Understanding the physical and social environmental determinants of road traffic injury in South Africa

Abstract Road traffic injuries (RTIs) are a major public health challenge, accounting for significant injury, economic and psycho-social burden to societies across the world. While decreases are projected for many high-income countries (HICs) over the next decade or so, staggering increases in the burden of mortality and morbidity are forecast for low- and middle-income countries (LMICs). The unique contextual influences on RTIs in LMICs are, however, not well understood. Conceptual frameworks applied mostly to HICs also do not provide adequate recognition of the unique contextual influences of LMICs. Accordingly, the research in this thesis adopts a predominantly geographical approach to incorporate a large range of physical and social environmental effects, and which are aggregated at different spatial and spatial-temporal scales to understand the contextual influences to road traffic injuries (RTIs) in the South African (S.A) setting. In this regard, four studies are presented; these include: a geographical epidemiology and risk analysis at the district council level and for time, space and population aggregations; an integrated spatialtemporal analysis at the province-week level; a fine-scale geographical analysis at the police area level; and a small area analysis at the suburb level for the city of Durban. In addition to important effects relating to alcohol and travel exposure, findings have shown most environmental influences on RTIs in S.A to be development-related, including effects relating to social and area deprivation, violence and crime, and rurality. With the exception of rurality, the above effects showed a positive association with the occurrence of RTIs in S.A. The findings have implications for alignment and possible integration of road safety policies and practices with other developmental policies in the country. In addition, this research has shown that geographical approaches may provide a useful analytical framework for understanding the complexity and interacting influences within broader systems-based approaches; and especially those of the contextual environment that are particularly relevant for LMIC settings

Zero-tolerance drink-driving and road safety in South Africa: What are the options?

Alcohol is a major contributing factor to the burden of road traffic crashes and injuries in South Africa. There has been an increase in political interest and engagement on the issue of drink-driving in recent months following government restrictions on the sale and public consumption of alcohol during the COVID-19 lockdowns along with proposed zero-tolerance drink-driving legislation. In this paper, we critically examine global research and experiences with the adoption of zero-tolerance approaches to drink-driving along with key South African contextual considerations to provide evidence-based and contextually relevant recommendations for advancing zero-tolerance drink-driving legislation in the country. There is significant evidence to support the adoption of zero-tolerance legislation but at a blood alcohol concentration (BAC) threshold limit for the general driving population set at 0.02 g/100 mL (rather than the zero-BAC limit proposed through the Road Traffic Amendment Bill) to allow for variance in testing. Recommendations centre on the proposed legislation incorporating a gradualist approach and its location within a broader zero-tolerance approach that includes other complementary interventions to enable implementation. Significance: The recommended blood alcohol level of 0.02 g/100 mL is lower than the best practice limit recommended by the World Health Organization of 0.05 g/100 mL, following consideration of the road safety and general alcohol consumption challenges in South Africa and evidence of success from other similar country contexts. Broad principles and recommendations are presented to support the sustainable adoption of zero-tolerance drink-driving legislation in the country

Cannabis and other drug use among trauma patients in three South African cities, 1999 - 2001

Objective. To assess the extent of cannabis and other drug use among patients presenting with recent  injuries at trauma units in Cape Town, Port Elizabeth and Durban from 1999 to 2001.Design. Cross-sectional surveys were conducted during a 4- week period at each of the above sites in  1999, 2000 and 2001. The concept of an idealised week was used to render representative samples.Outcome measures. Cause of injury and biological markers toassess use of cannabis, methaqualone (Mandrax), opiates, cocaine, amphetamine, and  methamphetamine.Results. Over half of all patients tested experienced violent injuries. Excluding opiates, across sites and over time between 33% and 62% of patients tested positive for at least one drug  (N = 1 565). In most cases the drugs were cannabis and/ or methaqualone. While no inter-city differences were found,male patients were typically more likely to test positive for drugs in general and specific drugs such as  cannabis and the cannabis/methaqualone ('white pipe') combination than female patients. Drug positivity was higher in 2001 than in the previous 2 years in Cape Town, and patients injured as a result of violence in Cape Town and Durban were more likely to test positive for drugs than patients with certain other types of injuries.Conclusions. Drug use among trauma patients has remained consistently high for each of the 3 study periods. Efforts to combat the abuse of drugs such as cannabis and methaqualone would appear to be paramount in reducing the burden of injuries on health care services. The study has raised numerous issues requiring further research

Injury Control and Traffic Safety Training Course Report Back

No Abstract Available African Safety Promotion Vol.1(1) 2002: 76-7

Zero-tolerance drink-driving and road safety in South Africa: What are the options?

Alcohol is a major contributing factor to the burden of road traffic crashes and injuries in South Africa. There has been an increase in political interest and engagement on the issue of drink-driving in recent months following government restrictions on the sale and public consumption of alcohol during the COVID-19 lockdowns along with proposed zero-tolerance drink-driving legislation. In this paper, we critically examine global research and experiences with the adoption of zero-tolerance approaches to drink-driving along with key South African contextual considerations to provide evidence-based and contextually relevant recommendations for advancing zero-tolerance drink-driving legislation in the country. There is significant evidence to support the adoption of zero-tolerance legislation but at a blood alcohol concentration (BAC) threshold limit for the general driving population set at 0.02 g/100 mL (rather than the zero-BAC limit proposed through the Road Traffic Amendment Bill) to allow for variance in testing. Recommendations centre on the proposed legislation incorporating a gradualist approach and its location within a broader zero-tolerance approach that includes other complementary interventions to enable implementation. Significance: The recommended blood alcohol level of 0.02 g/100 mL is lower than the best practice limit recommended by the World Health Organization of 0.05 g/100 mL, following consideration of the road safety and general alcohol consumption challenges in South Africa and evidence of success from other similar country contexts. Broad principles and recommendations are presented to support the sustainable adoption of zerotolerance drink-driving legislation in the country

Cannabis and other drug use among trauma patients in three South African cities, 1999-2001

CITATION: Parry, C. D. H. et al. 2005. Cannabis and other drug use among trauma patients in three South African cities, 1999-2001. South African Medical Journal, 95(6):429-432.The original publication is available at http://www.samj.org.zaObjective. To assess the extent of cannabis and other drug use among patients presenting with recent injuries at trauma units in Cape Town, Port Elizabeth and Durban from 1999 to 2001. Design. Cross-sectional surveys were conducted during a 4-week period at each of the above sites in 1999, 2000 and 2001. The concept of an idealised week was used to render representative samples. Outcome measures. Cause of injury and biological markers to assess use of cannabis, methaqualone (Mandrax), opiates, cocaine, amphetamine, and methamphetamine. Results. Over half of all patients tested experienced violent injuries. Excluding opiates, across sites and over time between 33% and 62% of patients tested positive for at least one drug (N = 1 565). In most cases the drugs were cannabis and/or methaqualone. While no inter-city differences were found, male patients were typically more likely to test positive for drugs in general and specific drugs such as cannabis and the cannabis/methaqualone ('white pipe') combination than female patients. Drug positivity was higher in 2001 than in the previous 2 years in Cape Town, and patients injured as a result of violence in Cape Town and Durban were more likely to test positive for drugs than patients with certain other types of injuries. Conclusions. Drug use among trauma patients has remained consistently high for each of the 3 study periods. Efforts to combat the abuse of drugs such as cannabis and methaqualone would appear to be paramount in reducing the burden of injuries on health care services. The study has raised numerous issues requiring further research.Publisher’s versio