Identifying and Validating Alcohol Diagnostics for Injury-Related Trauma in South Africa: Protocol for a Mixed Methods Study.

BACKGROUND: The burden of alcohol use among patients with trauma and the relative injury risks is not routinely measured in South Africa. Given the prominent burden of alcohol on hospital trauma departments, South Africa needs practical, cost-effective, and accurate alcohol diagnostic tools for testing, surveillance, and clinical management of patients with trauma. OBJECTIVE: This study aims to validate alcohol diagnostics for injury-related trauma and assess its use for improving national health practice and policy. METHODS: The Alcohol Diagnostic Validation for Injury-Related Trauma study will use mixed methods across 3 work packages. Five web-based focus group discussions will be conducted with 6 to 8 key stakeholders, each across 4 areas of expertise (clinical, academic, policy, and operational) to determine the type of alcohol information that will be useful for different stakeholders in the injury prevention and health care sectors. We will then conduct a small pilot study followed by a validation study of alcohol diagnostic tools (clinical assessment, breath analysis, and fingerprick blood) against enzyme immunoassay blood concentration analysis in a tertiary hospital trauma setting with 1000 patients. Finally, selected alcohol diagnostic tools will be tested in a district hospital setting with a further 1000 patients alongside community-based participatory research on the use of the selected tools. RESULTS: Pilot data are being collected, and the protocol will be modified based on the results. CONCLUSIONS: Through this project, we hope to identify and validate the most appropriate methods of diagnosing alcohol-related injury and violence in a clinical setting. The findings from this study are likely to be highly relevant and could influence our primary beneficiaries-policy makers and senior health clinicians-to adopt new practices and policies around alcohol testing in injured patients. The findings will be disseminated to relevant national and provincial government departments, policy experts, and clinicians. Additionally, we will engage in media advocacy and with our stakeholders, including community representatives, work through several nonprofit partners to reach civil society organizations and share findings. In addition, we will publish findings in scientific journals. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/52949.

Alcohol diagnostic validation for injury-related trauma: Findings from a pilot study.

Introduction: Alcohol consumption is a key driver of the burden of violence and injury in South Africa (SA). Hence, we aim to validate various alcohol assessment tools against a blood test to assess their utility for improving national health practice and policy. Methods: We conducted a cross-sectional pilot study from 3 to 19 August 2022 at Groote Schuur Hospital in Cape Town, SA. This was to test logistics for the time of venous blood centrifugation and validation of alcohol assessment tools used in injured patients ahead of the main validation study. Adults aged 18 years and older, who were injured <8 h before arrival were included. Consent was obtained for venous blood alcohol testing to validate, as the gold standard, against the following: active- and passive breath alcohol testing, clinical screening and a finger prick test. Descriptive statistics were reported for the pilot study. Results: The active breath alcohol test's digital reading and the passive test's 'yes/no' results corresponded well against the venous blood alcohol results. The average time to centrifugation was within the laboratory's 2-h cut-off requirement to preserve the alcohol in the serum. Discussion and Conclusion: The pilot study was helpful in identifying challenges with one of the alcohol assessment tools and prevented further costs ahead of the main validation study. We also determined that the selected tertiary hospital site caused a delay in recruiting eligible patients due to other hospital referrals. Hence, the main validation study is in progress at a district-level hospital for a larger sample of eligible patients for testing.

Affordability and Availability of Child Restraints in an Under-Served Population in South Africa.

BACKGROUND: Child road traffic injuries are a major global public health problem and the issue is particularly burdensome in middle-income countries such as South Africa where injury death rates are 41 per 100,000 for under 5's and 24.5 per 100,000 for 5-14-year-old. Despite their known effectiveness in reducing injuries amongst children, the rates of use of child restraint systems (CRS) remains low in South Africa. Little is known about barriers to child restraint use especially in low- and middle-income countries. METHODS: We carried out observation studies and parent/carer surveys in 7 suburbs of Cape Town over a three month period to assess usage rates and explore the knowledge and perceptions of parents towards child restraint legislation, ownership and cost; Results: Only 7.8% of child passengers were observed to be properly restrained in a CRS with driver seatbelt use and single child occupancy being associated with higher child restraint use. 92% of survey respondents claimed to have knowledge of current child restraint legislation, however, only 32% of those parents/carers were able to correctly identify the age requirements and penalty. Reasons given for not owning a child seat included high cost and the belief that seatbelts were a suitable alternative. CONCLUSIONS: These findings indicate the need for a tighter legislation with an increased fine paired with enhanced enforcement of both adult seatbelt and child restraint use. The provision of low-cost/subsidised CRS or borrowing schemes and targeted social marketing through online fora, well baby clinics, early learning centres would be beneficial in increasing ownership and use of CRS.

