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Western Cape Injury Mortality Profile
2010-2016
Foreword
The release of the crime statistics in recent months have shown that violence and injuries are a significant public health concern, in South Africa and particularly in the Western Cape. South Africa has injury mortality rates more than double the global average, and in the Western Cape has both homicides and road traffic incidents are amongst the top ten leading causes of premature mortality.
Injury surveillance allows for the monitoring of temporal and demographic trends as well as the major causes of death and disability due to violence and injuries. While information is available via national vital statistics, this only enumerates the overall injury burden. Forensic Pathology Services (FPS) have an alternative source of cause and manner of death data that can be utilised by all stakeholders to instigate injury prevention strategies and programmes.
This report details the demographic profile and fatal injury trends in the Western Cape over a seven-year period, between 2010 and 2016. While the Department of Health sees the effects of violence and injuries, addressing the upstream factors must be a collaborative effort by all departments. The Western Cape provincial strategic goals speak to this integrated approach. Provincial strategic goal three (PSG 3) specifically refers to increasing wellness, safety and tackling social ills. PSG 3 has a range of initiatives, focussing on a whole-of-society approach. One of these is aimed at reducing alcohol-related harms. The report bears this out, as fifty percent of homicide victims and sixty percent of pedestrian fatalities tested positive for alcohol.
Child death review teams across the Western Cape have been established, putting into practice the multi-agency approach aimed at not only improved reporting but enabling real-time responses to ensure children are safer in their homes.
While this report shows some alarming trends, particularly in firearm-related homicides, and an increased caseload for FPS, knowing the pattern and trends of fatal injuries allows for the improved targeting of interventions.
Many thanks to all staff involved, from the day-to-day operations, to those who collated and analysed the data.
Dr. Beth EngelbrechtWestern Cape Head of HealthNovember 2018
Authors Dr Juliet Evans, Ms Erna Morden, Mr Nesbert Zinyakatira, Prof. David Coetzee, Dr Ziyanda
Mgugudo-Sello, Ms Vonita Thompson, Mr Michael Vismer, Prof. Lorna Martin, Prof. Johan
Dempers.
Acknowledgements The Western Cape Forensic Pathology Services, the Division of Forensic Medicine &
Toxicology, University of Cape Town and the Division of Forensic Medicine and Pathology,
University of Stellenbosch are thanked for their assistance with collection and capturing of
the data. Statistics South Africa are thanked for providing mortality data from the National
Vital Registration System. Prof. Deborah Bradshaw, Dr Pam Groenewald, Dr Richard
Matzopoulos, Mr Ian Neethling and Mr William Msemburi are thanked for their expert
technical assistance and ongoing support.
Cover photo: Ashraf Hendricks, March against gender based violence. GroundUp, 1 August
2016. CC BY-ND 4.0
Table of contents
Chapter Page Executive summary 1 1 Introduction 4 2 Forensic Pathology Services in the Western Cape 5 3 Injury mortality burden in the Western Cape 7 4 Homicide 9 5 Accidental injury deaths 12 6 Suicides 22 7 Child and adolescent injury mortality burden 24 8 Comparison to Stats SA cause of death profiles 28 9 Discussion 30 10 Methodology 33 11 Appendices 38 11.1 Appendix tables 38 11.2 District injury mortality profiles, 2016 46 11.3 Definitions 53
List of figures
Figure Page 2.1 Distribution of Forensic Pathology facilities in the Western Cape, 2010 -2016 5 2.2 FPS caseload by day of week and district 6 2.3 Average days from receipt of body to post-mortem per FPS district 6 2.4 Trend in FPS caseload by classification of death 6 3.1 Age and sex profile of injury deaths in the Western Cape, 2016 7 3.2 Trend in age-standardised injury mortality rates by district 8 3.3 Trend in the proportion of injury deaths by manner 8 4.1 Trend in homicide ASR by sex 9 4.2 Age-specific homicide rates by sex, 2016 9 4.3 Trend in male homicide ASR by district 9 4.4 Trend in female homicide ASR by district 9 4.5 Trend in male homicide ASR by major cause 10 4.6 Trend in female homicide ASR by major cause 10 4.7 Trend in male homicide ASR by Metro sub-district 10 4.8 Frequency of homicides by day of week, time of day, and alcohol level 11 5.1 Profile of transport-related deaths, 2016 12 5.2 Trend in male transport ASR by major cause 12 5.3 Trend in female transport ASR by major cause 12 5.4 Age-specific motor vehicle ASR by sex, 2016 13 5.5 Trend in motor vehicle ASR by district 13 5.6 Frequency of motor vehicle deaths by time of day, day of week, and
alcohol level 13 5.7 Age-specific pedestrian death rates by sex, 2016 15 5.8 Frequency of child (<15years) pedestrian deaths by time of day and day of
week 15 5.9 Frequency of pedestrian deaths (> 15years) by day of week, time of day,
and alcohol level 15 5.10 Age-specific railway death rates by sex, 2016 16 5.11 Frequency of railway deaths by day of week, time of day, and alcohol level 16 5.12 Age-specific motorcycle death rates by sex, 2016 17 5.13 Frequency of motorcycle deaths by day of week, time of day, and alcohol
level 17 5.14 Age-specific cyclist death rates by sex, 2016 18 5.15 Frequency of cyclist deaths by day of week, time of day, and alcohol level 18 5.16 Trend in accidental ASRs by major cause 19 5.17 Age-specific accidental fire death rates by sex, 2016 19
5.18 Frequency of accidental fire deaths by day of week, time of day and alcohol level 19
5.19 Age-specific accidental drowning rates by sex, 2016 20 5.20 Frequency of drowning by day of week, time of day, and alcohol level 20 5.21 Age-specific accidental falls death rates by sex, 2016 21 5.22 Age-specific accidental poisoning/overdose death rates by sex, 2016 21 6.1 Trend in suicide ASR by sex 22 6.2 Age-specific suicide rates by sex, 2016 22 6.3 Trend in male suicide ASR by major cause 22 6.4 Trend in female suicide ASR by major cause 22 7.1 Age and sex distribution of child and adolescent deaths, 2016 24 7.2 Trend in injury ASR by manner for children 0-4 years 24 7.3 Place of accidental drownings in children and adolescents 25 7.4 Trend in injury ASR by manner in children 5-9 years 26 7.5 Trend in injury ASR by manner in children 10-14 years 26
Figure Page 7.6 Trend in injury ASR by manner in adolescents 15-19 years 27 8.1 Comparison between Stats SA and FPS injury profile for the Western Cape,
2016 29 10.1 Forensic Pathology Service business process 33
List of tables Table Page 3.1 Trend in injury deaths as a proportion of all deaths in the Western Cape 7 4.1 Alcohol results: Homicide 11 5.1 Alcohol results: Accidental deaths 14 6.1 Alcohol results: Suicide 23 10.1 FPS data sources and linkage 34 10.2 Alcohol testing coverage and results 36 10.3 Cases excluded from rates calculations 37
Appendix tables
1 Proportion of cases received by Forensic Pathology facilities across the Western Cape between 2010 and 2016 38
2 Case mix per Forensic Pathology Facility, 2016 39
3 Trend in the number of accidental deaths by external cause, Western Cape 2010 – 2016 40
4 Trend in the number of homicide deaths by external cause, Western Cape 2010 – 2016 41
5 Trend in the number of suicides by external cause, Western Cape 2010 – 2016 41
6 Age-specific death rates and proportion of injury deaths by major cause in children under 5 years 42
7 Age-specific death rates and proportion of injury deaths by major cause in children 5-9 years 43
8 Age-specific death rates and proportion of injury deaths by major cause in children 10-14 years 44
9 Age-specific death rates and proportion of injury deaths by major cause in children 15-19 years 45
District injury mortality profiles (ASR), 2016 1 Western Cape and districts 46 2 Cape Winelands 47 3 Central Karoo 48 4 Cape Metro 49 5 Eden 50 6 Overberg 51 7 West Coast 52
1
Executive summary
This report presents trends in the age and sex-specific injury mortality profile for the Western Cape and its sub-districts for 2010 to 2016. Information is based on an extensive review of data on all cases admitted to Forensic Pathology Services (FPS) across the province. The main findings of the report are:
FPS had a 17% increase in caseload between 2010 and 2016, an average increase of 2.5% per year.
10 985 cases were received by FPS in 2016 compared to 9 381 in 2010; 60% of deaths were due to injuries (homicide, accidents and suicides), 32% due to
natural causes, 3% section 56 deaths (deaths occurring during or after a medical or surgical procedure), 2% foetuses and 2% undetermined causes;
Injuries accounted for 14% of all deaths in the Western Cape in 2016, with over 80% affecting males, in particular 20-39 year olds and children under 5 years.
The age-standardised injury mortality rate (ASR) increased from 98 deaths to 106 deaths per 100 000 population between 2010 and 2016;
In 2016, Central Karoo district had the highest injury ASR in the Province (165 deaths per 100 000) followed by the Metro (12 deaths per 100 000). Injury ASR in the Central Karoo decreased from 236 deaths per 100 00 in 2010, but remained unchanged for other districts.
Homicides accounted for 51% of all injury deaths in 2016, and homicide ASRs increased from 38 deaths per 100 000 in 2010 to 52 deaths per 100 000 in 2016.
The male homicide ASR was 96 deaths per 100 000 in 2016, a 38% increase since 2010;
The increased homicide ASR in males was due to an increase in firearm-related homicides, which doubled between 2010 and 2016, mainly in the Metro sub-districts of Klipfontein, Tygerberg and Mitchells Plain;
Female homicide ASR was 9 deaths per 100 000 in 2016, and has remained unchanged since 2010. Central Karoo district had the highest female homicide ASR (22 deaths per 100 000);
Homicide rates were highest in males between the ages of 20 and 39 years (239 deaths per 100 00), and there was an increase in homicide rates for adolescents between the ages of 15 and 19 years. There was an average of 20 homicides per year in children under 5;
50% of homicide deaths tested positive for alcohol.
2
Accidental (presumed unintentional) deaths accounted for 38% of all injury deaths. The major causes were transport related (60% of all accidental deaths: 35% motor vehicle fatalities and 25% pedestrian fatalities), fires (14%), drowning (9%), falls (6%), aspiration/chocking (2%) and accidental overdoses and poisoning (2%).
There was no change in transport-related ASRs between 2010 and 2016. Transport ASRs were highest in men, particularly children under 5 and older adults.
o The motor vehicle (occupant) ASR was 16 deaths per 100 000 in 2016. Central Karoo district had the highest motor vehicle ASR across all years (78 deaths per 100 000 in 2016), however the rate has declined significantly since 2010. Motor vehicle fatalities were more frequent over the weekend, and 40% of cases with known alcohol results had alcohol levels above the South African legal driving limit (0.05g/100ml).
o The pedestrian (road) fatality ASR was 20 deaths per 100 000 in 2016, and age-specific pedestrian mortality rates were highest in male children under 5 years. Child and adolescent (under 15 years) pedestrian fatalities occurred more frequently between 5 and 9pm on a Friday and Saturday, and between 1pm and 5pm throughout the week. Adolescent and adult (>15 years) pedestrian fatalities occurred more frequently between 9pm and 4am over weekends. Alcohol was associated with 60% of pedestrian fatalities.
o ASRs due to railway, motorcycle and cycling accidents were low (<1 death per 100 000) and remained unchanged between 2010 and 2016. Alcohol was associated with 30% of railway deaths, 45% motorcycle deaths and 30% cyclist deaths.
In 2016, the ASR due to accidental fires was 5 deaths per 100 000, drowning was 4 deaths per 100 000, and accidental poisonings/overdose was 2 deaths per 100 000. ASRs for these causes have remained unchanged since 2010.
o The age-specific death rates due to fires, drowning and overdose/poisoning were highest in male children under 5 years;
o A higher proportion of these deaths occurred on weekends, and 64% of fire, 47% of drownings and 75% of overdose/poisoning deaths tested positive for alcohol;
In 2016, the ASR due to accidental falls was 4 deaths per 100 000, and age-specific fall mortality rates were highest in persons over 75 years.
Suicides accounted for 11% of injury deaths and the suicide ASR was 11 per 100 000 in 2016, and remained unchanged since 2010:
Age-specific suicide rates were highest in men 20-39 years; There was an increase in the number of suicides in younger persons, with an
average of 13 suicides per year in 9-14 year olds since 2014.
3
The major cause of suicide in males was hanging, whereas in females it was intentional overdose or poisoning.
In conclusion, violence and alcohol abuse, particularly among young males, are the main factors underlying the high injury mortality burden in the Western Cape. There is also a high burden of injury mortality in children. A co-ordinated and concerted effort is required from all government sectors and civil society in order to address this. The establishment of Child Death Review (CDR) teams across the province is a pivotal intervention that demonstrates how a multi-agency approach can enhance reporting and enable a real-time response to ensure children are safer in their homes.
4
1. Introduction
Violence and injuries are a significant global public health concern, and have a substantial emotional, physical, and economic impact on society. More than 5 million people die each year as a result of injuries, accounting for 9% of the world’s deaths1. Additionally, millions of people suffer either temporary or permanent disability as a result of non-fatal injuries. In South Africa, injury mortality rates are more than double the global average, and in the Western Cape specifically, homicide was the 2nd leading cause and road traffic accidents the 8th leading cause of all premature mortality in 20152.
Injury surveillance is vital for monitoring temporal, demographic and socio-economic trends in the major causes of death and disability due to violence and injuries. There is a need for timely access to accurate injury mortality data in order to inform injury and violence prevention strategies directed at high risk groups and risk factors. Information supplied through national vital statistics (by Statistics South Africa) only provides overall burden of injury mortality (i.e. not cause specific) and is therefore insufficient for action at a local level. In the absence of effective vital registration systems, Forensic Pathology Services (FPS) have been shown to provide an alternative source of cause of death information for practitioners and policy makers to establish injury prevention strategies and programs.
FPS in the Western Cape are fortunate to have an electronic information system at all FPS facilities that allows for the collection of routine service-related data. The database includes demographic information on the deceased (age, sex), circumstance and cause of death, as well as location of incident and death on all cases received by FPS. This information has previously been used to inform the contribution of injury mortality to the overall mortality burden in the Province until 20133, and for operational reports for each FPS facility until 2011. However, in early 2012, critical information system issues impacting on data quality and completeness were identified, limiting the use of the FPS data for injury surveillance and reporting requirements of the service.
Acknowledging the need for updated information on injury burden, an extensive review of information on all cases received by FPS facilities in the Western Cape between 2010 and 2016 was conducted. This report details the trends in the demographic profile and pattern of fatal injuries in the Western Cape over this seven-year period.
