Admission in to Post Basic Nursing Progamme for 2023/2024
blue medical mask or surgical mask isolated on black background with clipping path



Federal teaching hospital Gombe (FTHG), as a foremost institution in the state has been at the Centre of promoting the sexual and reproductive rights of women, children and men in Gombe state and the North East sub-region of Nigeria. This is with the aim of helping the efforts of the state Government and International health community in curbing the ever-increasing menace of Gender based violence (GBV), and violence against women in particular.

With the formation of the Gombe state steering committee for the reduction of GBV in 2015, the Hospital has setup a GBV committee and response team to ensure that this problem is talked headlong.  FTHG being the only Tertiary Hospital in the State receives a lot of victims/survivors and referrals of bad cases from Hospitals in Gombe state and environs.

For many victims the Hospital is usually the first point of contact where they receive emergency care and other preventive care, before seeking justice with the security agencies and courts.

Members of GBV CLUB on a visit to CMD- Dr. Yusuf Abdullahi Mohd.


  1. Emergency treatment victims of rape and other physical abuse, including screening for sexual transmitted infections, prevention of unwanted pregnancies, psychological support etc.
  2. Evidence collection and preparing medical reports in conjunction with other health care givers managing the cases.
  3. Referral of cases and linkages to other reproductive health services, NGOs and the state response team.
  4. Data collection of cases of GBV and reports to the right authorities.
  5. Research into all matters concerning GBV in the state and region.
  6. Public awareness and advocacy on all GBV matter.



THE Current CMD has graciously approved the formation of the GBV Club in the hospital to further promotes the role of the hospital in making impact on these objectives.

The club is expected to ensure the supervision of the GBV response team as well as work on the advocacy and public awareness. All interested persons in all fields and specialties are welcome to join as members.

The GBV clinical response team is domiciled at the Reproductive Health and Family Planning Unit of the Department of Obstetrics and Gynaecology, FTHG/GSU. With the Head of the unit and Focal person.

DR Yusuf Abdullahi Mohd- CMD FTHG

DR CH Laima -Chairman GBVC FTHG

DR Safiya Abdullahi, Secretary GBVC FTHG.

Some members of FTHG GBV Club




The GBV response team for ease of work is located at the Gynae-emergency, Department of Obstetrics and Gynaecology under Team D- Reproductive Health Unit. All emergencies brought are managed by O&G Team on call are referred to Team D as soon as possible. Cases that involved other specialties like A&E, Paediatrics, ETC. will be co-managed by such departments after inviting the GBVRT via the O&G team on call for that day. This involved, women children and men.


Offences under the Act are listed below:

  • Rape
  • Incest
  • Inflicting physical injury on a person
  • Placing a person in fear of physical injury
  • Offensive conduct
  • Harmful traditional practices
  • Frustrating investigation
  • Wilfully making false statements,
  • Forceful ejection from home
  • Deprivation of liberty
  • Damage to property with intent to cause distress
  • Forced financial dependence or economic abuse
  • Force unjustified isolation or separation from family and friends
  • Emotional, verbal and psychological abuse
  • Abandonment of family without sustenance
  • Stalking
  • Intimidation of person
  • Spousal battery
  • Substance attack
  • Administering a substance with intent.
  • Indecent exposure
  • Political Violence



Violence Against Person Persons:  Any act of sexual assault that results in or likely to result in physical, sexual or mental harm or suffering to the person, including threat of such act, coercion or arbitrary deprivation of liberty, whether occurring in public or private life.

Violence Against Women: Any act of sexual assault that results in or is likely to result in physical, sexual or mental harm or suffering to women including threats of such acts, coercion or arbitrary deprivation of liberty whether occurring in public or private life.

 Violence against women shall be understood to encompass, but not be limited to the following: a) Physical, sexual and psychological violence occurring in the family, including battering, sexual abuse of female children in the household, dowry-related violence, female genital mutilation and other traditional practices harmful to women, non-spousal violence and violence related to exploitation; b) Physical, sexual and psychological violence occurring within the general community, including rape, sexual abuse, sexual harassment and intimidation at work, in educational institutions and elsewhere, trafficking in women and forced prostitution; c) Physical, sexual and psychological violence perpetrated or condoned by the State, wherever it occurs. Acts of violence against women also include forced sterilization and forced abortion, coercive/forced use of contraceptives, female infanticide and prenatal sex selection

Rape: When a person intentionally penetrates the vagina, anus or mouth of another person with any other part of his or her body or anything else and the other person does not consent to the penetration or the consent is obtained by force or by means of intimidation of any kind or by fear of harm or by means of false and fraudulent representation as to the nature of the act or the use of any substance or addictive capable of taking away the will of such person. Statutory rape: Unlawful Sexual intercourse by a child under the age of 14 years. A person convicted of rape is to be sent to prison for life.

