{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T01:49:08Z","timestamp":1792374548737,"version":"4.4.0"},"reference-count":42,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2017,11,22]],"date-time":"2017-11-22T00:00:00Z","timestamp":1511308800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>The purpose of this study was to estimate the economic burden of violence against children in South Africa. We assembled summative estimates of lifetime prevalence, calculated the magnitude of associations with negative outcomes, and thereby estimated the economic burden of violence against children. According to our calculations, 2.3 million and 84,287 disability-adjusted life-years (DALYs) lost in South Africa in 2015 were attributable to nonfatal and fatal violence against children, respectively. The estimated economic value of DALYs lost to violence against children (including both fatal and nonfatal) in South Africa in 2015 totalled ZAR173 billion (US $13.5 billion)\u2014or 4.3% of South Africa\u2019s gross domestic product (GDP) in 2015. In addition, the reduced earnings attributable to childhood physical violence and emotional violence in South Africa in 2015 were ZAR25.2 billion (US $2.0 billion) and ZAR9.6 billion (US $750 million), respectively. In addition, South Africa spent ZAR1.6 billion (US $124 million) on child care and protection in fiscal year 2015\/2016, many of which costs are directly related to violence against children. This study confirms the importance of prioritising violence against children as a key social and economic concern for South Africa\u2019s future.<\/jats:p>","DOI":"10.3390\/ijerph14111431","type":"journal-article","created":{"date-parts":[[2017,11,22]],"date-time":"2017-11-22T10:47:38Z","timestamp":1511347658000},"page":"1431","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":50,"title":["The Economic Burden of Violence against Children in South Africa"],"prefix":"10.3390","volume":"14","author":[{"given":"Xiangming","family":"Fang","sequence":"first","affiliation":[{"name":"College of Economics and Management, China Agricultural University, No. 17 Qinghuadong Road, Haidian District, Beijing 100083, China"},{"name":"School of Public Health, Georgia State University, 140 Decatur Street, Atlanta, GA 30303, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaodong","family":"Zheng","sequence":"additional","affiliation":[{"name":"College of Economics and Management, China Agricultural University, No. 17 Qinghuadong Road, Haidian District, Beijing 100083, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah","family":"Fry","sequence":"additional","affiliation":[{"name":"Moray House School of Education, St John\u2019s Land, 2.02, Holyrood Road, Edinburgh EH8 8AQ, Scotland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary","family":"Ganz","sequence":"additional","affiliation":[{"name":"Department of Psychology and Safety and Violence Initiative, University of Cape Town, Rondebosch 7701, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tabitha","family":"Casey","sequence":"additional","affiliation":[{"name":"Moray House School of Education, St John\u2019s Land, 2.02, Holyrood Road, Edinburgh EH8 8AQ, Scotland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Celia","family":"Hsiao","sequence":"additional","affiliation":[{"name":"Save the Children South Africa, 2nd Floor SAQA House, 1067 Arcadia Street, Hatfield 0028, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8727-4175","authenticated-orcid":false,"given":"Catherine","family":"Ward","sequence":"additional","affiliation":[{"name":"Department of Psychology and Safety and Violence Initiative, University of Cape Town, Rondebosch 7701, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2017,11,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"i3","DOI":"10.1136\/bmjgh-2016-000188","article-title":"How prevention of violence in childhood builds healthier economies and smarter children in the Asia and Pacific region","volume":"1","author":"Fry","year":"2016","journal-title":"BMJ Glob. Health"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1016\/j.chiabu.2015.02.012","article-title":"The burden of child maltreatment in the East Asia and Pacific region","volume":"42","author":"Fang","year":"2015","journal-title":"Child Abuse Negl."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/j.chiabu.2011.10.006","article-title":"The economic burden of child maltreatment in the United States and implications for prevention","volume":"36","author":"Fang","year":"2012","journal-title":"Child Abuse Negl."},{"key":"ref_4","unstructured":"Australian Institute of Family Studies (AIFS) (2016). The Economic Costs of Child Abuse and Neglect."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"176C","DOI":"10.2471\/BLT.14.140970","article-title":"The burden of child maltreatment in China: A systematic review","volume":"93","author":"Fang","year":"2015","journal-title":"Bull. World Health Organ."