1 Global Burden of Disease (GBD) 2016 Causes of Death Collaborators, Lancet 2017; 390: 1151–210 2 Evans J and Morden E. Western Cape Mortality Profile Estimates 2015. Cape Town: South Africa, 2018 (unpublished) 3 The Western Cape Department of Health, the City of Cape Town and the South African Medical Research Council (MRC) Burden of Disease Research Unit established a district wide local mortality surveillance system (LMSS) in 2009. Due to an amendment to the Birth and Deaths registration ACT in 2014, the Department of Health no longer has access to cause of death information recorded on the death notification form
5
2. Forensic Pathology Services in the Western Cape
FPS are responsible for determining the cause of all injury (non-natural) deaths and all sudden unexpected or unexplained deaths. The Western Cape FPS was established in 2006 when the Police mortuaries were transferred to the new Directorate FPS within the Department of Health (DoH). The service is currently rendered via sixteen FPS facilities 4 across the Province, and includes two academic facilities in the Cape Town Metropolitan Area (Metro), three referral facilities and smaller facilities and holding centres in the West Coast, Cape Winelands, Overberg, Eden and Central Karoo (rural) districts (Figure 2.1).
When a death is suspected of being due to injury or undetermined causes, the South African Police Service (SAPS) will conduct a scene investigation and the Emergency Medical Services (EMS) will confirm the death, following which the SAPS officer (or hospital) will contact the closest FPS facility. In the Metro, SAPS will contact the Metro EMS control centre via their SAPS Radio Control Centre and hospitals will contact the EMS Control Centre directly. The Control Centre will then dispatch either the Tygerberg or Salt River FPS vehicles to the scene/facility. In rural areas, SAPS or the hospital will contact the nearest FPS facility directly and they will dispatch a vehicle to the scene/facility. The forensic pathology officer(s) attending a scene will also conduct a scene investigation to collect information that assists pathologists in concluding cause of death and ensuring the required chain of evidence statements are recorded. FPS may only remove the deceased from a scene once the person has been declared dead by EMS and the crime and death scene investigations have been concluded.
Figure 2.1. Distribution of Forensic Pathology facilities in the Western Cape, 2010-2016.
4 During 2016 the Stellenbosch facility was closed, and all Swellendam cases were diverted to the Worcester forensic pathology facility.
6
In 2016, just under 11 000 cases were admitted across the 16 FPS facilities in the Western Cape. This was a 17% increase in caseload since 2010, with an average increase of 2.5% per year (Appendix Table 1). Two thirds of all cases were admitted to FPS facilities in the Metro, 15% in Overberg/Winelands, 10% in Eden/Central Karoo and 7% in West Coast. Across all FPS facilities, around half of all cases were received over weekends (Figure 2.2). At rural FPS facilities, the majority of cases were autopsied within 1-2 days, and at Metro facilities, within 2-3 days from receipt of the body (Figure 2.3).
Approximately 60% of all cases received by FPS were due to injuries, 32% natural causes, 3% section 56 deaths (deaths that occur during or after any medical or surgical procedure), 2% foetuses (including stillbirths, non-viable and undetermined foetuses) and 2% were due to undetermined causes (Figure 2.4; Appendix Table 2).
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Figure 2.4. Trend in FPS caseload by classification of death
Injury Natural Section 56Foetus Undetermined Non-human remainsTotal deaths
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Eden/Central Karoo Metro West Coast Winelands/Overberg+ Paarl
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Figure 2.2. FPS caseload by day of week and district
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Figure 2.3. Average days from receipt of body to post-mortem per FPS district
Eden/Central Karoo MetroWest Coast Winelands/Overberg + Paarl
7
3. Injury mortality burden in the Western Cape
In 2016, 14% (1 in 7) of all deaths5 in the Western Cape were due to injuries, compared to 12% in 2010 (Table 3.1). Approximately 60% of injury deaths occurred in persons aged 20-39 years, and 80% of all injuries occurred in males (Figure 3.1). The injury mortality age-standardised rate (ASR) for the province increased from 96 deaths to 106 deaths per 100 000 population from 2010 to 2016 (Figure 3.2).
Table 3.1. Trends in injury deaths as a proportion of all deaths in the Western Capea
Total Injury deaths b Homicide Suicide
Accidental deaths
Transport deaths c Other accidental deaths
2010 12.0% (n=5492) 5.1% (n=2329) 1.4% (n=650) 3.4% (n=1565) 2.0% (n=910)
2011 12.0% (n=5498) 5.2% (n=2370) 1.4% (n=660) 3.2% (n=1458) 2.1% (n=980)
2012 12.4% (n=5732) 5.6% (n=2567) 1.6% (n=736) 3.1% (n=1411) 2.1% (n=979)
2013 12.9% (n=5942) 6.3% (n=2912) 1.5% (n=700) 3.0% (n=1364) 2.0% (n=937)
2014 14.3% (n=6299) 7.5% (n=3290) 1.5% (n=644) 3.2% (n=1406) 2.1% (n=938)
2015 13.2% (n=6611) 6.9% (n=3441) 1.3% (n=674) 3.0% (n=1484) 2.0% (n=987)
2016 14.1% (n=6770) 7.2% (n=3474) 1.5% (n=718) 3.2% (n=1547) 2.1% (n=1006)
a Denominator used is the total number of deaths in Western Cape as supplied by Statistics South Africa; b FPS; % total; excludes section 56; c Transport related Includes: railway accidents and road accidents involving pedestrians, motor vehicle occupants, motorcycles, cyclists and other road traffic related deaths.
5 Based on total deaths for the Western Cape as reported by Statistics South Africa
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Figure 3.1. Age and sex profile of injury deaths in the Western Cape, 2016
Male Female
8
69% of all injury deaths occurred in the Metro, 12% in Cape Winelands, 8% in Eden, 5% in West Coast, 4% in Overberg and 2% in Central Karoo. However, injury ASRs were highest in Central Karoo across all years (Figure 3.2.). This is mainly due to the high transport-related mortality burden in relation to the small population (~75 000) in this district6. Between 2010 and 2016, injury mortality ASRs increased in the Metro (92 to 112 deaths per 100 000), remained similar in the Overberg (91 to 94 deaths per 100 000) and Cape Winelands (91 to 93 deaths per100 000), and decreased in the Central Karoo (263 to 165 deaths per 100 000), Eden (97 to 87 deaths per 100 000) and the West Coast (81 to 71 deaths per 100 000). District and sub-district ranking of cause specific injury ASRS are presented in Chapter 11. More detailed data on trends in cause specific injury deaths for each district and sub-district are available in supplementary tables on request from the authors.
Injury deaths are classified by the external manner or circumstance in which they occurred7, and include deaths due to homicide (sometimes referred to as assault or interpersonal violence), suicide, and accidental (unintentional) circumstances. Accidental causes include transport-related (road and rail) and other accidents such as falls, drowning, fires and accidental poisonings/overdose. In a very small proportion of cases (<1%), the manner remains undetermined after autopsy although the cause of death is determined as non-natural. In 2016, 7% of all deaths were due to homicide (1 in 14 deaths), 1.5% due to suicide (1 in 66 deaths), 3% were transport-related (1 in 33 deaths) and 2% due to other accidents (1 in 50 deaths) (Table 3.1). Homicide accounted for the majority of all injury deaths (51%), followed by accidents (38%) and suicides (11%) (Figure 3.3).
6 District and sub-district allocation of injury deaths is based on place of incident, and not place of residence of deceased (see methods) 7 Dettmeyer et al. Forensic Medicine – fundamentals and perspectives, 2014.
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2010 2011 2012 2013 2014 2015 2016
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Figure 3.2. Trend in age-standardised injury mortality rates by district
Cape Winelands Central KarooCape Metro EdenOverberg West Coast
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Figure 3.3. Trend in the proportion of injury deaths by manner
Homicide Suicide Accident
9
4. Homicide
In 2016, homicide accounted for 7% of all deaths, and 51 % of injury deaths in the Western Cape and the homicide ASR for all persons in the Western Cape was 52 deaths per 100 000 population, a 35% increase from 2010 (Figure 4.1).
The homicide ASR was 10 times higher in males compared to females, and the male homicide ASR increased by 39% since 2010, to 96 deaths per 100 000 population in 2016. This equates to 9 homicides per day in males in the Western Cape during 2016. Age-specific homicide rates were highest in males aged 20-34 years, reaching 262 deaths per 100 000 in this age-group (Figure 4.2). Male homicide ASRs were highest in the Metro district (118 deaths per 100 000), followed by Central Karoo district (77 deaths per 100 000) (Figure 4.3).
The female homicide ASR for the Western Cape in 2016 was 9 deaths per 100 000 population (equivalent to 1 female homicide per day) and has remained relatively unchanged since 2010 (Figure 4.1). Age-specific homicide rates were highest in women between the ages of 25-34 years compared to other age groups (19 deaths vs. <12 deaths per 100 000 population, respectively; Figure 4.2). In 2016, Central Karoo district had the highest female homicide ASR in the province (20 deaths per 100 000; Figure 4.4).
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Figure 4.1. Trend in homicide ASR by sex
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Figure 4.2. Age-specific homicide rates by sex, 2016
Person Male Female
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Figure 4.3. Trend in male homicide ASR by district
Winelands Central Karoo Cape MetroEden Overberg West Coast
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Figure 4.4. Trend in female homicide ASR by district
Winelands Central Karoo Cape MetroEden Overberg West Coast
10
The major causes of homicide were assault with a sharp object (46%), followed by assault with a firearm (36%) and assault with a blunt object (12%). The homicide ASR due to assault with a firearm doubled in males between 2010 and 2016 (Figure 4.5), and this accounted for the overall increase in the homicide ASR in the province. The firearm-related homicide ASR in males increased mainly in the Metro (24 to 52 deaths per 100 000), and specifically in the Klipfontein (48 to 116 deaths per 100 000), Tygerberg (19 to 85 deaths per 100 000) and Mitchells Plain (21 to 52 deaths per 100 000) sub-districts (Figure 4.7.).
Central Karoo district had the second highest homicide rate in the province, particularly in Beaufort West sub-district (38 deaths per 100 000). Homicide ASRs also increased significantly in Bergriver (133%) and Cape Aghulas (155%) sub-districts, whereas they decreased (>40%) in Swartland, Matzikama and Saldanha sub-districts (Supplementary tables).
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Figure 4.7. Metro sub-district trends in male homicide ASR
CT Southern CT Eastern CT NorthernCT Western CT Mitchells Plain CT KhayelitshaCT Tygerberg CT Klipfontein
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Figure 4.5. Trend in male homicide ASR by major cause
asphyxia/strangulation blunt forcecombination assault firearmsharp object
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Figure 4.6. Trend in female homicide ASR by major cause
asphyxia/strangulation blunt forcecombination assault firearmsharp object
11
Alcohol (EtOH) results were available for 80% of homicide deaths8. Of those with available results, 50% of homicide deaths tested positive for alcohol (i.e. had an alcohol concentration greater than 0g/100ml), and 45% had alcohol concentrations equal to or above 0.05g/100ml (the South African legal driving limit, Table 4.1). Over two thirds of homicides occurred between 5pm on a Friday evening and 4am on a Monday morning, with the highest proportion of homicides occurring between midnight on a Saturday night and 4am on a Sunday morning (Figure 4.8). Over 70% of homicide cases that occurred over weekends tested positive for alcohol.
Table 4.1 Alcohol results: Homicide
Alcohol results (% with results) Major causes % Alcohol measured EtOH=0g/100ml EtOH=0.01 –
0.049g/100ml EtOH≥
0.05g/100ml All homicides 80% 50% 5% 45% Sharp object 83% 30% 4% 66% Firearms 87% 73% 6% 21% Blunt force 61% 60% 6% 34%
8 Alcohol is not routinely measured on all cases as sometimes it is not possible, and not all alcohol results were available from the forensic chemistry laboratory when the data was analysed.
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Fri Sat Sun Mon Tues Wednes Thurs
% H
omici
de d
eath
s
Figure 4.8. Frequency of homicides by day of week, time of day, and alcohol level
EtOH>0 EtOH=0 Uknown EtOH
12
5. Accidental injury deaths
Accidental deaths accounted for 38% of all injury deaths in 2016. The major causes were transport -related (35% motor vehicle fatalities and 25% pedestrian fatalities), fires (14%), drowning (8.5%), falls (6%), aspiration/chocking (2%) and accidental overdoses and poisoning (2%). The remaining proportion were due to a range of other accidental circumstances including anaphylaxis, animal attacks and envenomation, electrocution and aviation accidents to name a few (Appendix Table 3).
Transport fatalities Transport deaths accounted for 7.2% of all injury deaths and around 60% of accidental deaths in the Western Cape. The major causes of transport-related deaths were motor vehicle (occupant) fatalities (42%), pedestrian fatalities (45%), motorcycle fatalities (4%), cyclist fatalities (2%) and railway-related fatalities (7%; includes both passenger and pedestrian fatalities involving a train) (Figure 5.1). For both males and females, ASRs for transport-related deaths have remained unchanged since 2010 (Figure 5.2, Figure 5.3), however ASRs were 3-4 times higher in males compared to females for all major causes of transport-related deaths.
2% 4%
7%
45%
42%
Figure 5.1. Profile of transport-related deaths, 2016
Cyclist
Motorcycle
Railway accidents
Pedestrian
Motor vehicle
0
5
10
15
20
25
2010 2011 2012 2013 2014 2015 2016
Deat
hs/ 1
00 0
00 p
opul
atio
n
Figure 5.2. Trend in male transport ASR by major cause
Railway Cyclist Motor vehicleMotorcycle Pedestrian
0
2
4
6
8
10
2010 2011 2012 2013 2014 2015 2016
Deat
hs/ 1
00 0
00 p
opul
atio
n
Figure 5.3. Trend in female transport ASR by major cause
Railway Cyclist Motor vehicleMotorcycle Pedestrian
13
Motor vehicle fatalities Motor vehicle fatalities includes both passengers and drivers. In 2016, age-specific motor vehicle mortality rates were highest in persons 80 years and older, followed by males aged 30-34 years, and males under 5 years (Figure 5.4.). Whilst the majority (40%) of motor vehicle fatalities occurred in the Metro district, Central Karoo district had the highest motor vehicle mortality ASR (Figure 5.5). The high ASR in Central Karoo was mainly due to the high number of fatal accidents (of both residents and non-residents) occurring along the N1 national road that connects Cape Town with cities like Bloemfontein and Johannesburg. Notably, motor vehicle mortality ASR declined significantly in the Central Karoo between 2010 and 2016.
Over half of all motor vehicle fatalities occurred over a weekend, with the highest proportion of deaths occurring between midnight on a Saturday and 8am on a Sunday morning (Figure 5.6.). Alcohol results were available for 57% of all motor-vehicle fatalities. Of those with alcohol results available, 48% had a positive alcohol result, and 42% had an alcohol level over the legal driving limit (Table 5.1).