Child abuse: The employment, use, persuasion, inducement, enticement, or coercion of any child to engage in any sexually explicit conduct or simulation of such conduct for the purpose of producing visual depiction of such conduct; or the rape, and in cases of caretaker or interfamilial relationships, statutory rape, molestation, prostitution, or other forms of sexual exploitation of children, or incest with children.  Incest: Knowingly and willfully having carnal knowledge of another within the prohibited degree of consanguinity and affinity as contained in the Act with or without consent.

Spousal battery: Physical assault by a spouse

Stalking means repeatedly:

  1. Watching or loitering outside of or near the building or place where another person resides, works carries on business, studies or happens to be; or
  2. Be repeatedly following, pursuing or accosting any person in a manner which induces fear or anxiety or discomfort.

Administration of substance: Intentionally administering a substance to, or causing a substance to be administered to or taken by another person with the intention of stupefying or overpowering that person so as to enable any person to engage in a sexual activity with that person. This may also be with intent to affect the outcome of a pregnancy.

Indecent Exposure: the intentional exposure of the genital organs, or a substantial part thereof with the intention of causing distress to the other party.

Reproductive and sexual coercion: Behaviour intended to maintain power and control in a relationship related to reproductive health by someone who is, was, or wishes to be involved in an intimate or dating relationship with an adult or adolescent. This includes birth control sabotage, pregnancy pressure and coercion, intentionally exposing a partner to STIs, etc.

Harmful traditional practices: Forms of violence which have been committed primarily against women and girls in certain communities and societies for so long that they are considered, or presented by perpetrators, as part of accepted cultural practice.

Female Genital Mutilation or Cutting (FGM or FGC) or female circumcision: All procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs whether for cultural or other non-therapeutic reasons.

Gender-Based Violence: Physical, sexual, mental or economic harm inflicted on a person because of socially ascribed power imbalances between males and females. It also includes the threat of violence, coercion and deprivation of liberty, whether in public or in private (unicef.org)

Victims: Individuals (i.e. women, men, or children) who report or were reported to have been sexually assaulted.

Patients: Individuals who are receiving a service from, or are being cared for by, a health worker.

Health Workers: Professionals who provide health services; for example, doctors, nurses and other professionals who have specific training in the field of health care delivery.

Internally Displaced Persons/People: are persons or groups of persons who have been forced or obliged to flee or to leave their homes or places of habitual residence, in particular as a result of or in order to avoid the effects of armed conflict, situations of generalized violence, violations of human rights, or natural or human-made disasters, and who have not crossed an internationally recognized state border. (i-a min standards p)

Assent: The expressed willingness to participate in services. This applies to younger children who are by definition too young to give informed consent, but old enough to understand and agree to participate in services. Informed assent is therefore the expressed willingness of the child to participate in services.

Informed Consent: Approval or assent, particularly and especially after thoughtful consideration. Free and informed consent is given based upon a clear appreciation and understanding of facts, implications and future consequences of an action. In order to give informed consent, the individual concerned must have all adequate relevant facts at the time consent is given, and be able to evaluate and understand the consequences of an action. They must also be aware of and have the power to exercise their right to refuse to engage in an action and/or to not be coerced. Children are generally considered unable to provide informed consent because they may not have the ability and/or experience to anticipate the implications of an action, and because they may not understand or be empowered to exercise their right to refuse. There are also instances where consent might not be possible due to cognitive impairments and/or physical, sensory or intellectual disabilities.

Technologically-Facilitated Gender-Based Violence: Action by one or more people that harms others based on their sexual or gender identity or by enforcing harmful gender norms. This action is carried out by using the internet or mobile technology and includes stalking, bullying, sexual harassment, defamation, hate speech and exploitation. (Hinson L, Mueller J, O’Brien-Milne L, Wandera N. (2018).

Some members at the workshop on clinical magement of rape -Bauchi


The handling of a victim after Sexual and Gender Based Violence (SGBV) before a decision is taken to report can impact on the outcome. How the victim and the circumstance are handled should form part of the message for all stakeholders, especially the public.

  1. Report as soon as possible: Late reportage is not uncommon. Late reportage or not reporting at all will allow all the possible consequences of Sexual and Gender Based Violence (SGBV) run their courses. It will also allow time for forensic evidence to disappear and for the culprit to escape.
  2. Maintain confidentiality and do not create a scene: When sexual assault has been made known or discovered, the first person to know should keep the information as closed as possible. Making the knowledge public will increase the victim’s psychological trauma and get him/her more stigmatized in the society. Information should be limited to those who will act in place of the parents/guardian, necessary witnesses, medical personnel and the police. If the case gets to the police first before the hospital or medical facility, request to speak in confidence with the police on duty rather than talking loudly for everyone to hear when presenting the case. Encourage the police to get the victim to the hospital as soon as possible.
  3. Provide cover/clothing for the victim after taking pictures for evidence.
  4. Keep all evidence intact, like soiled/torn clothing.
  5. Secure the crime site if possible.

