Noodlottige kindermishandeling: ‘n literatuuroorsig en die profiel in die Suid-Vrystaat (1995-2003)/ Fatal child abuse: a literature review and the profile in the Southern Free State (1995-2003)

Abstract

Introduction: Child abuse is a social problem with far-reaching consequences. Serious underreporting of cases occurs, and no studies could be found which investigates the South African context of the problem. In this study we aimed to determine the profile of victims of fatal child abuse in the Southern Free State. Methods: All child deaths of children 10 years and younger in the period 1 January 1995 to 31 December 2003 were identified in the register of deaths at the SA Police Mortuary, Bloemfontein. The reports of these deaths were evaluated to identify possible cases of fatal child abuse. Irrelevant reports were eliminated until a group of possible cases of fatal child abuse were identified. In cases where there was uncertainty about the cause of death, a registrar in Forensic Medicine was consulted. In some cases she advised that a history be obtained from police reports. Cases which could not be confirmed in this way were included in a so-called grey area. Nineteen cases were identified, and a further 4 placed in the grey area. Results: Of the 19 cases, the majority were female (14). The median age of cases was 2 years. Cases showed an even distribution regarding race. No patterns regarding annual or monthly distribution were found. Most victims, 73.7% (14 of 19 cases), were of normal weight and no victims suffered from malnutrition. Head injuries were the most common cause of death (63.2%) followed by multiple injuries (21.2%). Conclusion: If doctors are aware of the signs of child abuse cases can be identified early. In this way a significant decrease in mortality and morbidity can occur. ___________________________________________________ Inleiding: Kindermishandeling is ’n sosiale probleem met verreikende gevolge. Ernstige onderrapportering van gevalle vind plaas, en geen studies kon opgespoor word wat die Suid-Afrikaanse konteks van die probleem ondersoek nie. In hierdie studie is gepoog om die profiel van die slagoffers van noodlottige kindermishandeling in die Suid-Vrystaat te ondersoek. Metodes: Alle kindersterftes van kinders van tien jaar en jonger is uit die register van sterftes by die SAPD- (Suid-Afrikaanse Polisiediens-)lykshuis, Bloemfontein, geïdentifiseer. Hierdie sterftes se verslae is vir gevalle van noodlottige kindermishandeling geëvalueer. Irrelevante verslae is geëlimineer totdat ’n groep moontlike gevalle van noodlottige kindermishandeling verkry is. In gevalle waar daar twyfel oor die oorsaak van dood was, is ’n kliniese assistent in Geregtelike Geneeskunde geraadpleeg. In sommige gevalle het die assistent aanbeveel dat ’n geskiedenis uit polisieverslae verkry moes word. Indien gevalle nie op so ’n wyse bevestig kon word nie, is dit in die sogenaamde ‘grys area’ ingesluit. Negentien gevalle is geïdentifiseer en vier is in die grys area geplaas. Resultate: Uit die 19 gevalle was die meerderheid vroulik (14). Die mediaanouderdom van slagoffers was twee jaar. Die slagoffers toon ’n eweredige verspreiding t.o.v. ras. Geen patroon kon geïdentifiseer word in die jaarlikse en maandelikse verspreiding van sterftes nie. Die meeste van die slagoffers, 73.7% (14 van 19 gevalle), was van normale massa, en geen slagoffers het aan ’n wanvoedingsiekte gely nie. Hoofbeserings was die algemeenste oorsaak van sterftes (63.2%), gevolg deur veelvuldige beserings (21.2%). Gevolgtrekking: Indien dokters bedag is op die tekens van kindermishandeling, kan gevalle vroeg geïdentifiseer word. Sodoende kan ’n beduidende verlaging in mortaliteit en morbiditeit bewerkstellig word.