},{"key":"ref_6","unstructured":"Casey, T., Ganz, G., Fry, D., Zheng, X., Fang, X., Hsiao, C., and Ward, C. (2017). The Consequences of Violence against Children in South Africa: A Systematic Review and Meta-Analysis. Child Abuse Rev., under review."},{"key":"ref_7","unstructured":"Artz, L., Burton, P., Ward, C.L., Leoschut, L., Phyfer, J., and Lloyd, S. (2016). Optimus Study South Africa, Technical Report, UBS Optimus Foundation."},{"key":"ref_8","unstructured":"Ezzati, M., Lopez, A.D., Rodgers, A., and Murray, C. (2004). Child sexual abuse. Comparative Quantification of Health Risks: Global and Regional Burden of Disease Attributable to Selected Major Risk Factors, World Health Organization."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1690","DOI":"10.1001\/jama.280.19.1690","article-title":"What\u2019s the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes","volume":"280","author":"Zhang","year":"1998","journal-title":"JAMA"},{"key":"ref_10","unstructured":"World Health Organization (2001). Macroeconomics and Health. Investing in Health for Economic Development, WHO."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1590\/S1020-49892008000900007","article-title":"Economic value of disability-adjusted life years lost to violence, estimates for WHO Member States","volume":"4","author":"Brown","year":"2008","journal-title":"Revista Panamerica de Salud P\u00fablica"},{"key":"ref_12","unstructured":"(2017, July 04). Global Burden of Disease (GBD) Results Tool. GHDx. Available online: http:\/\/ghdx.healthdata.org\/gbd-results-tool."},{"key":"ref_13","unstructured":"World Health Organization (2017, July 04). WHO Methods and Data Sources for Global Burden of Disease Estimates 2000\u20132011. Available online: http:\/\/www.who.int\/healthinfo\/statistics\/GlobalDALYmethods2000_2011.pdf."},{"key":"ref_14","unstructured":"United Nations Population Division (2013). World Population Prospects, United Nations. 2012 Revision."},{"key":"ref_15","unstructured":"(2017, July 08). Statistics South Africa, Available online: http:\/\/cs2016.statssa.gov.za\/."},{"key":"ref_16","unstructured":"(2017, July 08). National Treasury, Available online: http:\/\/www.treasury.gov.za\/documents\/provincial%20budget\/2016\/7.%20EPRE%20standardised%20tables%20in%20Excel%20format\/Default.aspx."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"562","DOI":"10.2471\/BLT.12.117036","article-title":"The epidemiology of child homicides in South Africa","volume":"91","author":"Mathews","year":"2013","journal-title":"Bull. World Health Organ."},{"key":"ref_18","unstructured":"Statistics South Africa (2016). Gross Domestic Product, Fourth Quarter 2015 (P0441)."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1016\/S0167-6296(97)00005-2","article-title":"Disability-adjusted life years, a critical review","volume":"16","author":"Anand","year":"1997","journal-title":"J. Health Econ."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1423","DOI":"10.1136\/bmj.319.7222.1423","article-title":"The value of DALY life, problems with ethics and validity of disability adjusted life years","volume":"319","author":"Arnesen","year":"1999","journal-title":"BMJ"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1306","DOI":"10.1016\/S0140-6736(05)76084-0","article-title":"Are disability weights universal?","volume":"354","author":"James","year":"1999","journal-title":"Lancet"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1093\/heapol\/czl018","article-title":"Calculating QALYs, comparing QALY and DALY calculations","volume":"21","author":"Sassi","year":"2006","journal-title":"Health Policy Plan."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.chiabu.2006.06.008","article-title":"Poly-victimization: A neglected component in child victimization","volume":"31","author":"Finkelhor","year":"2007","journal-title":"Child Abuse Negl."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1080\/0312407X.2010.508533","article-title":"Impact of childhood abuse: Biopsychosocial pathways through which adult mental health is compromised","volume":"63","author":"Coates","year":"2010","journal-title":"Aust. Soc. Work"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1016\/j.socscimed.2008.12.004","article-title":"Violence from parents in childhood and obesity in adulthood: Using food in response to stress as a mediator of risk","volume":"68","author":"Greenfield","year":"2009","journal-title":"Soc. Sci. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e004644","DOI":"10.1136\/bmjopen-2013-004644","article-title":"Association between childhood adversities and long-term suicidality among South Africans from the results of the South African Stress and Health study: A cross-sectional study","volume":"4","author":"Bruwer","year":"2014","journal-title":"BMJ Open"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1080\/14330237.2011.10820494","article-title":"Childhood exposure to community and domestic violence: Prevalence, risk factors and posttraumatic outcomes in a South African student sample","volume":"21","author":"Collings","year":"2011","journal-title":"J. Psychol. Afr."