Understanding how children die in South Africa: Learning from the child death review pilot

Large numbers of children die yearly as a result of fatal violence in South Africa, with the child homicide rate estimated to be more than double the global homicide rate. Child death review teams have been established in high... [ view full abstract ]

Large numbers of children die yearly as a result of fatal violence in South Africa, with the child homicide rate estimated to be more than double the global homicide rate. Child death review teams have been established in high income settings to systematically review deaths from birth to adolescence as a public health response to identify preventable deaths and improving health and child protection. The aim of this CDR pilot was to establish the efficacy of CDR teams in a middle income setting in order strengthen health and child protection systems.

CDR teams was established at two pilot sites in South Africa and all child deaths were reviewed at the two sites for the period 1st January 2014 – 31st December 2014. Data was collected on the demographics of the child, cause of death, circumstances of the death and social context of the family. In addition modifiable factors in all cases were also documented.

A total of 711 cases were reviewed, with more than half (53%) of the deaths due to natural causes and 43% non-natural causes. Most (96%) of the natural deaths occurred in the under-5 age group and with the burden highest in the under one age group. Overall the most likely cause of death was lower respiratory tract infections followed by homicide and road traffic injuries. As children got older the risk for homicidal deaths increased with 45% of the homicide in the 15-17 year age group. The burden of fatal child abuse was found to be among the under-5 year old group with 78% of the fatal child abuse cases in this age group.


CDR teams have shown efficacy in better identifying deaths due to child abuse and neglect through a multi-disciplinary approach and regular case reviews.