Knowledge and Willingness to Utilize Hepatitis B Preventive Measures among Pregnant Women in Ado-Ekiti, Southwest, Nigeria.

Introduction: Mother-to-child transmission remains an important mode of transmission of hepatitis B infection particularly in endemic areas. The knowledge and practices of pregnant women about mother-to-child transmission (MTCT) of hepatitis B virus (HBV) may influence the uptake of strategies to reduce mother-to-child transmission of infection. Objectives: This study assessed the knowledge and willingness to uptake hepatitis B virus infection preventive services among pregnant women in Ado-Ekiti, Nigeria. Methods: This was a cross-sectional study that involved 373 pregnant women at the Ekiti State University Teaching Hospital (EKSUTH) and Maternal Child Specialist Clinics, Ado-Ekiti, Nigeria. A structured questionnaire was used to assess their knowledge, practices, and perceptions about MTCT of hepatitis B infection. Results: Only 52.5% (196) of the respondents had good knowledge, although the majority 290 (77.7%) had heard of hepatitis B infection prior to the survey. Only 147 (39.4%) of the respondents had ever had hepatitis B screening. More persons with professional jobs had good knowledge about hepatitis B infection compared with other occupations (p < 0.001). However, more respondents aged 30-34 years had poor knowledge about hepatitis B infection compared with other age groups (p = 0.045). Respondents with good knowledge about hepatitis B infection were willing to uptake hepatitis B infection prevention services (p < 0.001). Conclusion: This study showed that respondents with professional jobs had good knowledge about hepatitis B infection and those who had good knowledge about the infection were willing to utilize hepatitis B preventive measures. Awareness of MTCT of HBV did not translate into good practice as only few respondents had screened for hepatitis B. There is a need to intensify education about modes of transmission of hepatitis B infection with an emphasis on promoting good preventive practices.

Human milk banking acceptability among pregnant and nursing mothers in Southwest Nigeria.

Background: Human milk bank is a sustainable source of donor human milk (DHM) which is an acceptable alternative to the mother's milk and it is not routinely available in Nigeria, a multi-ethnically diverse country.The study aimed to assess the willingness to donate or accept human milk among pregnant women and mothers attending the antenatal, immunization, outpatient, under-five, and neonatal follow-up clinics in selected health facilities in Ekiti State, Southwest Nigeria. Study Design and Methods: A descriptive cross-sectional, mixed methods study design was used to collect data in selected health facilities in Ekiti State. Questionnaires and focus group discussions were used to collect quantitative and qualitative data respectively while data analysis was done using the IBM® Statistical Package for Social Science SPSS version 26® and thematic analysis respectively. Results: Of the 798 respondents, 529 (66.3%) and 626 (78.4%) did not know about wet nursing or human milk banking (HMB) respectively and 139 (17.4%) were willing to donate their breastmilk for a stipend. In the focus group discussion, 50% had heard about wet nursing but none heard about HMB. Maternal educational level had a significant impact on their willingness to donate or accept DHM (p < 0.00). Wholesomeness, cultural, and religious biases were major reasons affecting HMB acceptability. Conclusions: Awareness and perception of HMB are poor. Appropriate information, education, and counselling on HMB are needed to drive the adoption and establishment of HMB in Nigeria.

Pattern of admissions and outcome in the children emergency department of a tertiary health institution in Southwestern Nigeria: A four-year review.

Introduction: Pediatrics and adolescents are susceptible to illnesses that often necessitate emergency attention. Morbidity and mortality from illnesses in these ages have attracted much interest globally, particularly in Africa. Knowledge of pattern and outcomes of admissions may guide policy and interventions especially in resource constrained settings. The study aimed to determine the pattern of admissions, outcomes and seasonal variations of conditions that presented at the children emergency of a tertiary health institution over a four-year period. Methods: A retrospective descriptive study of children emergency admissions from January 2016 to December 2019. Information obtained included age, diagnosis, month and year of admission, and outcome. Descriptive statistics were used to describe the demographic characteristics and Chi-squared test to assess their associations with the diagnoses made. Results: There were 3,223 admissions. There were more males (1866; 57.9%) and more toddlers (1181; 36.6%). The highest number of admissions were observed in the year 2018 (951; 29.6%) and during the wet season (1962; 60.9%). There was an overall mortality rate of 7%; complicated malaria, gastroenteritis and meningitis were the leading causes of death. Malaria (χ2 = 135.522, p value < 0.001), and gastroenteritis (χ2 = 130.883, p value < 0.001) were predominant among the toddlers while sepsis (χ2 = 71.530, p value < 0.001) and pneumonia (χ2 = 133.739, p value < 0.001) were more among the infants. Typhoid enteritis (χ2 = 26.629, p value < 0.001) and HIV (χ2 = 16.419, p value = 0.012) were commoner among the early adolescents. Conclusion: The major causes of death in the study area are preventable with more of these amongst the children under the age of 5 years. There are seasonal and age-related patterns to admissions and the need for policy formulations and emergency preparations to be tailored towards these observed patterns through the year.

