Intentional injury and violence in Cape Town, South Africa: an epidemiological analysis of trauma admissions data

Background Injury is a truly global health issue that has enormous societal and economic consequences in all countries. Interpersonal violence is now widely recognized as important global public health issues that can be addressed through evidence-based interventions. In South Africa, as in many low- and middle-income countries (LMIC), a lack of ongoing, systematic injury surveillance has limited the ability to characterize the burden of violence-related injury and to develop prevention programmes. Objective To describe the profile of trauma presenting to the trauma centre of Groote Schuur Hospital in Cape Town, South Africa – relating to interpersonal violence, using data collected from a newly implemented surveillance system. Particular emphasis was placed on temporal aspects of injury epidemiology, as well as age and sex differentiation. Design Data were collected prospectively using a standardized trauma admissions form for all patients presenting to the trauma centre. An epidemiological analysis was conducted on 16 months of data collected from June 2010 to October 2011. Results A total of 8445 patients were included in the analysis, in which the majority were violence-related. Specifically, 35% of records included violent trauma and, of those, 75% of victims were male. There was a clear temporal pattern: a greater proportion of intentional injuries occur during the night, while unintentional injury peaks late in the afternoon. In total, two-third of all intentional trauma is inflicted on the weekends, as is 60% of unintentional trauma. Where alcohol was recorded in the record, 72% of cases involved intentional injury. Sex was again a key factor as over 80% of all records involving alcohol or substance abuse were associated with males. The findings highlighted the association between violence, young males, substance use, and weekends. Conclusions This study provides the basis for evidence-based interventions to reduce the burden of intentional injury. Furthermore, it demonstrates the value of locally appropriate, ongoing, systematic public health surveillance in LMIC.

[1]  L. Knowlton,et al.  Trauma Surveillance in Cape Town, South Africa: An Analysis of 9236 Consecutive Trauma Center Admissions. , 2014, JAMA surgery.

[2]  Jennifer Bleck,et al.  Tip of the iceberg: reporting and gender-based violence in developing countries. , 2014, American journal of epidemiology.

[3]  N. Schuurman,et al.  Confronting the data-divide in a time of spatial turns and volunteered geographic information , 2013 .

[4]  Bernadette A. Thomas,et al.  Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010 , 2012, The Lancet.

[5]  J. Seekings,et al.  Violence, violence prevention, and safety: a research agenda for South Africa. , 2012, South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde.

[6]  N. Schuurman,et al.  Collecting injury surveillance data in low- and middle-income countries: The Cape Town Trauma Registry pilot , 2011, Global public health.

[7]  Hadley K. Herbert,et al.  Global health: injuries and violence. , 2011, Infectious disease clinics of North America.

[8]  J. Myers,et al.  Applying upstream interventions for interpersonal violence prevention: an uphill struggle in low- to middle-income contexts. , 2010, Health policy.

[9]  R. Matzopoulos,et al.  Local-level mortality surveillance in resource-limited settings: a case study of Cape Town highlights disparities in health. , 2010, Bulletin of the World Health Organization.

[10]  E. Nsereko,et al.  Injury surveillance in a central hospital in Kigali, Rwanda. , 2010, Journal of emergency nursing: JEN : official publication of the Emergency Department Nurses Association.

[11]  A. Hyder,et al.  The global burden of unintentional injuries and an agenda for progress. , 2010, Epidemiologic reviews.

[12]  L. Li,et al.  Evaluation of an emergency department-based injury surveillance project in China using WHO guidelines , 2009, Injury Prevention.

[13]  E. Kolo,et al.  Implementing a hospital based injury surveillance system: a case study in Nigeria , 2008, Medicine, conflict, and survival.

[14]  D. Clark,et al.  The value of trauma registries. , 2008, Injury.

[15]  H. Ford,et al.  Development of a hospital-based trauma registry in Haiti: an approach for improving injury surveillance in developing and resource-poor settings. , 2007, The Journal of trauma.

[16]  R. Norman,et al.  The high burden of injuries in South Africa. , 2007, Bulletin of the World Health Organization.

[17]  A. Zwi,et al.  Violence: a priority for public health? (part 2) , 2007, Journal of Epidemiology and Community Health.

[18]  M. Peden,et al.  Estimating the South African trauma caseload , 2006, International journal of injury control and safety promotion.

[19]  S. Murray.  Global injury and violence , 2006, Canadian Medical Association Journal.

[20]  L. Fingerhut,et al.  Addressing the growing burden of trauma and injury in low- and middle-income countries. , 2005, American journal of public health.

[21]  C. Parry,et al.  Alcohol use and trauma in Cape Town, Durban and Port Elizabeth, South Africa: 1999–2001 , 2004, Injury control and safety promotion.

[22]  Debbie Bradshaw,et al.  Initial burden of disease estimates for South Africa, 2000. , 2003, South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde.

[23]  E. Krug,et al.  The world report on violence and health , 2002, The Lancet.

[24]  J. Corrigall,et al.  Violence, Alcohol Misuse and Mental Health: Gaps in the health system's response , 2012 .

[25]  C. Groenewald,et al.  The state of the population in the Western Cape province , 2008 .

[26]  K. Hofman,et al.  Addressing the growing burden of trauma and injury in low- and middle-income countries. , 2005, American journal of public health.

[27]  J. Singh,et al.  South African Health Review 2005. , 2005 .

[28]  J. Murphy.  World report on violence and health. , 2002, Irish medical journal.

[29]  Egbert Krug.  World Report on Violence and Health, World Health Organization , 2002 .

[30]  N. Schuurman,et al.  International Journal of Health Geographics Open Access Research Injury Surveillance in Low-resource Settings Using Geospatial and Social Web Technologies , 2022 .