Lu-Anne Swart

Magnitude and categories of pedestrian fatalities in South Africa

Road traffic injuries, a major global public health burden, are concentrated in low-income and middle-income countries.(1) In contrast to high-income countries, pedestrians make up the largest group of road traffic injuries and fatalities in low- and middle-income countries. This article presents an analysis of pedestrian fatalities (2001-2004) in four South African cities. The article describes the magnitude, demographic, and temporal factors associated with pedestrian fatalities and presents a typological analysis to identify particular groups of at risk pedestrians. The analysis can serve to inform the development of prevention programmes tailored to the needs of specific at risk pedestrian groups. Data were obtained from the National Injury Mortality Surveillance System (NIMSS). The results indicated that there were a total of 7433 pedestrian deaths (2001-2004) for the four cities and the majority occurred over weekends. Most (56.7%) were between ages 20 and 44 years. Overall, there were 3.3 male pedestrian deaths for every female pedestrian death, and over half (58%) of the 4004 cases tested were positive for alcohol. A typological analysis identified three categories of pedestrian fatalities: (1) male pedestrian fatalities that showed high levels of alcohol concentrations, (2) female and elderly pedestrian deaths that occurred between 6 AM and midday, and (3) children, adolescents, and young adult pedestrian fatalities that typically occurred during weekday afternoons and evenings. The findings call for multiple strategies for combating pedestrian fatalities.

Paraprofessional home visitation program to prevent childhood unintentional injuries in low-income communities: a cluster randomized controlled trial

Objective: To investigate the effectiveness of a paraprofessional home visitation program (HVP) to improve home safety and prevent injuries among children living in low-income settings. Methods: The HVP was implemented in two low-income communities in South Africa. In each community, approximately 200 households were randomly selected for the trial. Eligible households were those with children aged ⩽10 years. Intervention households received four visits, one every two weeks, by trained paraprofessionals that focused on a specific injury topic and consisted of: information dissemination about specific injury prevention practices; home inspection accompanied by information about home hazards; and the supply of safety devices. The key outcomes to measure the presence of home hazards were scores for burns (safety practices, paraffin, and electrical), poisoning, and falls. Results: Significant reductions were found for injury risks related to burn safety practices. For injury risks related to electrical burns, paraffin burns, and poisoning, a decline was also noted although this was not statistically significant. No decline was noted for fall-related risks. Conclusions: Subject to further replication and evaluation, home visits by paraprofessionals providing safety education, home inspection, and safety devices be considered for integration into a comprehensive child injury prevention strategy in low-income communities.

Rape Surveillance through District Surgeon Offices in Johannesburg, 1996–1998: Findings, Evaluation and Prevention Implications

Rape prevention efforts are hampered by a chronic lack of adequate epidemiological and surveillance data. Information on identifying factors such as the who, when, where and how of rape is needed to inform the design of effective intervention programmes. Results from a demonstration Rape Surveillance Project show that records of rape cases presenting at three medico-legal clinics provide a valuable source for the epidemiological surveillance of rape. From January 1996 to December 1998 a surveillance questionnaire was completed for rape victims presenting at the Hillbrow, Lenasia South, and Chris Hani Baragwanath Medico-Legal Clinics in Gauteng. Analysis of the data suggests which women are most at risk for being raped, by whom they are raped, the areas where attacks most often occur, and the day and time when rapes are mostly committed. Despite the limited database and difficulties with generalizing findings beyond the three clinics, it is apparent that surveillance procedures have enormous import for sexual violence prevention and intervention. Implications for prevention strategies, aftercare, policy formulation, and future research are discussed. Methodological issues and institutional constraints are also discussed with a view to strengthening and developing such information management systems.

