Injury-related mortality in South Africa: a retrospective descriptive study of postmortem investigations

Abstract

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.

Child deaths in South Africa: Lessons from the child death review pilot

“…From personal experience (LJM serves as a member of the National Forensic Pathology Service Committee) and involvement in national mortality-based studies of two of the authors (SM and LJM), it is suggested that the Western Cape referral pattern is different from the national referral pattern in that most SUDIs are not referred to the FPS, but declared as natural deaths by medical practitioners in the community, and are therefore never brought to the attention of the health surveillance system. [13,14] A concern is the potential for child homicides, in particular deaths from neglect, to remain undetected. This may also place other children in the family at risk.…”

Energy poverty, shack fires and childhood burns

“…Fires kill thousands of people every year, with many more disabled or seriously injured, resulting in untold and often lifelong misery and entrenched poverty. [13] These deaths are mainly categorised as owing to flame burns, although in informal settlements liquid and food burns are also a significant cause of burn injury and hospitalisation. In SA, children are a vulnerable population, because of their more limited risk appraisal capacities and physiology.…”

South Africa’s vital statistics are currently not suitable for monitoring progress towards injury and violence Sustainable Development Goals

“…[12] The misclassification of injury deaths is another major limitation. [2,13] The Inquest Act of 1959 [14] precludes forensic pathologists from reporting the manner of death, i.e. whether it is due to homicide, suicide, transport or other unintentional injuries, on the basis that it may prejudice the findings of the inquest.…”

“…[1] Police statistics on homicide, and transport deaths from the Road Traffic Management Corporation, are considered to be under-reported [2] and are not a reliable source for monitoring SDGs.…”