OALibJOpen Access Library Journal2333-9705Scientific Research Publishing10.4236/oalib.1104516OALibJ-83742ArticlesBiomedical&Life Sciences Business&Economics Chemistry&Materials Science Computer Science&Communications Earth&Environmental Sciences Engineering Medicine&Healthcare Physics&Mathematics Social Sciences&Humanities Sexual Abuse among Female Undergraduates in Tertiary Institutions in IMO State, Southeast Nigeria: Prevalence, Pattern and Determinants ChukwumaB. Duru1ChinyereM. Aguocha2AnthonyC. Iwu1UcheR. Oluoha1IjeomaN. Okedo-Alex3IkechiOhanle4ErnestNwaigbo4Department of Community Medicine, Federal Teaching Hospital, Abakaliki, NigeriaDepartment of Psychiatry, Imo State University, Owerri, NigeriaDepartment of Community Medicine, Imo State University Teaching Hospital, Orlu, NigeriaDepartment of Community Medicine, Imo State University, Owerri, Nigeria04042018050412419, March 201810, April 2018 13, April 2018© Copyright 2014 by authors and Scientific Research Publishing Inc. 2014This work is licensed under the Creative Commons Attribution International License (CC BY). http://creativecommons.org/licenses/by/4.0/

Introduction: Sexual abuse is a global public health problem that cuts across social class, cultures, tribes etc. and has permeated the fabrics of tertiary institutions and many work places as long as humans have reasons to interact. Aim: To determine the prevalence, pattern and determinants of sexual abuse among undergraduates in tertiary institutions in Imo State, Nigeria. Methodology: This study was a descrip tive, cross sectional survey of 600 female students in tertiary institutions in Imo State Nigeria. They were selected using the multistage sampling technique and data were collected using a pretested, semi-structural and self-administered questionnaire and analyzed using a computer soft-ware (EPI INFO version 3.3.2). Descriptive statistics was presented using summary indices, frequency tables and percentages. Associations between variables were done using the chi-square and logistic regression. A p-value of less than 0.05 was considered significant. Results: The mean age of the respondents was 21.7 3.2 years. The current and life-time prevalence of sexual abuse among the respondents was 15.2% and 34% respectively and the commonest form of sexual abuse experienced was founding/grabbing of sensitive body parts (52.5%). Factors found to influence current occurrence of sexual abuse among the students were; age (p = 0.010), tribe (p = 0.008), marital status (p < 0.001), type of student in secondary school attended (p = 0.001), faculty of study (p = 0), year in school (p < 0.0001), persons currently shared room with (p < 0.0001) and level of knowledge about sexual abuse (p = 0.007). Conclusion: The prevalence of abuse as revealed in this study was high. There is need to develop appropriated prevention strategies by the universities to curb this menace against our women.

Sexual Abuse Prevalence Pattern Determinants Female Tertiary Institutions Imo State1. Introduction

Gender-based violence against women, which is a public health problem, has been acknowledged worldwide as a violation of basic human rights. An increasing amount of research highlights the health burdens, intergenerational effects, and demographic consequences of such violence [1] [2] . The World Health Organization defines such violence as “the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, or deprivation” [3] . Sexual abuse which is a form of such violence also referred to as molestation, is the forcing of undesired sexual behavior by one person upon another. When that force is immediate, of short duration, or infrequent, it is called sexual assault [4] . American Psychological Association (APA) defined sexual abuse as an unwanted sexual activity with perpetrators using force, making threats or taking advantage of victims notable to give consent [5] . Sexual abuse may take many forms and vary in terms of frequency, duration, invasiveness of the acts involved, and the use of force or coercion [6] . The term sexual abuse also covers any behavior by an adult towards a child to stimulate either the adult or the child sexually [7] . Both sexes are affected, though most of the cases occur among females, especially female children and adolescents. Contrary to myth that most perpetrators are strangers, wide spread research has revealed that most of the assailants are usually intimate partners, friends and someone within the family. Males perpetrate the majority (80% - 95%) of sexual abuse, though there are certainly some cases in which female offenders victimize male or female children [5] [8] [9] [10] [11] . Sexual abuse or harassment is a global issue that cuts across, social class, cultures, tribes etc., and has permeated the fabrics of tertiary institutions, and many work places as long as human have reasons to interact [12] [13] . The actual prevalence of sexual abuse/violence is unknown as a result of gross under-reporting even though it has been reported as the fastest growing crime in many parts of the world [14] [15] . However, in a WHO Multi-country survey, the life-time prevalence of sexual partner violence reported by women, aged 15 - 49 years range from 6% in Japan to 59% in Ethiopia, with rates in the majority of cases falling between 10% and 50% [16] [17] . Studies have shown that 1 in 4 women may have experienced sexual violence by an intimate partner and up to a third of adolescent girls reported their experience as being forced [18] [19] [20] . Almost 1 in 5 women has been sexually abused by a man at some time in her life [14] . In a 2011 survey of high students in US, 11.8% of girls and 4.5% of boys from grades 9 - 12 reported that they were forced to have sexual intercourse at some time in their lives [21] , while a study of undergraduate women also in the US revealed that 19% of them experienced attempted or completed sexual assault since entering college [22] . In Africa the prevalence was generally high and varies between countries; it was 16% in Cameroun, 23% in Sierra Leone, 34.4% in Ethiopia, 49% in Ghana, 65.6% in Zimbabwe and 67% in Botswana [23] - [28] . In Nigeria, reports also vary from the different regions of the country. A study from a university in the South eastern part of the country reported 36.7% [29] , studies from three South-south universities reported; 51.7% [30] , 46.7% [31] and 18.4% [32] respectively while lower figures were reported from two institutions in Northern Nigeria (13.8% and 22.2%) [33] [34] . Some of the predisposing factors and determinants of sexual abuse/violence reported in previous studies were; age, sex, marital status of female, socioeconomic status of women and poverty, educational status of women, occupation, living in arrangement, orphan status, type of family, current parents, marital status, alcohol consumption, drug use, previous experience of rape or sexual abuse, multiple sexual partners, younger age at coitarche, history of forced coitarche, coitarche with relatives and unknown persons, year of study and living status of student and being a college or university student among others [29] [31] [33] - [41] . Studies have shown that sexual abuse/violence have negative impacts on the physical, social and mental health of the victim [31] [36] [41] . Some of the consequences include reproductive health problems like unwanted pregnancy, sexually transmitted diseases/HIV etc., all forms of injuries, depression, anxiety, social isolation, loss of self-esteem, distrust of others, substance abuse, post-traumatic disorder, disability and even death [31] [42] [43] [44] . The problem of sexual abuse against female undergraduates in our tertiary institutions has remained largely unaddressed, it prevents this students from attaining their maximum intellectual, emotional and educational potentials [31] . It is a psychological threat to a conducive learning environment [30] [31] . Various forms of sexual abuse has been reported to occur among undergraduates in university setting which include rape (attempted or completed), unwanted sexual advances, sexual harassment, demanding sex in-return for favor, sexual abuse of mentally or physically disabled people, pornography and internet sexual abuse, fondling and grabbing of sensitive body parts among others [30] [31] . Despite the problems caused by sexual violence in our environment, majority of the cases were not reported, primarily because of cultural issues and patrichial nature of our society with male dominance [30] [31] [40] . This has led to rising cases of abuse especially in our universities, where even reported cases has not been give appropriate attention and the culprit move freely thereby worsening the state of the abused females.

