Naeemah Abrahams

The global prevalence of intimate partner homicide: a systematic review

BACKGROUNDnHomicide is an important cause of premature mortality globally, but evidence for the magnitude of homicides by intimate partners is scarce and hampered by the large amount of missing information about the victim-offender relationship. The objective of the study was to estimate global and regional prevalence of intimate partner homicide.nnnMETHODSnA systematic search of five databases (Medline, Global Health, Embase, Social Policy, and Web of Science) yielded 2167 abstracts, and resulted in the inclusion of 118 full-text articles with 1122 estimates of the prevalence of intimate partner homicide after double-blind screening. All studies were included that reported the number or proportion of women or men who were murdered by an intimate partner in a country, province, or town, using an inclusive definition of an intimate partner. Additionally, a survey of official sources of 169 countries provided a further 53 estimates. We selected one estimate per country-year using a quality assessment decision algorithm. The median prevalence of intimate partner homicide was calculated by country and region overall, and for women and men separately.nnnFINDINGSnData were obtained for 66 countries. Overall 13·5% (IQR 9·2-18·2) of homicides were committed by an intimate partner, and this proportion was six times higher for female homicides than for male homicides (38·6%, 30·8-45·3, vs 6·3%, 3·1-6·3). Median percentages for all (male and female) and female intimate partner homicide were highest in high-income countries (all, 14·9%, 9·2-18·2; female homicide, 41·2%, 30·8-44·5) and in southeast Asia (18·8%, 11·3-18·8; 58·8%, 58·8-58·8). Adjustments to account for unknown victim-offender relationships generally increased the prevalence, suggesting that results presented are conservative.nnnINTERPRETATIONnAt least one in seven homicides globally and more than a third of female homicides are perpetrated by an intimate partner. Such violence commonly represents the culmination of a long history of abuse. Strategies to reduce homicide risk include increased investment in intimate partner violence prevention, risk assessments at different points of care, support for women experiencing intimate partner violence, and control of gun ownership for people with a history of violence. Improvements in country-level data collection and monitoring systems are also essential, because data availability and quality varied strongly across regions.nnnFUNDINGnWHO, Sigrid Rausing Trust, and the UK Economic and Social Research Council.

Worldwide prevalence of non-partner sexual violence: a systematic review.

BACKGROUNDnSeveral highly publicised rapes and murders of young women in India and South Africa have focused international attention on sexual violence. These cases are extremes of the wider phenomenon of sexual violence against women, but the true extent is poorly quantified. We did a systematic review to estimate prevalence.nnnMETHODSnWe searched for articles published from Jan 1, 1998, to Dec 31, 2011, and manually search reference lists and contacted experts to identify population-based data on the prevalence of womens reported experiences of sexual violence from age 15 years onwards, by anyone except intimate partners. We used random effects meta-regression to calculate adjusted and unadjusted prevalence for regions, which we weighted by population size to calculate the worldwide estimate.nnnFINDINGSnWe identified 7231 studies from which we obtained 412 estimates covering 56 countries. In 2010 7.2% (95% CI 5.2-9.1) of women worldwide had ever experienced non-partner sexual violence. The highest estimates were in sub-Saharan Africa, central (21%, 95% CI 4.5-37.5) and sub-Saharan Africa, southern (17.4%, 11.4-23.3). The lowest prevalence was for Asia, south (3.3%, 0-8.3). Limited data were available from sub-Saharan Africa, central, North Africa/Middle East, Europe, eastern, and Asia Pacific, high income.nnnINTERPRETATIONnSexual violence against women is common worldwide, with endemic levels seen in some areas, although large variations between settings need to be interpreted with caution because of differences in data availability and levels of disclosure. Nevertheless, our findings indicate a pressing health and human rights concern.nnnFUNDINGnSouth African Medical Research Council, Sigrid Rausing Trust, WHO.

