Child_sexual_abuse_and_its_determinants_among_chil

PLOS GLOBAL PUBLIC HEALTH
RESEARCH ARTICLE
Child sexual abuse and its determinants

among children in Addis Ababa Ethiopia:
Systematic review and meta-analysis
Birye Dessalegn Mekonnen ID1, Sintayehu Simie Tsega ID2*
1 Amhara Public Health Institute, Bahir Dar, Ethiopia, 2 Department of Medical Nursing, School of Nursing,
College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
a1111111111 * simies952@gmail.com
a1111111111
a1111111111
a1111111111 Abstract
a1111111111
Child sexual abuse is a significant public health concern and a breach of basic human rights
affecting millions of children each year globally. It is typically not reported by victims, hence
it remains usually concealed. Except for single studies with varying reports, there is no
OPEN ACCESS national studies conducted on child sexual abuse in Ethiopia. Therefore, this review deter-
Citation: Mekonnen BD, Tsega SS (2024) Child mined the pooled magnitude and determinants of sexual abuse among children in Ethiopia.
sexual abuse and its determinants among children Potential articles were searched from PubMed, Science Direct, Scopus, and Web of science
in Addis Ababa Ethiopia: Systematic review and using relevant searching key terms. The Joanna Briggs Institute (JBI) critical appraisal
meta-analysis. PLOS Glob Public Health 4(4):
checklist was used to evaluate the quality of all selected articles. Data were analyzed using
e0001979. https://doi.org/10.1371/journal.
pgph.0001979 STATA Version 14 software. Publication bias was checked using Egger’s test and funnel
plot. Cochran’s chi-squared test and I2 values were used to assess heterogeneity. A ran-
Editor: Lana Clara Chikhungu, University of
Portsmouth, UNITED KINGDOM dom-effects model was applied during meta-analysis. The pooled prevalence of sexual
abuse among 5,979 children in Ethiopia was 41.15% (95% CI: 24.44, 57.86). Sex of children
Received: April 24, 2023
(OR: 2.14, 95%CI: 1.12, 4.06), smoking (OR: 4.48, 95%CI: 1.26, 76.79), khat chewing (OR:
Accepted: February 29, 2024
3.68, 95%CI: 1.62, 21.93), and alcohol use (OR: 4.77, 95%CI: 2.22, 10.25) were the deter-
Published: April 3, 2024 minants of child sexual abuse. The main perpetrators of sexual abuse against children were
Peer Review History: PLOS recognizes the neighbors, boy/girlfriends, family members, school teachers, and stranger person. Child
benefits of transparency in the peer review sexual abuse commonly took place in the victim’s or perpetrator’s home, school, and neigh-
process; therefore, we enable the publication of
bor’s home. This review revealed that the magnitude of child sexual abuse in Ethiopia was
all of the content of peer review and author
responses alongside final, published articles. The relatively high and multiple factors determined the likelihood of sexual violence against chil-
editorial history of this article is available here: dren. Thus, policy-makers and concerned stakeholders should strengthen comprehensive
https://doi.org/10.1371/journal.pgph.0001979 sexual and reproductive health education to reduce the magnitude and consequences of
Copyright: © 2024 Mekonnen, Tsega. This is an child sexual abuse. Moreover, support with special attention should be given to children with
open access article distributed under the terms of mental illness and physical disabilities.
the Creative Commons Attribution License, which
permits unrestricted use, distribution, and
reproduction in any medium, provided the original
author and source are credited.
Data Availability Statement: All data are in the

manuscript and/or supporting information files. Introduction
Funding: The authors received no specific funding Child sexual abuse is the participation of a child (below the age of 18 years) in sexual activity
for this work. that she or he is unable to give informed consent, does not fully understand, the child is not
PLOS Global Public Health | https://doi.org/10.1371/journal.pgph.0001979 April 3, 2024 1 / 15

