Developing an understanding of fatal child abuse and neglect: Results from the South African child death review pilot study

Abstract

Fatal child abuse is the severest consequence of violence against children. Yet, little is known about this phenomenon, as routine data do not describe it. Child death review (CDR) teams have been established to systematically review deaths from birth to adolescence as a public health response to better identify child abuse deaths, to develop policy and to improve the child protection response. This article describes the incidence of fatal child abuse and injury patterns associated with such deaths. CDR teams reviewed all child fatalities from 1 January to 31 December 2014 at two pilot sites in South Africa (SA). Data were collected on demographics, causes and circumstances of the death, and family social context. We assessed the feasibility of CDR teams in the SA setting to strengthen the identification of child abuse deaths and influence practice. A total of 707 cases were reviewed. Over half (52.4%) of the deaths were due to natural causes. A third were caused by murder, with nearly half (44%) of all murders attributed to fatal child abuse. The burden of fatal child abuse and neglect was found among the <1-year age group. Abandonment at birth was most common, followed by blunt force injuries and strangulation/asphyxiation deaths. CDR teams are effective in better identifying deaths due to child abuse and neglect via a multidisciplinary approach and regular case reviews.