Evaluate the victim in a room that satisfies the guiding principles of safety, confidentiality, etc and always get ready all you need for sample collection including rape kits.

Step One: A survivor-centred approach starts with preparing the survivor for evaluation. This includes the following:

  • Introduce yourself.
  • Limit the number of people in the room to the minimum necessary. If the survivor wishes, ensure that a trained support person or trained health worker of the same sex accompanies the survivor throughout the examination. Ask if they also want to have a specific person present (e.g., family member or friend).
  • Determine the best way to communicate and adapt to the victim’s communication skill level and language. Avoid medical terminology and jargon.
  • Obtain informed consent (or a parent’s informed consent in the case of a child).
  • Explain what is going to happen during each step of the examination, why it is important, what it will tell you, and how it will influence the care you will give. Make sure the survivor understands everything.
  • Reassure the survivor they are in control of the examination. Explain that they can refuse any aspect of the examination they do not wish to undergo, and that this will not affect their access to treatment or care, but may affect the extent of treatment or prevention if that is later decided. Document the victim’s decision.
  • Reassure the survivor that the examination findings will be kept confidential unless the survivor decides to bring criminal charges.
  • Provide psychological first aid.

Ask the survivor if they have any questions

Step Two: Obtain consent/assent and consent. Consent may be needed for most court cases. The table below is adapted from the IRC.

Age group (years)



If no caregiver or not in child’s best interest


0 – 5


Informed consent

Other trusted adults or case worker’s informed consent

Written consent

6 – 11

Informed assent

Informed consent

Other trusted adults or case worker’s informed consent

Oral assent, Written consent

12 – 14

Informed assent

Informed consent

Other trusted adults or child’s informed assent

Oral assent, Written consent

15 – 18

Informed consent

Informed consent with child’s permission

Child’s informed consent and sufficient level of maturity takes due weight

Written consent

 Step Three: History

  • The third step is to take the history. Ensure the following: If the history-taking is conducted in the treatment room, cover the medical instruments until they are needed.
  • Before taking the history, review any documents or paperwork brought by the survivor. Do not ask questions that have already been asked and documented by other people involved in the case except to seek for more clarification.
  • Avoid any distraction or interruption during the history-taking.
  • Make sure the survivor feels comfortable. Use a calm tone. If culturally appropriate, maintain eye contact. Be aware of the survivor’s body language and your own.
  • Be systematic. Proceed at the survivor ‘s own pace. Be thorough, but don‘t force the survivor.
  • Let the survivor tell their story the way they want to. Document the incident in the survivor’s own words.
  • Avoid questions that suggest blame (e.g., What were you doing there alone?).
  • Be compassionate and non-judgmental.
  • Explain what you are going to do at every step.


 Be ready to deal with their various emotions/feelings. The following are suggested responses:

Hopelessness: Reassure the person and tell her/him encouraging things

Despair: Focus on the strategies and resourcefulness through which the person will get better.

Powerlessness and loss of control: Say, “You have choices and options today on how to proceed.”

Flashbacks: Say, “These will resolve with the healing process.”

Disturbed sleep: Say, “This will improve with the healing process.”

Denial: Say, “I’m taking what you have told me seriously. I will be here if you need help in the future.”

 Guilt and self-blame: Say, “You are not to blame for what happened to you. The person who assaulted you is responsible for the violence.”

Shame: Say, “There is no loss of honour in being assaulted. You are an honourable person.”

Fear: Emphasize, “You are safe now.” You can say, “That must have been very frightening for you.”

Numbness: Say, “This is a common reaction to severe trauma. You will feel well again. All in good time.”

Mood swings: Explain that these are common and should resolve with the healing process. A legitimate feeling and avenues can be found for its safe expression. Assist the patient in experiencing those feelings. For example, “You sound very angry.”

Anxiety: Tell the patient that these symptoms will ease with the use of the appropriate stress management techniques and offer to explain these techniques.

Helplessness: Say, “It sounds as if you were feeling helpless. We are here to help you.”


  • The date and time of the sexual violence
  • The location and description of the type of surface on which the violence occurred
  • The name, identity and number of assailants
  • The nature of the physical contacts and detailed account of violence inflicted
  • Use of weapons and restraints
  • Use of any medications/drugs/alcohol/inhaled substances
  • Use of condoms and lubricants
  • Any subsequent activities by the survivor that may alter evidence e.g. Bathing, douching, wiping, the use of tampons and changes of clothing
  • Any symptoms that may have developed since the violence e.g. Genital bleeding, discharge, itching, sores or pain
  • Current sexual partner/s (be tactical about this especially for singles/divorced/widowed/separated)
  • Last consensual sexual intercourse

Gynaecological history:

