance of providing care and protection to children, and making
group members aware of social work interventions in relation to CSA [182].
 PAGE 15

C. Methodology and Ethics Studies

Studies in the methodology theme included work on improving or testing various tools and
approaches to measure CSA including specific questionnaires and technology to understand
and predict the impact of CSA [185, 186]; testing validity and reliability of specific CSA
instruments [187-189]; comparing methods to increase reporting and identify CSA [190]; and
guidelines for methods to improve diagnosis of CSA among medical and legal professionals
[191-193]. One study was included in as an ethical study [194].

Two studies tested tools and technology to better understand and predict the impact of CSA
[185, 186]. The first study tested the reliability and validity of the “Shame Questionnaire” [185].
This study compared scores among girls who had experienced sexual abuse to scores among
girls who had never experienced sexual abuse. Results were consistent with theoretical
hypotheses: girls who experienced more traumatic events had higher scores. However, there
was no significant difference in mean scores among girls who had experienced sexual abuse
compared to girls who had not experienced sexual abuse [185]. The second study investigated
machine learning to predict the development of depression and PTSD in children who had
experienced CSA. Survivors’ records were examined and predictions were compared to
psychiatric evaluations and concluded that predictions were accurate [186].

Three studies in this theme studied the validity and reliability of specific instruments [187, 188].
One study tested the validity and reliability of the Turkish version of the “Child Sexual Abuse
Knowledge/Attitude Scale” for parents (CSAKAS) and found the scale to be a valid and reliable
tool that could be used to evaluate the knowledge and attitudes of parents about CSA [188].
Another study tested the reliability and validity of the “What If Situations Test” (WIST) for
Turkish culture, a test used to assess pre-schooler’s skills regarding self-protection against CSA.
It was found that the Test’s adaptation to Turkish culture was reliable and valid [187]. The last
study tested the adaptability, reliability, and validity of the ISPCAN child abuse screening tool-
retrospective version in Sri Lanka [189]. The study found the screening tool to have adequate
validity for the assessment of physical, sexual and emotional abuse during childhood among Sri
Lankan young adults [189].

One study compared measuring CSA through individual computer-assisted self-administered

surveys (ACASI) to participatory social mapping activities [190]. The study found that group-
based narratives of violence focused on events pereptrated by strangers or members of the
community [190] whereas ACASI interviews revealed violence perpetrated by family members
and intimate partners [190].

Three case study reports emphasized the use of a specific methodology to improve medico-
legal services responses to reports of CSA [191-193]. One report emphasized the importance of
prompt collection and submission of biological evidence in cases of suspected CSA [191]. This
conclusion was based on a case of adolescent injury which seemed like an accident but was CSA
 PAGE 16

[191]. Another study recommended the Polymerase Chain Reaction (PCR) test to detect STDs
in cases suspected of CSA [192]. The study provided a series of cases where this test was used
and was able to identify the perpetrator and gonorrhea [192]. Similarly, another report showed
how some medical conditions can be misinterpreted as physical CSA indicators by using one
case as an example [193].

Lastly, only one study focused on ethics of CSA research [194]. This study with CSA survivors
investigated the impact of being a research participant and found that victims of abuse were
more likely than non-victims to report benefits (71.9% vs 67.1%; p=.02) and harms (31% vs
20.9%; p</01), and were less likely to report experiencing regret from involvement (13.1% vs
16.7%; p=.02) [195].

D. Theory and Framework Studies

There were only two studies included in the theory and framework theme [195, 196]. One study
analyzed current frameworks for developing CSA prevention and response interventions. The
study argued that medical and legal measures should focus on reducing current threats for CSA
by identifying and treating individuals with paraphilia, specifically pedophilia [195]. The other
study looked into the intersections of violence against women and violence against children.
This study investigated adding prevention of HIV and CSA among children within existing HIV
and violence prevention programs directed at adults [196]. The study found that sexual and
physical violence in childhood were linked to negative health outcomes such as increased sexual
risk taking, and experiencing IPV during adolescence [196]. It suggested that interventions
seeking to prevent HIV should increase knowledge among children and caregivers by addressing
attitudes and practices around violence and dating relationships [196]. Programs should also
build awareness of services available for children who experience violence [196].
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V. Commentary
Geographical Representation in CSA Research
Similar to the overall trends, in all regions, except for East Europe and Central Asia, studies
focused on understanding CSA across populations were more numerous (75%) with less
attention to intervention research (19%) and all other thematic areas (6%). Almost half (49,5%)
of the research studies included were from the Sub-Saharan Africa region and 61,1% of all
intervention research studies were also from this region. About half of the existing evidence
base was spread thinly across the rest of the 5 regions and a small group of multi-country, multi-
region studies.

Figure 2. Number of articles per geographical region

East Asia and the Pacific 3

Multi-regional (Global) 4

Europe and Central Asia 6

Latin American and the Caribbean 13

South Asia 17

Middle East and North Africa 55

Sub-Saharan Africa 96

0 20 40 60 80 100 120

Further analysis revealed country-level disparities within some regions. For example, in Sub-
Saharan Africa, the majority of studies (n=38 out of 96; about 40%) came from South Africa and
in the Middle East and North Africa region, the majority of studies (n=49 out of 55; about 88%)
came from Turkey. In the Latin America and the Caribbean region, the largest concentration of
studies came from Mexico (n=7 out of 13; about 54%). In all Asian regions, the largest
concentration of studies from a single country came from Malaysia (n=4). Lastly, in Eastern
Europe, the largest concentration of studies came from Serbia (n=3). Overall, there is very little
CSA research coming from LMICs which makes it difficult to build a nuanced contextual
understanding of CSA and CSA interventions for a large proportion of the global population.
 PAGE 18

Methodological Gaps: Defining and Measuring CSA

Most studies discussed CSA in general and did not specify particular types of CSA. A few studies
focused on intrafamilial/incest and online sexual exploitation, but it was uncommon for this
level of specificity to be the focus of the study. Understanding different forms of CSA is
important in order for us to understand the problem and build adequate service responses and
prevention interventions that address multiple forms of CSA.

The majority of studies used self-report methods to measure CSA including a variety of
questionnaires and interviewing methods. A few studies relied on scales and indexes to
measure CSA including: the Traumatic Experiences Checklist [5], Child Abuse Scale [128],
Children’s Impact of Traumatic Events Scale [63], and the Childhood Sexual Abuse
Measurement [68]. Other studies utilized evaluations by a child and adolescent psychologist
[33, 186]. Lastly, a few studies utilized a mixture of questionnaires and interviews to measure a
child’s experience of sexual violence [80, 115, 127, 133].

Intersectional Research
An intersectional approach is more inclusive and appreciates diversity in order to ensure that
we build understanding and interventions for children in all their diversity – not only for a small
but dominant group. That is, intersectional research would dive into experiences, perspectives,
and needs of vulnerablised or marginalised groups (e.g., LGBTQ populations, individuals with
HIV, orphaned children, children with disabilities, marginalized groups etc.) as well as the
norms, systems, and social structures that create and perpetuate this marginalisation, inequity,
and vulnerability. Across all thematic areas, 25 studies (12,7%) were conducted with an
intersectional perspective [32, 33, 40, 44, 45, 47, 48, 72, 79, 89, 105, 107-115, 148, 162, 174,
190, 196]. Seven of these studies focused on individuals living with HIV or on individuals at risk
of contracting HIV. Five studies worked with orphaned or street-living children and three studies
worked with orphaned children at risk of contracting HIV. Five studies focused on children with
disabilities and three studies worked with refugee populations or individuals in conflict areas.
Lastly, one study worked with individuals utilizing substances and one study looked at sexual
violence against boys. In this review, there was a lack of LGBTQ focused studies.

Feminist Perspective
The review found only one study that indicated that they applied a feminist perspective [76].
This study investigated the experiences of girls’ and boys’ of sexual abuse by adults in a post-
conflict region in Northern Uganda and reviewed interventions (both prevention and response)
that worked on improving the current state of children at risk of CSA. The study found that there
was a need for separate, specialized units for reporting and handling cases of CSA. Training of
personnel and a new filing system within child protection agencies was also identified as a need.
Lastly, the study found that there was a need for family programs for both fathers and mothers
on child protection strategies for prevention and mitigation of CSA. A feminist approach to CSA
research could contribute to the field by promoting a an analysis of norms, systems and
structures which create vulnerabilities or protection against CSA as well as a power analysis to
understand another perspective of CSA.
 PAGE 19

Gaps
Most CSA research in LMICs was epidemiological rather than evaluating or improving current
systems and programmes of prevention and response to CSA. In studies that were categorised
as epidemiological research, many focused on CSA’s impact on a child’s mental health and
bodily functioning. Despite the focus on the mental health impact of CSA, there were only a few
response interventions that focused on mental health. Many studies focused on the potential
increased risk of CSA for orphaned and street children, however there are not additional
prevention and response interventions that focus on serving these groups of children. A greater
variety of epidemiological research is necessary, specifically to identify the risk and drivers of
different types of CSA in different environments (e.g., in schools, online, by adults or by peers).
In particular, more research is needed to better understand the drivers of different types of CSA
perpetration. This understanding can inform the design of primary prevention interventions to
effectively prevent and end perpetration of CSA.

