Experiences of children with intentional injury in a low-resource setting in South Africa

Childhood exposure to violence in South Africa is extremely high. Despite alarming rates of intentional injuries among children, there is limited research on their experiences. This study explored the lived experiences of children who were intentionally injured in a low-resource setting in South Africa. We purposively selected 37 children aged 8-16 years from the Sinethemba longitudinal study who had presented for medical treatment following a moderate-severe intentional injury. Semi-structured interviews explored children's perceptions of the event. The transcribed interviews were analysed using thematic analysis in ATLAS.ti. Results indicated that most injuries were inflicted by other children, arising from peer-group conflicts, exacerbated by a perceived need to show strength among boys. Most children experienced a lack of support from people who witnessed the incident, resulting in significant delays in accessing medical treatment. Immediate responses from families often prioritised retaliation/confronting the perpetrators before seeking medical care for children. Participating children also described mixed experiences within the hospital, including supportive care and perceived judgemental attitudes. Post-event, children described changes in caregiver behaviour, with some being more nurturing, whilst others became overprotective. Despite perceptions of child agency in the event leading to their intentional injury, and extreme normalisation of violence at individual, family and community levels, children described experiencing traumatic responses, including fear and a desire for revenge. These findings provide novel data that can help inform interventions, not only for intentionally injured children but also for caregivers and healthcare professionals who play an important role in children's recovery.