Linking mortuary data improves vital statistics on cause of death of children under five years in the Western Cape Province of South Africa.

OBJECTIVES: Reducing child mortality requires good information on its causes. Whilst South African vital registration data have improved, the quality of cause-of-death data remains inadequate. To improve this, data from death certificates were linked with information from forensic mortuaries in Western Cape Province. METHODS: A local mortality surveillance system was established in 2007 by the Western Cape Health Department to improve data quality. Cause-of-death data were captured from copies of death notification forms collected at Department of Home Affairs Offices. Using unique identifiers, additional forensic mortuary data were linked with mortality surveillance system records. Causes of death were coded to the ICD-10 classification. Causes of death in children under five were compared with those from vital registration data for 2011. RESULTS: Cause-of-death data were markedly improved with additional data from forensic mortuaries. The proportion of ill-defined causes was halved (25-12%), and leading cause rankings changed. Lower respiratory tract infections moved above prematurity to rank first, accounting for 20.8% of deaths and peaking in infants aged 1-3 months. Only 11% of deaths from lower respiratory tract infections occurred in hospital, resulting in 86% being certified in forensic mortuaries. Road traffic deaths increased from 1.1-3.1% (27-75) and homicides from 3 to 28. CONCLUSIONS: The quality and usefulness of cause-of-death information for children in the WC was enhanced by linking mortuary and vital registration data. Given the death profile, interventions are required to prevent and manage LRTI, diarrhoea and injuries and to reduce neonatal deaths.

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.

Daily brief restraint stress alters signaling pathways and induces atrophy and apoptosis in rat skeletal muscle.

Skeletal muscle protein loss, known as atrophy, occurs during inactivity, disease, and aging. Atrophy may be the result of increased catabolic factors, e.g. glucocorticoids, or reduced influence of anabolic factors, e.g. insulin. The purpose of this study was to investigate atrophy, signaling mechanisms, and apoptosis in a rat model of restraint stress in 40 adult male Wistar rats. Due to the anxiolytic effects of Sutherlandia frutescens, we also determined if any of the molecular events in gastrocnemius muscle would be affected by daily treatment with S. frutescens. Rats were randomly assigned to four experimental groups: control placebo (CP); control Sutherlandia (CS) treatment; Restraint Placebo (RP) and Restraint Sutherlandia (RS) treatment. Restraint resulted in a significant increase in myostatin which was significantly reduced with Sutherlandia treatment. In addition, MyoD expression was significantly attenuated in RP and this effect was also counteracted by Sutherlandia treatment. Restraint also resulted in a significant attenuation of the PI3-Kinase/Akt signaling pathway and increased apoptosis which was reversed with Sutherlandia treatment. This study demonstrates for the first time that psychological stress elevates markers of muscle atrophy and apoptosis, whilst a herbal remedy, Sutherlandia, inhibits apoptosis, and signaling pathways associated with muscle atrophy.

Disability weights from a household survey in a low socio-economic setting: how does it compare to the global burden of disease 2010 study?

BACKGROUND: The global burden of disease (GBD) 2010 study used a universal set of disability weights to estimate disability adjusted life years (DALYs) by country. However, it is not clear whether these weights can be applied universally in calculating DALYs to inform local decision-making. This study derived disability weights for a resource-constrained community in Cape Town, South Africa, and interrogated whether the GBD 2010 disability weights necessarily represent the preferences of economically disadvantaged communities. DESIGN: A household survey was conducted in Lavender Hill, Cape Town, to assess the health state preferences of the general public. The responses from a paired comparison valuation method were assessed using a probit regression. The probit coefficients were anchored onto the 0 to 1 disability weight scale by running a lowess regression on the GBD 2010 disability weights and interpolating the coefficients between the upper and lower limit of the smoothed disability weights. RESULTS: Heroin and opioid dependence had the highest disability weight of 0.630, whereas intellectual disability had the lowest (0.040). Untreated injuries ranked higher than severe mental disorders. There were some counterintuitive results, such as moderate (15th) and severe vision impairment (16th) ranking higher than blindness (20th). A moderate correlation between the disability weights of the local study and those of the GBD 2010 study was observed (R(2)=0.440, p<0.05). This indicates that there was a relationship, although some conditions, such as untreated fracture of the radius or ulna, showed large variability in disability weights (0.488 in local study and 0.043 in GBD 2010). CONCLUSIONS: Respondents seemed to value physical mobility higher than cognitive functioning, which is in contrast to the GBD 2010 study. This study shows that not all health state preferences are universal. Studies estimating DALYs need to derive local disability weights using methods that are less cognitively demanding for respondents.