There is also a need for strengthening ethics guidelines that should drive all aspects of CSA
research including methodologies, tools, dissemination, and funding research for impact that
can improve the survivors’ lives and keep children safe from all forms of sexual abuse. Ethics
review committees may also prefer to assess proposals using clearly defined, shared ethical
guidelines.

The field would also benefit greatly from priority driven research to systematically build the
evidence base in ways that will address strategic gaps in understanding and practice. The focus
and relevance of research questions and ensuring that they are equitable and non-
discriminatory can be strengthened by a shared research agenda.

There is a clear gap in research on the intersections between CSA and violence against women
(VAW) both to better understand where these two types of violence intersect and the pathways
between them, as well as to guide effective and ethical actions to address both CSA and VAW
at the intersections.
 PAGE 20

VI. Concluding Remarks

This review was helpful to show the vast range of existing research on CSA inLMICs. The findings
of the review show that there is not a cohesive body of knowledge on CSA from LMICs – the
research does not appear to be driven by strategic priorities. Much of the research studies do
not have a clear policy or practice imperative and the tools, methods, and ethics guiding the
research vary a lot. There are very few intervention studies. The current body of evidence from
CSA research from LMICs does not provide clear knowledge to guide policy and practice. The
field would benefit from more research and this research needs to:

• be driven by a clear research agenda,

• use validated and reliable methods, tools, and measures for ethical research,
• focus on hard to reach and vulnerable populations,
• build a better understanding of CSA perpetration to drive prevention strategies, and
• investigate multi-component intervention models and frameworks.
 PAGE 21

References
1. Dubowitz, H., Child sexual abuse and exploitation-A global glimpse. Child Abuse Negl,
2017. 66: p. 2-8.
2. Bramer, W.M., et al., Optimal database combinations for literature searches in
systematic reviews: a prospective exploratory study. Syst Rev, 2017. 6(1): p. 245.
3. Baytunca, M.B.A., Emsal; Ozbaran, Burcu; Kaya, Ahsen; Kose, Sezen; Aktas, Ekin Ozgur;
Aydın, Rezzan; Guney, Selcen; Yuncu, Zeki; Erermis, Serpil; Bildik, Tezan; Aydin, Cahide,
Childhood sexual abuse and supportive factors. 2017. p. 10-15.
4. Van Der Walt, L.S., Sharain; Martin, Lindi; Lammers, Kees; Seedat, Soraya Resilience
and post-traumatic stress disorder in the acute aftermath of rape: a comparative
analysis of adolescents versus adults. 2014. p. 239-249.
5. Kanwal Dar, L.H., Shazia, Traumatic experiences and dissociation in patients with
conversion disorder - PubMed. 2018. p. 1776-1781.
6. Alşen Güney, S.B., Özlem; Kaya, Hasan; Arıer Arısın, Sevi, How Do Childhood and Parental
Anxiety Features Affect the Consequences of Child Sexual Abuse? 2020, Routledge. p.
413-431.
7. Asmal, L.K., Sanja; Du Plessis, Stefan; Scheffler, Frederika; Chiliza, Bonginkosi; Fouche,
Jean Paul; Seedat, Soraya; Dazzan, Paola; Emsley, Robin, Childhood Trauma Associated
White Matter Abnormalities in First-Episode Schizophrenia. 2019. p. 369-376.
8. Biedermann, S.V.M., Stefanie; Simmons, Candice; Nöthling, Jani; Suliman, Sharain;
Seedat, Soraya, Sexual abuse but not posttraumatic stress disorder is associated with
neurocognitive deficits in South African traumatized adolescents. 2018, Elsevier. p. 257-
267.
9. Sanchez, S.E.P., Omar; Chaves, Diana Z.; Zhong, Qiu Yue; Gelaye, Bizu; Simon, Gregory
E.; Rondon, Marta B.; Williams, Michelle A., Childhood physical and sexual abuse
experiences associated with post-traumatic stress disorder among pregnant women.
2017, Elsevier Inc. p. 716-723.e1.
10. Nodzenski, M.K., Ligia; Pocock, Nicola S.; Stoeckl, Heidi; Zimmerman, Cathy; Buller, Ana
Maria, Post-trafficking stressors: The influence of hopes, fears and expectations on the
mental health of young trafficking survivors in the Greater Mekong Sub-region. 2020.
11. Richter, L.M.M., Shanaaz; Nonterah, Engelbert; Masilela, Lee Anne A longitudinal
perspective on boys as victims of childhood sexual abuse in South Africa: Consequences
for adult mental health. 2018, Elsevier. p. 1-10.
12. Lai, F.C.T., Maniam; Suriati Mohamed, Saini; Shamsul Azhar, Shah; Sit, Fong Loh;
Aishvarya, Sinniah; Zawaha Haji, Idris; Sulaiman Che, Rus; Siti Sa'adiah Hassan, Nudin;
Susan, Mooi Koon Tan, Sexual abuse and substance abuse increase risk of suicidal
behavior in Malaysian youth. 2013. p. 123-126.
13. Aydin, B.A., Seher; Turla, Ahmet; Dundar, Cihad, Nordic Journal of Psychiatry Depression
and post-traumatic stress disorder in child victims of sexual abuse: perceived social
 PAGE 22

support as a protection factor Depression and post-traumatic stress disorder in child

victims of sexual abuse: perceived social s. 2016.
14. Kiss, L.Y., Katherine; Pocock, Nicola; Zimmerman, Cathy, Exploitation, violence, and
suicide risk among child and adolescent survivors of human trafficking in the greater
mekong subregion. 2015. p. 15-17.
15. Wahab, S.M.K.T., Susan; MMed AdvMCh AdoPsych, DCH; Marimuthu, Sheila; MMed
Paeds, MBBS; Razali, Rosdinom; Asiah Muhamad, Nor; Statistic, MPH; Wahab MMed,
Suzaily, Young female survivors of sexual abuse in Malaysia and depression: What
factors are associated with better outcome? 2013.
16. Soylu, N.A., Muhammed; Gba Yüksel, Tu˘ Early-married and sexually abused girls
differ in their psychiatric outcomes. 2014. p. 1552-1559.
17. Do˘ Gangün, B.G.b., Burak M; Gönültas¸b, Gönültas¸; Uzun-O˘ Guz, Esin; Oral, Gökhan;
Öztürk, Meral, Psychological complaints reported by sexually abused children during
criminal investigations: Istanbul example. 2016. p. 54-61.
18. Tekin, A.M., Ceren; Sağbilge, Ezgi; Kenar, Jülide; Yayla, Sinan; Özer, Akil;
Karamustafalioğlu, Oğuz Nordic Journal of Psychiatry The relationship between
childhood sexual/ physical abuse and sexual dysfunction in patients with social anxiety
disorder. 2015. p. 88-92.
19. Say, G.N.B., Zehra; Karabekiroʇlu, Koray; Yüce, Murat; Akbaş, Seher, Abuse
Characteristics and Psychiatric Consequences Associated with Online Sexual Abuse.
2015, Cyberpsychol Behav Soc Netw. p. 333-336.
20. Celbis, O.A., İsmail; Ayaz, Nusret; Börk, Turgay; Karatoprak, Serdar, Evaluation of Incest
Cases: 4-Years Retrospective Study. 2020. p. 79-89.
21. Fekih-Romdhane, F.T., Salma; Cheour, Majda, Childhood sexual abuse as a potential
predictor of psychotic like experiences in Tunisian college students. 2019, Elsevier Ireland
Ltd. p. 181-188.
22. Mert, K.A., Sena Dilek, Working with women in Turkey exposed to childhood sexual
abuse. 2018. p. 517-525.
23. Penning, S.L.C., Steven J, Traumatic Reenactments of Child Sexual Abuse in a Nonclinical
Sample of South African Adolescents. 2014. p. 708-726.
24. Amone-P'olak, K.O., Emilio; Jones, Peter Brian, The effects of sexual violence on
psychosocial outcomes in formerly abducted girls in Northern Uganda: the WAYS study.
2015.
25. Milovancević, M.P., et al., Psychopathology and resilience in relation to abuse in
childhood among youth first referred to the psychiatrist. Vojnosanit Pregl, 2014. 71(6):
p. 565-70.
26. Tekin, A., et al., The relationship between childhood sexual/physical abuse and sexual
dysfunction in patients with social anxiety disorder. Nord J Psychiatry, 2016. 70(2): p. 88-
92.
27. Penning, S.L. and S.J. Collings, Perpetration, revictimization, and self-injury: traumatic
reenactments of child sexual abuse in a nonclinical sample of South African adolescents.
J Child Sex Abus, 2014. 23(6): p. 708-26.
 PAGE 23

