Research | Open Access | Volume 9 (3): Article 158 | Published: 30 Sep 2026
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Table 1: Prevalence of Childhood Sexual Abuse (CSA) by Sociodemographic, Behavioural and Household Characteristics among Youth Aged 18–24 Years (N = 1,576)
Table 2:Factors associated with childhood sexual abuse (CSA) among youth aged 18–24 years, Mozambique VACS 2019
Áuria Ribeiro Banze1,2,&, Nilsa Nascimento2, Angelo Augusto2, Rachid Muleia2, Cynthia Semá Baltazar1
1Field Epidemiology Training Program – Instituto Nacional de Saúde, Mozambique, 2 Instituto Nacional de Saúde (INS), Mozambique
&Corresponding author: Áuria Ribeiro Banze, Instituto Nacional de Saúde, P.O. Box 264, Maputo, Mozambique, Email: auria.banze@ins.gov.mz ORCID: https://orcid.org/0000-0001-7384-4632
Received: 08 Feb 2026, Accepted: 15 Sep 2026, Published: 30 Sep 2026
Domain: Child and Adolescent Health
Keywords: Child sexual abuse, Prevalence, Risk factors, Mozambique, Adolescents
©Áuria Ribeiro Banze et al. Journal of Interventional Epidemiology and Public Health (ISSN: 2664-2824). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Cite this article: Áuria Ribeiro Banze et al. Unveiling childhood sexual abuse in Mozambique: A national prevalence study and call for targeted intervention. Journal of Interventional Epidemiology and Public Health. 2026; 9(3):158. https://doi.org/10.37432/jieph-d-26-00042
Introduction: Child sexual abuse (CSA) is a critical public health concern and a severe violation of human rights, leading to long-term physical, emotional, and psychological consequences. In Mozambique, CSA remains substantially underreported, limiting the effectiveness of prevention and response strategies. This study assessed the prevalence and factors associated with CSA among Mozambican youth using data from the 2019 Violence Against Children and Youth Survey (VACS).
Methods: We analyzed nationally representative, cross-sectional VACS data collected between July and September 2019. The analytic sample included 1,576 youth aged 18–24 years. Descriptive statistics and weighted Pearson’s chi-square tests examined bivariate associations. Multivariable logistic regression models accounting for sampling weights, clustering and stratification were used to identify factors independently associated with CSA.
Results: Overall, 9.4% of youth reported CSA. Prevalence was higher among females (15.0%) than males (10.0%) and among those aged 18–21 years (16.2%) compared with 22–24 years (7.1%). In adjusted models, female sex (adjusted odds ratio [aOR] 2.49; 95% CI: 1.31–4.71), younger age (22–24 vs. 18–21 years: aOR: 0.39; 95% CI 0.20–0.78), residence in the Southern region compared with the North (aOR: 2.28; 95% CI: 1.04–5.00), and having two or more lifetime sexual partners compared with one partner (aOR: 1.73; 95% CI: 1.02–2.95) were independently associated with higher odds of reporting CSA, while married participants had lower odds of reporting CSA than unmarried participants (aOR: 0.49; 95% CI: 0.26–0.90). Education level, employment status, age at first sexual intercourse, orphanhood status, and sex of household head were not significantly associated with CSA in the adjusted model.
Conclusion: CSA remains an important public-health concern among Mozambican youth. The findings support prioritizing prevention and response interventions for adolescent girls, who showed higher reporting of CSA in this study. Other observed associations should be interpreted cautiously because the cross-sectional design does not allow causal inference.
Childhood should be a time of innocence and healthy growth. However, for millions of children worldwide, it is marked by profound and often invisible suffering. Violence during childhood not only compromises children’s immediate well-being but also has devastating and long-lasting effects that reverberate throughout their lives [1–3]. In Mozambique and globally, children who experience such violence face a heightened risk of developing mental health disorders, including anxiety, mood disorders, and high-risk behaviours such as substance abuse and unsafe sexual practices [1,4,5].
