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Childhood death rates declined in Sweden from 2000-2014 but deaths from external causes were not always investigated.
Uppsala University, National Centre for Knowledge on Men. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Paediatric Inflammation Research.
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2018 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227Article in journal (Refereed) Epub ahead of print
Abstract [en]

AIM: Countries that conduct systematic child death reviews report a high proportion of modifiable characteristics among deaths from external causes and this study examined the trends in Sweden.

METHODS: We analysed individual level data on external, ill-defined and unknown causes from the Swedish cause of death register from 2000-2014 and mortality rates were estimated for children under the age of one and for those aged 1-14 and 15-17 years.

RESULTS: Child deaths from all causes were 7,914 and 2,006 (25%) were from external, ill-defined and unknown causes: 610 (30%) were infants, 692 (34%) were 1-14 and 704 (35%) were 15-17. The annual average was 134 cases (range 99-156) during the study period. Mortality rates from external, ill-defined and unknown causes in children under 18 fell 19%, from 7.4 to 6.0 per 100,000 population. A sizeable number of infant deaths (8.0%) were registered without a death certificate during the study period, but these counts were lower in children aged 1-14 (1.3%) and 15-17 (0.9%).

CONCLUSION: Childhood deaths showed a sustained decline from 2000-2014 in Sweden and a quarter were from external, ill-defined or unknown causes. Systematic, interagency death reviews could yield information that could prevent future deaths. This article is protected by copyright. All rights reserved.

Place, publisher, year, edition, pages
2018.
Keywords [en]
Cause of death, Child death review, Child mortality, Register data, Sweden
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-347800DOI: 10.1111/apa.14309PubMedID: 29520820OAI: oai:DiVA.org:uu-347800DiVA, id: diva2:1195928
Funder
The Swedish Crime Victim Compensation and Support AuthorityAvailable from: 2018-04-07 Created: 2018-04-07 Last updated: 2018-04-17
In thesis
1. Health sector and community response to child maltreatment in Sweden and in a European context
Open this publication in new window or tab >>Health sector and community response to child maltreatment in Sweden and in a European context
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background Child maltreatment is a public health problem of global magnitude. This thesis examined different aspects of the multi-sector response to child maltreatment in Sweden and in Europe.

Aims To explore how child physical abuse (CPA) is disclosed and how adolescents perceive adult support when they report physical abuse. To examine how police-reported cases of suspected CPA were associated with criminal investigation procedures and prosecutions. To assess how physicians who care for maltreated children across Europe are organised to recognise and respond to child abuse and neglect. To investigate time trends in rates of childhood deaths in Sweden recorded as due to external, ill-defined and unknown causes, from 2000 to 2014.

Methods We analysed data from a school-based national survey of adolescents, police records of reported suspected CPA in a metropolitan area, a purposeful survey of European child abuse physicians and individual-level data from the Swedish cause of death register. We used quantitative methods to calculate prevalence, descriptive statistics, odds ratios, logistic regression and trends in mortality rates. Qualitative methods included content analysis and narrative synthesis.

Results Only a minority of reported CPA was brought to the attention of professionals and the most prominent barrier to disclosure was lack of trust in adults or authorities. The police-reported cases of suspected CPA were characterised by high severity, but only a small proportion of the 158 alleged child victims were physically examined and only half were forensically interviewed. All 88 responding physicians in 22 European countries described multidisciplinary involvement in the management of suspected child maltreatment, but wide variations in the organisational approaches were revealed. A sustained decline in childhood deaths from external causes during a 15-year period was observed. A sizeable number of infant deaths were recorded each year as ill-defined or with incomplete documentation from clinicians.

Conclusions The results presented in this thesis suggest that the multi-sector response in Sweden and in Europe is insufficiently organised, with no clear mandate for the health sector to robustly combat child maltreatment, and that this may undermine the ability of society to adequately protect children.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2018. p. 101
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1465
Keywords
Child physical abuse, Cause of death, Child death review, Disclosure, Police report, Child mortality, Register data, Multidisciplinary team
National Category
Medical and Health Sciences Clinical Medicine
Research subject
Pediatrics; Pediatrics
Identifiers
urn:nbn:se:uu:diva-347796 (URN)978-91-513-0342-0 (ISBN)
Public defence
2018-06-07, Gunnelsalen Auditorium, Psychiatry House, Sjukhusvägen 10, Uppsala, 13:15 (English)
Opponent
Supervisors
Funder
The Swedish Crime Victim Compensation and Support Authority
Available from: 2018-05-16 Created: 2018-04-17 Last updated: 2018-10-08

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Lucas, StevenJanson, StaffanHellström-Westas, Lena

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