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. Author manuscript; available in PMC: 2016 Apr 11.
Published in final edited form as: Child Abuse Negl. 2015 Apr 14;44:46–55. doi: 10.1016/j.chiabu.2015.03.011

Perpetrators and context of child sexual abuse in Kenya

Mary W Mwangi a,✉, Timothy A Kellogg b, Kathryn Brookmeyer c, Robert Buluma d, Laura Chiang e, Boaz Otieno-Nyunya a, Kipruto Chesang a; Kenya 2010 Violence against Children Survey Team
PMCID: PMC4826906  NIHMSID: NIHMS765531  PMID: 25882669

Abstract

Child sexual abuse (CSA) interventions draw from a better understanding of the context of CSA. A survey on violence before age 18 was conducted among respondents aged 13–17 and 18–24 years. Among females (13–17), the key perpetrators of unwanted sexual touching (UST) were friends/classmates (27.0%) and among males, intimate partners (IP) (35.9%). The first incident of UST among females occurred while traveling on foot (33.0%) and among males, in the respondent’s home (29.1%). Among females (13–17), the key perpetrators of unwanted attempted sex (UAS) were relatives (28.9%) and among males, friends/classmates (31.0%). Among females, UAS occurred mainly while traveling on foot (42.2%) and among males, in school (40.8%). Among females and males (18–24 years), the main perpetrators of UST were IP (32.1% and 43.9%) and the first incident occurred mainly in school (24.9% and 26.0%), respectively. The main perpetrators of UAS among females and males (18–24 years) were IP (33.3% and 40.6%, respectively). Among females, UAS occurred while traveling on foot (32.7%), and among males, in the respondent’s home (38.8%); UAS occurred mostly in the evening (females 60.7%; males 41.4%) or afternoon (females 27.8%; males 37.9%). Among females (18–24 years), the main perpetrators of pressured/forced sex were IP and the first incidents occurred in the perpetrator’s home. Prevention interventions need to consider perpetrators and context of CSA to increase their effectiveness. In Kenya, effective CSA prevention interventions that target intimate relationships among young people, the home and school settings are needed.

Keywords: Children, Child sexual abuse, Sexual violence, Perpetrators, Violence against children survey, Kenya

Introduction

Sexual abuse of children is a major global public health and child rights issue. Although few countries have conducted population-based surveys on child sexual abuse (CSA), the magnitude of the problem in Africa (Andersson et al., 2012; Lalor, 2004a,b; Moore, Awusabo-Asare, Madise, John-Langba, & Kumi-Kyereme, 2007; Pitche, 2005; World Health Organization –WHO, 2013) and the developed world (Gilbert et al., 2009) is alarming.

Several studies and meta-analyses have identified numerous adverse health, behavioral and social outcomes of CSA (Agardh, Odberg-Pettersson, & Östergren, 2011; Chan, Yan, Brownridge, Tiwari, & Fong, 2011; Exner-Cortens, Eckenrode, & Rothman, 2013; Reza et al., 2009). In settings with a generalized HIV epidemic, child sexual abuse is associated with HIV and other sexually transmitted infections (Andersson, Cockcroft, & Shea, 2008). Owing to the stigma, fear and threats associated with CSA, many child survivors rarely report the abuse (Erulkar, 2004; Moore et al., 2007), making it difficult for them to access health, psycho-social and other services that would minimize the negative outcomes of CSA.

The design of effective CSA prevention programs and policies depends on a better understanding of the perpetrators and context of CSA. In recent years, countries in Sub-Saharan Africa (SSA) and elsewhere have begun to collect systematic and nationally representative data on violence against children (UNICEF, 2007; United Nations Children’s Fund Tanzania, U.S. Centers for Disease Control and Prevention, Muhimbili University of Health and Allied Sciences, 2011) to inform and evaluate national responses to CSA. These and other studies of child sexual abuse in SSA show that it occurs at all levels of society and perpetrators are typically men and older boys who are known to the child (Lalor, 2004a,b; Reza et al., 2009; Yahaya, Soares, Ponce De Leon, & Macassa, 2012). Although the main perpetrators of CSA vary by country and sex of the victim, findings from these studies indicate that CSA is primarily perpetrated by intimate partners (e.g., boyfriends, girlfriends, husbands) and other male relatives (Erulkar, 2004; Reza et al., 2009; UNICEF, 2007). In Tanzania, the main perpetrators of CSA reported by 13–24 year old females were neighbors and strangers, and dating partners and strangers for 13–24 year old males (UNICEF et al., 2011). In both Swaziland and Tanzania, a substantial proportion of perpetrators were at least 5 years older than their female victims (Reza et al., 2009; UNICEF et al., 2011). Additionally, in Swaziland the first incident of CSA for females most often occurred in the respondent’s home or neighborhood (Reza et al., 2009).

In 2010, Kenya conducted the first Violence against Children (VAC) survey. In this paper, we examined and describe the perpetrators and context of different types of CSA among respondents aged 13–17 years and 18–24 years and discuss implications for CSA prevention and response in Kenya. In examining the perpetrators and context of CSA we focus on first incidents. Information on the first incident of various types of CSA is useful in enhancing our understanding of risk factors and could inform primary prevention efforts.

Methods

Design

A nationally-representative cross-sectional household VAC survey was conducted in Kenya in 2010. A three-stage cluster sample survey design was used. First, 238 clusters were randomly selected from the National Sample Survey and Evaluation Program (NASSEP) IV frame. The selected clusters were then randomly assigned for either male or female survey administration as an ethical measure to protect the confidentiality of respondents and eliminate possibility of retaliation that would occur if a male perpetrator and a female survivor in the same cluster or household were to be interviewed. In the second stage, an equal probability systematic sampling method was applied in each cluster to select a uniform sample of households per cluster (an average of 35 households per cluster). In the third stage, we randomly selected one female or one male participant in each selected household that had at least one person aged 13–24 years living in the household using the Kish Method (Kish, 1949).

We used a three-stage consent process; for respondent ages 17 years and below, we sought permission from the parent or guardian to interview the eligible minor. To protect respondents from potential retaliation in the household or community, parents/guardians were told that the survey would focus on the “health, education and life experiences” of Kenyan children and youth without any reference to experiences with violence. Upon obtaining permission from a parent/guardian to interview the eligible minor, the interviewer sought initial consent from the respondent after presenting the survey as one on “children’s health and education.” If the eligible respondent agreed to learn more about the study, the interviewer met with the respondent in a private space, provided full disclosure about the content of the survey (including sexual violence related questions) and obtained verbal informed consent. Potential respondents were informed that participation in the survey was voluntary and that they could stop the interview at any time or skip any questions that elicited discomfort. For respondents ages 18 or older, the same process was followed except for stage one.