Child sexual abuse (CSA) refers to any sexual activity involving a child who cannot give informed consent, whether due to age, developmental stage or power imbalance. It includes both contact acts (such as fondling or penetration) and non-contact acts, such as exposing a child to sexual acts or pornographic content. CSA often involves coercion, manipulation, deception, or an abuse of power [6]. According to the World Health Organization (WHO), CSA is the involvement of a person under 18 years in sexual activity that they do not fully comprehend, are unable to give informed consent to, or for which they are not developmentally prepared [7].
The health impacts of CSA are profound and diverse, ranging from physical issues such as injuries and malnutrition to severe mental disorders, including Post-Traumatic Stress Disorder (PTSD) and depression, along with an increased risk of suicide [2,3,8]. Research consistently demonstrates that CSA generates long-term developmental, behavioural and social consequences, extending well into adulthood, reinforcing the need for early identification and intervention [9–11].
According to the World Health Organization (WHO) Global Status Report on Preventing Violence Against Children 2020, approximately one in two children aged 2 to 17 years experience some form of violence each year [1]. Global meta-analytic estimates suggest that approximately 9% of girls and 3% of boys have experienced forced sexual intercourse [12], and approximately 120 million girls have experienced forced sexual contact before the age of 20 [1]. In Africa, the prevalence of sexual abuse is 20.2% for girls and 19.3% for boys [13]. Studies show that sub-Saharan Africa has some of the highest rates of child sexual violence, often exacerbated by poverty, armed conflict and harmful traditional practices such as early and forced marriage [14,15]. In Mozambique, early marriage remains a critical issue, with nearly 48% of girls married before the age of 18, increasing their vulnerability to sexual violence and exploitation [16].
Mozambique has recently strengthened its legal framework to protect children from early and forced unions. The 2019 Law on the Prevention and Combat of Premature Unions establishes 18 years as the minimum legal age for marriage for both girls and boys and prohibits child marriage, although gaps in enforcement and persistent social norms mean that early and informal unions remain common in many regions [17].
Despite the alarming situation, data on the magnitude of sexual violence in Mozambique remain scarce. Studies among school populations reveal that fewer than 5% of young people report having experienced sexual abuse, although underreporting remains a significant challenge [18]. Community-based studies suggest that many cases go unreported due to stigma, fear of retaliation, and lack of trust in law enforcement [15,19]. In addition, weaknesses in judicial and child protection systems, including limited enforcement of existing laws and inadequate survivor-friendly mechanisms, discourage victims from seeking justice and contribute to a cycle of impunity [16].
Although child sexual abuse persists, population-based prevalence estimates that accurately reflect the true scale of the problem are still lacking [5]. Underreporting, social norms that normalise or minimize violence, and limited child-friendly reporting channels make it difficult to obtain a comprehensive understanding of the prevalence and impact of child sexual abuse [18]. Moreover, there is a critical shortage of adequately trained professionals capable of identifying, documenting, and managing cases of child abuse in Mozambique, particularly in rural and low-resource settings where health and social services are limited [20]. The lack of specialized services and shelters for child survivors, as well as limited access to trauma-informed psychosocial support, further complicates recovery efforts and increases the likelihood of revictimization [21].
The objective of this study is to assess the prevalence of childhood sexual abuse among youth aged 18 to 24 in different sociodemographic contexts in Mozambique, identifying associated risk factors to inform and guide prevention and support policies and programs targeted at the most vulnerable groups. By understanding the specific factors that contribute to the vulnerability of children in Mozambique, the additional objective of this study is to provide evidence-based recommendations for interventions that can reduce the prevalence of sexual abuse and improve outcomes for survivors.
Study design
In the current study, we used data from the Mozambique Violence Against Children and Youth Survey (VACS-2019) conducted between July and September 2019 among children and youth aged 13 to 24 years. The VACS-2019 is a household cross-sectional, nationally representative survey implemented by the Government of Mozambique through the Instituto Nacional de Saúde (INS), in collaboration with the Instituto Nacional de Estatística (INE), the Ministry of Gender, Children and Social Action (MGCAS). and the Ministry of Health (MISAU), with technical assistance from the U.S. Centres for Disease Control and Prevention (CDC), United Nations Children’s Fund (UNICEF), and Together for Girls [22].