PLOS GLOBAL PUBLIC HEALTH Child sexual Abuse and its determinants
Competing interests: The authors have declared developmentally prepared [1]. It includes a variety of activities such as sexual intercourse,
that no competing interests exist. attempted sexual intercourse, oral-genital contact, exposing children to pornography or adult
sexual activity, fondling of genitals, and the use of the child for prostitution [2,3].
Child sexual abuse is a widespread and serious global public health problem and great viola-
tion of human rights that is now recognized as a public health priority [4]. Though sexual
abuse affects people of all ages, genders, and sexual orientations, the majority of victims are
women, children, and adolescents [5,6]. The global prevalence of child sexual abuse which has
been estimated at 7.9% for males and 19.7% for females [7].
Child sexual abuse is a persistent form of child abuse that is often not reported, difficult to
identify, and therefore often remains concealed [8]. It remains usually hidden in many devel-
oping countries as victims cannot report such assaults [9]. Factors that could contribute for
underreporting include discrepancies in the definitions of sexual abuse, committed in com-
plete privacy, fear of social stigma against survivors, and cultural and social norms [10,11].
Child sexual abuse is strongly associated with social determinants such as weak rule of law,
poor governance, social, cultural and gender norms, low income, unemployment, limited edu-
cational opportunities, and gender inequality [12,13]. Likewise, factors such as social isolation,
parental conflicts, lack of parental control, the absence of one or both parents, and family
adversity have been associated to a higher risk of child sexual abuse [13–16].
Child sexual abuse has long-lasting effects and can be overwhelming for a child’s relation-
ships and social life [17,18]. Existing literature have revealed that childhood sexual abuse was
associated psychosocial problems, psychiatric disorders, self-harm, and physical health prob-
lems such as sexually transmitted diseases including HIV, unwanted pregnancy, unsafe abor-
tion, and obesity [19–23]. Similarly, systematic reviews have also indicated that sexual abuse in
childhood was associated with psychosocial, psychiatric and health outcomes such as sub-
stance misuse, depression, post-traumatic stress disorder and anxiety over the life course [24–
26].
In Ethiopian, there are no national pooled prevalence studies conducted on child sexual
abuse except for individual studies with inconsistence reports. Additionally, identification of
perpetrators, determinants, and consequences of child sexual abuse have not been well
described. Thus, a systematic review and quantitative synthesis of findings from prevalence
studies conducted on child sexual abuse is required. Therefore, this systematic review aimed to
estimate the pooled prevalence and determinants of child sexual abuse in Ethiopia. Hereafter,
recognizing the magnitude of child sexual abuse and its determinants helps to develop com-
prehensive strategies and interventions most fitted for children and inform policy-makers.
Methods
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist
was used to prepare and report this systematic review and meta-analysis (S1 Checklist). The
protocol for this systematic review was developed and registered on the International Prospec-
tive Register of Systematic Reviews (CRD42022362613).
Eligibility criteria
Observational studies that report the prevalence and/ or determinants of child sexual abuse,
studies that published and reported in the English language, both published and non-peer
reviewed but publicly available studies conducted only in Ethiopia were considered. Articles
that did not report the prevalence and/ or determinants of child sexual abuse, case reports,
commentaries, case studies, and review articles were excluded.

Information sources and search strategy

A systematic search of potentially relevant articles was performed from PubMed, Science
Direct, Scopus, and Web of science until 28 August 2022. Literature search was conducted
using the following keywords: “Magnitude”, “Prevalence”, "sexual abuse", “sexual violence”,
“sexual harassment”, “rape”, “sexual coercion”, "sex offense", “child”, “children”, “under 18
years age”, “below 18 years age”, “associated factors”, “determinants”, “predictors” and “Ethio-
pia”. The search was conducted using a variety of truncation, Boolean operators such as “OR”
or “AND”. Moreover, non-peer reviewed but publicly available articles were searched from
Google.
Study selection
Article screening process was performed using the EndNote X7.2.1 (Thomson Reuters, New
York, USA) software citation manager. Two reviewers (BDM and SST) thoughtfully review the
titles and abstracts of articles for relevance of the studies. Subsequently, full-text studies were
retrieved and assessed to approve eligibility. The overall study selection processes were sum-
marized using the PRISMA flow diagram.
Data extraction and quality assessment

