- Email: [email protected]
A profile of child branding cases in Kashmir valley
Accepted Manuscript A profile of child branding cases in Kashmir valley Arsalaan F. Rashid, Lecturer, Kaiser Ahmed, Professor & Head, Farida Noor, Professor & Head PII:
S1752-928X(17)30046-X
DOI:
10.1016/j.jflm.2017.05.001
Reference:
YJFLM 1487
To appear in:
Journal of Forensic and Legal Medicine
Received Date: 11 June 2016 Revised Date:
8 March 2017
Accepted Date: 1 May 2017
Please cite this article as: Rashid AF, Ahmed K, Noor F, A profile of child branding cases in Kashmir valley, Journal of Forensic and Legal Medicine (2017), doi: 10.1016/j.jflm.2017.05.001. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
TITLE PAGE Original Research Paper
RI PT
A Profile of Child Branding Cases in Kashmir Valley Arsalaan F.Rashid1 , Kaiser Ahmed2 , Farida Noor3.
1. Lecturer ; Department of Forensic Medicine, Government Medical College
SC
Srinagar , J & K, India.
2. Professor & Head ; Department of Pediatrics, Govt. Medical College Srinagar, J & K, India.
M AN U
3. Professor & Head ; Department of Forensic Medicne, Govt. Medical College Srinagar, J & K, India.
Mailing Addresses:
1. House No.1, Lane No. 2, Opposite Masjid Ibrahim, Ibrahim Colony, Hyderpora, Srinagar, Jammu and Kashmir India- 190014. Email – [email protected] Phone No. +91-9796963052
TE D
2. Shah Anwar Colony ; Hyderpora ; Srinagar . Phone No. 09419019198 3. House no. 139; Near Raj bagh police station [email protected] Phone no 9796113414
Arsalaan F. Rashid
EP
Corresponding Author :
AC C
Lecturer ; Department of Forensic Medicine, Government Medical College Srinagar J & K, India. Email – [email protected] Phone No. +91-9796963052
ACCEPTED MANUSCRIPT
A Profile of Child Branding Cases in Kashmir Valley Introduction
M AN U
SC
RI PT
Branding is a traditional practice of creating 'burns' on the skin with a hot iron rod or metallic object that derives its roots from Norse Brena – A 12th century word meaning “ to burn to light ” [1]. Branding was one of the main ways of torturing or punishing prisoners .Army deserters used to be branded during the American Civil War [2]. The practice of child branding has been observed widely in India . The present study aims to establish a pattern between child branding and its medical; social and economic correlations .Among these correlations the present study will focus on disease related morbidity and mortality; role of community based faith healers [“quacks”]; poverty and illiteracy. The study will also reveal how bits and pieces of scientific information have been used to misdiagnose and mistreat a significant population belonging to pediatric age group. It will further try to evaluate the role of “pain gating” mechanisms as a means of pain relief and the partial success in motivating a significant population by these healers to be part of such practices. Material and Methods
AC C
EP
TE D
The present study was conducted in a tertiary care pediatric hospital over a period of two years between January 2012 to December 2013. A total number of 35 cases with alleged history of branding were identified out of which 11 cases were excluded for lack of proper history; late stage of admission where alleged wounds had already healed; or where a chain of evidence could not be established. This prospective study was based on clinical history taking and examination. Any previous record establishing a link between injuries inflicted on child in past and the present admission was also cross examined. The study size being small it was decided to divide the sample in three age groups [0-5 years; 5-10 years; more than 10 years] where the effect on normal growth patterns could be studied over a period of time. Regular follow up of discharged patients was carried out on outpatient basis but this depended upon the consent and willingness of the parents. Till completion of the study all of the 24 cases included in study were on regular follow up which in addition to regular treatment protocols included intensive parent education against use of non scientific methods of healing.
