To examine the epidemiological patterns and trends of sexual violence against adults and children before and during the COVID-19 pandemic in the Buffalo City and Amathole districts of the Eastern Cape Province, South Africa.

Observational, retrospective, cross-sectional study based on a review of medical records of survivors of sexual violence who reported for healthcare between January–December 2019 and January–December 2020.

The study was conducted in two healthcare facilities in the Buffalo City and Amathole districts of the Eastern Cape Province, South Africa.

A total of 1957 survivors of sexual violence presented for healthcare at the two healthcare facilities during the study period. Inclusion criteria were survivors of all ages with confirmed cases of sexual violence; records with no evidence of sexual violence were excluded.

Primary outcome measures were prevalence and distribution of sexual violence before and during the COVID-19 pandemic. The secondary outcome measures were demographic characteristics of survivors (age, sex and ethnicity), perpetrator identity and location of incidents.

The majority of survivors were female (93.6%), and 49% were under 18 years of age. Most were Black (96.3%) and resided in rural (45.6%) or semiurban (45.6%) areas. Perpetrator identity was unknown in 42.5% of cases. Among known perpetrators, non-partners such as neighbours (22.5%) and family members (13.6%) were most common. More cases were reported pre-pandemic (n=930; 60.5%) compared with during the pandemic (n=608; 39.5%). During the pandemic, 45.0% of cases occurred in the perpetrator’s home, and 53.7% occurred in rural settings. Most pandemic-period cases (63.1%) were reported during alert level 1, when most social and economic activities had resumed.

Overall, there was a high rate of sexual violence, with trends correlating with the extent of COVID-19 restrictions; the highest rates were reported pre-pandemic and during alert level 1. These findings highlight the importance of prioritising the safety of women and children and informing protective strategies in both rural and urban areas during future emergency responses.