Childhood and adolescent fatalities at the Pretoria Medico-Legal Laboratory: 2005 - 2009

Abstract

Children and young adults (adolescents) are particularly vulnerable to inflicted and accidental fatal injuries. [1,2] The United Nations Children's Fund (UNICEF) convention on the right of the child defines a child as 'a person below the age of 18, unless the laws of a particular country set the legal age for adulthood younger'. [3] According to Statistics South Africa (SA) (2008), [4] the leading underlying natural cause of death in children <14 years of age was intestinal infectious diseases (21.8% of deaths), followed by influenza and pneumonia-collectively accounting for a third of deaths in this age group. HIV/AIDS is a leading cause of mortality, with a prevalence rate of 10.6% in SA in 2009, and an estimated 5.21 million people living with the disease. [5,6] Individuals aged between 15 and 24 years are recorded as having the highest incidence of the disease. In SA, the age group 15-49 years is most at risk for non-natural deaths, with 13.9% of deaths in this group being non-natural and the most common circumstance/external cause of death interpersonal violence (assault). [4] The high incidence of child fatalities due to road traffic accidents has been well documented worldwide. In San Diego, Fraga et al. [1] reported (in their study conducted at the medico-legal mortuary) that road traffic fatalites were the leading cause of accidental death (40.2% of cases). In Nebraska, Okoye and Okoye [7] reviewed medico-legal childhood deaths over a 7-year period and reported motor vehicle accidents as the cause of death in 23.6% of cases. In Brazil, Modelli et al., [8] reporting on deaths in children <12 years, found the leading external cause of death to be road traffic fatalities (22% of cases). In Nigeria, Nwafor et al. [9] reviewed deaths in children ≤14 years; in a 20-year period, road traffic accidents accounted for 74.6% of accidental deaths and 15.4% of total deaths. In SA, Bass et al. [10] reviewed children <14 years who presented to Red Cross War Memorial Children's Hospital in Cape Town. They indicated that 430 children were involved as pedestrians in accidents over a 12-month period, with 106 fatalities. Deaths due to asphyxia in children was the second most common cause of death in the study by Fraga et al., [1] accounting for 22.7% of cases. Okoye and Okoye [7] indicated asphyxia mainly in children <5 years, with a total of 22 (15.7%) cases, and 7 (5%) cases of drowning. Modelli et al. [8] indicated asphyxia in 17% of cases. Homicides in children <18 years accounted for 24.2% of deaths in San Diego, [1] 5% in Nebraska, [7] 1.5% in Nigeria, [9] and 13% in Istanbul. [11] Suicide in children accounted for 9.4% of deaths in San Diego, [1] 13.6% in Nebraska, [7] and 7.4% in the Istanbul study. [11] Cases due to natural causes on completion of the medico-legal investigation of death and that were admitted to the medico-legal mortuaries mentioned in the abovementioned studies accounted for 30% of deaths in the Okoye and Okoye [7] study, 50% in the Modelli et al. [8] study, 77.5% in the Nwafor et al. [9] study, ...

Injury-related Pediatric Mortality in Shiraz, Iran: A Community-based Survey

“…This is similar to reports from South Africa, San Diego, and Lorestan province of Iran (3,5,10). This is possibly due to enough knowledge and ability of such children to perform hanging.…”

“…The greatest mortality rate secondary to poisoning was observed in children aged 15 -18 years followed by 1 -4 years, which is similar to the studies in Lorestan and South Africa (5,10). In another recent study from Shiraz, children aged 13 -18 years had the highest hospital admissions due to poisoning (34).…”

“…Deceased cases due to electrical injury, falling down, burns, and drowning were also more common in smaller children similar to reports from Lorestan and South Africa (5,10). The exploratory nature of children with less than 5 years of age (30) and their lack of awareness to avoid highrisk behaviors are probably the explanation for these findings (31).…”

“…Intentional injuries including homicide and suicide accounted for 24.2% and 9.4% of deaths in San Diego (3) and 14% and 7% of deaths in South Africa (5) reports, respectively. The higher rate of homicidal -related mortality in these 2 studies is probably due to easier access to firearms, the most common means of firearm, in the United States and South Africa compared with Iran (3,5). Most suicidal deaths in our study were performed by hanging, as previous studies in Shiraz (41) and in the South Africa report (5).…”

“…While more than 95% of all children and adolescents injury -related deaths are in countries with low-or middle -income, injuries are responsible for about 40% of deaths in those 1 -18 years old in high -income countries (4). The most common causes of injuries include road traffic injuries and drowning (3,5,6).…”