Observation and Results
Out of a total of 35 cases 24 cases satisfied the inclusion criteria and were thoroughly analyzed on various parameters. 12 cases [50%] were found in age group of 0-5 years; 8 cases were found in age group of 5-10 years [33.34%] and 4 cases were found in age group of more than 10 years [ 16.66%]; [Table 1] . About 18 cases [75%] belonged to male sex and 6 cases [25%] belonged to female sex; [Table 1]. Demographic data obtained from relatives of these patients revealed that 20 cases [91.66%] belonged to rural setting and only 2 cases [8.34%] belonged to urban areas [Table 2]. Taking distribution of injuries over the body into consideration; a maximum of 12 injuries [50%] were located over the abdominal area. 4 cases [16.67%] each had injuries over chest and upper limbs respectively. 3 cases had injuries over the lower limbs [12.50%] and only
ACCEPTED MANUSCRIPT
DISCUSSION
TE D
M AN U
SC
RI PT
one case [4.16%] had injury over back [Table 3]. All injuries [100%] were burns in nature ; about 5 cases [ 4.16% ] were superficial and rest 19 cases [ 79.16%] were deep burns [Table 4]. The burns were inflicted by hot metal rods , coal or wood. Medicolegally 20 cases [83.34%] were simple injuries and the rest 4 cases were grievous injuries [16.66%] leaving the wounds in different stages of permanent disfigurement and also causing intense pain and prolonged hospital stay [ more than 20 days]; [Table 5] . An analysis of possible causes leading the parents to cause such painful and disfiguring injuries to their own children [Figure 1 & 2] gave some shocking insights into this behavior. The most important among them being rural demography [91.66%] .This practice was very common among nomadic sheep herders residing in hilly regions locally known as “gujjar-bakerwaals” where modern facilities of health care were not available .The other reasons that perhaps supplemented the former cause was presence of widespread superstition [ 83.34% ] and illiteracy [ 75% ] in the affected population [Table 6]. This troika of backwardness ; illiteracy and superstition resulted in widespread malpractices carried out by so called faith healers [“quacks”] who virtually kept the population hostage to their totally flawed approach of medication that also included child branding. While doing this analysis ; an interesting scenario emerged – it was found that in 50 % cases there was some degree of relief of underlying symptoms especially pain .The reason for this relief being perhaps the pain gating mechanisms that result in suppression of one pain by another even powerful pain stimulus. This was authenticated by the fact that in about 75% cases relief of pain did not relieve the underlying disease process which made the same people seek tertiary care; only this time their condition having deteriorated further. In many such cases the disease process had gone way beyond normal outpatient treatment modalities like in fulminent hepatic failure where the children were usually critical at the time of admission.
AC C
EP
The study of injuries inflicted on children owes its origin to Caffey, [3] who in 1946 drew attention to the occurrence of dissimilar injuries in children namely fractures of the long bones and subdural hematoma and regarded them as injuries inflicted by parents or those in charge of the child. Child abuse was first reported by Evans in 1955. Although general awareness of child abuse is increasing, abuse by burning is often unrecognized. Child abuse by burning is defined as the action of intentionally inflicting injuries on a child by burning [4,5] Several workers Gill [6] ; Stone [7] ; Phillips et a1 [5] have drawn attention to the use of heat as a means of child abuse. In South Asian countries like India and Pakistan branding has been used as a means of treatment of acute and chronic illness ; the intention of the parents being to provide cure to their children in absence of proper health care facilities and under influence of illiteracy and superstitious beliefs. Branding as treatment has been reported from India for convulsions [8]; ear discharge and hepatoslenomegaly [9] . A recent study from India showed that jaundice was amongst the commonest complaints for which patients opted for traditional / alternative forms of treatment [10]. Complications arising from branding include acute infection, transmission of blood-borne pathogens, allergic reactions, and sequelae arising from third-degree burns [11,12,13] . The practice of putting saliva / ash / herbal paste on the burn wounds adds to the morbidity [14]. Evil eye to be a cause of pediatric ailments has been reported in many studies [15,16]. Measles and chicken-pox are regarded as "curse of goddess" or "wrath of god" in study done in one group of north Indian population [17]. Role of branding in disease management or in subjective control of
ACCEPTED MANUSCRIPT
M AN U
SC
RI PT
pain is unclear [18]. It is proposed that the secondary inflammatory response to the applied irritant comprising vasodilation, enzyme release, swelling, edema, blebs, vesicles and suppuration may aid leucocytes and opsonins released in the inflamed area, leading to bacterial destruction. In addition, this response aids in the rapid elimination of toxins [19]. The influence of counter-irritants may be summarized in a reflex action; for example, the production and conduction of an impulse from the periphery to nerve centers modifies the nerve function and blood supply in distant parts [ pain gating mechanisms] [20]. It is significant to note that in this study no case could be linked to malafide child abuse. In all these cases the children were subjected to tortuous treatment only because of their inaccessibility to modern means of treatment; widespread prevalence of superstition and illiteracy. In all these cases the parents intended to see their children in good health. This observation is in stark contrast to those made in western and certain Asian countries where primary reason of child abuse is causing intentional pain for sake of pervert reasons [ battered baby syndrome ; paedophilia etc] [21,22].