Therefore our study aim is to assess the prevalence, pattern and determinants of sexual abuse among females in tertiary institutions in Imo State with a view of informing policy makers and the public of the burden of sexual abuse and how this can be greatly reduced and save our women from its long term effects. Theses study findings will help to reveal the magnitude of sexual abuse, the prevalent patterns of sexual abuse and the main perpetrators of this senseless act in our tertiary institutions in Imo state, Nigeria. Also the short and long term health and mental consequences of sexual abuse will be revealed which will in turn guide our policy makers in developing appropriate policies that will help curb this menace in our institutions of higher learning.

2. Methodology2.1. Study Area

Imo State is one of the 36 States of Nigeria in the South Eastern Region of the country. It has a total population of about 3.93 million people, comprising more males than females (2.03 million and 1.9 million people respectively) and an annual growth rate of about 3.0%. The majority of the people living in the State are of Igbo tribe extraction and the state has one the highest literacy rate in the country of over 95%. Important educational institutions in the state include; Imo State University, Federal University of Technology, Eastern Palm University, Alvan Ikoku Federal College of Education, Federal Polytechnic, Nekede, Imo State Polytechnic, School of Nursing and Health Sciences, African Institute of Science and Technology, Seat of Wisdom Seminary School among others.

2.2. Study Population and Design

The study population comprised female undergraduate students of the selected institutions in Owerri Imo state. This is a descriptive cross sectional study on the prevalence, pattern and determinants of sexual abuse among female students in tertiary institutions in Imo State, South East, Nigeria.

2.3. Inclusion and Exclusion Criteria

1) Inclusion: Only female students of the selected institutions were studied whether they were on part time or full-time basis were enrolled and studied

2) Exclusion criteria: All visitors to the institution were excluded no matter their status. All male students, lecturers and staff of the institution were excluded for the survey.

2.4. Sample Size Determination

Using the Cochran sample size formula for cross sectional studies in populations greater than 10,000 people and the prevalence of sexual abuse in a closely related study from Nigeria, with a prevalence of 46.7% [31] , and applying the formula below, the minimum sample size required for the study was 366 students.

n = Z 2 P q / d 245

where n is the minimum sample size, Z = standard normal deviate set at 95% significance level ≈ 1.96, p = the prevalence of life-time abuse from a previous study = 46.7%, q = 1 − p, d = the degree of accuracy set at 0.05. But a sample size of 600 students were enrolled and studied to cover for attrition.

2.5. Sampling Technique

The study was carried out using the multistage sampling technique.

STAGE 1: This involved the stratification of the institutions into two categories; category A comprised Universities while category B comprised other higher institutions excluding universities and using simple random sampling by balloting one institution was selected from each category. Three Hundred students each was studied in both institutions.

STAGE 11: This involved selection of the Faculties and Departments to be studied. This was done using proportionate simple random sampling by balloting based on population size of the selected Faculties and Departments.

STAGE 111: This involves the selection of study participants. This was done using cluster sampling technique. The classes studied were grouped into clusters from 100 - 600 level. And one cluster from each class was selected using simple random sampling. All selected clusters were studied.

2.6. Data Collection and Analysis

Data was collected using a pretested, semi-structured, self-administered questionnaire. The questionnaire contained three sections; Section A: Socio demographic characteristics of respondents, Section B: Awareness and knowledge about sexual abuse, Section C: Prevalence and experience of sexual abuse among students. Quantitative data collected were cleaned and validated manually, while a computer software package (EPI INFO version 3.3.2) was used for data entry and analysis. Frequencies and percentages of relevant variables were generated, bivariate analysis conducted using Chi-square and logistic regression to test associations between variables. For the purpose of this study, knowledge of respondents about sexual abuse was scored using five awareness questions, each question assigned scores 0 - 5 with a maximum total score of 25 for all the five questions. The score was graded as poor if the respondent scored 0% - 49% of the total, fair if the respondent scored 50% - 69% of the total and high/good knowledge if the respondents scored ≥70% of the total score. A p-value < 0.05 was considered statistically significant.

2.7. Ethical Approval

Ethical approval was gotten from the Faculty of Clinical Medicine, Madonna University Nigeria, before proceeding to the study. Approvals were gotten from the relevant university authorities and verbal consent was obtained from all participants after full explanation of the purpose of the study before proceeding to the interview. The research was conducted in line with laid down procedures at Helsinki (1964) in use of human subjects.

3. Result3.1. Socio-Demographic Characteristics of Respondents

The mean age of respondents was 21.7 ± 3.2 years and the majority of the undergraduates studied were singles (87%). A higher proportion of them attended private secondary schools 241 (40.2%), that were mainly situated in the urban areas (66.7%). Majority of them attended mixed schools 356 (59.3%), were day students only, (60.7%) and were in the faculty of Arts/Education, (61.7%). Most of the students were above 100 level, (93.5%), of which majority of them reside off campus (53.5%), share room with someone (80.5%) and many of those who share room with someone do that with their female friends 295 (61.1%). Most of the respondents were sponsored in school by family members (95.8%) and were of Igbo extraction, (92.5%). A higher proportion of them were Catholics (48.7%) (Table 1 and Table 2).

