Evaluation of a Cape Town Safety Intervention as a Model for Good Practice: A Partnership between Researchers, Community and Implementing Agency

VPUU has a wealth of experience to share and is engaged with broader national and international policymakers and implementing agencies. Researchers are grappling with the difficulty of providing a rigorous project evaluation for these collaborations which could identify project elements that work with a view to their replication. This paper traces the evolution of an evidence-based approach to violence prevention in the Western Cape Province of South Africa. The Violence Prevention through Urban Upgrading (VPUU) project in Cape Town uses such an approach, and relies on a 'whole-of-society' methodology as well. The project and the difficulty of its evaluation are discussed. A partnership between VPUU, researchers, the community and local government has revealed both opportunities and obstacles, which are the subjects of a case study described here

The cost of harmful alcohol use in South Africa

PKBackground. The economic, social and health costs associated with alcohol-related harms are important measures with which to inform alcohol management policies and laws. This analysis builds on previous cost estimates for South Africa. Methods. We reviewed existing international best-practice costing frameworks to provide the costing definitions and dimensions. We sourced data from South African costing literature or, if unavailable, estimated costs using socio-economic and health data from secondary sources. Care was taken to avoid possible causes of cost overestimation, in particular double counting and, as far as possible, second-round effects of alcohol abuse. Results. The combined total tangible and intangible costs of alcohol harm to the economy were estimated at 10 - 12% of the 2009 gross domestic product (GDP). The tangible financial cost of harmful alcohol use alone was estimated at R37.9 billion, or 1.6% of the 2009 GDP. Discussion. The costs of alcohol-related harms provide a substantial counterbalance to the economic benefits highlighted by the alcohol industry to counter stricter regulation. Curtailing these costs by regulatory and policy interventions contributes directly and indirectly to social well-being and the economy. Conclusions. Existing frameworks that guide the regulation and distribution of alcohol frequently focus on maximising the contribution of the alcohol sector to the economy, but should also take into account the associated economic, social and health costs. Current interventions do not systematically address the most important causes of harm from alcohol, and need to be informed by reliable evidence of the ongoing costs of alcohol-related harms

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

This is the final version of the article. Available from Taylor & Francis via the DOI in this record.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, a lack of ongoing, systematic injury surveillance has limited the ability to characterize the burden of violence-related injury and to develop prevention programs. 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 center. An epidemiological analysis was conducted on 16 months of data collected from June 2010 to October 2011. Results: 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. Fully 2/3 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.This study was partly funded by a GEOIDE grant (SSII-54)

Trauma Surveillance in Cape Town, South Africa: An Analysis of 9236 Consecutive Trauma Center Admissions.

PublishedJournal ArticleResearch Support, Non-U.S. Gov'tThis is the final version of the article. Available from American Medical Association via the DOI in this record.IMPORTANCE: Trauma is a leading cause of death and disability worldwide. In many low- and middle-income countries, formal trauma surveillance strategies have not yet been widely implemented. OBJECTIVE: To formalize injury data collection at Groote Schuur Hospital, the chief academic hospital of the University of Cape Town, a level I trauma center, and one of the largest trauma referral hospitals in the world. DESIGN, SETTING, AND PARTICIPANTS: This was a prospective study of all trauma admissions from October 1, 2010, through September 30, 2011, at Groote Schuur Hospital. A standard admission form was developed with multidisciplinary input and was used for both clinical and data abstraction purposes. Analysis of data was performed in 3 parts: demographics of injury, injury risk by location, and access to and maturity of trauma services. Geographic information science was then used to create satellite imaging of injury "hot spots" and to track referral patterns. Finally, the World Health Organization trauma system maturity index was used to evaluate the current breadth of the trauma system in place. MAIN OUTCOMES AND MEASURES: The demographics of trauma patients, the distribution of injury in a large metropolitan catchment, and the patterns of injury referral and patient movement within the trauma system. RESULTS: The minimum 34-point data set captured relevant demographic, geographic, incident, and clinical data for 9236 patients. Data field completion rates were highly variable. An analysis of demographics of injury (age, sex, and mechanism of injury) was performed. Most violence occurred toward males (71.3%) who were younger than 40 years of age (74.6%). We demonstrated high rates of violent interpersonal injury (71.6% of intentional injury) and motor vehicle injury (18.8% of all injuries). There was a strong association between injury and alcohol use, with alcohol implicated in at least 30.1% of trauma admissions. From a systems standpoint, the data suggest a mature pattern of referral consistent with the presence of an inclusive trauma system. CONCLUSIONS AND RELEVANCE: The implementation of injury surveillance at Groote Schuur Hospital improved insights about injury risk based on demographics and neighborhood as well as access to service based on patterns of referral. This information will guide further development of South Africa's already advanced trauma system.This work was supported by the Canadian Institute for Health Research and the Social Sciences and Humanities Research Council