We adapted the standardized questionnaires used in the 2009 Tanzania VAC survey (UNICEF et al., 2011). Interviewers conducted interviews primarily in Kiswahili and English but the survey was translated into an additional 11 commonly spoken vernacular languages. Thirty-two interview teams with 3–5 trained interviewers administered a structured questionnaire to eligible participants (ages 13–24 years). The questionnaire included information on socio-demographic characteristics, sexual, physical and emotional violence. In this paper, we focus on sexual violence. Respondents were asked questions about experience of sexual violence before age 18 years and in the year before the survey, perpetrators of child sexual abuse and the context in which they experienced the first incident of each type of child sexual abuse.

Measures

Child Sexual Abuse

We adopted the legal definition of a child. Section 8 of the Kenya Sexual Offences Act of 2006 (The Sexual Offences Act, 2006) defines a child as “anyone below the age of 18 years.” Child sexual abuse was defined as having ever experienced (i) unwanted sexual touching (e.g., touching in a sexual way, kissing, grabbing or fondling), (ii) attempted unwanted sexual intercourse (perpetrator attempted intercourse but the act was not completed), (iii) pressured intercourse (unwanted sex was completed through use of threats or non-physical pressure), and (iv) physically forced sex (unwanted intercourse completed through physical force). Respondents were asked questions about their lifetime experience of sexual abuse, experiences of sexual abuse in the year before the survey, as well as details on the first incident of sexual abuse. For this analysis, we limited reported sexual abuse to the first incident of each type of sexual abuse for respondents between 13 and 17 years, and first incident before age 18 for respondents aged 18–24 years.

Perpetrators of CSA

Respondents who said they had experienced any of the four types of child sexual abuse were asked to state if more than one perpetrator was involved, if they knew the perpetrator, their relationship to the perpetrator (e.g., family/relatives, neighbor, stranger, boyfriend/girlfriend/partner [the term intimate partner is used to refer to all three], authority figure) and the relative age of the perpetrator (older, younger, same age as the respondent). Respondents who said the perpetrator was older were asked if the perpetrator was 10 or more years older.

Context of CSA

The context of CSA is defined by two measures related to the first incident of each type of CSA (i) location where it occurred, and (ii) time when it occurred.

Ethical Review

We adhered to the WHO guidelines on ethics and safety in studies that address violence against women (WHO, 2001) with adaptation for males and to the context of children. The survey protocol was reviewed and approved by the Kenya Medical Research Institute (KEMRI) and the U.S. Centers for Disease Control and Prevention (CDC) institutional review boards. We provided referral services for confidential and free counseling to willing participants who met specified criteria for service referral, including respondents who experienced violence in the 12 month period before the survey, those who became upset during the interview or those who asked for help related to violence. Professional counselors offered confidential counseling to distressed participants in a safe location after the interview.

Data Analysis

Data were entered into Epi Info version 3.5.1 and all analyses were performed in SAS 9.3 (SAS Institute Inc., Cary, North Carolina, USA) using the SURVEYFREQ procedure to take into account the stratified cluster design of the survey. All estimates were weighted to account for sampling probability and to adjust for non-response. Where possible, we conducted separate bivariate analysis on perpetrators and the context of the first incident of the four types of CSA before age 18 among male and female respondents in the two age groups (13–17 and 18–24). We present separate proportions and respective 95% confidence intervals (CI) for male and female respondents in the two age groups. The older age group (18–24 year olds) was examined to provide the nature of perpetration and context for an adult cohort that had fully experienced childhood. The younger age group (13–17 year olds) was examined separately due to the fact that the cohort had not yet completed childhood and the violence reported was more recent that reported by the older age group.

Results

Socio-Demographic Characteristics and Experience of Sexual Violence before Age 18

Overall, 2,683 respondents aged 13–24 years completed the survey (1,227 females and 1,456 males). Of these, 1,292 were aged 13–17 years (546 females and 746 males) and 1,391 were aged 18–24 years (681 females and 710 males).

Respondents Ages 13–17

Overall, 85.7% of respondents aged 13–17 years were currently attending school (84.0% females and 87.3% males) and 59.0% were in primary school, while 39.9% had completed primary education (Table 1). A large majority of the respondents in this age group (99%) were not married or cohabiting at the time of the survey (female 98.1%, male 99.8%). About one in every four females (23.1%) and 11.8% of males reported they had experienced some type of sexual abuse during their lifetime (unwanted sexual touching, unwanted attempted sex, pressured or physically forced sex). Unwanted sexual touching was the most commonly reported type of lifetime child sexual abuse (females 16.9%; males 6.9%) followed by unwanted attempted sex and pressured sex (Table 1).

Table 1.

Socio-demographic characteristics and child sexual abuse experience before age 18 among respondents aged 13–24 years by age group and sex.

Characteristic 13–17 years
18–24 years
Female
Male
Female
Male
na % (95% CI)a n % (95% CI) n % (95% CI) n % (95% CI)
Total 546 – 746 – 681 – 710 –
Education
Never attended school 8 1.5 (0.0–3.5) 5 0.8 (0.0–1.6) 50 6.0 (3.3–8.7) 22 3.8 (0.0–8.9)
Primary incomplete 310 55.5 (49.9–61.1) 436 62.4 (56.2–68.7) 169 21.1 (15.5–26.7) 122 17.0 (13.6–20.4)
Complete primary 224 43.0 (37.1–49.0) 298 36.8 (30.5–43.1) 457 72.9 (66.5–79.3) 563 79.2 (74.0–84.5)
Currently attending school 453 84.0 (79.1–88.9) 655 87.3 (83.7–90.8) 111 22.7 (18.0–27.4) 238 35.0 (29.0–41.0)
Marital status
Ever been married/cohabited 20 3.6 (1.3–5.9) 8 0.6 (0.1–1.1) 403 51.1 (45.1–57.1) 145 17.6 (13.6–21.6)
Single/never married 529 98.1 (96.4–99.8) 735 99.8 (99.7–100.0) 320 55.8 (49.8–61.8) 580 86.1 (82.5–89.6)
Married/cohabitating 14 1.9 (0.2–3.6) 3 0.2 (0.0–0.3) 357 43.9 (38.0–49.9) 119 13.9 (10.4–17.5)
Separated 0 – 0 – 1 0.3 (0.0–1.0) 0 –
Self-reported CSA
Any type of sexual abuse 114 23.1 (17.3–29.0) 78 11.8 (8.8–14.9) 206 31.9 (27.0–36.8) 119 17.5 (12.9–22.1)
Sexual touching 83 16.9 (12.6–21.2) 49 6.9 (4.8–9.1) 126 20.7 (16.2–25.1) 73 10.8 (7.0–14.5)
Attempted sex 47 8.1 (5.2–11.0) 31 6.0 (3.6–8.4) 94 15.3 (11.5–19.1) 56 7.2 (4.6–9.9)
Physically forced sex 17 4.4 (0.6–8.1) 7 0.8 (0.1–1.5) 53 7.1 (4.1–10.0) 12 1.4 (0.2–2.6)
Pressured sex 19 5.1 (1.3–8.9) 17 2.8 (1.3–4.4) 66 9.6 (6.8–12.4) 28 3.6 (1.6–5.6)
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a

