Sexual abuse of a minor is the involvement of a child in sexual activity. This is because he/she is developmentally unprepared, does not understand, and cannot give informed consent. The society underestimates this significant problem as many cases go unreported. This study reports the index case of sexual abuse of a 6-year-old orphan by an adult. She was brought to the Children’s Emergency Room of David Umahi Federal University Teaching Hospital (DUFUTH), Uburu, Ebonyi State, Nigeria by a neighbor on account of sexual abuse by penetration on three different occasions by the same person. It was the third episode that the child volunteered the information after the assailant was caught in a similar act. She was managed by the Gender-Based Violence (GBV) unit of DUFUTH where necessary examinations, counseling, laboratory investigation, and follow-up were done, including Anti-retroviral screening. She was placed on antibiotics for one week, post-exposure prophylaxis for 28 days, and recommended for a second anti-retroviral screening in three months. She was also referred to the Gender-Based Violence (GBV) Unit of a State General Hospital for collaboration and further documentation in the approved GBV register.

• Rape

• Sexual abuse

• Minor

• Penetration

• DUFUTH

• Ebonyi State

Edoiseh EF (2024) Rape of Vulnerable Female Minor, an Orphan in a Rural Area by a Neighbor: A Case Report. JSM Clin Case Rep 12(5): 1252.

Rape is defined as the penetration no matter how slight, of the vagina or anus with any body part or object, or oral penetration by a sex organ of another person, without the consent of the victim.1 When a child/minor (<18 years) is the victim of such abuse, it becomes Child Sexual Abuse (CSA) [1]. CSA is a crime that refers to the involvement of a child in sexual activity that he/she is not capable of understanding, is not developmentally prepared for, and is unable to give informed consent [2]. Studies have shown that CSA is common in females than males, occurs in familiar settings and the perpetrators are usually known to the victims [3-6]. The offenders could be close relatives, friends, or neighbors. The risk factors associated with CSA include poverty, ignorance, poor education, and unstable home environments [3 6]. It is important to understand the diversities of sexual violence as not only a physical act but also verbal or visual sexual abuse or any act that forces a person to join in unwanted sexual contact or attention [7].

Despite the legal provisions of life in jail for sexual assaulters in Nigeria [8]. This does not serve as a deterrent to sexual assault since a significant prevalence rate still exists. The reportage of most cases of sexual assault suffers setbacks for fear of stigmatization, and failure of prosecution of alleged perpetrators, victims may be ashamed, embarrassed, or afraid to tell the police, friends, or family about the violence. Victims may also keep quiet because they have been threatened with further harm if they tell anyone or are told not to think that anyone would help them [9].

In Nigeria, abuse against children is rampant although it is largely under-reported [10]. Under-reporting stems from a cultural justification of certain forms of abuse associated with cultural practices and the reluctance of children to speak about prior abusive experiences [10]. Fear of their assailant’s threats or their parent’s reaction may be the cause of this reluctance [10]. Also, some children may be either too young to understand their experience or unable to speak for themselves [10]. The prevailing belief in some regions of Nigeria that children and young domestic workers are the property of male heads of household and their relatives often seems to contribute to both the abuse and the reluctance of others to become involved to stop the violence [11].

According to United Nations Children Emergency Fund (UNICEF), one in four girls and 10 % of boys have been victims of sexual violence in Nigeria. Fewer than five out of 100 of the children who reported violence, received any form of support [12]. It has been reported that about two million Nigerian girls experience sexual abuse annually and that only 28 percent of rape cases are reported. Of those, only 12% result in convictions [13]. Also, data gathered by Rule of Law and Anti-Corruption (RoLAC) from 32 Sexual Assault Referral Centers (SARCs) in Nigeria shows that over 75 percent of victims are children [14].

A 6-year-old female orphan was brought to the Children’s Emergency Room of our facility by a neighbor with a complaint of rape by an adult male neighbor. The victim was said to have lost both her parents and grandmother and was living with her great-grandmother in a rural area. She was said to have been sexually assaulted by penetration on three different occasions by the assailant and volunteered the information two days before her hospital visit because the suspect was caught in a similar act.

According to the victim, the man undressed her and undressed himself and had sexual intercourse with her while covering her mouth. She was threatened not to divulge the information on any account. This incident was said to have happened three times and the last episode happened five days before presenting in the hospital. The victim was conscious, withdrawn, and made poor eye contact. On physical examination, she was afebrile, not pale, anicteric, acyanosed, and had no sign of dehydration. There was no sign of meningeal irritation, and muscle tone and reflexes were normal in all limbs. There was no history of fever, vulva pain, vaginal bleeding or discharge. Normal female external genitalia was seen, no healed or healing scar or wound. There was no obvious discharge and hymen was not seen.