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Collings, S.J., Penning, S.L., and Valjee, S.R. (2014). Lifetime poly-victimization and posttraumatic stress disorder among school-going adolescents in Durban, South Africa. J. Psychiatry Open Access, 17.","DOI":"10.4172\/Psychiatry.1000133"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1093\/aje\/kwh194","article-title":"Prevalence and patterns of gender-based violence and revictimization among women attending antenatal clinics in Soweto, South Africa","volume":"160","author":"Dunkle","year":"2004","journal-title":"Am. J. Epidemiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2764","DOI":"10.1177\/0886260510390960","article-title":"Gender differences in risk for intimate partner violence among South African adults","volume":"26","author":"Gass","year":"2011","journal-title":"J. Interpers. Violence"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1177\/0081246313516258","article-title":"Childhood sexual abuse and HIV sexual-risk behaviour among men who have sex with men in South Africa","volume":"44","author":"Heusser","year":"2014","journal-title":"S. Afr. J. Psychol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1016\/j.chiabu.2010.05.002","article-title":"Associations between childhood adversity and depression, substance abuse and HIV and HSV2 incident infections in rural South African youth","volume":"34","author":"Jewkes","year":"2010","journal-title":"Child Abuse Negl."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1603","DOI":"10.1016\/S0277-9536(01)00294-5","article-title":"Risk factors for domestic violence: Findings from a South African cross-sectional study","volume":"55","author":"Jewkes","year":"2002","journal-title":"Soc. Sci. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1589","DOI":"10.1016\/j.socscimed.2008.07.023","article-title":"Risk for post-traumatic stress disorder associated with different forms of interpersonal violence in South Africa","volume":"67","author":"Kaminer","year":"2008","journal-title":"Soc. Sci. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1017\/S0021932006001325","article-title":"Coerced first sexual intercourse and selected reproductive health outcomes among young women in KwaZulu-Natal, South Africa","volume":"39","author":"Maharaj","year":"2007","journal-title":"J. Biosoc. Sci."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Meinck, F., Cluver, L.D., and Boyes, M.E. (2015). Longitudinal predictors of child sexual abuse in a large community-based sample of South African youth. J. Interpers. Violence, 1\u201333.","DOI":"10.1177\/0886260515596331"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"43","DOI":"10.2989\/17280583.2012.731410","article-title":"Prevalence and factors associated with depressive symptoms among young women and men in the Eastern Cape Province, South Africa","volume":"25","author":"Nduna","year":"2013","journal-title":"J. Child Adolesc. Ment. Health"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1097\/OLQ.0000000000000247","article-title":"Associations between psychosocial factors and incidence of sexually transmitted disease among South African adolescents","volume":"42","author":"Jemmott","year":"2015","journal-title":"Sex. Transm. Dis."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"708","DOI":"10.1080\/10538712.2014.931319","article-title":"Perpetration, revictimization, and self-injury: Traumatic reenactments of child sexual abuse in a nonclinical sample of South African adolescents","volume":"23","author":"Penning","year":"2014","journal-title":"J. Child Sex. Abuse"},{"key":"ref_40","first-page":"18","article-title":"Prevalence and risk factors for intimate partner violence among Grade 8 learners in urban South Africa: Baseline analysis from the Skhokho Supporting Success cluster randomised controlled trial","volume":"8","author":"Shamu","year":"2015","journal-title":"Int. Health"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1847","DOI":"10.1016\/j.socscimed.2010.08.015","article-title":"Adversities in childhood and adult psychopathology in the South Africa Stress and Health Study: Associations with first-onset DSM-IV disorders","volume":"71","author":"Slopen","year":"2010","journal-title":"Soc. Sci. Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1007\/s11469-014-9516-z","article-title":"Childhood punishment and risk for alcohol use disorders: Data from South Africa","volume":"13","author":"Sorsdahl","year":"2015","journal-title":"Int. J. Ment. Health Addict."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/14\/11\/1431\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T18:50:41Z","timestamp":1760208641000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/14\/11\/1431"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,11,22]]},"references-count":42,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2017,11]]}},"alternative-id":["ijerph14111431"],"URL":"https:\/\/doi.org\/10.3390\/ijerph14111431","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,11,22]]}}}