All the ns presented are unweighted but the proportions and respective 95% CI are weighted. Due to missing responses, totals vary between variables/

Respondents Ages 18–24

Among respondents aged 18–24 years, 22.7% of females and 35.0% of males were attending school and a large majority had completed primary education (72.9% and 79.2%, respectively). Over half (55.8%) of female and 86.1% of male respondents were single or had never been married. More women (31.9%, CI 27.0–36.8) than men (17.5%, CI 12.9–22.1) reported that some form of child sexual abuse occurred before the age of 18 – unwanted sexual touching (20.7%, CI 16.2–25.1 vs. 10.8% CI 7.0–14.5), unwanted attempted sex (15.3%, CI 11.5–19.1 vs. 7.2% CI 4.6–9.9), physically forced sex (7.1%, CI 4.1–10.0 vs. 1.4% CI 0.2–2.6) and pressured sex (9.6%, CI 6.8–12.4 vs. 3.6% CI 1.6–5.6).

Perpetrators and Context of the First Incident CSA among Respondents Aged 13–17 Years

Unwanted Sexual Touching

Among female respondents, the most commonly reported perpetrators of the first incident of unwanted sexual touching were friends/classmates (27.0%), strangers (21.2%), and neighbors (19.2%). The most commonly reported perpetrators among males were intimate partners (35.9%) and neighbors (26.1%) (Table 2). Only a small proportion of respondents (females 9.5% and males 8.9%) reported perpetrators were family members or relatives. Most of the respondents reported that the perpetrator of the first incident of unwanted sexual touching was someone they knew (females 78.8% and males 88.8%). A large majority of female and male respondents who reported unwanted sexual touching indicated that the first incident was carried out by a single perpetrator (88.9% and 90.8%, respectively). Over half of females (56.1%) and 40.2% of males reported the perpetrator of the first incident was older than themselves and of these, 29.5% of females and 42.4% of males reported the perpetrator was 10 or more years older. Among females, the first incident occurred while traveling on foot (33.0%) and in school (25.2%) while among males, it occurred in the respondent’s home (29.1%) and in school (15.6%). A large majority of female and male respondents reported that the first incident occurred in the afternoon (43.9% and 40.4%) or evening hours (39.8% and 28.5%), respectively.

Table 2.

Perpetrator characteristics and context of the first incident of unwanted sexual touching and unwanted attempted sex among children aged 13–17 years.

Unwanted sexual touching
Unwanted attempted sex
Female
Male
Female
Male
na % (95% CI)a n % (95% CI) n % (95% CI) n % (95% CI)
Total 83 49 47 31
Number of perpetrators
One 75 88.9 (80.8–97.0) 43 90.8 (81.4–100.0) 43 92.9 (84.6–100.0) 26 79.8 (63.4–96.2)
2+ persons 7 10.3 (2.3–18.2) 6 9.2 (0.0–18.6) 4 7.1 (0.0–15.4) 4 17.6 (0.8–34.3)
Knew perpetrator
Yes 69 78.8 (63.7–93.9) 44 88.0 (77.1–98.9) 37 73.7 (56.8–90.6) 24 78.8 (61.8–95.8)
No 14 21.2 (6.1–36.3) 5 12.0 (1.1–22.9) 10 26.3 (9.4–43.2) 7 21.2 (4.2–38.2)
Perpetrator
Stranger/unknown 14 21.2 (6.1–36.3) 5 12.0 (1.1–22.9) 10 26.3 (9.4–43.2) 7 21.2 (4.2–38.2)
Boy/girlfriend/partner 16 16.8 (7.6–26.1) 17 35.9 (16.7–55.0) 7 16.6 (4.4–28.9) 8 28.7 (7.7–49.7)
Family/relative 7 9.5 (0.4–18.5) 8 8.9 (0.9–16.9) 11 28.9 (12.3–45.5) 2 3.3 (0.0–8.8)
Neighbor 20 19.2 (10.1–28.4) 12 26.1 (10.9–41.2) 14 21.7 (7.9–35.6) 1 7.2 (0.0–21.0)
Friend/classmate 18 27.0 (13.7–40.4) 5 7.6 (0.0–15.1) 4 4.6 (0.0–11.3) 10 31.0 (11.9–50.1)
Other 8 6.2 (0.5–11.9) 2 9.5 (0.0–22.3) 1 1.8 (0.0–5.4) 3 8.5 (0.0–19.2)
Perpetrator age
Older 45 56.1 (41.5–70.6) 24 40.2 (23.5–56.8) 36 75.7 (61.6–89.8) 16 49.4 (26.3–72.4)
Younger 0 – 4 2.6 (0.0–5.7) 0 – 2 3.6 (0.0–8.7)
Same 34 40.1 (26.1–54.0) 21 57.3 (40.3–74.2) 10 21.2 (7.7–34.7) 13 47.1 (23.9–70.2)
Don’t know 3 3.8 (0.0–9.2) 0 – 1 3.1 (0.0–9.1) 0 –
Relative age of perpetratorb
10 years or older 20 29.5 (14.9–44.2) 10 42.4 (17.9–66.8) 14 38.8 (18.7–58.9) 5 33.2 (6.4–60.0)
Less than 10 years old 22 61.5 (46.1–77.0) 12 41.2 (17.4–65.0) 22 61.2 (41.1–81.3) 10 64.4 (37.8–91.1)
Don’t know 2 8.9 (0.0–20.5) 2 16.4 (0.0–37.2) 0 – 1 2.4 (0.0–7.3)
Location of first incident
My home 10 14.5 (3.0–26.0) 16 29.1 (12.4–45.7) 13 33.9 (15.0–52.9) 8 21.7 (6.7–36.6)
Perpetrator’s home 11 11.3 (2.7–19.8) 5 15.4 (0.0–32.6) 5 9.8 (0.5–19.1) 4 17.2 (0.0–36.7)
School 18 25.2 (11.6–38.8) 9 15.6 (2.8–28.4) 4 6.6 (0.0–14.3) 11 40.8 (18.1–63.5)
Traveling on foot 26 33.0 (18.3–47.8) 5 12.4 (1.5–23.3) 20 42.2 (24.5–59.9) 1 0.8 (0.0–2.3)
Other location 18 16.0 (7.1–24.9) 14 27.6 (12.7–42.4) 5 7.4 (0.0–18.0) 7 19.6 (0.0–39.6)
Time incident occurred
Morning 9 11.5 (2.8–20.2) 7 14.3 (1.5–27.1) 6 13.7 (1.7–25.8) 6 20.0 (1.1–38.8)
Afternoon 33 43.9 (28.5–59.2) 18 40.4 (22.4–58.5) 21 47.7 (31.8–63.5) 8 32.9 (12.1–53.7)
Evening 36 39.8 (25.5–54.2) 19 28.5 (12.9–44.0) 18 37.3 (21.1–53.4) 12 30.0 (11.4–48.6)
Late 5 4.8 (0.0–10.2) 5 16.8 (3.2–30.4) 2 1.3 (0.0–3.5) 5 17.1 (0–35.3)
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a

All the ns presented are unweighted but the proportions and respective 95% CI are weighted. Due to missing responses, totals vary between variables.

b

Among respondents who said the perpetrator was older than themselves.

