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ORIGINAL ARTICLE
Year : 2021  |  Volume : 24  |  Issue : 11  |  Page : 1645-1648

Child deaths due to firearm-related İnjuries in Adana, Turkey


1 Department of Forensic Medicine, Cukurova University, Adana, Turkey
2 Department of Forensic Medicine, Council of Forensic Medicine, Diyarbakır, Turkey
3 Department of Forensic Medicine, Council of Forensic Medicine, Adana, Turkey

Date of Submission22-Sep-2020
Date of Acceptance19-Mar-2021
Date of Web Publication15-Nov-2021

Correspondence Address:
Dr. Z Erdem
Department of Forensic Medicine, Council of Forensic Medicine, Adana
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njcp.njcp_549_20

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   Abstract 


Background: Death by firearm is unacceptable for children who need to be under the protection of the state and the family, wherever and however. Firearm-related fatality is common among all ages. One of the causes of this high rate is likely the easy access to firearms. Aim: This study aims to discuss the characteristics of deaths attributable to childhood firearm injuries in Adana, Turkey and to compare them with similar studies. Patients and Methods: In this study, the records of 448 (1.97%) cases under 18 years of age who died due to firearm-related injuries among a total of 22,668 cases whose autopsies were performed by the Morgue Department, Council of Forensic Medicine Adana Group Administration between January 1, 2004 and December 12, 2017 were retrospectively evaluated. Results: Age ranged from 45 days to 18 years; 285 cases were male and 163 cases were female, and male/female ratio was 1.7. The majority of cases were between 13 and 18 years of age (n: 340, 76.0%). According to the manner of death, the leading cause was homicide (n: 212, 47.4%) and the most frequently used type of firearm were shotguns (n: 226). Single firearm wound was present in 82.8% of the cases. The location of entrance wounds revealed that 185 wounds were located in the head-neck. Although homicide was the leading manner of death among the overall cases, it was determined that suicide was the leading cause among the 13-18 age group (n: 149). Firearm-related injuries and deaths in children should bring child neglect to the agenda. Conclusion: Presence of firearms at home and easy access are the causes of increased firearm injuries and death in children. Easily accessible weapons in homes are often involved in suicides and homicides, as well as accidents, which are more common in young children and adolescents. We believe that the use of firearms outside of the security forces should be prohibited and that strict laws should be enforced on the handling and use of firearms.

Keywords: Autopsy, child, death, firearm, injury


How to cite this article:
Kaya K, Akgunduz E, Erdem Z, Hilal A. Child deaths due to firearm-related İnjuries in Adana, Turkey. Niger J Clin Pract 2021;24:1645-8

How to cite this URL:
Kaya K, Akgunduz E, Erdem Z, Hilal A. Child deaths due to firearm-related İnjuries in Adana, Turkey. Niger J Clin Pract [serial online] 2021 [cited 2021 Nov 28];24:1645-8. Available from: https://www.njcponline.com/text.asp?2021/24/11/1645/330471




   Introduction Top


In accordance with the Convention on the Rights of the Child, individuals in our country under the age of 18 years are considered children. It is unacceptable for a child to die under the protection of the state and his/her family during childhood, regardless of the origin of the firearm injury. Firearm-related deaths are frequently encountered in Forensic Medicine applications, likely due to the fact that firearms are easily accessible in many countries. In the United States, about 50,000 people die annually due to violence-related injuries. It was also reported that suicides were the top cause of violent deaths, followed by homicides, and the most commonly used method was firearms with a rate of 48.2%.[1] In the year 2010, 1970 children, meaning approximately five children per day, were killed by firearms in the United States.[2] In the Scandinavian countries, where laws on firearms are very strict, the rate of using firearms in murders and suicides is very low compared to other countries.[3]

In most countries, there are more men than women in the youth suicide statistics. Although rates vary from country to country, suicide is one of the most common causes of death among young people. Because of the increased risk of suicide with increasing age, adolescents are the main target of suicide prevention. As is known, less than half of the young people who committed suicide received psychiatric care, and therefore, broad prevention strategies are needed in health and social services.

This study aims to discuss the characteristics of deaths attributable to childhood firearm injuries in Adana, Turkey, and to compare them with similar studies.