3.2. Awareness and Knowledge about Domestic Violence

Most of the respondents, (81.8%) have heard about sexual abuse and the common sources of information were from; television, (61.1%), newspaper, (53.8%), friends, (53.0%), and radio (51.9%). The most common definition of sexual abuse known was sexual act without consent (89.2%), and common forms of sexual abuse mentioned were; Fondling/grabbing of private body parts (86.4%), rape (66.8%) and exposure to pornography (46.4%). Common victims of sexual abuse mentioned were; children, (74.1%), females, (69.0%) and singles, (57.2%). Majority of the respondents (96.3%) mentioned females as the genders most affected. Teacher/lecturers (72.3%), intimate partners (44.2%) were the common perpetrators of abuse mentioned. Commonest place that abuse takes place was in secretes corners (71.1%), followed closely by school/office (67.4%) and clubs (58.7%). Transmission of STI (77.8%) was the commonest consequence of abuse mentioned. A higher proportion of the students had poor knowledge about sexual abuse, (47.0%). The commonest factor leading to sexual abuse suggested by respondents was ignorance, 214 (14.4%) followed by financial problem, 196 (13.2%) and indecent dressing, 158 (10.6%). The commonest preventive measures to stop sexual abuse suggested by respondents were self-control 336 (17.3%) followed by stopping of lonely visits 225 (11.6%), punishment for offenders 215 (11.1%), and avoidance of bad company 185 (9.5%) (Table 3).

3.3. Prevalence and Pattern of Sexual Abuse

About one-third (34%) of the students had experienced sexual abuse in their life-time with majority of them, (54.9%) experiencing it more than once in their life-time. The major forms of sexual abuse ever experienced were; fondling/grabbing of sensitive body parts/kissing, (52.5%), rape, (19.1%) and sex for favor, (13.2%). The commonest scene of occurrence of life-time sexual abuse

Sociodermographic characteristics of respondents
VARIABLEFREQUENCYPERCENTAGE
AGE GROUP <20 21 - 25 >26 Total230 306 64 60038.3 51.0 9.7 100
MARITAL STATUS Single Ever married Total522 78 60087.0 13.0 100
TYPE OF SECONDARY SCHOOL ATTENDED Public Private Missions Total239 241 120 60039.8 40.2 20.0 100
LOCATION OF SECONDARY SCHOOL ATTENDED Urban Rural Total400 200 60066.7 33.3 100
FORM OF SECONDARY SCHOOL ATTENDED Girls only Mixed school Total244 356 60040.7 59.3 100
TYPE OF STUDENT IN SECONDARY SCHOOL Boarding student only Day student only Both Total176 364 60 60029.3 60.7 10.0 100
FACULTY OF STUDY Art/Education Social sciences/Sciences Health sciences Total370 150 80 60061.7 25.0 13.3 100
LEVEL 100 200 300 >400 Total39 118 246 197 6006.5 19.7 41.0 32.9 100
RESIDENCE IN CURRENT SCHOOL In-school hostel Off campus hostel Family house Total155 321 124 60025.8 53.5 20.7 100
SHARING ROOM WITH SOMEONE Yes No Total483 117 60080.5 19.5 100
PERSON SHARED ROOM WITH (n = 483) Female friend Boyfriend Relative Total295 70 118 48361.1 14.5 24.4 100
SPONSORSHIP IN SCHOOL Non-self Self Total575 25 60095.8 4.2 100
RELIGION Catholic Pentecostal Orthodox ISLAM Total292 179 122 7 60048.7 29.8 20.3 1.2 100
TRIBE Igbo Non-Igbo Total555 45 60092.5 7.5 100

reported was home of perpetuators, (72.6%). The common circumstances that lead to the abuse were; visiting the house of the perpetuator, (62.7%) and violence/force, (34.8%). Current experience of sexual abuse among the students was 15.2% and the commonest form of sexual abuse experienced was fondling/grabbing of sensitive body parts/kissing, (59.3%) followed by rape, (40.7%) and sex for favor, (29.6%). The common perpetrators of current sexual abuse were; casual partners, (57.1%), teachers/lecturers/boss, (51.7%) and intimate partner, (33.0%). The commonest place of occurrence is the home of the perpetuator (68.1%) followed by office, (58.3%). Visiting of the perpetuator, (56%) was the highest circumstances leading to abuse followed by violence/force, (47.3%). The commonest consequence of abuse mentioned was emotional problem, (57.8%) followed by psychological problems, (33.8%) (Table 4).

Factors found to be significantly associated with life-time experience of sexual abuse were; tribe of respondent, (Χ2 = 8.103, p = 0.004), type of secondary school attended, (X2 = 10.432, p = 0.001), type of student in secondary school attended, (X2 = 11.812, p = 0.001), faculty of study, (X2 = 41.147, p = 0), level/year in school, (X2 = 7.321, p = 0.007), persons shared room with, (X2 = 44.813, p = 0), and level of knowledge about sexual abuse, (X2 = 15.454, p < 0.001). Students who were non-Igbos, (OR: 2.38; 1.29 - 4.39), attended private secondary schools, (OR: 1.57; 1.08 - 2.29), were day students in secondary schools attended, (OR: 2.19; 1.21 - 3.97), currently studying in Faculty of Health Sciences, (OR: 12.19; 6.64 - 22.39) and at 100 level of their study, (OR: 2.41; 1.25 - 4.63) were more likely to have experienced sexual abuse in their life-time than others. On the other hand students who attended mission secondary schools, (OR: 0.59; 0.36 - 0.99), shared room currently with their boyfriend, (OR: 0.09; 0.04 - 0.20) and

