Abusive head trauma from shaking is a recognised common cause of fatal head injury in young children globally, although there is little evidence of its occurrence in South Africa. This is perplexing given that the country has amongst the highest reported under-five child mortality and infanticide rates worldwide. To determine whether infants under one-year are violently shaken, a cross-sectional study was conducted with 385 mothers and other primary female caregivers (ages 18 to 60 years; mean age = 27 years) from three high-risk communities in Cape Town. Semi-structured interviews were used to examine: (1) the incidence of shaking, (2) the triggers for shaking, (3) the risk factors for shaking, thoughts of shaking, and knowledge of the dangers of shaking, and (4) the methods used to console crying infants. Results showed that 13.2% (n = 51) of all participants self-reported violent shaking, and 20% (n = 77) had thoughts of shaking their infants. Following a content analysis, three primary triggers for shaking were identified, these were: inconsolable infant crying, feeling angry or frustrated, and being stressed. Findings from a thematic analysis also showed that shaking occurred during a momentary loss of control, and participants seemed to have limited support at the time. The results from three hierarchical logistic regression analyses showed that (1) alcohol use, infant age, a lower knowledge of the dangers of shaking, inconsolable crying, and having thoughts of shaking, predicted shaking, (2) caregiver age, infant age, knowledge of the dangers of shaking, and caregiver responses to infant crying, predicted having thoughts of shaking, and (3) social support, caregiver history of childhood abuse, and having thoughts of shaking, predicted knowledge of the dangers of shaking. Finally, a content analysis revealed three protective factors for infant crying, these were: (1) having easy, contented children, (2) not feeling stressed in response to infant crying, and (3) leaving an infant alone to self-soothe. Taken together, the current findings have programmatic implications that may help prevent the violent shaking of young children in South Africa.

Student Number : 9703129J - MSc(Med) research report - School of Pathology - Faculty of Health Sciences / Down syndrome is the commonest cause of congenital developmental disability in industrialized countries, where it occurs in approximately 1.4 per 1000 live births. In South Africa, the birth prevalence of Down syndrome was documented as 1.8 and 2.09 per 1000 live births in urban and rural populations, respectively. The physical, psychosocial and emotional burden of Down syndrome on affected families is significant. The aim of this study was to determine the reproductive choices of women with a child with Down syndrome, aged 1 year or older. The survey was conducted using a structured questionnaire. The sample consisted of fifty women; 36 African, 4 Asian and 10 Caucasian. The questionnaire assessed the mothers’ knowledge of Down syndrome prior to diagnosis, what counselling was received and how this knowledge was utilised. Information was also obtained on the mothers’ use of family planning, the knowledge and use of prenatal medical genetic screening and diagnosis, and what decisions would be made in future pregnancies. None of the sample group of mothers had prenatal diagnosis in their pregnancy with their Down syndrome child, but 76% (38) said that they would want prenatal diagnosis in any future pregnancies. Of the 50 mothers, 21 (42%) said they would terminate a pregnancy if Down syndrome had been detected, 26 (52%) said they would not, and 3 (6%) said they were unsure what they would have done if faced with this decision. Of the Caucasian women, 40% (4) said they would opt for termination of pregnancy, 40% (4) said they would not and 20% (2) were unsure. Of the African and Asian women, 52.8% (19) and 75% (3) respectively said they would not terminate an affected fetus. The information from this study can be used to improve the understanding of how women and their families cope with their children with Down syndrome and give insight for the provision of more effective and comprehensive genetic counselling.