Unisa online - Mapping the highway of violence

Front from left: Prof Rita Maré, Prof Jeanine Vellema, Dr Lindiwe Makubalo & Prof Kopano Ratele Back from left: Dr Ashley van Niekerk, Prof Anthony Mbewu, Prof Tinyiko Maluleke & Mr Hilton Donson

"The highway of violence takes especially the young, but not exclusively. It is a highway which perhaps needs to be explored a little deeper: the anger, the sharp and blunt objects, the guns and the bullets." So said Prof Tinyiko Maluleke, Executive Director of Research, at the release of the 9th Annual Report of the National Injury Mortality Surveillance System (NIMSS) on 5 November 2008 in the Senate Hall on the Muckleneuk campus. NIMSS is an ongoing project of the Crime, Violence and Injury Lead Programme, which is co-directed by the Medical Research Council (MRC) and Unisa. Speaking at the launch, Prof Anthony Mbewu, MRC President, said that the programme was committed to using good science to foster safety promotion. Dr Ashley van Niekerk, MRC-Unisa Crime, Violence and Injury Lead Programme, highlighted the twin problem of violence and transport-related incidents that are still the major causes of non-natural deaths in the country. Dr Lindiwe Makubalo, Chief Director: Health Information, Epidemiology, Evaluation and Research, speaking on behalf of the Minister of Health, stressed the importance of the report. "It helps us reflect collectively on what it is we need to do and what should be done to reduce these deaths.... NIMSS clearly contributes significantly to a more complete and comprehensive understanding of violence and injury." Dr Makubalo appealed to the national and provincial Departments of Health as well as their allied sectors to begin to find ways to structure their interventions so that they could have significant impact in the next few years.

A panel comprising Mr Hilton Donson, NIMSS Coordinator, MRC-Unisa Crime, Violence and Injury Lead Programme; Prof Kopano Ratele, Acting Director: Institute for Social and Health Sciences, Unisa; Prof Jeanine Vellema, Chief Specialist: Forensic Pathology Service, Johannesburg; and Prof Tinyiko Maluleke reflected on some of the issues raised by NIMSS and engaged in a question and answer session with members of the audience.

The closing remarks and the vote of thanks were delivered by Prof Rita Maré, who called on the panel to remain the voice of all victims of violence and road carnage in South Africa.

More about NIMSS

Violence and motor vehicle accidents continue to be major causes of death in South Africa. Despite the magnitude of these problems, death as a result of preventable causes continues to be a cause for concern for any person or organisation interested in the health and social wellbeing of the population.

Information about deaths due to external causes is vital for monitoring demographic, seasonal and socioeconomically-related trends in these major causes of death and disability. Since 1991 and since the promulgation of Act 52 of 1992, which precluded entry of the external cause of death in the death register for injury cases, such information has been missing from the national vital statistics on causes of death. Police data systems only record information for violence and the national transport information system records information for certain subgroups of motor vehicle collision deaths. Death due to suicide, burns, other unintentional causes and where the manner of death is undetermined are not tracked by any agency --- except the National Injury Mortality Surveillance System (NIMSS).

NIMSS and the Crime, Violence and Injury Lead Programme

NIMSS is an ongoing project of the Crime, Violence and Injury Lead Programme which is co-directed by the Medical Research Council and the University of South Africa. Established in 1999 to fill the gap of information about causes of death, NIMSS provides the most comprehensive information about deaths due to external causes. The information is collated from existing investigative procedures at mortuaries, state forensic chemistry laboratories and the courts. All deaths due to external causes are included, allowing an overview of how the different categories of external cause (eg gunshots, drowning) contribute to the profile of non-natural mortality in men, women and children.

The 9th Annual Report of NIMSS contains the most comprehensive description of the who, what, when, where and how of non-natural injuries in South Africa. NIMSS has full coverage in the four largest cities of South Africa, namely, Cape Town, eThekwini/Durban, Johannesburg and Tshwane/Pretoria.

Highlights from the 9th annual report

The 9th annual report covers the period 1 January to 31 December 2007. During this period, a total of 33 513 deaths were registered at the mortuaries covered by NIMSS.

Figure 1: Overall manner of death (N = 33513)

Sex, age and population group

Of the 33 513 non-natural deaths, 79% were male and 19% female. Africans constituted 76% of all cases, whites 10%, coloureds 9% and Asians 3%. The majority of deaths were of young adults, with 36% of all cases aged 15-29 years, and 32% aged 30-44 years. A total of 5% of the deaths were younger than 5 years, another 4% were aged 5-14 years, 15% were aged 45-59 years, and 7% were 60 years and older.