Awareness and knowledge of respondents about sexual abuse
VARIABLEFREQUENCYPERCENTAGE
AWARE ABOUT SEXUAL ABUSE (n = 600) Yes No Total491 109 60081.8 18.2 100
**SOURCE OF INFORMATION (n = 491) Television Newspaper Friends Radio School Internet Parents/relatives Seminar/workshop Health personnel Books Church Market Billboards Government agencies Non-Governmental Organization300 264 260 255 232 223 179 161 156 155 145 114 106 94 8961.1 53.8 53.0 51.9 47.3 45.4 36.5 32.8 31.8 31.6 29.5 23.2 21.6 19.1 18.1
**MEANING OF SEXUAL ABUSE (n = 491) Sexual act without consent Rape Verbal excuse of sexual nature Sexual act by family member Sexual act for favor Sexual act by relatives/friends438 287 156 153 152 9489.2 58.5 31.8 31.2 31.0 19.1
**FORMS OF SEXUAL ABUSE KNOWN (n = 491) Fondling/Grabbling of sensitive body parts Rape Exposure to pornography Sex for favor Incest Degrading sexual comments Oral contact with genitalia Penetration with digits424 328 228 154 153 138 135 11786.4 66.8 46.4 31.4 31.2 28.1 27.5 23.8
**VICTIMS OF SEXUAL ABUSE (n = 491) Children Females Singles Married women Elderly women Males364 336 281 214 186 18074.1 69.0 57.2 43.6 37.9 36.7
GENDER MOST AFFECTED (n = 600) Female Male Total578 22 60096.3 3.7 100
**COMMON PERPETRATORS OF ABUSE (n = 491) Teachers/Lecturers Intimate partner Casual partners Family members/Friends Colleagues Spiritual leaders Parents355 217 208 192 171 131 12772.3 44.2 42.4 39.1 34.8 26.7 25.9
COMMON PLACE OF ABUSE (n = 491) Secret corners School/office Clubs Home Hotels Public places349 331 288 282 254 21171.1 67.4 58.7 57.4 51.7 43.0
**FACTORS LEADING TO SEXUAL ABUSE (n = 491) Ignorance Financial problems Indecent dressing Poor family upbringing Lack of self-control Social problems Pornography Peer group pressure For favor done Love for pleasure Internet/social media Personal greed Others1214 196 158 130 128 128 116 103 97 80 75 63 2514.4 13.2 10.6 8.8 8.6 8.3 7.8 6.9 6.1 5.4 5.1 4.2 1.7
**HOW TO PREVENT OF SEXUAL ABUSE (n = 491) Self-control Avoid lonely visitations Punish offenders Avoid bad company Adequate security Strict regulations Use of law enforcements agents Empowerment of women Information dissemination Proper psychiatric examinations Proper monitoring of event336 225 215 185 170 154 152 130 122 120 10668.4 45.8 43.8 37.7 34.6 31.4 31.0 26.5 24.9 24.4 21.6
**CONSEQUENCES MENTIONED (n = 491) Sexually transmitted infections Emotional problems Psychological problems Physical injuries Social problems Morbidities Mortalities382 338 315 304 200 176 16977.8 67.2 64.2 61.9 40.7 35.8 34.4
LEVEL OF KNOWLEDGE (n = 600) Poor (0% - 49%) Moderate (50% - 79%) Good (≤80%) Total282 243 75 60047.0 40.5 12.5 100

**= Multiple Response Applicable, Others1 = war/crisis, family problems.

Prevalence and pattern of sexual abuse
VARIABLEFREQUENCYPERCENTAGE
EVER BEEN ABUSED (n = 600) Yes No Total204 396 60034.0 66.0 100
FREQUENCY OF ABUSE (n = 204) Once 2 - 4 times Many times Total94 69 41 20446.1 33.8 20.1 100
**FORMS OF SEXUAL ABUSE EXPERIENCED (n = 204) Fondling/grabbing of sensitive body parts/kissing Rape Sex for favor Degrading sexual comments Anal intercourse Exposure to pornography Penetration with digits Incest Oral sex107 39 27 26 17 14 14 12 952.5 19.1 13.2 12.8 8.3 6.8 6.8 5.8 4.4
**PLACES OF OCCURRENCE (n = 204) Home of perpetrator Office Hostel Road Hotel Car Classroom Home of victim/Bush/party place148 54 33 32 31 23 21 772.6 26.5 16.2 15.7 15.2 11.3 10.3 3.4
**CIRCUMSTANCES LEADING TO ABUSE (n = 204) Visitation to home of perpetrator Violence/force Seeking favor Indecent dressing Drunkenness Drugs/Displacement/Crises137 71 44 38 25 667.2 34.8 21.6 18.6 12.3 2.9
CURRENT ABUSE IN LAST ONE YEAR (n = 600) Yes No Total91 509 60015.2 84.8 100.0
**FORM OF ABUSE CURRENTLY EXPERIENCED (n = 91) Fondling/Grabbing of body parts/kissing Rape Sex for favor Degrading sexual comment Exposure to pornography/internet sex Incest Penetration with digits Oral sex56 37 27 26 14 12 10 961.5 40.7 29.6 28.6 15.4 13.2 11.0 9.9
**MAIN PERPETRATORS (n = 91) Casual partner Teacher/Lecturer/Boss Intimate partner Family member Friend Spiritual leader Colleague Stranger52 47 30 16 14 12 12 557.1 51.7 33.0 17.6 15.4 13.2 13.2 5.5
**PLACES OF ABUSE (n = 91) Home of perpetrator Office Hostel Road Car Classroom Hotel Victims home/bush/party place63 53 31 22 18 14 12 369.2 58.2 36.3 24.2 19.8 15.4 13.2 3.3
**CIRCUMSTANCES LEADING TO ABUSE (n = 91) Visitation Violence/force Seeking favor Indecent dressing Drunkenness Drugs/Displacement/Crises51 43 22 22 19 456.0 47.3 24.1 24.1 9.9 4.4
**CONSEQUENCES OF THE ABUSE (n = 204) Emotional problems Psychological problems Had STI Physical injury Mental problems Social problems UTI/other morbidities Infertility118 69 49 38 27 26 16 857.8 33.8 24.0 18.6 13.2 12.7 7.8 3.9

**= Multiple response.

had good knowledge about sexual abuse, (OR: 0.24; 0.12 - 0.51) were the least likely to have experienced sexual abuse in their life-time (Table 5).