Estimating the burden of disease attributable to interpersonal violence in South Africa in 2000

To the Editor: Violence, previously considered a social issue, is now an acknowledged public health problem. It is defined as the intentional use of physical force or power, threatened or actual, against another person, against oneself, or against a group or community, that results in injury, death or deprivation. 1 In this study we focus on exposure to the interpersonal type of violence, which includes acts of family violence and community violence. Family violence is further categorised by victim: child, intimate partner, or elder. Community violence occurs among unrelated individuals and includes sexual assault and rape by strangers as well as youth violence. In South Africa (SA) violence has become the normative and accepted strategy for resolving conflict. This is the result of many decades of social injustice and political violence including state-sponsored violence. The political transition has seen a decrease in political conflict but exceedingly high levels of interpersonal violence remain, fuelled by rapid urbanisation and ongoing economic disparities. Injuries directly related to interpersonal violence caused an estimated 27 563 deaths in South Africa in 2000. The age-standardised homicide rate (65 per 100 000) was more than seven times the global average, placing South Africa among the most violent countries in the world. 2 Homicide was the leading cause of fatal injury in males and rates peaked in the 15 - 29-year age group at 184 per 100 000, ninefold higher than the global rate. 2 High levels of gender-based violence are also evident with excessive rates of female homicides. A recent study has shown that 1 in every 2 women killed by a known perpetrator in South Africa is killed by an intimate partner, leading to the highest reported intimate femicide rate in the world: 9 per 100 000 women. 3

Women in South Africa: Intentional violence and HIV/AIDS: Intersections and prevention

South Africa is experiencing the turbulent aftermath of apartheid and the ravages of HIV/AIDS. Levels of violence are extremely high. In South Africa, violence has become normative and, to a large extent, accepted rather than challenged. Unusual for sub-Saharan Africa, there is a strong national research institute and rigorous data-based scientific literature describing the situation. Much of the research has focused on violence against women. This article reviews the intersection of HIV/AIDS and violence in the lives of women in South Africa. The evidence for the need for positive change is solid. The potential for positive change in South Africa is also very strong. There are suggestions that an African renaissance based on the principle of ubuntu has already begun on national, community, family, and individual levels. If so, it can lead the way to a society with decreased levels of violence and decreased levels of HIV transmission.

Managing and resisting stigma: a qualitative study among people living with HIV in South Africa

Living with HIV is of daily concern for many South Africans and poses challenges including adapting to a chronic illness and continuing to achieve and meet social expectations. This study explored experiences of being HIV‐positive and how people manage stigma in their daily social interactions.

Exploring Mental Health Adjustment of Children Post Sexual Assault in South Africa

Large numbers of children are affected by child sexual abuse in South Africa. This study aimed to assess psychological adjustment of children post sexual assault. In-depth, semistructured interviews were conducted with caretakers, and structured interviews using mental health assessment screening tools were given to children at three intervals over a five-month period after presentation at a sexual assault center. Almost half of the children met clinical criteria for anxiety, and two-thirds met criteria for full symptom post-traumatic stress disorder two to four weeks post disclosure. With standard care, we observed some recovery; 43.3% of children still met full symptom post-traumatic stress disorder nearly six months postdisclosure. Our findings indicate that current practice in South Africa does not promote adequate recovery for children.

Injury-related mortality in South Africa: a retrospective descriptive study of postmortem investigations.

Abstract Objective To investigate injury-related mortality in South Africa using a nationally representative sample and compare the results with previous estimates. Methods We conducted a retrospective descriptive study of medico-legal postmortem investigation data from mortuaries using a multistage random sample, stratified by urban and non-urban areas and mortuary size. We calculated age-specific and age-standardized mortality rates for external causes of death. Findings Postmortem reports revealed 52u2009493 injury-related deaths in 2009 (95% confidence interval, CI: 46u2009930–58u2009057). Almost half (25u2009499) were intentionally inflicted. Age-standardized mortality rates per 100u2009000 population were as follows: all injuries: 109.0 (95% CI: 97.1–121.0); homicide 38.4 (95% CI: 33.8–43.0; suicide 13.4 (95% CI: 11.6–15.2) and road-traffic injury 36.1 (95% CI: 30.9–41.3). Using postmortem reports, we found more than three times as many deaths from homicide and road-traffic injury than had been recorded by vital registration for this period. The homicide rate was similar to the estimate for South Africa from a global analysis, but road-traffic and suicide rates were almost fourfold higher. Conclusion This is the first nationally representative sample of injury-related mortality in South Africa. It provides more accurate estimates and cause-specific profiles that are not available from other sources.

