Academic journal article Bulletin of the World Health Organization

Homicide in Children and Adolescents: A Case-Control Study in Recife, Brazil

Academic journal article Bulletin of the World Health Organization

Homicide in Children and Adolescents: A Case-Control Study in Recife, Brazil

Article excerpt

Voir page 6 le resume en francais. En la pagina 6 figura un resumen en espanol.

Introduction

Violence is a global problem and mortality associated with it is particularly high in the Americas. In Brazil, for example, external causes are the second leading cause of death overall and the principal cause among those aged 15-19 years, where they account for about 80% of all deaths; homicide is the main cause of death, being responsible for close to 30% of deaths among this age group, with the vast majority of deaths (93%) occurring among males (1). Between 1977 and 1994 the specific death rate due to homicide increased by 160% nationwide. Firearm-related mortality is particularly high in large urban centres and is alarmingly so in Rio de Janeiro and Recife (2, 3); the highest incidence is reported among males aged 15-19 years, but younger age groups are also seriously affected (4). Such a high rate of homicide and violence is a burden for health and health services (5).

The main cause of violence is poverty, and the reduction of poverty is the most important preventive intervention. But what can be done to reduce homicide among children and adolescents at the moment? The risk factors associated with homicide and violence and potentially effective primary prevention strategies have recently been reviewed in the USA (6), where firearm-related death rates among teenagers are up to 20 times higher than those in Europe (7) and are by far the highest among industrialized and upper-middle-income countries (8, 9). But risk factors and preventive strategies differ according to the setting, despite some similarities in violence and homicide rates. The objective of this study was to identify modifiable factors associated with homicide in children and adolescents that could be used for preventive interventions in Recife and possibly other similar areas of Brazil.

Materials and methods

The study was conducted in the city of Recife (population, 1.35 million) in the state of Pernambuco, north-east Brazil. The estimated mid-year population in the age group 0-19 years in 1997 was 518 000. For the present study, the cases were homicide victims under 20 years of age, who had been identified at the Institute of Forensic Medicine (IFM), Metropolitan Police Department, Recife, between 1 January and 31 December 1997. They represent most of the homicide victims among under-20-year-olds in Recife in 1997, since only those corpses that disappear from a murder scene (number unknown but probably low) do not end up at IFM for autopsy. The controls were identified (1:1 ratio with cases) among children and adolescents living in the same neighbourhood as the cases, and were paired by age and sex. In practice, after identifying the residence of a case, the control was the first individual of the same age and sex identified after walking to the right from house to house in the same road up to a maximum distance of 500 m. If no control was found to the right, the procedure was repeated to the left. All controls were identified within one week of identification of each case.

After a pilot phase in late 1996, during which an unsuccessful attempt was made to first interview the relatives of the cases at home and gather data through the police officers at IFM, we concluded that the most reliable data collection tool was in anonymous questionnaire administered by female community health workers. As members of the community trained to deal with common child health problems, these workers are well accepted by families mainly because they share the same language and culture. For the purpose of this study, they were issued white uniforms by the Instituto Materno Infantil de Pernambuco, a well-known non-profit hospital in Recife, to demonstrate that they had no connection with police activities. Two interviewers handed a questionnaire to the closest available relative of each case at IFM on the day the family came to claim the corpse after the autopsy. …

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