Factors found to be significantly associated with current experience of sexual abuse among the students were; age of the respondents, (Χ2 = 6.630, p = 0.010), tribe of respondents, (Χ2 = 7.120, p = 0.008), marital status, (X2 = 14.290, p < 0.001), type of student in secondary school attended, (X2 = 10.746, p = 0.001), Faculty of study, (X2 = 38.005, p = 0), level/year in school, (X2 = 22.205, p < 0.0001), persons currently shared room with, (X2 = 19.520, p < 0.0001), and level of knowledge about sexual abuse, (X2 = 7.170, p = 0.007). Students who were non-Igbos, (OR: 2.48; 1.25 - 4.94), ever married, (OR: 2.79; 1.61 - 4.84), currently studying in Faculty of Health Sciences, (OR: 8.09; 4.60 - 14.22) and in 100 level of their study, (OR: 4.61; 2.32 - 9.18) were more likely to have currently experienced sexual abuse than others. On the other hand students within the age

Determinants of life-time experience of sexual abuse among students
VARIABLESEVER EXPERIENCE OF SEXUAL ABUSESTATISTICS/(X2) P-VALUEOR (95% CI)
YES (%)NO (%)TOTAL (%)
AGE GROUP
<20 21 - 25 >26 Total67 (29.1 ) 111 (36.3) 26 (40.6) 204 (34.0)163 (70.9) 195 (63.7) 38 (59.4) 396 (66.0)230 (100) 306 (100) 64 (100) 600 (100)0.042 p = 0.8381.00 1.37 (0.96 - 2.00) 1.67 (0.94 - 2.96)
TRIBE Igbo Non-Igbo Total180 (32.4) 24 (53.3) 204 (34.0)375 (67.6) 21 (46.7) 396 (66.0)555 (100) 45 (100) 600 (100)8.103 p = 0.004*1.00 2.38* (1.29 - 4.39)
RELIGION Catholic Orthodox Pentecostal Others1 Total98 (33.6) 42 (34.4) 64 (35.8) 0 (0.0) 204 (34.0)194 (66.4) 80 (65.6) 115 (64.2) 7 (100.0) 396 (66.0)292 (100) 122 (100) 179 (100) 7 (100) 600 (100)0.074 p = 0.7851.00 1.04 (0.67 - 1.62) 1.10 (0.75 - 1.63) Na
MARITAL STATUS Single Ever married Total177 (33.9) 27 (34.6) 204 (34.0)345 (66.1) 51 (65.4) 396 (66.0)522 (100) 78 (100) 600 (100)0.015 p = 0.9020.97 (0.59 - 1.60) 1.00
TYPE OF SECONDARY SCHOOL ATTENDED
Public Private Missionary Total76 (31.8) 102 (42.3) 26 (21.7) 204 (34.0)163 (68.2) 139 (57.7) 94 (78.3) 396 (66.0)239 (100) 241 (100) 120 (100) 600 (100)10.432 p = 0.001*1.00 1.57* (1.08 - 2.29) 0.59* (0.36 - 0.99)
LOCATION OF SECONDARY SCHOOL ATTENDED
Urban Rural Total129 (32.3) 75 (37.5) 204 (34.0)271 (67.7) 125 (62.5) 396 (66.0)400 (100) 200 (100) 600 (100)1.638 p = 0.2001.00 1.26 (0.88 - 1.80)
FORM OF SECONDARY SCHOOL ATTENDED
Girls only Mixed Total86 (35.2) 118 (33.1) 204 (34.0)158 (64.8) 238 (66.9) 396 (66.0)244 (100) 356 (100) 600 (100)0.285 p = 0.5941.00 1.10 (0.78 - 1.55)
TYPE OF STUDENT IN SECONDARY SCHOOL ATTENDED
Boarding Day student Mixed Total63 (35.8) 108 (29.7) 33 (55.0) 204 (34.0)113 (42.9) 256 (44.0) 27 (13.1) 396 (66.0)176 (100) 364 (100) 60 (100) 600 (100)11.812 p = 0.0011.00 0.76 (0.52 - 1.12) 2.19* (1.21 - 3.97)
FACULTY Arts/Education Social/Sciences Health Sciences Total97 (26.2) 42 (28.0) 65 (81.3) 204 (34.0)273 (73.8) 108 (72.0) 15 (18.7) 396 (66.0)370 (100) 150 (100) 80 (100) 600 (100)41.147 p = 0*1.00 1.10 (0.72 - 1.67) 12.19* (6.64 - 22.39)
LEVEL IN SCHOOL 100 ≥200 Total21 (53.8) 183 (32.6) 204 (34.0)18 (46.2) 378 (67.4) 396 (100)39 (100) 561 (100) 600 (100)7.321 p = 0.007*2.41* (1.25 - 4.63) 1.00
RESIDENCE IN SCHOOL
School hostel Off campus Family house Total47 (30.3) 118 (36.8) 39 (31.5) 204 (34.0)108 (69.7) 203 (63.2) 85 (68.5) 396 (66.0)155 (100) 321 (100) 124 (100) 600 (100)2.237 p = 0.1351.00 1.34 (0.89 - 2.01) 1.05 (0.63 - 1.76)
SHARING ROOM Yes No Total169 (35.0) 35 (29.9) 204 (34.0)314 (65.0) 82 (70.1) 396 (66.0)483 (100) 117 (100) 600 (100)1.081 p = 2981.00 0.79 (0.51 - 1.23)
PERSON SHARED ROOM WITH n=483
Female friend Boy friend Relative TOTAL111 (47.4) 7 (7.4) 51 (32.9) 169 (35.0)123 (52.6) 87 (92.6) 104 (67.1) 314 (65.0)234 (100) 94 (100) 155 (100) 483 (100)44.813 p = 0*1.00 0.09* (0.04 - 0.20) 0.54* (0.36 - 0.83)
SOLE SPONSOR IN SCHOOL
Self Non-self Total13 (52.0) 191 (33.2) 204 (34.0)12 (48.0) 384 (66.8) 396 (66.0)25 (100) 575 (100) 600 (100)3.767 p = 0.0521.00 0.46 (0.21 - 1.03)
LEVEL OF KNOWLEDGE
Poor Moderate Good Total101 (35.8) 94 (38.7) 9 (12.0) 204 (34.0)181 (64.2)) 149 (61.3) 66 (88.0) 396 (66.0)282 (100) 243 (100) 75 (100) 600 (100)15.454 p < 0.0011.00 1.13 (0.79 - 1.61) 0.24* (0.12 - 0.51)

*= statistically significant.

group of 21 - 25 years of age, (OR: 0.44; 0.22 - 0.86) who were day students during their secondary school education, (OR: 0.43; 0.27 - 0.70), currently shared room with their boyfriend, (OR: 0.12; 0.04 - 0.38) and had good knowledge about sexual abuse, (OR: 0.21; 0.06 - 0.71) were the least likely to have currently experienced sexual abuse in the last one year than their counterparts.

