Numerous studies from Africa and the rest of the world had shown that child sexual abuse (CSA) is a considerable public health problem
. However, until recently little attention has been paid to CSA in sub-Saharan Africa (SSA). Most of the peer-reviewed research on the sexual abuse of children in SSA is largely confined to the Republic of South Africa
 while other reported studies in SSA are in the context of school. The current data on Africa from the World Health Organization Global School-based Student Health Survey estimated lifetime prevalence of sexual abuse among primary students aged between 13–15 years in the five countries surveyed in SSA to range from 9% to 33%
. In a cross study comparison of prevalence of CSA in South Africa, between 3.2% and 7.1% of all respondents report experiencing unwanted or forced sexual intercourse as a child
. In Swaziland, the prevalence of sexual violence before 18 years of age was 33.2% among participants aged 13–24 years
. While the understanding of the burden of sexual abuse in children and its relationship with adverse health behaviour has increased globally, such studies in children are nonexistent in Africa. In addition, the nature and causes of CSA is complicated due to many factors, including sexual behaviours.
When dealing with sexual behaviours, it is widely believed that focusing on individual levels ignores the broader social context within which sexual behaviour occurs. Previous studies that have investigated factors affecting CSA in SSA were based solely on the assessment of the impact of individual level variables
[4–10]. However, other violence research has indicated the importance of community level factors as well as measures of social disorganization and experience of sexual violence
. It is important to examine whether this relationship is applicable to CSA. Thus, this study draws upon social disorganization theory
 to examine and better understand community characteristics that may predict CSA. Although originally concerned with community conditions like delinquency and crime, social disorganization theory offers potentially important insights concerning how the characteristics of communities might be related to sexual violence. This study relies on a framework centred on the social disorganization theory (or model) to investigate the impact of neighborhood level factors on childhood sexual abuse. The framework conceptualises CSA as a multifaceted phenomenon based on interplay of individual, family, community and societal factors. In addition, the model takes into account measures of social disorganization and their role in influencing CSA.
Social disorganization identifies neighbourhood poverty, residential instability, family disruption, population density and proximity to urban areas as key structural factors that diminish community-level self-regulatory capacity
. The social disorganization thesis argues that communities with strong informal social networks are able to monitor and regulate sexual violent behavior
. Consequently, structural factors that increase the complexity of community social organization and undermine informal social networks enhance the range of sexual violent behaviours pursued by residents
[14, 15]. Poverty reduces the resources necessary to sustain basic institutions like the family and organizations in neighbourhoods
. Social disorganization theory hypothesizes that the disruptive effects of immigration, industrialisation and urbanisation lead to changes in the social structure of neighbourhoods via ethnic diversity, residential instability and neighbourhood poverty. The resulting structural changes diminish the social cohesion of neighbourhoods and reduce the power of the social norm and the informal social control required to regulate deviant behaviour. This can result in CSA. The theory proposed that high ethnic diversity gives rise to social isolation
. This in turn leads to structural barriers and cultural adaptations that undermine social organization. Shaw and McKay
 also traced social disorganization to conditions endemic to the urban areas that were the only places the newly arriving poor could afford to live, resulting in a high rate of turnover in the population (residential instability). These high levels of residential turnover can disrupt existing social networks. Urbanisation has been found to be negatively associated with the coherency of the normative environment
. Increasing urbanisation may give rise to an environment facilitating higher levels of sexual violent activity by creating greater anonymity with minimal risk of being “found out”
. Non-traditional family structures, such as female-headed (matriarchal) households for example, have been linked to social disorganization. Social disorganization has received support from research conducted on extramarital sexual activity of Zambian men
. Research on extramarital sex is supported by Bishai and colleageus
 who found Ugandan men in ethnically heterogeneous communities to be more likely to report such activities.
To the best of our knowledge, there has been no multilevel study performed to date that examined the association between community-level measures of social disorganization and experience of CSA in the context of SSA.
Thus, the aim of this study is to answer the following research questions:
Do neighbourhoods and countries differ in terms of the risks of CSA?
Are neighbourhood-level measures of social disorganization associated with self-reported CSA after adjustment for individual-level variables?