Under-five mortality and child-abuse-related-deaths in the former USSR. Is there an under-reporting of abuse-related deaths?

Abstract

The study explores the former USSR countries `Under-fives’ Child Mortality Rates (CMR) and Child-Abuse-Related-Deaths (CARD), since the end of the Soviet Union and asks whether there has been an `under-reporting’ of CARD? W.H.O. under-five mortality rates per million (pm) were extracted for 1988-90 compared with 2008-10 for CMR and confirmed and possible CARD. Possible CARD are Undetermined Deaths(UnD) and Ill-Defined Signs & Symptoms (IDSS) and as these categories have been linked to under-reporting of CARD. CMR and CARD odds ratio calculated and correlated to determine possible underreporting of CARD. Seven countries met the UNICEF objective of reducing CMR; five halving their previous USSR rate. Russian CARD at 29pm is highest but six countries rates were less than 10pm. Undetermined Deaths (UnD) increased in Kazakhstan 13-fold, Belarus 8 times, Ukraine seven and in Russia more than four. Ill-defined deaths trebled in Belarus, and rose more than 25% in Kazakhstan, Georgia and Ukraine. CARD significantly correlated with UnD but not with CMR. Odds ratios of CMR to CARD categories were substantial, more than 4.1:1 in Belarus, Kazakhstan, Russia and Ukraine, indicating possible under-reporting of CARD. Despite CMR improvements, this first-ever study of former USSR countries should alert the authorities of Belarus, Kazakhstan, the Russian Federation and the Ukraine to the extent of possible child abuse.