Conclusion
EP
TE D
The main conclusion of the study relates to mismanagement in the treatment of pediatric age group population due to illiteracy ; poverty ; non availability of treatment facilities especially in rural areas of population. This leads to mushrooming of unqualified and criminal medical practices which not only increase the mortality and morbidity rates in a population but also decrease the productivity that such a population could have in overall development of nation as children suffering from such malpractices succumb to chronic illnesses at a time when their physical growth is expected to be maximum . A very positive outcome of the study was parent education regarding the evil practices carried out by these faith – healers. It was heartening to note that after discharge of such children from tertiary care a significant change in attitude of parents towards these so called healers was noted. This was not restricted to the affected family only but also to nearby community. Conflict of Interest
AC C
None Declared References
1. Karamanoukian R, Ukatu C, Lee E, Hyman J, Sundine M, Kobayashi M, Evans GR: Aesthetic skin branding: a novel form of body art with adverse clinical sequela. J Burn Care Res 2006, 27:108-110. 2. Steven Kroeter .Untitled by Anonymous: An Ode to Branding.2009.
3. Caffey, J, American J'ournal of Roentgenology, 1946, 56, 163.
ACCEPTED MANUSCRIPT
4. Daria S, Sugar NF, Feldman KW, Boos SC, Benton SA, Ornstein A.: Into hot water head first: Distribution of intentional and unintentional immersion burns. Paediatr Emerg Care, 20: 30210, 2004.
RI PT
5. Phillips PS, Pickrell E, Morse TS: Intentional burning: A severe form of child abuse. J American College Emergency Physicians, 3: 388-90, 1974. 6. Gil, D G, Violence against Children. Cambridge, Massachusetts, Harvard University Press, 1970. 7. Stone, N H, et al, Surgical Clinics of North America, 1970, 50, 1419.
SC
8. Phillips, S P, et al, Journal of the American College of Emergency Physicians, 1974, 3, 388.
M AN U
9. Kushwaha KP , Mathur GP, Mathur S, Singh Y, Sati TR. Superstitious therapy during illnesses of preschool children . Indian Pediatr 1986 ; 23 : 163-168. 10. Taneja DK, Singal PK, Dhawan S. Superstitions in pediatric illnesses among rural mothers. Indian PediaIr 1988; 25: 447-452. 11. Yadav RJ, Pandey A, Singh P. A study on acceptability of Indiansystem of medicine and homeopathy in India: results from theState of West Bengal. Indian J Public Health. 2007; 51:47–9.
TE D
12. Raza S, Mahmood K, Hakeem , Polsky S, Haemel A, Rai SA, et al. Adverse clinical sequelae after skin branding: a case series. Journal of Medical Case Reports. 2009; 3:25. 13. Kumar S, Kumar PR. Skin branding. J Postgrad Med. 2004; 50:204.
EP
14. Yadav RJ, Pandey A, Singh P. A study on acceptability of Indian system of medicine and homeopathy in India: results from the State of West Bengal. Indian J Public Health. 2007; 51:47–9.
