Shanaaz Mathews

Mortality of Women From Intimate Partner Violence in South Africa: A National Epidemiological Study

The purpose of this article is to describe mortality of women from intimate partner violence (IPV) in South Africa using a retrospective national study in a proportionate random sample of 25 mortuaries. Homicides identified from mortuary, autopsy, and police records. There were 3,797 female homicides, of which 50.3% were from IPV. The mortality rate from IPV was 8.8 per 100,000 women. Mortality from IPV were elevated among those 14 to 44 years and women of color. Blunt force injuries were more common, while strangulation or asphyxiation were less common. The national IPV mortality rate was more than twice that found in the United States. The study highlights the value of collecting reliable data across the globe to develop interventions for advocacy of which gender equity is critical.

Intimate femicide-suicide in South Africa: a cross-sectional study

OBJECTIVE To examine the incidence and patterns of intimate femicide-suicide in South Africa and to describe the factors associated with an increase in the risk of suicide after intimate femicide (i.e. the killing of an intimate female partner). METHODS A cross-sectional retrospective national mortuary-based study was conducted at a proportionate random sample of 25 legal laboratories to identify all homicides committed in 1999 of women aged over 13 years. Data were collected from the mortuary file, autopsy report and a police interview. FINDINGS Among 1349 perpetrators of intimate femicide,19.4% committed suicide within a week of the murder. Suicide after intimate femicide was more likely if the perpetrator was from a white rather than an African racial background (odds ratio, OR: 5.8; 95% confidence interval, CI: 1.21-27.84); was employed as a professional or white-collar worker rather than a blue-collar worker (OR: 37.28; 95% CI: 5.82-238.93); and owned a legal gun rather than not owning a legal gun (OR: 45.26; 95% CI: 8.33-245.8). The attributable fraction shows that 91.5% of the deaths of legal gun-owning perpetrators and their victims may have been averted if this group of perpetrators did not own a legal gun. CONCLUSION South Africa has a rate of intimate femicide-suicide that exceeds reported rates for other countries. This study highlights the public health impact of legal gun ownership in cases of intimate femicide-suicide.

Intersections of ‘sanitation, sexual coercion and girls’ safety in schools’

Objective  To explore safety for girls in schools, particularly how girls perceive and negotiate dangers and risks associated with the use of toilets.

Intimate Partner Femicide in South Africa in 1999 and 2009

Naeemah Abrahams and colleagues compare the incidence of female homicide in women aged over 14 years in South Africa in 1999 and 2009 and analyze the fatal violent attacks perpetrated by intimate partners.

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

The epidemiology of child homicides in South Africa.

OBJECTIVE To describe age- and sex-specific rates of child homicide in South Africa. METHODS A cross-sectional mortuary-based study was conducted in a national sample of 38 medicolegal laboratories operating in 2009. These were sampled in inverse proportion to the number that were operational in each of three strata defined by autopsy volume: < 500, 500-1499 or > 1499 annual autopsies. Child homicide data were collected from mortuary files, autopsy reports and police interviews. Cause of death, evidence of abuse and neglect or of sexual assault, perpetrator characteristics and circumstances surrounding the death were investigated. FINDINGS An estimated 1018 (95% confidence interval, CI: 843-1187) child homicides occurred in 2009, for a rate of 5.5 (95% CI: 4.6-6.4) homicides per 100 000 children younger than 18 years. The homicide rate was much higher in boys (6.9 per 100 000; 95% CI: 5.6-8.3) than in girls (3.9 per 100 000; 95% CI: 3.2-4.7). Child abuse and neglect had preceded nearly half (44.5%) of all homicides, but three times more often among girls than among boys. In children aged 15 to 17 years, the homicide rate among boys (21.7 per 100 000; 95% CI: 14.2-29.2) was nearly five times higher than the homicide rate among girls (4.6 per 100 000; 95% CI: 2.4-6.8). CONCLUSION South Africas child homicide rate is more than twice the global estimate. Since a background of child abuse and neglect is common, improvement of parenting skills should be part of primary prevention efforts.

Guns and gender-based violence in South Africa

BACKGROUND The criminal use of firearms in South Africa is widespread and a major factor in the country having the third-highest homicide rate in the world. Violence is a common feature of South African society. A firearm in the home is a risk factor in intimate partner violence, but this has not been readily demonstrated in South Africa because of a lack of data. METHODS We drew on several South African studies including national homicide studies, intimate partner studies, studies with male participants and studies from the justice sector, to discuss the role of gun ownership on gender-based violence. CONCLUSION Guns play a significant role in violence against women in South Africa, most notably in the killing of intimate partners. Although the overall homicide data suggest that death by shooting is decreasing, data for intimate partner violence are not readily available. We have no idea if the overall decrease in gunshot homicides applies to women in relationships, and therefore gun control should remain high on the legislative agenda.

Impact of telephonic psycho-social support on adherence to post-exposure prophylaxis (PEP) after rape.

Abstract South Africa has one of the highest rates of both rape and HIV infections. Of great concern is the possibility of HIV transmission during the assault, but adherence to post-exposure prophylaxis (PEP) has been varied and low. We developed a telephonic psycho-social support, leaflet and adherence diary intervention for rape victims and tested its impact on adherence to PEP. A randomised control trial was conducted in the Western and Eastern Cape and 279 rape survivors were enrolled in two arms. The intervention involved the providing of an information leaflet including an adherence diary and follow-up support through telephone calls by a counsellor during the 28 days of taking the PEP. The controls received the leaflet. Follow-up interviews and tablet checks were done with 253 participants to assess adherence. The primary outcome was completion of 28 days of PEP with no more than three missed doses (94% adherence). There was more adherence in the intervention arm (38.2% vs. 31.9%), but the estimated intervention effect of 6.5% (95% CI: −4.6 to 17.6%) was not statistically significant, p=0.13. The intervention was associated with the reading of the pamphlet (p=0.07) and an increased use of the diary (p=0.01), but did not reduce depressive psychopathology. Overall adherence was greater amongst those who read the leaflet and used the medication diary. The study showed that the intervention was not effective in significantly improving adherence and adherence levels were low in both study arms. Further research to understand reasons for non-adherence is needed before further interventions are developed.

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.

Applying upstream interventions for interpersonal violence prevention: An uphill struggle in low- to middle-income contexts

In South Africas Western Cape province, interpersonal violence was identified among the key prevention priorities in the provincial governments Burden of Disease (BoD) Reduction project. To date, there are no adequate systematic reviews of the full range of potential intervention strategies. In response, available data and the literature on risk factors and prevention strategies for interpersonal violence were reviewed with a view to providing policy makers with an inventory of interventions for application. Given the predominance of upstream factors in driving the provinces rates of interpersonal violence, efforts to address its burden require an intersectoral approach. Achievable short-term targets are also required to offset the long-term nature of the strategies most likely to affect fundamental shifts. Documentation and evaluation will be important to drive long-term investment, ensure effectiveness and enable replication of successful programmes and should be considered imperative by interpersonal violence prevention policymakers in other low- to middle-income contexts.