  • Last menstrual period
  • Number of pregnancies
  • Use (and type) of current contraception methods

 Male- specific history

  • Any pain or discomfort experienced in the penis, scrotum or anus
  • Any urethral or anal discharge
  • Difficulty or pain on passing urine or stool


Ask questions to elicit risk factors. These may include

  • lower levels of education (perpetration of sexual violence and experience of sexual violence);
  • a history of exposure to child maltreatment (perpetration and experience);
  • witnessing family violence (perpetration and experience);
  • antisocial personality disorder (perpetration);
  • harmful use of alcohol (perpetration and experience); 
  • harmful masculine behaviours, including having multiple partners or attitudes that condone violence (perpetration);
  • community norms that privilege or ascribe higher status to men and lower status to women; 
  • low levels of women’s access to paid employment; and
  • low level of gender equity (discriminatory laws, etc.). past history of exposure to violence;
  • marital discord and dissatisfaction;
  • difficulties in communicating between partners; and
  • male controlling behaviours towards their partners.
  • beliefs in family honour and sexual purity;
  • ideologies of male sexual entitlement; and
  • weak legal sanctions for sexual violence.
  • Walking at odd times / places unaccompanied
  • one female heads of household
  • children and young adults
  • children in foster care
  • physically and mentally challenged persons
  • persons in prison or detention
  • persons with mental illness or under the influence of alcohol or drug
  • single parent homes
  • persons with a history of rape or sexual abuse
  • persons involved in prostitution
  • persons in an abusive intimate or dependent relationship
  • victims of war or armed conflict situations
  • the homeless or impoverished

For children, the questions may be a little different.

  • When did this happen?
  • Was this the first time this happened or has it happened before?
  • What threats were made? Or incentives were given?
  • What part of your body was touched or hurt?
  • Do you have any pain in your bottom or genital area?
  • Is there any blood in your panties?
  • Do you have difficulty or pain with voiding or defecating?
  • Have you taken a bath since the sexual violence?
  • When was the last time you had sexual intercourse? (explain why you need to ask about this).
  • When was your last menstrual period? (girl)


The fourth step is the physical examination (which includes the genital examination and forensic evidence collection)

  • Reassure the survivor again and seek further consent
  • Try to make the victim feel comfortable and relaxed as much as possible.

A systematic ‘’Head to Toe’’ approach may ensure all is covered.

  • First, note the survivor’s general appearance and demeanor.
  • Take the vital signs, i.e. pulse, blood pressure, respiration and temperature.
  • Inspect both sides of both hands for injuries. Examine the wrists for signs of ligature marks.
  • Inspect the face and the eyes. If there is pain in a particular area, reassure and perform that examination last.
  • Gently palpate the scalp to check for tenderness, swelling or depression.
  • Inspect the ears, not forgetting the area behind the ears, for evidence of shadow bruising; shadow bruising develops when the ear has been struck onto the mastoid.
  • Carefully examine the neck. The neck area is of great forensic interest; bruising can indicate life-threatening violence.
  • Examine the breasts and trunk with as much dignity and privacy as can be afforded.
  • Inspect the forearms for defense related injuries. These are injuries that occur when the subject raises a limb to ward off force to vulnerable areas of the body, and include bruises, abrasions, lacerations and incised wounds.
  • Examine the inner surfaces of the upper arms and armpit or axilla for bruises.
  • Recline the position of the survivor for abdominal examination, which includes abdominal palpation to exclude any internal trauma or detect pregnancy.
  • While in the reclined position, examine the legs, starting with the front.
  • If possible, ask the survivor to stand for inspection of the back of the legs. An inspection of the buttocks is also best achieved with the survivor standing.
  • Collect any biological evidence with moistened swabs (for semen, saliva, blood) or tweezers (for hair, fibres, grass and soil).



The Genito-Anal Examination for Adults

  • Try to make the victim feel as comfortable and as relaxed as possible.
  • Explain to them each step of the examination. For example, say, “I’m going to have a careful look. I’m going to touch you here in order to look a bit more carefully. Please tell me if anything feels tender.”
  • Examine the external areas of the genital region and anus as well as any markings on the thighs and buttocks.
  • Inspect the mons pubis; examine the vaginal vestibule, paying special attention to the labia majora, labia minora, clitoris, hymen or hymenal remnants, posterior fourchette and perineum.
  • Take a swab of the external genitalia before attempting any digital exploration or speculum examination. Gently stretch the posterior fourchette area to reveal abrasions that are otherwise difficult to see. If any bright blood is present, gently swab in order to establish its origin, i.e. whether it is vulval or vaginal.
  • Warm the speculum prior to use by immersing it in warm water. Insert the speculum. Inspect the vaginal walls for signs of injury, including abrasions, lacerations, and bruising.
  • Collect any trace evidence, such as foreign bodies and hairs, if found. Suture any tears, if indicated.
  • Remove the speculum. Remember: Prepare/assemble the PRC kit before the survivor comes in.
  • If available, ensure a trained support person of same sex accompanies the survivor throughout the examination.

