Child sexual abuse (CSA) is a significant health problem with poten-tial long-term consequences for victims, therefore knowledge regarding sexual abuse is essential for children. Educating children about body parts, good and bad touch develops positive body image and self-confidence. Informed and confident children are more likely to prevent themselves from abuse and reach out for the help. This quantitative descriptive survey based study evaluates and compares the knowledge and alertness against CSA among children of both genders. 100 participants of age bracket 6 to 12 years old both genders from different areas of Karachi were select-ed through simple random sampling technique. Informed consent was taken from the parents of the participants. The survey of 20-25 minutes was done in a course of 2 weeks in a semi structures setting. Each question was explained to children taken in group of 5, in simple and comprehensible Urdu language. Assessment was done using The Child Knowledge of Abuse Questionnaire – Rev II (CKAQ-REV II). Result indicates negligible difference of knowledge and skills about CSA between girls and boys. More than average of the children in the study have marked ‘False’ and ‘I don’t know’ on the application based questions that depict poor practical skills. Mean score of girls and boys on CKAQ-REV II is 16 and 17 respective-ly that shows children of Pakistani society are at high risk of CSA. Similar study can be performed to find the correlation of knowledge and awareness of CSA between children and their parents.

Child sexual abuse, knowledge, abuse, questionnaire, survey, Pakistani society, sexual trauma

Mahnoor Anwar

Occupational Therapist

Institute of Physical Medicine & Rehabilitation Dow University of Health Sciences [email protected]


Fatima Khan

Senior Lecturer

Ziauddin College of Rehabilitation Sciences

Ziauddin University

[email protected]

[Anwar M, Khan F. Child sexual abuse; comparison of knowledge and alertness among genders. Pak. j. rehabil. 2018;7(1):48-56]


Child sexual abuse (CSA) is a serious global health issue with lifelong consequences for the survivors, therefore knowledge regarding sexual abuse is essential for children. CSA occurs when a child is forced to take part in sexual activities. It can vary in forms like verbal abuse, online abuse and much more. CSA is generally divided into two broad cate-gories i.e. contact abuse and non-contact abuse. In contrast to non-contact abuse, contact abuse involves activities in which the abuser makes physi-cal contact with the child; it may include penetra-tion while the non-contact abuse includes non-touching activities such as pornography1. CSA is a global health issue of great magnitude affect-ing children of all ages, genders, races, ethnicity and socioeconomic classes. The offender is often an adult but can be another child too. The vast majority of sexual offenders are someone the child and the family already know and trust. The knowl-edge of sexual abuse is demand of present time while alertness is essential.

CSA is a type of trauma that instills guilt in the victims. In childhood sexual abuse, the victim is too young to take appropriate action and seek out for help. If it is not addressed on time, it can lead to lifelong psychological problems. The offender is often the close friend or associate to the family which further creates hindrance to report CSA. Present quantitative study aims to compare and evaluate child’s knowledge and alertness in boys and girls against child sexual abuse.

Recently, there has been increased attention to CSA as a global issue for which solutions must be devised in order to protect children from further harm and prevent others from becoming victims. Although CSA is a widespread phenomenon, it remains difficult to collect reliable prevalence data. A meta-analysis conducted by Stoltenberg et al. looking at worldwide data revealed that the preva-lence of self-reported childhood sexual abuse cases was 11.8%, with 18% prevalence for girls and 7.6% for boys between 1980 and 20082. In another study approximately 5.6 percent of adolescents 15-19 years of age reported that they felt pressured the first time they had sex, with adolescent girls more likely to feel pressure than boys (9.7 percent and 2.5 percent respectively)3. Another study shows self-reported CSA cases are more common in girls (133/1000) than boys (41/1000) in Asia4.

In Pakistan an organization named Sahil works on child protection while keeping a keen focus on child sexual abuse, the organization publish yearly report by gathering data from different sources like newspaper (national and regional), media reports, police reports and unregistered parent reports. Latest finding of year 2017 reveals that in a day more than 9 children have been sexually abuse in the country. The total 3445 child abuse cases were reported in newspapers from all four provinces in the year 20175. The present number of cases is only the small portion of total cases as many cases remain unreported, actual number of CSA in Pakistan can be assumed to be much higher.

