Important note: Information in this article was accurate in 2004. The state of the art may have changed since the publication date.
Sunday Times (Johannesburg) - October 17, 2004
Nashira Davids and Ilse Fredericks
The two-year-old girl from Goodwood, in Cape Town, is one of hundreds of children treated in hospital each month for devastating accidents - most of which happen at home.
Last month alone, 743 children were treated in the country's only dedicated paediatric hospital - Cape Town's Red Cross Children's Hospital.
Nearly 80% of the injuries could have been prevented.
Local and international studies show that the country's child-safety record is one of the worst in the world, with more than 17 children dying every day from accidents that happen mostly at home and on the road.
According to a 2002 13-country survey, carried out by the international child-safety advocacy group Safe Kids, South Africa fared worst in terms of children's deaths due to unintentional injury.
The Red Cross Children's Hospital treats 10000 cases every year.
"Most people do not realise that childhood injuries have reached epidemic proportions in South Africa," said Nelmarie du Toit, the assistant director of the Child Accident Prevention Foundation of South Africa.
"Instead of building new hospitals, the government should invest in injury prevention initiatives that will pay off and save money in the long run."
But while the government intends to implement a national plan to improve children's safety next year, top child-safety researchers said that there was a lack of reliable research to reflect the extent of the problem, which in turn hampered injury-prevention initiatives.
Du Toit said that of the 743 children treated at the Red Cross Children's Hospital last month, 80% were victims of preventable accidents.
Safe Kids estimates that 6500 children in South Africa die every year because of accidents, and that this costs the country more than R6.4-billion.
In its 2002 international study, there were 44.3 deaths due to unintentional injuries per 100 000 South African children - the worst performer in the 13-country study. The best performer was Germany, with 5.8 deaths per 100 000, but even developing countries such as Brazil - with 16.6 child deaths per 100 000, and Vietnam, with 38.1 out of 100 000 - fared better.
South African parents can be prosecuted for neglect and face fines exceeding R20000 or jail time in terms of the Child Act.
But, according to Du Toit, parents are rarely prosecuted. She said one child was admitted to the hospital's trauma unit more than 30 times for injuries ranging from poisoning to falling off a bed. These cases were simply referred to social workers for investigation.
The child-accident prevention foundation, based at the Red Cross Children's Hospital, is one of the few bodies in the country carrying out designated research on child safety.
Dr Sebastian van As, head of the hospital's trauma unit and director of the foundation, said: "A child up to the age of 10 cannot really assess danger. There should be more awareness that children are not small adults."
Lesley Matzopoulos, the executive director of Safe Kids' local office, said: "Eastern Cape or Limpopo province would be particularly bad places to have an accident. Rural areas are often far from hospitals, making injuries difficult to treat. Some children may not get to hospital in time to prevent serious damage.
"An average ride to a hospital could be as long as four hours, " she said.
The latest report released by the Medical Research Council's Burden of Disease Unit revealed that the top cause of death in the 10-to-14 age group was not HIV/Aids.
"As children get older, external causes of death [like road injuries and drowning] rise in importance. This is particularly noticeable among boys, who die in greater numbers than girls.
Last year, the Minister of Health, Manto Tshabalala-Msimang, announced the formation of the steering committee for the Healthy Environments For Children Alliance. The group's focus will include environmental lead exposure, water and sanitation and unintentional injuries.
Angela Mathee, who is on the alliance's steering committee, said the first "state of children's environmental health report" would be released next year.
Mathee said there had been a "very weak focus" on children's environmental health in most developing countries, and that the report - due for release next year - would "pull together what we know on environmental risks to children's health".
"We hope to use that information to develop a national action plan for healthy environments for South African children," she said.
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