28. Oshodi, Y.M., Muiruri; Lachman, Anusha; Seedat, Soraya Immediate and Long-Term
Mental Health Outcomes in Adolescent Female Rape Survivors. 2020, J Interpers
Violence. p. 252-267.
29. Ortiz-Guzmán, J.A.I.-A., María C.; Alvarado-Cruz, Francisco J.; Graciano-Morales,
Hermelinda; Jiménez-Genchi, Alejandro, Características clínicas de mujeres con
depresión mayor que sufrieron abuso sexual en la infancia. 2018. p. 295-301.
30. Kuo, C.M., Catherine; Lovette, Ashleigh; Harrison, Abigail; Orchowski, Lindsay;
Pellowski, Jennifer A; Atujuna, Millicent; Stein, Dan J; Brown, Larry K Perpetration of
sexual aggression among adolescents in South Africa. 2019. p. 32-36.
31. Celik, G.T., Ayşegül; Yoruldu, Belgin; Varmiş, Dilek; Çekin, Necmi; Avci, Ayşe; Evliyaoğlu,
Nurdan; Nasiroğlu, Serhat, Recantation of Sexual Abuse Disclosure Among Child Victims:
Accommodation Syndrome. 2018, Routledge. p. 612-621.
32. Shamu, S.S., Patience; Zarowsky, Christina; Temmerman, Marleen; Shefer, Tamara;
Abrahams, Naeemah Does a history of sexual and physical childhood abuse contribute
to HIV infection risk in adulthood? A study among post-natal women in Harare,
Zimbabwe. 2019. p. 1-11.
33. Stojadinović, A.B.A., Daliborka; Perinović, Marija; Rončević, Nevenka. , Sexual Behavior
of Street Children. 2015. p. 245-250.
34. Solakoglu, O.D., Nichola; Belshaw, Scott H., The Effect of Sexual Abuse on Deviant
Behaviors Among Turkish Adolescents: The Mediating Role of Emotions. 2018. p. 24-49.
35. Chiang, L.F.C., Jieru; Gladden, Matthew R.; Mercy, James A.; Kwesigabo, Gideon; Mrisho,
Fatma; Dahlberg, Linda L.; Nyunt, Myo Zin; Brookmeyer, Kate A.; Vagi, Kevin HIV and
childhood sexual violence: Implications for sexual risk behaviors and HIV testing in
Tanzania. 2015. p. 474-488.
36. Unikel-Santoncini, C.R.-L., Luciana, Juarez-Garcia, Francisco, [Association of childhood
sexual abuse and disordered eating in a sample of Mexican adolescents] - PubMed. 2011.
p. 475-83.
37. Goldenberg, S.M.S., Jay G.; Engstrom, David; Bojorquez-Chapela, Ietza; Usita, Paula;
Rolón, María Luisa; Strathdee, Steffanie A., Exploring the context of trafficking and
adolescent sex industry involvement in Tijuana, Mexico: consequences for HIV risk and
prevention. 2015, Violence Against Women. p. 478-499.
38. Demirci, E., Non suicidal self-injury, emotional eating and insomnia after child sexual
abuse: Are those symptoms related to emotion regulation? 2017. p. 17-21.
39. Richter, L.K., Arnošt; Desmond, Chris; Celentano, David; Morin, Steve; Sweat, Michael;
Chariyalertsak, Suwat; Chingono, Alfred; Gray, Glenda; Mbwambo, Jessie; Coates, Tom,
Reported Physical and Sexual Abuse in Childhood and Adult HIV Risk Behaviour in Three
African Countries: Findings from Project Accept (HPTN-043). 2014. p. 381-389.
40. Oluwatoyin Folayan, M.H., Abigail; Brown, Brandon; Odetoyinbo, Morolake; Stockman,
Jamila K; Ajuwon, Ademola J; Cáceres, Carlos F Associations between Forced Sexual
Initiation, HIV Status, Sexual Risk Behavior, Life Stressors, and Coping Strategies among
Adolescents in Nigeria. 2016.
41. Soylu, N.A., Muhammed; Gökten, Emel Sarı; Alpaslan, Ahmet Hamdi; Dönmez, Yunus
Emre; Özcan, Özlem Özel; Ayaz, Ayşe Burcu; Tufan, Ali Evren Gender Differences in
 PAGE 24

Sexually Abused Children and Adolescents: A Multicenter Study in Turkey. 2016,

Routledge. p. 415-427.
42. Meade, C.S.W., Melissa H; Sikkema, Kathleen J; Deng, Lisa X; Ranby, Krista W; Skinner,
Donald; Pieterse, Desiree; Kalichmann, Seth C, Methamphetamine use is associated with
childhood sexual abuse and HIV sexual risk behaviors among patrons of alcohol-serving
venues in Cape Town, South Africa. 2012. p. 232-239.
43. Valle, R.B.-O., Antonio; Gálvez-Buccollini, Juan Antonio; Gutiérrez, César; Martins, Silvia
S., Intrafamilial and extrafamilial sexual assault and its association with alcohol
consumption. 2018. p. 1-10.
44. Icard, L.D.J., John B.; Teitelman, Anne; O'Leary, Ann; Heeren, G. Anita, Mediation effects
of problem drinking and marijuana use on HIV sexual risk behaviors among childhood
sexually abused South African heterosexual men. 2014, Elsevier Ltd. p. 234-242.
45. Ağaçhanlı, R.A., İzgi; Evren, Cuneyt; Alnıak, Izgi, Substance Use & Misuse Sexual
Dysfunctions are Predicted by Childhood Sexual Abuse in Women with Opioid Use
Disorder Sexual Dysfunctions are Predicted by Childhood Sexual Abuse in Women with
Opioid Use Disorder. 2018. p. 2184-2189.
46. Teitelman, A.M.B., Scarlett L; Jemmott III, John B; Icard, Larry; Ali, Samira; Ngwane,
Zolani; Makiwane, Monde, Childhood Sexual Abuse and Sociodemographic Factors
Prospectively Associated with Intimate Partner Violence Perpetration Among South
African Heterosexual Men. 2017. p. 170-178.
47. Lewis, I.R., Journal of Child Sexual Abuse At Risk: The Relationship between Experiences
of Child Sexual Abuse and Women's HIV Status in Papua New Guinea. 2012. p. 273-294.
48. Mall, S.S., Leslie, Attitudes toward condom education amongst educators for Deaf and
hard-of-hearing adolescents in South Africa. 2014. p. 4-7.
49. Boyce, S.C., et al., Childhood Experiences of Sexual Violence, Pregnancy, and Marriage
Associated With Child Sex Trafficking Among Female Sex Workers in Two US-Mexico
Border Cities. Am J Public Health, 2018. 108(8): p. 1049-1054.
50. Mason, C.K., Neil, Sexual abuse in malawi: Patterns of disclosure. 2014, Routledge. p.
278-289.
51. Ayaydin, H.A., Osman; Akdeniz, Nilgun Okumus; Kok, Burcu Ece; Gunes, Adem; Yildirim,
Abdurrahman; Deniz, Gunnur, Immune system changes after sexual abuse in
adolescents. 2016. p. 105-112.
52. Baris Usta, M.T., Korhan; Akbas, Seher; Aydin, Berna Gokce; Say, Nur., Nordic Journal of
Psychiatry Decreased dehydroepiandrosterone sulphate levels in adolescents with post-
traumatic stress disorder after single sexual trauma. 2015. p. 116-120.
53. Muller, D.E., Sheri lee; Szabo, Christopher P.; Pitts, Neville; Jacklin, Lorna., Disparate
plasma cortisol concentrations in sexually abused female children from Johannesburg,
South Africa. 2014, Elsevier Ltd. p. 1778-1786.
54. Pacharabumrung, P.T., Seree; Suwannarurk, Komsun; Bhamarapravatana, Kornkam;
Sangviroon, Alisara; Napakorn, Kitinapa., Physical health consequences of child sexual
assault in Police General Hospital - PubMed. 2014. p. 1227-33.
55. Serbulent, K.O., Kara; Murat, Tutanc; Kilic, Serbulent., Inflammatory parameters in
sexually abused children. 2017. p. 1213-1218.
 PAGE 25