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Fri Sat Sun Mon Tues Wednes Thurs
% M
otor
veh
icle
deat
hs
Figure 5.6. Frequency of motor vehicle deaths by time of day, day of week, and alcohol level
OH>0 OH=0 OH unknown
0
5
10
15
20
25
30
35
0-4
5-9
10-
1415
-19
20-2
425
-29
30-3
435
-39
40-4
445
-49
50-5
455
-59
60-6
465
-69
70-7
475
-79
80+
Deat
hs/ 1
00 0
00 p
opul
atio
n
Figure 5.4. Age-specific motor vehicle ASR by sex, 2016
Male Female
0
50
100
150
200
2010 2012 2014 2016
Deat
hs/ 1
00 0
00 p
opul
atio
n
Figure 5.5. Trend in motor vehicle ASR by district
Cape Metro Winelands Central KarooEden Overberg West Coast
14
Table 5.1 Alcohol results: Accidental deaths
Alcohol results (% with results) Major causes % Alcohol measured EtOH=0g/100ml EtOH=0.01 –
0.049g/100ml EtOH≥
0.05g/100ml All accidents 58% 48% 5% 47% Transport (all) 62% 49% 5% 46% Motor vehicle 57% 52% 6% 42% Pedestrian 63% 40% 4% 56% Motorcycle 74% 55% 5% 40% Cyclist 67% 70% 1% 29% Railway 83% 70% 3% 27% Fires 54% 36% 4% 60% Drowning 48% 53% 5% 42% Falls 33% 69% 7% 24% Overdose/poisoning 76% 25% 4% 71%
Pedestrian fatalities In 2016, age-specific pedestrian mortality rates were highest in male children under the age of 5 years (Figure 5.7). Whilst almost 70% of pedestrian fatalities occurred in the Metro, pedestrian mortality ASRs were similar across districts, and there were no notable changes in pedestrian ASRs between 2010 and 2016. In 2016, the sub-districts with the highest pedestrian ASRs were Breede Valley (24 deaths per 100 000), Laingsburg (20 deaths per 100 000), Theewaterskloof (18 deaths per 100 000), Western and Tygerberg (16 deaths per 100 000 each).
Among children under 15 years, pedestrian fatalities occurred more frequently between 5pm and 9pm on a Friday and Saturday, and between 1pm and 5pm throughout the week (Figure 5.8). In persons over 15 years of age, pedestrian fatalities occurred more frequently between 9pm and 4am on Fridays, Saturdays and Sundays (Figure 5.9.). Alcohol results were available for 60% of pedestrian fatalities, of which 60% had positive alcohol levels (Table 5.1). Of those with positive alcohol results, 60% had an alcohol concentration >0.2g/100ml, and 25% >0.3g/100ml. Furthermore, 90% of pedestrian fatalities that occurred between 9pm and 4am on a Saturday/Sunday tested positive for alcohol
15
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Fri Sat Sun Mon Tues Wednes Thurs
% P
edes
tria
n de
aths
Figure 5.9. Frequency of pedestrian deaths (>15 years) by day of week, time of day, and alcohol level
EtOH>0 EtOH=0 Uknown EtOH
0
20
40
60
80
0-4
5-9
10-
1415
-19
20-2
425
-29
30-3
435
-39
40-4
445
-49
50-5
455
-59
60-6
465
-69
70-7
475
-79
80+
Deat
hs/ 1
00 0
00 p
opul
atio
n
Figure 5.7. Age-specific pedestrian death rates by sex, 2016
Male Female Person
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Fri Sat Sun Mon Tues Wednes Thurs
% P
edes
tria
n de
aths
<15
Figure 5.8. Frequency of child (<15years) pedestrian deaths by time of day and day of week
<1 1-4 5-9 10-14
15
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Fri Sat Sun Mon Tues Wednes Thurs
% P
edes
tria
n de
aths
Figure 5.9. Frequency of pedestrian deaths (>15 years) by day of week, time of day, and alcohol level
EtOH>0 EtOH=0 Uknown EtOH
0
20
40
60
80
0-4
5-9
10-
1415
-19
20-2
425
-29
30-3
435
-39
40-4
445
-49
50-5
455
-59
60-6
465
-69
70-7
475
-79
80+
Deat
hs/ 1
00 0
00 p
opul
atio
n
Figure 5.7. Age-specific pedestrian death rates by sex, 2016
Male Female Person
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Fri Sat Sun Mon Tues Wednes Thurs
% P
edes
tria
n de
aths
<15
Figure 5.8. Frequency of child (<15years) pedestrian deaths by time of day and day of week
<1 1-4 5-9 10-14
16
Railway fatalities On average, 100 railway fatalities occurred every year between 2010 and 2016, with the majority (92%) being pedestrians and the remaining proportion passengers dying from injuries sustained after accidentally falling out of a train (Appendix Table 3). Railway fatality ASRs have not changed between 2010 and 2016 (Figures 5.2 and 5.3). Age-specific railway pedestrian mortality rates were highest in males aged 30-34 and 40-44 years, and females aged 60-64 years (Figure 5.10). Alcohol results were available for 80% of railway fatalities, and among these 30% had positive alcohol levels (Table 5.1). Railway fatalities were more frequent on weekdays between 8 and 10 in the morning and 7 and 9 in the evening (Figure 5.11).
Motorcycle fatalities On average, 65 motorcycle fatalities occurred every year between 2010 and 2016 (Appendix Table 3). In 2016, age-specific motorcycle mortality rates were highest in males aged 25-34 years (Figure 5.12.). Over 70% of motorcycle fatalities occurred in the Metro, however, ASRs did not differ significantly between districts. Sub-districts with the highest motorcycle mortality ASRs were Kannaland (4 deaths per 100 000), Cape Agulhas (2 deaths per 100 00), Metro Northern (2 deaths per 100 000) and Stellenbosch (2 deaths per 100 000).
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Fri Sat Sun Mon Tues Wednes Thurs
% R
ailw
ay d
eath
s
Figure 5.11. Frequency of railway deaths by day of week, time of day and alcohol level
EtOH>0 EtOH=0 Uknown EtOH
0
2
4
6
8
0-4
5-9
10-1
415
-19
20-2
425
-29
30-3
435
-39
40-4
445
-49
50-5
455
-59
60-6
465
-69
70-7
475
-79
80+
Deat
hs/ 1
00 0
00 p
opul
atio
n
Figure 5.10. Age-specific railway death rates by sex, 2016
Male Female Person
17
The majority of motorcycle fatalities occurred over the weekend, and the highest proportion of deaths occurred between 1pm and 5pm on a Saturday (Figure 5.13). Alcohol results were available for approximately 74% of motorcycle fatalities, of which 45% had positive results (Table 5.1).
Cyclist fatalities On average, 30 cyclist fatalities occurred every year between 2010 and 2016 (Appendix Table 3). Although cyclist mortality rates were generally low across all age-groups, age-specific cyclist mortality rates were highest in males aged 70-74 years. Cyclist fatalities in females were particularly uncommon, with deaths only occurring in females aged 65-69 years old in 2016 (Figure 5.14). Approximately half of all cyclist fatalities occurred in the Metro, with no notable difference observed in cyclist mortality ASRs between districts. Sub-districts with the highest cyclist mortality ASRs were Hessequa (3 deaths per 100 000), Knysna (3 deaths per 100 000) and Oudtshoorn (2 deaths per 100 000).
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Fri Sat Sun Mon Tues Wednes Thurs
% M
otor
cycle
dea
ths
Figure 5.13. Frequency of motorcycle deaths by day of week, time of day, and alcohol level
EtOH>0 EtOH=0 Uknown EtOH
0
2
4
60-
45-
910
-14
15-1
920
-24
25-2
930
-34
35-3
940
-44
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-54
55-5
960
-64
65-6
970
-74
75-7
980
+
Deat
hs/ 1
00 0
00 p
opul
atio
n
Figure 5.12. Age-specific motorcycle death rates by sex, 2016
Male Female Person
18
The majority of cyclist fatalities occurred between 1pm and 5pm on a Friday and between 9pm and 12pm on a Saturday (Figure 5.15). Alcohol results were available for 67% of cyclist fatalities, of which 30% had a positive result (Table 5.1).
Fires
Fires were the commonest cause of accidental death after transport-related accidents. An average of 300 people die due to accidental fires in the Western Cape every year, and in 2016, the fire mortality ASR was 5 deaths per 100 000 population and remained relatively unchanged since 2010 (Figure 5.16). Fire mortality ASRs were 3 times higher in males compared to females, and age-specific fire mortality rates were highest in males under 5 years old and persons aged 75-79 years (Figure 5.17). In 2016, two thirds of all deaths due to accidental fires occurred in the Metro (6 deaths per 100 000), however Swellendam (16 deaths per 100 000), Knysna (12 deaths per 100 000) and Tygerberg (10 deaths per 100 000) sub-districts had the highest fire mortality ASRs.
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Fri Sat Sun Mon Tues Wednes Thurs
% C
yclis
t dea
ths
Figure 5.15. Frequency of cyclist deaths by day of week, time of day and alcohol level
EtOH>0 EtOH=0 Uknown EtOH
012345
0-4
5-9
10-1
415
-19
20-2
425
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475
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Deat
hs/ 1
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opul
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nFigure 5.14. Age-specific cyclist death rates by sex, 2016
Male Female Person
19
Deaths due to accidental fires occurred more frequently between midnight on a Saturday and 8 am on a Sunday (Figure 5.18). Alcohol was measured in 60% of cases, of which 65% tested positive for alcohol (Table 5.1).
Drowning
On average, 200 people drown per year in the Western Cape (Appendix Table 3). In 2016, the accidental drowning ASR was 4 deaths per 100 000 population, and remained relatively unchanged since 2010 (Figure 5.16). Overall, the drowning ASR was 7 times higher in males compared to females, and age-specific fire mortality rates was significantly higher in male children under 5 years compared to other age-groups (40 deaths per 100 000) (Figure 5.19). Sub-districts with the highest drowning mortality ASR were Cederberg (27 deaths per 100 000), followed by Prince Albert (20 deaths per 100 000), Matzikama (11 deaths per 100 000) and Overstrand (11 deaths per 100 000).
0%2%4%6%8%
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Fri Sat Sun Mon Tues Wednes Thurs
% F
ire d
eath
s
Figure 5.18. Frequency of accidental fire deaths by day of week, time of day and alcohol level
EtOH>0 EtOH=0 EtOH unknown
0
2
4
6
8
2010 2011 2012 2013 2014 2015 2016Deat
hs/ 1
00 0
000
popu
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Figure 5.16. Trend in accidental ASRs by major cause
Accidental overdose/poisoning DrowningFalls FiresOther accidents
0
10
20
30
40
0-4
5-9
10-1
415
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455
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465
-69
70-7
475
-79
80+De
aths
/ 100
000
pop
ulat
ion
Figure 5.17. Age-specific accidental fire death rates, 2016
Male Female
20
Almost half (48%) of drownings occurred in a natural body of water (includes the sea and rivers), 30% in dams and reservoirs, 13% in swimming pools and 3% in baths. A higher proportion of drownings occurred during the daytime, particularly over weekends (Figure 5.20), and alcohol was measured in 48% of cases, of which 47% tested positive (Table 5.1).
Falls
The fall mortality ASR was relatively low across all years (< 4 deaths per 100 00 population in 2016), however age-specific fall mortality rates were significantly higher in persons over 80 years compared to other age groups (Figure 5.21). Fall mortality ASRs were highest in the Metro, particularly the Western, Tygerberg and Southern sub-districts. Alcohol results were available in 30% of cases, and only a third of these had positive results (Table 5.1).
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Figure 5.20. Frequency of drowning by day of week, time of day and, alcohol level
EtOH>0 EtOH=0 EtOH unknown
01020304050
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Figure 5.19. Age-specific accidental drowning rates by sex, 2016
Male Female Person
21
Accidental poisoning and overdoses
In 2016, age-specific accidental poisoning or overdose mortality rates were highest in male children under 5 years, followed by males aged 30-34 years (5.22). Overdose and poisonings were grouped according to WHO ICD-10 categories, with the highest proportion of deaths due to alcohol intoxication, followed by overdose on narcotics and hallucinogens. However, in 30% of cases the agent of overdose or poisoning was unknown9. In 2016, overdose/poisoning ASRs were highest in Cederberg, Oudtshoorn and Witzenberg sub-districts.
9 Toxicology results not always available and/or suspected agent not noted.
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Figure 5.21. Age-specific accidental fall death rates by sex, 2016
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Figure 5.22. Age-specific accidental poisoning/overdose death rates by sex, 2016
Male Female Person
22
6. Suicides
In 2016, suicides accounted for 11% of all injury deaths in the Western Cape, with an ASR of 11 deaths per 100 000 population (Figure 6.1). For both males and females, the suicide ASR remained relatively unchanged between 2010 and 2016, however ASRs were approximately 3 times higher in males compared to females across all years (17 vs. 5 deaths per 100 000 population, respectively in 2016).
The youngest suicide reported in the Western Cape during this period was 9 years old, and at least one 9-year-old child committed suicide per year between 2014 and 2016. Whilst the age-specific suicide rate in children aged 10-14 years was very low (<1 death per 100 000), up to 12 suicides per year occurred in this age group. Age-specific suicide rates increased from 15 years of age onwards (Figure 6.2). For females, age-specific rates were relatively similar between 15 and 60 years of age (8 deaths per 100 000), thereafter suicide rates declined in older women. In contrast, suicide mortality rates in males increased with age, with the highest age-specific suicide rate observed in males aged 25-29 years (33 deaths per 100 000) and males 70 years and older (>25 deaths per 100 000 population).
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2 0 1 0 2 0 1 1 2 0 1 2 2 0 1 3 2 0 1 4 2 0 1 5 2 0 1 6
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Figure 6.1. Trend in suicide ASR by sex
Male Female Person
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Male Female Person
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14
Hanging Overdose/poisoning Firearm
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Figure 6.3. Trend in male suicide ASR by major cause
2010 2011 2012 2013
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Figure 6.4. Trend in female suicide ASR by major cause
2010 2011 2012 2013 2014 2015 2016
23
Two thirds of suicides occurred in the Metro, and suicide ASRs were similar across districts. The major means of suicide were hanging (60%), intentional overdose/poisoning (20%) and with a firearm (10%). For males, suicide ASRs were highest for hanging followed by overdose/poisoning, then firearm (Figure 6.3.). In contrast, female suicide ASRs were higher for intentional overdose/poisoning compared to hanging and firearm use (Figure 6.4). Alcohol results were available for approximately 75% of cases, of which 37% tested positive (Table 6.1.).
Table 6.1. Alcohol results: Suicide
Alcohol results (those tested) Major causes % Alcohol
measured EtOH=0g/100ml EtOH=0.01 –
0.049g/100ml EtOH≥
0.05g/100ml All suicide 75% 63% 6% 31% Hanging 82% 61% 6% 32% Shot 82% 64% 3% 33% Overdose/poisoning 50% 65% 9% 26%
24
7. Child and adolescent injury mortality burden
The World Health Organization (WHO) defines a child as a person under the age of 18 years, and an adolescent between 10 and 19 years10. In 2016, 13 percent of all injury deaths in the Western Cape occurred in children and adolescents under the age of 19
years. The majority of injury deaths occurred in young male adolescents aged 15-19 years, in particular 18 and 19 years olds. There was also a high burden of injury deaths in children under 5 years (Figure 7.1).