Mortality trends and differentials in South Africa from 1997 to 2012: second National Burden of Disease Study.

BACKGROUND: The poor health of South Africans is known to be associated with a quadruple disease burden. In the second National Burden of Disease (NBD) study, we aimed to analyse cause of death data for 1997-2012 and develop national, population group, and provincial estimates of the levels and causes of mortality. METHOD: We used underlying cause of death data from death notifications for 1997-2012 obtained from Statistics South Africa. These data were adjusted for completeness using indirect demographic techniques for adults and comparison with survey and census estimates for child mortality. A regression approach was used to estimate misclassified HIV/AIDS deaths and so-called garbage codes were proportionally redistributed by age, sex, and population group population group (black African, Indian or Asian descent, white [European descent], and coloured [of mixed ancestry according to the preceding categories]). Injury deaths were estimated from additional data sources. Age-standardised death rates were calculated with mid-year population estimates and the WHO age standard. Institute of Health Metrics and Evaluation Global Burden of Disease (IHME GBD) estimates for South Africa were obtained from the IHME GHDx website for comparison. FINDINGS: All-cause age-standardised death rates increased rapidly since 1997, peaked in 2006 and then declined, driven by changes in HIV/AIDS. Mortality from tuberculosis, non-communicable diseases, and injuries decreased slightly. In 2012, HIV/AIDS caused the most deaths (29·1%) followed by cerebrovascular disease (7·5%) and lower respiratory infections (4·9%). All-cause age-standardised death rates were 1·7 times higher in the province with the highest death rate compared to the province with the lowest death rate, 2·2 times higher in black Africans compared to whites, and 1·4 times higher in males compared with females. Comparison with the IHME GBD estimates for South Africa revealed substantial differences for estimated deaths from all causes, particularly HIV/AIDS and interpersonal violence. INTERPRETATION: This study shows the reversal of HIV/AIDS, non-communicable disease, and injury mortality trends in South Africa during the study period. Mortality differentials show the importance of social determinants, raise concerns about the quality of health services, and provide relevant information to policy makers for addressing inequalities. Differences between GBD estimates for South Africa and this study emphasise the need for more careful calibration of global models with local data. FUNDING: South African Medical Research Council's Flagships Awards Project.

Fatal violence among children under 15 years in four cities of South Africa, 2001-2005.

Homicide rates for South African children were estimated at double the global average in 2000. This article presents a secondary data analysis of the National Injury Mortality Surveillance System (NIMSS), with full coverage in four major metropolitan cities. Child homicide rates for 2001-2005 were calculated within the 0-4, 5-9 and 10-14 year age groups. The homicide rates were similar to the global pattern, with higher rates for boys, and among children aged 0-4 years than for older children. Poisson regression, accounting for city level clustering, was used to investigate age, sex and period effects in the homicide rate. The model indicated that the gender difference was more marked in the 10-14 year age groups (RR = 2.17; 95% CI 1.97-2.38) than in the 5-9 year (RR = 1.43; 95% CI 1.27-1.62) with the 0-4 year age group in-between (RR = 1.80; 95% CI 1.55-2.10). These data confirm previous observations that fatal violence among children is a public health concern, but, given the high rates of homicide among South African adults and other competing public health problems, it is difficult to motivate for action to address the issue of violence against children. Nonetheless, there are sufficient indications that efforts to reduce childhood violence are urgently needed.