The body count : using routine mortality surveillance data to drive violence prevention

Includes bibliographical references.This thesis describes the conceptualisation, development and implementation of a mortuary-based system for the routine collection of information about homicide. It traces the evolution of the system from its conceptualisation in 1994, through various iterations as a city-level research tool, to a national sentinel system pilot, as a multicity all-injury surveillance system, and finally its institutionalisation as a provincial injury mortality surveillance system in the Western Cape. In so doing, it demonstrates that the data arising from medico-legal post-mortem investigations described in this thesis were an important source of descriptive epidemiological information on homicide. The 37,037 homicide records described in the thesis were drawn from Cape Town, Durban, Johannesburg, Port Elizabeth and Pretoria, for which the surveillance system maintained full coverage from 2001 to 2005. The aim was to apply more complex statistical analysis and modelling than had been applied previously

Gendered endings: Narratives of male and female suicides in the South African Lowveld

This is the author's accepted manuscript. The final publication is available at Springer via http://dx.doi.org/10.1007/s11013-012-9258-y. Copyright @ Springer Science+Business Media, LLC 2012.Durkheim’s classical theory of suicide rates being a negative index of social solidarity downplays the salience of gendered concerns in suicide. But gendered inequalities have had a negative impact: worldwide significantly more men than women perpetrate fatal suicides. Drawing on narratives of 52 fatal suicides in Bushbuckridge, South Africa, this article suggests that Bourdieu’s concepts of ‘symbolic violence’ and ‘masculine domination’ provide a more appropriate framework for understanding this paradox. I show that the thwarting of investments in dominant masculine positions have been the major precursor to suicides by men. Men tended to take their own lives as a means of escape. By contrast, women perpetrated suicide to protest against the miserable consequences of being dominated by men. However, contra the assumption of Bourdieu’s concept of ‘habitus’, the narrators of suicide stories did reflect critically upon gender constructs

Drivers’ risk profile indicates the need for a graduated driving licence in South Africa

Background. Current driver mortality estimates do not consider the great differences in exposure across the population, giving a false impression that driver deaths are lowest in the youngest age group. Interventions to reduce risk among the younger age group include graduated driver licensing (GDL) . a three-phase licensing system for novice drivers consisting of a learnerfs permit, a provisional license, and a full license.Objectives. We calculated driver fatality rates per 10 000 registereddrivers in each age group and assessed the need for stricter licensingconditions for novice and younger drivers. Methods. Age-specific driver mortality rates were calculated using Western Cape Province 2008 mortuary data. The total number of licensed drivers in each age group served as the denominator. Incidence rate ratios were calculated using the age group of 65 - 79 years as the reference. Chi-square test of trendon incidence rate ratios for the age groups was done. Statistical significance was set as p<0.05.Results. There were 339 driver deaths; mean age was 39.4}13.8 years, and males accounted for 80% of the deaths. Age-specific driver mortality rates were highest in the youngest age group (15 - 19 years). There was a significant progressive decrease (except for the age group 45 - 49 years) in the risk of death from road traffic injuries with increasing age compared with the age group .65 years (chi2 for trend p<0.0001).Conclusion. This study showed a relationship between driverfs mortality risk and younger age, and underscores the need for introduction of a GDL programme in South Africa