Malaria prevention practices and malaria prevalence among children living in a rural community in Southwest Nigeria.

INTRODUCTION: Living conditions in most rural African communities favour malaria transmission and threaten global eradication. Prevention strategies and interventions such as the use of bed nets have reduced the prevalence of malaria. This study described the various methods employed to prevent malaria and their effects on malaria parasite prevalence among children living in a rural community in Nigeria. METHODOLOGY: A community-based cross-sectional study conducted among 357 children aged 1-15 years, in a Nigerian rural community. Data was analyzed using SPSS version 25. Chi-squared test of association with a level of significance of p < 0.050 was used. RESULTS: Only 110 (30.8%) participants owned mosquito nets. Mostly those from the high social class (45; 40.9%) used the nets, and these were mostly 'under-five' children. Thirty-six (10.1%) were routinely given antimalarial drugs for malaria prophylaxis. Also, 102 (28.6%), 151 (42.3%), 278 (77.9%), 99 (27.7%) and 15 (5.0%) children used insecticides, local herbs, window nets, outlet door nets and mosquito repellent creams respectively. None of the methods employed to prevent malaria had statistically significant effect on malaria parasite prevalence among participants (p > 0.050). CONCLUSIONS: Malaria prevention methods were mostly practiced by participants of the high social class while children under-five considerably used mosquito nets. This study highlights the need to address the socio-demographic imbalance regarding malaria preventive measures in the community where the study was conducted. There is also a need to regulate the use of antimalarial drugs for malaria prophylaxis in the rural community. These suggest that the current malaria prevention methods in the community be reviewed.

A ten-year review of neonatal tetanus cases managed at a tertiary health facility in a resource poor setting: The trend, management challenges and outcome.

BACKGROUND: Neonatal Tetanus (NNT) is a vaccine preventable disease of public health importance. It is still being encountered in clinical practice largely in developing countries including Nigeria. NNT results from unhygienic delivery practices and some harmful traditional cord care practices. The easiest, quickest and most cost-effective preventive measure against NNT is vaccination of the pregnant women with the tetanus toxoid (TT) vaccine. The case-fatality rate from tetanus in resource-constrained settings can be close to 100% but can be reduced to 50% if access to basic medical care with adequate number of experienced staff is available. MATERIALS AND METHODS: This retrospective study reviewed the admissions into the Special Care Baby Unit (SCBU) of the Ekiti State University Teaching Hospital, Ado-Ekiti from January 2011 to December 2020. The folders were retrieved from the records department of the hospital; Information obtained from folders were entered into a designed proforma for the study. RESULTS: During the study period, NNT constituted 0.34% of all neonatal admissions with case fatality rate of 52.6%. Seven [36.8%] of the babies were delivered at Mission home/Traditional Birth Attendant's place while 5 [26.3%] were delivered in private hospitals. Cord care was with hot water compress in most of these babies16 [48.5%] while only 9% of the mothers cleaned the cord with methylated spirit. Age at presentation of less than one week was significantly associated with mortality, same with presence of autonomic dysfunction. Low family socio-economic class 5 was significantly associated with poor outcome, so also maternal age above 24 years. CONCLUSION: This study revealed that neonatal tetanus is still being seen in our clinical practice with poor outcome and the risk factors are the same as of old. Increased public health campaign, promotion of clean deliveries, safe cord care practices, affordable and accessible health care provision are recommended to combat NNT scourge.

A Ten-Year Review of the Pattern and Outcome of Childhood Diabetes in Two State Teaching Hospitals in South-West Nigeria.