4. Discussion

The mean age of the respondents in this survey was 21.7 ± 3.2 years which was similar to mean ages found in others studies conducted among students in tertiary institutions in Nigeria [10] [12] [29] [30] [31] [33] [34] . This is expected in university setting where majority of them are within the age range of youth and young adults. A higher proportion of the students (81.8%) were aware of sexual abuse; though a small proportion of them (12.5%) had good knowledge about sexual abuse and the common sources of information were from the mass media, friends, school, internet, parents and relatives. This level of awareness was similar to that reported among female students in Malawi [45] but lower than figures reported from Osun State, Nigeria (97%) [12] and from India, (88.1%) [46] . The common sources of information were similar to what was reported in some of the reviewed studies [46] [47] . This high awareness and low level of knowledge found in this study is worrisome which puts to question the quality

Determinants of current sexual abuse among students
VARIABLESCURRENT EXPERIENCE OF SEXUAL ABUSESTATISTICS (X2)OR (95% CI)
YES (%)NO (%)TOTAL (%)P-VALUE
AGE GROUP <20 21 - 25 >26 Total40 (17.4 ) 36 (11.8) 15 (23.4) 91 (15.2)190 (82.6) 270 (88.2) 49 (76.6) 509 (84.8)230 (100) 306 (100) 64 (100) 600 (100)6.630 p = 0.010*0.69 (0.35 - 1.35) 0.44* (0.22 - 0.86) 1.00
TRIBE Igbo Non-Igbo Total78 (14.1) 13 (28.9) 91 (15.2)477 (85.9) 32 (71.1) 509 (84.8)555 (100) 45 (100) 600 (100)7.120 p = 0.008*1.00 2.48* (1.25 - 4.94)
RELIGION Catholic Orthodox Pentecostal Islam Total47 (16.1) 20 (16.4) 24 (13.4) 0 (0.0) 91 (15.2)245 (83.9) 102 (83.6) 155 (86.5) 7 (100.0) 509 (84.8)292 (100) 122 (100) 179 (100) 7 (100) 600 (100)0.382 p = 0.5361.00 1.02 (0.58 - 1.81) 0.81 (0.47 - 1.37) 0.0
MARITAL STATUS Single Ever married Total68 (13.0) 23 (29.5) 91 (15.2)454 (87.0) 55 (70.5) 509 (84.8)522 (100) 78 (100) 600 (100)14.290 p < 0.0011.00 2.79* (1.61 - 4.84)
TYPE OF SECONDARY SCHOOL ATTENDED
Public Private Missionary Total40 (16.7) 32 (13.3) 19 (15.8) 91 (15.2)199 (83.3) 209 (86.7) 101 (84.2) 509 (84.8)239 (100) 241 (100) 120 (100) 600 (100)0.062 p = 0.8041.00 0.76 (0.46 - 1.26) 0.94 (0.52 - 1.70)
LOCATION OF SECONDARY SCHOOL ATTENDED
Urban Rural Total54 (13.5) 37 (18.5) 91 (15.2)346 (86.5) 163 (81.5) 509 (84.8)400 (100) 200 (100) 600 (100)2.591 p = 0.1081.00 1.45 (0.92 - 2.30)
FORM OF SECONDARY SCHOOL
Girls only Mixed school Total44 (18.0) 47 (13.2) 91 (15.2)200 (82.0) 309 (86.8) 509 (84.8)244 (100) 356 (100) 600 (100)2.626 p = 0.1051.00 1.45 (0.92 - 2.26)
TYPE OF STUDENT IN SECONDARY SCHOOL ATTENDED
Boarding Day student Mixed Total39 (22.2) 40 (11.0) 12 (20.0) 91 (15.2)137 (77.8) 324 (89.0) 48 (80.0) 509 (84.8)176 (100) 364 (100) 60 (100) 600 (100)10.746 p = 0.001*1.00 0.43* (0.27 - 0.70) 0.87 (0.43 - 1.82)
FACULTY Art/Education Social/Sciences Health sciences Total34 (9.2) 21 (14.0) 36 (45.0) 91 (15.2)336 (90.8) 129 (86.0) 44 (55.0) 509 (84.8)370 (100) 150 (100) 80 (100) 600 (100)38.005 p = 0*1.00 1.61 (0.90 - 2.88) 8.09* (4.60 - 14.22)
LEVEL IN SCHOOL 100 ≥200 Total15 (38.5) 76 (13.5) 91 (15.2)24 (61.5) 485(86.5) 509 (84.8)39 (100) 561(100) 600 (100)22.205 p < 0.00014.61* (2.32 - 9.18) 1.00
RESIDENCE IN CURRENT SCHOOL
School hostel Off campus Family house Total28 (18.1) 46 (14.3) 17 (13.7) 91 (15.2)127 (81.9) 275 (85.7) 107 (86.3) 509 (84.8)155 (100) 321 (100) 124 (100) 600 (100)0.242 p = 0.6231.00 0.76 (0.45 - 1.27) 0.72 (0.37 - 1.39)
SHARING ROOM Yes No Total75 (15.5) 16 (13.7) 91 (15.2)408 (84.5) 101 (86.3) 509 (84.8)483 (100) 117 (100) 600 (100)0.251 p = 0.6161.00 0.86 (0.48 - 1.54)
PERSONS SHARED WITH (n= 483)
Female friend Boyfriend Relative Total52 (22.2) 3 (3.2) 20 (12.9) 75 (15.5)182 (69.3) 91 (96.8) 135 (87.1) 408 (84.5)234 (100) 94 (100) 155 (100) 483 (100)19.520 p < 0.00011.00 0.12* (0.04 - 0.38) 0.52* (0.30 - 0.91)
SOLE SPONSOR IN SCHOOL
SELF Non-self Total2 (8.0) 89 (15.4) 91 (15.2)23 (92.0) 486 (84.5) 509 (84.8)25 (100) 575 (100) 600 (100)1.041 p = 0.3081.00 2.11 (0.49 - 9.09)
LEVEL OF KNOWLEDGE
Poor Moderate Good Total46 (16.3) 42 (17.2) 3 (4.0) 91 (15.2)236 (83.7) 201 (82.7) 72 (96.0) 509 (84.8)282 (100) 243 (100) 75 (100) 600 (100)7.170 p = 0.007*1.00 1.07 (0.68 - 1.70) 0.21* (0.06 - 0.71)

*= statistically significant.