   Material and Methods Top


Among the total of 22,668 cases whose medico-legal autopsies were performed by the Morgue Department, Council of Forensic Medicine Adana Group Administration between January 1, 2004 and December 31, 2017, the records of 448 (1.97%) cases under the age of 18 with firearm-related deaths were retrospectively evaluated in terms of age, gender, origin, number of gunshot wounds and shooting distance. Ethics committee approval was received on 20 November 2019 with the number 2019/175.


   Results Top


Of the 22,668 medico-legal autopsies carried out over a period of 8 years, 448 (1.97%) were found to be younger than 18 years of age and injured by firearms. The distribution of children who died after gunshot injury by years and gender is presented in [Figure 1]. The ages of cases were found to be between 45 days and 18 years. It was seen that 163 were women and 285 were men of the cases; male/female ratio was found to be 1.7.
Figure 1: Distribution of deaths by years and genders

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When the age distribution of the cases was examined, it was determined that 340 (76.0%) of the cases were between the ages of 13 and 18. When deaths due to firearms were evaluated according to origin, it was observed that 212 (47.4%) deaths were due to homicide, followed by 161 deaths (35.9%) due to suicide and 75 deaths due to undetermined causes. The distribution of the cases according to origin is presented in [Figure 2].
Figure 2: Distribution of the cases according origins

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It was found that 371 (82.8%) of the cases had a single gunshot entrance wound, 47 cases had 2-3 gunshot entrance wounds and 30 cases had 4 or more gunshot entrance wounds. The highest number of gunshot entrance wounds was observed in an 18-year-old homicide case with 11 wounds.

Among the 13-18 age group, suicide was the top cause (n: 149), followed by homicide (n: 138). There were no suicides in the 0-6 age group, in which the leading cause was accidents.

When the types of firearms were evaluated, shotguns were involved in 226 cases, handguns in 213 cases and rifles in 9 cases. The distribution of the firearm types is shown in [Figure 3].
Figure 3: Distribution of the firearms

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According to the location of gunshot wounds in the body, wounds were distributed equally in the head-neck and chest-back regions, with 185 wounds in the head-neck, 185 wounds in the chest-back, 79 wounds in the abdominal region, and 23 wounds in the extremities [Figure 4]. In terms of shooting distance, adjacent shot was at the first place with 179 wounds and it was followed by long distance shots with 126 wounds.
Figure 4: Body Distribution of Shootings

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   Discussion Top


It is known that deaths due to firearms have an important place in violent deaths. Demetrietes et al. conducted a study in Los Angeles and revealed that 45.3% of traumatic deaths were due to homicides, followed by traffic accidents, indicating that violent deaths are a significant public health problem.[4]

Among all age groups in our country, handguns were the most common type of firearm involved in firearm-related deaths.[5],[6] In a study that only included children who died from firearm-related injuries in Konya, Turkey, shotguns (66%) were the most common type of firearm used.[7] Shotguns were also found to be the most common type of firearm in our study, involved in 45.8% of the cases. We believe that easy access to firearms in households significantly contributes to firearm-related deaths in children.

A study conducted in Nebraska reported that childhood deaths comprised 10.9% of the autopsies, and among these, deaths due to firearm injury in childhood had a rate of 0.62%. This rate is lower than 1.97% which was detected in our study. This situation is interpreted as using firearms at a higher rate in the region where the study was conducted than in a country where firearms are widely used, such as the USA.[8]

In the study conducted in Konya, Turkey, it was stated that childhood deaths due to firearm injuries were most common among the 15-18 age group.[7] Similarly, 76.0% of the cases in our study were among the 13-18 age group.

In the study conducted in Antalya, Turkey, firearm-related deaths were the leading manner of death in childhood suicides.[9] According to the Turkish Statistical Institute, firearms were the top suicide method between 2006 and 2015 (10 years) in our country.[10] Our previous study conducted in our region also found that firearms were the second most common method in suicides, in accordance with the country's general.[11] In our study, suicides are the second leading cause of deaths due to firearms in childhood. This is remarkable in terms of demonstrating the prevalence of easy access and use of firearms.

