Academic journal article Bulletin of the World Health Organization

The Epidemiology of Child Homicides in South Africa/Epidemiologie Des Homicides D'enfants En Afrique Du Sud/ la Epidemiologia De Los Homicidios De Menores En Sudafrica

Academic journal article Bulletin of the World Health Organization

The Epidemiology of Child Homicides in South Africa/Epidemiologie Des Homicides D'enfants En Afrique Du Sud/ la Epidemiologia De Los Homicidios De Menores En Sudafrica

Article excerpt

Introduction

Thousands of children are victims of homicide annually, despite the right to protection and care afforded under the United Nations Convention on the Rights of the Child. (1) Child homicides receive relatively little attention in terms of public health and policy in most countries and research on the subject is seldom conducted, especially in low- and middle-income settings. An increasing evidence base shows that homicides contribute substantially to the burden of premature death among males between the ages of 15 and 24 years. (2) Mortality trends observed in 50 countries belonging to all income categories over a 50-year period (1955 to 2004) clearly point to a progressive rise in violent deaths among young men, a trend that is expected to continue in developing countries. (3) In 2002, an estimated 53 000 child homicides took place in the world and the highest child homicide rates were observed in sub-Saharan Africa, although the data from this region was scarce and of questionable quality. (3)

Young children are at greater risk of being killed as a result of child abuse than adolescents, who are most commonly killed during episodes of interpersonal violence. (1,3,4) Although a large proportion of child homicide deaths result from child abuse, many are thought to be under-detected in routine surveillance systems, (5) largely owing to under-reporting and concealment. Only one third of all child deaths resulting from child abuse are classified as homicides. (5) Children in the first year of life are the most vulnerable to becoming victims of homicide, (6,7) including maternal infanticide. (8,9) The killing of female infants is a recognized problem in some patriarchal societies where girls are less valued than boys and viewed as a financial liability. (10) A homicide study in Dar-es-Salaam, in the United Republic of Tanzania, showed a very high rate of early infanticide (27.7 per 100000 infants less than 1 week old) but an overall homicide rate among children younger than 15 years of 0.54 per 100 000. (11) Older children are much less likely to experience fatal abuse or neglect, but homicide patterns among young men mirror those in adult males, with the crime often committed by friends, acquaintances or strangers. (12,13)

Little is known about child homicide in South Africa. According to one study in four cities among children younger than 15 years, homicide rates in the country resemble global rates. (14) Even less is known about child abuse and neglect leading to death, but child maltreatment is believed to be common. In South Africa rape, including child rape, has a high incidence, as do all forms of sexual abuse. Physical punishment, often severe, has been reported as ubiquitous and emotional abuse and neglect are common. (15) The need for child protection services far outweighs the ability of existing services to respond. (16) Understanding the epidemiology of child abuse that culminates in death is critical for developing and monitoring interventions to prevent it. To explore this problem in South Africa we conducted a nationwide study of child homicide as part of a broader study of female homicide, whose findings are reported elsewhere. (17) In this article we describe the incidence of child homicide and of fatal child abuse and neglect (defined in the section that follows), by age and sex.

Methods

We conducted a retrospective, national mortuary-based study of the female and child homicide cases that were brought before a sample of South Africa's state-run medicolegal laboratories (mortuaries) between 1 January and 31 December 2009. Under the Inquest Act of 1959, anyone who dies from a non-natural cause in South Africa has to undergo a post-mortem examination. (18,19) Hence, we sampled the country's medicolegal laboratories to identify deaths from homicide in children aged younger than 18 years. To obtain a nationally-representative sample of homicides, we included in the sampling frame all 123 medicolegal laboratories that were operating in South Africa in 2009. …

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