Perpetration of violence against intimate partners: health care implications from global data

Intimate partner violence is a widespread global phenomenon engendering serious health problems for women and children.[1][1]–[3][2] Consequently, there have been many recommendations to identify and intervene with victims in the health care system. Although evidence of the efficacy of

Forensic Medicine in South Africa: Associations between Medical Practice and Legal Case Progression and Outcomes in Female Murders

Background Forensic medicine has been largely by-passed by the tide of health systems research and evidence based medicine. Murder victims form a central part of forensic medical examiners case load, and women murdered by intimate partners are an important subgroup, representing the most severe form and consequence of intimate partner violence. Our aim was to describe the epidemiology of female murder in South Africa (by intimate and non-intimate partners); and to describe and compare autopsy findings, forensic medical management of cases and the contribution of these to legal outcomes. Methods We did a retrospective national study in a proportionate random sample of 25 medico-legal laboratories to identify all homicides in 1999 of women aged 14 years and over. Data were abstracted from the mortuary file and autopsy report, and collected from a police interview. Findings In 21.5% of cases the perpetrator was convicted. Factors associated with a conviction for the female murders included having a history of intimate partner violence 1.18 (95%CI: 0.16–2.20), weapon recovered 1.36 (95% CI:0.58–2.15) and a detective visiting the crime scene 1.57 (95% CI:0.14–3.00). None of the forensic medical activities increased the likelihood of a conviction. Conclusion The findings raise important questions about the role of forensic medicine in these cases.

Gender Differences in Homicide of Neonates, Infants, and Children under 5 y in South Africa: Results from the Cross-Sectional 2009 National Child Homicide Study

Background Homicide of children is a global problem. The under-5-y age group is the second largest homicide age group after 15–19 y olds, but has received little research attention. Understanding age and gender patterns is important for assisting with developing prevention interventions. Here we present an age and gender analysis of homicides among children under 5 y in South Africa from a national study that included a focus on neonaticide and infanticide. Methods and Findings A retrospective national cross-sectional study was conducted using a random sample of 38 medico-legal laboratories operating in 2009 to identify homicides of children under 5 y. Child data were abstracted from the mortuary files and autopsy reports, and both child and perpetrator data data were collected from police interviews. We erred towards applying a conservative definition of homicide and excluded sudden infant death syndrome cases. We estimated that 454 (95% CI 366, 541) children under the age of 5 y were killed in South Africa in 2009. More than half (53.2%; 95% CI 46.7%, 59.5%) were neonates (0–28 d), and 74.4% (95% CI 69.3%, 78.9%) were infants (under 1 y), giving a neonaticide rate of 19.6 per 100,000 live births and an infanticide rate of 28.4 per 100,000 live births. The majority of the neonates died in the early neonatal period (0–6 d), and abandonment accounted for 84.9% (95% CI 81.5%, 87.8%) of all the neonates killed. Distinct age and gender patterns were found, with significantly fewer boy children killed in rural settings compared to urban settings (odds ratio 0.6; 95% CI 0.4, 0.9; p = 0.015). Abuse-related killings and evidence of sexual assault were more common among older girls than in all other age and gender groups. Mothers were identified as the perpetrators in all of the neonaticides and were the most common perpetrators overall (71.0%; 95% CI 63.9%, 77.2%). Abandoned neonates were mainly term babies, with a mean gestational age of 38 wk. We did not have information on abandonment motives for all newborns and did not know if babies were abandoned with the intention that they would die or with the hope that they would be found alive. We therefore considered all abandoned babies as homicides. Conclusions Homicide of children is an extreme form or consequence of violence against children. This national study provides one of the first analyses of neonaticide and infanticide by age and gender and shows the failure of reproductive and mental health and social services to identify and help vulnerable mothers. Multi-sectoral prevention strategies are needed.