56. Sezgin, A.U.P., Raija-Leena., Impacts of early marriage and adolescent pregnancy on
mental and somatic health: the role of partner violence. 2019. p. 155-166.
57. Simsek, S.U., Cem; Kaplan, Ibrahim; Yuksel, Tugba; Aktas, Huseyin., ScienceDirect BDNF
and cortisol levels in children with or without post-traumatic stress disorder after
sustaining sexual abuse. 2015. p. 45-51.
58. Suthapom, S.T., Seree; Aojanepong, Tepchongchit; Sangviroon, Alisara; Napakorn,
Kitinapa; Bhamarapravatana, Kornkarn, Characteristics and health consequences of
adolescent sexual assault at Police General Hospital, Thailand - PubMed. 2014. p. 1221-
6.
59. Sam-Soto, S.S., Reyna; Flores-Ramos, Mónica; Rodríguez-Bosch, Mario; García-Salazar,
Danae; Hernández-Mohar, Gabriela; García-Espinosa, Verónica., [WEIGHT GAIN DURING
PREGNANCY AND PERINATAL OUTCOMES IN PREGNANT ADOLESCENTS WITH A HISTORY
OF SEXUAL ABUSE]. 2015, Nutr Hosp. p. 1075-1081.
60. Şimşek, Ş.K., Ibrahim; Uysal, Cem; Yüksel, Tuʇba; Alaca, Rümeysa, The Levels of Cortisol,
Oxidative Stress, and DNA Damage in the Victims of Childhood Sexual Abuse: A
Preliminary Study. 2016. p. 175-184.
61. Şimşek, Ş., et al., Examining the levels of BDNF and cortisol in children and adolescent
victims of sexual abuse--a preliminary study. Compr Psychiatry, 2015. 61: p. 23-7.
62. Amone-P'Olak, K.L., Tlholego Molemane; Ovuga, Emilio; Abbott, Rosemary Ann; Meiser-
Stedman, Richard; Stewart, David Gage; Jones, Peter Brian., Sexual violence and general
functioning among formerly abducted girls in Northern Uganda: the mediating roles of
stigma and community relations--the WAYS study. 2016, BMC Public Health.
63. Wondie, Y.Z., Workie; Tafesse, Biruk; Reschke, Konrad; Schröder, Harry, The
psychosocial consequences of child sexual abuse in ethiopia: A case-control comparative
analysis. 2011. p. 2025-2041.
64. Dursun, O.B.S., Mustafa Talip; Esin, Ibrahim Selcuk; Ançi, Yüksel; Şermin Sapmaz, Yalin.,
Does Working with Child Abuse Cases Affect Professionals' Parenting and the
Psychological Well-Being of Their Children? 2014. p. 557-571.
65. Masilo, G.M.D.-M., Mashudu., Experiences of mothers of sexually abused children in
North-West province, post disclosure. 2016. p. e1-e9.
66. Vural, P.H., Sengul; Turkmen, Nursel; Eren, Bulent; Buyukuysal, Caatay., Perceived
parental acceptance/rejection and psychopathology in a group of sexually abused
children/adolescents - PubMed. 2012. p. 363-9.
67. Koçtürk, N.B., Filiz, Social Support of Adolescent Survivors of Child Sexual Abuse and
Sexual Revictimization in Turkey. 2018, Routledge. p. 38-52.
68. Sivis-Cetinkaya, R., Turkish School Counselors' Experiences of Reporting Child Sexual
Abuse: A Brief Report. 2015. p. 908-921.
69. Yılmaz Irmak, T.A., Şeyda; Thompson, Dennis, Coping Strategies and Depression Among
College Students Following Child Sexual Abuse in Turkey. 2016, Routledge. p. 881-894.
70. Aydin, B.A., Seher; Turla, Ahmet; Dundar, Cihad; Yuce, Murat; Karabekiroglu, Koray Child
Sexual Abuse in Turkey: An Analysis of 1002 Cases. 2015. p. 61-65.
71. Bakal, U.S., · M; Tartar, · T; Cigsar, · E B; Kazez, · A, Twenty years of experience with
perineal injury in children. 2016. p. 599-603.
 PAGE 26

72. Von Hohendorff, J.F.H., Luísa; Helena Koller, Silvia., "A boy, being a victim, nobody really
buys that, you know?": Dynamics of sexual violence against boys. 2017. p. 53-64.
73. Gul, H.G., Ahmet; Yurumez, Esra; Öncü, Bedriye Voices of adolescent incest victims:
A qualitative study on feelings about trauma and expectations of recovery. 2020,
Elsevier. p. 67-74.
74. Essabar, L., A. Khalqallah, and B.S. Dakhama, Child sexual abuse: report of 311 cases with
review of literature. Pan Afr Med J, 2015. 20: p. 47.
75. Cisse, C.T., et al., [Epidemioclinical and legal aspects and cost management of sexual
abuse among minors in Dakar, Senegal]. J Gynecol Obstet Biol Reprod (Paris), 2015.
44(9): p. 825-31.
76. Nyangoma, A.E., Florence; Omona, Julius, Child Sexual Abuse and Situational Context:
Children’s Experiences in Post-Conflict Northern Uganda. 2019, Routledge. p. 907-926.
77. Jengtee, S.A., Palisara; Aimarom, Chatchai; Plitapolkamrpim, Adisak; Arj-ong
Vallipakron, Sakda, The study of familial history and associated risks of sexually abused
children at Ramathibodi Hospital - PubMed. 2014. p. 923-31.
78. Yahaya, I.U., Olalekan A.; Soares, Joaquim; Macassa, Gloria, Social disorganization and
history of child sexual abuse against girls in sub-Saharan Africa: a multilevel analysis.
2013.
79. Sommer, M.M.-L., Miguel; Williams, Anaise; Mayevskaya, Yana; Falb, Kathryn; Abdella,
Gizman; Stark, Lindsay How gender norms are reinforced through violence against
adolescent girls in two conflict-affected populations A R T I C L E I N F O. 2018. p. 154-
163.
80. Mulumeoderhwa, M.H., & Geoff, Forced sex, rape and sexual exploitation: attitudes and
experiences of high school students in South Kivu, Democratic Republic of Congo. 2015.
p. 284-295.
81. Bingenheimer, J.B.R., Elizabeth, Risk for Coerced Sex Among Female Youth in Ghana:
Roles of Family Context, School Enrollment And Relationship Experience. 2014. p. 184-
195.
82. Meinck, F.C., Lucie Dale; Boyes, Mark Edward, Longitudinal Predictors of Child Sexual
Abuse in a Large Community-Based Sample of South African Youth. 2017. p. 2804-2836.
83. Abrahams, N.M., Shanaaz; Lombard, Carl; Martin, Lorna J.; Jewkes, Rachel, Sexual
homicides in South Africa: A national cross-sectional epidemiological study of adult
women and children. 2017. p. 1-13.
84. McCleary-Sills, J.D., Zayid; Rwehumbiza, Annagrace; Hamisi, Aziza; Mabala, Richard,
Gendered norms, sexual exploitation and adolescent pregnancy in rural Tanzania. 2013,
Reproductive Health Matters. p. 97-105.
85. Clüver, F.E., Diane; Young, Charles, SAHARA-J: Journal of Social Aspects of HIV/AIDS An
Open Access Journal Experiences of sexual relationships of young black women in an
atmosphere of coercion Experiences of sexual relationships of young black women in an
atmosphere of coercion. 2013.
86. Ramiro, L.S.M., Andrea B.; Tan, Janelle Rose; Mariano, Kachela; Miranda, Gaea Marie;
Bautista, Greggy, Online child sexual exploitation and abuse: A community diagnosis
using the social norms theory. 2019, Elsevier. p. 104080.
 PAGE 27