AC C
15. Adhisivam B, Gowtham R. Branding treatment of children in rural India should be banned. BMJ. 2005;330:481. 16. George B, Sathy N. Saguna Bai NS. Atmar ME. Superstitions. beliefs and practices during childhood illnesses. Indian Pediatr 1989; 26: 936-38. 17. Tomar, Balvir S, Superstitions and child health. Indiatl Pedialr 1980; 17: 883-.885. 18. Gupte S. Viral infections. In : Gupta S (Ed.), Short textbook of pediatrics. 9th Edn. Jaypee Brothers, New Delhi 200 I: 165. 19. Karamanoukian R, Ukatu C, Lee E, Hyman J, Sundine M, Kobayashi M, Evans GR:
ACCEPTED MANUSCRIPT
Aesthetic skin branding: a novel form of body art with adverse clinical sequela. J Burn Care Res 2006, 27:108-110.
RI PT
20. LaMotte RH, Thalhammer JG, Torebj Auork HE, Robinson CJ: Peripheral neural mechanisms of cutaneous hyperalgesia following mild injury by heat. J Neurosci 1982, 2:765-781. 21. World report on violence and health .Child abuse and neglect by parents and other caregivers Chapter 3 ;Page 63; table 3.1[Internet]. Geneva: World Health Organization. Available from: http://www.who.int/violence_injury_prevention/violence/global_campaign/en/chap3.pdf
AC C
EP
TE D
M AN U
SC
22. Freund K, Watson R, Dickey R. Does sexual abuse in childhood cause pedophilia: an exploratory study. Arch Sex Behav 1990, Dec;19(6):557-68.
ACCEPTED MANUSCRIPT
Table No. 1 Age/Sex Distribution CASES
PERCENTAGE
SEX
CASES
0-5
12
50
MALES
18
5 - 10
8
33.34
FEMALES
6
> 10
4
16.66
24
100
URBAN
CASES
2
PERCENTAGE
8.34
M AN U
Table No. 2 Demographic Profile SNO.
75 25
SC
24
PERCENTAGE
RI PT
AGE GROUP
100
RURAL
TOTAL
22
24
91.66
100
CHEST
CASES
4
PERCENTAGE
16.67
ABDOMEN
BACK
12 50
EP
SNO.
TE D
Table No. 3 Distribution of Injuries
LOWER LIMBS 3
TOTAL
1
UPPER LIMBS 4
4.16
16.67
12.50
100%
S NO. CASES
AC C
Table No. 4 Types of Burns
PERCENTAGE
SUPERFICIAL BURN 5
DEEP BURN
TOTAL
19
24
4.16
79.16
100 %
24
ACCEPTED MANUSCRIPT
Table No. 5 Medico legal Classification SIMPLE
GREVIOUS
DANGEROUS
CASES
20
4
NIL
PERCENTAGE
83.34
16.66
-
100
[ n = 24 ]
No.
Percentage
20
83.34
16
66.67
18
75.00
12
50.00
Unsuccessful relief of some chronic underlying disease
18
75.00
Demography – rural ; hilly areas inaccessible to modern medical care
22
91.66
Superstition Recommendation by peer group Illiteracy
M AN U
Most probable reason for Child Branding
24
SC
Table No. 6 Probable Underlying Factors
TOTAL
RI PT
SNO.
AC C
EP
TE D
Successful relief of pain on previous occasion
TE D
M AN U
SC
RI PT
ACCEPTED MANUSCRIPT
AC C
EP
Figure 1. Healed Branding marks over abdominal area in child brought to hospital for passage of loosely formed stools.
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SC
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ACCEPTED MANUSCRIPT
AC C
EP
Figure 2. Same child on close shot showing fully healed burns with permanent scarification. The child had recurrent episodes of passage of loosely formed stools and failure to thrive and a provisional diagnosis of metabolic disorder was made at time of admission.
ACCEPTED MANUSCRIPT
Article Highlights for review
AC C
EP
TE D
M AN U
SC
RI PT
The article is a two year study on Child branding practices in Kashmir valley practiced by faith healers [quacks]. These healers possibly relieve the initial stigmata of the disease by playing with body’s “pain gating mechanisms”. The mistreated disease condition continues to fester undiagnosed which increases its morbidity and mortality. The study aims to establish a pattern between child branding and its medical; social and economic correlations. A positive outcome of this study is educating people to shun such practices and follow proper treatment regimens.