Head to Toe Examination for Children

 The physical examination of children should be conducted according The physical examination of children should be conducted according to the procedures outlined for adult’s section. Before examination, ensure that consent has been obtained from the child and/or the caregiver as appropriate. If the child refuses the examination, it would be appropriate to explore the reasons for refusal.

When performing the head-to-toe examination of children, the following points are important:

  • Record the height and weight of the child.
  • In the mouth/pharynx, note petechiae of the palate or posterior pharynx and look for any tears to the frenulum.
  • Record the child’s sexual development and check the breasts for signs of injury.
  • Note: Consider examining very small children while on their mother’s or care giver’s lap. If the child still refuses, the examination may be deferred or even abandoned. Never force the examination, especially if there are no reported symptoms or injuries because findings will be minimal, and any coercion may mean yet another violence to the child.
  • Consider sedation or a general anaesthetic, only if the child refuses the examination and conditions requiring medical attention, such as bleeding or a foreign body, are suspected.



The Genito-Anal Examination for Girls

 Whenever possible, do not conduct a speculum examination on girls who have not reached puberty. It might be very painful and cause additional trauma. A speculum may only be indicated when the child has internal bleeding arising from a vaginal injury as a result of penetration. In this case:

  • Help the child to lie on her back or side.
  • Use a paediatric speculum and conduct the examination under general anaesthesia.
  • Check for blood spots or trauma to the urethra.
  • Examine the anus for bruises, tears or discharge. You may need to refer the child to a higher-level health facility for this procedure.

 The Genito-Anal Examination for Boys

  • Check for injuries to the skin that connects the foreskin to the penis.
  • Check for discharge at the urethral meatus (tip of penis).
  • In older boys, pull back the foreskin to examine the penis. Do not force it since doing so can cause trauma, especially in younger boys.
  • Help the boy to lie on his back or on his side and examine the anus for bruises, tears or discharge.
  • Avoid examining the boy in a position in which he was violated as this may mimic the position of abuse.
  • Consider digital rectal examination only if medically indicated.

Findings and injuries





Record the anatomical position of the wound(s)


The dimensions of the wound(s) should be measured


Describe the shape of the wound(s) – e.g., linear, curved, irregular


Note the condition of the surrounding or the nearby tissues (e.g., bruised, swollen).


Observation of colour is particularly relevant when describing bruises


Comment on the apparent direction of the force applied (e.g., in abrasions)


Note the presence of any foreign material in the wound (e.g., dirt, glass, sand).


Comment on any evidence of healing. Note that accurate ageing is impossible and great caution is required when commenting on this aspect.


The characteristics of the edges of the wound(s) may provide a clue as to the weapon used.


Use accepted terminology wherever possible


Give an indication of the depth of the wound(s). This may have to be an estimate.


Forensic specimens




Sampling technique

Anus (rectum)


  Cotton swabs and microscope slides. swab Blood Drugs

Use swab and slides to collect and plate material; lubricate instruments with water, not lubricant



Lubricant Cotton

Dry swab after collection



Appropriate tube

Collect 10mls of venous blood


DNA (victim)

Appropriate tube

Collect 10mls of blood


Adherent foreign material e.g. semen, blood, hair, fibre

Paper bags

Clothing should be placed in a paper bag(s). Collect paper sheet or drop cloth. Wet items should be bagged separately



Cotton swabs and microscope slide

Use separate swabs and slides to collect and plate material collected from the external genitalia, vaginal vault and cervix; lubricate speculum with water not lubricant or collect a blind vaginal swab


Comparison to hair found at scene

Sterile container

Cut approximately 20 hairs and place in sterile container.



Cotton swabs, sterile container (for oral washings) or dental flossing

Swab multiple sites in mouth with one or more swabs (see Fig. 12). To obtain a sample of oral washings, rinse mouth with 10ml water and collect in sterile container


Skin, blood, fibres, etc. (from assailant)

Sterile toothpick or similar or nail scissors/clippers

Use the toothpick to collect materials from under the nail(s), or, the nails can be cut and clippings collected in a sterile container

Sanitary pads/tampons

Foreign material (e.g. semen, blood, hair)

Sterile container

Collect if used during or after vaginal or oral penetration



Cotton swab

Swab sites where semen may be present


Saliva (e.g. at sites of kissing, biting or licking), blood

Cotton swab


Foreign material (e.g. vegetation, matted hair or foreign hair)

Swab or tweezers

Place material in sterile container (e.g. envelope, bottle)



Sterile container

Collect 100mls of urine

Forensic Timescales




Kissing, licking, biting

48 hours or longer

48 hours or longer

Oral penetration

48 hours (2 days)

48 hours (2 days)

Vaginal penetration

7 days

Not available

Digital (finger) penetration

12 hours

12 hours

Anal penetration

72 hours (three days)

72 hours (three days

In Drug Facilitated Sexual Assault (DFSA), detection times of substances used are within three days in blood and four days in urine. Hair analysis is sometimes done in delayed presentation of suspected DFSA.


