Self-inflicted ingestion of harmful chemicals in adolescents and adults: risk factors and characteristics.

BACKGROUND: Injury due to ingestion of harmful chemicals has become an area of concern globally. In South Africa, paraffin has been widely implicated in multiple health outcomes, including severe ingestion injuries. A specific category of such injuries is those that are self-inflicted. A significant proportion of self-inflicted ingestion is reported to be intentional, although intentionality for self-infliction may be difficult to determine. Nonetheless, the identification of key explanatory risks and demographic factors of self-inflicted ingestion may contribute towards a better understanding of self-inflicted and harmful chemical ingestion injuries. METHODS: This study used secondary data that had been collected on burn injuries of all causes, including those due to the ingestion of harmful chemicals, from a sample of South Africans from low-income communities close to major metropolitan centres. The current analysis focused on the risks for self-inflicted ingestion injuries and used logistic regression to determine risks for self-inflicted ingestion as differentiated from ingestion due to the actions of another person (other-inflicted ingestion) by sex and age cohort of the victim, and the presence of alcohol, by examining paraffin ingestion versus that of other chemicals. RESULTS: The overwhelming majority of ingestion injuries (92.1%) were self-inflicted. The current findings indicate that sex (with females almost twice as likely to present with self-inflicted ingestion), age cohort (with those aged 18-29 and 30-44 years old four times more likely affected than older adults), presence of alcohol (twice as likely present than amongst individuals reporting ingestion injuries inflicted by others), and chemicals other than paraffin (three times more likely) are key explanatory factors for an increased risk for self-inflicted ingestion of harmful chemicals. CONCLUSIONS: The study empirically confirms the role of several key risk factors in what remains a relatively unreported and understudied phenomenon, but which appears to align with the demographic and risk profile reported for suicidal injuries through chemical ingestion, i.e. intentional self-inflicted ingestion. The findings may contribute towards improved safety policies on the availability and sale of chemical products and more focussed community interventions for at-risk individuals such as females and young people. It also flags the importance of assessing for alcohol use and alcohol use disorders at hospital admission of self-ingestion injuries.

Child pedestrian crossing behaviour and associated risk factors in school zones: a video-based observational study in Kampala, Uganda.

BACKGROUND: Pedestrian crashes, often occurring while road crossing and associated with crossing behaviour, make up 34.8% of road casualties in Uganda. This study determined crossing behaviour and associated factors among child pedestrians around primary schools in Kampala, Uganda. METHODS: We conducted a cross-sectional study in 2022 among 2100 primary school children. Data on their crossing behaviour were collected using video recordings from cameras staged at the crossing points of 21 schools. We estimated prevalence ratios (PR) with their corresponding 95% CIs using a modified Poisson regression model for the association between unsafe behaviour and the predictors. RESULTS: The prevalence for each of 5 unsafe child pedestrian behaviour was 206 (25.8%) for crossing outside the crosswalk, 415 (19.8%) for failing to wait at the kerb, 238 (11.3%) for failing to look for vehicles, 361 (17.2%) for running and 235 (13%) for crossing between vehicles. There was a higher likelihood of crossing outside the crosswalk when an obstacle was present (adjusted PR (aPR) 1.8; 95% CI 1.40 to 2.27) and when children crossed alone (aPR 1.5; 95% CI 1.13 to 2.06). Children who crossed without a traffic warden (aPR 2; 95% CI 1.40 to 2.37) had a significantly higher prevalence of failing to wait at a kerb. CONCLUSION: These findings reveal the interaction between child pedestrians, vehicles and the environment at crossings. Some factors associated with unsafe child pedestrian behaviour were the presence of an obstacle, crossing alone and the absence of a traffic warden. These findings can help researchers and practitioners understand child pedestrian crossing behaviour, highlighting the need to prioritise targeted safety measures.

The converging influence of social, economic and psychological factors on public responsiveness to the COVID-19 pandemic in South Africa.