S1752-928X(17)30046-X
DOI:
10.1016/j.jflm.2017.05.001
Reference:
YJFLM 1487
To appear in:
Journal of Forensic and Legal Medicine
Received Date: 11 June 2016 Revised Date:
8 March 2017
Accepted Date: 1 May 2017
Please cite this article as: Rashid AF, Ahmed K, Noor F, A profile of child branding cases in Kashmir valley, Journal of Forensic and Legal Medicine (2017), doi: 10.1016/j.jflm.2017.05.001. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
TITLE PAGE Original Research Paper
RI PT
A Profile of Child Branding Cases in Kashmir Valley Arsalaan F.Rashid1 , Kaiser Ahmed2 , Farida Noor3.
1. Lecturer ; Department of Forensic Medicine, Government Medical College
SC
Srinagar , J & K, India.
2. Professor & Head ; Department of Pediatrics, Govt. Medical College Srinagar, J & K, India.
M AN U
3. Professor & Head ; Department of Forensic Medicne, Govt. Medical College Srinagar, J & K, India.
Mailing Addresses:
1. House No.1, Lane No. 2, Opposite Masjid Ibrahim, Ibrahim Colony, Hyderpora, Srinagar, Jammu and Kashmir India- 190014. Email – [email protected] Phone No. +91-9796963052
TE D
2. Shah Anwar Colony ; Hyderpora ; Srinagar . Phone No. 09419019198 3. House no. 139; Near Raj bagh police station [email protected] Phone no 9796113414
Arsalaan F. Rashid
EP
Corresponding Author :
AC C
Lecturer ; Department of Forensic Medicine, Government Medical College Srinagar J & K, India. Email – [email protected] Phone No. +91-9796963052
ACCEPTED MANUSCRIPT
A Profile of Child Branding Cases in Kashmir Valley Introduction
M AN U
SC
RI PT
Branding is a traditional practice of creating 'burns' on the skin with a hot iron rod or metallic object that derives its roots from Norse Brena – A 12th century word meaning “ to burn to light ” [1]. Branding was one of the main ways of torturing or punishing prisoners .Army deserters used to be branded during the American Civil War [2]. The practice of child branding has been observed widely in India . The present study aims to establish a pattern between child branding and its medical; social and economic correlations .Among these correlations the present study will focus on disease related morbidity and mortality; role of community based faith healers [“quacks”]; poverty and illiteracy. The study will also reveal how bits and pieces of scientific information have been used to misdiagnose and mistreat a significant population belonging to pediatric age group. It will further try to evaluate the role of “pain gating” mechanisms as a means of pain relief and the partial success in motivating a significant population by these healers to be part of such practices. Material and Methods
AC C
EP
TE D
The present study was conducted in a tertiary care pediatric hospital over a period of two years between January 2012 to December 2013. A total number of 35 cases with alleged history of branding were identified out of which 11 cases were excluded for lack of proper history; late stage of admission where alleged wounds had already healed; or where a chain of evidence could not be established. This prospective study was based on clinical history taking and examination. Any previous record establishing a link between injuries inflicted on child in past and the present admission was also cross examined. The study size being small it was decided to divide the sample in three age groups [0-5 years; 5-10 years; more than 10 years] where the effect on normal growth patterns could be studied over a period of time. Regular follow up of discharged patients was carried out on outpatient basis but this depended upon the consent and willingness of the parents. Till completion of the study all of the 24 cases included in study were on regular follow up which in addition to regular treatment protocols included intensive parent education against use of non scientific methods of healing.