87. Marret, M.J.C., Wan Yuen, Victimization After Meeting With Online Acquaintances: A
Cross-Sectional Survey of Adolescents in Malaysia. 2018. p. 2352-2378.
88. Banwari, M., Poverty, child sexual abuse and HIV in the Transkei region, South Africa.
2011, Makerere University Medical School. p. S117.
89. Williams, T.P.C., Vidur; Chikanya, Sharon R., "It isn't that we're prostitutes": Child
protection and sexual exploitation of adolescent girls within and beyond refugee camps
in Rwanda. 2018. p. 156-166.
90. Hounmenou, C., An initial exploration of prostitution of boys in the West African region.
2017, Elsevier. p. 188-200.
91. Adjej, J.K.S., Elizabeth M., Boys are not exempt: Sexual exploitation of adolescents in sub-
Saharan Africa. 2017, Elsevier Ltd. p. 14-23.
92. Kisanga, F.N., Lennarth; Hogan, Nora; Emmelin, Maria, Parents experiences of reporting
child sexual abuse in Urban Tanzania. 2013. p. 481-498.
93. Yahaya, I.D.L., Antonio Ponce; Uthman, Olalekan A.; Soares, Joaquim; Macassa, Gloria.,
Individual and community-level socioeconomic position and its association with
adolescents experience of childhood sexual abuse: a multilevel analysis of six countries
in Sub-Saharan Africa. 2014, J Inj Violence Res.
94. Beyene, A.S.C., Catherine; Roba, Hirbo Shore; Melka, Alemu Sufa; Loxton, Deborah,
Gender-based violence among female youths in educational institutions of Sub-Saharan
Africa: A systematic review and meta-analysis 11 Medical and Health Sciences 1117
Public Health and Health Services. 2019, Systematic Reviews. p. 1-14.
95. Fan, A.Z.K., Howard; Gupta, Sundeep; Wadonda-Kabondo, Nellie; Shawa, Mary; Mercy,
James, Do self-reported data reflect the real burden of lifetime exposure to sexual
violence among females aged 13-24 years in Malawi? 2016. p. 72-79.
96. Swedo, E.A.S., Steven A.; Msungama, Wezi; Massetti, Greta M.; Kalanda, McKnight;
Saul, Janet; Auld, Andrew F.; Hillis, Susan D., Childhood Violence Is Associated with
Forced Sexual Initiation Among Girls and Young Women in Malawi: A Cross-Sectional
Survey. 2019, Elsevier Inc. p. 265-272.e1.
97. Miller, J.A.S., Edward A.; Coffman, Donna; Mathews, Catherine; Wegner, Lisa, Forced
Sexual Experiences and Sexual Situation Self-Efficacy Among South African Youth. 2016,
Blackwell Publishing Inc. p. 673-686.
98. Cluver, L.D.R., William E.; Toska, Elona; Zhou, Siyanai; Campeau, Laurence;
Shenderovich, Yulia; Orkin, Mark; Desmond, Chris; Butchart, Alexander; Taylor, Howard;
Meinck, Franziska; Sherr, Lorraine, Violence prevention accelerators for children and
adolescents in South Africa: A path analysis using two pooled cohorts. 2020. p. 1-21.
99. Anthony, E.R.H., Tracy N; Darnell, Doyanne A; Armistead, Lisa; Cook, Sarah L; Skinner,
Donald, Caregiver-Youth Communication about Sex in South Africa: The Role of Maternal
Child Sexual Abuse History. 2014. p. 657-673.
100. Mwanukuzi, C. and T. Nyamhanga, "It is painful and unpleasant": experiences of sexual
violence among married adolescent girls in Shinyanga, Tanzania. Reprod Health, 2021.
18(1): p. 1.
 PAGE 28

101. Puri, M.F., Melanie; Tamang, Jyotsna; Lamichhane, Prabhat; Shah, Iqbal, The prevalence
and determinants of sexual violence against young married women by husbands in rural
Nepal. 2012.
102. Thi, M.L., Hong; Tran, Thach Duc; Nguyen, Huong Thanh; Fisher, Jane; Hailes, Jean, Early
Marriage and Intimate Partner Violence Among Adolescents and Young Adults in Viet
Nam. 2014. p. 889-910.
103. Gönültaş, B.M.S., Bahadir, Event locations in extrafamilial child sexual molestation cases:
The Istanbul example. 2018. p. 1164-1178.
104. Kucuk, S., Analyses of Child Sex Abuse Cases in Turkey: A Provincial Case. 2016,
Routledge. p. 262-275.
105. Koçtürk, N.Y., Fadime, Characteristics of victims and perpetrators of intrafamilial sexual
abuse. 2019, Elsevier. p. 104122.
106. Taktak, Ş., et al., Characteristics of paraphilics in Turkey: A retrospective study-20years.
Int J Law Psychiatry, 2016. 49(Pt A): p. 22-30.
107. Birdthistle, I.J.F., Sian; Mwanasa, Stewart; Nyagadza, Auxillia; Gwiza, Edmore; Glynn,
Judith, Child sexual abuse and links to HIV and orphanhood in urban Zimbabwe. 2011. p.
1075-1082.
108. Kidman, R.P., Tia, The relationship between parental presence and child sexual violence:
Evidence from thirteen countries in sub-Saharan Africa. 2016. p. 172-180.
109. Cluver, L.O., Mark; Boyes, Mark; Gardner, Frances; Meinck, Franziska, Transactional sex
amongst AIDS-orphaned and AIDS-affected adolescents predicted by abuse and extreme
poverty. 2011. p. 336-343.
110. Mandalazi, P.B., C.; Umar, E., Street Children's Vulnerability to HIV and Sexually
Transmitted Infections in Malawian Cities. 2013. p. 1-4.
111. De Lind Van Wijngaarden, J.W.S., Bettina T; Iqbal, Qasim, Culture, Health & Sexuality An
International Journal for Research, Intervention and Care Sexual abuse, social stigma and
HIV vulnerability among young feminised men in Lahore and Karachi, Pakistan. 2012.
112. Nichols, J.E., L; Mwangi, A; Morantz, G; Vreeman, R; Ayaya, S; Ayuku, D; Braitstein, P,
Physical and sexual abuse in orphaned compared to non-orphaned children in sub-
Saharan Africa: A systematic review and meta-analysis. 2014. p. 304-316.
113. Soylu, N.A., Ahmet Hamdi; Ayaz, Muhammed; Esenyel, Selcen; Cahit Oruç, Mü
Psychiatric disorders and characteristics of abuse in sexually abused children and
adolescents with and without intellectual disabilities. 2013. p. 4334-4342.
114. Devries, K.M.K., Nambusi; Zuurmond, Maria; Parkes, Jenny; Child, Jennifer C; Walakira,
Eddy J; Naker, Dipak, Violence against primary school children with disabilities in
Uganda: a cross-sectional study. 2014.
115. Nyokangi, D.P., Nareadi, Factors Contributing to Sexual Violence at Selected Schools for
Learners with Mild Intellectual Disability in South Africa. 2016, Blackwell Publishing Ltd.
p. 231-241.
116. Mathews, S.H., Natasha; Abrahams, Naeemah, A Psychosocial Understanding of Child
Sexual Abuse Disclosure Among Female Children in South Africa. 2016, Routledge. p.
636-654.
 PAGE 29

117. Abeid, M.M., Projestine; Olsson, Pia; Darj, Elisabeth; Axemo, Pia, Community
perceptions of rape and child sexual abuse: a qualitative study in rural Tanzania. 2014.
118. Do, H.N., et al., Perception and Attitude about Child Sexual Abuse among Vietnamese
School-Age Children. Int J Environ Res Public Health, 2019. 16(20).
119. Koçtürk, N.Y., Fadime, The Characteristics of Child Sexual Abuse in the School
Environment in Turkey. 2018, Routledge. p. 852-869.
120. Behrman, J.A.P., Amber B; Palermo, Tia, Does Keeping Adolescent Girls in School Protect
Against Sexual Violence? Quasi-Experimental Evidence From East and Southern Africa.
2017. p. 184-190.
121. Teigan, D.S., Kulasingam; Katherine M, Kamm; Dickson, Chinunje; Rogers, Malamsha;
Said, Mawji; Rainer, Kapinga; Charles, Majinge, Risk-Taking Behaviors and Sexual
Violence Among Secondary School Students in Tanzania. 2019. p. 749-755.
122. De Vries, H.M.E., Sander; Jinabhai, Champak; Meyer-Weitz, Anna; Sathiparsad, Reshma;
Taylor, Myra, Adolescents' Beliefs About Forced Sex in KwaZulu-Natal, South Africa.
2014. p. 1087-1095.
123. Shrestha, R.K., Pramila; Suwal, Asha; Copenhaver, Michael Sex Trafficking Related
Knowledge, Awareness, and Attitudes among Adolescent Female Students in Nepal: A
Cross-Sectional Study. 2015.
124. Frías, S.M.E., Joaquina, Gendered experiences of sexual abuse of teenagers and children
in Mexico. 2014, Elsevier Ltd. p. 776-787.
125. Postmus, J.L.H., Gretchen L.; Davis, Rebecca; Johnson, Laura; Koechlein, Elizabeth;
Winter, Samantha, Examining gender based violence and abuse among Liberian school
students in four counties: An exploratory study. 2015, Elsevier Ltd. p. 76-86.
126. Naidoo, S.S., Benn; Hein De Vries, Taylor, Myra, Prevalence and Risk Factors Associated
with Forced-Sex Among South African High School Students. 2017. p. 1035-1043.
127. Van Decraen, E.M., Kristien; Herbots, Sarah; Van Rossem, Ronan; Temmerman, Marleen,
Sexual coercion among in-school adolescents in Rwanda: prevalence and correlates of
victimization and normative acceptance - PubMed. 2012. p. 140-54.
128. Ashraf, F.N., Faiza; Masood, Afsheen; Malik, Sadia, Gender comparisons and prevalence
of child abuse and post-traumatic stress disorder symptoms in adolescents. 2019. p. 320-
324.
129. Méndez-López, C.P., Noemí, Victimization and poly-victimization in a community sample
of Mexican adolescents. 2019, Elsevier. p. 104100.
130. van der Kooij, I.W.B., Shandra; Nieuwendam, Josta; Lindauer, Ramón J.L.; Graafsma, Tobi
L.G., The Prevalence of Sexual Abuse in Adolescence in Suriname. 2019, Routledge. p.
435-451.
131. Okur, P.V.D.K., Leontien M.; Bogaerts, Stefan, Research on prevalence and media
coverage of child sexual abuse - Prevalence and nature of child sexual abuse in the
Netherlands: Ethnic differences? 2015, Routledge. p. 1-15.
132. Sumner, S.A.M., James; Saul, Janet; Motsa-Nzuza, Nozipho; Kwesigabo, Gideon; Buluma,
Robert; Marcelin, Louis; Lina, Hang; Shawa, Mary; Moloney-Kitts, Michele; Kilbane,
Theresa; Sommarin, Clara; Ligiero, Daniela; Brookmeye, Kathryn; Chiang, Laura.,
 PAGE 30

