South African Medical Research Council's Flagships Awards Project.

ObjectiveTo investigate injury-related mortality in South Africa using a nationally representative sample and compare the results with previous estimates.MethodsWe conducted a retrospective descriptive study of medico-legal postmortem investigation data from mortuaries using a multistage random sample, stratified by urban and non-urban areas and mortuary size. We calculated age-specific and age-standardized mortality rates for external causes of death.FindingsPostmortem reports revealed 52 493 injury-related deaths in 2009 (95% confidence interval, CI: 46 930–58 057). Almost half (25 499) were intentionally inflicted. Age-standardized mortality rates per 100 000 population were as follows: all injuries: 109.0 (95% CI: 97.1–121.0); homicide 38.4 (95% CI: 33.8–43.0; suicide 13.4 (95% CI: 11.6–15.2) and road-traffic injury 36.1 (95% CI: 30.9–41.3). Using postmortem reports, we found more than three times as many deaths from homicide and road-traffic injury than had been recorded by vital registration for this period. The homicide rate was similar to the estimate for South Africa from a global analysis, but road-traffic and suicide rates were almost fourfold higher.ConclusionThis is the first nationally representative sample of injury-related mortality in South Africa. It provides more accurate estimates and cause-specific profiles that are not available from other sources.

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A survey of medical superintendents revealed that an estimated 1.5 million trauma cases presented to South Africa's 356 secondary and tertiary level hospitals in 1999. Injury rates for traffic, violence and other injuries showed considerable inter-provincial variation, with violence accounting for more than half of the trauma caseload. This type of survey is a simple low cost alternative for monitoring injury patterns and supplementing burden of disease and injury costing studies.

Methods An injury surveillance system was introduced in the emergency departments of two hospitals in Makwanpur district. Anonymous data on patients presenting with an injury were collected 24 hours a day between April 2019 and February 2020. A process evaluation involved 14 interviews to explore sustainability of the model. Results Over 11 months, a total 6942 adult patients with injuries attended the study hospitals. More than half attendees (64.3%) were male and most (55.7%) were young adults (18-35 years). Most injuries were unintentional (86.3%, n=5988); predominantly road traffic injuries (32.2%), falls (25.6%) and animal related harm (20.1%). The hospital management and clinical staff valued the availability and usefulness of injury data that had been collected from the hospital-based surveillance. Conclusion A large proportion of the work presenting to these two hospitals is injury related, and potentially preventable. Road traffic injuries are a significant component of the adult injuries. The lack of capacity of hospital staff for collecting injury data is a major barrier for sustaining the injury surveillance system in the longer term. Learning Outcomes Rich injury data can be obtained by embedding data collectors in emergency departments. Such data can enable monitoring of epidemiological trends. Effective surveillance systems require investment and capacity.