Observation and Results
Out of a total of 35 cases 24 cases satisfied the inclusion criteria and were thoroughly analyzed on various parameters. 12 cases [50%] were found in age group of 0-5 years; 8 cases were found in age group of 5-10 years [33.34%] and 4 cases were found in age group of more than 10 years [ 16.66%]; [Table 1] . About 18 cases [75%] belonged to male sex and 6 cases [25%] belonged to female sex; [Table 1]. Demographic data obtained from relatives of these patients revealed that 20 cases [91.66%] belonged to rural setting and only 2 cases [8.34%] belonged to urban areas [Table 2]. Taking distribution of injuries over the body into consideration; a maximum of 12 injuries [50%] were located over the abdominal area. 4 cases [16.67%] each had injuries over chest and upper limbs respectively. 3 cases had injuries over the lower limbs [12.50%] and only
ACCEPTED MANUSCRIPT
DISCUSSION
TE D
M AN U
SC
RI PT
one case [4.16%] had injury over back [Table 3]. All injuries [100%] were burns in nature ; about 5 cases [ 4.16% ] were superficial and rest 19 cases [ 79.16%] were deep burns [Table 4]. The burns were inflicted by hot metal rods , coal or wood. Medicolegally 20 cases [83.34%] were simple injuries and the rest 4 cases were grievous injuries [16.66%] leaving the wounds in different stages of permanent disfigurement and also causing intense pain and prolonged hospital stay [ more than 20 days]; [Table 5] . An analysis of possible causes leading the parents to cause such painful and disfiguring injuries to their own children [Figure 1 & 2] gave some shocking insights into this behavior. The most important among them being rural demography [91.66%] .This practice was very common among nomadic sheep herders residing in hilly regions locally known as “gujjar-bakerwaals” where modern facilities of health care were not available .The other reasons that perhaps supplemented the former cause was presence of widespread superstition [ 83.34% ] and illiteracy [ 75% ] in the affected population [Table 6]. This troika of backwardness ; illiteracy and superstition resulted in widespread malpractices carried out by so called faith healers [“quacks”] who virtually kept the population hostage to their totally flawed approach of medication that also included child branding. While doing this analysis ; an interesting scenario emerged – it was found that in 50 % cases there was some degree of relief of underlying symptoms especially pain .The reason for this relief being perhaps the pain gating mechanisms that result in suppression of one pain by another even powerful pain stimulus. This was authenticated by the fact that in about 75% cases relief of pain did not relieve the underlying disease process which made the same people seek tertiary care; only this time their condition having deteriorated further. In many such cases the disease process had gone way beyond normal outpatient treatment modalities like in fulminent hepatic failure where the children were usually critical at the time of admission.
AC C
EP
The study of injuries inflicted on children owes its origin to Caffey, [3] who in 1946 drew attention to the occurrence of dissimilar injuries in children namely fractures of the long bones and subdural hematoma and regarded them as injuries inflicted by parents or those in charge of the child. Child abuse was first reported by Evans in 1955. Although general awareness of child abuse is increasing, abuse by burning is often unrecognized. Child abuse by burning is defined as the action of intentionally inflicting injuries on a child by burning [4,5] Several workers Gill [6] ; Stone [7] ; Phillips et a1 [5] have drawn attention to the use of heat as a means of child abuse. In South Asian countries like India and Pakistan branding has been used as a means of treatment of acute and chronic illness ; the intention of the parents being to provide cure to their children in absence of proper health care facilities and under influence of illiteracy and superstitious beliefs. Branding as treatment has been reported from India for convulsions [8]; ear discharge and hepatoslenomegaly [9] . A recent study from India showed that jaundice was amongst the commonest complaints for which patients opted for traditional / alternative forms of treatment [10]. Complications arising from branding include acute infection, transmission of blood-borne pathogens, allergic reactions, and sequelae arising from third-degree burns [11,12,13] . The practice of putting saliva / ash / herbal paste on the burn wounds adds to the morbidity [14]. Evil eye to be a cause of pediatric ailments has been reported in many studies [15,16]. Measles and chicken-pox are regarded as "curse of goddess" or "wrath of god" in study done in one group of north Indian population [17]. Role of branding in disease management or in subjective control of
ACCEPTED MANUSCRIPT
M AN U
SC
RI PT
pain is unclear [18]. It is proposed that the secondary inflammatory response to the applied irritant comprising vasodilation, enzyme release, swelling, edema, blebs, vesicles and suppuration may aid leucocytes and opsonins released in the inflamed area, leading to bacterial destruction. In addition, this response aids in the rapid elimination of toxins [19]. The influence of counter-irritants may be summarized in a reflex action; for example, the production and conduction of an impulse from the periphery to nerve centers modifies the nerve function and blood supply in distant parts [ pain gating mechanisms] [20]. It is significant to note that in this study no case could be linked to malafide child abuse. In all these cases the children were subjected to tortuous treatment only because of their inaccessibility to modern means of treatment; widespread prevalence of superstition and illiteracy. In all these cases the parents intended to see their children in good health. This observation is in stark contrast to those made in western and certain Asian countries where primary reason of child abuse is causing intentional pain for sake of pervert reasons [ battered baby syndrome ; paedophilia etc] [21,22].