Prevalence of Sexual Violence Against Children and Use of Social Services- Seven
Countries, 2007-2013. 2009. p. 94-104.
133. Moore, A.M.M., Nyovani; Awusabo-Asare, Kofi, Culture, Health & Sexuality An
International Journal for Research, Intervention and Care Unwanted sexual experiences
among young men in four sub-Saharan African countries: prevalence and context. 2012.
p. 1021-1035.
134. Yahaya, I.S., Joaquim; De Leon, Antonio Ponce; Macassa, Gloria, A comparative study of
the socioeconomic factors associated with childhood sexual abuse in sub-Saharan Africa.
2012, African Field Epidemiology Network. p. 51.
135. Decker, M.R.P., Sarah; Olumide, Adesola; Acharya, Rajib; Ojengbede, Oladosu;
Covarrubias, Laura; Gao, Ersheng; Cheng, Yan; Delany-Moretlwe, Sinead; Brahmbhatt,
Heena, Prevalence and health impact of intimate partner violence and non-partner
sexual violence among female adolescents aged 15-19 years in vulnerable urban
environments: A multi-country study. 2014, Elsevier Inc. p. S58-S67.
136. Ward, C.L.A., Lillian; Leoschut, Lezanne; Kassanjee, Reshma; Burton, Patrick., Sexual
violence against children in South Africa: a nationally representative cross-sectional
study of prevalence and correlates. 2018, The Author(s). Published by Elsevier Ltd. This
is an Open Access article under the CC BY-NC-ND 4.0 license. p. e460-e468.
137. Rumble, L.M., Taizivei; Chigiji, Handrick; Salama, Peter; Nolan, Anthony; Sammon, Elayn;
Muwoni, Leon, Childhood sexual violence in Zimbabwe: Evidence for the epidemic
against girls. 2015, Elsevier Ltd. p. 60-66.
138. Tran, N.K., et al., Changes in the prevalence of child maltreatment in Vietnam over 10
years. Child Abuse Negl, 2018. 80: p. 172-182.
139. Marie, S.M., B; Salvador, Jazelyn M; Calacal, Gayvelline C; Sagum, Minerva S; Ruth,
Miriam; Dalet, M; Delfin, Frederick C; Tabbada, Kristina A; Ann, Shiela; Franco, Edith L;
Perdigon, Henry B; Madrid, Bernadette J; Tan, Merle P; Corazon, Maria; De Ungria, A, Y-
STR DNA analysis of 154 female child sexual assault cases in the Philippines. 2011. p.
817-824.
140. Makhtar Mbacke Leye, M.F., Adama; Wone, Issa; Diedhiou, Demba; Diongue,
Mayassine; Niang, Khadim; Seck, Ibrahima; Ndiaye, Papa; Tal Dia, Anta, [Study of
determinants of rape in minors in the Kolda region of Senegal] - PubMed. 2014. p. 131-
8.
141. Stark Id, L.S., Ilana; Hoover, Anna; Gordon, Rebecca; Ligiero, Daniela; Massetti, Greta
Sex and age effects in past-year experiences of violence amongst adolescents in five
countries. 2019.
142. Musiwa, A.S., Intrafamilial Child Sexual Abuse: A Unique Silent Epidemic. Perspectives of
Victim-Friendly Court Professionals in Marondera District, Zimbabwe. 2019, Routledge.
p. 860-884.
143. Butun, C.Y., Ali; Ozer, Erdal; Yilmaz, Eda; Aybuke Sari, Seda, A Nonrandom Sample of 55
Sexual Abuse Cases in Sivas. 2014. p. 1.
144. Pereira, A., et al., Disclosure, reporting and help seeking among child survivors of
violence: a cross-country analysis. BMC Public Health, 2020. 20(1): p. 1051.
 PAGE 31

145. Roberts, E., et al., Low program access despite high burden of sexual, structural, and
reproductive health vulnerabilities among young women who sell sex in Mombasa,
Kenya. BMC Public Health, 2020. 20(1): p. 806.
146. Murphy, M.B., Jeffrey B.; Ovince, Junior; Ellsberg, Mary; Contreras-Urbina, Manuel, The
effects of conflict and displacement on violence against adolescent girls in South Sudan:
the case of adolescent girls in the Protection of Civilian sites in Juba. 2019, Taylor &
Francis. p. 181-191.
147. Gezie, L.D.W., Alemayehu; Kebede, Yigzaw; Gebeyehu, Abebaw, Sexual violence at each
stage of human trafficking cycle and associated factors: A retrospective cohort study on
Ethiopian female returnees via three major trafficking corridors. 2019.
148. Rio Navarro, J.C., Julien; Rocillo Arechaga, Eva; Zuniga, Edgardo; Navarro, Rio J;
Arechaga, Rocillo E; Sans Frontières, Médecins, Physical and sexual violence, mental
health indicators, and treatment seeking among street-based population groups in
Tegucigalpa, Honduras Investigación original / Original research. 2012. p. 2012.
149. Alşen Güney, S.B., Özlem; Cevher Binici, Nagihan, An Overview of a Hospital-Based Child
Advocacy Center’s Experience from Turkey. 2018, Routledge. p. 476-489.
150. Fouché, A.l.R., Liana, Social workers' views on pre-trial therapy in cases of child sexual
abuse in South Africa A R T I C L E I N F O. 2017. p. 23-33.
151. Mathews, S.A., Naeemah; Jewkes, Rachel, Exploring Mental Health Adjustment of
Children Post Sexual Assault in South Africa. 2013. p. 639-657.
152. Ebuenyi, I.D.C., Uzoechi E.; Dariah, Gerald O., Implications of Silence in the Face of Child
Sexual Abuse: Observations from Yenagoa, Nigeria. 2018, Afr J Reprod Health. p. 83-87.
153. Mulambia, Y.M., Aaron J; Macdonald, Geraldine; Kennedy, Neil, Are one-stop centres an
appropriate model to deliver services to sexually abused children in urban Malawi? 2018.
154. Alşen Güney, S.B., Özlem, Protective and Supportive Injunctions for Children Exposed to
Sexual Abuse: The First Data from Turkey. 2020, Routledge. p. 627-637.
155. Yevtieieva, D.L., A.; Maryniv, V. , PUBERTY VS AGE: ON THE ISSUE OF A WARNING SIGN
OF A VICTIM OF NON-VIOLENT INTERCOURSE WITH A MINOR - PubMed. 2019. p. 145-
150.
156. Bimbinov, A.A., [The harm to health of the under-age individuals as an objective criterion
for the differentiation of criminal responsibilities for committing non-violent sexual
offence against them]. 2016, Sud Med Ekspert. p. 4-6.
157. Shuko Musiwa, A., How Has the Presence of Zimbabwe's Victim-Friendly Court and
Relevant Child Protection Policy and Legal Frameworks Affected the Management of
Intrafamilial Child Sexual Abuse in Zimbabwe? The Case of Marondera District. 2018. p.
1748-1777.
158. Miller, A.J.T., Kristin Barlup, Educating Physicians Internationally in the Diagnosis of Child
Sexual Abuse: Evaluation of a Brief Educational Intervention in Malawi. 2014. p. 247-
255.
159. Rolovic, J.S.S., Nikola Perceived Skill and Willingness to Address Child Sexual Abuse:
Assessing Serbian and Montenegrin Pediatricians. 2020, Routledge. p. 112-128.
 PAGE 32

