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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 50year 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 53000
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 100000.11
Methods
We conducted a retrospective, national mortuary-based study
of the female and child homicide cases that were brought before
a sample of South Africas 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 countrys medicolegal laboratories to identify deaths from homicide in children aged younger
than 18 years. To obtain a nationally-representative sample of
Gender and Health Research Unit, Medical Research Council, PO Box 19070, Tygerberg 7405, Cape Town, South Africa.
Forensic Medicine and Toxicology, University of Cape Town, Cape Town, South Africa.
c
Biostatics Unit, Medical Research Council, Cape Town, South Africa.
Correspondence to Shanaaz Mathews (e-mail: shanaaz.mathews@uct.ac.za).
(Submitted: 26 December 2012 Revised version received: 14 April 2013 Accepted: 18 April 2013 Published online: 31 May 2013)
a
562
Research
Epidemiology of child homicides in South Africa
81
33
9
123
20 (24.7)
13 (39.4)
5 (55.5)
38 (30.9)
Results
According to our estimate, 1018 (95% CI:
8431187) child homicides occurred in
South Africa in 2009. This is equivalent
Research
Shanaaz Mathews et al.
Table 2. Child homicide rates, by age and sex of victim, South Africa, 2009
Age (years)
<5
59
1014
1517
<18
Malesa
Femalesb
All childrenc
193 (149238)
42 (1668)
71 (40103)
344 (225463)
650 (522779)
7.6 (5.89.3)
1.6 (0.62.6)
2.7 (1.53.9)
21.7 (14.229.2)
6.9 (5.68.3)
208 (145270)
45 (2367)
39 (1663)
72 (37106)
364 (292434)
8.3 (5.810.7)
1.7 (0.92.6)
1.5 (0.62.4)
4.6 (2.46.8)
3.9 (3.24.7)
405 (309501)
87 (58116)
110 (75146)
416 (273558)
1018 (8481187)
7.9 (6.19.9)
1.7 (1.12.2)
2.1 (1.42.8)
13.2 (8.717.7)
5.5 (4.66.4)
Discussion
This is the first national study of child
homicide to be conducted in South Africa. Our estimated rate of child homicide
for 2009 i.e. 5.5 per 100000 children
under the age of 18 years is double
WHOs estimated global rate of 2.4 per
100000 but resembles its estimate for
the African Region (5.6 per 100 000).1
Nearly half (44.4%) of all child homicides
in this study involved fatal child abuse, a
rate much higher than Australias, which
is 36%.4 The high rate in South Africa
reflects the countrys very high general
homicide rate and childrens vulnerable
position in South African society.
We found the homicide rate among
boys to be greater than among girls, with
a more pronounced difference between
the two than suggested by WHO. The
rate of infant abandonment was significantly higher among females than
among males. Similarly, one quarter of
all girl homicides were related to sexual
assault. Overall child abuse and neglect
were involved in three quarters of all girl
homicides but only in one quarter of boy
homicides. In contrast, the risk of death
resulting from interpersonal violence
was very high among teenage boys. Understanding this bimodal sex pattern is
important for the planning of preventive
interventions, since it points to different
risks for different age groups.21
The rate of homicide is distinctly