Children under 5 Among young children under 5 years, 70% of injury deaths occurred in 1 to 4 year olds, 22% in 1 to 11 month olds and 8% in neonates (0-27 days old). Accidents accounted for 90% of injury deaths in this age group, and the age-specific accidental death rate in 0-4 year olds was more than double that of the other child and adolescent age groups. Male children were disproportionately affected, with accidental death rates 8 times higher than females of the same age (Figure 7.2).
10 http://www.who.int/topics/adolescent_health/en/
50 0 50 100 1500-6 days
7-27 days1-11mths
123456789
10111213141516171819
Number of injury deaths
Age
Figure 7.1. Age and sex distribution of child and adolescent injury deaths, 2016
female male
050
100150200250300
Accident Homicide Accident Homicide Accident Homicide
Persons Males FemalesDeat
hs/ 1
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Figure 7.2. Trend in injury ASR by manner for children 0-4 years
2010 2011 2012 2013 2014 2015 2016
25
The leading cause of death in children under 5 was pedestrian fatalities, accounting for 21% of injury deaths in this age group (Appendix Table 6). Pedestrian fatality rates in male children under 5 were 8-10 times higher than rates in other age groups. Pedestrian fatalities were more likely to occur in the afternoon/early evening and over the weekend. Sub-districts with the highest under 5 pedestrian fatality rates were Matzikama (44 deaths per 100 000), Cape Agulhas (39 deaths per 100 000), Langeberg (19 deaths per 100 000) and Swartland (18 deaths per 100 000).
Accidental drowning was the second leading cause of injury death in children under 5 (17% in 2016), and accounted for 35% of all drowning deaths in the Province. Approximately one third occurred in swimming pools, a third in other bodies of water including dams, canals, storage tanks, and 20% in seas and rivers (Figure 7.3). Sub-districts with the highest drowning rates for children under 5 were Prince Albert (87 deaths per 100 000), Cederberg (40 deaths per 100 000) and Witzenberg (36 deaths per 100 000).
Fires were the third leading cause of death (15%), followed by aspiration/choking (8%), motor vehicle accidents (8%) and asphyxia (6%). 2% of injury deaths in children were due to accidental overdose/poisoning, including pesticides. The remaining ~17% of deaths were caused by a range of other accidental circumstances, including electrocution, falls, hot liquid burns and being caught or struck by an object.
An average of 20 homicides occurred per year in children under 5, and in 2016, the homicide rate in children under 5 was the second highest compared to other age categories under 19 years. The homicide rate in male children was up to 7 times higher than females across the 7-year period. The major causes of homicide were assault with blunt force, neglect/abandonment, poisoning, drowning and fire (Appendix Table 6).
Children 5 – 9 and 10 – 14 years Injury death rates in children between 5-14 years of age were low in comparison to other age groups. Accidental causes accounted for 95% of injury deaths in children 5 to 9 and
0102030405060708090
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unspecifieddrowning/submersion
other specified
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26
72% in 10 to 14 years old. Accidental death rates were higher in male children 5 to 9 and 10 to 14-years old (Figure 7.4, Figure 7.5).
For both 5 to 9 and 10 to 14 year olds, pedestrian fatality was the leading cause of accidental death, followed by drowning, fire and motor vehicle accidents (passenger). Approximately one quarter of child drownings occurred in children 5 – 9 years of age, with 76% of drownings occurring in the sea or rivers and other specified bodies of water (dams, reservoirs; Figure 7.3).
Homicide accounted for a small proportion of injury deaths in 5 to 9 year olds, with an average of 6 homicides per year in this age group. Homicides accounted for a much larger proportion of injury deaths in children 10 to 14 years, with an average of 18 homicides per year in this age group. The major means of homicide in this age group were assault with a sharp object or firearm, and rates were higher in males compared to females (Appendix Tables 7-8).
Since 2014 one suicide per year occurred in children aged 5 to 9 years, and 7 suicides in children 10 to 14-years old.
05
1015202530
Homicide Accident Suicide Homicide Accident Suicide Homicide Accident Suicide
Persons Males Females
Deat
hs/ 1
00 0
00 p
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nFigure 7.4. Trend in injury ASR by manner in children 5-9 years
2010 2011 2012 2013 2014 2015 2016
0
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Homicide Accident Suicide Homicide Accident Suicide Homicide Accident Suicide
Persons Males Females
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Figure 7.5. Trend in injury ASR by manner in children 10-14 years
2010 2011 2012 2013 2014 2015 2016
27
Adolescents 15 – 19 years In adolescents 15 to 19 years of age, approximately 60% of injury deaths were in 18 and 19 year olds. The profile of injury deaths in 15 to 19 year olds was very different to that of other child age groups. In 2016, 67% of deaths were due to homicide, 25% due to accidents and 10% due to suicides. Homicide rates were up to 17 times, accidents 4 times, and suicide 3 times higher in males compared to females (Figure 7.6).
The major causes of accidental deaths in this age category were road traffic accidents, railway accidents, and drownings. In this age group more transport accidents were due to motor vehicle accidents (as opposed to pedestrian), however the majority (78%) were indicated as passenger fatalities and not driver fatalities.
19% of child and adolescent drownings occurred in 15 to 19 year olds, with the majority occurring in natural or other specified bodies of water (Figure 7.3). Railway accidents were the fourth leading cause of accidental deaths in this age group, with the majority as railway pedestrian fatalities (49 in total) as opposed to train passengers.
Homicide rates in males 15-19 years increased from 86 deaths per 100 000 to 114 deaths per 100 000 between 2010 and 2016. The major means of homicide were assault with a sharp object, firearm and blunt force. Although the number of homicides in 15-19 year olds due to strangulation, smothering or asphyxiation was small (23), 73% were in females, double the rate in males.
0
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Homicide Accident Suicide Homicide Accident Suicide Homicide Accident Suicide
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Figure 7.6. Trend in injury ASR by manner in adolescents 15-19 years
2010 2011 2012 2013 2014 2015 2016
28
8. Comparison to Stats SA cause of death profiles
Mortality data from the vital registration systems permit the production of high level mortality statistics on a continuous basis and contribute to the understanding of the burden of disease at national and provincial geographic levels. In South Africa, the registration of deaths falls under the mandate of the Department of Home Affairs (DHA) as governed by the Births and Deaths Registration Act 1992 (Act No. 51 of 1992) (Republic of South Africa, 1992). All death notification forms (where the cause of death is documented) are subsequently collected by Statistics South Africa from DHA for capturing, processing, assessment, analysis and dissemination of statistical reports and datasets on mortality and causes of death. Reports are released annually, with an approximate 2-year time lag (e.g. 2016 mortality figures were released in 2018). Whilst South Africa has made great strides in improving the coverage and completeness of vital registration over the past 20 years, major challenges remain with the quality of cause of death information, namely a high proportion of ill-defined deaths, underreporting of HIV and an inaccurate profile of injury deaths. Given the high injury burden in South Africa, the poor quality of injury mortality data in South Africa is of great concern. The main reasons for this are twofold:
i. Statistics South Africa currently follow WHO ICD-10 coding rules which state that injuries with unspecified intent (manner) on the death notification form should default to accidental. This has resulted in Statistics South Africa reporting high numbers of gunshots and hangings as accidental rather than due to homicide or suicide, and subsequent misclassification of injury deaths to accidental causes in national mortality statistics. The scale of the misclassification is shown in Figure 8. 1 below, which compares the FPS injury mortality profile (presented in this report) with that of Statistics South Africa 2016 Cause of death report11. The Statistics South Africa data reports 64% of injuries as due to accidental causes other than transport accidents compared with 14% from FPS data; homicide 24% vs 48%; suicide 1% vs 10% and transport 8% vs 22%.
ii. Underlying this, some forensic pathologists are reluctant to report the manner of death on the death certificate as is recommended by the World Health Organisation (WHO). This is due, in part, to fear of contravening section 20 (4) of the Inquest Act and/or sections 15 and 17 of the Births and Deaths Registration Act 51 of 1992, that have been interpreted by some forensic pathologists as preventing them from reporting the manner of death for injuries. As a result, for many of the injury deaths, only the nature of injury e.g. gunshot, multiple injuries, stab wound etc. are reported as the cause of death but not the manner of death (assault, suicide, accident). From a public health point of view, knowing the detail on the manner of death is essential as prevention
11 Mortality and cause of death report 2016, Statistics South Africa 2018.
29
strategies are quite different for intentional injuries (homicide and suicide) and unintentional injuries (road traffic injuries). Both Acts need to be reviewed in order to ensure that the collection of manner of death for injuries is not compromised. Figure 8.1. Comparison between Stats SA and FPS injury profile for the Western Cape, 2016
48%
10%
22%
14%
6%
FPS 2016
24%
1%8%
64%
2% 1%Stats SA 2016 Homicide
Suicide
Transport
Other Accident
Section 56
Undeterminedintent
29
strategies are quite different for intentional injuries (homicide and suicide) and unintentional injuries (road traffic injuries). Both Acts need to be reviewed in order to ensure that the collection of manner of death for injuries is not compromised. Figure 8.1. Comparison between Stats SA and FPS injury profile for the Western Cape, 2016
48%
10%
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6%
FPS 2016
24%
1%8%
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2% 1%Stats SA 2016 Homicide
Suicide
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Section 56
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30
9. Discussion
Injuries accounted for 14% of all deaths in 2016 with over 80% affecting males, particularly in the age group 20 to 39 years. The majority of injury deaths were due to homicide, and in 2016 the Western Cape homicide rate was 52 per 100 000 compared to the global rate of 5 per 100 00012. There was also a notable increase in homicide rates between 2010 and 2016. Age and male sex are the principal biological drivers, and the scourge of youth violence and the high rate of homicide in males 15 to 19 years of age is very concerning. The Metro sub-districts of Klipfontein, Tygerberg and Mitchells plain are particularly affected by violence. The City of Cape Town has a long history of street crime and gangsterism and policing has been unable to provide adequate social protection against crime and violence.
Following the Western Cape Burden of Disease (BOD) study in 2007, the high burden of injury in the Western Cape has been a major concern. In response to the violence and the associated growing burden of injuries, the Western Cape Government drafted a policy framework for integrated violence prevention in 2013. The strategy identifies the broad structural issues that need to be addressed in the long term and these include poverty, deprivation and inequality. It therefore acknowledged the need for an intersectoral multi-government and societal approach to prevent violence, and aimed to enhance collaboration between the health, criminal justice, education and societal development sectors for the adoption of shared strategies.
In line with this, a major intervention to reduce injury mortality in children has been the introduction of child death reviews (CDRs) at dedicated sites across the province. Many countries use a standardised CDR process to investigate unnatural and natural unexpected deaths in children under 18 years of age, in order to improve child health and protection systems. A CDR pilot was initiated by the Children’s Institute and the Division of Forensic Medicine and Toxicology, University of Cape Town at Salt River mortuary in Cape Town from January to December 2014. Following the success of the pilot, the CDR process is being extended to all mortuaries in the Western Cape. The multidisciplinary teams include representatives from the police service, social services, health, forensic pathology and prosecution services. A standardised approach is used to understand the context in which each death occurred, including biological and psychological, family, social and cultural factors as well access to and response of the health and social welfare system. Based on the findings appropriate action is taken to improve child health and protection services, and since the introduction of the CDR teams there has been an increased conviction rate for offenders.
12 GBD 2016 Causes of Death Collaborators, Lancet 2017; 390: 1151–210
31
Aside from the CDRs, there is little evidence available on the implementation of other interventions aimed at reducing violence in the Province. Firearm deaths have increased and there is a need for strict firearm control to reduce the demand for and availability of firearms13. Early childhood development programs have been shown to alleviate societal risks that result from poor family cohesion and partner abuse. Programs that worked in decreasing youth violence include life skills training, family therapy and educational incentives for at risk high-school students.
Alcohol consumption was an associated factor for all injury deaths and hence interventions to reduce alcohol consumption during high risk periods, such as weekends, are urgently required. Specifically, short-term evidence based interventions should focus primarily on reducing the availability of alcohol with interventions that affect long term change to the social environment and social norms that support violence.
Transport related deaths account for the largest proportion of accidental injury deaths and there has not been a decrease in deaths over the past 7 years, although there has been a decrease in the Central Karoo district. This may be due to the installation of average speed over distance cameras on the N1 in 2011 as a decrease in collisions has been noted. Legislation and enforcement on the use of child restraints in vehicles have been shown to have a major effect on motor vehicle fatalities in children. Almost 50% of transport deaths were pedestrians and in particular males under 5 years of age. Appropriate town planning and interventions to divert traffic away from residential areas have had the greatest impact on pedestrian deaths in other countries. Traffic calming measures such as speed bumps have also decreased pedestrian deaths around schools in Durban14. Other measures include the strict enforcement of speed limits and other rules of the road, in particular enforcement of the blood alcohol driving limits. Training programmes for parents and secure play areas have also decreased road deaths in children.
There are a large number of informal settlements in Cape Town and fires are a continual risk. There has not been a decrease in deaths due to fires. Mortality is mostly in males under the age of five and older persons, and a high proportion of fire fatalities tested positive for alcohol. A systematic improvement of town planning, for example ensuring adequate distance between dwellings so the fire services can have access, and the use of safer building materials and installation of fire alarms are required. Drowning continues to be a leading cause of injury mortality particularly in males under five. Adult vigilance together with safety measures, such as fencing and/or covers, are required to mitigate drowning risk, particularly around swimming pools with younger
13 Matzopolous, R et al. A retrospective time trend study of firearm and non-firearm homicide in Cape Town from 1994 to 2013. South African Medical Journal, [S.l.], v. 108, n. 3, p. 197-204, feb. 2018. ISSN 2078-5135. 14 Nadesan-Reddy, N, & Knight, S. (2013). The effect of traffic calming on pedestrian injuries and motor vehicle collisions in two areas of the eThekwini Municipality: A before-and-after study. SAMJ: 103(9), 621-625.
32
children. Unintentional poisoning/overdose was also highest in males under five. Caregiver education on the use of child resistant containers and better methods of storage are required. Although the suicide mortality rate has remained stable, there has been an increase in suicides in children. Restricting access to pesticides and medication as well the prevention and treatment of depression, alcohol and substance abuse have been found to be effective interventions. FPS collect a wealth of information that is invaluable for injury surveillance as evidenced by this report. However, due to the multiple (and in some cases duplicate) data collection processes that exist between FPS facilities and Pathologists, collation and cleaning of this information was particularly onerous. In order to meet the legal, operational and surveillance requirements of FPS and the Department, critical information system enhancements should be prioritised.