The survey employed a three-stage stratified cluster sample design with separate samples for males and females. The sample was stratified by province (Gaza and Zambezia only) and area of residence (urban or rural), covering 385 enumeration areas (EA) in the first stage. In the second stage, 25 households per EA were systematically selected, and in the third stage, one eligible participant aged 13–24 years was randomly selected from each household for interview. This included 2.973 households for males and 6.462 for females, during July to September 2019. The province of Sofala (with approximately 8% of the Mozambique population) was excluded from the survey due to significant infrastructure damage, displacement of residents, and humanitarian crisis after the landfall of cyclones Idai and Kenneth in March and April 2019, respectively [22]. This exclusion may affect the generalizability of findings to the entire country, particularly given Sofala’s unique coastal and peri-urban characteristics.
All analyses incorporated survey sampling weights and accounted for clustering and stratification, in accordance with VACS analytic guidelines. Weighted prevalence estimates were calculated using the survey weights provided in the VACS dataset, which account for the probability of selection, non-response, and post-stratification adjustments to align with population totals.
Study measures
The explanatory variables considered in this study were chosen based on previous empirical studies and their availability in the VACS dataset[22–24]. These included socio-demographic, sexual history and family background factors.
The socio-demographic variables included age (in years), sex, marital status, highest level of education, geographic region (North, Centre, South), and employment status. Sexual history variables included age at first sexual intercourse (categorised as <15, 15–17 and 18-24 years), whether the first sexual intercourse was pressured or forced, and the number of lifetime sexual partners (one partner and two or more partners). Family background variables included orphanhood status (not orphaned, orphaned before age 18 or orphaned after age 18) and sex of the household head. Additionally, we included condom use frequency among sexually active participants, categorised as “always” and “never/infrequent”. “Infrequent use” was defined as using condoms sometimes or almost never, but not at every sexual intercourse.
The outcome variable was CSA, defined as whether the participant reported any form of sexual abuse before age 18, based on VACS items capturing unwanted sexual touching, attempted sex, pressured sex and forced sex. Specifically, participants were asked about experiences before age 18, including: (1) being touched in a sexual way against their will, (2) being forced or pressured to have sexual intercourse, and (3) attempted sexual intercourse against their will. A positive response to any of these items was classified as CSA. This operational definition focuses on contact and attempted contact forms of CSA, consistent with the VACS methodology, and does not include non-contact forms such as exposure to pornography or sexual exploitation. Because CSA is defined as an event occurring before age 18, analyses were restricted to respondents aged 18–24 years who could retrospectively report childhood events. All variables were coded according to standard VACS definitions [25], and no recategorization beyond these specifications was applied.
Statistical analysis
For this study, we employed descriptive and multivariate analysis. Descriptive statistics were used to summarise the characteristics of the study population and to estimate the prevalence of the outcome variable across socio-demographic and child sexual abuse-related factors. To assess bivariate associations between the outcome and explanatory variables, we applied Pearson’s Chi-square test of independence with Rao-Scott correction, which accounts for the complex survey design. To examine the association between the covariates and child sexual abuse, both univariable and multivariable logistic regression analyses were performed to estimate crude odds ratios (ORs) and adjusted odds ratios (aORs), respectively, with corresponding 95% confidence intervals (CIs).
Owing to the epidemiological relevance of the selected covariates and the relatively small number of explanatory variables, all variables were included in the multivariable model regardless of their statistical significance in the unadjusted logistic regression. The final model was assessed for multicollinearity, and no variable was found to have a variance inflation factor (VIF) greater than five. Condom use was not included in the regression analysis due to a substantial amount of missing data.
All analyses accounted for the complex sampling design of the VACS, incorporating sampling weights, clustering and stratification using the survey package in R software, version 4.4.1. The results are presented in the form of percentages and odds ratios (OR) with corresponding 95% confidence intervals (CI) for regression estimates. Statistical significance was set at a two-sided alpha level of 0.05. It should be noted that the incorporation of sampling weights enabled us to estimate weighted prevalences. Sampling weights were constructed by the VACS survey implementation team to account for the probability of selection at each stage of the three-stage stratified cluster design (enumeration area, household and individual respondent) and were calibrated to national age-sex population totals (Table 2). Therefore, the percentages presented in this manuscript are weighted percentages.
