3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item The factors contributing to delayed discharge of patients with suspected non-accidental injury in a quaternary paediatric orthopaedic ward(2024) Simmons, Dina YaeliIntroduction Child abuse is a critically important discussion within any society and poses challenges in the social, legal and medical systems. The international literature is rich with descriptions of patient and family based risk factors and suspicious injuries. Based on these descriptions, we have created a protocol for the identification and investigation of children with suspected non-accidental injuries. The paediatric orthopaedic ward is faced with many children being delayed in the ward once fit for discharge due to delays in investigations or regulatory body assessments of these cases. This study aimed to quantify those delayed discharges and describe the demographics and risk factors for abuse we see within the local population. Methodology After obtaining ethics clearance and hospital approval, the study was conducted as a retrospective review of records from the Teddy Bear Clinic, as well as admission records of the children. The study examined the demographic characteristics of the children, their family background, injury characteristics and referral to Child Welfare. The delay of discharge from hospital was quantified for each child in days and was then compared to the initial characteristics of each child. Results Records were collected from 1 January 2015 to 31 December 2020. Seventy-nine complete records were included in the review. There were 40 male and 39 female patients with an average age of 20 months. Sixty children (75.9%) were under the age of 36 months. Of the 35 (44.3%) foreign nationals, 31 were undocumented. Seventy-three (94.1%) of the cases sustained lower limb fractures of which 51 were femur fractures. Fifty-two of the cases showed a delayed discharge of the child. The delay ranged from 1 to 233 days. Examining patient characteristics showed an association between an age less than 36 months and delayed discharge. There were no significant correlations between caregiver characteristics and delayed discharge. The admission progress revealed that the later the day of completion of investigations, the more likely there was to be a discharge delay. There was also a statistically significant correlation between referral to Child Welfare and delayed discharge. Discussion The majority of the patients referred for investigation were below the age of 36 months which agrees with the literature that this is the highest risk group. We could not identify any specific caregiver characteristics which were risk factors for suspicion. Delayed discharge of patients was associated with age less than 36 months, upper limb fractures and referral to Child Welfare. Despite the delayed discharge, most children were returned to the same home environments and in two described cases they were placed back into a high risk situation. Conclusion This review investigated the demographics of the children in the paediatric orthopaedic ward with a suspected non-accidental injury. The study also highlighted the challenges of inadequate support from regulatory social services when trying to assist these children.Item Monitoring and evaluation for crime prevention: the 16 days of no violence against women and children campaign(2014-01-02) Bosilong, Kgomotso Pearl.South Africa has the highest levels of violent crime in the world and is home to high levels of violence against women and children. In response to the challenge imposed by the high level of crime and violence, the South African Government initiated the development of the National Crime Prevention Strategy(NCPS). One of the goals of the NCPS is to identify and implement programmes to prevent crime and to support, protect and empower victims of crime and violence, with special focus on women and children. Responding to the international call to prevent and act against women and child abuse and within the ambit of the NCPS, the 16 Days of No Violence against Women and Children Campaign (referred to as the 16 Days Campaign in this research) was established in1999. The main aim of the 16 Days Campaign is to generate an increased awareness of the negative impact of crime and violence on women and children thus contributing to the prevention of crime and violence against women and children. The first impact assessment of the 16 Days Campaign was undertaken by the Council for Scientific and Industrial Research (CSIR) in 2009. The CSIR report states that the 16 Days Campaign has not yet showed a positive impact due to the lack of proper planning, implementation and monitoring and evaluation (M&E) system tofacilitate the assessment of its impact. The majority of Government departments and Non-Governmental Organisations (NGOs) that participated in this research (99%) do not know the tools used to monitor and evaluate the 16 Days Campaign. Each department or participating NGO works in silos and does not share good practice on M&E of the 16 Days Campaign, rendering planning, implementation inadequate and subsequently M&E inconsistent. This research demonstrates that the GCIS Tracker Survey and Exit Reports are not effective M&E Tools for the 16 Days Campaign. It proposes a iii comprehensive M&E Framework based on the insight from the literature review, good practice and inputs from participants. The M&E Framework facilitates the planning, implementation, monitoring and evaluation and impact assessment of the 16 Days Campaign.Item Modelling the differential incidence of child abuse, neglect and exploitation in poor households in South Africa(2012-09-19) Mbecke, Za-Mulamba PaulinChild abuse is rife and on the increase in South Africa. The review of five theories of child abuse shows that each theory is unitary, limited and isolated and proposes an incomplete understanding of and solution to child abuse. The ineffectiveness of prevention, intervention actions against child abuse and the poor management and control of child abuse cases are the consequence of unfocussed and disintegrated policies and programmes biased towards overestimated poor economic conditions. This research argues that poor economic conditions are not the sole important variables contributing to child abuse. This hypothesis is confirmed by the observation of the Memorial Institute‟s child abuse database. The purpose of this research is therefore to facilitate a clear understanding of child abuse in order to assist decision making for the prevention of, interventions against and management of child abuse cases. The research proposes the Integrated Modelled Theory that combines variables from different theories to facilitate a clear understanding of child abuse and consequently inform prevention, intervention and management actions through integrated and focused policies and programmes.Item Social Factors that Contribute to Child Abuse in Informal Settlements: A case study of Ivory Park(2007-02-28T14:09:44Z) Nathane, Motlalepula SophieGiven the high incidences of child abuse not only in informal settlements, but in South Africa as a whole. The present study looks at the social factors that contribute to child abuse in informal settlements. To identify specific social factors in an informal settlement i.e. Ivory Park, which make children in this community to be vulnerable to child abuse. The study aims to identify different forms of child abuse, which occur in Ivory Park, to develop an understanding of the family structure and the functioning of the families. The study further explored the perception of community members on child abuse, and their knowledge and awareness on children’s rights. The study also attempts to bring to our attention that concern about the problem of child abuse is not new. It acknowledges the historical context of this problem, that throughout history children world-wide have been subjected to domination, murder, abandonment, mutilations and forced labour. Practices that seem brutal and senseless today like infanticide and ritual sacrifices of children are actually recorded in the Bible. These were considered normal and acceptable practices at the time. The systematic study of child abuse is fairly a recent phenomenon, it’s only in the sixties that this issue has been discussed and debated in certain parts of the world. The study also points out that the problem of child abuse is not unique to South Africa, but it is a problem in many parts of the world. Also that the understanding of child abuse has shifted over time. The central force behind these changes has been the establishment of various organisations in North America and Europe. These organisations opposed violence against children and advocated for the rights of the children. In South Africa this change came about when the present South African government ratified the United Nations Convention on the Rights of the Children in 1996 and also when the Rights of the Child were enshrined in Section 28 of the Bill of Rights of the Constitution of the Republic of South Africa. The study poses a question as to why child abuse cases and statistics seem to be on the rise and understanding why children are being abused when there are so many pieces of legislation and human rights documents, that aims to safeguard the interest and the protection of children particularly in South Africa. The study also looks at different theoretical perspective on child abuse to help us in terms of explaining and understanding as to why children are abuse. Finally, the study looks at different social factors specific to South Africa that might contribute to child abuse, and the history and location of Ivory Park. On the basis of the findings of this study, the researcher makes some recommendations through which professionals in the helping professions together with community members can address the problem of child abuse in informal settlement.