Browsing by Author "Mathews, Shanaaz"

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    Child death reviews in the context of child abuse fatalities - learning from international practice
    (Children's Institute, 2005-03) Mathews, Shanaaz; Abrahams, Naeemah; Martin, Lorna J
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    Children's Institute submission on the Criminal Law (Sexual Offences and Related Matters) Amendment Act Amendment Bill [B 18-2014]
    (2015) Jamieson, Lucy; Mathews, Shanaaz
    A submission by the Children’s Institute to the Portfolio Committee on Justice and Correctional Services, Parliament, on the Criminal Law (Sexual Offences and Related Matters) Amendment Act Amendment Bill [B 18-2014]. In the submission, the CI addresses concerns around the requirements for reporting sexual offences and the ethical dilemmas posed by the requirement to report sexual activities between consenting adolescents. The CI submits that: 1. Consensual sexual activities between adolescents should not be a crime. 2. Children convicted of sexual offences should be assessed before their names are added to the National Register of Sex Offenders. 3. Once found to be a risk and placed on the National Register of Sex Offenders children convicted of sexual offences should be assessed before their names are removed.
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    Developing a psychosocial understanding of child sexual abuse disclosure among a group of child and adolescent females in Cape Town, South Africa.
    (2012) Hendricks, Natasha; Orner, Phyllis; Mathews, Shanaaz
    To develop an understanding of the factors that promotes and inhibits child sexual abuse (CSA) disclosure and its impact on the child and caregiver. Young girls and adolescents between the ages of 8-17 years who experienced penetrative sexual abuse were recruited from two sexual assault centres in the Western Cape, South Africa. On arrival at the centre, caregivers were approached and informed about the study and informed consent was obtained from those who agreed to participate in the study. This study has shown that factors promoting CSA disclosure include circumstances around the incident, caregiver concerns around the child's behavior, which made caregivers suspicious and allowed them to create an enabling environment to facilitate disclosure for the child as well as coercion by caregivers to talk.
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    Forensic medicine in South Africa: associations between medical practice and legal case progression and outcomes in female murders
    (Public Library of Science, 2011) Abrahams, Naeemah; Jewkes, Rachel; Martin, Lorna J; Mathews, Shanaaz
    BACKGROUND: Forensic medicine has been largely by-passed by the tide of health systems research and evidence based medicine. Murder victims form a central part of forensic medical examiners' case load, and women murdered by intimate partners are an important subgroup, representing the most severe form and consequence of intimate partner violence. Our aim was to describe the epidemiology of female murder in South Africa (by intimate and non-intimate partners); and to describe and compare autopsy findings, forensic medical management of cases and the contribution of these to legal outcomes. METHODS: We did a retrospective national study in a proportionate random sample of 25 medico-legal laboratories to identify all homicides in 1999 of women aged 14 years and over. Data were abstracted from the mortuary file and autopsy report, and collected from a police interview. FINDINGS: In 21.5% of cases the perpetrator was convicted. Factors associated with a conviction for the female murders included having a history of intimate partner violence 1.18 (95%CI: 0.16-2.20), weapon recovered 1.36 (95% CI:0.58-2.15) and a detective visiting the crime scene 1.57 (95% CI:0.14-3.00). None of the forensic medical activities increased the likelihood of a conviction. CONCLUSION: The findings raise important questions about the role of forensic medicine in these cases.
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    Gender differences in homicide of neonates, infants, and children under 5 y in South Africa: results from the cross-sectional 2009 National Child Homicide Study
    (Public Library of Science, 2016) Abrahams, Naeemah; Mathews, Shanaaz; Martin, Lorna J; Lombard, Carl; Nannan, Nadine; Jewkes, Rachel
    Jewkes and colleagues present a cross-sectional study that reveals levels of child homicide in South Africa. Identifying causes and vulnerable mothers will lead to prevention methods and strategies.
