CHILD-ABUSE SERVICES AT A CHILDRENS-HOSPITAL IN CAPE-TOWN, SOUTH-AFRICA

Since the establishment of a Child Abuse Management Service at the Red Cross War Memorial Children's Hospital in the early 1980s, there has been a steady increase in patient numbers. In order to assess the profile of patients, and also the allocation of staff to the service, all child abuse related patients seen at the Red Cross War Memorial Children's Hospital in Cape Town over the period of June 1989 through July 1990 were reviewed. Five hundred and three children with a median age of less than 7 years were seen. Abuse was confirmed in 389 (160 physical abuse and 229 sexual abuse). Abuse was suspected and not confirmed in 114 (41 physical and 73 sexual). Half of the patients presented to the hospital outside of normal working hours. Eighty-one percent of children less than 5 years of age were seen in the Trauma Unit by surgical residents with minimal pediatric training. One hundred and thirty four of the patients were Xhosa speaking while only one social worker and no medical staff could speak Xhosa. Pediatric residents were involved in the care of less than 2% of cases. Conclusion: Management of child abuse constitutes a significant commitment and appropriate staff allocation is essential. Although it is not possible for each child in whom abuse is suspected to be seen by a specialist, they should be seen by those staff with the most expertise. Staff allocation must take into account the needs for education, training, and audit as well as service provision.