He M et al. conducted a study in Shanghai, and reported that only 14 deaths were related to firearms among 2,696 homicides between 2000 and 2009, ranking firearms in the seventh place among causes of death.[12] The rates in our country are very different. Previous studies showed that firearm-related deaths were the leading cause with 66.9% in Antalya, 68.2% in Edirne and 80% in our province.[5] In our work, even in childhood, homicides involving firearms are in the first place with a rate of 47.4%. The rates in our study are similar to the USA, where we have more weapons and use is not under control. Easy access to firearms should be prevented, similar to Scandinavian countries and China.

Suicide rates in adolescents increase significantly with age. Suicide is one of the most common causes of death among adolescents. Although suicide rates differ between countries, teen suicide is a major public health problem worldwide. Therefore, prevention of suicide in young people is extremely important. To be successful, preventing teen suicide cannot be limited to, for example, psychiatric care, but action must be taken at different levels of society. The main purpose of effective prevention of young suicides is to reduce suicide risk factors. Psychiatric morbidity, particularly mood disorders, antisocial disorders and substance abuse are strongly associated with teen suicide. For this reason, the recognition and effective treatment of these disorders are of great importance in the clinical prevention of child and adolescent suicides.[13]


   Conclusion Top


Firearm-related deaths and injuries in children should bring child neglect to the agenda. Easy access to firearms in households cause increased rates of death and injury in children. Easily accessible weapons in homes are often involved in suicides and homicides, as well as accidents, which are more common in young children and adolescents. We believe that firearms should be prohibited except for security forces, and strict laws for carrying and using firearms should be enforced.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Karch DL, Dahlberg LL, Patel N, Davis TW, Logan JE, Hill HA, et al. Surveillance for violent deaths– National violent death reporting system, 16 States 2006. MMWR Surveill Summ 2009;58:1-44.  Back to cited text no. 1
    
2.
Flores G, Lesley B. Children and US federal policy on health and health care seen but not heard. JAMA Pediatr 2014;168:1155-63.  Back to cited text no. 2
    
3.
Hougen HP, Rogde S, Poulsen K. Homicide in two Scandinavian capitals. Am J Forensic Med Pathol 1999;20:293-9.  Back to cited text no. 3
    
4.
Demetriades D, Murray J, Sinz B. Epidemiology of major trauma and trauma deaths in Los Angeles country. J Am Coll Surg 1998;187:373-83.  Back to cited text no. 4
    
5.
Karagöz MY, Karagöz SD, Atılgan M, Demirca C. An Analysis of 133 firearm deaths. Bull Leg Med 1996;3:122-6.  Back to cited text no. 5
    
6.
Azmak D, Altun G, Bilgi S, Yılmaz A. Firearm fatalities in Edirne 1984-1997. Forensic Sci Int 1998;95:231-9.  Back to cited text no. 6
    
7.
Demirci Ş, Doğan KH, Deniz I. The deaths related to firearm injuries during the age of childhood in Konya. The Bulletin of Legal Medicine.2009;14:22.  Back to cited text no. 7
    
8.
Okoye CN, Okoye MI. Forensic epidemiology of childhood deaths in Nebraska, USA. J Forensic Leg Med 2011;18:366-74.  Back to cited text no. 8
    
9.
Atılgan M, Demirçin S. Suicidal childhood deaths with firearms in Antalya, Turkey. J Forensic Leg Med 2013;20:644-6.  Back to cited text no. 9
    
10.
Demir M. Gender differences in suicide methods in Turkey. Forensic Res Criminol Int J 2017;4:169-74.  Back to cited text no. 10
    
11.
Arslan M, Akcan R, Hilal A, Batuk H, Cekin N. Suicide among children and adolescents: Data from Cukurova, Turkey. Child Psychiatry Hum Dev 2007;38:271-7.  Back to cited text no. 11
    
12.
He M, Fang YX, Lin JY, Ma KJ, Li BX. Unnatural deaths in Shanghai from 2000 to 2009: A retrospective study of forensic autopsy cases at the Shanghai public security bureau. PloS One 2015;25:1-10.  Back to cited text no. 12
    
13.
Pelkonen M, Marttunen M. Child and adolescent suicide. Pediatr-Drugs 2003;5:243-65.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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