Ethical considerations
The Mozambique VACS 2019 followed the ethical and safety guidelines set by the World Health Organization (WHO) for research on violence [26]. These guidelines require special protection for minors and vulnerable populations, including mandatory protocols for referral to support services for participants who disclose experiences of violence. The survey protocol underwent an independent review and received approval from the Mozambique Ministry of Health’s National Bioethics Committee (CNBS), the INS Institutional Ethics Committee (CIE), and the CDC Institutional Review Board. These approvals ensured that the rights and well-being of all human research participants were safeguarded.
Both the study protocols and the interviewer training complied with strict standards to guarantee the safety, privacy, and confidentiality of children and young people involved in the violence survey.
The informed consent process began with obtaining permission from the head of the household. For participants under 18, parental or guardian consent was mandatory. Individuals aged 18 and older, as well as emancipated minors, provided their own written informed consent. Emancipated minors were classified as those between 13 and 17 years old who were either married or had been previously married, living independently without adult supervision (with both parents deceased and not residing in a care facility), or acting as the head of a household while caring for siblings.
Among 1,576 youth aged 18–24 years, 157 participants reported CSA, corresponding to a weighted prevalence of 9.4%. Prevalence estimates were weighted to account for the complex survey design, including sampling weights, clustering, and stratification, in accordance with VACS analytic guidelines. Table 1 presents the distribution of CSA across socio-demographic, behavioural, and household characteristics.
CSA prevalence was significantly higher among younger respondents (16.2% among those aged 18–21 vs 7.1% among those aged 22–24; p=0.007) and was somewhat higher among females than males in the descriptive analysis, although this difference did not reach statistical significance (15.0% vs 10.0%; p=0.123). Differences by marital status were significant, with higher prevalence among unmarried (17.7%) than married youth (9.0%; p=0.008).
Marked regional variation was observed in the descriptive analysis. Prevalence reached 20.0% in the Southern region, 12.5% in the Central, and 8.5% in the North (p=0.020), and this regional difference was retained in the adjusted model. Employment status was not associated with CSA (12.2% among employed vs 13.2% among unemployed; p=0.724).
Regarding sexual behaviors, participants with two or more lifetime sexual partners showed higher prevalence (14.3%) than those with one partner (9.8%; p=0.059), a difference that reached statistical significance in the adjusted model. No meaningful differences were observed by age at sexual debut (15.1% among those <15 years; 14.3% at 15–17; 9.2% at 18-24; p=0.124).
With respect to family context and protection, no differences were found by orphanhood status (13.2% not orphan, 12.3% orphaned before 18, 11.8% orphaned after 18; p=0.900); prevalence was slightly higher in female- versus male-headed households (14.8% vs 11.2%; p=0.222); and condom use showed no association with CSA (12.3% infrequent/never use vs 19.1% consistent use; p=0.320, Table 1).
Married participants had significantly lower odds of reporting CSA compared with unmarried participants (aOR=0.49; 95% CI: 0.26–0.90; p=0.022). Compared with participants with primary education or less, those with secondary or higher education showed slightly higher, non-significant odds of reporting CSA (aOR=1.27; 95% CI: 0.72–2.27; p=0.409); educational attainment was therefore not independently associated with CSA after adjustment (Table 2).
Region was independently associated with CSA: youth in the Southern region had significantly higher odds of reporting CSA than those in the North (aOR=2.28; 95% CI 1.04–5.00; p=0.041), while the Central region did not differ significantly from the North (aOR=1.63; 95% CI 0.74–3.59; p=0.227). Having two or more lifetime sexual partners, compared with one partner, was also independently associated with higher odds of reporting CSA (aOR=1.73; 95% CI 1.02–2.95; p=0.043). No statistically significant associations were found for employment status, age at first sexual intercourse, orphanhood status, or sex of the household head.
In descriptive analyses, pressured or forced first sexual intercourse was associated with reported CSA. However, because this variable may overlap conceptually with the CSA outcome, it was excluded from the adjusted regression model to avoid collinearity and should not be interpreted as an independent predictor.
