Adolescent homicide victimisation in Johannesburg, South Africa

In South Africa there has been growing national concern about the high levels of interpersonal violence especially among young people. Several incidents of school homicides in particular made newspaper headlines during 2006 and a national public hearing on “School Based Violence” was also convened by the Human Rights Commission to address the problem. However, incidents of school-associated violent deaths represent only a small proportion of adolescent homicides. The National Injury Mortality Surveillance System, which captures approximately 40% of the annual nonnatural deaths in South Africa, reveal that the majority (52%) of nonnatural deaths among youth between the age of 15 and 24 years are due to violence. Unpublished NIMSS data for 2004 shows that of the 8575 violent deaths where age was recorded, young people between the ages of 15 to 24 years accounted for more than a quarter (26.3%) of homicides.Institute for Social and Health Science

The malignant epidemic-changing patterns of trauma

Objectives and Setting. The worldwide burden of trauma is increasing, but is unequally distributed between nations. Trauma in South Africa targets the young and productive in society and imposes a major burden on the health infrastructure. We undertook a review of injury trends among patients attending the Johannesburg Hospital Trauma Unit (JHTU) and the Johannesburg Medicolegal Laboratory (JMLL) in order to document the evolution in patterns of trauma over a 17-year period of great social and political change. Design, subjects and outcome measures. This was a retrospective review of all priority-one patients attending the JHTU from January 1985 to December 2001. The JHTU trauma database was used to retrieve information on patient demographics, wound mechanism and injury severity. The database at the JMLL, maintained since 1996, was examined and the manner and place of death were analysed.Results. The JHTU has seen an unprecedented increase in the number of trauma patients over the last 17 years. The patients' demographic profiles have altered and injury is now predominantly due to interpersonal violence. Unnatural deaths examined at the JMLL have declined by 19% since 1996; however, the proportion of those deaths due to gunshot wounds has risen.Conclusions. The social and political changes in South Africa in recent years have led to changes in the injury profiles seen at the JHTU. Part of the increase can be explained by desegregation and a reduction in the provision of local hospital services; however, the impact of urbanisation within South Africa, cross-border migration and the high incidence of substance abuse are recognised. Evidence supports the implementation of legislative, environmental, social and behavioural interventions to contain and reduce the incidence and impact of violence and injury. Concerted efforts must be made at all levels to curb South Africa's  trauma  epidemic