Population-based statistics on deaths from child abuse and neglect are only routinely available in countries that have reliable national statistics on child murder. For low-income and middle-income countries, relatively little is known about prevalence trends of child murder. South Africa is an exception, having conducted dedicated national studies on child murders for 2009 and 2017 to provide data on child murders overall and on child abuse and neglect-related murders. We aimed to compare child abuse and neglect-related murders in South Africa across two surveys to determine any change between 2009 and 2017. We conducted two retrospective national mortuary-based surveys on murder of children aged 0–17 years for 2009 and 2017 from a proportionate random sample of medico-legal laboratories in South Africa. A sampling frame of medico-legal laboratories for each study year was prepared with stratification by medico-legal laboratory size. A minimum of 2 years after the crime was allowed before data collection to enable progression of the investigation process. Child abuse and neglect-related murders were identified using both medico-legal laboratory post-mortem autopsy reports and police data. To identify a child abuse and neglect-related murder, we primarily used the framework of abuse happening within the context of responsibility of care arrangements but broadened this to include all perpetrators and abuse identified from the data. We stratified age into 0–4, 5–9, 10–14, and 15–17 years and further stratified children younger than 5 years into early neonates (newborns killed within 6 days of birth), 7 days to 11 months, and 1–4 years. We calculated incidence rate ratios (IRR) with 95% CIs to compare rates between 2009 and 2017. An estimated 458 (95% CI 377–539) children in 2009 and 213 (179–247) children in 2017 were murdered in circumstances of child abuse and neglect. The percentage of all child murders that were child abuse and neglect-related declined from 2009 to 2017 (458 [45·0%] of 1018 in 2009 213 [25·0%] of 851 in 2017), with the overall age-standardised rate decreasing from 2·6 to 1·1 per 100 000 children aged 0–17 years (IRR 0·43 [95% CI 0·35–0·54]). Girls represented 276 (60·3%) of 458 murders in 2009, which declined to 96 (45·1%) of 213 murders in 2017, and boys represented 178 (38·9%) of 458 murders in 2009 and 109 (51·4%) of 213 murders in 2017. The decrease was statistically significant for girls in the 0–4 year (IRR 0·33 [0·22–0·49]) and 5–9 year (0·33 [0·15–0·73]) age groups and for boys in the 0–4 year age group (0·49 [0·33–0·71]). Among early neonates (within 6 days of birth), the decrease in child abuse and neglect-related murders was more pronounced among girls than among boys (IRR 0·33 [95% CI 0·19–0·56] 0·46 [0·28–0·77]). Child abuse and neglect-related murders are common in South Africa but our study shows that they can be reduced. The high rate of these murders points to the need to continue research and monitoring to inform priority targeted interventions and to better understand the impact of child support policies. Ford Foundation and South African Medical Research Council.

中文翻译：

---

南非虐待儿童和与忽视相关的谋杀案：2009 年和 2017 年两次全国调查的比较


只有在拥有可靠的儿童谋杀国家统计数据的国家，才能常规获得基于人口的虐待和忽视儿童死亡统计数据。对于低收入和中等收入国家，人们对儿童谋杀的流行趋势知之甚少。南非是个例外，该国在 2009 年和 2017 年对儿童谋杀案进行了专门的全国研究，以提供总体儿童谋杀案以及虐待和忽视儿童相关谋杀案的数据。我们的目的是通过两项调查比较南非的儿童虐待和忽视相关谋杀案，以确定 2009 年至 2017 年之间的变化。我们对 2009 年和 2017 年 0-17 岁儿童谋杀案进行了两次全国太平间回顾性调查南非法医实验室的按比例随机抽样。每个研究年的法医学实验室抽样框架是按法医学实验室规模分层准备的。犯罪发生后至少 2 年才允许收集数据，以便调查过程取得进展。使用法医实验室尸检报告和警方数据确定了虐待儿童和与忽视相关的谋杀案。为了确定虐待儿童和与忽视相关的谋杀案，我们主要使用了在护理责任安排范围内发生的虐待框架，但将其范围扩大到包括从数据中确定的所有肇事者和虐待行为。我们将年龄分层为 0-4、5-9、10-14 和 15-17 岁，并将 5 岁以下儿童进一步分层为早期新生儿（出生后 6 天内死亡的新生儿）、7 天至 11 个月和 1 岁。 –4 年。我们计算了 95% CI 的发病率比 (IRR)，以比较 2009 年和 2017 年之间的发病率。 2009 年估计有 458 名 (95% CI 377–539) 名儿童和 2017 年有 213 名 (179–247) 名儿童在虐待和忽视儿童的情况下被谋杀。从 2009 年到 2017 年，与虐待和忽视儿童有关的所有儿童谋杀案的百分比有所下降（2009 年 1018 起中有 458 起 [45·0%]，2017 年 851 起有 213 起 [25·0%]），总体年龄标准化发病率从每 10 万名 0-17 岁儿童 2·6 降至 1·1（IRR 0·43 [95% CI 0·35–0·54]）。 2009 年 458 起谋杀案中，女孩占 276 起 (60·3%)，这一数字下降到 2017 年 213 起谋杀案中的 96 起 (45·1%)，而 2009 年 458 起谋杀案中，男孩占 178 起 (38·9%)，男孩占 109 起 (51 2017 年 213 起谋杀案中，有·4%）。对于 0-4 岁（IRR 0·33 [0·22–0·49]）和 5-9 岁（0·33 [0· 15–0·73]）年龄组和 0–4 岁年龄组的男孩（0·49 [0·33–0·71]）。在早期新生儿（出生 6 天内）中，女孩中虐待儿童和忽视相关谋杀的减少比男孩更为明显 (IRR 0·33 [95% CI 0·19–0·56] 0·46 [ 0·28–0·77]）。虐待儿童和与忽视有关的谋杀在南非很常见，但我们的研究表明，这种情况是可以减少的。这些谋杀案的高发生率表明需要继续研究和监测，以便为优先有针对性的干预措施提供信息，并更好地了解儿童抚养政策的影响。福特基金会和南非医学研究委员会。