160. Nadeem, T.A., Nargis; Hamid, Sahar Nadeem, Cultural considerations in providing
trauma care to female, childhood sexual abuse survivors: Experiences from Pakistan.
2020, Elsevier. p. 101885.
161. Kandemir, E.Y., Yasin; Ozmansur, Nurdan; Gunaydin, Hilal; Demirel, Omer Faruk; Berber,
Gurol; Kantarci, Nabi; Aliustaoglu, Suheyla; Emul, Murat, Attitudes among medical and
nonmedical university students toward the survivors of childhood abuse. 2012. p. 753-
757.
162. Daniels, J.K.R., Arnošt; Makusha, Tawanda; Heerden, Alastair Van; Gray, Glenda;
Chingono, Alfred; Mbwambo, Jessie K K; Coates, Thomas; Richter, Linda, Effects of a
Community Intervention on HIV Prevention Behaviors among Men Who Experienced
Childhood Sexual or Physical Abuse in Four African Settings: Findings from NIMH Project
Accept (HPTN 043). 2014.
163. Merrill, K.G.M., Jamison C; Hershow, Rebecca B; Barkley, Chris; Rakosa, Boitumelo;
Decelles, Jeff; Harrison, Abigail, Linking at-risk South African girls to sexual violence and
reproductive health services: A mixed-methods assessment of a soccer-based HIV
prevention program and pilot SMS campaign. 2018. p. 12-24.
164. Harrison, R.E.P., Linda; Vere, Michael; Chonzi, Prosper; Hove, Brian Tafadzwa; Mabaya,
Sharon; Chigwamba, Margaret; Nhamburo, Juliana; Gura, Juliet; Vandeborne, An;
Simons, Sandra; Lagrou, Daphne; De Plecker, Eva; Van Den Bergh, Rafael, Care
requirements for clients who present after rape and clients who presented after
consensual sex as a minor at a clinic in Harare, Zimbabwe, from 2011 to 2014. 2017, PLoS
One.
165. Visser, M.D.P., Jessica., An expressive art group intervention for sexually abused
adolescent females. 2015. p. 199-213.
166. Vermeulen, T.G., Abraham P., Family Resilience Resources in Coping With Child Sexual
Abuse in South Africa. 2015. p. 555-571.
167. Masilo, G.M.D.-M., Mashudu, Guidelines for support to mothers of sexually abused
children in North-West province. 2017. p. 1-9.
168. Kotzé, J.M.B., Hanneke, Child sexual abuse: The significance of the history and testifying
on non-confirmatory findings. 2019. p. 1-7.
169. Chan, L.F.M., Susan; Tan, Koon; Ang, Jin Kiat; Kamal Nor, Norazlin; Sharip, Shalisah, A
Case of Sexual Abuse by a Traditional Faith Healer: Are There Potential Preventions?
2012. p. 613-620.
170. Barr, A.L.K., Louise; Franҫa-Junior, Ivan; Allen, Elizabeth; Naker, Dipak; Devries, Karen M,
Methods to increase reporting of childhood sexual abuse in surveys: the sensitivity and
specificity of face-to-face interviews versus a sealed envelope method in Ugandan
primary school children. 2017.
171. Sanberk, İ.E., Meltem; Kabakçı, Duygu, An Investigation of Socially Advantaged and
Disadvantaged Turkish Mothers’ Views About Training on Preventing Children From
Sexual Abuse. 2017. p. 288-307.
172. Miller, K.S.W., Kate; Pruitt, Kaitlyn L; Saul, Janet Curriculum Development Around
Parenting Strategies to Prevent and Respond to Child Sexual Abuse in Sub-Saharan
 PAGE 33

Africa: A Program Collaboration Between Families Matter! and Global Dialogues. 2015,
Journal of Child Sexual Abuse p. 839-852.
173. Apaydın Cırık, V.E., Emine; Velipaşaoğlu, Sevtap, Educating children through their
parents to prevent child sexual abuse in Turkey. 2020. p. 523-532.
174. Kucuk, S.P., Nurgun; Erdem, Emine, Increasing awareness of protection from sexual
abuse in children with mild intellectual disabilities: An education study. 2017, Elsevier. p.
153-158.
175. Baiocchi, M.O., Benjamin; Langat, Nickson; Boothroyd, Derek B; Sinclair, Jake; Pavia, Lee;
Mulinge, Munyae; Githua, Oscar; Golden, Neville H; Sarnquist, Clea, A Behavior-Based
Intervention That Prevents Sexual Assault: the Results of a Matched-Pairs, Cluster-
Randomized Study in Nairobi, Kenya. 2017. p. 818-827.
176. Decker, M.R., et al., Sexual violence among adolescent girls and young women in
Malawi: a cluster-randomized controlled implementation trial of empowerment self-
defense training. BMC Public Health, 2018. 18(1): p. 1341.
177. Jemmott, J.B.O.L., Ann; Jemmott, Loretta Sweet; Ngwane, Zolani Philemon;Teitelman,
Anne Marie; Makiwane, Monde Blessing; Bellamy, Scarlett L., Effect of a Behavioral
Intervention on Perpetrating and Experiencing Forced Sex among South African
Adolescents: A Secondary Analysis of a Cluster Randomized Trial. 2018. p. 1-13.
178. Citak Tunc, G.G., Gulay; Ozyazicioglu, Nurcan; Ak, Bedriye; Isil, Ozlem; Vural, Pinar,
Preventing Child Sexual Abuse: Body Safety Training for Young Children in Turkey. 2018,
Routledge. p. 347-364.
179. Sarnquist, C.O., Benjamin; Sinclair, Jake; Gitau, Carolinah; Paiva, Lee; Mulinge, Munyae;
Cornfield, David N.; Maldonado, Yvonne, Rape Prevention Through Empowerment of
Adolescent Girls. 2014, American Academy of Pediatrics. p. e1226-e1232.
180. Mantula, F.S., Haroon, Child Sexual Abuse in Zimbabwe. 2016, Routledge. p. 866-880.
181. Gautam Poudel, P.B., Cristina S., Social determinants of child trafficking addressed by
government and non-government strategies in South and Southeast Asia: an integrative
review. 2019. p. 808-819.
182. Masilo, D.T., Prevention of Child Sexual Abuse within the Family System: Guidelines for
an Educational Social Group Work Program. 2018, Routledge. p. 335-346.
183. Mosavel, M.A., R; Simon, C, Perceptions of gender-based violence among South African
youth: implications for health promotion interventions. 2011.
184. Williams, T.P.B., Agnes; Betancourt, Theresa S., Transactional sex as a form of child
sexual exploitation and abuse in Rwanda: Implications for child security and protection.
2012. p. 354-361.
185. Michalopoulos, L.T.M.M., Laura K.; Kane, Jeremy C.; Van Wyk, Stephanie Skavenski;
Chomba, Elwyn; Cohen, Judith; Imasiku, Mwiya; Semrau, Katherine; Unick, Jay; Bolton,
Paul A., Testing the validity and reliability of the Shame Questionnaire among sexually
abused girls in Zambia. 2015. p. 1-17.
186. Gokten, E.S.U., Caglar, Prediction of the development of depression and post-traumatic
stress disorder in sexually abused children using a random forest classifier. 2021, Elsevier
B.V. p. 256-265.
 PAGE 34

187. Citak Tunc, G.G., Gulay; Ozyazicioglu, Nurcan; Ak, Bedriye; Isil, Ozlem; Vural, Pinar,
Determining the Appropriateness of the “What If” Situations Test (WIST) with Turkish
Pre-Schoolers. 2018, Routledge. p. 292-304.
188. Çömez İkican, T.K., Leyla, Child sexual abuse knowledge/attitude scale for parents:
Reliability and validity of the Turkish version. 2021, Blackwell Publishing Inc. p. 791-799.
189. Chandraratne, N.K.F., Asvini D; Gunawardena, Nalika; Fernando, A D., Cultural
adaptation, translation and validation of the ISPCAN Child Abuse Screening Tool-
Retrospective Version (ICAST-R) for young adults in Sri Lanka. 2018. p. 11-22.
190. Stark, L.S., Marni; Davis, Kathryn; Asghar, Khudejha; Assazenew Baysa, Asham; Abdela,
Gizman; Tanner, Sophie; Falb, Kathryn, Disclosure bias for group versus individual
reporting of violence amongst conflict-affected adolescent girls in DRC and Ethiopia.
2017.
191. Karabağ, G.T., Halil İbrahim; Sunay Yavuz, Mehmet; Genç, Abdülkadir; Akın, Ufuk; Saraç,
Selma, The importance of clinical approach in aggravated sexual abuse: Case report.
2018.
192. Sathirareuangchai, S.P., Peerayuht The usefulness of Neisseria gonorrhoeae strain
typing by Pulse-Field Gel Electrophoresis (PFGE) and DNA detection as the forensic
evidence in child sexual abuse cases: a case series. 2015. p. 153-157.
193. Sener, M.T.V., Talip; Sahpaz, Ahmet Physical Findings Mimicking Sexual Abuse in a
Drowning Patient Who Was Treated in the Intensive Care Unit: A Report on a Fatal Case.
2018, Lippincott Williams and Wilkins. p. 351-353.
194. Mcclinton Appollis, T.M., Sander; De Vries, Petrus J; De Vries, Hein; Lund, Crick;
Mathews, Cathy; Appollis, Tracy Mcclinton, The Impact of Participation in Research
About Abuse and Intimate Partner Violence: An Investigation of Harms, Benefits, and
Regrets in Young Adolescents in the Western Cape of South Africa. 2020. p. 943-963.
195. Kulik, A., et al., [PEDOPHILIA AS A CAUSE OF CHILD SEXUAL ABUSE: A MEDICAL AND
LEGAL PROBLEM]. Georgian Med News, 2021(312): p. 172-180.
196. Sommarin, C.K., Theresa; Mercy, James A.; Moloney-Kitts, Michele; Ligiero, Daniela P. ,
Preventing sexual violence and HIV in children. 2014. p. 217-223.
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Appendix I
Keywords for CSA were established by testing different combinations of keywords in the PubMed
MeSH terms database and identifying keywords most used within the criteria and parameters outlined
below. Low- and middle-income country names were included as search terms., and searches were
applied within title and abstract fields as well as within MeSH terms in articles on PubMed. The search
strategy is illustrated in the table below.

