Abstract:
Background: Child sexual abuse (CSA) is a significant public health problem affecting one billion
children aged 2 to 17 globally. The prevalence of CSA in Tanzania is one of the highest; however,
how health care providers manage CSA cases has not been studied.
Objectives: This study investigated how medical, nursing, and midwifery professionals in Tanzania
handle cases of CSA and identified the factors that facilitate or impede the provision of quality
care to CSA victims.
Methods: Participants were 60 experienced healthcare professionals and 61 health students
working in Dar es Salaam, Tanzania. We conducted 18 focus groups stratified by profession
(midwifery, nursing, or medicine) and experience (practitioners versus students).
Results: Three main themes emerged. First, child abuse management involved using a multi disciplinary approach, including proper history taking, physical assessment, treatment, and
referral. Second, factors that enhanced disclosure of CSA included building rapport, privacy, and
confidentiality. Third, factors that impeded care included fear of harm to the child if the abuse
was reported, abuse reporting being perceived as a “waste of time” for providers, loss of evidence
from the victim, family resistance, poverty, corruption and cultural dynamics.
Conclusions: Midwives, nurses and doctors were all experienced in and reported similar challenges
in addressing CSA. At a structural level, the ratio of providers to patients in health facilities in hibits quality care. These findings have implications for strengthening CSA policy/guidelines and
clinical practice in Tanzania. Mandated CSA training is necessary for midwifery, nursing, and
medical students as well as in continuing education courses for more experienced providers.