of information they heard about sexual abuse and who was the person that taught them about it. The mass media which is the commonest source of information in this study will not be able to always give an in-depth information on most health related matters and therefore should not usually be a reliable source when it comes to appropriate knowledge about health issues. The prevalence of life-time experience of sexual abuse in this study was 34.0%. This figure was within the range reported in WHO multi-county life-time prevalence of sexual partners violence among women aged 15 - 49 years, (6% to 59%) [16] [17] . It was also comparable to the prevalence rate reported in a university from the same region of the country, (36.7%) [29] but studies from two other regions of the country; South-South region, (51.7% and 46.7%) [30] [31] and South West, (58%) [48] reported higher prevalence rates. Nevertheless, lower figures were reported among students from universities in Northern region of the country, (13.8% and 22.2%) [33] [34] . This variation in life-time prevalence rates from different studies could be due to the differences that might have existed in the methodologies used, definition criteria applied, cultural and religious issues and level of awareness about sexual abuse. The prevalence of current sexual abuse in the last one year preceding study was 15.2%. This was lower than the figure reported among female students in Ethiopia which stood at 24.4% [41] . The commonest form of sexual abuse reported in this study was fondling/ grabbing of sensitive body parts which was followed by rape. This was similar to what was reported in a study among female university students in the south-south region of the country [31] , and also from Malawi where they reported touching of breast in a sexual manner as the most common form [47] , but differs with the report among female students from Calabar, Nigeria which reported unwanted sexual remarks and advances as the commonest form [30] . Majority of the perpetrators where men known to the victims which were mostly casual partners, teachers/lectures or intimate partners and this act occurs mostly during visitations at the home or office of the perpetrators. The study in Port-Harcourt, South-south, Nigeria [31] , also revealed that most of the perpetrators were known to the victims but reported intimate partners as the commonest perpetrators while our study reported casual partners. Other studies also reported similar pattern with slight differences, with a study in Calabar, Nigeria [30] implicating lectures as one of the common perpetrators while the study in Kano, Nigeria, did not implicate lectures as major perpetrators.

Factors found to influence current occurrence of sexual abuse in this study were; age, tribe, marital status, type of student in secondary school attended, faculty of study, persons currently shared rooms with, year in school and level of knowledge about sexual abuse. Those within the ages of 21 - 25 years were least likely to have been currently abused when compared to others. A study among Ethiopia female students [41] reported a similar pattern which showed that students 20 - 24 years of age were about 2 times more likely to have been currently abused than their counterparts in other age group. Nevertheless on the contrary Ogbonnaya et al., reported higher prevalence of sexual assaults in students greater than 30 years of age [29] . Also a special report from the US Department of Justice revealed that females aged 18 - 24 had higher rates of rape and sexual assaults than females in other age groups [49] . This could be explained by the fact that at this age group many young adults engage in risky behaviours that could expose them to sexual violence and abuse. Married non-Igbo females students were more likely to have been currently abused than singles Igbo girls. This was similar to what was reported in Ebonyi [29] but differs with that reported from the North East Nigeria which showed that singles were more abused than their married counterparts [33] . Yet some other studies did not show any association between marital associated and occurrence of sexual abuse [38] [50] . This higher prevalence among the married as reported in this survey could have been contributed to by their partners who could be living together with them, irrespective of the challenges they face in school with other students. Female students in the Faculty of Health Sciences, who shared room with a female friend, lived in a boarding school during secondary education and being a 100 level student were more likely to have been currently abused than their counterparts. The study in Port-Harcourt [31] reported a similar higher prevalence among students in their first year of study though a study from the North Eastern part of the country showed no association [33] . This could be due to the fact that most students in their first year, are usually young and naive and can be usually deceived by the perpetrators with little or no resistance. Another study in Nigeria [37] , also reported some important family determinants of sexual abuse which were; parents not living together, not living with parents, family type and current parents marital status, which is similar to finding in our study in which those who shared room with a female friend outside family care and those who lived in school hostels during their secondary school days were more likely to have been currently abused than others. This finding of protective role of the family is not new in this part of the world where family ideals are kept and transferred from generation to generation, and must be obeyed by all members especially the young people. Knowledge about sexual abuse was found to influence the occurrence of reported sexual abuse with those that have high knowledge about sexual abuse being more likely to have been currently abused than those with low knowledge. This was not consistent with what was reported in Malawi45 which showed that there was no association between knowledge and occurrence of sexual abuse. It is only those who have in-depth knowledge about sexual abuse that could ascertain when it occurred and what really constitutes an abuse. This could be the reason why female students in Health Science where more likely to report abuse in this study than others. The common health consequences of sexual abuse reported by those abused were emotional problems, psychological problems and transmission of sexually transmitted infections (STI) among others. This was similar to what was reported from other studies which were largely mental health problems like depression and guilty, physical injury and transmission of STI [30] [33] .

5. Conclusion

In conclusion our study revealed a high prevalence of sexual abuse among the female students and a sizable proportion of them experienced rape. We found that younger age group, women in their first year of study, women with low knowledge about sexual abuse and those living with female friends outside family care were more likely to have been currently sexually abused. Thus there is need to institute preventive strategies targeted at those at risk of being abused and also to teach reproductive health issues in their general courses. Universities should establish youth friendly centers to tackle specialized reproductive health problems associated with the youths. There is need to implement already existing laws to help manage issues of sexual abuse in our universities and also develop new policies where necessary to curb this public health menace that is capable of affecting the full development of our women.

Limitation

The study information was self-reported and could be subject to some form of bias, thus caution should be taken in generalizing the findings of this study.

Acknowledgements

I want to acknowledge the medical students who collected data for us and thank all the female students who participated in the study.

Author’s Contributions

We hereby declare that all the authors contributed to this research.

Conflicting Interest

We hereby declare no conflicting interest.

Source of Finding

There was no external source of finding.