different in males and females. Teenage
boys were victims of homicide five times
more often than teenage girls. The fact
that more than half of all the boys who
were victims of homicide were teenagers
is not surprising as violence and injury
deaths are the second leading cause of
death in South Africa and males aged
1529 years are disproportionately af-
Research
Epidemiology of child homicides in South Africa
Males (n=651)
Females (n=363)
39.6 (31.847.8)
8.6 (6.611.1)
10.9 (8.613.8)
41.0 (33.448.9)
29.7 (23.237.2)
6.5 (3.810.8)
11.0 (7.915.0)
52.9 (44.261.3)
57.2 (46.267.5)
12.3 (8.118.3)
10.8 (6.617.3)
19.7 (13.827.3)
34.0 (28.639.4)
14.2 (10.618.8)
45.9 (39.552.4)
6.2 (4.19.2)
28.1 (22.734.2)
16.5 (12.022.3)
49.4 (42.356.6)
6.0 (3.79.6)
44.0 (36.152.2)
10.0 (5.916.6)
39.6 (30.549.3)
6.5 (3.511.7)
29.8 (25.035.5)
42.8 (36.848.9)
4.6 (2.67.9)
13.6 (10.617.3)
1.9 (1.32.9)
7.2 (5.29.7)
30.6 (25.336.4)
39.8 (33.446.6)
5.5 (3.010.0)
14.1(10.218.9)
3.0 (2.04.5)
7.1 (4.810.5)
28.9 (21.937.1)
48.1 (40.955.3)
3.0 (1.27.3)
12.7 (8.918.0)
0
7.2 (4.411.8)
30.0 (23.437.5)
5.8 (3.59.3)
7.8 (5.111.6)
3.0 (1.75.2)
2.6 (1.64.3)
35.5 (28.942.8)
3.8 (2.65.6)
11.5 (8.415.6)
21.3 (15.129.2)
4.9 (2.69.3)
8.7 (5.513.6)
2.0 (0.84.9)
1.2 (0.52.8)
44.9 (38.551.5)
4.0 (2.56.3)
13.0 (9.317.9)
45.4 (36.754.3)
7.3 (4.112.5)
6.2 (3.510.5)
4.7 (2.29.6)
5.1 (2.79.6)
18.9 (12.627.4)
3.5 (1.58.1)
8.9 (5.015.4)
11.5 (8.515.3)
26.2 (20.233.3)
23.5 (19.727.7)
11.7 (8.615.6)
2.1 (1.23.7)
0.4 (0.11.4)
1.2 (0.52.7)
15.9 (12.320.3)
5.1 (3.08.5)
2.5 (1.44.6)
13.6 (10.317.8)
33.6 (26.541.5)
24.0 (19.728.8)
7.2 (4.511.1)
1.8 (0.84.3)
0.3 (0.01.5)
1.1 (0.42.7)
11.1 (7.915.5)
6.3 (3.710.6)
1.1 (0.42.7)
7.6 (4.412.9)
13.0 (8.419.7)
22.7 (16.130.9)
19.8 (13.827.5)
2.7 (1.06.8)
0.7 (0.13.4)
1.4 (0.44.4)
24.4 (18.631.2)
2.8 (1.07.1)
5.1 (2.410.3)
44.5 (37.551.5)
55.6 (48.562.5)
26.8 (20.034.8)
73.2 (65.280.0)
76.0 (70.580.7)
24.0 (19.329.5)
10.0 (7.413.4)
90.0 (85.993.0)
1.5 (0.54.3)
98.5 (95.799.5)
25.3 (18.533.7)
74.7 (66.481.5)
This value includes four cases that were excluded from the subgroup analysis because the sex and cause
of death could not be determined owing to the decomposition of the body.
Research
Shanaaz Mathews et al.
Table 4. Number and fraction of homicides involving the four main causes of death, by
age of victim, South Africa, 2009
Age
(years)
Blunt force
trauma
(n=238)
Strangulation/
asphyxiation
(n=118)
Gunshot
wound
(n=116)
All
(n=1018)
7.2
1.9
12.4
78.5
30.7
13.1
8.4
47.8
55.9
20.5
15.2
8.4
17.7
9.1
21.4
51.8
39.6
8.6
10.9
41.0
<5
59
1014
1517
Table 5. Fraction of homicides related to child abuse and neglect or to sexual assault, by
sex and age of victim, South Africa 2009
Age (years)
Males (n=174)
Females (n=276)
73.8 (66.481.2)
11.7 (7.016.3)
8.0 (3.912.0)
6.6 (3.69.7)
45.4 (39.551.5)
24.8 (9.351.4)
22.4 (6.952.8)
8.3 (1.535.6)
54.5 (48.560.5)
75.2 (48.690.7)
77.6 (47.293.1)
91.7 (64.498.5)
0.0647
0.0005
0.0000
0.0001
17.9 (2.833.1)
30.9 (15.746.0)
29.1 (18.339.8)
22.1 (11.033.3)
22.2 (6.354.8)
0.0
13.7 (2.450.8)
8.0 (1.434.9)
77.8 (45.293.7)
100
86.3 (49.297.6)
92.0 (65.198.6)
0.0832
0.0000
0.0002
0.0000
100000 6.9(
100000 3.9( ) 8.3 5.6 :% 95
.)4.7 - 3.2 :% 95
)% 44.5(
.