In this nationally representative sample of Mozambican youth, 9.4% reported CSA, providing an essential benchmark for understanding patterns of vulnerability and informing prevention efforts; CSA is preventable, and identifying population-level gradients is critical to guide policy and program responses. Five independent associations emerged from the adjusted model: females had higher odds of reporting CSA compared with males (aOR 2.49; 95% CI 1.31–4.71); youth aged 22–24 years had lower odds compared with youth aged 18–21 years (aOR 0.39; 95% CI 0.20–0.78); married participants had lower odds of reporting CSA compared with unmarried participants (aOR 0.49; 95% CI 0.26–0.90); youth in the Southern region had higher odds than those in the North (aOR 2.28; 95% CI 1.04–5.00); and youth reporting two or more lifetime sexual partners had higher odds than those reporting one partner (aOR 1.73; 95% CI 1.02–2.95). These five signals combine well-documented demographic gradients with behavioural and geographic factors and provide the anchor for interpreting the remaining findings.
The higher prevalence among females aligns with global evidence showing heightened exposure to coercion, exploitation and intimate-partner abuse, while boys continue to face structural barriers to disclosure shaped by masculinity stigma and fear of judgement [6,27]. In magnitude, our estimates are within the international range reported by confidential self-report surveys using comparable operational definitions [1,8,12]. Recent global modelling further underscores large sex gaps and pinpoints early adolescence as a critical window for prevention and early response [13].
The age pattern likely reflects recall effects, with younger respondents more likely to disclose due to reduced memory decay and greater proximity to the event [8,12]. Programmatically, this supports life-course-sensitive prevention with higher intensity in late adolescence and the transition to adulthood, coordinated across schools, community services and digital environments, with differentiated messaging for girls and boys [1,2]. While survivor selection among older youth cannot be excluded, this hypothesis requires longitudinal designs and cannot be tested in our cross-sectional data.
Married participants had significantly lower odds of reporting CSA compared with unmarried participants (aOR 0.49, 95% CI 0.26–0.90, p=0.022). This finding should not be interpreted simply as evidence that marriage is protective. In Mozambique, child marriage and early unions remain highly prevalent, with nearly half of girls married before the age of 18 and many unions occurring in informal or customary settings, which can increase vulnerability to sexual violence [17,16,28]. Under these conditions, married young people may be less likely to recognise certain experiences as abusive, especially when coercion occurs within marital or family relationships, and strong norms around family privacy and loyalty may discourage disclosure [1,27,16]. Therefore, the lower odds of reporting CSA among married participants in this study may reflect both differences in exposure and substantial underreporting and should be interpreted with caution rather than as a straightforward protective association. Educational attainment showed a small, statistically non-significant positive association with reporting CSA: compared with participants with primary education or less, those with secondary or higher education had slightly higher odds of reporting CSA (aOR 1.27, 95% CI 0.72–2.27, p=0.409); educational attainment was therefore not independently associated with CSA in the adjusted model. This finding should be interpreted cautiously, as the cross-sectional design precludes causal inference and the confidence interval is wide. Any residual gradient may reflect differences in recognition, disclosure, or willingness to report abusive experiences rather than a direct effect of schooling on CSA risk; more-schooled youth may possess better health literacy and greater awareness of abusive experiences, which may increase their likelihood of disclosure. [6,27]. Meta-analyses show that operational definitions and instruments can shift prevalence and association estimates substantially, cautioning against assuming intrinsically higher risk among more-schooled groups [10,12]. Narrative clinical syntheses in adolescents similarly highlight how service proximity and literacy shape recognition, help-seeking and continuity of care [29] .
In descriptive analyses, pressured or forced first sexual intercourse was associated with reported CSA. This association was not included in the adjusted regression model due to conceptual overlap with the CSA outcome. Approximately one third of participants who reported pressured or forced first sexual intercourse did not report CSA according to the operational definition used in this study, which may reflect differences in question wording, age at the coerced event, or reasons for non-disclosure. This highlights the importance of using behaviourally specific questions and interpreting sexual coercion variables cautiously when they overlap with the outcome being studied. This finding should be interpreted descriptively only and does not represent an independent predictor of CSA.