Cite this paper

Duru, C.B., Aguocha, C.M., Iwu, A.C., Oluoha, U.R., Okedo-Alex, I.N., Ohanle, I. and Nwaigbo, E. (2018) Sexual Abuse among Female Undergraduates in Tertiary Institutions in IMO State, Southeast Nigeria: Prevalence, Pattern and Determinants. Open Access Library Journal, 5: e4516. https://doi.org/10.4236/oalib.1104516

AppendixQuestionnaire Design

Section A―Socio Demographic Characteristics of Respondents

1) Age as at last birthday __________years

2) Marital Status (a) single [ ] (b) married [ ] (c) separated [ ] (d) divorced [ ] (e) widowed [ ] (f) living with partner [ ]

3) Type of secondary school attended (a) public/government school [ ] (b) private school [ ]

4) Location of secondary school attended (a) Urban area [ ] (b) Rural area [ ]

5) Form of secondary school attended (a) girls only school [ ] (b) mixed secondary school

6) Type of residence in secondary school attended (a) lived in the boarding school [ ] (b) was a day student [ ] (c) mixed both as a student [ ]

7) Faculty/department ………………………………………………

8) Level in school (a) 100 level [ ] (b) 200 level [ ] (c) 300 level [ ] (d) 400 level [ ] (e) 500 level [ ] (f) 600 level [ ]

9) Place of residence (a) school hostel [ ] (b) off campus [ ] (c) living with family members [ ]

10a) Do you share room with anybody yes [ ] No [ ]

10b) If yes, who are you sharing g with (a) female friend [ ] (b) boyfriend [ ] (c) relative [ ] (d) Others please specify ………………………

11) Who is your sole sponsor in school? (a) Both parents [ ] (b) father only [ ] (c) mother only [ ] (d) relative/family member [ ] (e) self [ ] (f) community/scholarship[ ] (g) others please specify …………………………..

12) Religion (a) catholic [ ] (b) orthodox (Anglican, Methodist, Baptist) [ ] (c) Pentecostal [ ] (d) Islam [ ] (e) others please specify ……………………..

13) Tribe? (a) Igbo [ ] (b) Yoruba [ ] (c) Hausa [ ] (d) Others …………………

Section B―Awareness and Knowledge of Respondents about Sexual Abuse

14a) Have you heard about sexual abuse (a) yes [ ] (b) No [ ]

14b) If yes what is your source (multiple response applied) (a) radio [ ] (b) television [ ] (c) newspaper [ ] (d) school [ ] (e) friends [ ] (f) parents [ ] (g) health personnel [ ] (h) church [ ] (i) market [ ] (j) seminars/workshop [ ] (k) books [ ] (l) bill board [ ] (m) non-governmental organization [ ] (n) government agencies [ ] (o) internet [ ] (p) others please specify ………………………

15) What do you understand as sexual abuse? (a) Sexual act without consent [ ] (b) sexual act for favour [ ] (c) verbal abuse of sexual nature [ ] (d) sexual act by family member/relative [ ]

16) What are the forms of sexual abuse that you know? (Multiple response applied) (a) fondling/grabbing of sensitive body part/unwanted touching [ ] (b) sex for favour [ ] (c) incest [ ] (d) exposure to pornography [ ] (e) degrading sexual comments [ ] (f) oral contacts with genitalia [ ] (g) penetration with digits [ [ (h) rape [l} others please specify ……………….

17) Who can be a victim (multiple response applicable) (a) children [ ] (b) married [ ] (c) singles [ ] (d) elderly [ ]

18) What gender is commonly affected? (a)Male [ ] (b) female [ ]

19) Who are common perpetrators (multiple response applicable) (a) parents [ ] (b) teachers/lecturers [ ] (c) intimate partner [ ] (d) colleagues [ ] (e) casual partner [ ] (f) family / parents friends [ ] (g) spiritual leaders [ ] (h) others please specify ………………….

20) Where do you think sexual abuse occurs (multiple response applicable) (a) the home [ ] (b) the schools/offices [ ] (c) the public places [ ] (d) the hotels [ ] the clubs (e) the secret corners [ ] (f) others please specify ………………………

21) What are the consequences of sexual abuse (multiple response applicable) (a) physical injuries [ ] (b) a sexually transmitted infection [ ] (c) emotional problems [ ] (d) infertility [ ] (e) psychological problem [ ] (f) social problem/stigma [ ] (g) morbidities [ ] (h) dissociation [ ] (l) mortality [ ] (j) others please specify ………………….

Section C―Prevalence and Pattern of Sexual Abuse Experienced

22a) Have you ever been sexually abused before? (a) Yes [ ] (b) No [ ]

22b) If yes, how many times? (a) Once [ ] (b) twice [ ] (c) three times [ ] (d) four times [ ] (e) Many [ ]

23) How were you abused? ……………………………………

24) Where did it occur? (Multiple response applicable) (a) Home of perpetrator [ ] (b) home of office [ ] (c) office [ ] (d) classroom [ ] (e) hostel [ ] (f) road [ ] (g) in a car [ ] (h) hotel [ ] (l) others please specify……………………

25) What circumstances led to the event (multiple response applicable) (a) Violence/force [ ] (b) visiting [ ] (c) drunk [ ] (d) seeking favour [ ] (e) indecent dressing [ ] (f) other please specify……………………

26a) Have you been sexually abused in the last one year? (a)Yes [ ] (b) No [ ]

26b) If yes, what form of sexual abuse have you had? (Multiple response applicable) (a) fondling/grabbing of sensitive body part/unwanted touching (b) vaginal/anal intercourse [ ] (c) sex for favour [ ] (d) incest [ ] (e) exposure to pornography [ ] (f) degrading sexual comments [ ] (g) oral contact with genitalia [ ] (h) penetration with digits [ ] (i) rape [ ] (j) other please specify…………………

27) Who were the persons that sexually abused you (Multiple response applicable) (a) My parents [ ] (b) teachers/lecturers/boss [ ] (c) intimate partner [ ] (d) colleagues [ ] (e) casual partner [ ] (f) family/parent’s friends [ ] (g) Spiritual leaders [ ] (h) others please specify……………………

28) Place the abused took placed? a) Home of perpetrator [ ] (b) home of office [ ] (c) office [ ] (d) classroom [ ] (e) hostel [ ] (f) road [ ] (g) in a car [ ] (h) hotel [ ] (l) others please specify……………………

29) Circumstances of the abuse (Multiple response applicable) (a) Violence/force [ ] (b) visiting [ ] (c) drunk [ ] (d) seeking favour [ ] (e) indecent dressing [ ] (f) other please specify……………………

30) Problems that the abuse cause you (multiple response applicable) (a) emotional [ ] (b) physical injury [ ] (c) transmission STI [ ] (d) mental problems [ ] (e) psychological problem [ ] (f) Social problem (g) morbidities [ ] (h) other please specify……………………

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