Trends and patterns of sexual assaults in Lagos south-western Nigeria
Oliver Chukwujekwu Ezechi1,&, Zaidat Adesola Musa1, Agatha
Nkiruka David1, Agatha Eileen Wapmuk1, Titilola Abike Gbajabiamila1,
Ifeoma Eugenia Idigbe1, Paschal Mbanefo Ezeobi1, Aigbe
Ohihoin1, Innocent Achanya Otobo Ujah1
1Clinical Sciences Division, Nigerian Institute of Medical Research Yaba Lagos, Nigeria
Oliver Chukwujekwu Ezechi, Clinical Sciences Division, Nigerian Institute of Medical Research Yaba Lagos, Nigeria
sexual assault is a severely traumatic experience that disproportionally affects women and girls. However there is limited information on the subject in our environment. This study was conducted to determine the trend and pattern of sexual assault among Nigerians.
a retrospective study of sexual assault victims managed at a large clinic
in South West Nigeria. Victims were identified from the programme data base
and case files retrieved from medical records department. Relevant information
extracted and managed with SPSS for windows version 19.
a steady increase in the proportion of reported cases of sexual violence
over the years (P<0.0001) was observed. Sexual assaults were recorded among
the males (6.1%), although female victims were in the majority (93.9%). Sexual
was found to be higher in person’s <20 years and the unmarried. Most sexual
assault occurred during the day time. Assailants were mostly persons known
to the victim (52.0%) and the assault occurred mostly in the assailants’ house
or office (48.5%). Sexual assault through vaginal route only (87.2%) was
the most common route of sexual assault. Threat of violence (31.1%) and physical
force (29.6%) was the common methods for overcoming the victims. Follow up
completed by 75.0% of the victims.
sexual assault is comenon in our environment, with increasing prevalence
and change in pattern. Young persons aged less than than 20 years constitutes the majority of victims and assailants were mostly persons known to them. The current
on the evils of sexual violence should be intensified.
Sexual assault is a severely traumatic experience that disproportionally
affects women and girls [1,2] .
It is often associated with psychological, physical, social distress
and occasionally result in fatality either from shock, severe injury
by the perpetrator in an attempt to conceal his identity [3,4].
Sexual assault encompasses a wide range of activities ranging from
rape to physically less intrusive sexual contacts, whether attempted
[1, 3, 4].
It involves lack of consent; the use of physical force, coercion,
deception or threat; and/or the involvement of a victim that is
under aged, mentally incapacitated or physically impaired as a
result of voluntary or involuntary alcohol or drug consumption
Although penile vaginal penetration or attempted penetration is
the commonest form of sexual assault, penile penetration or attempted
penetration of the
anus or mouth without consent is increasingly being reported .
Breast or genital fondling, forced or coerced touching of another’s genitalia
and forced or coerced anal or vaginal penetration with other body
parts or object are other forms of sexual assault .
Sexual assault is a pandemic crime that is characteristically underreported,
more especially in the low income countries , because
of the enduring culture of male dominance, female social and economic
disempowerment and poor or non-prosecution of sex offenders [4, 7].
According to World Health Organizationreports, one in every five
women is a victim of sexual assault  and globally,
35% of women have experiencedeither physical and/or sexual intimate
or non-partner sexual violence . The reported figures
are said to be inaccurate and often underestimate as most cases
of sexual assault are under-reported by the victims because of
the associated stigma
. In Nigeria, only 2 of 40 cases of rape are reported,
attributing this amongst other reasons, to the arduous legal requirements
needed to prove the cases and the associated stigma [1,11].
The reported incidence of sexual assault in Nigeria ranged from
13.8% among female students in Maiduguri  to 15%
among young females in Ibadan .
Until 2002, the management of sexual assault especially prevention was a major
challenge in our setting [1,10].
The introduction of the Federal Government of Nigeria antiretroviral
drug access programme in 2002 changed this poor out look as, a
number of post
exposure prophylaxis programmes was established across the country.
Public health education and campaign on the need for persons occupationally and non-occupationally exposed to HIV and other infectious agents to avail themselves of these services in other to avert infection were intensified.
It is hoped that a lot more persons sexually assaulted will avail themselves of this preventive service even if they do not want to report to the police. This will
in narrowing the gaps in the reported cases of sexual assault in
Nigeria and worldwide. This study was conducted to determine the trend and pattern of sexual assault on women, girls and men among Nigerians who presented for HIV post exposure prophylaxis between July 2006 to June 2015 at the HIV treatment centre, Nigerian Institute of Medical Research, Lagos.
