Study On Prevalence And Risk Factors Of CSA Among The Left-behind And Non-left-behind Children In Rural Primary Schools Of China

Objective:To explore the prevalence of child sexual abuse（CSA）,the status of knowledge of CSA prevention,the status of behavior of CSA prevention and their influencing factors among left-behind and non-left-behind children in rural primary school in China.And to provide evidence for education and intervention of CSA in rural primary schools in the future.Methods:Eight provinces/autonomous regions including SC,GZ,HN,HB,JX,ZJ,GX and XJ were selected by purpose sampling.And students in grades 1^stto 6^thfrom2-3 primary schools in rural areas of each province were selected as the participants.8011 rural primary school students were included totally,including 5946（74.22%）left-behind children and 2065（25.78%）non-left-behind children.The Child Sexual Abuse Status Questionnaire（Primary School Version）was conducted to obtain the subjects’general demographic information,knowledge and behavior of CSA prevention,and the prevalence of sexual abuse,etc.Epi Data3.1 was used to establish the database,and SPSS26.0 software was used for data analysis,including descriptive analysis,x²test,t test,and multivariate unconditional Logistic regression analysis.Result:（1）The prevalence of sexual abuse in children was 10.81%.There was no statistical difference in the prevalence of sexual abuse between left-behind children（11.10%）and non-left-behind children（9.98%）,but the prevalences of some moderate to severe sexual abuse behavior in left-behind children were significantly higher than those of non-left-behind children,including:violent kiss（4.46%vs.3.10%）,being asked to touch or look at his/her private parts（1.68%vs.0.48%）,being asked to look at pictures/video of naked bodies（1.83%vs.0.63%）.（2）The status and influencing factors of knowledge of preventing CSA:The total score of knowledge was 10,the average score of rural children was 7.62±1.52,and the score of left-behind children was significantly lower than that of non-left-behind children（7.50±1.59 vs.7.97±1.24,P<0.001）.The results of multivariate analysis showed that the protective factors of left-behind children’s knowledge of prevention were:non-only-child（OR=0.81/OR=0.75/OR=0.76）,senior grade（OR=0.66）,the caregiver is father/grandparent（OR=0.71/0.54）,caregiver’s education level is illiterate（OR=0.65）,while the risk factors were average/bad relationship with caregivers（OR=1.41/OR=3.07）,single parent left-behind type（OR=1.39/OR=1.25）.Among the non-left-behind children,the risk factors were average relationship with caregivers（OR=1.91）,and the caregivers had primary school education（OR=1.60）.（3）The status and influencing factors of behavior of preventing CSA:The total score of behavior of preventing CSA was 12,and the average score of rural children was 10.35±1.34,and the score of left-behind children was significantly lower than that of non-left-behind children（10.27±1.35 vs.10.57±1.30,P<0.001）.Multivariate analysis results showed that the protective factors of left-behind children are as follows:girls（OR=0.88）,high score of knowledge of preventing CAS（OR=0.85）;Risk factors were average/bad relationship with caregivers（OR=1.45/OR=2.23）and caregivers’primary/high school education（OR=1.36/OR=1.31）.Among the non-left-behind children,the protective factors were high score of knowledge of preventing CAS（OR=0.81）,senior grade（OR=0.62）,while the risk factors were caregiver’s literacy level was illiteracy/primary school（OR=1.99/OR=1.44）.（4）The influencing factors of CSA:Multivariate analysis results showed that the protective factors for the occurrence of sexual assault of left-behind children were girls（OR=0.45）,non-only child（OR=0.88）,middle/senior grade（OR=0.78/OR=0.65）,high score of knowledge of preventing CAS（OR=0.62）,while the risk factor was average/bad relationship with caregiver（OR=2.03/OR=2.62）.Among the non-left-behind children,the protective factor was girls（OR=0.43）,while the risk factor was average relationship with caregiver（OR=2.22）.Conclusions:The prevalence of CSA in rural primary school students in rural areas was high.The prevalences of moderate and severe sexual assault among left-behind children were significantly higher than those of non-left-behind children.The knowledge and behavior of CSA prevention of rural primary school children were at the average level,and compared with non-left-behind children,left-behind children were at a lower level.The influencing factors of the sexual assault of left-behind and non-left-behind children in rural areas are different,so corresponding intervention measures should be formulated according to the relevant influencing factors.