BACKGROUND: Childhood diabetes mellitus is a poorly researched topic in Nigeria. Its contribution to morbidity and mortality is vague. This study intends to provide additional information to the background data in Nigeria and hopefully proffers strategies to improving the outcome of this disease. METHODS: This is a retrospective descriptive study of all children managed for childhood diabetes mellitus at the Ekiti State University Teaching Hospital (EKSUTH) and LAUTECH Teaching Hospital (LTH), South West Nigeria, over a 10 year period. Relevant information was obtained from the case notes of all affected children. Data obtained were analysed with SPSS version 20 software. RESULTS: A total of 20 children were treated for diabetes mellitus (DM); there were 7 (35.0%) boys and 13 (65.0%) girls giving a M:F ratio of 1.0:1.9. Age range at presentation was 5 to 16 years and the mean age at presentation was 12.7 ± 2.89 years. Diabetic ketoacidosis (DKA) was the most common form of presentation in 13 (65.0%). Most [18 (90.0%)] of the patients had type 1 DM. Type 2 DM and glucocorticoid-induced diabetes mellitus were recorded in a case each, Eighteen (90%)patients had not been previously diagnosed by any form of screening prior to their presentation and admission in the hospital. Seven (35.0%) of the patient's care were affected by parental financial constraints. Five mortalities were recorded and one left against medical advice while the majority [14 (70.4%)] were discharged well and alive. The association between the greater numbers of deaths recorded in children with financial constraints was statistically significant (p < 0.05). CONCLUSION: Type 1 DM remains the most predominant form of diabetes in children and most of the patients presented in DKA. The proportion of deaths in this study is unacceptably high. There is a need to proffer strategies for earlier detection and management of children with diabetes mellitus prior to the onset or development of DKA and there is a need to assist with the funding of the care of children with diabetes mellitus.

Perceptions and Practice of Early Diagnosis of Sickle Cell Disease by Parents and Physicians in a Southwestern State of Nigeria.

BACKGROUND: Early sickle cell disease (SCD) diagnosis has shown promise in combating SCD in many countries. The aim of this study was to assess the practice and perception of early SCD diagnosis among a group of parents and physicians in Nigeria. Patients and Methods. This was a cross-sectional descriptive study conducted to assess the opinions and practice of early diagnosis of SCD among 135 physicians caring for SCD patients and 164 mothers of children with SCD in a southwestern state of Nigeria. RESULTS: Most physicians 132 (97.8%) were aware of prenatal SCD diagnosis, but only 51 (37.8%) would recommend it. Most physicians 129 (95.6%) routinely recommend premarital SCD genetic counseling and testing, and 89 (65.1%) were aware of the national government newborn screening program but lesser proportion 75 (55.6%) were willing to recommend it. Amongst the mothers, 154 (94%) and 158 (96%) had encountered genetic counseling for SCD and were willing to offer newborn screening to their children, respectively. On the contrary, fewer mothers 42 (25%) were aware of prenatal SCD diagnosis, 28 (17%) were willing to partake in it, and 44 (26%) were undecided. There were discrepancies in the willingness by physicians to practice early SCD diagnosis and its uptake by mothers (p < 0.0001). The commonest reason given by both the physicians and mothers for not practicing SCD prenatal diagnosis was the high cost of the procedure. CONCLUSION: The perceptions and practice of early SCD diagnosis was suboptimal in the study locality. Scaling up awareness and universal coverage are required.

Paediatric hypopituitarism: a case report and management challenges in a resource poor setting.

Hypopituitarism, a deficiency of one or more of the hormones produced by the pituitary gland, is a rare disorder. It can be congenital or acquired. Case report on childhood hypopituitarism is rare in Nigeria. We present a 15-year-old boy, second of a set of twins, who presented with short stature and delayed puberty. Subtle difference in stature, was noticed on review of their childhood pictures by 2 years of age though disparity in stature became obvious to the parents at 6 years of age and it became embarrassing at 15 years of age when parents decided to seek medical attention. He was a product of term gestation with birth weight of 3.2kg; there was no history suggestive of birth trauma. Developmental milestone in the first two years of life was essentially normal like his unaffected twin brother. At presentation both height and weight were below 3rd percentile for age, he had a low blood pressure of 80/50mmHg, infantile male external genitalia with testicular volume of 2ml, bone age of 7 years, very low serum testosterone, growth hormone, adrenocorticotropic hormone, thyroxine, follicle stimulating hormone, leutenizing hormone, Cortisol and high thyroid stimulating hormone. He achieved remarkable improvement in physical activity, height, weight and hormonal profile within the first 7 months of hormone replacement therapy but could not sustain therapy because of financial constraint. Paediatric hypopituitarism is a rare and treatable disorder. Early presentation, diagnosis and appropriate hormone replacement therapy at affordable price is essential for survival and good prognosis.