The study was conducted at the HIV treatment centre, Nigerian Institute of Medical Research, Lagos. The centre started operations in 2002 following the commencement of the Federal Government of Nigeria Antiretroviral access programme. The centre currently provides comprehensive HIV care, treatment and support for over 23,000 patients. Sixty five percent of the patients come from Lagos and the rest from the other 5 states of southwestern
Nigeria as well as from north-central, south-south and south-eastern Nigeria. A little over 0.03% comes from neighbouring West African countries. Patients are enrolled into the HIV treatment programme following a referral from the HIV Counselling and Testing Centre, Nigerian Institute of Medical Research, Lagos or transfer from other Government of Nigeria HIV treatment centres.
The HIV treatment centre has a HIV post exposure prophylaxis programme that operates a free 24-hour service. All cases of occupational and non-occupational exposure to infectious agents are provided services using a standardised management protocol. Patients are either self-referred or referred from public and private hospitals/clinics, NGOs and the police. Information was collected from the patients using a pre-assessment, entry and visit forms. Collected information was entered prospectively into the programme data base.
All cases of sexual assault seen over a period of 10 years (January 2006 to December 2015) were retrieved from the programme data base, de-identified and analysed with SPSS for windows version 19.
Compliance with ethical standards
this study was funded by research fund from Nigerian Institute of Medical Research Lagos. Treatment and care of the patients was supported by AIDS Prevention Initiative in Nigeria (APIN).
all procedures performed in this study were in accordance
with the ethical standards of the Institutional Review Board, Nigerian Institute
of Medical Research, Lagos who gave the ethical approval for the study and with
the 1964 Helsinki declaration and its later amendments or comparable ethical
A total of twentyone thousand one hundred and ninety nine patients
presented at the treatment centre for services including post exposure
prophylaxis during the ten year period; of which one hundred and
ninety six were cases
of sexual assault (0.9%). Table
1 shows the trend in cases of sexual assault among patients seen
at the treatment centre. There was a steady increase in the proportion
of patients that presented for sexual assault among the patients.
a tenfold increase in the proportion of patients presenting with
sexual assault from 0.2% in 2006 to 2.0% in 2015 (Chi Square for
trend 51.45; P<0.0001).
Table 2 shows
the socio-demographic characteristics of sexual assaulted victims. The ages ranged
from 3 to 53 years with a mean of 21.2 ± 8.8 years. Over two third of the patients
(68.3%) were aged less than 30 years, with those aged 10-19 years constituting
35.2% of cases. Majority of the sexual assault victims were students (51.5%)
and unmarried (73.9%). Of the 196 cases of sexual assault victims, while females
were in the majority (184; 93.9%), the remaining 12(6.1%) patients were males.
The age of the male victims ranged from 19 to 41 years with a mean of 24.9 ± 4.9
The type of sexual assault by sex of the victim is shown in Table
3. Sexual assault through vaginal route only was the commonest type of
assault (171; 87.2%), followed by assault through anal penetration only (11;
5.6%). In the remaining thirteencases, assault was through the mouth (4; 2.0%)
and multiple routes (9; 4.6%). Among the twelve male victims, nine (75.0%) were
assaulted through the anus.
The time of sexual assault is shown in Table
4. While majority of the assaults occurred during the day (53.6%), in
the remaining ninety one cases the assaults were during the night (46.4%). While
over two-third (75.3%) of cases occurred during the day, in those aged above
30 years majority of the assault (75.6%) occurred at night (p=0.000. OR: 5.7;
95% CI: 2.9-11.1).The time interval between assault and presentation in the centre
range from about 4 hours to 96 hours; with majority presenting within 72 hours
(90.8%). Only 34.6% of the patients presented within 24 hours (Table
While the place of assault in most cases were the assailant’s home or office
(48.5%), in others the assault took place at victims home (19.9%), uncompleted
building (10.7%), street corner (11.2%), friend’s house (5.1%),taxi/bus (3.1%)
or hotel/guest house (2.6%). The assailants’ were known to the victims in majority
(102; 52.0%) of cases (friends (27.0%), neighbour (17.9%), authority figure (4.6%)
and relations (2.6%). The other assailants were unknown to the victim (52; 26.5%)
or criminals/armed robbers (42; 21.4%). The number of assailants ranged from
one to seven. While in the majority of cases only one assailant was involved
in the assault (139;70.9%), in the remaining cases, two assailants (37;18.9%),
or more assailants (15;7.7%) and unknown number of assailants (5;2.5%) were involved
in the attack. The method of overcoming the victim ranged from physical force
(29.6%), threat of violence (31.1%), deceit (19.4%), drug/alcohol (17.3%) or
money (2.6%). Fifty five (28.1%) out of the 196 victim sustained physical injuries(9.2%)
and anogenital injuries (18.9%). Majority of the genital injuries were sustained
by victims aged less than 20 years. All the patients had HIV screening and only
was confirmed HIV positive (0.5%). Only 67(34.2%) of the patients had hepatitis
B screening. All the victims except 19(9.7%) received post exposure prophylaxis
One hundred and seventy four women received emergency contraception (95.0%) and
147(75.0%) completed 3 month follow up. Only 21.9% of the victims had reported
to the police before presentation.