On presentation of this patient, the pediatrician on call informed the management about the case being the first presentation of its kind in this facility. Immediately, the management swung into action and constituted a committee of seven persons to form the Gender-Based Violence Unit of the hospital to take over the management of this patient immediately. The Clinic was set up within the public health department which is composed of a consulting room and a counseling unit. The unit is composed of two obstetricians, one pediatrician, one public health physician, one family physician, one medical officer, and one nurse. The GBV unit came into existence immediately and currently making concerted efforts to get it registered with the necessary authorities for national and international recognition.

Tests such as retroviral screening test (RVST), Hepatitis B surface antigen (HBsAg), hepatitis C virus (HCV), and Venereal Disease Research Laboratory test (VDRL) were conducted and the results turned out all negative. She was placed on antibiotics, two times daily for one week. It was recommended that the HIV I & II test be repeated after 3 months, and she was commenced on post-exposure prophylaxis for 28 days. She was counseled and referred to the Gender-Based Violence (GBV) Unit at one of the State General Hospitals with the approved GBV register for documentation, while case was followed up.

This is an index case of child sexual abuse presented in David Umahi Federal University Teaching Hospital (DUFUTH), Uburu, Ebonyi State, Nigeria, allegedly perpetrated against a 6-year old female orphan by a male adult above 30 years of age. There may have been an increased vulnerability of the child to sexual abuse with apparent less parental supervision and protection due to her peculiar circumstances. Child sexual abuse was influenced by a decline in socioeconomic status, disruption of intimate relationships, and commoner in those from disturbed and disrupted families and in those who also reported physical and emotional abuse [15,16]. Sexual abuse among adolescents may take many forms and vary in terms of frequency, duration, invasiveness of the acts involved, and the use of force or coercion [16].

The safety of children and young women within communities – to attend school, and to move freely within their communities and their homes without fear of violence or sexual assault is a basic human right [11]. It is possible that the circumstances that nature has thrown this minor into have made her vulnerable to sexual abuse.

Most victims do not know the appropriateness of obtaining medical care after abuse, they may lack support from their family members who seldom believe them or think they were the ones who were promiscuous or dressed or behaved inappropriately [17]. West African countries lack resources and child welfare programs, and are unable to provide adequate support and services to victims of sexual abuse. Furthermore, in some cases, a compensation payment from the perpetrator to the victim’s family serves as punishment, and the offense is not reported to the police [17]. Generally, poverty has also been reported as a reason for not seeking medical care, including after CSA [18,19].

Sexual assault may pose some complications for the victim such as long-term emotional and psychological damage. People with a history of sexual abuse have been found to develop post-traumatic stress disorder more often than war veterans [20]. Other impacts of child sexual abuse include poor school performance, substance abuse, delinquency, prostitution, sexual dysfunction, mental illness, suicide, and transmission of abusive behavior to subsequent generations [21-23].

The need for the education of children about physical boundaries and calling for help should be an important part of increasing street safety, especially for unaccompanied minors [11]. Better awareness through schools, religious institutions, and government, is needed to educate children and parents alike about the dangers of violence/abuse, boundaries, and personal safety [11]. Law enforcement agencies are an important part of the loop in ensuring that allegations of child sexual abuse are appropriately investigated and the assailants are brought to book to serve as a deterrent to intending culprits.

Sexual abuse of minors is a despicable and criminal act. Close parental care and supervision are necessary measures for the protection of minors against sexual abuse. Children should be enlightened at home, in school, and in their religious centers on the need and means of reporting any form of abuse, including sexual acts. There is a need for a coordinated forensic medical response to cases of sexual violence, and a one-stop center for specialized management would be an effective and efficient modality. The availability and access to appropriate care may encourage early visits to such medical facilities for expert care. A multidisciplinary approach, including the role of law enforcement agents should be operational. Rape among female minors is better avoided by ensuring that the vulnerable girls (orphans being cared for by aged grannies or in rural settings) are helped and empowered by the community, faith-based organizations and government. Health facilities should also ensure a functional Gender-Based Violence Unit is set up for proper care in the event of similar circumstances. Such social schemes will go a long way to reduce this menace especially in rural settings.

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