Early coerced sexual experiences have been linked in multiple studies to long-term mental-health and psychosocial sequelae across the life course, including increased risk of internalising disorders, depression, anxiety and other adverse outcomes in adulthood and older age [1,11,30].
Geographical variability was retained after adjustment: youth in the Southern region had significantly higher odds of reporting CSA than those in the North (aOR 2.28, 95% CI 1.04–5.00, p=0.041), while the Central region did not differ significantly from the North (aOR 1.63, 95% CI 0.74–3.59, p=0.227). This regional gradient may reflect differences in sociodemographic composition, social norms, access to services, and willingness to disclose experiences of sexual violence [1,19], and may also relate to uneven implementation of national legal and policy frameworks such as the 2019 Law on the Prevention and Combat of Premature Unions (Lei n.º 19/2019) across provinces. In addition, local evidence documents persistent gaps in emergency-care screening, documentation and protocolized referral pathways across multiple regions of Mozambique, suggesting that system-level constraints are widespread and represent immediate operational priorities for strengthening the health-sector response, particularly in the Southern region [16,20,21].
Youth reporting two or more lifetime sexual partners had significantly higher odds of reporting CSA than those reporting one partner (aOR 1.73, 95% CI 1.02–2.95, p=0.043). This association may reflect greater cumulative exposure to risk contexts among youth with more partners, but could also reflect a reverse pathway, whereby early sexual abuse increases subsequent risk behaviour and number of partners. Given the cross-sectional design, the direction of this association cannot be established, and it should be interpreted as a marker of vulnerability rather than as an independently modifiable risk factor.
CSA reporting was slightly higher among youth living in female-headed households than among those living in male-headed households in the descriptive analysis (14.8% vs. 11.2%; p=0.222). However, this difference was not statistically significant, and sex of the household head was not independently associated with reported CSA in the adjusted model (aOR 0.94, 95% CI 0.55–1.61, p=0.823). This finding should therefore be interpreted with caution. The sex of the household head alone does not capture the complexity of family life, including whether the child lived with one or both parents, the presence of other adult caregivers, household economic vulnerability, or the quality of relationships within the household. Evidence from sub-Saharan Africa suggests that children’s vulnerability to sexual violence may be shaped more by household structure, parental absence, and family disruption than by the sex of the household head alone [14]. Therefore, this variable should be interpreted as a limited proxy for household context rather than as an independent indicator of CSA risk.
Limitations
The study has several limitations. First, the cross-sectional design precludes causal inference; associations identified in this study should be interpreted as correlates rather than determinants of CSA. Second, retrospective self-report is subject to recall bias, particularly among older respondents (aged 22-24 years), and social desirability bias may have contributed to underreporting, especially among males. Third, the exclusion of Sofala province (approximately 8% of the population) due to cyclone damage may affect the generalizability of findings to the entire country, particularly given Sofala’s unique coastal and peri-urban characteristics. Fourth, important contextual risk factors (e.g., caregiver history of violence, detailed socioeconomic status, household composition, quality of family relationships) were not available in the dataset, limiting the explanatory depth of the analysis. Fifth, the requirement for parental consent for participants under 18 may have introduced selection bias, potentially excluding youth in abusive situations where parents were the perpetrators. Finally, temporality between some variables (e.g., educational attainment and CSA) could not be established, and the direction of association remains unclear.
Supplementary note on variable exclusion
The variable ‘pressured or forced first sexual intercourse’ was excluded from the adjusted regression model due to conceptual overlap with the CSA outcome. Although this variable showed a strong descriptive association with CSA, it may itself constitute an incident of CSA and was therefore not included as an independent predictor. Descriptive findings related to this variable are presented in Table 1 and discussed cautiously in the discussion section. This decision was made to avoid collinearity and ensure that the adjusted model reflects independent associations with CSA.
This study found that childhood sexual abuse remains an important public-health concern among Mozambican youth aged 18 to 24 years. The findings support prioritising prevention and response interventions for adolescent girls and young women, younger adolescents, and youth in the Southern region, who showed higher, independently associated odds of reporting CSA in this study.
