Researchers who found alarming levels of child abuse in a six-year study at the Chris Hani Baragwanath Academic Hospital, have called for greater awareness from healthcare workers and others to improve early identification and referral pathways, writes MedicalBrief.
The researchers noted that child abuse and neglect are global phenomena, and a significant problem in South Africa (SA). A separate Optimus study found that one in three children has been sexually abused. The incidence of physical abuse among children ranged from 8%-34.8%, while that of emotional abuse at some point in the life of a child ranged from 10.8%-26.1%.
For the Chris Hani Baragwanath Academic Hospital study, researchers undertook a retrospective study – published in the South African Medical Journal – profiling patients managed by the Suspected Child Abuse and Neglect (SCAN) Programme at hospital between 2018 and 2024.
Local experts A Le Roux, N Patel, S Velaphi and J Scribante wrote that healthcare professionals have a legal and moral obligation to protect children, saying many cases of abuse go unreported, and thousands of children do not receive adequate treatment and rehabilitation.
Detection and management, including reporting, of suspected abuse and neglect, face several challenges. Inexperienced healthcare professionals may have difficulty making the diagnosis in patients presenting with medical complaints and subtle signs of abuse and/or neglect.
Mandatory reporters may fail to report for various reasons, including unfamiliarity with the reporting process and fear of jeopardising the doctor-patient/family relationships.
Another challenge is the investigation of these cases at the statutory level.
At Chris Hani Baragwanath, there is often a delay in feedback from statutory social services and/or investigating officers, leading to prolonged hospital admissions.
Exacerbating the issue, in SA, few specialised centres deal with cases of child abuse.
Furthermore, the data presented in this study are not routinely collected at local, regional, or provincial healthcare facilities.
At CHBAH, in the Department of Paediatrics, in association with the Surgeons for Little Lives non-profit organisation, the SCAN programme assists with the detection and management of suspected child abuse and neglect.
The programme aims to ensure the safety and well-being of the youngsters presenting to CHBAH, and to detect and prevent ongoing abuse and neglect.
This study aimed to retrospectively describe the profile of these patients, and was conducted in the Department of Paediatrics in the 2 680-bed central hospital.
Dedicated
The SCAN programme was established in 2018 at CHBAH and offers a referral and consultation inpatient service, as well as a dedicated clinic held once a week.
At the end of 2024, 589 patients had been managed in the programme, which has a part-time medical officer and a data capturer.
A total of 589 children (aged ≤14 years) were included in this study, with 316 of them being female, and with a mean age of 4.60 years. The majority of patients (234, 39.73%) were referred from the paediatric department. Of the referrals, 338 (57.39%) were for physical abuse, 129 (21.91, 0%) for sexual abuse, 20 (3.40%) for emotional abuse and 184 (31.24%) for deliberate neglect. Three hundred and fifty-six (60.44%) patients were reported to statutory social services. A majority (76, 32.62%) of patients not reported were already known to these services. For 170 (28.86%) patients, a case docket was opened with the SAPS, and of these, 35 (5.94%) were enrolled in court.
The researchers said that because dedicated child abuse centres are scarce in South Africa, it is essential that clinicians maintain a high index of suspicion to detect and diagnose hidden or non-obvious cases of abuse and neglect.
Continued efforts to raise awareness of the SCAN Programme and to facilitate broader engagement across departments and in the community – for example, community healthcare workers, social workers, teachers and police officials – are essential to ensure that all at-risk children are appropriately identified and referred, suggested the researchers.
Expansion of the programme would further enhance its capacity to meet this need.
Long stays
The median length of hospital stay among the study cohort was 23.5 days. However, 3.06% of patients experienced admissions exceeding 100 days, with the longest admission lasting 541 days.
While some prolonged hospitalisations were attributable to ongoing medical or surgical needs, the predominant cause was the delay in receiving feedback from statutory social services regarding discharge planning.
Although the programme maintains a generally positive working relationship with these services, the overall efficiency of the child protection system needs to be strengthened.