BACKGROUND: This study assessed the influence of social, economic, and psychological factors on South African's responsiveness to the COVID-19 pandemic. Although the South African government responded quickly to manage the pandemic, the strict lockdown placed a significant burden on the population. Understanding the converging influence of social, economic, and psychological factors on the population's responsiveness is important for improving people's cooperation in controlling COVID-19 and for supporting individuals and communities during the ongoing and future pandemics. METHODS: Using data collected from a national telephonic survey (December 2020 to March 2021), we assessed whether selected social, economic and psychological factors were related to: 1) adoption of COVID-19 behavioural measures (hand hygiene, wearing of face masks, and physical distancing), and 2) adherence to government restrictions on movement. RESULTS: South Africans were highly responsive to the pandemic with respondents generally reporting that they very often engaged in the protective behaviours and often to very often adhered to government restriction on movement. However, those from the white population group; with a higher education; living in uncrowded households; who perceived less vulnerability to contracting COVID-19; supported the measures; trusted the scientists; thought the measures by government were implemented fairly and fairly enforced by the police; felt more anxious, sad, hopeless, isolated, angry or had trouble sleeping; inclined to engage in coping behaviour, were more likely to adopt COVID-19 protective behaviours. Furthermore, females, those with a lower education, those less likely to have experienced poverty since the beginning of lockdown; who perceived greater vulnerability to COVID-19, trusted government, and were more supportive of the behavioural measures were more likely to adhere to the restrictions of movement. CONCLUSIONS: Strengthening the South African population's responsiveness to the pandemic requires supporting those living in poor socioeconomic circumstances, promoting trust in the scientific evidence, and ensuring that the measures by government are perceived to be fairly implemented and fairly enforced by the police. Due to the impact on livelihoods, restrictions of movement should only be considered if necessary, and this will require trust and confidence in government and strategies to support those experiencing financial hardship.

Enablers of psychosocial recovery in pediatric burns: perspectives from the children, parents and burn recovery support staff.

BACKGROUND: Pediatric burn injuries are a major cause of death and injury, occurring mainly in resource poor environments. Recovery from burns is widely reported to be constrained by physical, psychological, relationship and reintegration challenges. These challenges have been widely described, but not the enablers of psychosocial recovery. This is especially true in pediatric burn research, with few multi- perspective studies on the recovery process. METHODS: This qualitative study involved 8 focus group discussions (four with 15 children post-burn injury, four with 15 caregivers) and 12 individual interviews with staff working in pediatric burns that explored the psychosocial needs of children after a burn and the enablers of their recovery. Purposive sampling was utilized and recruitment of all three categories of participants was done primarily through the only hospital burns unit in the Western Cape, South Africa. The interviews focused on factors that supported the child's recovery and were sequentially facilitated from the child and the family's experiences during hospitalization, to the return home to family and friends, followed by re-entry into school. Thematic analysis was used to analyze verbatim interview transcripts. RESULTS: The recovery enablers that emerged included: (i) Presence and reassurance; indicating the comfort and practical help provided by family and close friends in the hospital and throughout the recovery process; (ii) Normalizing interactions and acceptance; where children were treated the same as before the injury to promote the acceptance of self and by others especially once the child returned home; and (iii) Sensitization of others and protection; signifying how persons around the child had assisted the children to deal with issues in the reintegration process including the re-entry to school. CONCLUSIONS: This study indicates that the psychosocial recovery process of children hospitalized for burns is enabled by the supportive relationships from family members, close friends and burn staff, present during hospitalization, the return home, and school re-entry. Support included comfort and physical presence of trusted others and emotional support; affirmation of the child's identity and belonging despite appearance changes; and the advocacy and protection for the re-entry back into the school, and more generally the community.

Childhood vulnerability to drowning in the Western Cape, South Africa: Risk differences across age and sex.

