Infant abuse in Osaka: Health center activities from 1988 to 1999.

BACKGROUND

In 1988, the first survey of child abuse in Japan was conducted in Osaka Prefecture as a joint effort between medical, health and welfare agencies. Ensuing surveys in 1988 revealed that infant abuse had a death rate of 10% in Health Center.

METHODS

In 1996 and 1999, surveys were performed on 130 and 215 abused children under 18 years of age. They were studied in terms of their activity of Health Center, including help, means of involvement by health visitors.

RESULTS

Fifty-five percent of children were detected via health centers. In 69% of cases, health visitors listened to parents and promptly contacted other agencies. Ninety-five percent of cases had home visits. The concerted effort of the health centers with allied disciplines in Osaka Prefecture yielded the following changes: the mortality rate decreased from 9.8% in 1988 to 2.3% in 1996, and institutionalized cases tripled from 13.7% in 1988 to 39.5% in 1999. The rate of admission to day care centers increased from 22.4% in 1988 to 58.7% in 1999. Along with the constant support of health visitors, day care centers provided secure support and protection for parents and infants.

CONCLUSIONS

Effective prevention and treatment become possible only when treatment of the child's physical and psychological health, mental care for parents and tangible support for childrearing and daily life were undertaken in a concerted way. To this end, a systematic commitment of all child agencies, child guidance centers, as well as medical, health educational, welfare and other allied disciplines is required.