33
10. Methodology
Data sources FPS BIM minimum dataset
The base data (minimum dataset) used in this report was extracted from the FPS business information management (BIM) system. The FPS BIM is an information management platform that allows for the collection of routine service-related data primarily to support operational service processes within FPS facilities. The system was developed in 2006 and has been operational at all mortuaries since 2007. Due to some data capturing issues at some facilities, the first reliable data provincially is available since 2010. The business process followed for each case received by a FPS facility (and where information is both generated and collected) is shown in Figure 10.1 below. The FPS BIM database includes demographic information of the deceased (age, sex), circumstance and cause of death, as well as location and time of death on all cases received by FPS.
Figure 10.1. Forensic Pathology Service business process
Forensic Pathologist datasets
Due to critical system issues in the FPS BIM (identified in 2012) that resulted in capturing backlogs and data inaccuracies, several data gaps in the FPS database were identified. Therefore, the data extracted15 from the FPS BIM was further strengthened by databases maintained by Forensic Pathologists at Tygerberg and Salt River forensic laboratories (the two academic FPS laboratories) as well as a database maintained by a pathologist covering the Winelands/Overberg region. These databases included more detailed, and
15 The data extracted from the FPS BIM is for 7 years. For the minimum dataset, 2010 – 2014 was extracted 20 Jan 2016, 2015 extracted 28 Sept 2016 and 2016 extracted 7 Feb 2017. These years where then combined into a single dataset. The samples were extracted 8 March 2017 and special circumstances 30 Jan 2018.
34
in some cases updated information, on cause and manner of death, that is not available in the FPS BIM database.
Case files (Electronic Content Management, ECM)
The FPS BIM supports a paper-based data collection system (many forms legally required to be in hard copy). These forms also serve as a fail-safe if there is any missing information in the FPS BIM and are stored electronically in case files, using an electronic content management (ECM) system. Approximately 10 000 cases were reviewed using ECM to access case files, owing to missing or unclear information, mostly for the period 2014 – 2016.
Samples dataset
Alcohol concentration (blood or eye fluid) and carboxyhaemoglobin saturation (carbon monoxide level) was also extracted from the FPS BIM, or obtained from the aforementioned databases, or case review if available. There is a backlog for toxicological investigations, thus these results are not readily available, or timeously updated on the FPS BIM when results are returned.
Data linkage The numerous data sources were linked using the unique case file number. The minimum dataset served as the starting point. The table below details the dataset source, the number of cases from that dataset (across the 7-year report period), how many cases were in both the minimum dataset and additional source (matched), the extra cases (not matched), and the revised total after the merge.
Table 10.1. FPS data sources and linkage
Data source Number of cases
Matched Extra cases
Total cases* Dropped cases†
Years
FPS BIM (minimum) 70 593 - - 70 593 - 2010 - 2016 FPS BIM Samples§ 36 033 36 027 6 70 599 - 2010 - 2016 MRC** 36 814 36 798 16 70 615 3 2010 - 2013 Pathology databases
Salt River 23 042 23 029 13 70 628 761 2010 - 2016 Winelands/Overberg 1 803 1 796 7 70 635 7 2011 - 2016
Tygerberg 21 916 21 904 12 70 647 32 2010 - 2016 Special circumstances‡ 70 648 70 637 9 70 656 63 2010 - 2016
*updated totals after each merge, including unmatched cases. †cases dropped from data sources as no information populated i.e. case file
numbers created but not used or duplicate case file numbers. § Separate export from FPS BIM including alcohol and carbon monoxide
concentration **The MRC conducted local mortality surveillance and provided their cleaned data back to FPS. ‡ Separate export from FPS BIM
to get information on special circumstances relating to the case (e.g. Independent Police Investigative Directorate (IPID) cases) yielded an extra
9 cases that were not included in the original dataset received, but should have been. 7 of these (from 2014) were included in the final dataset.
The total number of cases represented in the table includes 27 non-human (remains) cases.
35
Data cleaning Dates Six different dates relating to a case are available in the final dataset viz. birth, injury, incident, death, logged, received and post-mortem. These dates are necessary for informing service flow (e.g. time lapse between death and post-mortem), as well as age calculations. All data sources were used to create a final date field, with the initial FPS BIM extract treated as correct, unless a reviewed case indicated otherwise. If the FPS BIM extract did not include a date i.e. missing, an alternate source was utilised if possible.
Dates of birth and death were used to calculate age. Injury date was used as a proxy if no date of death was available. Estimated age is recorded in the FPS BIM system as well as at autopsy. If birth date was missing, an estimated date of birth was calculated using the death date and estimated age, if available. If, despite all attempts, dates of birth or death were still not available, they were left blank.
For each of these dates, less than 1% were missing, with the highest proportion of incomplete data being for date of the birth (n=285).
Age Age was calculated in years, months and days using the dates of death and birth. These calculated ages were used to create neonate, infant and 5-year age categories. A total of 287 had an unknown age (285 missing birth date, 24 missing death date, 2 negative age).
Sex The final sex variable was populated using all available data sources. The sex is categorised into male, female, unknown (whether missing or undetermined) and also notes non-human remains. Less than 1% (339) of all cases had an unknown sex.
Alcohol concentration Alcohol (EtOH) concentration results are from the samples extract from the FPS BIM system. The alcohol concentrations were largely from blood samples, with a few instances from eye fluid samples. These were combined into a single field, and as with the other variables, additional data sources were used to augmented any missing results.
Of all cases, 51% had a sample sent for alcohol testing, for 29% of cases it’s unknown whether or not a sample was sent, and 20% of cases did not have a sample sent for alcohol testing. Of the 51% sent for testing, just over 7% of cases still had results outstanding and less than 1% were non-viable samples (Table 10.2). The alcohol results were grouped into ten categories; 0, 0.01 – 0.049 (0.05g/100ml is the South African driving legal limit), 0.06 – 0.09, and then units of 9 through to 0.6 or greater. These groupings reflect increasing level of impairment.16 For extremely high alcohol concentrations 16ABC of Alcohol: Alcohol in the body BMJ 2005; 330:85–7
36
(>=0.6g/100ml), the original laboratory reports were reviewed to ensure these values were correct.
Table 10.2. Alcohol (EtOH) testing coverage and results
Alcohol testing and results Number of cases (% total) Unknown if requested 20 312 (29%) EtOH not requested 14 095 (20%) EtOH requested 36 249 (51%) Requested EtOH results Number of cases (% EtOH requested) Non-viable sample 91 (0.3%) Awaiting result 2 676 (7%) EtOH results available 33 482 (92%) Available EtOH results Number of cases (% available EtOH) Natural causes 2 835 (8%) Injury causes 29 848 (89%) Remaining FPS cases 799 (2%)
Geographical allocation of injury deaths Where available, information on the street, suburb and town for place of injury, incident and death are captured by FPS for each case. These variables were used to map injury deaths to sub-district and district of injury, incident and death, based on the 2011 Census boundaries. In the present analysis, place of incident was used to allocate deaths to district and sub-district, and not place of residence of the deceased. As a result, district and sub-district injury profiles in this report may differ to those reported previously. Global positioning system (GPS) coordinates are available for a subset of the data, largely based on place of incident. However, GPS coordinates is incomplete for earlier years, and the quality (correctness) is variable across all the years. As extensive cleaning is required, GPS coordinates were not utilised for this analysis. Over the 7-year period, 15 cases (11 injury) had an incident address outside the Western Cape, and were thus excluded from all analyses.
Causes of death The remit of FPS is injury deaths, sudden and unexpected deaths, or deaths where the circumstances are unknown (see Definitions). Injury deaths are the focus of this analysis and categorised by manner of death into homicide, suicide or accidental deaths. The external causes of death were used to aid in this categorisation.
The external causes of death were coded to ICD-10 codes in the chapters V – Y (external causes of morbidity and mortality). They were then grouped into major causes for each manner of death (see Definitions section). Examples of major external causes include gun shot, sharp object, drowning or motor vehicle.
37
Calculations and exclusions Injury death rates Only injury deaths with known age, sex and incident location were included in analyses for age-standardised and age-specific death rates (n= 42 356, Table 10.3). The population estimates for the Western Cape was obtained from the National Department of Health were used to calculate the age-specific and age-standardised rates17. Assuming the age distributions from the 2001 and 2011 Census by five-year age groups and sex for the sub-districts and districts in the province, the ratio method 18of projecting geographic subdivisions was used to estimate the populations of the district municipalities and sub-health district stratified by sex and five-year-age groups between 2002 and 2021. The WHO age distribution for the world was used as the standard for calculating age-standardised rates. Table 10.3. Cases excluded from mortality rates calculations
Manner of death Unknown age
Unknown sex Unknown age and sex
Unknown district
Total
Assault 38 8 6 3 55 Suicide 6 1 7 Accident 37 15 6 58 Undetermined unnatural 1 1 Total 82 23 13 3 121
17 South Africa National Department of Health. 2017. District Health Planning and Monitoring Framework. http://www.health.gov.za/DHP/
18 Shryock, H. S. and J. S. Siegel (1976). The Methods and Materials of Demography (Condensed Edition). San Diego
38
11. Appendices
11.1 Appendix Tables
Appendix Table 1. Proportion (%) of cases received by Forensic Pathology facilities across the Western Cape between 2010 and 2016
FPS District FPS facility 2010 2011 2012 2013 2014 2015 2016 Total Metro Tygerberg 30 30 31 31 31 30 34 31
Salt River 32 31 31 30 33 34 30 33 Total 62 61 62 61 64 64 64 64
Eden/Central Karoo
Beaufort West 2 2 1 1 1 1 1 1 George 4 4 3 3 3 3 3 3 Knysna 2 2 2 2 2 2 2 0 Laingsburg 2 1 1 1 1 1 1 1 Mossel Bay 2 1 1 1 1 1 1 1 Oudtshoorn 2 2 2 1 1 2 1 2 Riversdale 1 1 1 1 1 1 1 1 Total 15 13 11 10 10 11 10 9
West Coast Malmesbury 2 2 2 2 2 2 2 2 Stellenbosch 5 5 6 5 5 5 2 5 Vredenburg 1 1 2 1 1 2 1 1 Vredendal 2 3 2 2 2 2 2 2 Total 10 11 12 10 10 11 7 10
Winelands Hermanus 3 4 4 4 3 4 3 3 Paarl 4 4 4 4 5 4 5 4 Swellendam 1 1 1 1 1 1 0 1 Wolseley 2 1 2 1 2 2 2 2 Worcester 6 5 5 5 5 5 6 5 Total 16 15 16 15 16 16 16 15
39
Appendix Table 2. Case mix per Forensic Pathology Facility*, 2016
Forensic Laboratory
Natural Injury Section 56 Foetus Undetermined Non-human Total n % n % n % n % n % n % n
Beaufort West 24 21.8 85 77.3 0 0 1 0.9 0 0 0 0 110 George 84 26.6 212 67.1 13 4.1 1 0.3 6 1.9 0 0 316 Hermanus 128 38.2 199 59.4 3 0.9 4 1.2 1 0.3 0 0 335 Knysna 69 38.3 110 61.1 0 0 1 0.6 0 0 0 0 180 Laingsburg 74 71.8 22 21.4 0 0 7 6.8 0 0 0 0 103 Mossel Bay 27 22.0 90 73.2 3 2.4 0 0 3 2.4 0 0 123 Malmesbury 73 38.6 112 59.3 1 0.5 2 1.1 1 0.5 0 0 189 Oudtshoorn 63 39.4 91 56.9 1 0.6 2 1.3 3 1.9 0 0 160 Paarl 182 35.1 321 61.9 7 1.4 3 0.6 6 1.2 0 0 519 Riversdale 29 39.2 42 56.8 0 0 1 1.4 2 2.7 0 0 74 Salt River 1 056 28.9 2 272 62.3 226 6.2 46 1.3 47 1.3 3 0.1 3 650 Stellenbosch 103 40.1 139 54.1 8 3.1 2 0.8 5 2.0 0 0 257 Swellendam 6 75 2 25 0 0 0 0 0 0 0 0 8 Tygerberg 1 084 28.8 2 321 61.6 181 4.8 76 2.0 103 2.7 1 0.0 3 766 Vredenburg 67 43.8 82 53.6 2 1.3 1 0.7 1 0.7 0 0 153 Vredendal 56 30.0 128 68.5 0 0 2 1.1 1 0.5 0 0 187 Wolseley 69 33.5 134 65.1 1 0.5 0 0 2 1.0 0 0 206 Worcester 224 34.5 408 62.9 3 0.5 9 1.4 5 0.8 0 0 649 Total 3 418 31.1 6 770 61.6 449 4.1 158 1.4 186 1.7 4 0.1 10 985
* During 2016 the Stellenbosch facility was closed, and all Swellendam cases were diverted to the Worcester forensic pathology facility.
