Janssen T L, van Dijk M, Al Malki I, van As A B
University of Cape Town, Red Cross War Memorial Children's Hospital, Cape Town, South Africa.
Paediatr Int Child Health. 2013 Nov;33(4):216-27. doi: 10.1179/2046905513Y.0000000091. Epub 2013 Sep 12.
The reason for this review is the lack of data on the management of physical abused children in Africa. The primary goal of the first part is to outline the management of physical child abuse in (South) Africa and provide suggestions for other governments in Africa on which to base their management of physical child abuse, at both governmental and hospital management level. The main aim of the second part is to outline the extent of the problem as seen at the Red Cross Memorial Children's Hospital (RCH) in Cape Town.
The National Library of Medicine's PubMed database was searched for articles specifically about the management of physical child abuse. Hospital data were analysed in two phases: one addressed various types of assault in order to assess the number of patients admitted to the trauma unit of RCH between 1991 and 2009, and the other to identify all children with suspected non-accidental injury (NAI) presenting to the trauma unit at RCH from January 2008 until December 2010.
Information on physical abuse of children in Africa in the English scientific literature remains disappointing with only two articles focusing on its management. RCH data for the period 1991-2009 recorded a total number of 6415 children hospitalised with injuries following assault, who accounted for 4.2% of all trauma admissions. Types of abuse included assault with a blunt or sharp instrument, rape/sexual assault and human bite wounds. Over the last 2 decades, there has been a minor decline in the number of cases of severe abuse requiring admission; admissions for other injuries have remained stable. More detailed analysis of hospital data for 2008-2010, found that boys were far more commonly assaulted than girls (70.5% vs 29.5%). Physical abuse appeared to be the most common cause of abuse; 89.9% of all boys and 60.5% of all girls presented after physical abuse.
In order to eradicate child abuse, awareness of it as to be promoted in the community at large. Because the types of child abuse vary between countries, each requires its own research in order to develop a policy tailored to their particular requirements. In summary, an increased focus on the prevention of violence against children is urgently needed in order to curb the increasing trend of assaults on children. As the causes and risk factors for violence against children vary, multi-disciplinary and multi-sectoral co-operation and collaboration will be required. It is hoped that this report will help raise awareness among health-care practitioners of NAI and its complexities.
进行本综述的原因是非洲缺乏有关受身体虐待儿童管理的数据。第一部分的主要目标是概述（南）非对受身体虐待儿童的管理情况，并为非洲其他国家政府在政府和医院管理层面上对受身体虐待儿童的管理提供依据和建议。第二部分的主要目的是概述开普敦红十字会纪念儿童医院（RCH）所呈现的这一问题的严重程度。
检索美国国立医学图书馆的PubMed数据库，查找专门关于受身体虐待儿童管理的文章。医院数据分两个阶段进行分析：一个阶段针对各类攻击行为，以评估1991年至2009年期间入住RCH创伤科的患者数量；另一个阶段用于识别2008年1月至2010年12月期间到RCH创伤科就诊的所有疑似非意外受伤（NAI）儿童。
英文科学文献中关于非洲儿童身体虐待的信息仍然令人失望，仅有两篇文章关注其管理。1991 - 2009年期间RCH的数据显示，共有6415名儿童因攻击受伤住院，占所有创伤入院患者的4.2%。虐待类型包括钝器或利器攻击、强奸/性侵犯和人类咬伤。在过去20年里，需要住院治疗的严重虐待病例数量略有下降；其他伤害的入院人数保持稳定。对200八 - 2010年医院数据的更详细分析发现，男孩遭受攻击的情况远比女孩常见（70.5%对29.5%）。身体虐待似乎是最常见的虐待形式；所有男孩中有89.9%以及所有女孩中有60.5%是在遭受身体虐待后前来就诊的。
为了根除虐待儿童现象，需要在广大社区提高对此的认识。由于不同国家的虐待儿童类型各不相同，每个国家都需要开展自身的研究，以便制定符合其特定需求的政策。总之，迫切需要更加关注预防针对儿童的暴力行为，以遏制针对儿童攻击行为不断增加的趋势。由于针对儿童暴力行为的原因和风险因素各不相同，将需要多学科和多部门的合作与协作。希望本报告有助于提高医疗从业者对NAI及其复杂性的认识。