Unwanted Attempted Sex

Eight percent of females and six percent of males reported unwanted attempted sex (Table 1). Most of the respondents who reported unwanted attempted sex knew the perpetrator (female 73.7% and male 78.8%) (Table 2). Among females, the most common perpetrators were family/relatives (28.9%), strangers (26.3%) and neighbors (21.7%) while the most common perpetrators among males were friends/classmates (31.0%), intimate partners (28.7%), and strangers (21.2%). A large majority of females and males reported that the first unwanted attempted sex was carried out by one perpetrator (92.9% and 79.8%, respectively). Three out of every four females (75.7%) and about half of the males (49.4%) reported the perpetrator of the first incident of unwanted attempted sex was older than them. Of those who reported the perpetrator was older, 38.8% of females and 33.2% of males reported the perpetrator was 10 or more years older than them. A large majority of females reported that the first incident of unwanted attempted sex occurred while traveling on foot (42.2%), in the respondent’s home (33.9%), and in the afternoon (47.75%) or evening hours (37.3%). Among males, the first incident occurred mainly in school (40.8%) and in the respondent’s home (21.7%) and during the afternoon (32.9%) or evening hours (30.0%).

Physically Forced Sex

Four percent of females and one percent of males aged 13–17 years reported physically forced sex (Table 1) that was carried out by one perpetrator (Table 4). Over ninety percent of females and all males knew the perpetrator. Among females, the key perpetrators were intimate partners (47.6%) and family/relatives (24.9%) and among males, intimate partners (54.0%) and friends/classmates (22.5%). For both female and male respondents, the first incident of physically forced sex occurred in the respondent’s home or in school during evening hours (Table 4).

Table 4.

Perpetrator characteristics and context of the first incident of physically forced sex and pressured sex before age 18 among female and male respondents aged 13–17 years.

Physically forced sex
Pressured sex
Female
Male
Female
Male
n % (95% CI) na % (95% CI) n % (95% CI) na % (95% CI)
Total 17 7 19 – 17 –
Number of perpetrators
One person 17 100 (–) 7 100 (–) 18 97.0 (90.7–100.0) 14 67.2 (36.8–97.6)
2+ persons 0 – – – 1 3.0 (0.0–9.3) 3 32.8 (2.4–63.2)
Knew perpetrator
Yes 14 93.0 (82.3–100) 7 100 (–) 19 100 (–) 13 67.5 (36.7–98.3)
No 3 7.0 (0.0–17.7) 0 – 0 2.2 (0.0–5.6) 4 32.5 (2.4–63.2)
Perpetrator
Stranger/unknown 3 7.0 (0.0–17.7) 0 – 0 – 4 32.5 (1.7–63.3)
Boy/girlfriend/partner 3 47.6 (1.0–94.2) 3 54.0 (7.6–100) 11 72.5 (43.0–100) 5 23.8 (0.3–47.2)
Family/relative 3 24.9 (0.0–57.6) 2 15.1 (0.0–41.4) 0 – 3 8.6 (0.0–20.0)
Neighbor 5 12.9 (0.0–29.3) 1 8.5 (0.0–25.8) 2 6.3 (0.0–16.5) 1 6.1 (0.0–18.0)
Friend/Classmate 2 5.0 (0.0–13.9) 1 22.5 (0.0–61.9) 2 13.7 (0.0–38.1) 3 20.9 (0.0–47.5)
Other 1 2.7 (0.0–8.5) 0 – 4 7.5 (0.0–17.0) 1 8.1 (0.0–23.7)
Perpetrator age
Older 11 48.2 (3.6–92.8) 3 33.2 (0.0–74.8) 10 25.4 (0.2–50.6) 9 52.0 (21.9–82.0)
Younger 0 – 2 24.8 (0.0–59.3) 0 – 1 3.5 (0.0–10.5)
Same 6 51.8 (7.2–96.4) 2 42.0 (0.0–91.6) 9 74.6 (49.4–99.8) 7 44.6 (14.4–74.7)
Don’t know 0 – 0 – 0 0
Relative age of perpetratorb
10+ years older 6 39.7 (4.0–75.4) 2 32.3 (0.0–90.0) 6 58.0 (25.7–90.3) 3 41.4 (0.0–87.1)
Less than 10 years older 4 60.3 (24.6–96.0) 1 67.7 (10.0–100.0) 4 42.0 (9.7–74.3) 5 52.8 (8.4–97.2)
Don’t know 0 – 0 – 0 – 1 5.8 (0.0–17.7)
Location of first incident
My home 4 15.8 (0.0–35.4) 3 22.7 (0.0–53.3) 3 19.3 (0.0–45.9) 6 34.5 (5.3–63.7)
Perpetrator’s home 3 7.9 (0.0–19.1) 0 – 11 37.1 (5.1–69.0) 1 3.9 (0.0–11.7)
School 1 15.5 (0.0–44.6) 1 22.5 (0.0–61.9) 0 – 3 14.0 (0.0–32.6)
Traveling on foot 2 2.5 (0.0–6.6) 1 12.8 (0.0–38.3) 2 40.1 (0.0–84.2) 4 24.3 (0.0–49.1)
Other location 7 58.4 (18.1–98.7) 2 42.0 (0.0–91.6) 3 3.5 (0.0–9.5) 3 23.3 (0.0–52.7)
Time incident occurred
Morning 0 – 1 12.8 (0.0–38.3) 1 4.9 (0.0–15.1) 4 13.9 (0.0–28.6)
Afternoon 6 22.2 (0.0–46.1) 2 24.8 (0.0–64.1) 10 63.4 (28.0–98.9) 5 26.2 (0.8–51.5)
Evening 7 67.3 (34.1–100) 2 42.0 (0.0–91.6) 5 26.7 (0.0–58.8) 6 51.8 (21.7–81.9)
Late 3 7.0 (0.0–17.3) 1 8.5 (0.0–25.8) 3 4.9 (0.0–11.9) 2 8.2 (0.0–20.8)
Don’t know 1 3.5 (0.0–10.8) 1 12.0 (0.0–35.6) 0 – 0 –
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a

All the ns presented are unweighted but the proportions and respective 95% CI are weighted. Due to missing responses, totals vary between variables.

b

Among respondents who said the perpetrator was older than themselves.