INTRODUCTION: Drowning is amongst the leading causes of death of children and young people worldwide, with high concentrations in Southeast Asia and Sub-Saharan Africa. In the Western Cape province in South Africa, drowning mortality rates for children were reported at 3.8 per 100,000 population. Internationally, evidence suggests that unimpeded access to water bodies and containers and lapses in supervision together with the child's limited developmental capacities, place children at greater risk of drowning. This study examined the risk for fatal drowning by age cohort and sex in child and adolescent (0-19 years old) in the Western Cape. METHOD: Demographic and descriptive data for child drowning fatalities from 2010 to 2016 were obtained from the Western Cape Forensic Pathology Service. Descriptive variables included location of drowning incident by body of water, time of day, day of week and season. Data were analysed by age cohorts aligned to child psychosocial developmental stages. Descriptive statistics reported fatality frequencies by age cohort and sex, and logistic regression was conducted to detect differences in drowning risk across these categories. RESULTS: A total of 538 childhood drowning fatalities were analysed, with the highest proportion occurring in children aged 13-19 years (29.6%) and the majority occurring in males (75.8%). Sex, location of drowning incident and season were significant predictors of drowning across the age cohorts. Relative to females, males between ages 0-1 and 2-3 years were less likely to drown when compared with older children. CONCLUSION: This study confirms existing evidence that children younger than five are most at risk of drowning. In contrast to international and local research findings that have indicated a similar or higher risk for drowning amongst boys compared with girls aged 3 years and younger, this study identified that males were less likely to drown between the ages of 0 and 3 years compared with girls.

Fatal drowning in the Western Cape, South Africa: a 7-year retrospective, epidemiological study.

INTRODUCTION: Drowning is a neglected public health threat in low-income and middle-income countries where the greatest drowning burden is observed. There is a paucity of drowning surveillance data from low-resource settings, particularly in Africa. Understanding local epidemiological factors will enable the development of context-specific drowning prevention initiatives and the appropriate allocation of resources. AIM: The primary aim of this study was to describe the epidemiology of fatal drowning in the Western Cape, South Africa. METHOD: This retrospective study describes fatal drowning incidents captured in the Western Cape vital registration system between 2010 and 2016. Data were obtained from the Forensic Pathology Services of the Western Cape Government. One-way analysis of variance was performed to detect a trend in mean drowning mortality rates between 2010 and 2016. χ2 tests for independence were performed to detect differences in the distribution of variables between groups. RESULTS: A total of 1391 fatal drownings occurred in the Western Cape between 2010 and 2016, with an age-adjusted drowning mortality rate of 3.2 per 100 000 population. Rates were fourfold higher in men compared with women. Children, particularly young children aged 0-4 years, and young adult men between 20 and 34 years of age were identified to be at high risk of fatal drowning. Drowning occurred predominantly in large, open bodies of water with concentrations in summer and public holidays. CONCLUSIONS: The Western Cape drowning prevention strategy should prioritise interventions to reduce drowning in children and young adult men, with a targeted focus on festive periods such as public holidays.

Community, intervention and provider support influences on implementation: reflections from a South African illustration of safety, peace and health promotion.

BACKGROUND: The development, implementation and evaluation of community interventions are important for reducing child violence and injuries in low- to middle-income contexts, with successful implementation critical to effective intervention outcomes. The assessment of implementation processes is required to identify the factors that influence effective implementation. This article draws on a child safety, peace and health initiative to examine key factors that enabled or hindered its implementation, in a context characterised by limited resources. METHODS: A case study approach was employed. The research team was made up of six researchers and intervention coordinators, who led the development and implementation of the Ukuphepha Child Study in South Africa, and who are also the authors of this article. The study used author observations, reflections and discussions of the factors perceived to influence the implementation of the intervention. The authors engaged in an in-depth and iterative dialogic process aimed at abstracting the experiences of the intervention, with a recursive cycle of reflection and dialogue. Data were analysed utilising inductive content analysis, and categorised using classification frameworks for understanding implementation. RESULTS: The study highlights key factors that enabled or hindered implementation. These included the community context and concomitant community engagement processes; intervention compatibility and adaptability issues; community service provider perceptions of intervention relevance and expectations; and the intervention support system, characterised by training and mentorship support. CONCLUSIONS: This evaluation illustrated the complexity of intervention implementation. The study approach sought to support intervention fidelity by fostering and maintaining community endorsement and support, a prerequisite for the unfolding implementation of the intervention.