Data were extracted from included articles by two reviewers (BDM and SST) independently
using the Joanna Briggs Institute (JBI) tool adapted for cross-sectional studies. The following
data were collected from selected articles: first author name, study design, study setting, year of
publication, sample size, response rate, number of participants, prevalence of child sexual
abuse, perpetrators, determinants, consequences of child sexual abuse.
The methodological quality of all included articles was evaluated by two reviewers (BDM
and SST) independently using the JBI critical appraisal checklist. The overall methodological
quality of each article was based on the sum of points gained, which ranged from 0 to 10
points. Accordingly, all studies scored � 60% of the JBI quality appraisal criteria and were
included in the review. Any disagreements during data extraction and quality assessment were
resolved through discussion with the third reviewer.
Operational definitions
Child: is a person under the age of 18 years, unless the laws of a specific country set the legal
age for adulthood earlier [27].
Child sexual abuse: is the involvement of a child in sexual activity such as intercourse,
attempted intercourse that she or he is unable to fully understand and give informed consent
[4]. In this review, child sexual abuse was considered if the primary studies reported any type
or forms of sexual abuse such as completed or attempted sexual act.
Data analysis
The results of included studies were described and summarized using figures, tables, and forest
plots. Meta-analysis was executed using STATA 14. Heterogeneity effect sizes was assessed
using the Q statistic and quantified by I2 values. The existence of heterogeneity between
included studies was presumed when p < 0.1 or I2 > 50% [28]. A random-effects model was
performed to execute the pooled prevalence of child sexual abuse as substantial heterogeneity
was exhibited across included studies.
Publication bias was evaluated using Egger’s test and inspection of asymmetry funnel plot.
A p-value � 0.05 for Egger’s test was indicative of presence of publication bias [29]. To assess

the presence effect of outliers, sensitivity analysis was performed [30]. All statistical analyses
were considered statistically significant at a p-value of 0.05.
Results
Study selection
Initially, the search strategy produced 8,646 recorded literatures. A total of 2,785 records were
removed because of duplication. Then, 5,861 articles were screened based on their titles and
abstracts, which results in the removal of 5,820 articles. Consecutively, the remaining 41 full-
text articles were independently assessed based on the inclusion criteria, which results in fur-
ther exclusion of 33 articles. Full-text articles were excluded because of variation in study loca-
tions and population, not clearly report the outcome of interest, and some were reviews.
Finally, eight studies were included in this systematic review (Fig 1).
Study characteristics
In this review, a total of 5,979 children were included from an estimated 6,003 sample size. The
sample size of the selected articles ranged from 327 [31] to 1,666 [32]. Regarding study design
Fig 1. PRISMA flow diagram for meta-analysis of child sexual abuse in Ethiopia.
https://doi.org/10.1371/journal.pgph.0001979.g001

Table 1. Summary of studies included in the meta-analysis of child sexual abuse in Ethiopia, 2022.
Author Year Study Study design Sample Response Number of Outcome Prevalence Quality
area size rate participants (event) (%) score
Abera et al [35] 2021 Dire Cross-sectional 794 98.8 785 384 48.9 9
Dawa quantitative
Alemayehu et al. [36] 2022 Addis Cross-sectional 422 100 422 180 42.7 9
Ababa quantitative
Assabu G et al [34] 2019 Addis Cross-sectional 1500 100 1500 1100 73.4 7
Ababa quantitative
Chemimdessa A et al 2014 Addis Mixed (Quantitative and 422 96.4 407 160 39.3 6
[37] Ababa Qualitative)
Habtamu D and A. 2013 Addis Mixed (Quantitative and 422 100 422 55 13.1 8
Adamu [33] Ababa Qualitative)
Jibril Jemal [32] 2012 Addis Mixed (Quantitative and 1666 100 1666 384 23.1 7
Ababa Qualitative)
Muluwork Tefera [31] 2017 Addis Cross-sectional 327 100 327 133 40.7 7
Ababa quantitative
Takele M et al [38] 2020 Addis Cross-sectional 450 100 450 217 48.2 8
Ababa quantitative
https://doi.org/10.1371/journal.pgph.0001979.t001
of included studies, five studies were quantitative cross-sectional, and three studies employed a
mixed (quantitative and qualitative) study design approach. Almost all (n = 7) of the studies
were conducted in Addis Ababa. All studies included in this review were conducted from 2012
to 2021. The magnitude of child sexual abuse ranged from 13.1% [33] to 73.4% [34]. The result
of the quality assessment indicated that one study was scored 6 points, three were scored 7
points, two were scored 8 points, and two were scored 9 points (Table 1).
Sensitivity analysis and publication bias