Associations with marital status, number of lifetime sexual partners, and other sociodemographic factors should be interpreted with caution. Cross-sectional design does not allow causal inference, and some patterns may reflect differences in recognition, disclosure or reporting rather than direct risk. The lower reporting among married youth, for example, should not be interpreted as evidence that marriage is protective, given the high prevalence of child marriage and early unions in Mozambique and the potential for underreporting within intimate relationships. Similarly, the association with a higher number of lifetime sexual partners should be interpreted as a marker of vulnerability rather than a modifiable risk factor, given the possibility of reverse causation. Future studies should prioritize the inclusion of marginalized populations, including out-of-school youth and those in informal unions, to better understand the full spectrum of CSA experiences and reporting barriers. Based on the findings of this study, the following considerations are offered for policy and programmatic action
Prioritize adolescent girls in prevention strategies: Given the higher prevalence of CSA reported among females, prevention programs should prioritize adolescent girls through age-appropriate and gender-responsive interventions. This recommendation is directly supported by the observed higher prevalence among females in this study.
Strengthen surveillance and reporting systems: Given the likelihood of underreporting, particularly among boys and married youth, efforts should be made to strengthen safe, confidential, and youth-friendly mechanisms for disclosure. This recommendation is derived from the observed patterns of reporting and the known limitations of self-report data.
Implement age-specific prevention: The higher prevalence among younger respondents (18-21 years) suggests the need for targeted prevention efforts during late adolescence. This recommendation is supported by the observed age gradient in CSA reporting.
Target high-burden regions and vulnerability markers: Given the independently higher odds of reporting CSA among youth in the Southern region and among those with a higher number of lifetime sexual partners, prevention and response resources should be prioritized geographically, and services should be linked with sexual and reproductive health programs that reach youth with multiple partners. This recommendation is directly supported by the significant adjusted associations observed for region and lifetime sexual partners in this study.
What is already known about the topic
What this study adds
The authors of this work declare no competing interests.
Availability of data and materials
All study information and datasets are fully accessible at the Mozambique Instituto Nacional de Saúde (INS) data repository for researchers who meet the criteria for accessing confidential data. The data originates from the VACS 2019 study, and the authors can be contacted through: http:/www.ins.gov.mz.
Conceptualization: Áuria Ribeiro Banze
Formal Analysis: Rachid Muleia
Investigation: Angelo Augusto
Validation: Áuria Ribeiro Banze, Nilsa Nascimento, Angelo Augusto, Rachid Muleia, Cynthia Semá Baltazar
Visualization: Áuria Ribeiro Banze, Angelo Augusto, Rachid Muleia
Supervision: Angelo Augusto
Writing – Original Draft: Áuria Ribeiro Banze
Writing – Review & Editing: Nilsa Nascimento, Angelo Augusto, Rachid Muleia, Cynthia Semá Baltazar
| Characteristics | CSA (%) | No CSA (%) | p-value |
|---|---|---|---|
| Age group (years) | |||
| 18-21 | 108 (16.2) | 863 (83.8) | 0.007 |
| 22-24 | 48 (7.1) | 557 (92.9) | |
| Sex | |||
| Male | 27 (10.0) | 363 (90.0) | 0.123 |
| Female | 129 (15.0) | 1057 (85.0) | |
| Marital status | |||