Driver yield and safe child pedestrian crossing behavior promotion by a school traffic warden program at primary school crossings: A cluster-randomized trial.

OBJECTIVE: To determine the effect of a school traffic warden program on increasing driver yield and safe child pedestrian crossing behavior in Kampala, Uganda. METHODS: We designed and implemented a school traffic warden program in specific school zones in Kampala, Uganda. We randomly assigned 34 primary schools in Kampala, in a 1:1 ratio, using a computer-generated randomization sequence, to control or intervention arms in a cluster randomized trial. Each school in the intervention group received one trained adult traffic warden stationed at roads adjacent to schools to help young children safely cross. The control schools continued with the standard of care. We extracted and coded outcome data from video recordings on driver yield and child crossing behavior (defined as waiting at the curb, looking both ways for oncoming vehicles, not running while crossing, and avoiding illegal crossing between vehicles) at baseline and after 6 months. Using a mixed effect modified Poisson regression model, we estimated the prevalence ratio to assess whether being in a school traffic warden program was associated with increased driver yield and safe crossing behavior. RESULTS: A higher proportion of drivers yielded to child pedestrians at crossings with a school traffic warden (aPR 7.2; 95% CI 4.42-11.82). Children were 70% more likely to demonstrate safe crossing behavior in the intervention clusters than in control clusters (aPR 1.7; 95% CI 1.04-2.85). A higher prevalence was recorded for walking while crossing (aPR 1.2; 95% CI 1.08-1.25) in the intervention clusters. CONCLUSION: The school traffic warden program is associated with increased driver yield and safe child pedestrian crossing behavior, i.e., stopping at the curb, walking while crossing, and not crossing between vehicles. Therefore, the school traffic warden program could be promoted to supplement other road safety measures, such as pedestrian safety road infrastructure, legislation, and enforcement that specifically protects children in school zones.

Antiviral Drug Candidate Repositioning for Streptococcus suis Infection in Non-Tumorigenic Cell Models.

The increasing prevalence of antimicrobial resistance against zoonotic bacteria, including Streptococcus (S.) suis, highlights the need for new therapeutical strategies, including the repositioning of drugs. In this study, susceptibilities of bacterial isolates were tested toward ten different 3-amidinophenyalanine (Phe(3-Am)) derivatives via determination of minimum inhibitory concentration (MIC) values. Some of these protease inhibitors, like compounds MI-432, MI-471, and MI-476, showed excellent antibacterial effects against S. suis. Their drug interaction potential was investigated using human liver microsomal cytochrome P450 (CYP450) measurements. In our work, non-tumorigenic IPEC-J2 cells and primary porcine hepatocytes were infected with S. suis, and the putative beneficial impact of these inhibitors was investigated on cell viability (Neutral red assay), on interleukin (IL)-6 levels (ELISA technique), and on redox balance (Amplex red method). The antibacterial inhibitors prevented S. suis-induced cell death (except MI-432) and decreased proinflammatory IL-6 levels. It was also found that MI-432 and MI-476 had antioxidant effects in an intestinal cell model upon S. suis infection. Concentration-dependent suppression of CYP3A4 function was found via application of all three inhibitors. In conclusion, our study suggests that the potential antiviral Phe(3-Am) derivatives with 2',4' dichloro-biphenyl moieties can be considered as effective drug candidates against S. suis infection due to their antibacterial effects.

Health in South Africa: changes and challenges since 2009.

