Prevalence, risk factors, nature, and nutritional impact of sexual abuse among young girls: A school-based study

Abstract Sexual abuse among adolescent girls is underreported in low and middle income countries including Nepal. This study aimed to estimate the prevalence of SA among school girls, examined associated sociodemographic and contextual factors describe the nature and reporting patterns of abuse and assess the relationship with nutritional status. A school based cross sectional study was conducted, among 330 female students (ages 14-19) were selected through simple random sampling from two schools. Data were collected using a validated self-administered questionnaire covering demographic characteristics, abuse experiences, psychosocial responses and reporting patterns. Anthropometric measurements were used to assess BMI-for-age and height-for-age Z scores calculated using WHO AnthroPlus. Logistic regression analysis was used to identify factors independently associated with sexual abuse and adjusted odds ratio with 95% confidence intervals were calculated. SA prevalence was 33.3%. Most perpetrators were male (61.5%) and known to the victim, 63.3% involved perpetrator use. Reporting was low (16.5%) due to fear (42.2%) and shame (22%). Significant predictors included lower maternal education (AOR=3.03) and living in joint families (AOR=2.34).After adjusting for confounders, SA was strongly associated with thinness (AOR=5.59; 95% CI; 2.54-12.26), severe thinness (AOR=18.81; 95% CI: 4.21-84.07) and stunting (AOR=3.79; 95% CI: 1.88-7.62). One in three girls experienced sexual abuse, which is strongly correlated with growth impairment and malnutrition. These findings suggest that anthropometric deficits may serve as clinical red flags for underlying trauma. Strengthening school-based nursing programs and primary care screening is essential for early identification and safeguarding.