High prevalence of non-accidental trauma among deceased children presenting at Level I trauma centers in the Netherlands

Purpose Between 0.1—3% of injured children who present at a hospital emergency department ultimately die as a result of their injuries. These events are typically reported as unnatural causes of death and may result from either accidental or non-accidental trauma (NAT). Examples of the latter include trauma that is inflicted directly or resulting from neglect. Although consultation with a forensic physician is mandatory for all deceased children, the prevalence of fatal inflicted trauma or neglect among children is currently unclear. Methods This is a retrospective study that included children (0–18 years) who presented and died at one of the 11 Level I trauma centers in the Netherlands between January 1, 2014, and January 1, 2019. Outcomes were classified based on the conclusions of the Child Abuse and Neglect team or those of forensic pathologists and/or the court in cases referred for legally mandated autopsies. Cases in which conclusions were unavailable and there was no clear accidental cause of death were reviewed by an expert panel. Results The study included 175 cases of childhood death. Seventeen (9.7%) of these children died due to inflicted trauma (9.7%), 18 (10.3%) due to neglect, and 140 (80%) due to accidents. Preschool children (< 5 years old) were significantly more likely to present with injuries due to inflicted trauma and neglect compared to older children (44% versus 6%, p < 0.001, odds ratio [OR] 5.80, 95% confidence interval [CI] 2.66–12.65). Drowning accounted for 14 of the 18 (78%) pediatric deaths due to neglect, representing 8% of the total cases. Postmortem radiological studies and autopsies were performed on 37 (21%) of all cases of childhood death. Conclusion One of every five pediatric deaths in our nationwide Level I trauma center study was attributed to NAT; 44% of these deaths were the result of trauma experienced by preschool-aged children. A remarkable number of fatal drownings were due to neglect. Postmortem radiological studies and autopsies were performed in only one-fifth of all deceased children. The limited use of postmortem investigations may have resulted in missed cases of NAT, which will result in an overall underestimation of fatal NAT experienced by children.

So Much Life in Such a Short Time: An Exploration of Children’s Obituaries

As childhood death is considered nonnormative and outside of the life course, children may be memorialized differently than adults who have had an opportunity for fuller lives. As obituaries are cultural artifacts used to provide public documentation of personal legacies, this study sought to determine how children obituaries differ from traditional obituaries of those who have lived full lives. I content analyzed 63 children’s obituaries to determine how they differ in intention and use of linguistic devices from what we know about traditional obituaries. Several key themes emerged in the obituary content – passions, religion and faith, children’s role as siblings, their effect on those around them, and messages written directly to the deceased children. These children’s obituaries read as tributes to the children’s lives, rather than as resumes as traditional obituaries often do.

Role of Persistent Diarrhea Control in Declining Infant and Childhood Mortality in Indonesia

In diarrheal diseases control program (CDD), the mechanism of diarrheal diseases (DD) death can be classified into: dehydration, dysentery, complication, and persistent diarrhea. The aim of the presentation is to predict the share of these components and to highlight the role of persistent diarrhea. Demographic figures were inferred from the Census and the 1985 Inter-Censal Survey data. Rates on DD were inferred from the National Household Health Surveys and relevant reports. The mechanisms of death were inferred from the pattern of DO death in Palembang General Hospital. By fair prediction, in infants, 1.5 lives will be saved per 1000 live births through COD Program, 88% is the share of persistent diarrhea control, and 20% of better management of DD complicated with other diseases. In 1-4 years of age, the figures are 68% and 38%, respectively. The share of promoting rehydration and dysentery management will be minimal in declining infant mortality rate (MR) and childhood death rate (CDR) between 1992 and 2000. The share of COD in declining IMR and CDR must depend on a better management of persistent and complicated DD.

Long-term impact of community-based participatory women’s groups on child and maternal mortality and child disability: follow-up of a cluster randomised trial in rural Nepal

BackgroundCommunity-based women’s groups practising participatory learning and action (PLA) can reduce maternal and neonatal mortality in low-income countries. However, it is not clear whether these reductions are associated with subsequent increased or decreased rates of childhood death and disability. We assessed the impact on child deaths and disability beyond the perinatal period among participants in the earliest trial in Nepal 2001–2003.MethodsHousehold interviews were conducted with mothers or household heads. At cluster and individual levels, we analysed disability using pairwise log relative risks and survival using multilevel logistic models.FindingsFrom 6075 children and 6117 mothers alive at 4 weeks post partum, 44 419 children (73%) were available for interview a mean 11.5 years later. Rates of child deaths beyond the perinatal period were 36.6 and 52.0 per 1000 children in the intervention and control arms respectively. Rates of disability were 62.7 and 85.5 per 1000 children in the intervention and control arms respectively. Individual-level analysis, including random effects for cluster pairing and adjusted for baseline maternal literacy, socioeconomic status and maternal age, showed lower, statistically non-significant, odds of child deaths (OR 0.70 (95% CI 0.43 to 1.18) and disability (0.64 (0.39 to 1.06)) in the intervention arm.ConclusionCommunity-level exposure to women’s groups practising PLA did not significantly impact childhood death or disability or death beyond the perinatal period. Follow-up of other trials with larger sample sizes is warranted in order to explore the possibility of potential long-term survival and disability benefits with greater precision.