Acute hypervitaminosis A misdiagnosed as malaria in a 7-year-old Nigerian boy.

Vitamin A supplementation program where single high-dose vitamin A supplements are provided to the qualified (infants and children) at regular intervals is operational in Nigeria as a public health initiative to control vitamin A deficiency which is prevalent in our country in accordance with the WHO recommendations. Reports of symptomatic acute hypervitaminosis A are scarce. We report a case of acute hypervitaminosis A resulting from accidental ingestion of vitamin A supplement capsules. This is to reiterate the need for caregivers to keep drugs out of the reach of children. Clinicians should also have a high index of suspicion.

Knowledge, attitudes and screening practices regarding prostatic diseases among men older than 40 years: a population-based study in Southwest Nigeria.

INTRODUCTION: Despite the global increase in awareness of prostatic diseases resulting from widespread availability of screening tools, there is no evidence that the knowledge, attitudes and screening practices of Nigerian men have improved regarding prostatic diseases. METHODS: A descriptive cross-sectional study amongst 305 community-dwelling men. Respondents were selected using multi-staged sampling techniques. Knowledge, attitudes and screening practices were determined based on responses to a semi-structured KAP questionnaire. Data were analyzed using SPSS version 18. Pearson's chi-square and Fisher's exact test (two-tail) with level of significance set at 0.05 were used to determine the level of statistical significance. Pearson's correlation coefficient was used to establish correlation between variables. RESULTS: Mean age of respondents was 63.4±11.8 years. Slightly less than half, 145(47.5%) were aware of prostate cancer (PCa) while only 99(32.5%) and 91(29.8%) were aware of BPH and prostatitis respectively. About a quarter (25.1%) had heard of PSA. The main sources of information were radio and television. Overall, 143(46.9%) respondents had good knowledge while 162(53.1%) had poor knowledge. Sexually transmitted disease was the commonest misconception as the cause of prostatic diseases. Overall, 44.3% had good attitudes. Only 31(10.2%) respondents had ever carried out screening for PCa. Only educational and occupational status had significant associations with level of knowledge and attitudes of participants. The only factor that influenced screening practices was educational status. CONCLUSION: There is a poor level of knowledge, attitudes and screening practices regarding prostatic diseases in Nigeria. We recommend a widespread public health education to improve knowledge, attitudes and screening practices for prostatic diseases.

Pattern and outcome of dog bite injuries among children in Ado-Ekiti, Southwest Nigeria.

INTRODUCTION: Dog bites in humans are a major public health problem. Globally, millions of people are bitten by dogs but most of the fatal cases occur in children. There is paucity of data on dog bite related diseases among Nigerian children. Objectives: to determine the pattern of dog bite injuries and associated health problems among children seen at Ekiti State University Teaching Hospital. METHODS: This is a retrospective study on the clinical data of patients managed for dog bite related injuries between January 2010 and June 2014. RESULTS: In all, 84 cases of dog bite injuries were managed constituting 0.89% of the total consultations; six (7.1%) had rabies. Most of the victims were aged 6-12 years (60.7%) and majority (71.4%) was boys. Eighty two percent of the victims presented within 24hrs of the injury. Thirty-six (43%) had WHO grade 3 dog bite injury at presentation and the lower limb was the commonest (57.1%) bite site. Use of herbal preparation was the most common pre-hospital treatment 60%. Although 92.9% received anti-rabies vaccine, only 64.3% of them completed the vaccination schedule. The case fatality rate for dog bite was 7.14%. The six that died all presented late, had no post exposure prophylaxis and died within 24 hours of admission. CONCLUSION: There is need for public enlightenment on dangers associated with dog bites and also for the government to defray the high cost of post exposure prophylaxis treatment for children.

Evaluation of a Portable Haemoglobin Metre Performance in Children with Sickle Cell Disease and Implications for Healthcare in Resource-poor Settings.