Child Sexual Abuse (CSA) is one of the biggest social and health problems around the globe with long term adverse psychological and social conse-quences. CSA link to lifetime psychopathologies have been demonstrated by many clinicians and researchers6. Despite overwhelming evidences of negative psychological consequences of CSA, study shows that impact of CSA is variable and many victims do not exhibit clinical level of symp-toms. It is secondary to the fact that CSA has diverse characteristics that can cause wide range of outcomes. The other reasons may include asymp-tomatic survivors that have developed avoidant and other coping styles and insufficient severity of abuse. The asymptomatic survivors are more resilient and can deal with distress more effectively than symptomatic survivors6-8.

According to one study, CSA and other child maltreatments are found to be one of the major risk factor to develop Non suicidal self-harm injuries later in adulthood9. Many mental health problems other than post-traumatic stress disorder and distur-bance in behavior are linked to CSA. Symptoms of Major Depressive disorders are found in victimized children. Sexually abused children are more likely to exhibit sexualized behaviors than their non-abused counterparts. These children during their teenage period are more likely to get involve in substance abuse and self-harm behaviors10-11.

CSA is a subject of great annoyance and discom-posure across all the cultures despite it is highly widespread across the world. The effects of CSA may not always show initially but carries serious threat to their well-being. Despite this fact, it is one of the most unaddressed subjects across all the cultures. It is true to the fact that too much social taboos are attached to it. Victim fears to report the abuse out of fear of rejection, guilt and shame. Angie C. Kennedy found that CSA, intimate partner violence, Sexual Assault survivors experienced stigma including victim blaming messages from their disclosure. Such reaction causes survivors to internalize shame and self-blame12.

According to one of the estimation, 15-20% of girls and boys from all socioeconomic groups in Pakistan are exposed to sexual harassment and abuse before reaching 18 years (The Bitter Truth-Rozan), with many cases going unreported or undetected, it can be assumed that the real statistics will be much higher13. One of the reasons of high preva-lence of CSA is the ignorance. A large number of children around the globe are not given education about sexual abuse. Many adults do not have knowledge and skills to identify changing behaviors in their children stemming from CSA11.

According to experts, if children are given educa-tion and taught skills to respond to bad touch, the CSA incidence can be controlled. Assertive and well-informed children are more likely to protect themselves from abuse11.

The study was conducted in China, Beijing by Yichen Jin, Jingqi Chen & Buyi Yu (2016) to examine level of knowledge against prevention of child sexual abuse. This study was conducted on school aged children from grade 1 to 5, 559 participants from one primary school took part in the study. The respondents were asked to fill questionnaire which was about knowledge and skills related to CSA prevention. The result of this study revealed the truth that majority of the children lacked knowledge and skills and thus education programs related to CSA should be introduced in schools particularly in the elementary classes14.

Child sexual abuse (CSA) is a significant health problem with potential long-term consequences for victims,   therefore   knowledge   regarding   sexual abuse is essential for children. Equipping children with knowledge of CSA is very essentially as they cannot be always protected and guarded by their parents. Well informed children will respond assert ively to such happening and will reach out for the help.   This is a quantitative study to evaluate and compares the knowledge and alertness against child sexual abuse among children of both genders.


The present study is descriptive survey based research. The sample of 100 children of both genders in age bracket 6 yrs to 12 yrs. old were selected through Simple Random technique from different areas of Karachi. These children were not provided with any formal training about Child Sexual Abuse prior to the study. The survey was done in a course of 2 weeks. Data collection tool used was Child Knowledge of Abuse Questionnaire

Rev II. The Children were divided into 2 groups according to their gender. Each question was explained to them in simple and comprehensible Urdu language followed by 20 to 25 minutes to complete the survey form. The children with low IQ and those who have got formal training against Child Sexual abuse in past 6 months in schools, summer camps or any other organization were excluded from the study. Data analysis was done by SPSS version 20, t-test applied.