An epidemiological study of injury in a low socioeconomic context: implications for prevention

Epidemiological information identifying injury magnitude and risks is vital for the development of prevention and safety promotion programmes, especially for low income, marginalised communities where the incidence of injury tends to be disproportionately high. This paper, accordingly, reports on a household survey, conducted in an informal settlement southwest of Johannesburg, South Africa, and designed to gather epidemiological data for the purposes of informing the development of appropriate community-based injury prevention and safety promotion programmes. Data were collected for a one-year period prior to October 1998. An analysis of the data identified the causes of injuries, which residents were most at risk, and where and when injuries most often occurred. By way of conclusion, we make a few recommendations for preventive measures.

Household and caregiver characteristics and behaviours as predictors of unsafe exposure of children to paraffin appliances

This study examines adult safety knowledge and practices regarding the use of paraffin cooking appliances. The use of these is common in South Africa with injury risks that are poorly understood. This cross-sectional study was in an informal settlement in Johannesburg, South Africa, where children were reportedly at high risk for burns. This study sought to clarify relationships between key risks and developed individual and composite variables from theoretical constructs and operational definitions of risks for burns. Risks included Child Use of Paraffin Appliances, Child Proximity to Cooking, Risky Stove Use, Caregivers Burn Treatment Knowledge, Children Locked in House, Children Alone in House. Number of children remains as in proof as this was not a composite scale. Child Proximity to Cooking was associated with more children in the home. Households where children were in greater proximity to cooking were 6 times more likely to be left alone at home, with caregivers with no education over 100 times more likely to lock their children at home. Children locked in were often from homes where caregivers used appliances unsafely. In settings with hazardous energy use, compressed household configurations, and families with multiple children, Risky Stove Use and the practice of locking children in the home may be catastrophic.

The Situational Context of Adolescent Homicide Victimization in Johannesburg, South Africa

Although studies have described the incidence and epidemiology of adolescent homicide victimization in South Africa, little is known about the situational contexts in which they occur. This study aimed to describe the victim, offender, and event characteristics of adolescent homicide and to generate a typology based on the particular types of situational contexts associated with adolescent homicide in South Africa. Data on homicides among adolescents (15-19 years) that occurred in Johannesburg (South Africa) during the period 2001-2007 were obtained from the National Injury Mortality Surveillance System (NIMSS) and police case records. Of the 195 cases available for analysis, 81% of the victims were male. Most of the offenders were male (90%), comprising of strangers (42%) and friends/acquaintances (37%). Arguments (33%) were the most common precipitating circumstances, followed by revenge (11%), robbery (11%), and acts of vigilantism/retribution for a crime (8%). Through the use of cluster analysis, the study identified three categories of adolescent homicide: (a) male victims killed by strangers during a crime-related event, (b) male victims killed by a friend/acquaintance during an argument, and (c) female victims killed by male offenders. The results can serve to inform the development of tailored and focused strategies for the prevention of adolescent homicide.

Evaluating the Effectiveness of Complex, Multi-component, Dynamic, Community-Based Injury Prevention Interventions: A Statistical Framework:

Dynamic violence and injury prevention interventions located within community settings raise evaluation challenges by virtue of their complex structure, focus, and aims. They try to address many risk factors simultaneously, are often overlapped in their implementation, and their implementation may be phased over time. This article proposes a statistical and analytic framework for evaluating the effectiveness of multilevel, multisystem, multi-component, community-driven, dynamic interventions. The proposed framework builds on meta regression methodology and recently proposed approaches for pooling results from multi-component intervention studies. The methodology is applied to the evaluation of the effectiveness of South African community-centered injury prevention and safety promotion interventions. The proposed framework allows for complex interventions to be disaggregated into their constituent parts in order to extract their specific effects. The potential utility of the framework is successfully illustrated using contact crime data from select police stations in Johannesburg. The proposed framework and statistical guidelines proved to be useful to study the effectiveness of complex, dynamic, community-based interventions as a whole and of their components. The framework may help researchers and policy makers to adopt and study a specific methodology for evaluating the effectiveness of complex intervention programs.