ADVERSE CHILDHOOD EXPERIENCES AND SEXUAL RISK BEHAVIOUR INSTUDENTS OF A TERTIARY INSTITUTION IN SOUTHWEST NIGERIA

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O.O. Sekoni¹, O.M. Dania²

1. Department of Community Medicine, College of Medicine, University of Ibadan, Nigeria.
2. Department of Community Medicine, University College Hospital, Ibadan, Nigeria.

Abstract

Introduction: Adverse Childhood Experiences (ACE) are negative occurrences in childhood, including abuse (emotional, physical, and sexual abuse), neglect (emotional and physical) or household dysfunctions, which are linked to compromised health and well-being in adulthood. The consequences are wide and diverse including Sexual Risk Behaviour (SRB).

Aim: We embarked on this study to identify types and prevalence of ACE as well as the association between ACE and the adoption of SRB among the students of a tertiary institution in Oyo State, Nigeria.

Subjects and Methods: A descriptive cross-sectional study was conducted amongst students of Oyo State College of Agriculture and Technology. A questionnaire was used to obtain information on sociodemographic characteristics, ACE and SRB. Descriptive and inferential statistics were used to analyse the data as applicable.

Results: A total of 395 respondents participated in the study. The mean age of respondents was 21.06±3.13years. Emotional abuse and physical neglect had the highest prevalence of 65.6% and 44.3% respectively. Unprotected sex was the most prevalent SRB (19.5%). Majority (91.4%) of the respondents had experienced at least one ACE. There was a graded dose response between ACE and SRB. Participants with sexual risk behaviour were twice likely to have been exposed to household dysfunction (OR: 2.2 CI 1.3 – 3.7).

Conclusion: ACE and its subsequent effect on developing SRB have been demonstrated; its prevention and early identification should be an integral part of public health programs.

Keywords: Childhood trauma, Adverse childhood experiences, Sexual risk behaviour, Nigeria

Introduction

Adverse Childhood Experiences (ACE) are negative occurrences in childhood, including abuse, neglect or household dysfunctions, which are linked to compromised health and well-being in adulthood.¹ The burden and effect of ACE have been well established in developed countries.² The effects are lasting and wide, ranging from cardiovascular disorders, metabolic abnormalities, and health risk behaviour to cancers and mental illness.^3,4,5 Exposure to ACE has been associated with alterations in the development of children’s brains as well as changes in their immunological and hormonal systems.⁶ This developmental alteration explains the increased risk for health harming and anti-social behaviours in those with greater exposure to ACE.⁶ Childhood adversity is therefore termed a hidden health crisis with far reaching consequences.⁷

Childhood abuse which is an ACE has three components: emotional, physical, and sexual abuse. Emotional abuse is defined as injury to the psychological capacity or emotional stability of the child as evidenced by an observable or substantial change in behaviour, emotional response, or cognition.⁸ The symptoms of emotional damage result from harm to a child’s psychological or intellectual functioning and it includes any of the following exhibited to a severe degree: anxiety, depression, withdrawal, outward aggressive behaviour or substantial change in behaviour.⁹ Physical abuse is defined as physical injury inflicted on a child by other than accidental means.¹⁰ It varies from severe or frequent bruising to more serious injuries.¹¹ Sexual abuse is defined as sexual exploitation of a child, permitting or encouraging a child to engage in prostitution or in the production of child pornography.⁸

Childhood neglect has two components: emotional and physical neglect. Neglect is frequently defined as the failure of a parent or other person with responsibility for the child to provide needed food, clothing, shelter, medical care, or supervision to the degree that the child’s health, safety, and well-being threatened with harm.¹

The third category of ACE is the household dysfunction which includes growing up with domestic violence, parental marital discord, and substance abuse, mentally ill, or criminal household members.^12,13 Of all the stated components of ACE, the physical abuse component of ACE may not be easily distinguishable from corporal punishment.¹⁴

Corporal punishment is a common practise in homes and schools in low income countries as a measure of instilling discipline.14

Corporal punishment is defined as any punishment in which physical force is used and intended to cause some degree of pain or discomfort, however light.¹⁵ Corporal punishment is legally permitted in Nigeria with a caveat on threshold of severity.¹³ However, it is common culturally albeit with differences across ethnic groups. It has however been shown to increase the risk for more forms of abuse.¹⁶ It has been described as a form of violence against children, has also been shown to be empirically similar to physical and emotional abuse and argued to be considered as an ACE.¹² ACE are said to occur across race, economic classes and geographic regions with a higher prevalence amongst those living in poverty.¹⁷ With a high prevalence of corporal punishment in Nigeria coupled with 70% of Nigerians living below the poverty line, there is a need to explore the occurrence and effects of ACE in the country.

One of the documented consequences of ACE is SRB with previous studies showing a positive linear relationship between ACE and SRB.¹⁸ A fifth of the Nigerian population are between the age of 15 and 24years.¹⁸ Globally, one person out of every five is between the age of 15 – 24 years.¹⁹ This age grouphas the highest prevalence of SRB in most societies.⁹ SRB is commonly defined as behaviour that increases one’s risk of contracting Sexually Transmitted Infections (STI(s)) and experiencing unintended pregnancies. They include having sex at an early age, having multiple sexual partners, sex while under the influence of alcohol or drugs, and unprotected sexual intercourse.⁹ Consequences of SRB include unwanted pregnancy, unsafe abortion and STI(s). These consequences pose a huge demand on the weak health care system.

Research has shown a clear connection across the life course with paediatric conditions such as attention deficit and emotional dysregulation being linked to early abuse or neglect.² With the growing evidence of ACE and its association with diverse health related events, this life course perspective provides the opportunity to examine life no longer as disconnected stages but as an integrated spectrum across time.². Such evidence is limited in developing countries; which may be attributed to poor reporting and documentation. We embarked on this study to identify the types andprevalence of ACE as well as the association between ACE and the adoption of SRB among the students of a tertiary institution in Oyo State, Nigeria.