The result of sensitivity analysis revealed that no individual studies significantly affect the
pooled prevalence of child sexual abuse. Egger’s rank test and Egger’s test were performed to
evaluate the presence of publication bias. Accordingly, the results of the tests indicated that
publication bias was not detected, with the p-value of 0.956, and symmetry of the funnel plot
(Fig 2).
Prevalence of child sexual abuse

The pooled prevalence of sexual abuse among 5,979 children in Ethiopia was 41.15% (95% CI:
24.44, 57.86). In this meta-analysis, random-effects model was applied because of high hetero-
geneity (I2 = 99.5%, p < 0.001) was detected across the included studies (Fig 3).
Dealing with heterogeneity

Subgroup analysis and meta-regression were conducted to detect the potential sources of het-
erogeneity between studies. Furthermore, random-effects model was used during meta-analy-
sis. The subgroup analysis was performed based on study design (cross sectional quantitative
Vs mixed study). The result indicated that there was no significant difference in the level of
heterogeneity across study designs used in the included studies (Fig 4).
A meta-regression analysis was done based on year of publication, study design and sample
size. Accordingly, the results of the meta regression analysis showed all the variables had no
significant effect on the pooled prevalence of child sexual abuse in Ethiopia (Table 2).

Fig 2. Graphic representation of publication bias using funnel plots.

Perpetrators of child sexual abuse

The main perpetrators of sexual abuse against children were neighbors, with pooled prevalence
of 34.3% (14.04, 54.59) followed by boy/ girlfriends at 15.9% (11.00, 20.80). Child sexual abuse
commonly took place in the victim’s or perpetrator’s home, school, neighbor’s home, Hotel,
and in the public street. Table 3 shows the perpetrators of sexual abuse against children.
Determinants of child sexual abuse

The factors associated with child sexual abuse that were consistently reported in more than
one primary study were pooled quantitatively. Accordingly, the results of the meta-analysis
showed that female children were about 2.14 times (OR: 2.14, 95%CI: 1.12, 4.06) more likely to
experience sexual abuse. Furthermore, children who smoke cigarette (OR: 4.48, 95%CI: 1.26,
76.79), khat chewing (OR: 3.68, 95%CI: 1.62, 21.93), and alcohol use (OR: 4.77, 95%CI: 2.22,
10.25) were more likely to experience any type of sexual abuse (Table 4). There is likely an
interaction between the variables of alcohol use, khat chewing, and gender, suggesting that
boys are more likely to engage in these behaviours.
The determinants of child sexual abuse not included in the meta-analysis due to inconsis-
tent categorization or being reported only in one primary study were systematically reviewed.
Hence, children over the age of 14, and rural residents were more likely to experience sexual
abuse [35,36,38]. Additionally, children who had mental illness and physical disability were
more likely to be sexually abused [36]. Furthermore, children who did not have an open dis-
cussion with their parents on sexual and reproductive health, and living with their single par-
ent were also more likely to experience sexual abuse [35,36].