Pressured Sex

Five percent of females and three percent of males aged 13–17 years reported pressured sex (Table 1). A large majority of females (97%) and 67.2% of males reported that one perpetrator was involved in the first incident (Table 4). Female respondents were more likely to know the perpetrator (100%) compared to male respondents (67.5%). The key perpetrators of pressured sex among females were intimate partners (72.5%); and among males, strangers (32.5%), intimate partners (23.8%) and friends/classmates (20.9%). The first incident of pressured sex among females mainly occurred in the afternoon while traveling on foot (40.1%) and in the perpetrator’s home (37.1%) and among males in the respondent’s home (34.5%) mainly in the evening (Table 4).

Perpetrators and Context of the First Incident of CSA before Age 18 among Respondents Aged 18–24 years

Unwanted Sexual Touching

Among females aged 18–24 years, the most commonly reported perpetrators of the first incident of unwanted sexual touching before age 18 were intimate partners (32.1%) and neighbors (24.1%). The most commonly reported perpetrators among males were intimate partners (43.9%) (Table 3). A large majority of female and male respondents knew the perpetrator of the first incident (91.0% and 98.6%, respectively) and one in ten reported multiple perpetrators were involved in the first incident (12.4% and 14.3%, respectively). Nearly three-quarters of female respondents (72.1%) reported that the perpetrator was older than them compared with one-third of male respondents (32.7%). Among respondents who reported the perpetrator was older than them, 53.5% of females and 28.7% of males reported the perpetrator was 10 or more years older (Table 3). Among females, the first incident of unwanted sexual touching occurred mainly in school (24.9%), while traveling on foot (20.8%), in the perpetrator’s home (17.2%) and in the evening (47.2%) or afternoon hours (41.1%). Among males, the first incident mainly occurred in school (26.0%), in the respondent’s home (24.1%), and occurred mainly in the evening (46.5%) or afternoon hours (32.3%) (Table 3).

Table 3.

Perpetrator characteristics and context of the first incident of unwanted sexual touching and unwanted attempted sex before age 18 among respondents aged 18–24 years.

Unwanted sexual touching
Unwanted attempted sex
Female
Male
Female
Male
na % (95% CI)a n % (95% CI) n % (95% CI) n % (95% CI)
Total 126 73 94 56
Number of perpetrators
One person 111 87.6 (78.5–96.6) 65 85.7 (74.9–96.4) 84 89.2 (81.3–97.2) 48 92.9 (86.6–99.2)
2+ persons 14 12.4 (3.3–21.4) 8 14.3 (3.6–25.1) 10 10.8 (2.8–18.7) 7 6.0 (0.1–11.9)
Knew perpetrator
Yes 109 91.0 (85.6–96.4) 70 98.6 (96.6–100.0) 86 92.6 (86.1–99.0) 49 87.2 (74.9–99.4)
No 17 9.0 (3.6–14.4) 3 1.4 (0.0–3.4) 8 7.4 (1.0–13.9) 5 12.8 (0.6–25.1)
Perpetrator
Stranger/unknown 17 9.0 (3.6–14.4) 3 1.4 (0.0–3.4) 8 7.4 (1.0–13.9) 5 12.8 (0.6–25.1)
Boy/girlfriend/partner 40 32.1 (20.1–44.1) 28 43.9 (27.5–60.3) 31 33.3 (19.4–47.2) 20 40.6 (24.5–56.7)
Family/relative 12 12.7 (3.3–22.1) 8 13.1 (0.0–27.5) 8 18.0 (0.9–35.1) 5 7.7 (0.0–15.7)
Neighbor 30 24.1 (14.6–33.6) 13 14.9 (5.9–23.8) 29 25.3 (13.6–37.1) 11 19.8 (7.3–32.3)
Friend/classmate 15 10.7 (4.9–16.5) 12 18.6 (8.0–29.2) 7 7.3 (1.6–13.0) 5 7.8 (1.2–14.5)
Other 10 8.4 (0.90–15.8) 9 4.6 (8.2–2.0) 11 8.6 (2.4–14.9) 10 11.4 (2.6–20.1)
Perpetrator age
Older 82 72.1 (62.6–81.6) 29 32.7 (15.7–49.7) 66 73.4 (62.0–84.8) 31 51.3 (34.2–68.4)
Younger 1 0.6 (0.0–1.8) 8 11.9 (2.4–21.4) 0 – 6 11.1 (0.0–22.3)
Same 42 27.0 (17.7–36.3) 35 54.6 (38.8–70.3) 26 24.6 (13.4–35.8) 19 37.5 (21.1–53.9)
Don’t know 1 0.3 (0.0–1.0) 1 0.8 (0.0–2.3) 2 2.0 (0.0–5.1) 0 –
Relative age of perpetratorb
10+ years older 44 53.5 (40.7–66.4) 11 28.7 (9.0–48.4) 30 46.5 (28.3–64.7) 14 40.3 (14.9–65.8)
Less than 10 years older 38 46.5 (33.6–59.3) 15 67.5 (46.0–88.9) 32 52.5 (34.3–70.6) 14 57.8 (32.3–83.3)
Don’t know 0 – 1 3.8 (0.0–11.5) 1 1.0 (0.0–3.0) 2 1.9 (0.0–5.2)
Location of first incident
My home 21 11.2 (5.0–17.5) 19 24.1 (7.2–41.0) 21 24.7 (8.3–41.1) 18 38.8 (22.9–54.8)
Perpetrator’s home 20 17.2 (10.0–24.3) 3 3.5 (0.0–7.9) 16 21.9 (10.4–33.4) 6 8.5 (0.7–16.3)
School 28 24.9 (15.5–34.2) 18 26.0 (11.9–40.1) 10 10.1 (3.6–16.7) 9 10.3 (3.3–17.3)
Traveling on foot 26 20.8 (12.3–29.4) 5 8.1 (0.1–16.2) 32 32.7 (18.8–46.6) 8 18.1 (7.2–28.9)
Other location 30 25.9 (14.7–37.1) 28 38.3 (20.8–55.8) 14 9.2 (3.1–15.3) 15 8.5 (0.7–16.3)
Time incident occurred
Morning 7 5.7 (0.0–12.0) 4 5.5 (0.0–11.3) 5 6.4 (0.0–12.9) 5 10.7 (0.0–23.2)
Afternoon 56 41.1 (29.9–52.2) 22 32.3 (13.8–50.9) 31 27.8 (16.2–39.3) 19 37.9 (24.1–51.8)
Evening 54 47.2 (34.3–60.1) 34 46.5 (27.6–65.4) 53 60.7 (46.8–74.6) 27 41.4 (35.9–56.9)
Late 7 5.3 (0.4–10.2) 12 15.7 (0.8–30.5) 5 5.1 (0.0–10.4) 5 9.9 (0.0–20.1)
Don’t know 1 0.7 (0.0–2.2) 0 – 0 – 0 –
Open in a new tab
a

All the ns presented are unweighted but the proportions and respective 95% CI are weighted. Due to missing responses, totals vary between variables.

b

Among respondents who said the perpetrator was older than themselves.