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    Health service utilisation prior to out-of-hospital natural deaths among children under five in Metro West, Cape Town in 2018: a retrospective analysis of data from the Child Death Review
    (2022) Jacobs, Solomon M; Mathews, Shanaaz; Hendricks, Michael; Phillips, Tammy
    Background In the Metro West geographical service area within the City of Cape Town district the under-five mortality rate in the Metro West GSA decreased from 25 per 1000 live births in 2010 to 22 deaths per 1000 live births in 2013, but the rate of decrease slowed down in part because of the amount of child deaths outside of health facilities. Fifty-five percent of under-five deaths occur out-of-hospital in South Africa, with a similar percentage in the Metro West (49-52% in 2010 to 2015). Describing factors that enable or prevent health service usage among natural under-five deaths is an important precursor for effective interventions. Objectives and Methods A retrospective cross-sectional design utilised secondary, routinely collected data from 1 January to 31 December 2018 on under-five out-of-hospital natural deaths reported to Salt River Mortuary. We used the data, which included routine interviews with the caregivers, together with social and medical data collated by the Child Death Review, to describe the cause of death, the socio-demographic profile, and the routine and prior-to-death health service usage. Dimensions of health service access according to the WHO and Anderson, respectively, were used as a heuristic lens to describe the applicable variables and to formulate a priori multivariable logistic regression models to compare those who did and did not seek care before death. These dimensions include physical accessibility, financial affordability, the health needs of the child as well as the existing health behaviour of the caregiver. Results Of the 187 cases described, 68% died of lower respiratory tract infections and 8% of diarrhoea. Fifty four percent of cases were younger than 3 months, and 40% were born prematurely. In terms of the residential health sub-district, 37% resided in Mitchells Plain, 29% in Klipfontein, 18% in Western and 14% in Southern; 52% resided in needy or very needy areas. Mothers were single (69%), unemployed (73%) and lived in informal housing (46%). Of the cases who were alive at the time, immunisation coverage was 79%, 70% and 68% at the 6-, 10- and 14-week visits. However, only 23% of mothers sought health care prior to the child's death. Overall, 51% of the mothers recognised symptoms of illness prior to death and symptoms were recognised in 95% of the mothers who sought health care compared to 37% of the mothers who did not seek health care (p-value < 0.001). Multivariable logistic regression models showed the importance in recognising symptoms in seeking health care (aOR 18.28, 95% CI 3.67-90.93), and that, while not statistically significant, the recognition of symptoms was less likely at younger ages (aOR 0.28, 95% CI 0.07-1.14 for cases younger than 3 months compared to those older than 6 months) Conclusion The study identified key risk factors implicated in the out-of-hospital deaths in Metro West and the need for mothers to identify and seek health care when their child is symptomatic. There should be focused support during the first 1000 days for mothers identified as being at-risk, namely: those who are single, unemployed, lack social support and abuse substances, and for babies with prematurity and HIV-exposure. Counselling should emphasise the recognition of LRTI symptoms and health care seeking to prevent child deaths and reduce the under-five mortality. Further research is needed to consolidate which provincial geographical areas should be prioritized for targeted interventions that impact on health care seeking behaviour, as well as the most effective child health education and messaging. Data paucity on medical history may be addressed by data augmentation from the Provincial Health Data Centre and improvements should be made for capturing children's anthropometry.
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    Helping children recover from trauma
    (2016-10-01) Mathews, Shanaaz; Berry, Lizette; Lake, Lori
    Violence against children is widespread, and the impact of violence on children extends beyond the physical injuries to have lasting psychosocial consequences. The Children’s Act outlines government’s obligation to prevent violence against children, protect child victims from further harm, and support and treat children who have experienced violence to restore them to physical and psychological well-being. Early access to therapeutic support for traumatised children helps mitigate negative effects such as violence and riskybehaviour, depression, anxiety and suicide, and ensure better outcomes in the long term. But little is known about current models of therapeutic care for child sexual abuse (CSA) victims in South Africa, or their efficacy in facilitating psychological recovery. This research brief examines a local, innovative, therapeutic programme for sexually abused children living in rural areas, and considers what kind of therapeutic responses are appropriate in low- and middle-income countries (LMIC).