| Not married | 80 (17.7) | 463 (82.3) | 0.008 |
| Married | 76 (9.0) | 955 (91) | |
| Highest level of education | |||
| Primary/never | 53 (10.4) | 680 (89.6) | 0.228 |
| Completed Secondary school or higher | 103 (14.6) | 733 (85.4) | |
| Region | |||
| North | 20 (8.5) | 291 (91.5) | 0.020 |
| Center | 58 (12.5) | 655 (87.5) | |
| South | 78 (20) | 474 (80) | |
| Employment status | |||
| Yes | 54 (12.2) | 434 (87.8) | 0.724 |
| No | 102 (13.2) | 986 (86.8) | |
| Number of lifetime partners | |||
| One | 47 (9.8) | 582 (90.2) | 0.059 |
| Two or more | 109 (14.3) | 838 (85.7) | |
| Age at sexual debut | |||
| <15 | 43 (15.1) | 290 (84.9) | 0.124 |
| 15-17 | 85 (14.3) | 674 (85.7) | |
| 18-24 | 28 (9.2) | 456 (90.8) | |
| Orphanhood status | |||
| Not orphan | 100 (13.2) | 866 (86.8) | 0.900 |
| Orphan before 18 | 41 (12.3) | 385 (87.7) | |
| Orphan after 18 | 15 (11.8) | 160 (88.2) | |
| Sex of household head | |||
| Male | 73 (11.2) | 690 (88.8) | 0.222 |
| Female | 82 (14.8) | 725 (85.2) | |
| Condom Use | |||
| Infrequent | 113 (12.3) | 1148 (87.7) | 0.320 |
| Always | 34 (19.1) | 165 (80.9) | |
| * Percentages are weighted to account for the VACS complex survey design including sampling weights, clustering, and stratification. | |||
| † The variable ‘pressured or forced first sexual intercourse’ is not included in this table because it may itself constitute a CSA event under our operational definition. Descriptive findings for this variable are reported in the Results section. | |||
| ‡ Denominators vary slightly across characteristics due to item-level missing data, handled by listwise deletion within each variable; percentages are calculated based on the number of participants with non-missing data for each characteristic. | |||
| Table 2: Factors associated with childhood sexual abuse (CSA) among youth aged 18–24 years, Mozambique VACS 2019 | |||||
|---|---|---|---|---|---|
| Factor | Crude OR (95% CI) | P-value | Adjusted OR (95% CI) | P-value | |
| Age group (years) | |||||
| 18–21 | Ref | Ref | |||
| 22–24 | 0.41 (0.22–0.8) | 0.009 | 0.39 (0.20–0.78) | 0.008 | |
| Sex | |||||
| Male | Ref | Ref | |||
| Female | 1.58 (0.88–2.84) | 0.125 | 2.49 (1.31–4.71) | 0.005 | |
| Marital status | |||||
| Not married | Ref | Ref | |||
| Married | 0.46 (0.26–0.82) | 0.009 | 0.49 (0.26–0.90) | 0.022 | |
| Highest level of education | |||||
| Primary or less | Ref | Ref | |||
| Secondary or higher | 1.47 (0.78–2.76) | 0.230 | 1.27 (0.72–2.27) | 0.409 | |
| Region | |||||
| North | Ref | Ref | |||
| Center | 1.55 (0.71–3.36) | 0.273 | 1.63 (0.74–3.59) | 0.227 | |
| South | 2.69 (1.36–5.32) | 0.005 | 2.28 (1.04–5.00) | 0.041 | |
| Employment status | |||||
| Yes | Ref | Ref | |||
| No | 1.09 (0.68–1.75) | 0.724 | 0.88 (0.51–1.52) | 0.657 | |
| Number of lifetime partners | |||||
| One | Ref | Ref | |||
| Two or more | 1.54 (0.98–2.4) | 0.061 | 1.73 (1.02–2.95) | 0.043 | |
| Age at sexual debut | |||||
| < 15 | Ref | Ref | |||
| 15–17 | 0.94 (0.55–1.61) | 0.823 | 0.75 (0.44–1.3) | 0.308 | |
| 18–24 | 0.57 (0.35–0.91) | 0.020 | 0.58 (0.33–1.02) | 0.061 | |
| Orphanhood status | |||||
| Not orphan | Ref | Ref | |||
| Orphan before 18 | 0.92 (0.57–1.48) | 0.727 | 0.8 (0.50–1.27) | 0.340 | |
| Orphan after 18 | 0.87 (0.4–1.89) | 0.731 | 0.92 (0.46–1.86) | 0.815 | |
| Sex of household head | |||||
| Male | Ref | Ref | |||
| Female | 1.37 (0.83–2.27) | 0.223 | 0.94 (0.55–1.61) | 0.823 | |
| * Adjusted odds ratios derived from multivariable logistic regression models accounting for the VACS complex survey design. | |||||
| 1 Coerced or pressured first sexual intercourse may itself constitute a CSA event; therefore, this variable reflects conceptual overlap and possible separation in the model and should not be interpreted as an independent predictor. | |||||