Trends in child homicides in South Africa: evidence from three national surveys: 2009, 2017, and 2020/2021

Abstract

Background Violence against children is a global public health problem, and despite the scarcity of data in low and middle-income countries, African children are reported to experience the highest levels of violence. Not much is known about child homicide, the most severe form of violence against children. Using data from three national surveys, we explore trends in child homicide rates and cause of death by age and sex over time. Methods We conducted three (2009, 2017 and 2020/2021) national retrospective mortuary-based studies of South African children 0–17 years. Data was collected from medico-legal laboratories and police investigations, and included location and cause of death, and the victim-perpetrator relationship. Age-standardized rates and incidence rate ratios (IRR) test were used to compare homicide rates across the three surveys. Findings An estimated 1018 children (95% CI=848−1187) were murdered in 2009, compared to 893 (95% CI=808−978) in 2017, and 948 children (95% CI=861−1036) in 2020/2021. The overall estimated child homicide rate slightly decreased from 5.6/100,000 in 2009 to 5.1/100,000 in 2020/2021, with a statistically significant decrease in rates among the youngest age group (0−4 years) (IRR: 0.48; 95% CI=0.38−0.60), and a statistically significant increase among older children (15−17 years) between 2009 and 2017 (IRR: 1.35; 95% CI=1.13−1.61). Gun-related deaths increased among older male victims between 2017 and 2020/2021 (IRR: 1.54; 95% CI=1.09–2.20). Interpretation The sex- and age-specific patterns of child homicides and the rising use of firearms underscore the need for coordinated, multi-sectoral strategies to protect children and strengthen targeted violence prevention initiatives. Funding Ford Foundation, Centers for Disease Control and Prevention Foundation, and South African Medical Research Council.