Since the 2009 Lancet Health in South Africa Series, important changes have occurred in the country, resulting in an increase in life expectancy to 60 years. Historical injustices together with the disastrous health policies of the previous administration are being transformed. The change in leadership of the Ministry of Health has been key, but new momentum is inhibited by stasis within the health management bureaucracy. Specific policy and programme changes are evident for all four of the so-called colliding epidemics: HIV and tuberculosis; chronic illness and mental health; injury and violence; and maternal, neonatal, and child health. South Africa now has the world's largest programme of antiretroviral therapy, and some advances have been made in implementation of new tuberculosis diagnostics and treatment scale-up and integration. HIV prevention has received increased attention. Child mortality has benefited from progress in addressing HIV. However, more attention to postnatal feeding support is needed. Many risk factors for non-communicable diseases have increased substantially during the past two decades, but an ambitious government policy to address lifestyle risks such as consumption of salt and alcohol provide real potential for change. Although mortality due to injuries seems to be decreasing, high levels of interpersonal violence and accidents persist. An integrated strategic framework for prevention of injury and violence is in progress but its successful implementation will need high-level commitment, support for evidence-led prevention interventions, investment in surveillance systems and research, and improved human-resources and management capacities. A radical system of national health insurance and re-engineering of primary health care will be phased in for 14 years to enable universal, equitable, and affordable health-care coverage. Finally, national consensus has been reached about seven priorities for health research with a commitment to increase the health research budget to 2·0% of national health spending. However, large racial differentials exist in social determinants of health, especially housing and sanitation for the poor and inequity between the sexes, although progress has been made in access to basic education, electricity, piped water, and social protection. Integration of the private and public sectors and of services for HIV, tuberculosis, and non-communicable diseases needs to improve, as do surveillance and information systems. Additionally, successful interventions need to be delivered widely. Transformation of the health system into a national institution that is based on equity and merit and is built on an effective human-resources system could still place South Africa on track to achieve Millennium Development Goals 4, 5, and 6 and would enhance the lives of its citizens.

Assault burn injuries in adolescents and adults in South Africa: risk factors and characteristics.

Assault burns comprise a significant subset of burns, with a greater risk of severe injuries. This South African study used a national dataset from major hospitals to identify risks and injury characteristics of assault burns. The analysis sample comprised 2658 adolescent and adult cases and employed logistic regression with bootstrapping to examine the risk of assault compared to unintentional burns. The study indicates that 17.4% of burns were due to assault. Males were 1.5 times more likely than females to be burn assault victims. Compared to adults 55 years and older, young adults 22-39 years were at greatest risk, followed by youth 13-21 years. Assault injuries were five times more likely due to chemical attacks and three times more likely to scalds than to flame burns. The head, neck and trunk were most affected. Where alcohol was indicated, assault burns were five times more likely than unintentional burns. The findings may indicate the need for targeted prevention strategies such as conflict resolution, alcohol use management and the control of corrosive chemicals.

Restorying the self: an exploration of young burn survivors' narratives of resilience.

The results of this exploratory study reflect a shift from public health studies that aim to examine the risk and prevalence of burn injury, toward eliciting survivors' subjective meaning-making processes beyond the injury event. We drew on a narrative framework to explore how young survivors' experiences of burn injury led to reconstructions of self and shifts in thinking about others and the world. Although participants' narratives revealed elements of heightened self-awareness, need for acceptance, and desire for recognition, these stood alongside counter narratives denoting positive, transformative, and resilient aspects of healing that reflected a rebirth of the self, life having purpose, and psychospiritual growth. A multidimensional and relational framework for resilience acknowledges the "deficient," but also recognizes the pathways to growth, healing, meaning, and purpose. This shift toward person-centered meanings has value in informing interventions beyond the immediate "wound care," toward the survivors' lifelong (re)negotiation of identity, appearance, psychological adjustment, and social reintegration.

Fatality risk and issues of inequity among vulnerable road users in South Africa.