40
Appendix Table 3. Trend in the number of accidental deaths by external cause, Western Cape 2010-2016
Accident causes 2010 2011 2012 2013 2014 2015 2016 Total Transport-related Motor vehicle 738 634 579 556 616 650 636 4 409 Cyclist 28 42 29 24 29 29 31 212 Motorcycle 60 64 80 68 73 64 62 471 Pedestrian 626 628 602 598 581 618 694 4 347 Other road traffic accidents 11 1 3 3 7 14 13 52 Railway 102 89 118 115 100 109 111 744 Aviation 2 10 0 5 3 13 3 36 Major accidental causes Overdose/poisoning 52 77 102 79 78 103 104 595 Falls 151 134 148 136 184 162 180 1 095 Fire 358 356 337 338 299 344 316 2 348 Drowning 193 225 219 202 200 195 214 1 448 Other accidental causes Animal-related Bee sting 3 0 2 1 1 3 1 11 Bitten/struck by mammal 0 0 1 1 1 1 1 5 Dog bite 6 2 1 1 2 0 4 16 Scorpion sting 1 0 0 0 0 1 0 2 Shark bite 0 1 0 0 0 1 0 2 Snake bite 0 3 1 0 1 2 4 11 Spider bite 0 1 0 0 0 0 0 1 Other causes Anaphylaxis (nuts, shellfish, unknown) 1 1 2 3 1 1 2 11
Asphyxia 8 18 16 20 18 17 21 118 Aspiration/choking 43 46 43 46 47 49 51 325 Exposure to elements 2 7 5 21 9 13 8 65 Explosion 1 5 1 4 2 2 3 18 Drug withdrawal 0 0 0 0 0 0 1 1 Electrocution 23 30 28 21 36 24 35 197 Hanging/strangulation 1 1 1 2 1 1 1 8 Hot liquid burns 4 1 5 6 3 5 6 30 Industrial 1 1 1 0 0 0 0 3 Jumping/diving into water 2 0 0 0 0 0 1 3 Lightning 0 0 0 1 1 4 1 7 Privation 1 1 1 0 0 1 1 5 Sharp object 7 3 7 4 3 6 5 35 Shot 3 4 1 4 3 3 1 19 Sport related 2 1 1 1 0 1 1 7 Struck/caught/pinned/crushed by object 16 27 35 20 23 20 24 165
Unspecified 30 25 32 21 22 15 17 162 Total 2 476 2 438 2 401 2 301 2 344 2 471 2 553 16 984
41
Appendix Table 4. Trend in the number of homicide deaths by external cause, Western Cape 2010 - 2016
Assault causes 2010 2011 2012 2013 2014 2015 2016 Total Sharp object 1 285 1 223 1 297 1 290 1 373 1 456 1 604 9 528 Assault w/incl firearm 545 637 790 983 1 307 1 349 1 250 6 861 Blunt force 358 373 314 433 421 427 433 2 759 Combination 42 49 83 93 106 106 96 575 Smother/strangle/asphyxia 51 48 44 71 50 52 53 369 Unspecified means 19 16 16 11 4 10 6 82 Fire 11 8 10 11 9 14 8 71 Neglect/abandonment 5 1 8 7 9 9 10 49 Bodily force 8 4 4 1 4 9 2 32 Drowning 2 4 1 1 3 4 2 17 Thrown from train 1 2 1 4 0 0 1 9 Assault poisoning 0 1 0 2 0 1 4 8 Sequelae following assault 0 1 0 1 2 1 3 8 Hanging 0 0 0 2 1 2 1 6 Pushed/thrown from height 0 2 0 1 1 1 0 5 Carbon monoxide poisoning 2 0 0 0 0 0 0 2 Assault by motor vehicle 0 0 0 1 0 0 1 2 Electrocution 0 1 0 0 0 0 0 1 Total 2 329 2 370 2 568 2 912 3 290 3 441 3 474 20 384
Appendix Table 5. Trend in the number of suicides by external cause, Western Cape 2010-2016
Suicide causes 2010 2011 2012 2013 2014 2015 2016 Total Hanging 354 360 428 414 400 407 440 2 803 Overdose/poisoning 155 136 147 144 126 138 135 981 Shot 72 77 85 70 52 71 75 502 Gassing (carbon monoxide) 20 23 25 18 16 16 14 132 Jump 17 21 12 13 18 7 13 101 Suicide by jumping in front of train 13 17 15 11 11 8 18 93 Sharp object 6 10 10 16 6 10 9 67 Fire 5 9 4 8 4 4 7 41 Drowning 2 1 3 3 4 6 2 21 Suicide by strangulation/suffocation 1 2 1 1 4 4 3 16 Unspecified means 2 1 5 1 0 0 0 9 Suicide as a pedestrian 2 1 1 0 2 2 0 8 Suicide by motor vehicle (driver) 0 0 0 1 1 1 2 5 Electrocution 1 2 0 0 0 0 0 3 Total 650 660 736 700 644 674 718 4 782
42
Appe
ndix
Tab
le 6
. Age
-spe
cific
deat
h ra
tes a
nd p
ropo
rtio
n of
inju
ry d
eath
s by m
ajor
caus
e in
child
ren
unde
r 5 ye
ars
Pers
ons 0
-4 y
ears
Se
lect
ed a
ccid
ent c
ause
s Ca
uses
20
10
2011
20
12
2013
20
14
2015
20
16
Ra
te
%
Rate
%
Ra
te
%
Rate
%
Ra
te
%
Rate
%
Ra
te
%
Accid
enta
l ove
rdos
e/po
isoni
ng
1.3
2.2
1.0
1.3
2.2
3.3
2.5
3.6
1.9
3.1
0.6
1.0
1.3
2.0
Accid
enta
l dro
wni
ng
6.5
10.6
9.
6 13
.0
7.9
11.6
10
.1
14.6
9.
7 16
.2
9.5
14.4
10
.5
16.8
Ac
ciden
tal f
alls
1.6
2.7
1.3
1.7
1.6
2.3
1.0
1.4
1.3
2.1
1.6
2.4
2.2
3.6
Accid
enta
l fire
12
.1
19.6
13
.5
18.2
10
.4
15.4
10
.5
15.0
10
.1
16.8
9.
8 14
.9
9.3
14.8
Tr
ansp
ort:
mot
or v
ehicl
e 6.
9 11
.1
8.0
10.8
7.
3 10
.7
4.1
5.9
4.4
7.3
6.3
9.6
5.1
8.2
Tran
spor
t: pe
dest
rian
14.7
23
.8
15.7
21
.2
11.7
17
.2
19.6
28
.2
10.4
17
.3
14.2
21
.6
12.8
20
.4
Accid
ent:
othe
r 10
.1
16.4
15
.7
21.2
14
.9
21.9
15
.5
22.3
10
.7
17.8
13
.0
19.7
14
.7
23.5
As
saul
t cau
ses
Caus
es
2010
20
11
2012
20
13
2014
20
15
2016
Rate
%
Ra
te
%
Rate
%
Ra
te
%
Rate
%
Ra
te
%
Rate
%
As
saul
t: st
rang
le/s
mot
her/
asph
yxia
1.
0 1.
6 1.
6 2.
2 0.
3 0.
5 0.
3 0.
5 2.
8 4.
7 1.
3 1.
9 1.
0 1.
5 As
saul
t: bl
unt f
orce
2.
6 4.
2 1.
9 2.
6 3.
2 4.
7 0.
6 0.
9 2.
2 3.
7 2.
5 3.
9 1.
6 2.
6 As
saul
t: co
mbi
natio
n 0.
0 0.
0 0.
0 0.
0 0.
3 0.
5 0.
3 0.
5 0.
3 0.
5 0.
3 0.
5 0.
3 0.
5 As
saul
t w/in
cl fir
earm
0.
0 0.
0 0.
6 0.
9 0.
6 0.
9 0.
3 0.
5 1.
9 3.
1 0.
6 1.
0 0.
6 1.
0 As
saul
t: sh
arp
obje
ct
0.7
1.1
1.0
1.3
3.2
4.7
0.6
0.9
1.3
2.1
0.6
1.0
0.3
0.5
Assa
ult:
othe
r 0.
7 1.
1 1.
6 2.
2 2.
5 3.
7 2.
9 4.
1 2.
5 4.
2 4.
4 6.
7 2.
6 4.
1 No
te: R
ate
= ag
e-sp
ecifi
c de
ath
rate
; % =
pro
port
ion
of to
tal u
nnat
ural
dea
ths f
or a
ge g
roup
. Acc
iden
tal c
ause
s exc
lude
d: a
viat
ion,
railw
ay, R
TA: c
yclis
t, RT
A: m
otor
cycle
, RTA
: oth
er (r
epre
sent
ing
~1%
per
yea
r)
43
Appe
ndix
Tab
le 7
. Age
-spe
cific
deat
h ra
tes a
nd p
ropo
rtio
n of
inju
ry d
eath
s by m
ajor
caus
e in
child
ren
5-9
year
s
Pers
ons 5
-9 y
ears
Se
lect
ed a
ccid
ent c
ause
s Ca
uses
20
10
2011
20
12
2013
20
14
2015
20
16
Ra
te
%
Rate
%
Ra
te
%
Rate
%
Ra
te
%
Rate
%
Ra
te
%
Accid
enta
l dro
wni
ng
4.1
22.2
4.
1 22
.0
4.1
20.8
3.
8 21
.1
3.9
18.7
2.
5 14
.6
5.7
26.1
Ac
ciden
tal f
ire
2.3
12.2
2.
5 13
.2
2.9
14.6
3.
0 16
.7
2.0
9.4
1.7
10.1
4.
0 18
.3
Tran
spor
t: m
otor
veh
icle
3.1
16.7
2.
7 14
.3
3.1
15.6
2.
0 11
.1
2.4
11.2
1.
7 10
.1
3.2
14.8
Tr
ansp
ort:
pede
stria
n 6.
6 35
.6
5.4
28.6
6.
9 35
.4
5.6
31.1
8.
6 41
.1
7.5
43.8
5.
9 27
.0
Accid
ent:
othe
r 1.
7 8.
9 1.
4 7.
7 1.
0 5.
2 1.
6 8.
9 1.
4 6.
5 1.
0 5.
6 1.
1 5.
2 As
saul
t cau
ses
Caus
es
2010
20
11
2012
20
13
2014
20
15
2016
Rate
%
Ra
te
%
Rate
%
Ra
te
%
Rate
%
Ra
te
%
Rate
%
As
saul
t: st
rang
le/s
mot
her/
asph
yxia
0.
0 0.
0 0.
4 2.
2 0.
6 3.
1 0.
4 2.
2 0.
0 0.
0 0.
0 0.
0 0.
0 0.
0 As
saul
t: bl
unt f
orce
0.
2 1.
1 0.
2 1.
1 0.
0 0.
0 0.
2 1.
1 0.
0 0.
0 0.
4 2.
3 0.
4 1.
7 As
saul
t: co
mbi
natio
n 0.
0 0.
0 0.
0 0.
0 0.
2 1.
0 0.
0 0.
0 0.
0 0.
0 0.
2 1.
1 0.
0 0.
0 As
saul
t w/in
cl fir
earm
0.
0 0.
0 0.
4 2.
2 0.
2 1.
0 0.
4 2.
2 0.
2 0.
9 0.
2 1.
1 0.
6 2.
6 As
saul
t: sh
arp
obje
ct
0.0
0.0
0.2
1.1
0.0
0.0
0.2
1.1
0.2
0.9
0.0
0.0
0.
0 0.
0 As
saul
t: ot
her
0.4
2.2
0.4
2.2
0.2
1.0
0.0
0.0
0.2
0.9
0.4
2.3
0.0
0.0
Suici
de ca
uses
Ca
uses
20
10
2011
20
12
2013
20
14
2015
20
16
Ra
te
%
Rate
%
Ra
te
%
Rate
%
Ra
te
%
Rate
%
Ra
te
%
Suici
de: o
verd
ose/
poiso
ning
0.
0 0.
0 0.
0 0.
0 0.
0 0.
0 0.
0 0.
0 0.
0 0.
0 0.
0 0.
0 0.
0 0.
0 Su
icide
: han
ging
0.
0 0.
0 0.
0 0.
0 0.
0 0.
0 0.
0 0.
0 0.
2 0.
9 0.
2 1.
1 0.
2 0.
87
Suici
de: f
irear
m
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
Suici
de: o
ther
0.
0 0.
0 0.
0 0.
0 0.
0 0.
0 0.
0 0.
0 0.
0 0.
0 0.
0 0.
0 0.
0 0.
0 No
te: R
ate
= ag
e-sp
ecifi
c de
ath
rate
; % =
pro
port
ion
of to
tal u
nnat
ural
dea
ths f
or a
ge g
roup
. Acc
iden
tal c
ause
s exc
lude
d: fa
lls, o
verd
ose/
poiso
ning
, avi
atio
n, ra
ilway
, RTA
: cyc
list,
RTA:
mot
orcy
cle, R
TA: o
ther
(ran
ging
2 –
9%
per
yea
r)
44
Appe
ndix
Tab
le 8
. Age
-spe
cific
deat
h ra
tes a
nd p
ropo
rtio
n of
inju
ry d
eath
s by m
ajor
caus
e in
child
ren
10-1
4 ye
ars
Pers
ons 1
0-14
yea
rs
Sele
cted
acc
iden
t cau
ses
Caus
es
2010
20
11
2012
20
13
2014
20
15
2016
Rate
%
Ra
te
%
Rate
%
Ra
te
%
Rate
%
Ra
te
%
Rate
%
Ac
ciden
tal d
row
ning
3.
2 15
.8
5.2
28.9
3.
0 19
.0
3.7
21.7
1.
8 11
.0
4.7
23.5
2.
7 14
.8
Accid
enta
l fire
1.
0 5.
0 1.
6 8.
9 1.
2 7.
6 1.
6 9.
6 0.
8 4.
9 1.
6 8.
2 2.
7 14
.8
Tran
spor
t: m
otor
veh
icle
4.4
21.8
1.
8 10
.0
3.2
20.3
1.
6 9.
6 1.
6 9.
8 2.
1 10
.2
2.0
11.4
Tr
ansp
ort:
pede
stria
n 4.
4 21
.8
3.2
17.8
3.
2 20
.3
2.2
13.3
4.
7 28
.1
3.3
16.3
3.
7 20
.5
Accid
ent:
othe
r 0.
8 4.
0 0.
6 3.
3 1.
2 7.
6 0.
8 4.
8 1.
0 6.
1 0.
8 4.
1 0.
6 3.
4 As
saul
t cau
ses
Caus
es
2010
20
11
2012
20
13
2014
20
15
2016
Rate
%
Ra
te
%
Rate
%
Ra
te
%
Rate
%
Ra
te
%
Rate
%
As
saul
t: st
rang
le/s
mot
her/
asph
yxia
0.
4 2.
0 0.
0 0.
0 0.
0 0.
0 0.
0 0.
0 0.
8 4.
9 0.
6 3.
1 0.
2 1.
1 As
saul
t: bl
unt f
orce
0.
4 2.
0 0.
6 3.
3 0.
0 0.
0 0.
4 2.
4 0.
2 1.
2 0.
4 2.
0 0.
2 1.
1 As
saul
t: co
mbi
natio
n 0.
2 1.
0 0.
0 0.
0 0.
2 1.
3 0.
0 0.
0 0.
6 3.
7 0.
0 0.
0 0.
0 0.
0 As
saul
t w/in
cl fir
earm
0.
8 4.
0 0.
6 3.
3 1.
0 6.
3 1.
0 6.
0 2.
1 12
.2
2.1
10.2
1.
8 10
.2
Assa
ult:
shar
p ob
ject
1.
6 7.
9 1.
8 10
.0
1.4
8.9
1.2
7.2
1.0
6.1
2.5
12.2
1.
4 8.
0 As
saul
t: ot
her
0.4
2.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
Suici
de ca
uses
Ca
uses
20
10
2011
20
12
2013
20
14
2015
20
16
Ra
te
%
Rate
%
Ra
te
%
Rate
%
Ra
te
%
Rate
%
Ra
te
%
Suici
de: o
verd
ose/
poiso
ning
0.
2 1.
0 0.
4 2.
2 0.
0 0.
0 0.
4 2.
4 0.
0 0.
0 0.
6 3.
1 0.
4 2.
3 Su
icide
: han
ging
0.
8 4.
0 1.
0 5.
6 0.
8 5.
1 1.
8 10
.8
1.2
7.3
1.2
6.1
1.0
5.7
Suici
de: f
irear
m
0.0
0.0
0.4
2.2
0.0
0.0
0.2
1.2
0.2
1.2
0.0
0.0
0.0
0.0
Suici
de: o
ther
0.
2 1.
0 0.
0 0.
0 0.
0 0.
0 0.
0 0.
0 0.
0 0.
0 0.
0 0.
0 0.
0 0.
0 No
te: R
ate
= ag
e-sp
ecifi
c de
ath
rate
; % =
pro
port
ion
of to
tal u
nnat
ural
dea
ths f
or a
ge g
roup
. Acc
iden
tal c
ause
s exc
lude
d: fa
lls, o
verd
ose/
poiso
ning
, avi
atio
n, ra
ilway
, RTA
: cyc
list,
RTA:
mot
orcy
cle, R
TA: o
ther
(ran
ging
1 –
9%
per
yea
r)
45
Appe
ndix
Tab
le 9
. Age
-spe
cific
deat
h ra
tes a
nd p
ropo
rtio
n of
inju
ry d
eath
s by m
ajor
caus
e in
child
ren
15-1
9 ye
ars.