A multidisciplinary approach is one of the important principles of child abuse and neglect management. Only 3.40% of patients were referred to other healthcare professionals after SCAN programme consultation.
This is not a true reflection of the involvement of other healthcare professionals in the management of patients, as they may have been the ones who made the initial referrals to the SCAN programme, or they may already have been consulted by the treating physicians.
One hundred and eighty-two (30.9%) patients were discharged from the hospital without a scheduled SCAN programme clinic date for follow-up. These patients were discharged from the ward without any communication with the programme.
Although all attempts are made to contact caregivers by telephone, for various reasons, this is not always successful. Educating healthcare professionals will ensure a better understanding of the implications of discharging suspected abuse and neglect patients before reaching the desired outcome.
The development and implementation of a standard operating procedure may contribute to addressing this problem.
The SCAN programme aims to detect suspected abuse and neglect of child patients early, to protect these patients from harm and to prevent maltreatment. The results of this study highlight the need to expand the SCAN programme at CHABH to ensure that vulnerable patients receive the care they need.
Creating awareness among healthcare professionals could be extended to the community, and could be linked with community-based services, improving identification and monitoring of child abuse cases in the public health system.
Study details
A profile of Suspected Child Abuse and Neglect Programme patients at Chris Hani Baragwanath Academic Hospital, 2018 – 2024
A Le Roux, N Patel, S Velaphi, J Scribante.
Published in the SA Medical Journal in October 2026
Abstract
Background
In South Africa, few recognised centres deal specifically with cases of child abuse, resulting in limited knowledge of the profile of suspected abuse and neglect patients in SA hospitals. The Suspected Child Abuse and Neglect (SCAN) Programme assists with the detection and management of suspected child abuse and neglect in children.
Objectives
To provide a retrospective description of the profile of suspected abused and neglected patients presenting to the SCAN Programme at Chris Hani Baragwanath Academic Hospital (CHBAH) from 2018 to 2024.
Method
A retrospective, contextual, descriptive research design was used. All patients aged ≤14 years with suspected abuse and or neglect referred to the SCAN Programme at CHBAH were included.
Results
A total of 589 patients were included, of whom 316 (53.65%) were female, with a mean (standard deviation) age of 4.60 (4.16) years. Most patients (234, 39.73%) were referred from the paediatric department. Of the referrals, 338 (57.39%) were for physical abuse, 129 (21.91, 0%) for sexual abuse, 20 (3.40%) for emotional abuse and 184 (31.24%) for deliberate neglect. Three hundred and fifty-six (60.44%) patients were reported to statutory social services. A majority (76, 32.62%) of patients not reported were already known to these services. For 170 (28.86%) patients, a case docket was opened with the South African Police Service (SAPS), and of these, 35 (5.94%) were enrolled in court. Only 198 (48.65%) patients who had a SCAN Programme Clinic appointment attended the clinic. For the 182 (30.90%) patients for whom no clinic appointment was made, 40 (21.98%) patients were discharged from the SCAN Programme as no abuse or neglect was identified, 33 (18.13%) were transferred back to their referral facility, 56 (30.77%) were removed and placed by statutory social services without notifying the Programme and 37 (20.33%) patients died. Sixteen (8.79%) patients were discharged from the treating ward without notifying the Programme and had unknown outcomes.
Conclusion
The SCAN Programme aims to detect suspected abuse and neglect of children early, to protect these patients from harm and to prevent maltreatment. The results of this study highlight the need to expand the SCAN Programme at CHABH to ensure that vulnerable patients receive the needed care.
A le Roux,1 MB ChB, MSc Med Bioethics and Health Law;
N Patel,2 FC Paed Surg (SA), MMed (Surgery);
S Velaphi,1 FC Paed (SA), PhD;
J Scribante,2 PhD
1 Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, and Chris Hani BaragwanathAcademic Hospital;
2 Department of Paediatric Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand; Surgeons for Little Lives, Johannesburg.
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Child Gauge flags maternal violence and neglect in SA
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