Unwanted Attempted Sex

The main perpetrators of unwanted attempted sex among female and male respondents were intimate partners (33.3% and 40.6%) and neighbors (25.3% and 19.8%), respectively. A large majority of females (92.6%) and males (87.2%) who reported unwanted attempted sex before age 18 knew the perpetrator and reported a single perpetrator was involved (89.2% and 92.9%, respectively) (Table 3). A large majority of females (73.4%) and half of males (51.3%) reported the perpetrator was older than them. Of these, 46.5% of females and 40.3% of males reported the perpetrator was 10 or more years older than themselves. The first incident of unwanted attempted sex among females occurred while traveling on foot (32.7%), in the respondent’s home (24.7%) or in the perpetrator’s home (21.9%) while among males, it occurred in the respondent’s home (38.8%) and while traveling on foot (18.1%). The first incident of unwanted attempted sex before age 18 occurred mainly in the evening (females 60.7% and males 41.4%) or afternoon hours (females 27.8% and males 37.9%).

Physically Forced Sex

Due to the small number of male respondents aged 18–24 years who reported physically sex, discussion of perpetrator characteristics and context of physically forced sex is limited to females aged 18–24 year-olds. A large majority of the perpetrators of the first incident of physically forced were known to female respondents (95.3%) and nearly all respondents (98.2%) reported that only one perpetrator was involved in the first incident (Table 5). The main perpetrators of the first incident were intimate partners (50.1%). Close to two-thirds of females who reported physically forced sex before age 18 reported that the perpetrator of the first incident was older than the respondent (68.5%). The first incident of physically forced sex mainly occurred in the perpetrator’s home (41.7%) and while traveling on foot (24.2%) and mostly in the afternoon (40.2%) and evening (37.9%) (Table 5).

Table 5.

Perpetrator characteristics and context of the first incident of physically forced sex and pressured sex before age 18 among female and male respondents aged 18–24 years.

Physically forced sex
Pressured sex
Female
Male
Female
Male
n % (95% CI) na % (95% CI) n % (95% CI) na % (95% CI)
Total 53 – 12 – 66 – 28 –
Number of perpetrators
One person 52 98.2 (94.6–100) 9 82.0 (56.3–100) 61 90.6 (81.4–99.8) 25 93.2 (83.7–100)
2+ persons 1 1.8 (0.0–5.4) 3 18.0 (0.0–43.7) 5 9.4 (0.2–18.6) 3 6.8 (0.0–12.3)
Knew perpetrator
Yes 47 95.3 (90.7–99.8) 12 100 (–) 63 97.8 (94.4–100) 27 98.5 (95.4–100)
No 5 4.7 (0.2–9.3) 0 – 2 2.2 (0.0–5.6) 1 1.5 (0.0–4.6)
Perpetrator
Stranger/unknown 6 9.3 (0.6–18.0) 2 18.8 (0.0–43.8) 2 2.2 (0.0–5.6) 1 1.5 (0.0–4.6)
Boy/girlfriend/partner 24 50.1 (26.1–74.2) 6 60.6 (30.0–91.1) 33 55.9 (39.9–71.9) 15 57.7 (35.3–80.1)
Family/relative 5 16.0 (0.9–31.8) 2 6.8 (0.0–18.3) 1 1.1 (0.0–3.3) 2 9.4 (0.0–22.1)
Neighbor 7 6.4 (0.1–12.7) 1 3.8 (0.0–11.5) 9 15.8 (4.0–27.6) 3 20.3 (0.0–41.5)
Friend/classmate 4 6.2 (0.0–14.9) 1 3.8 (0.0–11.5) 5 9.5 (0.0–21.1) 2 3.9 (0.0–10.4)
Other 8 12.0 (0.6–23.4) 0 – 16 15.5 (4.5–26.6) 5 7.1 (0.3–14.0)
Perpetrator age
Older 39 68.5 (51.2–85.8) 4 54.7 (11.5–97.9) 38 60.2 (43.8–76.7) 9 46.1 (24.2–68.1)
Younger 2 3.4 (0.0–9.1) 2 10.8 (0.0–27.8) 0 – 3 12.1 (0.0–27.2)
Same 11 27.4 (13.2–41.7) 6 34.5 (0.0–73.4) 27 39.3 (22.8–55.8) 16 41.8 (21.8–61.7)
Don’t know 1 0.6 (0.0–1.9) 0 – 1 0.5 (0.0–1.4) 0 –
Relative age of perpetratorb
10+ years older 16 41.6 (15.3–68.0) 2 26.7 (0.0–76.2) 16 40.7 (21.6–59.9) 2 20.3 (0.0–48.7)
Less than 10 years older 22 58.4 (32.0–84.7) 2 73.3 (23.8–100) 19 59.3 (40.1–78.4) 6 77.0 (47.7–100)
Don’t know 0 – 0 – 0 – 1 2.8 (0.0–8.7)
Location of first incident
My home 9 13.3 (3.7–22.9) 6 62.9 (24.1–100) 18 17.2 (8.1–26.3) 8 30.4 (3.3–57.4)
Perpetrator’s home 21 41.7 (24.2–59.6) 1 3.2 (0.0–10.2) 28 44.4 (28.0–60.8) 5 17.2 (0.0–35.5)
School 2 3.0 (0.0–8.2) 1 18.5 (0.0–52.2) 2 3.0 (0.0–8.5) 5 20.6 (3.7–37.4)
Traveling on foot 11 24.2 (10.2–38.2) 1 3.4 (0.0–10.6) 7 17.4 (4.2–30.7) 2 3.7 (0.0–9.0)
Other location 10 17.8 (7.7–28.0) 3 11.9 (0.0–28.2) 11 17.9 (4.1–31.6) 8 28.1 (7.2–49.0)
Time incident occurred
Morning 3 4.6 (0.0–12.0) 1 12.0 (0.0–35.6) 1 1.7 (0.0–5.0) 1 4.5 (0.0–13.5)
Afternoon 18 40.2 (24.0–53.4) 2 44.2 (0.0–92.0) 22 36.3 (20.7–51.9) 5 31.2 (4.3–58.2)
Evening 20 37.9 (22.2–53.6) 7 37.7 (0.0–76.8) 31 47.2 (31.2–63.8) 15 43.3 (23.3–63.2)
Late 12 17.3 (5.0–29.6) 2 6.0 (0.0–15.1) 11 14.4 (4.4–24.4) 7 21.0 (3.1–38.8)
Don’t know 0 – 0 – 1 0.4 (0.0–1.3) 0 –
Open in a new tab
a

All the ns presented are unweighted but the proportions and respective 95% CI are weighted. Due to missing responses, totals vary between variables.

b

Among respondents who said the perpetrator was older than themselves.