Parents of the selected children were briefed about the research objectives and method. They were explained about the Questionnaire. Prior informed consent was taken from the parents of children observed under the study.


Results of this study showed that 56% of the females (n=50) and 52% of males responded true in item-10 of CKAQ-REV II. 62% females and 52% males answered true in response to item-12, similarly for item-22 61% and 56% female and male participants responded true while 41% and 64% responded true in item-31.For item-32, 32% females and 30% males marked true. Overall, the obtained responses varied according to gender perceptions (Figure 1-2).


Both quantitative and qualitative item analysis convincingly revealed that there is no significant difference in the knowledge of CSA concepts between genders as measured by the CKAQ-REV II. As the average difference between scores of females and males on CKAQ-REV II is small so it is negligible. Thus we conclude that there is no signifi-cance difference of knowledge between girls and boys about child sexual abuse. This is true to the fact that in our society the children of either sex do not get proper education and awareness of child sexual abuse neither in school or home.

Child sexual abuse is disturbing and intimidating topic for parents and other care givers to address with children. Often caregivers fear that discussing the topic may frighten children and take away their innocence from them. Furthermore, there is still a great deal of stigma and shame associated with violence and abuse in our society that stops people from addressing issues and educating their children. This is the reason that child sexual abuse cases are increasing in our society day by day and yet our children are not prepare for it. By looking at the table no. 1 we can easily infer that girls have 48% of knowledge of child sexual abuse and boys have 51% of knowledge which falls in the alarming level.

Figure 1-2 shows that more than 50% of the children have marked application based questions true or I don’t know. We can infer from the reading (Figure 1-2) that children lack skills to execute their knowl-edge in real life situations. Majority of the children cannot discriminate between safe and unsafe situations and act accordingly. Thus these children are at high risk of abuse.

The results of the present study closely resembles to the study conducted by Wenjing Zhang and his fellows in Beijing, China. The researchers interviewed 136 children to examine the level of knowledge and skills related to CSA. The result showed lack of knowl-edge and skills about CSA in Chinese children. They found that less than half of the total children can discriminate stranger versus non stranger, only 16% of the children reported that bad touch should be reported, less than 30% of the children were aware about using verbal responses to refuse inappropriate touches which shows lack of knowledge and awareness. The parents of these children were also interviewed. Qualitative analysis showed that parents too lack knowledge and skills to train their children about CSA. In the same study less than half of the total parents discussed about good and bad touch and safe and unsafe places with their children15.

Limitation and Recommendations

The questionnaire used in the study was very com-plicated for children of age group 6-12 years old to understand no subscale was given which made it difficult for researcher to determine knowledge and alertness individually further determinants like basic knowledge of private body parts, good touch and bad touch questions was not categorize separately, if it was categorize in sections than interpretation and scoring would have been more specific. This questionnaire can be modified by adding below mentioned points.

  • Items can be divided into sub headings of knowl-edge, application and understanding of child sexual abuse.
  • Questions to judge knowledge about private body parts, private and public places can be added.
  • Question can be made more comprehensible and simple for children to understand.
  • Question to analyze child skills of incorporating knowledge into practical life situations can be added.

This study provides prospect for many future studies on wider population. As the parents and teachers are the primary informants to children, their attitudes, awareness knowledge and myths can be studied and correlated with the knowledge of the children. School curriculum can be explored too to examine the contribution of school in preparing the children. This will provide a way to work on the gaps and control the CSA incidents.

Children with physical and mental disabilities are more vulnerable to abuse than their counterparts as they lack the skills and understanding to respond effectively16. Further studies can be done on this population to assess and evaluate the parental involvement in educating their disabled children about CSA.


CSA occurs when child is forced into sexual activity. It has long-lasting devastating effects on the victim’s wellbeing. Its prevalence is increasing day by day around the globe affecting both genders irrespective of socioeconomic background. Despite of its increasing prevalence, it is least addressed. Children of Pakistani society are at high risk of CSA as they lack knowledge and skills.


We would like to show our sincere gratitude to Dr. Anjum Ara, Lecturer, Department of Clinical Psychology University of Karachi for mentoring us throughout the process.