Sexual Assault: Epidemiological Profile and Clinical Aspects at the Brazzaville University Hospital Center

Objective: to identify the socio-demographic profile of the alleged victims of sexual assault, to define the characteristics of the aggressors, to describe the types of clinical lesions, and to analyze the link between these different parameters. During the study period, 5620 clients were admitted to gynecological emergencies, including 150 for sexual assault (2.6%). The alleged victims of aggression were 14 years old on average [range: 2 - 49 years]. Among these clients, there were 147 (98%) women and 3 (2%) men [sex ratio: 0.02]. They had a primary education level of 38%, secondary to 42.7%, and single in 87.2% of cases. Clients came from home (69.3%) or police station (24.7%). The perpetrator was male, with an average age of 25.5 years [range: 16 to 35 years]. Regarding the relationship with the victim, the neighborhood accounted for 83%. The perpetrator was alone in 76.7% of cases, two (14%) or more (16.7%), up to 18. The aggressor’s home was the place of aggression (39.3%). The threats were made using knives (49.3%) and firearms (8.5%). The perpetrator used either his sex (79.9%), his fingers (34.2%) or an object (2.7%). The route of entry was vaginal (94.6%), anal (21.7%) and oral (10%). The abuser used the condom in 74.7% of cases. Customers had viewed within 24 hours (40.7%). The general state and hemodynamics at admission was normal for all clients. Physical injuries were injuries (23%) and scrapes (34.5%). External genitalia included perineal tears (28%), vaginal tears (8.6%), hymenal tears (7.3%), and old deflowering (72.7%). The hymen was intact in 20%. The bi-varied analysis found a correlation with a statistically significant difference in the age range of the alleged victims with the number of aggressors, the time of aggression, the path and type of penetration, and the weapon used for the threat.


Introduction
The care of alleged victims of sexual assault is a situation encountered in consultation in the gynaecological emergency services. According to the WHO, the annual rate of sexual assault worldwide can reach 800,000 people, and its prevalence is poorly known [1]. In the USA, its frequency varies between 15% and 25% of the female population in France, over a year 553,000 women aged 20 to 69 years report having been the victim of at least one sexual assault other than rape (touching of sex, breasts, buttocks and exhibition) and 62,000 women report being raped [2]. In Africa, the incidence of sexual violence ranges from 0.4% to 4.4% [3]. Sexual assault poses the problem of psychosocial impact and psychopathological sequelae. Despite this, it is neglected by most of the parties involved [4].
The lack of data and its growing incidence motivated this work whose general objective is to describe the epidemiological, clinical aspects of sexual violence at the University Hospital of Brazzaville, and specifically, to identify the socio-demographic profile alleged victims, define the characteristics of perpetrators, identify the types of clinical injuries, and the involvement of justice.

Patients and Method
The study was carried out in the Obstetrics Department of the University Hospital of Brazzaville from January 1, 2014 to December 31, 2016 or 24 months. It concerned all alleged victims of sexual violence admitted to the gynaecological emergency room. It was a retrospective and analytical study.
Patients who reported sexual violence, either came from themselves, or received on request from a doctor, had been included.
Patients who had not been included were consulting for trauma after consensual sex, cases of misappropriation of minors and cases of unexploitable violence.
Gynecological emergency records, as well as medical records, were used to collect the data. The variables studied were: the socio-demographic characteristics of the alleged victims of sexual assault, the characteristics of the perpetrator, the possible injuries found, and legal involvement. The data was collected using a fact sheet and recorded from CSPRO software. Data processing and statistical analysis are done using STATA and Microsoft Excel software. We used the chi-two correlation test in this work to analyze the link between two qualitative variables. We also used proportional tests to compare the proportions of the different samples. The average test was used for numerical variables by age group.

