The body count : using routine mortality surveillance data to drive violence prevention

Includes bibliographical references.This thesis describes the conceptualisation, development and implementation of a mortuary-based system for the routine collection of information about homicide. It traces the evolution of the system from its conceptualisation in 1994, through various iterations as a city-level research tool, to a national sentinel system pilot, as a multicity all-injury surveillance system, and finally its institutionalisation as a provincial injury mortality surveillance system in the Western Cape. In so doing, it demonstrates that the data arising from medico-legal post-mortem investigations described in this thesis were an important source of descriptive epidemiological information on homicide. The 37,037 homicide records described in the thesis were drawn from Cape Town, Durban, Johannesburg, Port Elizabeth and Pretoria, for which the surveillance system maintained full coverage from 2001 to 2005. The aim was to apply more complex statistical analysis and modelling than had been applied previously

Evaluation of a Cape Town Safety Intervention as a Model for Good Practice: A Partnership between Researchers, Community and Implementing Agency

VPUU has a wealth of experience to share and is engaged with broader national and international policymakers and implementing agencies. Researchers are grappling with the difficulty of providing a rigorous project evaluation for these collaborations which could identify project elements that work with a view to their replication. This paper traces the evolution of an evidence-based approach to violence prevention in the Western Cape Province of South Africa. The Violence Prevention through Urban Upgrading (VPUU) project in Cape Town uses such an approach, and relies on a 'whole-of-society' methodology as well. The project and the difficulty of its evaluation are discussed. A partnership between VPUU, researchers, the community and local government has revealed both opportunities and obstacles, which are the subjects of a case study described here

Gun control saves lives

Reducing firearm mortality by means of stricter gun control is one of the most important short- to medium-term measures to address the burden of violence in South Africa, while longer-term interventions and policy measures take effect

Drivers’ risk profile indicates the need for a graduated driving licence in South Africa

Background. Current driver mortality estimates do not consider the great differences in exposure across the population, giving a false impression that driver deaths are lowest in the youngest age group. Interventions to reduce risk among the younger age group include graduated driver licensing (GDL) . a three-phase licensing system for novice drivers consisting of a learnerfs permit, a provisional license, and a full license.Objectives. We calculated driver fatality rates per 10 000 registereddrivers in each age group and assessed the need for stricter licensingconditions for novice and younger drivers. Methods. Age-specific driver mortality rates were calculated using Western Cape Province 2008 mortuary data. The total number of licensed drivers in each age group served as the denominator. Incidence rate ratios were calculated using the age group of 65 - 79 years as the reference. Chi-square test of trendon incidence rate ratios for the age groups was done. Statistical significance was set as p<0.05.Results. There were 339 driver deaths; mean age was 39.4}13.8 years, and males accounted for 80% of the deaths. Age-specific driver mortality rates were highest in the youngest age group (15 - 19 years). There was a significant progressive decrease (except for the age group 45 - 49 years) in the risk of death from road traffic injuries with increasing age compared with the age group .65 years (chi2 for trend p<0.0001).Conclusion. This study showed a relationship between driverfs mortality risk and younger age, and underscores the need for introduction of a GDL programme in South Africa

VIOLENT DEATHS IN SA: The 2003 National Injury Mortality Surveillance System

The latest data from the National Injury Mortality Surveillance System – the most detailed source on the ‘who, what, when, where and how’ of fatal injuries in South Africa – shows that homicide remains the most common cause of injury-related deaths. Homicide rates varied significantly between the four major urban centres covered, and firearms were a key contributor to the high homicide rates. Alcohol was confirmed as an important risk factor for murder, with the highest percentage of alcohol positive cases being recorded in Cape Town

Piloting a trauma surveillance tool for primary healthcare emergency centres

Objective. We aimed to pilot a trauma surveillance tool for use ina primary healthcare emergency centre to provide a risk profile ofinjury patterns in Elsies River, Cape Town.Methods. Healthcare workers completed a one-page questionnairecapturing demographic and injury data from trauma patients presenting to the emergency unit of the Elsies River Community Health Centre over a period of 10 days.Results. Trauma cases comprised about one-fifth of the total headcount during the study period. Most injuries took place before midnight. Approximately 47% of the trauma patients were suspected of being under the influence of alcohol with 87% of these cases caused by interpersonal violence; 28% were males between 19 and 35 years old, suspected of being under the influence of alcohol and presenting with injuries due to violence.Conclusion. Injury surveillance at primary healthcare emergency centres provides an additional perspective on the injury burden compared with population-level mortality statistics, but the quality of data collection is limited by resource constraints. We recommend that the current trauma register be revised to separate trauma and medical headcounts and enable better resource planning at a facility and subdistrict level. Information gathered must be linked to health and safety interventions aimed at reducing the trauma burden within communities

Where have all the gun deaths gone?

Background. The low number of firearm assaults and overall assault-related deaths in Statistics South Africa’s death notification reports is incongruous with other recently released data, including police crime statistics.Methods. We conducted a review of all gunshot injuries recorded in death notifications from 1997 to 2013, including all cases in which the underlying cause of death was ascribed to cause-specific codes in the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) that referred to a gunshot injury.Results. We identified 105 694 gunshot-related injury deaths over the 17-year period, an average of 6 217 per annum. The total annual number of gunshot injuries increased from 1997 to 2000, at which point firearm-related deaths peaked at 9 540 recorded cases. Thereafter there was a steadily decreasing trend (interrupted only in 2006 and 2008) until 2011, when 3 793 deaths were attributed to gunshot-related injuries as the underlying cause – a decrease of >60% from the peak in 2000.Conclusion. The cause-specific profile for gunshot injury deaths in this study indicated extensive misclassification, which explained the near-absence of these injuries among assault cases. However, the trend in gunshot-related injury deaths irrespective of intent provides further support for the hypothesis that stricter gun control, coinciding with the implementation of the Firearms Control Act of 2000, accounts for this decrease