Manage according to the patient’s needs.


  1. Treatment of injuries
  • If necessary, and the patient agrees, take photographs first
  • Clean abrasions with chlorhexidine solution
  • Arrest bleeding and manage lacerations accordingly
  • Give tetanus toxoid injection 0.5mls intramuscularly
  • Give antibiotics for injuries, e.g., ampiclox 500mg qid for 5 days
  • Give medications/vaccinations for prophylaxis
  • If patient is already on ARVs, to continue his or her medications.




Post-exposure prophylaxis (2 Nucleoside Reverse Transcriptase Inhibitors + I Protease inhibitor for 28 days), e.g.:

 • Truvada (Tenofovir and Emtricitabine) one tablet once a day with or without food

• Kaletra (Lopinavir (400mg) and Ritonavir (100mg)) two tablets twice a day with or without food

 • Zidovudine (AZT) 300mg + lamivudine (3TC) 150mg each twice daily for 28 days

Treat nausea and vomiting with domperidone 10mg tablet three times a day.

Treat diarrhoea with two tablets of loperamide 2mg and the one PRN () maximum 8 tablets in 24 hours

Do HIV test at 3 months’ post completion of Post Exposure Prophylaxis (PEP) and at 6 months

Hepatitis B

Hepatitis B immunoglobulin and vaccination – if victim has not received complete dose of vaccination before.

 • Hepatitis B Immunoglobulin (HBIG) (especially if offender is Hepatitis B envelop Antigen (HBeAg) positive). HBIG is not contraindicated in pregnancy

• Hepatitis B vaccination (within 6 weeks of exposure) – 1ml Im in adults and adolescents > 13 years of age (Engerix B 20mcg three times or HBvaxPro 10mcg three times). Give half dose to younger victims.

 • Either dose is given at 0, 7, 21 days’ post exposure with booster dose at 12 months (super accelerated or very rapid schedule) or at 0, 1, 2 months after exposure with booster at 12 months (accelerated schedule)

Repeat test at 3 and 6 months’ post assault


Ceftriaxone 500mg as a single stat dose + Azithromycin 1g Per Os (PO) stat


Azithromycin 1g PO single stat dose (all patients) or Doxycycline 100mg bd for 14 days(non-pregnant)

Erythromycin 500mg orally 4 times a day for 7 days (pregnant) or

Amoxicillin 500mg orally 3 times a day for 7 days (pregnant)

Trichomonas Vaginalis

Metronidazole 2g PO single stat dose

Bacterial Vaginosis

Metronidazole 2g stat Doxycycline 100mg bd for 10 days


Benzathine Penicillin G 2.4 MIU IM single dose (pregnant and nonpregnant) or Doxycycline 100mg bd for 14 days (non-pregnant) or

Tetracycline 500mg qid for 14 days(non-pregnant)

 Erythromycin 500mg orally 4 times a day for 14 days (pregnant victims)

  • Give analgesics (diclofenac, ibuprofen)
  • Give anxiolytics if necessary (diazepam 5mg, or bromazepam 1.5mg) Refer more serious injuries to specialists (orthopaedic surgeon, gynaecologists, neurosurgeon, paediatric surgeon, etc.)
  1. Baseline screening for STIs
  • Counselling and tests for HIV – save sample and retest after 3 months if positive. Risk for HIV is higher if offender is from high risk group, if penetration took place, presence of other STIs in the victim, genital injuries and multiple offenders. Risk of HIV Transmission = offender’s risk x risk of exposure.
  • Risk of transmission from a known HIV positive source
  • Syphilis –VDRL or other serology – save sample and retest after 3 months if positive
  • Hepatitis B, Hepatitis C – save sample and retest after 3 months if positive
  • Neisseria Gonorrhoea – take specimen for gram stain for gram negative intracellular diplococci culture from site of penetration
  • Chlamydia trachomatis – take specimen from site of penetration for dual Nucleic Acid Amplification Technique (NAAT)
  • Yeast – wet slide for microscopy and culture
  • Bacterial vaginosis – wet slide for microscopy, Schiff test
  • Trichomonas vaginalis – wet slide for microscopy and culture
  1. Other investigations – Full Blood Count (FBC), liver enzymes if PEP is given, others as dictated by other findings
  2. Pregnancy test (when facilities are available, use blood test) –see below for management of positive pregnancy test
  3. Give emergency contraception (if pregnancy test is negative and patient presents within five days of assault)
  • Copper Intrauterine Device (IUD) up to 5 days’ post assault on any day of the menstrual cycle
  • Levonorgestrel 1.5mg single dose up to 5 days after the assault. Double the dose (to 3mg) if patient is on liver enzyme inducing medications like HIV PEP
  • Ulipristal (Ellaone) 30mg up to 5 days after assault
  • Postinor 2 two tablets single doseS or Post pill up to 120 hours after assault
  1. Refer to psychiatrist/clinical psychologist
  2. Refer for forensic medical examination if service is available within facility or close by
  3. Give follow-up date