Conclusion
EP
TE D
The main conclusion of the study relates to mismanagement in the treatment of pediatric age group population due to illiteracy ; poverty ; non availability of treatment facilities especially in rural areas of population. This leads to mushrooming of unqualified and criminal medical practices which not only increase the mortality and morbidity rates in a population but also decrease the productivity that such a population could have in overall development of nation as children suffering from such malpractices succumb to chronic illnesses at a time when their physical growth is expected to be maximum . A very positive outcome of the study was parent education regarding the evil practices carried out by these faith – healers. It was heartening to note that after discharge of such children from tertiary care a significant change in attitude of parents towards these so called healers was noted. This was not restricted to the affected family only but also to nearby community. Conflict of Interest
AC C
None Declared References
1. Karamanoukian R, Ukatu C, Lee E, Hyman J, Sundine M, Kobayashi M, Evans GR: Aesthetic skin branding: a novel form of body art with adverse clinical sequela. J Burn Care Res 2006, 27:108-110. 2. Steven Kroeter .Untitled by Anonymous: An Ode to Branding.2009.
3. Caffey, J, American J'ournal of Roentgenology, 1946, 56, 163.
ACCEPTED MANUSCRIPT
4. Daria S, Sugar NF, Feldman KW, Boos SC, Benton SA, Ornstein A.: Into hot water head first: Distribution of intentional and unintentional immersion burns. Paediatr Emerg Care, 20: 30210, 2004.
RI PT
5. Phillips PS, Pickrell E, Morse TS: Intentional burning: A severe form of child abuse. J American College Emergency Physicians, 3: 388-90, 1974. 6. Gil, D G, Violence against Children. Cambridge, Massachusetts, Harvard University Press, 1970. 7. Stone, N H, et al, Surgical Clinics of North America, 1970, 50, 1419.
SC
8. Phillips, S P, et al, Journal of the American College of Emergency Physicians, 1974, 3, 388.
M AN U
9. Kushwaha KP , Mathur GP, Mathur S, Singh Y, Sati TR. Superstitious therapy during illnesses of preschool children . Indian Pediatr 1986 ; 23 : 163-168. 10. Taneja DK, Singal PK, Dhawan S. Superstitions in pediatric illnesses among rural mothers. Indian PediaIr 1988; 25: 447-452. 11. Yadav RJ, Pandey A, Singh P. A study on acceptability of Indiansystem of medicine and homeopathy in India: results from theState of West Bengal. Indian J Public Health. 2007; 51:47–9.
TE D
12. Raza S, Mahmood K, Hakeem , Polsky S, Haemel A, Rai SA, et al. Adverse clinical sequelae after skin branding: a case series. Journal of Medical Case Reports. 2009; 3:25. 13. Kumar S, Kumar PR. Skin branding. J Postgrad Med. 2004; 50:204.
EP
14. Yadav RJ, Pandey A, Singh P. A study on acceptability of Indian system of medicine and homeopathy in India: results from the State of West Bengal. Indian J Public Health. 2007; 51:47–9.