Fig 3. Forest plot showing the pooled prevalence of child sexual abuse in Ethiopia, 2022.
Discussion
This meta-analysis showed that the pooled prevalence of child sexual abuse in Ethiopia was
41.15%. This finding was in line with the findings of a systematic review and meta-analysis
that reported the prevalence of child sexual abuse as 32% [39]. This implies that a significant
proportion of children experiencing sexual abuse in their lifetime, which requires the need of
prioritizing intervention that reduce child sexual abuse.
Female children were more likely to experience sexual abuse than male children. The find-
ings of a systematic review and meta-analysis also supported this finding, which indicated that
female sex, was associated with increased risk of child sexual abuse [40]. This could be attrib-
uted by the effect of community perception towards gender roles results in the expectation
that female be submissive to males [41,42]. Literature showed that masculinity, culture, social
norms, and beliefs about gender roles substantially contribute to the high prevalence of sexual
abuse among females [43,44].
Children who use alcohol were more likely to experience sexual abuse. This could be
because drinking alcohol can change one’s consciousness and ability to solve problems. In
addition to increasing risk-taking, alcohol also causes people to become less conscious of and
concerned about the effects of their actions [45]. Moreover, alcohol consumption decreases
one’s ability to decision making [46]. Similarly, the findings indicated that children who
smoke cigarette, and chew khat were more likely to experience any type of sexual abuse. The
stimulant effect of khat chewing exposes children to feelings of sexual activity such as watching
pornographic movies, which make them to easily manipulated by perpetrators [47]. Evidence

Fig 4. Subgroup analysis of child sexual abuse in Ethiopia, 2022.

indicated that perpetrators of sexual abuse usually use substances such as alcohol, chat, and
cigarette as tool to take advantage of someone who is vulnerable and lacking capacity for deci-
sion making [48,49]. In this review, gender is identified as determinants of child sexual abuse.
Hence, there is likely an interaction between the variables of alcohol use, khat chewing, and
gender, suggesting that boys are more likely to engage in these behaviours [50,51].
Children who had a mental illness and physical disability were more likely to be sexually
abused, which is supported by previous systematic reviews and meta-analysis [52]. This could
be because of children living with disability are more vulnerable to emotional, sexual, and
physical abuse and neglect than non-disabled children [53,54]. Similarly, children who lack
open discussion on sexual issues with parents were more likely to experience sexual abuse,
which is supported by a previous systematic reviews [55]. This could be due to less parental
Table 2. Results of meta-regression for child sexual abuse in Ethiopia, 2022.

Variable Std. Err. Meta-regression Coefficient (95%CI) p-value
Publication year 1.399 3.232 (-0.192, 6.657) 0.060
Study design
Cross-sectional quantitative 0.014 0.008 (-0.025, 0.041) 0.591
Mixed (quantitative and qualitative) 5.771 -0.241 (-14.363, 13.881) 0.968
Sample size 0.014 0.008 ( -0.025, 0.041) 0.589

Table 3. Perpetrators of child sexual abuse in Ethiopia, 2022.

Perpetrators of child sexual abuse Studies Estimates (95% CI) Pooled prevalence % (95% CI) Test of heterogeneity
I2 (%) P
Neighbors Assabu G et al. 28.8 (26.51, 31.09) 34.3 (14.04, 54.59) 99.19 0.000
Muluwork Tefera 54.6 (49.20, 59.99)
Abera et al. 19.9 (17.11, 22.69)
Boy/girlfriends Assabu G et al. 17.5 (15.58, 19.42) 15.9 (11.00, 20.80) 93.22 0.000
Alemayehu et al. 13.3 (10.06, 16.54)
Abera et al. 23.8 (20.82, 26.78)
Chemimdessa A et al. 16.2 (12.62, 19.78)
Stranger persons Assabu G et al. 4.8 (3.72, 5.88) 12.7 (1.88, 27.28) 99.45 0.000
Abera et al. 5.9 (4.25, 7.55)
Family members Assabu G et al. 23.6 (21.45, 25.75) 11.8 (1.79, 21.82) 99.04 0.000
Abera et al. 16.7 (14.09, 19.31)
School teachers Assabu G et al. 4.5 (3.45, 5.55) 9.09 (1.19, 19.38) 99.25 0.000
Abera et al. 25.0 (21.97, 28.03)
involvement in children’s sexual and reproductive health behaviors which leads to missing
opportunities to acquire experiences and life skills for the prevention of sexual abuse. Hence,
there should be a parent-child open discussion on sexual issues without considering it as
shameful and taboo.
The neighbors, family members, school teachers, boy/girlfriends, and stranger person were
identified as the most common perpetrators of sexual abuse against children. This is supported
by an existing literature which indicated that children were most commonly subjected to sex-
ual abuse by family members, neighbors, relatives, and other persons known to the victim
child [56,57]. While the primary studies reported boy/girlfriends (romantic friends) as perpe-
trators of child sexual abuse without specifying the more common gender, it was found that
boys are more likely to engage in sexual offense behaviors [58]. This review also indicated that
Table 4. Determinants of child sexual abuse in Ethiopia, 2022.