(english[Language]) OR (spanish[Language])) OR (french[Language])) OR

(arabic[Language])
AND
(CSA[MeSH Major Topic]) OR (child sexual abuse[MeSH Major Topic]) OR
(childhood sexual abuse[MeSH Major Topic]) OR (childhood sexual
violence[MeSH Major Topic]) OR (child sexual violence[MeSH Major Topic])
OR (child sexual assault[MeSH Major Topic]) OR (child exploitation[MeSH
Major Topic]) OR (child trafficking[MeSH Major Topic]) OR (child sexual
harassment[MeSH Major Topic]) OR (ASA[MeSH Major Topic]) OR
(adolescent sexual abuse[MeSH Major Topic]) OR (adolescent sexual
assault[MeSH Major Topic]) OR (adolescent sexual violence[MeSH Major
Topic]) OR (adolescent exploitation[MeSH Major Topic]) OR (adolescent
trafficking[MeSH Major Topic]) OR (adolescent sex trafficking[MeSH Major
Topic]) OR (adolescent sexual harassment[MeSH Major Topic]) OR
(adolescent grooming[MeSH Major Topic]) OR (teenage sexual
violence[MeSH Major Topic]) OR (teenage sexual abuse[MeSH Major Topic])
OR (teenage sexual assault[MeSH Major Topic]) OR (teenage
trafficking[MeSH Major Topic]) OR (teenage sex trafficking[MeSH Major
Topic])OR (teenage sexual harassment[MeSH Major Topic]) OR (teenage
exploitation[MeSH Major Topic]) OR (teenage sexual harassment[MeSH
Major Topic]) OR (teenage grooming[MeSH Major Topic]) OR
(molestation[MeSH Major Topic]) OR (child molestation[MeSH Major
Topic]) OR (child sexual molestation[MeSH Major Topic])
OR
(CSA[MeSH Terms]) OR (child sexual abuse[MeSH Terms]) OR (childhood
sexual abuse[MeSH Terms]) OR (childhood sexual violence[MeSH Terms])
OR (child sexual violence[MeSH Terms]) OR (child sexual assault[MeSH
Terms]) OR (child exploitation[MeSH Terms]) OR (child trafficking[MeSH
Terms]) OR (child sexual harassment[MeSH Terms]) OR (ASA[MeSH Terms])
OR (adolescent sexual abuse[MeSH Terms]) OR (adolescent sexual
assault[MeSH Terms]) OR (adolescent sexual violence[MeSH Terms]) OR
(adolescent exploitation[MeSH Terms]) OR (adolescent trafficking[MeSH
Terms]) OR (adolescent sex trafficking[MeSH Terms]) OR (adolescent sexual
harassment[MeSH Terms]) OR (adolescent grooming[MeSH Terms]) OR
(teenage sexual violence[MeSH Terms]) OR (teenage sexual abuse[MeSH
Terms]) OR (teenage sexual assault[MeSH Terms]) OR (teenage
trafficking[MeSH Terms]) OR (teenage sex trafficking[MeSH Terms])OR
 PAGE 36

(teenage sexual harassment[MeSH Terms]) OR (teenage exploitation[MeSH

Terms]) OR (teenage sexual harassment[MeSH Terms]) OR (teenage
grooming[MeSH Terms])OR (molestation[MeSH Terms]) OR (child
molestation[MeSH Terms]) OR (child sexual molestation[MeSH Terms])
OR
CSA[MeSH Subheading]) OR (child sexual abuse[MeSH Subheading]) OR
(childhood sexual abuse[MeSH Subheading]) OR (childhood sexual
violence[MeSH Subheading]) OR (child sexual violence[MeSH Subheading])
OR (child sexual assault[MeSH Subheading]) OR (child exploitation[MeSH
Subheading]) OR (child trafficking[MeSH Subheading]) OR (child sexual
harassment[MeSH Subheading]) OR (ASA[MeSH Subheading]) OR
(adolescent sexual abuse[MeSH Subheading]) OR (adolescent sexual
assault[MeSH Subheading]) OR (adolescent sexual violence[MeSH
Subheading]) OR (adolescent exploitation[MeSH Subheading]) OR
(adolescent trafficking[MeSH Subheading]) OR (adolescent sex
trafficking[MeSH Subheading]) OR (adolescent sexual harassment[MeSH
Subheading]) OR (adolescent grooming[MeSH Subheading]) OR (teenage
sexual violence[MeSH Subheading]) OR (teenage sexual abuse[MeSH
Subheading]) OR (teenage sexual assault[MeSH Subheading]) OR (teenage
trafficking[MeSH Subheading]) OR (teenage sex trafficking[MeSH
Subheading])OR (teenage sexual harassment[MeSH Subheading]) OR
(teenage exploitation[MeSH Subheading]) OR (teenage sexual
harassment[MeSH Subheading]) OR (teenage grooming[MeSH
Subheading])OR (molestation[MeSH Subheading]) OR (child
molestation[MeSH Subheading]) OR (child sexual molestation[MeSH
Subheading])
AND
(LMIC OR "developing country" OR "under-developed country" OR "third-
world country" OR "third-world nations" OR "under-developed nation" OR
"less-developed country" OR "least developed country" OR Afghanistan OR
Albania OR Algeria OR "America Samoa" OR Angola OR Argentina OR
Armenia OR Azerbaijan OR Bangladesh OR Belarus OR Belize OR Benin OR
Bhutan OR Bolivia OR "Bosnia and Herzegovina" OR Botswana OR Brazil OR
"Burkina Faso" OR Burundi OR "Cabo Verde" OR Cambodia OR Cameroon
OR "Central African Republic" OR Chad OR China OR Colombia OR Comoros
OR "Democratic Republic of the Congo" OR DRC OR "Republic of the Congo"
OR "Costa Rica" OR "Cote D'Ivoire" OR Cuba OR Djibouti OR Dominica OR
"Dominican Republic" OR Ecuador OR Egypt OR "El Salvador" OR "Equatorial
Guinea" OR Eritrea OR Eswatini OR Ethiopia OR Fiji OR Gabon OR Gambia
OR Georgia OR Ghana OR Grenada OR Guatemala OR Guinea OR Guinea-
Bissau OR Guyana OR Haiti Or Honduras OR India OR Indonesia OR Iran OR
Iraq OR Jamaica OR Jordan OR Kazakhstan OR Kenya OR Kiribati OR Korea
Or "Democratic People's Republic of Korea" OR Kosovo OR "Kyrgyz
Republic" OR Laos OR Lebanon OR Lesotho OR Liberia OR Libya OR
Madagascar OR Malawi OR Malaysia OR Maldives OR Mali OR "Marshall
Islands" OR Mauritania OR Mexico OR "Federated States of Micronesia" OR
Micronesia OR Moldova OR Mongolia OR Montenegro OR Morocco OR
 PAGE 37

Mozambique OR Myanmar OR Namibia OR Nepal OR Nicaragua OR Niger Or

Nigeria OR "North Macedonia" OR Pakistan OR "Papua New Guinea" OR
Paraguay OR Peru OR Philippines OR "Russian Federation" OR Rwanda OR
Samoa OR "Sao Tome and Principe" OR Senegal OR Serbia OR "Sierra Leone"
OR "Solomon Islands" OR Somalia OR "South Africa" OR "South Sudan" OR
"Sri Lanka" OR "St. Lucia" OR "St. Vincent and the Grenadines" OR Sudan OR
Suriname OR "Syrian Arab Republic" OR Syria OR Tajikistan OR Tanzania OR
Thailand OR Timor-Leste OR Togo OR Tunisia OR Turkey OR Turkmenistan
OR Tuvalu OR Uganda OR Ukraine OR Uzbekistan OR Vanuatu OR Venezuela
OR Vietnam OR "West Bank and Gaza" OR Yemen OR Zambia OR Zimbabwe
OR "south-south" OR "global south" OR EE OR "Eastern Europe" OR LAC OR
"Latin American and the Caribbean" OR MENA OR "Middle East and North
Africa" OR "Sub-Saharan Africa" OR "Asia and the Pacific" OR "Central Asia"
OR "East Asia" OR "the Pacific" OR "South Asia" OR "South East Asia")
 PAGE 38

Organisation: Sexual Violence Research Initiative

Email: svri@svri.org
Website: www.svri.org
Registrations: NPC 2019/197466/08
NPO 230-059