Looking back on 10 years of global road safety.

Every year more than 1.35 million people lose their lives on the road and tens of millions more are injured, some permanently. Since the early 2000s there has been renewed focus on the issue, with the United Nations, World Health Organization and the World Bank placing the issue higher on their agendas. Guided by the United Nations General Assembly, World Health Assembly resolutions and ministerial-level conferences on the global road safety crisis, multisectoral partnerships have synthesised the evidence, advocated for action (there are two Sustainable Development Goal targets with an ambitious goal of reducing deaths and injuries from road traffic crashes by 50%), raised public awareness, generated funding, piloted interventions and monitored progress. And yet the total number of deaths has plateaued despite some sporadic country-level successes. More needs to be done-more people need to be trained in countries to deliver, monitor and evaluate a systems approach to road safety, more solid evidence of what works in low-resource settings is needed (including sustainable transportation options) and there needs to be a greater focus on optimising care and support for those injured in crashes-if we are to begin to see numbers come down in the next decade.

Monitoring the Decade of Action for Global Road Safety 2011-2020: An update.

The United Nations Road Safety Collaboration (UNRSC) was set up in 2004 in response to the recognised need for the United Nations (UN) system to encourage efforts to address the global road safety crisis. In 2010, the UN General Assembly Resolution 64/255 declared 2011-2020 the Decade of Action for Road Safety with the overarching goal of stabilising and reducing the forecasted number of road traffic deaths by increasing activities at national, regional and global levels. In 2011, a Plan of Action for the Decade of Action, a tool to support the development of national and local plans of action, was launched. Countries are encouraged to implement activities according to the five pillars set out by the Plan of Action. The UNRSC, tasked to evaluate the overall impact of the Decade, developed and populated indicators for each pillar. Currently, 36 of 38 proposed indicators are populated by baseline data for 2010 from the second Global status report for road safety. However, gaps exist in data quality and availability on a global level. Therefore, there is an urgent need for improving data quality and availability to measure the progress of the Decade of Action.

Alcohol use in South Africa: findings from the South African Community Epidemiology Network on Drug use (SACENDU) Project.

OBJECTIVE: To provide community-level public health surveillance on alcohol misuse in South Africa and the associated negative consequences. METHOD: A descriptive, epidemiological study of alcohol use based on data gathered biannually from multiple sources over 4 years, including specialist treatment centers, trauma units, mortuaries, psychiatric facilities, and surveys of school students and arrestees. Networks were set up in five sentinel sites to facilitate the collection, interpretation and dissemination of data. RESULTS: Indicators point to the widespread misuse of alcohol. Alcohol consistently dominates the demand for substance use disorders treatment services. In the second half of 2000, 51.1% (Cape Town) to 77.0% (Mpumalanga) of patients reported alcohol as their primary substance of abuse. A high proportion of patients in trauma units tested positive for alcohol in 2000, ranging from 40.3% (Durban) to 91.8% (Port Elizabeth). Similarly, a high proportion of mortality cases tested positive for alcohol, ranging from 40.3% (Durban) to 67.2% (Port Elizabeth). Although treatment demand is dominated by men and older persons, alcohol misuse occurs among all sectors. School surveys reflect harmful drinking patterns among students, with 53.3% and 36.5% of male students in Durban and Cape Town, respectively, reporting heavy-drinking episodes by Grade 11. DISCUSSION: Alcohol misuse has a number of implications for public health policy, such as the need to develop protocols for the management of alcohol-positive patients in trauma units and to target prevention programs at heavy drinking by young people. Further monitoring of alcohol misuse and its associated negative consequences is required.