MEDIUM-TERM NEEDS (Patient reports after seven days of assault)

  1. Treat injuries (dressing, debridement, antibiotics)
  2. Screen for STIs and treat according to sensitivity tests or syndromic management if no facilities for screening
  3. Test for pregnancy; if positive see below for management of positive pregnancy test
  4. Give Hepatitis B vaccination
  5. Refer to psychiatrist/clinical psychologist
  6. Link to Sexual Assault Referral Centre (SARC) if accessible
  7. Give follow-up date

 If presenting after three months, screen for STIs, do Full Blood Count, Liver Function Tests, Urea and Electrolytes, Fasting blood sugar, Lipids and Amylase If patient presents after two weeks and pregnancy test is positive, she may be offered paternity testing if available.

MANAGEMENT OF PREGNANCY/POSITIVE PREGNANCY TEST A victim who is presenting within 10 days of assault whose pregnancy test is positive is likely to have been pregnant before the assault The provider should counsel with the patient and seek psychiatric consultation where such service is available. When her life is in such danger the provider should consider a therapeutic termination of the pregnancy to save her life. This is in accordance with the Nigerian law. Other conditions where the life of the woman is in danger include (but are not limited to) end-stage renal disease, severe heart failure, cancers (cervix or uterus, kidney, etc.) and severe pre-eclampsia/eclampsia.

When pregnancy test is negative, follow the guideline for pregnancy prevention above.

Victims who present several weeks after the assault and whose pregnancy tests are positive should be further examined using bimanual exam to ascertain the gestational age. They should be counselled, treated or given other preventive measures and referred for antenatal care or given options as discussed above accordingly. If they have already taken concoctions to terminate the pregnancy, more investigations should be carried out to check for possible organ damage. These laboratory tests should include renal function tests (electrolyte, urea and creatinine (EUC)), liver function tests and full blood count among others.

Where the medications or concoctions ingested by the victim for pregnancy termination have led to fetal demise, appropriate measures should be carried out for safe uterine evacuation. Manual Vacuum Aspiration (MVA) or medical means (misoprostol alone or in combination with mifepristone) should be used when the uterine size is before 13 weeks. For larger uterine sizes, medical induction or dilatation and evacuation (D&E) should be used. Uterine evacuation by any means should be performed only by trained persons.

For victims who are already pregnant before the sexual assault took place, they should be appropriately counseled for pregnancy continuation. For who opt for, or are fit for, continuation of pregnancy, the growing fetus should be taken into consideration for all preventive measures and treatment regimens. The following adjustments should be particularly noted:

  • Hepatitis B Immunoglobulin should be given instead of the active vaccine
  • Doxycycline should be avoided as treatment for syphilis, chlamydia or bacterial vaginosis. Tetracycline should be avoided for syphilis too.
  • Prolonged use (longer than a day) of Non-Steroidal Anti-Inflammatory Drugs (NSAIDS) should be avoided.
  • Avoid anaesthetic agents that may cause uterine contractions.
  • Avoid multiple x-ray exposure to the abdomen. The abdomen should be shielded when carrying out radiological (x-rays) examination of other parts of the body

LONG-TERM NEEDS (patient reports after one year)

  1. Counsel and screen for STIs/HIV and manage accordingly
  2. Refer for management of psychological consequences at SARC
  3. Take notice and modify care at antenatal, delivery and postnatal periods


Follow-up schedule should be discussed with the patient. It depends on the findings and the nature of injuries and care given. Vaccination schedules should be followed. It may take a few days to inspect wounds, discuss culture results and check improvements for other ailments, or longer as the case may dictate. Check HIV status and syphilis at three and six months


 From the first interaction through follow-up to referrals/discharge, proper documentation is important, especially for reports. Seek legal advice from the hospital legal unit or other sources including National Agency for the Prohibition of Trafficking in Persons, National Human Rights commission and NGOs that provide such specialized services. Follow the checklist in the box below.

Documenting cases of sexual abuse: a checklist for health workers

 The following checklist is intended to assist health workers develop their documentation skills:

• Document all pertinent information accurately and legibly.

• With the patient’s consent, notes, pictures, videos and diagrams should be created

during the consultation; this is likely to be far more accurate than when created from memory.

• Notes should not be altered unless this is clearly identified as a later addition or alteration. Deletions should be scored through once and signed, and not erased completely.

