Safety Netting through the Prevention and Detection of Child Abuse in Low and Middle Income Countries: Lessons from Pakistan
According to WHO, 6.3 million children died before the age of 5 years in 2013. Five percent of these deaths were due to injury and violence. In 2012, it was estimated that around 30,000 childhood deaths were caused due to non accidental injury (NAI) Child abuse or maltreatment can be physical, emotional, and/or sexual. Injury, overall, is reported as the third leading cause of death in children in Pakistan, with an annual injury mortality rate of 37 per 100,000 children aged 1 4 years. One can assume that much of this is accidental, but because no adequate screening is available for child NAI, there is a high likelihood that abuse is being overlooked. The main purpose of the present paper was to search the available biomedical literature relevant to child NAI in Pakistan and from that to tease out the epidemiology of the problem, especially that pertaining to presentations in the emergency department (ED) as many of the injured children are seen there. We argue that there is a need for the rapid development and implementation of ED based screening as part of the management of children, with suspected NAI being seen in the EDs of LMICs in general and Pakistan in particular. In tandem with further research in this crucial area, we also make the case for an advocacy based approach to facilitate health systems related policy formulation because child safety is at stake. We searched PubMed and Google Scholar for the following key words: "Non Accidental Injury," "Non Accidental Trauma," "Pediatric," "Child,"Emergency Room,"Intentional Injury," "Pakistan," and "Lower and Middle Income Countries." We used the MeSH term "Child Abuse" in our search. As there are limited articles published on child abuse in Pakistan, we also searched recent newspapers for information on the topic. As injury is a frequent emergency related presenting complaint, the pediatric ED is a likely place where child NAI could be detected. According to the U.K.'s National Institute of Health and Care Excellence (NICE) guidelines, it is important for the healthcare provider to be attentive and watchful and to pick up on certain clues from the interaction with the patient and the family, regarding NAI. Language: en