BACKGROUND: Contextual effects from the physical and social environment contribute to inequitable protection for a large proportion of road users, especially in low- and middle-income countries like South Africa where distorted urban planning and socio-spatial disparities from the apartheid era prevail. OBJECTIVES: This paper examines the differentiated risk of road traffic crashes and injuries to vulnerable road users in South Africa, including pedestrians, females and users of some modes of public transport, in relation to characteristics of the crashes that proxy a range of contextual influences such as rurality and socio-economic deprivation. METHODS: The study is based on a descriptive analysis of 33 659 fatal crashes that occurred in South Africa over a three-year period from 2016-2018. Measures of simple proportion, population-based fatality rate, "impact factor" and crash severity are compared between disaggregated groups using Chi-Square analysis, with the Cramer's V statistic used to assess effect size. RESULTS AND SIGNIFICANCE: Key findings show a higher pedestrian risk in relation to public transport vehicles and area-level influences such as the nature of roads or extent of urbanity; higher passenger risk in relation to public transport vehicles and rurality; and higher risk for female road users in relation to public transport vehicles. The findings have implications for prioritising a range of deprivation-related structural effects. In addition, we present a "User-System-Context" conceptual framework that allows for a holistic approach to addressing vulnerability in the transport system. The findings provide an important avenue for addressing the persistently large burden of road traffic crashes and injuries in the country.

Violence and injuries in South Africa: prioritising an agenda for prevention.

Violence and injuries are the second leading cause of death and lost disability-adjusted life years in South Africa. The overall injury death rate of 157.8 per 100,000 population is nearly twice the global average, and the rate of homicide of women by intimate partners is six times the global average. With a focus on homicide, and violence against women and children, we review the magnitude, contexts of occurrence, and patterns of violence, and refer to traffic-related and other unintentional injuries. The social dynamics that support violence are widespread poverty, unemployment, and income inequality; patriarchal notions of masculinity that valourise toughness, risk-taking, and defence of honour; exposure to abuse in childhood and weak parenting; access to firearms; widespread alcohol misuse; and weaknesses in the mechanisms of law enforcement. Although there have been advances in development of services for victims of violence, innovation from non-governmental organisations, and evidence from research, there has been a conspicuous absence of government stewardship and leadership. Successful prevention of violence and injury is contingent on identification by the government of violence as a strategic priority and development of an intersectoral plan based on empirically driven programmes and policies.

Fatal injuries among urban children in South Africa: risk distribution and potential for reduction.

OBJECTIVE: To determine the leading causes of fatal injury for urban South African children aged 0-14 years, the distribution of those causes and the current potential for safety improvements. METHODS: We obtained injury surveillance data from the National Injury Mortality Surveillance System 2001-2003 for six major South African cities varying in size, development and sociodemographic composition. We calculated age-adjusted rates, by sex, population group and city, for death from the five leading causes of fatal injury as well as population attributable risks (PARs). FINDINGS: The leading causes of fatal injury in childhood included road traffic injuries - among vehicle passengers and especially among pedestrians - drowning, burns and, in some cities, firearm injuries. Large differences in PARs were observed, particularly for population groups and cities. Disparities between cities and between population groups were largest for deaths from pedestrian injuries, while differences between boys and girls were greatest for drowning deaths. CONCLUSION: In the face of the high variability observed between cities and population groups in the rates of the most common types of fatal injuries, a safety agenda should combine safety-for-all countermeasures - i.e. lowering injury rates for all - and targeted countermeasures that help reduce the burden for those at greatest risk.

Barriers and enablers to the use of measures to prevent pediatric scalding in Cape Town, South Africa.

OBJECTIVE: Little attention has been paid to the prevention of pediatric scalding injuries in low-income settings, especially from the standpoint of local stakeholders. This study investigates stakeholder understandings of potential measures to prevent childhood scalding and the related hinders and enablers to such measures. DESIGN AND SAMPLE: The study utilized an exploratory qualitative design. Content analysis was applied to the transcriptions of interviews with 13 caregivers and 8 burn prevention research, policy, and practitioner professionals. MEASURES: The study used semistructured interviews using illustrations to generate data. The 21 individual interviews were audio-recorded, transcribed verbatim, and analyzed using content analytic steps. Interviews focused on 2 illustrations that depict circumstances that surround the occurrence of pediatric scalding typical for Cape Town. RESULTS: 3 categories of prevention measures were identified: enhancements to the safety of the home environment, changes to practice, and improvements to individual competence. The barriers identified were spatial constraints in homes, hazardous home facilities, and multiple family demands. CONCLUSIONS: Caregivers and professionals report a similar range of measures to prevent pediatric scalding. Many of these might not be readily implementable in low-income settings with key barriers that would need to be addressed by policymakers and prevention practitioners.