 • Ensure that the notes are accurate; deficiencies may cast doubts over the quality of the assessment.

.• Record verbatim any statements made by the victim regarding the assault. This is preferable to writing down your own interpretation of the statements made. Review or go through with the victim.

• Record the extent of the physical examination conducted and all “normal” or relevant negative findings


Guiding Principles

 Below are some guiding principles for health workers on reports and court evidence in sexual violence Writing reports

  1. Explain what you were told and what you observed.
  2. Use precise terminology. For example, write ‘’about five o’clock” instead of ‘’in the evening’’; “laceration across the left vulva” instead of “laceration in the private part.”
  3. Maintain objectivity.
  4. Stay within your field of expertise.
  5. Distinguish findings and opinions.
  6. Detail all specimens collected.
  7. Write what you would be prepared to repeat under oath in court.

 Giving evidence

  1. Be prepared.
  2. Listen carefully.
  3. Speak clearly.
  4. Use simple and precise language.
  5. Stay within your field of expertise.
  6. Separate facts and opinion.
  7. Remain impart


When the victim is brought to the Police Station immediately after the assault before medical attention is given, the officer on duty should not delay but bring the victim to the health facility forthwith, while carrying on investigations. When the reporting period is late, referral should still be made to the health facility. No victim should be denied prompt attention or turned away if she/he reports to the health facility without police accompaniment. When a victim reports without police involvement, her/his consent should be sought before informing the police. Functional communication lines with the police must be kept by all health facilities, however remote the location is. Service providers must avoid succumbing to pressure from the Police or other investigators and refer them to higher authorities whenever they feel pressured to do anything, they feel is unethical.



Some men, intending to get their partners pregnant, interfere with their family planning methods. They may hide contraceptive pills, intentionally refuse to use condoms, etc. In such cases, the health worker, when reported to, should refer patient to the family planning clinic or offer appropriate services. Postinor 2, IUCD or other emergency contraception should be given within 72 hours of unprotected sexual intercourse or broken condom. When pills are missed for one day, the pill should be taken the next day and another taken within 12 hours. If pills are missed for two days, two pills should be taken 12 hours apart for two days and the normal routine continued thereafter. If client misses pill for three or more days, the client should be assessed for pregnancy or given menstrual induction.





  • Take a full history – patient’s bio data, date and time of procedure, place procedure was done, who performed the procedure, type and sterility of instruments used, anaesthesia given, quantity of blood loss, loss of consciousness, fever, etc.
  • Do a comprehensive examination with particular emphasis on the external genitalia. Check vital signs, pallor, jaundice; check perineum for cuts, pus, blood, type of circumcision, sutures, etc. • Carry out laboratory investigations according to findings and need

. Manage according to findings – treat sepsis/septicaemia (antibiotics, dressing/sitz bath, incision and drainage), arrest bleeders, give analgesics and tetanus toxoid. Investigate for infection or anaemia. Give haematinics and transfuse blood if necessary.

  • Give psychosocial counselling.
  • Refer to appropriate medical discipline and/other agencies who can meet the identified need.


  • Full history and physical examination
  • Discuss the diagnosis and treatment options
  • May do deinfibulation or dilatation

The solution to the issue of harmful and other widowhood practices lies in public education. These practices vary and management of those of medical import should follow the usual method of history, physical examination, medical investigations and treatment. Some examples are mentioned here:

  • forced shaving of hair
  • forced wearing of black/white clothes
  • forced sleeping on the floor or mat
  • forced sleeping with corpse in a lock-up room
  • forced to refrain from taking bath for a period of time
  • forced to seclude
  • Seizing of the deceased properties and sometimes with the children from the widow
  • forced marriage of the widow to members of the family of the deceased husband
  • Ingestion of poisonous substances – some widows are made to ingest water used to bath their husband’s corpse or other substances to prove their innocence and absolve them from having a hand in their death. These widows should be carefully clerked to know the kind of fluid ingested and to check for any physical manifestation of poisonous substances. They should be observed, preferably in the hospital, if the substance is suspected to be poisonous and treated accordingly. Laboratory tests should be done to ascertain proper organ functions like liver function tests, renal function tests, full blood count, etc.
  • Trauma/physical injury – take history, examine and record findings in detail and manage accordingly.
  • Psychological trauma – give psychosocial counselling. May give anxiolytics or refer to a psychologist/psychiatrist and/or ask to change environment

This includes violence by military and paramilitary personnel, political thugs, religious thugs, tribal conflicts, prison inmates, school mates, etc. The principles written for sexual violence should be followed. Documentation, detailed history and physical examination, medical investigations, treatment and referral where necessary should be done. Involve the police at some point, if the case is not brought by the police


Make a careful examination and give detailed description of the corpse (swellings, wounds, fractures, etc.) and possibly take pictures before sending to the mortuary. If services are available, get permission and send for post mortem. Prepare a report and inform the Police.