Pressured Sex

A large majority of female (97.8%) and male (98.5%) respondents knew the perpetrators of the first incident of pressured sex (Table 5). Over ninety percent of female and male respondents reported that only one perpetrator was involved in the first incident (Table 5). The main perpetrators of the first incident of pressured sex among females and males were intimate partners (55.9% and 57.7%, respectively). More than half of females who reported pressured sex before age 18 reported the perpetrator of the first incident was older than the respondent (60.2%). For males, perpetrators of the first incident of pressured sex were mainly older (46.1%) or of the same age as the respondent (41.8%). The first incident of pressured sex among females mainly occurred in the perpetrator’s home and among males in the respondent’s home mostly during the afternoon and evening (Table 5).

Uptake of Survey Counseling Services

Twenty-six participants (18 females and 8 males) who had experienced violence received counseling sessions during and after the survey.

Discussion and Conclusions

We found remarkable consistency in the type of perpetrators of CSA before age 18 years among 18–24 year olds across different forms of CSA and among male and female respondents. The perpetrators of the first incident of unwanted sexual touching were largely people known to the respondent and were most likely to be intimate partners, friends/classmates, and neighbors. This pattern was similar for girls and boys. A similar pattern was evident for unwanted attempted sex. Key perpetrators of the first incident were again largely known to the respondents and were primarily intimate partners and neighbors. In addition, for both forms of CSA, among both girls and boys, a substantial proportion of perpetrators were 10 or more years older than the respondents who had experienced CSA (28.7–53.5%).

A similar pattern emerges for males and females aged 18–24 years who reported physically forced and pressured sex. The main perpetrators of the first incident of both types of CSA among female and male respondents were intimate partners and the first incident of either type of CSA among females occurred in the perpetrator’s home while for males, the first incident occurred in the respondent’s home.

The type of CSA perpetrators among 13–17 year olds was somewhat different and more varied than for 18–24 year olds. For both unwanted sexual touching and unwanted attempted sex, intimate partners remained the predominant type of perpetrator for boys, but not for girls. For girls, neighbors and strangers accounted for a substantial proportion of perpetrators for both of these forms of CSA. For unwanted attempted sex, however, family members or relatives accounted for the highest proportion of perpetrators among girls. About a third of the perpetrators were 10 or more years older than the respondents who had experienced CSA.

The context of child sexual abuse varied across forms of CSA, age and sex. Most 18–24 year old female respondents reported that the first incident of unwanted sexual touching before age 18 occurred in school, while traveling on foot and in the respondent’s home. Among 18–24 year old males their own homes and schools were the most common locations. The most common location for unwanted attempted sex before age 18 was traveling on foot for girls and in their own home for boys. For 13–17 year old girls the most common location was traveling on foot for both forms of CSA, while for boys their homes were the most common location for unwanted sexual touching and school for unwanted attempted sex. Regardless of the form of CSA, age, or sex, afternoon and evening hours were the most common times in which CSA occurred. The characteristics of perpetrators and context of the first incident of pressured and physically forced sex among females age 18–24 years were similar to those for the first incident of unwanted sexual touching and unwanted attempted sex before age 18.

These findings suggest that effective CSA prevention interventions need to be multifaceted to address different perpetrators and settings where various forms of CSA occur. They also suggest that the perpetrators and context of CSA may be changing over time as the involvement of strangers and a greater variation in types of perpetrators and context is evident for 13–17 year olds compared to 18–24 year olds.

Our findings are similar to those in other SSA countries (Pitche, 2005; Yahaya et al., 2012) and emphasize the need to formulate policies and interventions that target children, parents/caregivers, schools and child transportation. The Kenya National AIDS and STI Control Program (NASCOP) has recently integrated sexual violence prevention skills in Healthy Choices for a Better Future (an evidence-based HIV prevention intervention targeting youth ages 10–14 years) and in the Families Matter! Program (an HIV prevention intervention for parents of children ages 9–12 years that emphasizes sexual abstinence, effective parent–child communication and child monitoring skills) (NASCOP, 2013). Interventions that target parents/caregivers and schools need to emphasize the importance of child monitoring especially in the afternoon and evening hours when most incidents of child sexual violence occur. Given that children spend most of their time in school and walking to and from school is the main mode of transportation in Kenya, enforcement of safe school policies and promotion of affordable and safe travel options for children are needed to prevent CSA. These options include encouraging parent/care giver escort, group walks, and subsidized school transportation.

The prevention of CSA in Kenya can be strengthened by scaling up evidence-based and promising prevention strategies that address intimate partner violence among youth and adults. Kenya is currently implementing Stepping Stones, an HIV prevention program that aims to improve sexual health through building stronger, more gender equitable relationships with better communication and less violence between partners (Jewkes, Nduna, & Jama, 2002). A randomized controlled trial of the program found that in addition to reducing HIV infection the men in the program disclosed lower rates of perpetrating severe intimate partner violence at 12 and 24 months post intervention (Jewkes et al., 2006).

Our analysis has some limitations. We relied on retrospective self-reports of child sexual abuse that are subject to recall bias. Also, the analysis for respondents aged 13–17 years was limited to unwanted sexual touching and unwanted attempted sex due to the small number of respondents who reported pressured and physically forced sex most probably because many of the respondents had not completed their childhood. Similarly, we do not present perpetrator and context of CSA data for males aged 18–24 years who reported physically forced and pressured sex before age 18. Our analysis of perpetrators by type of sexual violence masks the possibility that children may experience multiple types of sexual violence over time and often by the same perpetrator. The survey did not collect data on the sex of the perpetrators of CSA, limiting our description of perpetrators and recommendations for addressing CSA. In spite of these limitations, our findings provide comprehensive data on the perpetrators and context of various forms of CSA by sex and age group that can be used to provide specific guidance in the design of CSA prevention and response programs.

Acknowledgments

The Kenya Violence against Children Survey was funded by UNICEF Kenya Country Office and received in-kind technical support by the CDC, Division of Violence Prevention in Atlanta and the CDC Division of Global HIV/AIDS in Kenya. We acknowledge Jonna Carlsson for providing leadership in all aspects of the survey; the Kenya National Bureau of Statistics who implemented the survey, and the Kenya VACS Technical Working Group for guidance and support in the survey development process. We acknowledge the Kenya VAC 2010 survey teams who administered the survey and team leads who took great care in ensuring the privacy and safety of the respondents. We are greatly indebted to all the households and participants who responded to the survey questions.