Variables Studies Odds ratio (95% CI) Pooled odds ratio % (95% CI) Test of
heterogeneity
I2 P
Sex Alemayehu et al. 1.9 (0.79, 4.72) 2.14 (1.12, 4.06) 0.00 0.75
Takele M et al. 2.4 (0.94, 6.0)
Alcohol Alemayehu et al. 2.2 (1.36, 3.53) 4.77 (2.22, 10.25) 89.84 0.001
Takele M et al. 5.97 (3.84, 9.28)
Abera et al. 8.02 (5.63, 11.43)
Chat Alemayehu et al. 3.6 (1.46, 28.69) 3.68 (1.62, 21.93) 0.00 0.15
Takele M et al. 3.8 (1.11, 31.68)
Cigarette Alemayehu et al. 5.9 (1.05, 42.12) 4.48 (1.26, 76.79) 0.00 0.30
Takele M et al. 3.8 (1.11, 36.02)

child sexual abuse commonly took place in the victim’s or perpetrator’s home, school, neigh-
bor’s home, hotel, and in the public street. Literature also indicated that perpetrators of sexual
abuse are more likely to commit the attack in the victim’s or perpetrator’s home [59,60]. This
implies that sexual offenders might consciously plan to commit sexual abuse.
The findings of this systematic review indicated that victims of child sexual abuse experi-
enced psychological consequences such as feeling lonely, attempt to commit suicide, fear of
males, and verbal and physical aggressiveness. This finding is supported by previous systematic
reviews [24,55,61–64]. Similarly, unwanted pregnancies, underwent an abortion, pain during
urination, and vaginal discharge were sexual and reproductive health consequences reported
by victims of child sexual abuse, which is supported by previous findings [24,61,63,65].
Limitations of the study

The following limitations should be considered when reading and interpreting the findings of
this study: Firstly, though meta-regression and subgroup analyses were done, the sources of
high heterogeneity across included studies was not identified. Secondly, the generalizability of
the review might not be in full confidence since the included studies were not from all the
regions of Ethiopia, almost all the studies were from Addis Ababa. Subsequently, regional dif-
ferences were not discussed because of the small number of studies from a limited geographic
area. Thirdly, the pooled odds ratio for some factors were not examined because of inconsis-
tent categorization. Fourthly, discussion of the findings comparing with existing evidence
couldn’t be done due to lack of comparable studies in the study country and worldwide. Nev-
ertheless, this systematic review provided the first pooled magnitude of child sexual abuse in
Ethiopia, to the best of the authors knowledge.
Implications of the study

