Fatal child abuse in South Africa – what can we gain by establishing Child Death Review Teams?

In Cape Town, we pride ourselves on knowing the number of people who use the Aerial Cableway annually, to reach the top of Table Mountain – recently named among the New7Wonders of Nature. With the City having recently taken the top spot on the New York Times’ list of 52 places to visit in 2014, we watch with interest the number of regional and international visitors to our City.

Yet, argues Archbishop Emeritus Desmond Tutu, in Cape Town, “it’s impossible to tell how many children have been brutally violated and/or killed over any given period because nobody appears to keep such records” (Weekend Argus, 22 March 2014).

Until recently, very little was known about child deaths in the context of violence in South Africa. The first national child homicide study recently established that 1018 children died due to homicide in 2009 at the rate of 5.5 per 100 000 children under 18 years[1].  The study also showed for the first time a relationship between child homicide and fatal child abuse in South Africa and estimated that just under half (44.6%) of child homicides occurred in a context of child abuse and neglect. Almost three quarters (74%) of fatal child abuse occurred in the 0-4 year age group, with most of these deaths occurring in the home.  In addition, the study found that medical practitioners, particularly forensic pathologists, deviated from their legal and ethical obligation to report suspected cases of child abuse and that these cases remain unreported[2].

After consulting with the South African Police Service, the Department of Justice and Constitutional Development, the Department of Social Development and Civil Society Organisations, the Children’s Institute has conceptualised a child death review mechanism which is soon to be piloted in two provinces in South Africa. The model proposes the establishment of multi-sectoral child death review teams to routinely investigate all child injury deaths in South Africa. The main purpose of child death review teams is to conduct a comprehensive review of suspected child abuse deaths, all injury-related child deaths, or all child deaths. Child death reviews aim to better understand how and why children die, and to use those findings to prevent other deaths and improve the health, safety and well-being of all children in the country.  Child death review teams will consist of core representatives from law enforcement, child protection/social services, a paediatric nurse/paediatrician, forensic pathologist and a prosecutor.

The mechanism will be piloted in the Western Cape and KwaZulu Natal in 2014.  In a context where violence against children seems to have become a pervasive problem in South Africa, the establishment of child death review teams promises to provide important vital statistics, as well as a strategy for ensuring that the cause of all child injury deaths in South Africa is identified, investigated and respond to, by child protection services.

[1] Mathews S, Abrahams N, Jewkes R, Martin LJ & Lombard C (in press). The epidemiology of child homicides in South Africa. Bulletin of the World Health Organisation.

[2] Mathews S, Abrahams N, Jewkes R, Martin LJ (2013). Underreporting child abuse deaths: Experiences from a national study on child homicide. South African Medical Journal, 103(3):132-133.


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