Child Death Reviews (CDRs) use an intersectoral approach to understand and prevent child deaths.¹ This project has been implemented by the Children’s Institute in collaboration with the Division of Forensic Medicine, University of Cape Town for the Western Cape and the Forensic Pathology Services, KwaZulu-Natal Department of Health for Kwa-zulu Natal. The CDR teams facilitate a coordinated response between the police, forensic pathology services, prosecution authorities, paediatricians, and social services in the management of child deaths. The efficacy of the model in the South African setting was tested through a process evaluation in 2014 at two sites, Salt River Mortuary in the Western Cape and Phoenix Mortuary in  Kwa-zulu Natal, with a focus on establishing the effectiveness of the teams to strengthen the health and child protection response systems.² This multi-agency approach brings together evidence from medical records, autopsy reports, police and social services investigations, and enables more effective identification of child abuse and neglect. It helps identify systems failures within different departments and opportunities to strengthen communication and coordination between them.

The CDR pilot has demonstrated how a multi-agency approach can enhance reporting and enable a real-time response to ensure children are safer in their homes. The value of making joint decisions also took the burden off the forensic pathologist and police as investigating child deaths in the home is incredibly difficult, particularly when there is a suspicion of a non-accidental injury at the hands of someone close to the child. Social services investigations have also proved crucial in identifying families in distress who require ongoing support to prevent further negative outcomes.

The project has been adopted by the Department of Health in the Western Cape as a “best practice model” and is being expanded across the province.

For queries about this project contact: Prof Shanaaz Mathews  – shanaaz.mathews@uct.ac.za

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[1] Mathews S, Abrahams N & Martin LJ (2013) Child death reviews in the context of child abuse fatalities – learning from international practice.  A briefing paper. Cape Town: Children’s Institute, UCT, The Gender and Health Research Unit, South African Medical Research Council, and the Division of Forensic Medicine and Toxicology, University of Cape Town.

[2] Mathews S, Martin L, Scott C, Coetzee D & Lake L (2015) Every child counts: Lessons learned from the South African Child Death Review pilot. A research brief. Cape Town: Children’s Institute, University of Cape Town.

Mathews S, Martin L, Coetzee D, Scott, C, Naidoo T, Brijmohun Y & Quarrie K (2016) The South African child death review pilot: a multi-agency approach to strengthen healthcare and protection for children. South African Medical Journal, 106(9): 895-899.

Further reading

• Abrahams N, Mathews S, Martin LJ, Lombard C, Nannan N & Jewkes R (2016) 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. PLoS Medicine, 13(4), e1002003.
• Dawson M, Mathews S, Abrahams N & Campbell J (2017) Death Reviews in the Context of Domestic Homicide in Low- to Middle-Income Countries: South Africa as a Case Study. In: Dawson M. (eds) Domestic Homicides and Death Reviews. Palgrave Macmillan, London.
• Mathews S, Abrahams N, Jewkes R, Martin LJ, & Lombard C (2013) The epidemiology of child homicides in South Africa. Bulletin of the World Health Organization, 91(8), 562–568.
• Mathews S & Martin L (2016) Developing an understanding of fatal child abuse and neglect: Results from the South African child death review pilot study. South African Medical Journal, 106(12), 1160-1163.
• Mathews S, Martin L, Coetzee D, Scott C & Brijmohun, Y (2016) Child deaths in South Africa: Lessons from the child death review pilot. South African Medical Journal, 106(9), 851-852.
• Mathews, S., Martin, L., Scott, C., Coetzee, D., & Lake, L. (2015). Every child counts: Lessons learned from the South African Child Death Review pilot. A research brief.