AC C
15. Adhisivam B, Gowtham R. Branding treatment of children in rural India should be banned. BMJ. 2005;330:481. 16. George B, Sathy N. Saguna Bai NS. Atmar ME. Superstitions. beliefs and practices during childhood illnesses. Indian Pediatr 1989; 26: 936-38. 17. Tomar, Balvir S, Superstitions and child health. Indiatl Pedialr 1980; 17: 883-.885. 18. Gupte S. Viral infections. In : Gupta S (Ed.), Short textbook of pediatrics. 9th Edn. Jaypee Brothers, New Delhi 200 I: 165. 19. Karamanoukian R, Ukatu C, Lee E, Hyman J, Sundine M, Kobayashi M, Evans GR:
ACCEPTED MANUSCRIPT
Aesthetic skin branding: a novel form of body art with adverse clinical sequela. J Burn Care Res 2006, 27:108-110.
RI PT
20. LaMotte RH, Thalhammer JG, Torebj Auork HE, Robinson CJ: Peripheral neural mechanisms of cutaneous hyperalgesia following mild injury by heat. J Neurosci 1982, 2:765-781. 21. World report on violence and health .Child abuse and neglect by parents and other caregivers Chapter 3 ;Page 63; table 3.1[Internet]. Geneva: World Health Organization. Available from: http://www.who.int/violence_injury_prevention/violence/global_campaign/en/chap3.pdf
AC C
EP
TE D
M AN U
SC
22. Freund K, Watson R, Dickey R. Does sexual abuse in childhood cause pedophilia: an exploratory study. Arch Sex Behav 1990, Dec;19(6):557-68.
ACCEPTED MANUSCRIPT
Table No. 1 Age/Sex Distribution CASES
PERCENTAGE
SEX
CASES
0-5
12
50
MALES
18
5 - 10
8
33.34
FEMALES
6
> 10
4
16.66
24
100
URBAN
CASES
2
PERCENTAGE
8.34
M AN U
Table No. 2 Demographic Profile SNO.
75 25
SC
24
PERCENTAGE
RI PT
AGE GROUP
100
RURAL
TOTAL
22
24
91.66
100
CHEST
CASES
4
PERCENTAGE
16.67
ABDOMEN
BACK
12 50
EP
SNO.
TE D
Table No. 3 Distribution of Injuries
LOWER LIMBS 3
TOTAL
1
UPPER LIMBS 4
4.16
16.67
12.50
100%
S NO. CASES
AC C
Table No. 4 Types of Burns
PERCENTAGE
SUPERFICIAL BURN 5
DEEP BURN
TOTAL
19
24
4.16
79.16
100 %
24
ACCEPTED MANUSCRIPT
Table No. 5 Medico legal Classification SIMPLE
GREVIOUS
DANGEROUS
CASES
20
4
NIL
PERCENTAGE
83.34
16.66
-
100
[ n = 24 ]
No.
Percentage
20
83.34
16
66.67
18
75.00
12
50.00
Unsuccessful relief of some chronic underlying disease
18
75.00
Demography – rural ; hilly areas inaccessible to modern medical care
22
91.66
Superstition Recommendation by peer group Illiteracy
M AN U
Most probable reason for Child Branding
24
SC
Table No. 6 Probable Underlying Factors
TOTAL
RI PT
SNO.
AC C
EP
TE D
Successful relief of pain on previous occasion
TE D
M AN U
SC
RI PT
ACCEPTED MANUSCRIPT
AC C
EP
Figure 1. Healed Branding marks over abdominal area in child brought to hospital for passage of loosely formed stools.
TE D
M AN U
SC
RI PT
ACCEPTED MANUSCRIPT
AC C
EP
Figure 2. Same child on close shot showing fully healed burns with permanent scarification. The child had recurrent episodes of passage of loosely formed stools and failure to thrive and a provisional diagnosis of metabolic disorder was made at time of admission.
ACCEPTED MANUSCRIPT
Article Highlights for review
AC C
EP
TE D
M AN U
SC
RI PT
The article is a two year study on Child branding practices in Kashmir valley practiced by faith healers [quacks]. These healers possibly relieve the initial stigmata of the disease by playing with body’s “pain gating mechanisms”. The mistreated disease condition continues to fester undiagnosed which increases its morbidity and mortality. The study aims to establish a pattern between child branding and its medical; social and economic correlations. A positive outcome of this study is educating people to shun such practices and follow proper treatment regimens.