Kwashiorkor como síntoma de maltrato y negligencia en Barcelona

Parental violence and the occurrence of severe and acute malnutrition in childhood

Evidence from developed countries has linked family violence with severe acute malnutrition (SAM), yet no similar studies have been conducted in developing countries where the risk of SAM is higher. To redress this gap, the objective of this study was to explore the role of intimate partner violence (IPV) among caregivers as an independent risk factor for SAM. A hospital-based case-control (n = 172 : 345) study was carried out in six paediatric hospitals of Rio de Janeiro (1995-99). Cases comprised children (1-24 months) admitted with SAM (weight-for-height z-score < -2 SD). Controls were children of the same age admitted for non-traumatic surgery. Couple violence was gauged through the Conflict Tactics Scales from two perspectives: (a) two ordinal variables characterising the intensity of verbal and physical aggression based on scores, and (b) a four-level variable representing a pattern of increasing violence seriousness. Unconditional logistic regression analysis was performed to control for confounding factors. Parents of SAM cases had higher Conflict Tactics scores than parents of controls, indicating more severe partner violence. The adjusted odds ratio for the comparison of the highest to the lowest scores (10 vs. 0) was 4.15 (95% confidence interval 1.55, 11.15). Using the four-level variable for violence seriousness, a threefold SAM risk was found for children with parents reporting severe physical abuse, but not for those with parents reporting verbal aggression or more minor physical assaults. In addition to traditionally studied risk factors, the findings suggest that family violence may also play an important role in SAM among children. Moreover, these findings indicate that the risk for SAM is not associated with all types of IPV, but that children exposed to severe and recurrent events are more likely to be admitted for SAM. For the prevention or early detection of SAM, this result points to a specific population group requiring rigorous public health targeting, especially in terms of accurate detection of both SAM and IPV, as well as appropriate handling and follow-up of violent families.

Malnutrition, a Rare Form of Child Abuse: Diagnostic Criteria

Infantile malnutrition is often difficult to diagnose as it is rarely observed in industrialized countries. It may be associated with physical violence or occur in isolation. The essential clinical sign is height and weight retardation, but malnutrition also causes a variety of internal and bone lesions, which lead to neuropsychological sequelae and death. We report a rare case of death by malnutrition in a female child aged 6 1/2 months. The infant presented height and weight growth retardation and internal lesions related to prolonged protein-energy malnutrition (fat and muscle wasting, thymic atrophy, liver steatosis) resulting in a picture of marasmus or kwashiorkor. We detail the positive and negative criteria that established the diagnosis of abuse, whereas the parents had claimed a simple dietary error.

[Foreign minors in the protection system of the Autonomous Community of Aragón (Spain)]

OBJECTIVES

To determine the prevalence of foreign minors in protection centers, their demographic characteristics, and reasons for entry, as well as the relation with geographic area, family, social and health risk factors, and high-priority health needs.

PATIENTS AND METHODS

We performed a retrospective cross-sectional study over an 11-year period (1992-2002). The health and socio-familial reports of 1,619 minors who were admitted to protection centers were reviewed and those from a foreign country were included. Compilation of information, definition of concepts, and health assessments were performed according to standard protocols.

RESULTS

Two hundred forty-one foreign minors (males 66.4 %) with a mean age (SD) of 11 (3.2) years (adolescents 64.7 %, infants-preschoolers 26.1 %) were admitted during the study period. The prevalence was 4.6 times higher than that expected. Origin: Africa 68.9 % (Maghreb 56.4 %, sub-Saharan 12.5 %), Europe 23.6 % (west 14.5 %, east 9.1 %), Latin-America 5.4 %, and Asia 2.1 %. Reasons for entry, demography and relation with geographic area were as follows: 1. Being an abandoned illegal immigrant 41.1 % (all male adolescents, 98 % from the Maghreb); 2. Maltreatment 33.2 % (passive maltreatment-to-active ratio 2.3:1, no difference by sex, age mode 2 years; Asia 80 %; Europe 61.5 %, west-to-east ratio 4.8:1, gypsy ethnicity from Portugal and Rumania 90.3 %; Latin-America 38.4 %; Africa 21.7 %, no difference by geographic area); 3. Temporary incapacity for their care 18.7 % (female-to-male ratio 1.8:1, age mode 1 year; Latin-America 38.4 %, Africa 18.1 %, Europe 17.5 %); 4. Other causes 7 %.

RISK FACTORS

at least one (78.4 %) and more than one (33.6 %); housing problems and especially living in a single parent family. Health disorders: at least one (65.1 %); disabling disease (2.1 %); main problems: dental (36.3 %), immunization (27.6 %), dermatologic (19.1 %), growth and nutrition (13.7 %), and infectious and parasitic diseases (13.3 %).

CONCLUSIONS

Being a minor immigrant in a foreign country with problems of documentation, housing or family regrouping and especially if there are language, cultural or racial (ethnic minorities) barriers is a major risk factor for living in a situation of vulnerability, risk or neglect/abandonment that requires social protection measures. Continuous follow-up by the social services of the adoptive community is required for the prevention and early detection of children in need of protection.