Results
During the study period, 5620 clients were received in gynaecological emergency departments, including 150 for sexual assault or 2.6%. Socio-demographic characteristics were represented by Table 1. The average age of alleged assault victims was 14 years, with extremes ranging from 2 to 49 years. Among these clients, 147 (98%) women and 3 (2%) sex ratio of 0.02. They had a primary education level at 38%, secondary at 42.7%, and single in 87.2% of cases. Clients came from home in 69.3% of cases, followed by the police station in 24.7% of cases. The perpetrator characteristics were represented by Table 2. He was male, with an average age of 25.5 years, extremes ranging from 18 to 35 years. In terms of the relationship with the victim, the neighbourhood represented 56.1%. The perpetrator was most often alone in 76.7% of cases, but there could be two The average number of attackers was 2 with extremes of 1 and 18 aggressors.
(6.6%) or more (16.7%), up to 18%. The alleged victim was returning from his home in 69.3%. The profile of the perpetrator, the home of the perpetrator was the place for the assault met at 39.3%. Threats were made with a knife in 49.3%, and the firearm in 8.5%. The perpetrator used his sex in 79.9% of cases, his fingers in 34.2% of cases and an object in 2.7% of cases. The pathway of penetration was vaginal for in 94.6% of cases, in 21.7% of cases and oral in 10% of cases. The perpetrator had used condoms in 74.7% of cases.
The clinical aspects were represented in Table 3. Customers had consulted within 24 hours in 40.7% of cases. The general and hemodynamic condition at admission was normal for all clients. Physical injuries were injuries in 23% of cases, and scratches in 34.5% of cases. At the genital level, they involved perineal tears in 28% of cases, vaginal tears in 8.6% of cases, hymenal tears in 7.3% of cases, and old deflowering in 72.7% of cases. The hymen was intact in 20% of cases.
The bi-varied analysis had found a correlation with a statistically significant difference in the age of the alleged victims with the number of assailants, with the time of aggression, with the path and type of penetration, and with the weapon used for the threat (Table 4).

Discussion
Our frequency is close to that reported by Traoré [5] in Senegal (3.12%), higher than faye [6] in Senegal (0.4%) and lower than Lawlor [7] in South Africa (54%), Open Journal of Obstetrics and Gynecology and Bordeaux, France, 30% of admissions to a reception centre for victims of aggression [8]. the low rates most often reported in African studies seem to do not reflect reality. The culture of family honour and own honour would prevent some women from consulting. To the extent that it is most often a family member, a close friend or the husband himself [9]. The alleged victims of violence were young, close to the perpetrator and the perpetrator's home was the most found location. This observation was also made by Leye [10] in Kolda, Senegal. The perpetrator was young, often alone, using a knife in the majority of cases as found in most African studies [8] [9] [10] [11]. A third of our clients arrived more than 24 hours after the assault. Indeed, in our context, there is no recognized centre for the care of alleged victims of aggression as in developed countries, let alone a centre for victims of sexual assault. Those affected arrive directly from the scene of the assault to the hospital when the physical trauma is visible. But the majority come from home, because they first get in shape before going to the health centre. The sex of the perpetrator was mainly used as an object of sexual assault as found in the Amah study [12] in Togo (62.5%) with a low condom use rate of 4.3%. This has been noted in the literature reporting that the prevalence of genital contact in Sub-Saharan Africa is high, but it remains low compared to studies in developed countries [12].
We found a correlation between the progression of the presumed victim's age with the timing of the assault, the type of penetration, the type of threat, the relationship to the victim, and the number of perpetrators. According to the O.
M.S., sexual assault is a public health problem.
Our study, although hospital, noted the importance and severity of the problem. The young age of the victims, and especially child abusers are known persons, type of threat according to age, lack of condom wearing, average time is less than 24 hours, with a high rate of no prosecution The alleged victims of this act are mainly children and adolescents.
The perpetrators are mostly people known to the victim; this explains the high rate of no legal action and therefore an out-of-court settlement. Victims' awareness of their rights and education for behavioural change may reduce this proportion of out-of-court settlement of sexual assaults.
The absence of condom use during this act puts victims at real infectious risk.

Conclusion
Sexual assaults at the Brazzaville University Hospital require multidisciplinary care involving gynaecologists, psychologists and other specialists depending on the types of injuries encountered. Strategies should be carried out to prevent events.