17 15
95 100000 21.7(
) 29.2 14.2 :%
2.4 :% 95 100000 4.6(
)6.8
.
.
.
38
.2009
1499 1499 500 500 :
.
.
.
1018
)1187 843 : % 95 (
)6.4 4.6 :% 95 ( 5.5 2009
. 18 100000
2009 38
566
<5005001499 >1499
Research
Epidemiology of child homicides in South Africa
2009 101895% CI
8431187 18
5.595% CI 4.66.4
6.9 95% CI 5.68.3
3.9 95% CI 3.24.7
44.5%
15 17
21.7 95% CI 14.229.2
4.6 95% CI 2.46.8
Rsum
pidmiologie des homicides denfants en Afrique du Sud
Objectif Dtailler les taux dhomicide denfants en Afrique du Sud par
ge et par sexe.
Mthodes Une tude transversale base sur les autopsies a t mene
sur un chantillon national de 38laboratoires mdico-lgaux en 2009.
Ces laboratoires ont t choisis en proportion inverse du nombre de
laboratoires qui taient oprationnels dans chacune des trois strates
dfinies par le nombre dautopsies ralises par an: <500, entre 500et
1499 ou >1499. Les donnes sur les homicides denfants ont t
collectes partir des fichiers mortuaires, des rapports dautopsie et des
interrogatoires de police. La cause de la mort, la preuve de labus, de la
ngligence ou de lagression, les caractristiques des agresseurs sexuels,
et les circonstances entourant le dcs ont t tudies.
Rsultats On estime que 1018 (intervalle de confiance de 95%: 843
1187) homicides denfants ont eu lieu en 2009, pour un taux de 5,5 (IC
.
,
38 - , 2009
.
, ,
: <500, 5001499 >1499 .
,
. :
,
,
, .
, 2009 1018 (95%
, : 843-1187) ,
Resumen
La epidemiologa de los homicidios de menores en Sudfrica
Objetivo Describir las tasas especficas por edad y sexo de los homicidios
de menores en Sudfrica.
Mtodos Se realiz un estudio transversal basado en datos de los
depsitos de cadveres en una muestra nacional de 38 laboratorios
mdico-legales activos en 2009. Se muestrearon en proporcin inversa al
nmero que estaba operativo en cada uno de los tres estratos definidos
por volumen de autopsias: <500, 5001499 o >1499 autopsias anuales.
Los datos de los homicidios de menores se recopilaron de los archivos
567
Research
Shanaaz Mathews et al.
era mucho ms alta en nios (6,9 por cada 100 000; intervalo de
confianza 95%: 5,68,3) que en nias (3,9 por cada 100 000; intervalo
de confianza 95%: 3,24,7). El abuso y abandono de los menores haba
precedido a casi la mitad (44,5%) de todos los homicidios, si bien fue tres
veces ms frecuente entre las nias que entre los nios. En menores de
15 a 17 aos, la tasa de homicidios masculina (21,7 por cada 100 000;
intervalo de confianza 95% 14,229,2) fue casi cinco veces mayor que
la femenina (4,6 por cada 100 000; intervalo de confianza 95%: 2,46,8).
Conclusin La tasa de homicidios de menores de Sudfrica es ms
del doble que la estimacin global. Como los precedentes de abuso y
abandono de los menores son habituales, la mejora de las competencias
de los padres debera formar parte de los primeros esfuerzos de
prevencin.
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