Pers
ons 1
5-19
yea
rs
Sele
cted
acc
iden
t cau
ses
Caus
es
2010
20
11
2012
20
13
2014
20
15
2016
Rate
%
Ra
te
%
Rate
%
Ra
te
%
Rate
%
Ra
te
%
Rate
%
Ac
ciden
tal d
row
ning
2.
8 3.
4 3.
4 4.
4 4.
4 5.
1 3.
1 3.
3 3.
5 3.
5 2.
2 2.
2 2.
6 2.
7 Ac
ciden
tal f
ire
2.4
2.9
1.8
2.4
2.0
2.3
1.6
1.6
1.8
1.8
2.5
2.5
1.8
1.9
Railw
ay a
ccid
ent
2.8
3.4
1.6
2.1
0.8
0.9
2.2
2.3
1.2
1.1
1.2
1.2
1.2
1.3
Tran
spor
t: m
otor
veh
icle
9.0
11.2
7.
3 9.
7 6.
3 7.
4 3.
5 3.
7 5.
3 5.
3 5.
5 5.
5 7.
5 7.
9 Tr
ansp
ort:
pede
stria
n 3.
5 4.
4 5.
9 7.
8 5.
3 6.
2 5.
3 5.
5 4.
3 4.
3 4.
3 4.
3 5.
5 5.
8 Ac
ciden
t: ot
her
1.6
2.0
0.6
0.8
0.8
0.9
1.0
1.0
0.8
0.8
1.6
1.6
1.6
1.7
Assa
ult c
ause
s Ca
uses
20
10
2011
20
12
2013
20
14
2015
20
16
Ra
te
%
Rate
%
Ra
te
%
Rate
%
Ra
te
%
Rate
%
Ra
te
%
Assa
ult:
stra
ngle
/sm
othe
r/as
phyx
ia
0.8
1.0
0.2
0.3
0.2
0.2
1.0
1.0
0.6
0.6
0.4
0.4
1.4
1.5
Assa
ult:
blun
t for
ce
6.5
8.1
6.9
9.1
5.3
6.2
8.3
8.6
7.0
7.0
7.4
7.4
6.3
6.7
Assa
ult:
com
bina
tion
0.4
0.5
1.0
1.3
2.4
2.8
3.3
3.5
2.0
2.0
2.2
2.2
2.2
2.3
Assa
ult w
/incl
firea
rm
12.4
15
.4
9.9
13
.1
13.2
15
.5
19.5
20
.3
29.7
29
.6
27.4
27
.3
21.9
23
.1
Assa
ult:
shar
p ob
ject
25
.8
32.0
24
.5
32.4
32
.2
37.6
34
.6
36.0
33
.1
32.9
31
.7
31.6
31
.3
33.1
As
saul
t: ot
her
1.4
1.7
0.4
0.5
0.8
0.9
0.4
0.4
0.4
0.4
0.2
0.2
0.0
0.0
Suici
de ca
uses
Ca
uses
20
10
2011
20
12
2013
20
14
2015
20
16
Ra
te
%
Rate
%
Ra
te
%
Rate
%
Ra
te
%
Rate
%
Ra
te
%
Suici
de: o
verd
ose/
poiso
ning
2.
4 2.
9 3.
4 5.
2 2.
8 3.
2 2.
8 2.
9 1.
4 1.
4 3.
1 3.
1 3.
0 3.
1 Su
icide
: han
ging
6.
1 7.
6 4.
2 5.
5 6.
3 7.
4 5.
3 5.
5 4.
7 4.
7 7.
2 7.
2 4.
5 4.
8 Su
icide
: fire
arm
0.
6 0.
7 0.
4 0.
5 0.
4 0.
5 1.
4 1.
4 0.
2 0.
2 0.
4 0.
4 0.
0 0.
0 Su
icide
: oth
er
0.4
0.5
0.4
0.5
0.2
0.2
0.8
0.8
0.8
0.8
0.0
0.0
0.4
0.4
Note
: Rat
e =
age-
spec
ific
deat
h ra
te; %
= p
ropo
rtio
n of
tota
l unn
atur
al d
eath
s for
age
gro
up. A
ccid
enta
l cau
ses e
xclu
ded:
falls
, ove
rdos
e/po
isoni
ng, a
viat
ion,
railw
ay, R
TA: c
yclis
t, RT
A: m
otor
cycle
, RTA
: oth
er (r
angi
ng 2
– 4
% p
er y
ear)
46
11.2 District injury mortality profiles, 2016 District and sub-district ranking of leading cause-specific age-standardised injury mortality rates (deaths per 100 000).
1. Western Cape and districts
Rank
Cape Winelands Central Karoo Cape Metro Eden Overberg West Coast Western Cape
1 Assault: sharp object (23.0)
Transport: motor vehicle
(68.9)
Assault w/incl firearm (27.7)
Assault: sharp object
(22.3)
Assault: sharp object (26.7)
Assault: sharp object (17.4)
Assault: sharp object (23.8)
2 Transport:
motor vehicle (17.7)
Assault: sharp object (31.3)
Assault: sharp object (24.7)
Suicide (16.5)
Transport: motor vehicle
(16.4)
Transport: motor vehicle
(13.6)
Assault w/incl firearm (18.5)
3 Transport: pedestrian
(13.7)
Transport: pedestrian
(16.1)
Transport: pedestrian
(11.1)
Transport: motor vehicle (10.4)
Transport: pedestrian
(11.2)
Accident: drowning (9.5)
Transport: pedestrian
(11.2)
4 Suicide (10.4) Suicide (15.2) Suicide (10.5) Transport: pedestrian
(7.6) Suicide (11.0) Suicide (8.3) Suicide (10.9)
5 Assault: blunt force (4.9)
Assault: blunt force (6.6)
Assault: blunt force (7.6)
Assault: blunt force
(5.7)
Accident: drowning (7.6)
Transport: pedestrian
(7.1)
Transport: motor vehicle
(10.2)
6 Accident: drowning
(4.6)
Accident: drowning (5.3)
Transport: motor vehicle
(6.5)
Accident: fire (4.7)
Accident: fire (5.7)
Assault: blunt force (4.0)
Assault: blunt force (6.6)
7 Assault w/incl firearm (3.9)
Accident: unspecified
(4.6)
Accident: fire (5.7)
Accident: drowning
(4.1)
Assault: blunt force (3.4)
Accident: fire (2.0)
Accident: fire (5.3)
8 Accident: fire (3.5)
Assault: combination
(4.4)
Accident: falls (4.5)
Accident: falls (2.7)
Assault w/incl firearm (3.1)
Accident: overdose/pois
oning (1.6)
Accident: drowning (3.8)
9 Accident: falls (2.2)
Assault w/incl firearm (2.7)
Railway accident (2.3)
Accident: overdose/poisoning (2.4)
Transport: motorcycle
(1.0)
Assault w/incl firearm (1.5)
Accident: falls (3.8)
10 Accident:
overdose/poisoning (1.5)
Assault: bodily force (1.6)
Assault: combination
(2.1)
Assault w/incl
firearm (1.9)
Accident: crushed (0.8)
Accident: falls (1.2)
Railway accident (1.7)
47
2. Cape Winelands
Rank
Witzenberg Drakenstein Stellenbosch Breede Valley Langeberg Cape Winelands
1 Assault: sharp object (23.8)
Assault: sharp object (22.1)
Assault: sharp object (20.3)
Transport: motor vehicle
(31.0)
Assault: sharp object (26.3)
Assault: sharp object (23.0)
2 Transport: motor vehicle (19.5)
Transport: pedestrian (12.3)
Transport: motor vehicle
(13.8)
Assault: sharp object (25.2)
Transport: motor vehicle
(20.9)
Transport: motor vehicle
(17.7)
3 Accident: drowning (8.1)
Transport: motor vehicle (9.7) Suicide (11.0)
Transport: pedestrian
(23.9)
Transport: pedestrian
(15.1)
Transport: pedestrian
(13.7)
4 Suicide (7.1) Suicide (8.1) Transport: pedestrian
(9.6) Suicide (15.2) Suicide (12.2) Suicide (10.4)
5 Transport: pedestrian (7.1)
Assault w/incl firearm (7.0)
Assault: blunt force (5.2)
Assault: blunt force (6.1)
Accident: drowning (3.9)
Assault: blunt force (4.9)
6 Assault: blunt force (4.5)
Accident: drowning (5.6)
Accident: fire (4.3)
Accident: fire (5.1)
Assault w/incl firearm (2.6)
Accident: drowning (4.6)
7 Accident:
overdose/poisoning (3.7)
Assault: blunt force (5.5)
Assault w/incl firearm (2.2)
Accident: falls (3.6)
Assault: blunt force (2.3)
Assault w/incl firearm (3.9)
8 Assault w/incl firearm (2.6)
Accident: falls (3.6)
Transport: motorcycle
(2.2)
Accident: drowning (3.6)
Transport: motorcycle
(1.9)
Accident: fire (3.5)
9 Accident: fire (2.3)
Accident: fire (3.1)
Railway accident (1.9)
Assault w/incl firearm (2.7)
Accident: fire (1.8)
Accident: falls (2.2)
10 Railway accident (1.4)
Assault: strangle/smother
/asphyxia (2.3)
Accident: unspecified
asphyxia (1.9)
Accident: overdose/pois
oning (1.5)
Accident: sharp object
(1.6)
Accident: overdose/pois
oning (1.5)
48
3. Central Karoo
Rank
Laingsburg Prince Albert Beaufort West Central Karoo
1 Transport: motor vehicle (136.7)
Transport: motor vehicle (52.1)
Transport: motor vehicle (60.2)
Transport: motor vehicle (68.9)
2 Suicide (32.9) Suicide (21.6) Assault: sharp object (38.5)
Assault: sharp object (31.3)
3 Accident: unspecified (21.7)
Accident: drowning (20.4)
Transport: pedestrian (15.9)
Transport: pedestrian (16.1)
4 Transport: pedestrian (20.2)
Assault: sharp object (19.6) Suicide (10.1) Suicide (15.2)
5 Assault: blunt force (11.1)
Transport: pedestrian (14.3) Assault: blunt force (8.0) Assault: blunt force
(6.6)
6 Assault: sharp object (11.1)
Assault: bodily force (8.9) Assault: combination (6.6) Accident: drowning
(5.3)
7
Accident: electrocution (7.7)
Assault w/incl firearm (2.4)
Accident: unspecified (4.6)
8
Accident: drowning (2.4) Assault: combination (4.4)
9 Accident: fire (2.4) Assault w/incl firearm (2.7)
10
Accident: overdose/poisoning (2.4)
Assault: bodily force (1.6)
49
4.
Cap
e M
etro
Rank
East
ern
Khay
elits
ha
Klip
font
ein
Mitc
hells
Pla
in
Nort
hern
So
uthe
rn
Tyge
rber
g W
este
rn
Cape
Met
ro
1 As
saul
t: sh
arp
obje
ct (2
1.9)
As
saul
t: sh
arp
obje
ct (3
7.2)
As
saul
t w/in
cl fir
earm
62.
2)
Assa
ult w
/incl
firea
rm (2
6.1)
As
saul
t: sh
arp
obje
ct (2
2.3)
As
saul
t w/in
cl fir
earm
(15.
0)
Assa
ult w
/incl
firea
rm (4
5.0)
As
saul
t: sh
arp
obje
ct (2
2.0)
As
saul
t w/in
cl fir
earm
(27.
7)
2 As
saul
t w/in
cl fir
earm
(15.
0)
Assa
ult w
/incl
firea
rm (2
7.8)
As
saul
t: sh
arp
obje
ct (4
6.8)
As
saul
t: sh
arp
obje
ct (1
9.0)
As
saul
t w/in
cl fir
earm
(16.
2)
Suici
de (8
.9)
Assa
ult:
shar
p ob
ject
(28.
1)
Assa
ult w
/incl
firea
rm (2
1.7)
As
saul
t: sh
arp
obje
ct (2
4.7)
3 Su
icide
(9.3
) Tr
ansp
ort:
pede
stria
n (1
2.8)
Tran
spor
t: pe
dest
rian
(15.
7)
Suici
de (8
.5)
Tran
spor
t: pe
dest
rian
(12.
1)
Assa
ult:
shar
p ob
ject
(8.8
)
Tran
spor
t: pe
dest
rian
(16.
0)
Tran
spor
t: pe
dest
rian
(16.
5)
Tran
spor
t: pe
dest
rian
(11.
1)
4 Tr
ansp
ort:
pede
stria
n (7
.8)
Assa
ult:
blun
t fo
rce
(9.3
) Su
icide
(13.
7)
Tran
spor
t: pe
dest
rian
(7.4
) Su
icide
(11.
6)
Tran
spor
t: pe
dest
rian
(4.9
) As
saul
t: bl
unt
forc
e (1
2.1)
Su
icide
(15.
5)
Suici
de (1
0.5)
5 Tr
ansp
ort:
mot
or v
ehicl
e (5
.4)
Suici
de (6
.7)
Assa
ult:
blun
t fo
rce
(12.
4)
Accid
ent:
fire
(5.4
)
Tran
spor
t: m
otor
veh
icle
(9.4
)
Accid
ent:
falls
(4
.9)
Tran
spor
t: m
otor
veh
icle
(10.
7)
Assa
ult:
blun
t fo
rce
(12.
8)
Assa
ult:
blun
t fo
rce
(7.6
)
6 As
saul
t: bl
unt
forc
e (4
.8)
Tran
spor
t: m
otor
veh
icle
(6.0
)
Accid
ent:
fire
(8.1
) As
saul
t: bl
unt
forc
e (3
.5)
Accid
ent:
fire
(8.1
)
Tran
spor
t: m
otor
veh
icle
(4.0
) Su
icide
(10.
6)
Tran
spor
t: m
otor
veh
icle
(10.
7)
Tran
spor
t: m
otor
veh
icle
(6.5
)
7 Ac
ciden
t: dr
owni
ng (3
.6)
Accid
ent:
fire
(5.9
)
Assa
ult:
com
bina
tion
(7.7
)
Tran
spor
t: m
otor
ve
hicle
(2.5
) As
saul
t: bl
unt
forc
e (5
.0)
Accid
ent:
fire
(2.6
) Ac
ciden
t: fir
e (1
0.6)
Ac
ciden
t: fa
lls
(9.7
) Ac
ciden
t: fir
e (5
.7)
8 Ac
ciden
t: fa
lls
(3.4
) Ac
ciden
t: dr
owni
ng (3
.2)
Tran
spor
t: m
otor
veh
icle
(4.6
)
Assa
ult:
com
bina
tion
(1.9
) Ac
ciden
t: fa
lls
(3.6
) Ac
ciden
t: dr
owni
ng (2
.2)
Accid
ent:
falls
(6
.5)
Accid
ent:
drow
ning
(3.6
) Ac
ciden
t: fa
lls
(4.5
)
9 Ac
ciden
t: fir
e (3
.0)
Railw
ay
accid
ent (
3.0)
Ra
ilway
ac
ciden
t (4.