Manner of death

Violence was the major cause of non-natural death, accounting for 36% (or 11 994 deaths) of all deaths. Transport-related deaths accounted for 32% (or 10 713) of deaths, followed by other unintentional injuries (13% or 4 391 deaths) and suicide (10% or 3 457 deaths). For 9% (or 2 958 deaths), the manner of death was undetermined. The leading manner of non-natural death for males was homicide (39%) and for females, transport-related death (36%).

External causes of death

Motor vehicle crashes overshadowed all other external causes and accounted for 30% of all cases. For children aged 0-4 years and for 85+ years, burns were the major cause of death. For children aged 5-14 years and for the 45-84 year age, group pedestrian injuries ranked first. For the age range 15-29 years, sharp object deaths ranked first, with firearms second. For the 30-44 year olds, firearms ranked first.

Violence

Nearly 40% of the 11 994 violence-related deaths were inflicted by sharp objects and just more than one-third by firearms. The number of cases rose sharply in the 15-19 year age group and peaked in the 25-29 age category. There were 6,5 male violent deaths for every female violent death. Of the males, 40% were killed with sharp objects and just one-third with firearms, while firearms followed by sharp objects accounted for 31% and 28% of female deaths respectively.

Sharp objects were the major external cause of violence for the ages 15-29, 35-39 and 45-49 years. Firearms were the largest single external cause of violence for the age groups 30-34, 40-44, 50-59, 65-69 and 80-84 years. Blunt objects were the major external cause of homicide for those aged 0-4, 10-14, 60-64, 70-79 and 85+ years. Most violence-related deaths occurred in and around private homes.

Figure 2: Homicide by victim age (n = 11314)

Suicide

Hanging accounted for 58% of the 3 457suicides recorded by NIMSS, poisoning for 17% and firearms for 15%. Nearly two-thirds of all suicide victims were aged between 20 and 39 years. There were 4,6 male suicides for every female suicide. The major external causes of suicide among males were hanging (62%) and firearms (15%), while among females it was poisoning (38%) and hanging (36%). Most suicides occurred in private homes.

Figure 3: Suicide by victim age (n = 3258)

Transport-related deaths

Of the 10 713 transport-related deaths, pedestrians accounted for 39%, passengers for 22% and drivers for 18%, while 4% involved cyclists and 3% were railway related. A further 14% of transport-related deaths were due to motor vehicle collisions; however the user category was unknown. There were 3,6 males per female transport-related death. Pedestrian deaths ranked as the top external cause of death for children among all age categories, except infants younger than one year. Most motor vehicle crash-related deaths occurred between 16:00 and 19:00, and over the weekend.

Figure 4: Transport deaths by victim age (n = 9915)

Burns, falls, drowning and other unintentional injuries deaths

Of the 4 391 deaths due to non-transport unintentional injuries, 39% were due to burns, 16% to drowning, 10% to falls and 35% to other unintentional injuries. Burns were the major external cause of death for children under 4 years of age, and the second major cause for children aged 5 to 9 years. Most burn and fall deaths occurred in private homes, and drowning deaths in the sea, lakes and rivers, although a substantial percentage of drownings also happened at private homes (eg in swimming pools).

Figure 5: Top 10 scenes of injury (n = 24791)

Time of death
The peak period(s) of death for

• homicide was 00:00 (22.4%) followed by 01:00-03:00 (10.3%);
• suicide was 16:00-20:00 (22.1%);
• transport-related deaths was 18:00-22:00 (26.3%); and
• non-transport related deaths was 14:00-16:00

Comparisons among Cape Town, eThekwini/Durban, Johannesburg and Tshwane/Pretoria

With an injury mortality rate of 144,9 deaths per 100 000 population, as well as a violence rate of 63,5 per 100 000, Cape Town is the most unsafe city among the four largest cities in South Africa. In contrast, Tshwane has the lowest overall injury mortality (81,1/100 00) and homicide rates (19,4/100 00). eThekwini/Durban and Johannesburg fall in between the other two cities for both overall and homicide rates. Johannesburg is the least safe city as far as transport-related deaths are concerned. The rate for transport deaths in Johannesburg is 42,7 deaths per 100 000 population, while in Cape Town it is 35,5/100 000; in eThekwini/Durban, it is 35,0/100 000, and in Tshwane, with the lowest rate, it is 29,6/100 00. Suicide rates are highest in Johannesburg (14,2/100 000 population), followed by eThekwini/Durban (11,9/100 000 population). Firearm suicide is relatively highest in Tshwane/Pretoria (3,3/100 000 population), while hanging suicide is relatively highest in eThekwini/Durban (7,8/100 000).

A copy of the full report can be found at http://www.mrc.ac.za/crime/nimms_rpt_Nov08.pdf.