title: Fatal child maltreatment associated with multiple births in Japan: nationwide data between July 2003 and March 2011.
abstract: OBJECTIVE
  The purpose of the present study is to clarify the impact of multiple births in fatal child maltreatment (child death due to maltreatment).
  
  
  METHODS
  The national annual reports on fatal child maltreatment, which contain all cases from July 2003 to March 2011, published by the Ministry of Health, Labor and Welfare of Japan, were used as the initial sources of information. Parent-child murder-suicide cases were excluded from the analyses. Multiple births, teenage pregnancy and low-birthweight were regarded as the exposed groups. The relative risks (RRs) and their 95 % confidence intervals (CIs) were estimated using the data from the above reports and vital statistics. These analyses were performed both including and excluding missing values.
  
  
  RESULTS
  Among 437 fatal child maltreatment cases, 14 multiple births from 13 families were identified. The RRs of multiple births per individual were 1.8 (95 % CI 1.0-3.0) when including missing values and 2.7 (95 % CI 1.5-4.8) when excluding missing values. The RRs of multiple births per family were 3.6 (95 % CI 2.1-6.2) when including missing values and 4.9 (95 % CI 2.7-9.0) when excluding missing values. The RR tended to be much lower than the RR of teenage pregnancy (RR 12.9 or 22.2), but slightly higher than the RR of low-birthweight (RR 1.4 or 2.9).
  
  
  CONCLUSIONS
  Families with multiple births had elevated risk for fatal child maltreatment both per individual and per family unit. Health providers should be aware that multiple pregnancies/births may place significant stress on families and should provide appropriate support and intervention.
authors.affiliation: Department of Health Science, Ishikawa Prefectural Nursing University, 1-1 Gakuendai, Kahoku, Ishikawa, 929-1210, Japan, sooki@ishikawa-nu.ac.jp.
authors.forename: Syuichi
authors.initials: S
authors.lastname: Ooki
mesh_terms: D000293:Adolescent; D002648:Child; D002649:Child Abuse / Q000401:mortality*; D002675:Child, Preschool; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007564:Japan / Q000453:epidemiology; D008297:Male; D009099:Multiple Birth Offspring; D012189:Retrospective Studies; D012306:Risk; D012307:Risk Factors; D011795:Surveys and Questionnaires
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