3)
Assa
ult:
smot
her/
stra
ngle
/sm
othe
r/as
phyx
ia
(1.7
)
Accid
ent:
drow
ning
(3.0
)
Accid
ent:
over
dose
/poi
soni
ng (2
.1)
Railw
ay
accid
ent (
3.3)
Ac
ciden
t: fir
e (3
.5)
Railw
ay
accid
ent (
2.3)
10
Railw
ay
accid
ent (
1.9)
Assa
ult:
com
bina
tion
(2.6
)
Accid
ent:
over
dose
/poi
soni
ng (2
.3)
Accid
ent:
drow
ning
(1.0
)
Tran
spor
t: m
otor
cycle
(2
.2)
Railw
ay
accid
ent (
1.5)
Accid
ent:
over
dose
/poi
son
ing
(2.3
)
Railw
ay
accid
ent (
3.0)
Assa
ult:
com
bina
tion
(2.1
)
50
5.
Eden
Rank
Kann
alan
d He
sseq
ua
Mos
sel B
ay
Geor
ge
Oudt
shoo
rn
Bito
u Kn
ysna
Ed
en
1 As
saul
t: sh
arp
obje
ct (1
3.1)
Tran
spor
t: m
otor
veh
icle
(30.
3)
Assa
ult:
shar
p ob
ject
(30.
8)
Assa
ult:
shar
p ob
ject
(26.
7)
Assa
ult:
shar
p ob
ject
(15.
9)
Assa
ult:
shar
p ob
ject
(16.
3)
Assa
ult:
shar
p ob
ject
(25.
3)
Assa
ult:
shar
p ob
ject
(22.
3)
2 Tr
ansp
ort:
mot
or
vehi
cle (1
0.6)
Su
icide
(10.
9)
Suici
de (2
0.5)
Su
icide
(21.
5)
Suici
de (8
.6)
Tran
spor
t: pe
dest
rian
(9.6
) Su
icide
(22.
6)
Suici
de (1
6.5)
3 As
saul
t: bl
unt f
orce
(7
.8)
Assa
ult:
blun
t fo
rce
(9.7
) Tr
ansp
ort:
mot
or
vehi
cle (6
.7)
Tran
spor
t: m
otor
ve
hicle
(12.
0)
Tran
spor
t: m
otor
ve
hicle
(7.4
) Ac
ciden
t: fir
e (4
.9)
Accid
ent:
fire
(12.
1)
Tran
spor
t: m
otor
ve
hicle
(10.
4)
4 Su
icide
(4.6
) As
saul
t: sh
arp
obje
ct (8
.5)
Tran
spor
t: pe
dest
rian
(6.3
) As
saul
t: bl
unt
forc
e (8
.9)
Accid
ent:
over
dose
/poi
soni
ng (6
.9)
Suici
de (4
.8)
Tran
spor
t: pe
dest
rian
(12.
0)
Tran
spor
t: pe
dest
rian
(7.6
)
5 Ac
ciden
t: un
spec
ified
as
phyx
ia (4
.1)
Tran
spor
t: pe
dest
rian
(5.6
) Ac
ciden
t: dr
owni
ng (5
.3)
Tran
spor
t: pe
dest
rian
(7.7
) Tr
ansp
ort:
pede
stria
n (6
.8)
Assa
ult w
/incl
firea
rm (2
.7)
Tran
spor
t: m
otor
ve
hicle
(6.8
) As
saul
t: bl
unt
forc
e (5
.7)
6 Tr
ansp
ort:
mot
orcy
cle (3
.5)
Accid
ent:
drow
ning
(3.7
) As
saul
t: bl
unt
forc
e (3
.7)
Accid
ent:
fire
(5.4
) As
saul
t: bl
unt
forc
e (4
.3)
Tran
spor
t: m
otor
ve
hicle
(2.2
) As
saul
t w/in
cl fir
earm
(4.9
) Ac
ciden
t: fir
e (4
.7)
7 Ac
ciden
t: ov
erdo
se/p
oiso
ning
(3
.5)
Tran
spor
t: cy
clist
(3.4
) Ac
ciden
t: fir
e (3
.6)
Accid
ent:
drow
ning
(5.4
) Ac
ciden
t: dr
owni
ng (2
.9)
Accid
ent:
falls
(1
.9)
Accid
ent:
drow
ning
(3.9
) Ac
ciden
t: dr
owni
ng (4
.1)
8
Assa
ult w
/incl
firea
rm (1
.9)
Accid
ent:
falls
(3
.4)
Accid
ent:
falls
(4
.0)
Accid
ent:
falls
(2
.4)
Accid
ent:
aspi
ratio
n/ch
okin
g on
food
(1.6
)
Accid
ent:
over
dose
/poi
soni
ng (3
.4)
Accid
ent:
falls
(2
.7)
9 Ac
ciden
t: un
spec
ified
(1
.6)
Accid
ent:
elec
troc
utio
n (3
.4)
Assa
ult:
stra
ngle
/sm
othe
r/a
sphy
xia (1
.9)
Accid
ent:
aspi
ratio
n/ch
okin
g on
food
(2.1
)
Accid
ent:
drow
ning
(1.5
) Tr
ansp
ort:
cycli
st
(3.0
)
Accid
ent:
over
dose
/poi
son
ing
(2.4
)
10
Accid
ent:
falls
(1
.3)
Unna
tura
l un
dete
rmin
ed
(2.3
)
Assa
ult w
/incl
firea
rm (1
.9)
Tran
spor
t: cy
clist
(1
.7)
As
saul
t: st
rang
le/s
mot
her
/asp
hyxia
(2.7
)
Assa
ult w
/incl
firea
rm (1
.9)
51
6. Overberg
Rank
Theewaterskloof Overstrand Cape Agulhas Swellendam Overberg
1 Assault: sharp object (35.8)
Assault: sharp object (17.2)
Transport: motor vehicle (23.7)
Assault: sharp object (26.1)
Assault: sharp object (26.7)
2 Transport: motor vehicle (20.3) Suicide (12.2) Assault: sharp object
(22.1) Transport: motor
vehicle (25.1) Transport: motor
vehicle (16.4)
3 Transport: pedestrian (18.5)
Accident: drowning (11.1)
Accident: drowning (9.4) Accident: fire (16.3) Transport: pedestrian
(11.2)
4 Suicide (12.5) Assault w/incl firearm (8.3)
Transport: pedestrian (6.5)
Transport: pedestrian (13.4) Suicide (11.0)
5 Accident: fire (6.3) Transport: motor vehicle (4.9)
Accident: positional asphyxia (3.5) Suicide (8.1) Accident: drowning
(7.6)
6 Assault: blunt force (5.6) Transport: pedestrian (3.5)
Assault: blunt force (2.8)
Accident: drowning (8.0) Accident: fire (5.7)
7 Accident: drowning (4.1) Accident: crushed (2.1) Suicide (2.5) Assault: blunt force (5.6)
Assault: blunt force (3.4)
8 Accident: overdose/poisoning (1.9) Accident: fire (1.7) Transport:
motorcycle (2.4) Accident: unknown
anaphylaxis (2.8) Assault w/incl firearm
(3.1)
9 Transport: motorcycle (1.6)
Accident: electrocution (1.2) Accident: fire (2.3) Assault: combination
(2.6) Transport: motorcycle
(1.0)
10 Accident: unspecified (1.6) Accident: falls (1.2) Accident: crushed (0.8)
52
7. West Coast
Rank
Matzikama Cederberg Bergrivier Saldanha Bay Swartland West Coast
1 Assault: sharp object (26.7)
Accident: drowning (26.9)
Assault: sharp object (16.1)
Assault: sharp object (21.6)
Transport: motor vehicle (15.5)
Assault: sharp object (17.4)
2 Transport:
motor vehicle (12.0)
Assault: sharp object (24.9)
Transport: motor vehicle
(11.2)
Transport: motor vehicle
(16.4)
Accident: drowning (8.6)
Transport: motor vehicle (13.6)
3 Accident: drowning
(11.2)
Transport: pedestrian
(15.7) Suicide (9.4) Suicide (11.5) Transport:
pedestrian (8.0) Accident:
drowning (9.5)
4 Transport: pedestrian
(8.3)
Transport: motor vehicle
(9.9)
Transport: pedestrian (9.1)
Accident: drowning (4.5)
Assault: sharp object (6.5) Suicide (8.3)
5 Suicide (6.8) Assault: blunt force (9.0)
Accident: drowning (4.4)
Assault: blunt force (1.7) Suicide (6.0) Transport:
pedestrian (7.1)
6 Assault: blunt force (6.6) Suicide (7.8) Assault: blunt
force (4.2)
Assault: strangle/smoth
er/asphyxia (1.7)
Accident: fire (3.9)
Assault: blunt force (4.0)
7 Accident: fire (2.8)
Accident: overdose/poiso
ning (7.2)
Aviation accident (1.6)
Accident: unspecified
aspiration/choking (1.1)
Assault: blunt force (2.3)
Accident: fire (2.0)
8 Accident: falls (2.7)
Assault w/incl firearm (6.9)
Accident: unspecified
(1.5)
Assault w/incl firearm (0.9)
Assault: strangle/smother
/asphyxia (1.7)
Accident: overdose/poisoni
ng (1.6)
9 Transport: cyclist (1.4)
Transport: tractor (4.3)
Assault w/incl firearm (1.4)
Accident: crushed (0.8)
Accident: overdose/poisoni
ng (1.6)
Assault w/incl firearm (1.5)
10 Accident: crushed (1.3)
Accident: falls (3.7)
Accident: crushed (1.4)
Transport: motorcycle
(0.7)
Accident: crushed (0.8)
Accident: falls (1.2)
53
11.3 Definitions Term Definition Death rates Age-specific death rate This is the crude death rate for a specific age group. It is expressed as the
number of deaths per 100 000 age group population. Age-standardised death rate The age-standardised death rate is a weighted mean of the age-specific
death rates using a standard population and expressed per 100 000 population.
Causes and circumstances of death Manner of death The manner of death is informed by the circumstances of death i.e. how
the death occurred. Class of death The class of death categorises the manner of death. Natural death This is a both a class and manner of death. An individual who died due
to natural causes, under no suspicious circumstances. Injury death Deaths due to injuries are a class of death due to unnatural causes Foetal death Foetuses presenting to FPS that were either still born, non-viable, or
undetermined cause of death. Undetermined death These are deaths that could not be classes as either natural, non-natural
or foetal deaths. Non-human remains Unknown remains discovered by members of the public and determined
by pathologists to be of non-human origin. Assault A manner of death whereby an individual is (intentionally) responsible
for the death of another. Also referred to as homicide. Suicide A manner of death whereby an individual intentionally and voluntarily
kills him-/herself. Accident A manner of death whereby an individual dies unintentionally. Section 56 This is a procedure-related death, so named for section 56 of the Health
Professions Act of 1974. Procedure-related deaths occur most often postoperatively, but could be following any medically-indicated procedure.
External cause of death Where the underlying cause of death is due to something external to the body e.g. cause of death might be due to exsanguination but preceded by multiple stab wounds with a sharp object. The external causes of death are coded to chapters V – Y ICD-10 codes.
Major causes of death, by manner Assault/Homicide Assault: smother/strangle/asphyxia
Homicides due to the following: Strangulation: assault by compression of neck with or without mention of ligature Smothering: assault by mechanical obstruction of airways Asphyxiation: asphyxia following assault of unspecified means
Assault: blunt force Death due to assault with a blunt object or unspecified blunt force. Assault: combination Death due to assault by a combination of specified means Assault with/including firearm Homicides due to the following:
Shot: assault with a gun or unspecified firearm Combination with firearm: assault by specified means, including a firearm.
Assault: sharp object Death due to assault with a sharp object.
54
Assault: other These include homicides due to all other assault causes, not mentioned above, including but not limited to: bodily force, drowning, electrocution, fire, poisoning and thrown from a train.
Suicide Suicide: overdose/poisoning Self-inflicted deaths due to specified and unspecified means of overdose
or poisoning including (but not limited to): carbon monoxide, alcohol, narcotics, prescribed and/or over-the-counter drugs, bleach, brake fluid and pesticides.
Suicide: hanging Self-inflicted death by hanging. Suicide: firearm Self-inflicted death using a firearm. Suicide: other Self-inflicted deaths due to all other forms of suicide, not mentioned
above, including but not limited to: drowning, electrocution, fire, sharp object (cutting/stab) and unspecified means.
Accident Accidental overdose/poisoning Unintentional deaths due to specified and unspecified means of
overdose or poisoning, including but not limited to: alcohol, traditional medicine, prescribed medication, toxic mushrooms and pesticides.
Aviation accident Unintentional deaths following accidents involving helicopters, light aircrafts, microlights or paragliders.
Accident drowning Unintentional death following drowning in the sea, river, lake, dam, bath, canal, swimming pool or unspecified body of water.
Accidental falls Unintentional death following a fall from height, mountain, stairs, building, donkey cart, slipping, tripping or unspecified falls.
Accidental fire Unintentional death following burns and/or smoke inhalation resulting from a fire.
Railway accident Unintentional death of either a pedestrian accidentally hit by a train, or a passenger accidentally falling out of a train.
Transport: cyclist Unintentional death of a cyclist accidentally hit by a motor vehicle, or other specified or unspecified transport e.g. truck
Transport: motor vehicle Unintentional death following a motor vehicle related road traffic accident of a driver, passenger or unspecified motor vehicle occupant as well as road traffic accidents resulting in a submerged motor vehicle whereby the occupant drowns, an occupant sustaining burns following spontaneous motor vehicle combustion, motor vehicle collision with a train or death as a consequence of injuries sustained in a road traffic accident that occurred more than a year prior death.
Transport: motorcycle Unintentional death of a motorcycle driver or passenger following a road traffic accident.
Transport: pedestrian Unintentional death of a pedestrian accidentally hit by a motor vehicle or other or unspecified means of transport e.g. heavy transport vehicle or truck.
Transport: other Unintentional death of either a pedestrian accidentally hit by a tractor or tractor occupant falling from or crashing a tractor.
Accident: other Unintentional deaths from all other forms of accidents not mentioned above, including but not limited to the following: Anaphylaxis, asphyxiation, aspiration, dog bites, bee stings, electrocution, gas tank explosion, exposure to the elements, firearm and sports related accidents.
To obtain additional information and/or copies of this document, please contact:
Western Cape Government Health P.O. Box 2060,
Cape Town,
8000
Website: www.westerncape.gov.za
ISBN: 978-0-621-46710-9
Title of Publications: Western Cape Injury Mortality Profile 2010-2016
This publication is also available for download, go to http://www.westerncape.gov.za/health