The prevalence of sexual assault among patients presenting for various
HIV services at our centre was 0.9%, with a steady increase over
the years (P<0.0001). Sexual assaults were recorded among the males (6.1%),
although female victims were in the majority (93.9%). Sexual assault
was found to
be higher in teenagers and the unmarried. Most sexual assault occurred
during the day time, however among older adult aged above 30 years
the assault was at night time. Assailants were known to the victim
in majority of the cases and the assault occurred either in the
assailants house/office (48.5%) or victims home (19.9%). Although
majority (90.8%) of the victims presented within 72 hours when
intervention could be effective, only 34.6% presented within 24 hours of
assault. The assailants were known to the victims in majority (52.0%) of
cases and were either a friend, neighbour, authority figure or a relation.
Assaults were perpetrated by one person in majority of cases (70.9%). Sexual
assaults through vaginal route only (87.2%) was
the most common route of sexual assault. Threat of violence (31.1%)
and physical force (29.6%) were the common methods for overcoming the victims,
who mainly sustained injury around the anogenital region (18.9%). Majority
of the anogenital
injuries were among victims less than 20 years. All victims except
9.7% received post exposure prophylaxis and all those found eligible for
emergency contraception received it (95.0%). Three months follow up was
completed by 75.0% of the victims.
The prevalence ofsexual assault in our cohort of 0.9% although similar to 0.8% reported by Akinlusi and colleagues from Lagos [1
], it was however lower than rates of 2.1-14.0% reported in other parts of Nigeria [3
], India [13
], Uganda [14
] and south Africa [15
].The low rate in our study suggests that recent campaigns are not achieving the expected objectives. However, it may be that lower rate found in our study may be either due to the type of denominator used in our study, the high number of the denominator used or that stigma associated with sexual violence is still keeping persons assaulted from reporting. Akinlusi et al [1
] similarly adduced large denominator as accountable for their low prevalence. The differential rates as a result of different denominator making comparison difficult, calls for the adoption of a consensus denominator by all. Although it could be argued that the rate is low in our centre, which may warrant the conclusion that sexual assault prevention programmes are working, the increasing trend observed over the years confirms otherwise. The assault prevention activities by government and non-governmental agencies geared towards the prevention of all forms of violence should not only be sustained but intensified. In addition, specific programmes targeting the stigmatisation of sexual assault victims making them not to report for treatment should be developed. The campaigns should emphasise how the confidentiality of victims are to be maintained. As most Nigerians residing in remote villages may not have the opportunity of access to psychological support, emergency contraception and post exposure prophylaxis, effort should be made to increase access to these services in these remote areas.
Often most report on sexual assault focuses on females, and rightly so as the
majority of sexual assault victims are females. However, prevention activities
need to start focusing on males too as we found that males were the victims of
sexual assault in 6.1% of our series While most reports on sexual assault in
Nigeria did not include male victims, studies from India [13
], Uganda [14
], and South
] supports our finding that males are also victims
of sexual assault. Sexual assault prevention programmes and activities should
start addressing factors that facilitate abuse of males especially boys, while
intensifying programmes that address sexual assault issues among females. Abused males were comparatively younger than their female counterparts suggesting that these young boys were taken advantage of. Majority (75.0%) of assault on males was through the anal route, pointing to the fact that perpetrators are men that have sex with men. The remaining male victims were forced to have oral sex with the assailant. The society often does not expect males to be sexually assaulted hence parents/guardians leave their wards in the care of potential assailants who soon take advantage of them. Public enlightenment programmes and activities against sexual
violence should also include that young boys are also at risk.