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    Intimate femicide-suicide in South Africa : the epidemiology of male suicide following the killing of an intimate partner
    (2005) Mathews, Shanaaz; Abrahams, Naeema; Mathews, Catherine; Jewkes, Rachel
    The few studies on intimate femicide-suicide have mainly been conducted in developed countries. These studies have found that a disproportionate number of male partners commit suicide after killing their female partner. However, not much is known about intimate femicide-suicide in developing countries. The purpose of this study was to describe: the incidence and patterns of intimate femicide-suicide in South Africa and to compare the factors which distinguish intimate femicide-suicide from cases in which the perpetrator does not commit suicide. The study was designed as a retrospective national mortuary based study of all female homicides where the victim was aged 14 years and older for the year 1999. Data was collected from a stratified cluster sample of 25 mortuaries in South Africa. National incidence rates and factors associated with perpetrator suicide were derived by taking into account the stratification and weighting of mortuaries. This study found that 19.4% of intimate femicide perpetrators also commit suicide within a week of the murder. The estimated rates for intimate femicide-suicide were 1.7/100 000 women 14 years and older and 2.1/100 000 males 14 years and older. A logistic regression analysis to compare the factors which distinguish intimate femicide-suicide from cases in which the perpetrator does not commit suicide shows that perpetrator suicide were associated with: the perpetrator being of White race; employed as a professional or white collar worker; and owing a legal gun. The study findings have shown that South Africa has the highest reported rate for intimate femicide-suicide in the world. This poses an important public health problem. Unraveling the factors associated with perpetrator suicide after killing an intimate partner is complex. However, legal gun ownership plays a significant role in such killings. It is therefore imperative that access to guns be controlled and monitored.
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    Morbidity and mortality among 5-17 year old children admitted in five hospitals in Kenya in the year 2013
    (2015) Osano, Bonface Ombaba; Mathews, Shanaaz; Were, Fred N
    Background: Global morbidity and mortality trends have changed over time and are expected to continue changing. Preventable diseases, such as those caused by infectious agents, still account for a large proportion of morbidity cases in Africa. With increased survival of children under five years old, there is likely to be a change in morbidity and mortality pattern s for children aged 6 - 18 years. However, there are few studies in Africa that explore the burden of disease (morbidity and mortality) and injuries in children above the age of five. This study aims to determine the morbidity and mortality patterns among children aged 5 - 17 years in six Kenyan hospitals in 2013. Methods: This study is designed as a retrospective review of patients' medical records. Data was collected from all patient records at Kisii Level 5 Hospital (KL5H), Naivasha County Referral Hospital, Karatina Hospital, Garissa Provincial General Hospital, Mbagathi District Hospital , and Gertrude ' s Children ' s Hospital in Kenya , of patients who presented from the 1st day of January to 31st December 2013. Data was analysed to provide descriptive statistics and Pearson's chi - square test and odds ratios were calculated to explore differences in morbidity and mortality rates between age categories, gender and hospitals. Results: 4 520 patient records were retrieved for patients who met the inclusion criteria. Among these admissions, 70% suffered from communicable diseases, maternal causes or nutritional diseases (32.3% were common infectious diseases , such as malaria and diarrhoea ; 14.9% were respiratory infections ; 24% were pregnancy related ), 33.1% suffered from non - communicable diseases , while 13% of the admissions had injuries (mainly from falls/trips and road traffic accidents), with motorcycles causing the majority (58%) of road traffic accidents . Injuries increased with age for males. The in-hospital mortality rate was 3.5%. Among deaths, 60% suffered from communicable diseases, maternal and nutritional causes; 41.3% suffered from non - communicable diseases and 11.9% had injuries. There were variations in admissions and deaths between the ages, gender s and hospitals. There were more female (57%) patients admitted but more male (57%) deaths. Conclusion: Infectious and maternal cause s are the biggest contributor to morbidity while infectious causes have the highest proportion of causes of death. There is a need to understand why the high proportion of females under 18 years of age is admitted for maternal al causes and to develop reproductive health services to better address the health care needs of adolescents on Kenya.
