A novel ED-based sexual assault centre in western Kenya: description of patients and analysis of treatment patterns.
BACKGROUND
The aim of this study was to establish the feasibility of a Kenyan emergency department (ED)-based sexual assault centre; and to improve knowledge of the characteristics of sexual assault in the region.


METHODS
The Center for Assault Recovery-Eldoret (CAR-E) was established to provide timely, culturally sensitive treatment of Kenyan sexual assault survivors using a standardised evaluation/treatment protocol. A retrospective review of charts of all sexual assault survivors attending CAR-E from May 2007-May 2008 was performed. Simple descriptive statistics, t tests, and OR were calculated.


RESULTS
CAR-E treated 321 survivors over 13 months. Patients' mean age was 15.9 years; 50% were younger than 14years old. Survivors were predominately female and single. Most knew their assailant. Younger age was associated with increased likelihood of genital trauma. Only 43% of assaults were reported to the police. Sexually transmitted infection prophylaxis was given per protocol to 84% eligible; emergency contraception to 64%; and HIV prophylaxis to 63%. Only 44% received counselling. Survivors were more likely to get sexually transmitted infection and HIV prophylaxis, and emergency contraception if they had genital injury.


CONCLUSIONS
Development of an ED-based sexual assault centre at a referral hospital in Kenya using a standardised history, physical, and treatment protocol was feasible, and high rates of prophylaxis were provided. Based on characteristics of people who have been assaulted, community prevention efforts should concentrate on decreasing the societal acceptability of rape. In conjunction with improvement of protocols at the centre under consideration, development of similar centres in sub-Saharan African ED should be encouraged.
Injury Prevention Center, Dept of Emergency Medicine, Alpert School of Medicine, Brown University, Providence, RI 02903, USA. mranney@lifespan.org
Megan L
ML
Ranney
Elissa
E
Rennert-May
Rachel
R
Spitzer
Mary Anyona
MA
Chitai
Sarah Ellen
SE
Mamlin
Hillary
H
Mabeya
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007223:Infant; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012742:Sex Offenses / Q000706:statistics & numerical data*; D012749:Sexually Transmitted Diseases / Q000517:prevention & control; D055815:Young Adult