The findings of a large percentage of sexual assault victims being persons aged
less than 20 yearsin this study is in keeping with previous studies in Nigeria
and elsewhere [1
Adolescent period is a period of adventure and experimentation and they may unknowingly
engage in behaviour that exposes them to sexual assault. The finding of most
of the assault being perpetrated by persons known to the victims, occurring during
the day and in assailants’ homes gives credence to the above statement. In addition
being young person they are unlikely to be allowed to go out in the night hence
the lower rateof assault during the night time compared to the adults. Also the
findings of the majority of assailants being person known to the victims and
occurring in assailant homes are similar to previous findings [4
In those studies blood relations, neighbours, acquaintances and authority figures
were found to be the main perpetrators like in our study [1
Adolescents and teenagers should therefore be educated on the dangers inherent
in total trust of persons known to them especially when such close acquaintances
invite them to their homes without their parents’ or guardians’ knowledge. The
high number of close acquaintances involved in sexual assault in our setting
may also account for the low level of reporting and prosecution of sexual assault
preparators, as there is the tendency to settle out of court to preserve family
respect and maintain friendship.
When the 72 hours window of opportunity to institute prevention activities is
taken into consideration, it may be said that our cohort of patients reported
on time compared to other studies, as all our patients presented with 96 hours
In these other studies some patients presented for care after 3 weeks to 3 months
of assault when neither pregnancy nor infection prevention activities could be
instituted. In our study although majority (90.8%) of the victims presented within
72 hours, only 34.6% presented within 24 hours of assault. The import of this
is that the very important evidence required for prosecution of perpetrator is
lost. Many reasons have been adduced for this delay ranging from lack of knowledge
of where to go for service, limited 24-hour rape crisis centres, effect of alcohol
or drugs used to overcome the victims and delay at the police stations [1
In previous studies in Nigeria, sexual assaults were mainly through the vagina
in our study a worrisome pattern was noticed as anal assault for both male and
victims was common. This is however similar to findings in south Africa, India
and Bangladesh [13
The observed new pattern in Nigeria from our study is thus very worrisome as
the risk of transmitted infection is much higher through anal intercourse than
vaginal intercourse. Even more worrisome is the large number of victims in our
study who reported being raped by more than one assailant. Victims reported number
of perpetrators ranging from one to seven; with more than 20% having been raped
by more than one person. This has implications for both the physical injury sustained
as well as the number and load of infection the victims are exposed to.
Adequate care was provided for the victims congruent with their time of presentation.
However worrisome is that not all the victims completed their follow up. This
made it difficult to determine the success of sexual assault management in this
study. Although none of the victims that completed follow up reported pregnancy
event or HIV infection, it may be that the event occurred in those who did not
complete the follow up visits as they may have been disappointed and thus stopped
coming. It is therefore important to institute a good tracking system to follow
up these victims not only for determination of treatment success, but for emotional
and psychological support as well as determination of reason for default if it occurs. Although our study has contributed to the body of knowledge on the trend and pattern of sexual assault in our setting, it is challenged by a number of issues and thus the result may be generalised with caution. Our study was institution-based and within a HIV treatment programme. This may have affected the prevalence and thus may not be a true reflection at population level. However the increasing
trend and changing pattern of sexual assault was informative as it is not prone
to bias from the system or the setting. The study design is also retrospective
and prone to loss of important data points. This study was conducted in a research
Institute and data collected by trained researchers using routine based data
capture instruments that ensured that all data points are collected during the
care of sexual assault victims.
This study generated some important findings that are not readily available in our setting ranging from the increased trend, involvement of male victims and sexual assault treatment success. Information obtained will feed into sexual assault prevention programmes and activities in our setting and elsewhere.
Sexual assault is common in our setting and its prevalence is increasing with changing pattern. Males are increasingly been assaulted, but female victims are still in the majority. Young persons aged less than 20 years constituted majority of the victims with persons known to them being the perpetrators in most cases. Although majority of the victims presented within 72 hours of assault, some others presented beyond 72hours when infection transmission and pregnancy could not be prevented. It is recommended that the current effort of public education and enlightenment on the evils of sexual violence and the need for the victims to present early should be intensified. Special programmes targeting young women and men too on how to prevent behaviours that put them at risk of sexual violence should be introduced in schools.
What is known about this topic
- Sexual violence against women is common;
- Sexual violence perpetrated by person known to the victims.
What this study adds
- Increasing trend of sexual violence in south-western Nigeria;
- Changing pattern with a large number of perpetrators not known to the victims;
- Male victims increasingly been involved.
The author's declare no competing interests.
All the authors have read and approuved witg the final version of the manuscript.
1: trends in cases of sexual assault during the 10 year study period
Table 2: sociodemographic characteristics of the sexual assault patients
Table 3: route of sexual assault by sex
Table 4: time of occurrence of sexual assault by age group
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