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    Out of Harm's Way? Tracking child abuse cases through the child protection system at five selected sites in South Africa - Research Report
    (Children's Institute, University of Cape Town, 2017-05-01) Jamieson, Lucy; Sambu, Winnie; Mathews, Shanaaz
    The study aims to document how the child protection system processes reported cases of child abuse, and make recommendations about how child protection services could be strengthened, to reduce the risk of trauma to children and breaking the inter-generational cycle of violence. In particular the study generates recommendations for the specificimprovement of child protection services within the local setting.
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    Submission on amendments to the Children's Act: corporal punishment, July 2013
    (Children's Institute, 2013-07) Jamieson, Lucy; Mathews, Shanaaz
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    The spatial distribution of injury mortality of children in the western geographic service area, City of Cape Town (2011-2015)
    (2023) Albertyn-Blanchard, Zulfah; Mathews, Shanaaz; Coetzee David
    Background: Child injury is a major global public health concern with accounting for nearly 300,000 deaths annually and non-fatal injuries resulting in long or short - disabilities. Young children are more likely to be involved in a non-fatal injury than adolescents, who are more likely to be involved in a fatal injury. Males are likely than females to suffer from a fatal or non-fatal injury. The likelihood to be injured has a spatial dimension with impoverished areas more likely to report injuries among adults and children compared to well-resourced areas. This differentiation is driven by inequality and social determinants which impacts the likelihood of implementing appropriate infrastructure and services to prevent these incidents, particularly in children. South Africa displays similar trends in the childhood injury pattern and the risks attributed to this burden. Method: This thesis retrospectively assesses the injury burden experienced by children aged 17 years and younger between 2011-2015 in the City of Cape Town (CoCT). Using routine mortuary data from Salt River Medico-legal Mortuary (SRM) across four sub-health districts of the CoCT namely Klipfontein, Mitchells Plain, Southern, and Western; the injury profile of children will be examined. The child death review (CDR) data will be used to determine the mortality profile of children aged 17 years and under. The Childsafe data will be used to determine the morbidity profile for children under 13 years, specifically RTCs. Exploratory analysis is used to describe demographic variables and create a heat map, and choropleth map of injury mortality, prior to a risk assessment of gender relative to various explanatory variables. Regression models adjusted for age, gender, time of day, and injury severity determined the likelihood of hospital admission for RTC injuries. Spatial regression models identified socioeconomic and geographical variables that influenced transportrelated injury mortality. Findings: This thesis found that more than 50 % of child injury deaths were unintentional (51.2%) across all age groups. Older male children (aged 15-17 years) mostly died from homicide, particularly due to sharp force injuries. This is the first study to report that most child injury deaths were located in the Klipfontein sub-health district, Nyanga has the highest prevalence ( give %) , with homicides more likely than any other form of injury death among children. We found that the injury mortality pattern for children differs dependent on their age, highest among ….. Most transport-related deaths occurred during daylight hours across all age groups. Utilising a heat map, cluster, and spatial regression analysis, this thesis found that Nyanga as the most deprived township also had the most transport-related injuries. Children aged 5-9 years contributed to the highest RTC premature mortality and non-fatal RCT incidents compared to other age groups. Males are more likely to be involved in both a fatal or non-fatal pedestrian RTC incident compared to females. Hospital admittance followed by a non-fatal RTC incident was mainly reported in children aged 5-9 years 2 compared to any other age group and was more likely to occur during afternoons or evenings over the weekend. Conclusion: Injuries are one of the leading causes of mortality and morbidity among children living in the CoCT, South Africa. This thesis provides insights to identify high-risk child populations through the use of a spatial conceptual framework the findings highlight factors that Increase risk for Injuries such as deprived suburbs, and the speed limit of the road, which has not been explored in other studies . This research highlights that children of a certain age are more vulnerable than others, especially males living in low socio-economic areas. There is an urgent need for more sustainable and representative national injury surveillance to be integrated with routine health information systems. The monitoring of child injury mortality in South Africa needs to be strengthened.