BACKGROUND: Sub-Saharan Africa has the largest burden and worst outcome of sickle cell disease (SCD). This gloomy outlook has been attributed to the lack of use of simple and cost-effective measures for diagnosis and treatment of the disease. Although haematology analysers are the gold standard for accurate measurement of haemoglobin (Hb) concentration, they are often out of reach of most health facilities in resource-poor settings, thus creating a care gap. We conducted this study to examine the agreement between a point-of-care device and haematology analyser for determining the Hb concentration in children with SCD and its usefulness in resource-poor settings. METHODS: Ethylenediaminetetraacetic acid blood samples collected from participants were processed to estimate their Hb concentration using two devices (Sysmex KX21N haematology analyser and portable mission Hb device). The agreement between the two sets of measurements was assessed by the Bland and Altman method. RESULTS: The intraclass and concordance correlation coefficients were 0.854 and 0.936, respectively. Sensitivity and specificity were 84.2% and 98.6%, respectively. The positive and negative predictive values were 94.1% and 96.0%, respectively. The Bland and Altman's limit of agreement was -2.3 to 1.6 and the mean difference was -0.34 with non-significant variability between the two measurements (p = 0.949). CONCLUSION: Hb concentration determined by the portable testing system is comparable with that determined by the haematology analyser. We recommend its use as a point-of-care device for determining Hb concentration of SCD children in resource-poor settings where haematology analysers are not available.

Lower Urinary Tract Symptoms: Prevalence, Perceptions, and Healthcare-Seeking Behavior amongst Nigerian Men.

PURPOSE: The aim of this study was to determine the prevalence of lower urinary tract symptoms (LUTS) and the factors influencing the healthcare-seeking behavior of men with LUTS. MATERIALS AND METHODS: A cross-sectional survey was performed of 658 men selected using multi-staged sampling techniques. They were interviewed about LUTS and their healthcare-seeking behavior. The data were analysed using PASW Statistics ver. 18. Associations between specific factors and healthcare-seeking behavior were examined using the chi-square and Fisher exact tests. RESULTS: The overall prevalence of LUTS was 59.1%. Storage symptoms (48.2%) were more prevalent than voiding (36.8%) or post-micturition (29.9%) symptoms. Approximately a quarter (25.5%) had a poor quality of life (QoL) score. The average duration of symptoms before seeking help was 3.4 years. Almost half (46.8%) of the men with LUTS had never sought help. Perceptions of LUTS as an inevitable part of ageing, subjective feelings of wellness, financial constraints, and fear of surgery were the most common reasons for not seeking help. The most common reasons for seeking help were to moderate-severe symptoms, impaired QoL, and fear of cancer. Severe LUTS, impaired QoL, and the concomitant presence of erectile dysfunction, dysuria, or haematuria were clinical factors that positively influenced healthcare-seeking behavior. CONCLUSIONS: In this population-based study, we found that the prevalence of LUTS was very high amongst adult males. However, only about half of these men sought medical attention. Their healthcare-seeking behavior was influenced by severity of symptoms, QoL scores, and socio-demographic factors such as educational status.

The financial burden of sickle cell disease on households in Ekiti, Southwest Nigeria.

BACKGROUND: Studies on economic impact of sickle cell disease (SCD) are scanty despite its being common among children in developing countries who are mostly Africans. OBJECTIVE: To determine the financial burden of SCD on households in Ado Ekiti, Southwest Nigeria. METHODS: A longitudinal and descriptive study of household expenditures on care of 111 children with SCD managed at the pediatric hematology unit of the Ekiti State University Teaching Hospital was conducted between January and December 2014. RESULTS: There were 64 male and 47 female children involved, aged between 15 and 180 months. They were from 111 households, out of which only eight (7.2%) were enrolled under the National Health Insurance Scheme. The number of admissions and outpatients' consultations ranged from 1 to 5 and 1 to 10 per child, respectively. Malaria, vaso-occlusive crisis, and severe anemia were the leading comorbidities. The monthly household income ranged between ₦12,500 and ₦330,000 (US$76 and US$2,000) with a median of ₦55,000 (US$333), and health expenditure ranged between ₦2,500 and ₦215,000 (US$15 and US$1,303) with a mean of ₦39,554±35,479 (US$240±215). Parents of 63 children lost between 1 and 48 working days due to their children's ill health. Parents of 23 children took loans ranging between ₦6,500 and ₦150,000 (US$39 and US$909) to offset hospital bills. The percentage of family income spent as health expenditure on each child ranged from 0.38 to 34.4. Catastrophic health expenditure (when the health expenditure >10% of family income) occurred in 23 (20.7%) households. Parents who took loan to offset hospital bills, low social class, and patients who took ill during the study period significantly had higher odds for catastrophic health expenditure (95% confidence interval [CI] 5.399-87.176, P=0.000; 95% CI 2.322-47.310, P=0.002; and 95% CI 1.128-29.694, P=0.035, respectively). CONCLUSION: SCD poses enormous financial burden on parents and households.