Neighbourhood characteristics associated with child pedestrian fatalities in Johannesburg, South Africa.

The present study investigated the relationship between neighbourhood characteristics and childhood pedestrian fatalities (2001-2010) in Johannesburg, South Africa. This cross-sectional study used negative binomial regression models. Results indicate that: areas with high concentrated disadvantage have elevated childhood pedestrian deaths, especially for those aged 5 to 9 years. Areas marked by residential mobility are associated with high pedestrian deaths among children 0 to 4 years. Black childhood pedestrian deaths are higher in areas marked by a high concentration of female-headed households. The analyses highlight the value of further exploring the effects of neighbourhood characteristics and suggest points of entry for interventions to reduce or prevent childhood pedestrian traffic mortality.

The role of concomitant alcohol and drug use in increased risk for burn mortality outcomes.

BACKGROUND: Burn injuries are a major cause of mortality and morbidity in low- and middle-income countries, with high rates in Sub-Saharan Africa. The risks may be heightened for persons who present with concomitant use of alcohol and illicit substances, which increase the risk for injury and severely compromise prognosis following injury. METHODS: This study utilised a national dataset on hospitalised burns in South Africa to explore the risk for mortality relative to morbidity. To assess the influence of alcohol and drugs in mortality outcomes, the analysis was restricted to adult cases, 18 years and older (N = 918). The primary statistical procedures used in the analysis were logistic regression models. FINDINGS: The results indicate that burn victims with full thickness and partial thickness burn degree and more than 30% TBSA had a significantly increased risk of mortality. In addition, the risk for mortality was increased ten times when concomitant alcohol and drugs were indicated compared to cases where these were absent. The length of stay in hospital diminished the risk for mortality by about 10%. INTERPRETATION: The findings may be explained by the role of skin as the main barrier against infections and the concurrent increase in risk of infection based on the degree and extent of any damage. The combined presence of both alcohol and drugs may predispose towards more severe burns and greatly compromise liver function with heightened risk for sepsis and death.

Female homicidal strangulation in urban South Africa.

BACKGROUND: Female strangulation in South Africa occurs in a context of pervasive and often extreme violence perpetrated against women, and therefore represents a major public health, social and human rights concern. South African studies that provide accurate descriptions of the occurrence of strangulation incidents among female homicide victims are limited. The current study describes the extent, distribution and patterns of homicidal strangulation of women in the four largest South African metropolitan centres, Tshwane/Pretoria, Johannesburg, Cape Town and Ethekwini/Durban. METHODS: The study is a register-based cross sectional investigation of female homicidal strangulation, as reported in the National Injury Mortality Surveillance System for the four cities, for the period 2001 to 2005. Crude, unadjusted female strangulation rates for age and population group, and proportions of strangulation across specific circumstances of occurrence were compiled for each year and aggregated in some cases. RESULTS: This study reports that female homicidal strangulation in urban South Africa ranges from 1.71/100 000 to 0.70/100 000. Rates have generally declined in all the cities, except Cape Town. The highest rates were reported in the over 60 and the 20 to 39 year old populations, and amongst women of mixed descent. Most strangulations occurred from the early morning hours and across typical working hours in Johannesburg and Durban, and to a lesser extent in Cape Town. Occurrences across Johannesburg, Durban and Pretoria were distributed across the days of the week; an exception was Cape Town, which reported the highest rates over the weekend. Cape Town also reported distinctly high blood alcohol content levels of strangulation victims. The seasonal variation in strangulation deaths suggested a pattern of occurrence generally spanning the period from end-winter to summer. Across cities, the predominant crime scene was linked to the domestic context, suggesting that perpetration was by an intimate partner or acquaintance. CONCLUSION: The study contributes to an emerging gendered homicide risk profile for a country with one of the highest homicide rates in the world. The results support the call for the development of evidence-based and gender-specific initiatives to especially address the forms of violence that instigate fatalities.