This study revealed that nearly half of children experienced sexual abuse by different perpetra-
tors. This finding infers the need of strengthening policy or regulations interventions specific
to child sexual abuse by in view of them as they are disadvantaged group. The finding also
implies the need of better performing for awareness creation on the concept of child sexual
abuse for the society. Besides, the finding could be attributed to the role of understanding the
burden of child sexual abuse for the likelihood and success of prevention and control interven-
tions. Literature also indicated that understanding the burden of child sexual abuse would help
for the likelihood and effectiveness of prevention and control strategies.
The current review provided vibrant evidence to notify policy-makers, and other concerned
stakeholders to prevent and control child sexual abuse. Some determinants were identified
that are associated with increased experiences of child sexual abuse. While the use of sub-
stances was identified as a determinant of child sexual abuse, we did not obtain clear informa-
tion on legislation regarding substance or drug use among children in Ethiopia. Thus, policy-
makers should develop and enforce comprehensive regulations to address and reduce sub-
stance use among children. In addition, prioritizing the determinants and the prevention of
child sexual abuse should be started sooner rather than later. Furthermore, health information
and education provision programs are necessary to empower the society. Moreover, special
support should be given for the victims. Perpetrators of child sexual abuse were identified as
individuals typically involved in such offenses against children. Therefore, enforcing appropri-
ate policies and legislation such as encouraging children and parents to report such acts, public
awareness creation campaigns, prompt punishment of the perpetrators are crucial to end child
sexual abuse. However, it is important to consider that many survivors tend not to report
abuse which may affect the prevalence estimates. Research indicated that survivors of sexual

abuse did not report the abuse due to a lack of awareness of how and to whom to report, a
desire to protect the family, fear that the abuser will retaliate, and financial dependence on the
perpetrator [66,67].
Conclusion
This review revealed that the magnitude of child sexual abuse in Ethiopia was relatively high
and multiple factors determined likelihood of sexual violence against children. Therefore, pol-
icy-makers, and other concerned stakeholders should design and implement interventions
that could empower the community in their struggle toward the prevention and elimination of
child sexual abuse, create awareness on the burden and consequences of child sexual abuse,
prompt punishment of the sex offenders, and control and monitor the implementation of poli-
cies and legislation. Moreover, support with special attention should be given to female chil-
dren and those who use alcohol, chat, and cigarette.
Supporting information
S1 Checklist. Preferred Reporting Items for Systematic Reviews and Meta-Analyses
(PRISMA) checklist.
(DOC)
Author Contributions
Conceptualization: Birye Dessalegn Mekonnen, Sintayehu Simie Tsega.
Data curation: Birye Dessalegn Mekonnen, Sintayehu Simie Tsega.
Formal analysis: Birye Dessalegn Mekonnen, Sintayehu Simie Tsega.
Funding acquisition: Birye Dessalegn Mekonnen, Sintayehu Simie Tsega.
Investigation: Birye Dessalegn Mekonnen, Sintayehu Simie Tsega.
Methodology: Birye Dessalegn Mekonnen, Sintayehu Simie Tsega.
Project administration: Birye Dessalegn Mekonnen, Sintayehu Simie Tsega.
Resources: Birye Dessalegn Mekonnen, Sintayehu Simie Tsega.
Software: Birye Dessalegn Mekonnen, Sintayehu Simie Tsega.
Supervision: Birye Dessalegn Mekonnen, Sintayehu Simie Tsega.
Validation: Birye Dessalegn Mekonnen, Sintayehu Simie Tsega.
Visualization: Birye Dessalegn Mekonnen, Sintayehu Simie Tsega.
Writing – original draft: Birye Dessalegn Mekonnen, Sintayehu Simie Tsega.
Writing – review & editing: Birye Dessalegn Mekonnen, Sintayehu Simie Tsega.
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PLOS GLOBAL PUBLIC HEALTH

Child sexual abuse and its determinants

Data Availability Statement: All data are in the

PLOS Global Public Health | https://doi.org/10.1371/journal.pgph.0001979 April 3, 2024 1 / 15

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Information sources and search strategy

Data extraction and quality assessment

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Sensitivity analysis and publication bias

Prevalence of child sexual abuse

Dealing with heterogeneity

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Fig 2. Graphic representation of publication bias using funnel plots.

Perpetrators of child sexual abuse

Determinants of child sexual abuse

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Fig 4. Subgroup analysis of child sexual abuse in Ethiopia, 2022.

Table 2. Results of meta-regression for child sexual abuse in Ethiopia, 2022.

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Table 3. Perpetrators of child sexual abuse in Ethiopia, 2022.

Table 4. Determinants of child sexual abuse in Ethiopia, 2022.

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Limitations of the study

Implications of the study

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