PCR Results and PMTCT Treatment Outcomes among HIV-Exposed Infants in a Tertiary Hospital in Nigeria, 2010-2014.

BACKGROUND: Early infant diagnosis (EID) of human immunodeficiency virus (HIV) infection in pediatrics with the use of DNA polymerase chain reaction (PCR) is a way of assessing the retroviral status of HIV-exposed infant with the view of early commencement of treatment for infected infants. It also serves as a way of assessing the effectiveness of prevention of mother-to-child transmission of HIV (PMTCT) in health care facilities. METHODS: This was a 5-year prospective cross-sectional study at the Ekiti State University Teaching Hospital, (EkSUTH) Ado-Ekiti, Nigeria. Babies delivered to HIV-positive mothers who presented at EkSUTH between January 2010 and December 2014 were enrolled in the present study. PCR was done twice for all HIV-exposed infants. Statistical analysis was done using SPSS version 16.0. RESULTS: One hundred and fifty eight infants were HIV exposed; 72 males and 86 females (M:F= 0.84:1). Eighty eight (55.7%) of the mothers had commenced highly active anti-retroviral therapy (HAART) before pregnancy, 56 (35.4%) during pregnancy, and 14 (8.9%) after delivery. Ten (6.3%) babies tested positive. Four (28.6%) of 14 exposed babies whose mothers commenced HAART after delivery tested positive to HIV compared to 3 (5.4%) of 56 babies whose mother commenced HAART during pregnancy and 3 (3.4%) of 88 babies whose mother commenced HAART before pregnancy. The difference was statistically significant (c(2) = 13.28, df = 4, p = 0.01). CONCLUSIONS AND GLOBAL HEALTH IMPLICATIONS: There is significant reduction in transmission of HIV from mothers to children with commencement of antiretroviral drugs before pregnancy in mothers and use of Nevirapine for all exposed babies for the first 6 weeks of life. Infants of HIV positive mothers can live healthy life free of HIV infection if their mothers participate in PMTCT program.

Pattern and medical care of child victims of sexual abuse in Ekiti, south-western Nigeria.

BACKGROUND: Child sexual assault (CSA) is a global health problem which affects many children and is often under-reported in developing countries. Data on CSA are few in these countries. AIMS AND OBJECTIVES: This study aimed to review the pattern and medical care of victims of CSA in a tertiary hospital over a 39-month period. METHODS: This is a retrospective, descriptive study. Case files of 28 cases of CSA were retrieved from those of 6535 patients seen in the paediatric out-patient department of Ekiti State University Teaching Hospital between 1 January 2010 and 31 March 2013. RESULTS: Victims of CSA accounted for 0.43% of new patients seen during the period under review with a yearly increase over that time. Victims were all female with a median age of 11.5 years and the age range was 4-17. They all had genito-urinary findings and 3.6% had an anal tear. The assailants were all male, mostly adults. A school-teacher and school-friends were the perpetrators in 3.6% and 10.8% of cases, respectively. All were screened for HIV, but only 60.7% were screened for hepatitis B and C. Only 60.7% received HIV post-exposure prophylaxis and none was given prophylaxis against viral hepatitis B and C. Of those eligible for post-exposure emergency contraception, only 43.8% received it. Antibiotics and analgesics were routinely given in 89.3% cases. Only one of the patients attended for follow-up. None had repeat serological screening tests. The police were involved in 60.7% of cases but there was no prosecution. CONCLUSION: Perpetrators of CSA are protean and, in the study area, there are gross inadequacies in the care provided for victims. Standard treatment protocols and additional training for health-care providers involved in the management of CSA victims are required.