Footnotes

Disclaimer

The findings and conclusions in this paper are those of the authors and do not necessarily represent the official position of the U.S. Centers for Disease Control and Prevention.

Attribution of support

This publication was made possible by technical support from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Centers for Disease Control and Prevention (CDC), Division of Global HIV/AIDS (DGHA).

References

  1. Agardh A, Odberg-Pettersson K, Östergren P. Experience of sexual coercion and risky sexual behaviors among Ugandan university students. BMC Public Health. 2011;11:527. doi: 10.1186/1471-2458-11-527. http://dx.doi.org/10.1186/1471-2458-11-527. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Andersson N, Cockcroft A, Shea B. Gender-based violence and HIV: Relevance for HIV prevention in hyper endemic countries of southern Africa. AIDS. 2008;22(4):S73–S86. doi: 10.1097/01.aids.0000341778.73038.86. http://dx.doi.org/10.1097/01.aids.0000341778.73038.86. [DOI] [PubMed] [Google Scholar]
  3. Andersson N, Paredes-Solis S, Milne D, Omer K, Marokoane N, Laetsang D, Cockcroft A. Prevalence and risk factors for forced sex among school-going youth: National cross-sectional studies in 10 southern African countries in 2003 and 2007. BMJ Open. 2012;2(2):e000754. doi: 10.1136/bmjopen-2011-000754. http://dx.doi.org/10.1136/bmjopen-2011-000754. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Chan KL, Yan E, Brownridge DA, Tiwari A, Fong DY. Childhood sexual abuse associated with dating partner violence and suicidal ideation in a representative household sample in Hong Kong. Journal of Interpersonal Violence. 2011;26(9):1763–1784. doi: 10.1177/0886260510372943. http://dx.doi.org/10.1177/0886260510372943. [DOI] [PubMed] [Google Scholar]
  5. Erulkar AS. The experience of sexual coercion among young people in Kenya. International Family Planning Perspectives. 2004;30(4):182–189. doi: 10.1363/3018204. http://www.guttmacher.org/pubs/journals/3018204.html. [DOI] [PubMed] [Google Scholar]
  6. Exner-Cortens D, Eckenrode J, Rothman E. Longitudinal associations between teen dating violence victimization and adverse health outcomes. Pediatrics. 2013;131(1):71–78. doi: 10.1542/peds.2012-1029. http://dx.doi.org/10.1542/peds.2012-1029. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Gilbert R, Widom CS, Browne K, Fergusson D, Webb E, Janson S. Burden and consequences of child maltreatment in high-income countries. Lancet. 2009;373:68–81. doi: 10.1016/S0140-6736(08)61706-7. [DOI] [PubMed] [Google Scholar]
  8. Jewkes R, Nduna M, Jama PN. Stepping stones, South African adaptation. 2. Pretoria: Medical Research Council; 2002. [Google Scholar]
  9. Jewkes R, Nduna M, Levin J, Jama N, Dunkle K, Khuzwayo N, Koss M, Puren A, Wood K, Duvvury N. A cluster randomized controlled trial to determine the effectiveness of Stepping Stones in Preventing HIV infections and promoting safer sexual behavior amongst youth in the rural Eastern Cape, South Africa: Trial design, methods, and baseline findings. Tropical Medicine and International Health. 2006;11:3–16. doi: 10.1111/j.1365-3156.2005.01530.x. http://dx.doi.org/10.1111/j.1365-3156.2005.01530.x. [DOI] [PubMed] [Google Scholar]
  10. Kenya . The Sexual Offences Act, 2006. 2006. [Google Scholar]
  11. Kish L. A procedure for objective respondent selection within a household. Journal of the American Statistical Association. 1949;44:380–387. [Google Scholar]
  12. Lalor K. Child sexual abuse in sub-Saharan Africa: A literature review. Child Abuse & Neglect. 2004a;28(4):439–460. doi: 10.1016/j.chiabu.2003.07.005. http://dx.doi.org/10.1016/j.chiabu.2003.07.005. [DOI] [PubMed] [Google Scholar]
  13. Lalor K. Child sexual abuse in Tanzania and Kenya. Child Abuse & Neglect. 2004b;28(8):833–844. doi: 10.1016/j.chiabu.2003.11.022. http://dx.doi.org/10.1016/j.chiabu.2003.11.022. [DOI] [PubMed] [Google Scholar]
  14. Moore AM, Awusabo-Asare K, Madise N, John-Langba J, Kumi-Kyereme A. Coerced first sex among adolescent girls in Sub-Saharan Africa. African Journal of Reproductive Health. 2007;11(3):62–82. [PMC free article] [PubMed] [Google Scholar]
  15. National AIDS and STI Control Program, Kenya. Families Matter! Program 2013 [Google Scholar]
  16. Pitche P. Child sexual abuse and sexually transmitted infections in sub-Saharan Africa. Médecine Tropicale. 2005;65(6):570–574. http://dx.doi.org/10.1016/j.chiabu.2008.09.006. [PubMed] [Google Scholar]
  17. Reza A, Breiding MJ, Gulaid J, Mercy JA, Blanton C, Mthethwa Z, Bamrah S, Linda L, Dahlberg LL, Anderson M. Sexual violence and its health consequences for female children in Swaziland: A cluster survey study. Lancet. 2009;373:1966–1972. doi: 10.1016/S0140-6736(09)60247-6. http://dx.doi.org/10.1016/S0140-6736(09)60247-6. [DOI] [PubMed] [Google Scholar]
  18. World Health Organization. Putting women first: Ethical and safety recommendations for research on domestic violence against women. Geneva, Switzerland: World Health Organization; 2001. [Google Scholar]
  19. World Health Organization. Global and regional estimates of violence against women: Prevalence and health effects of intimate partner violence and non-partner sexual violence. Geneva, Switzerland: World Health Organization; 2013. [Google Scholar]
  20. United Nations Children’s Fund Kenya Country Office, Division of Violence Prevention, National Center for Injury Prevention and Control, U.S. Centers for Disease Control and Prevention, Kenya National Bureau of Statistics. Violence against Children in Kenya: Findings from a 2010 National Survey. 2012. [Google Scholar]
  21. United Nations Children’s Fund, Swaziland. A national study on violence against children and young women in Swaziland. 2007. [Google Scholar]
  22. United Nations Children’s Fund Tanzania, U.S. Centers for Disease Control and Prevention, & Muhimbili University of Health and Allied Sciences. Violence against children in Tanzania: Findings from a national survey 2009. Dar es Salaam, Tanzania: United Republic of Tanzania; 2011. [Google Scholar]
  23. Yahaya I, Soares J, Ponce De Leon A, Macassa G. A comparative study of the socioeconomic factors associated with childhood sexual abuse in sub-Saharan Africa. Pan African Medical Journal. 2012;11:51. [PMC free article] [PubMed] [Google Scholar]

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