# Presentation: 515404

## An overview of fatal injury surveillance in South Africa

**Richard Matzopoulos **
**CRIME, VIOLENCE AND INJURY LEAD PROGRAMME**
- Medical Research Council
- University of South Africa Institute for Social and Health Sciences
- Centre for Peace Action

**An overview of fatal injury surveillance in South Africa**
**Cuernavaca, Mexico, 1-2 June 2005**

**Notes:**
Good afternoon, ladies and gentlemen. This afternoon I will be presenting a summary of the 
results from the National Injury Mortality Surveillance System for 2000. The work is 
currently being co-ordinated by the Crime, Violence and Injury Lead Programme, which  is 
co-directed by the MRC and UNISA. But we would also like to acknowledge the work of our 
other research partners, the CSIR, the World Health Organisation and the Centers for Disease 
Control, who were involved in the set-up phase along with our funders the Department of 
Arts, Culture, Science and Technology and the Department of Health.

The results I will be presenting are available in summary form in the attached press hand-out
and are also displayed on one of the posters near the restaurant. The full technical report 
describing  the results in more detail is available from the Crime, Violence and Injury 
secretariat for R50 per copy.

## National Injury Mortality Surveillance System (NIMSS) 

**strengths and weaknesses **
**strategic challenges **
**future plans for the NIMSS**

## history

-  1993 –1995 Cape Town
-  1998 – 2 years of DACST funding
-  national pilot – Gauteng, Durban, CT
- 1999 – 1st annual report – Kimberley, PE, EL
-  10 mortuaries, 5 provinces
-  2000 – 2nd report – Gauteng, PE
-  15 mortuaries, 5 provinces
-  2001 – 3rd report – Durban, EL, Mpumalanga
-  32 mortuaries, 6 provinces

**Notes:**
The foundations for the system were established at Salt River mortuary in 1993, when I completed a research project based on data extracted from Salt River and Tygerberg mortuaries under the supervision of Dr Len Lerer - a student of Prof Knobel, who is still the head of the Salt River mortuary. Another two reports were published by a group called the Non-natural Mortality Study Group for 1994 and 1995 and a paper was published in the SAMJ. 

In 1998 we established a consortium comprising the MRC, the UNISA ISHS and the CSIR, with support from the NDoH, the US CDC and applied for funding from the Dept o ACST through their innovation fund. We conducted a pilot study .....................

Now its interesting to note that at the same time that the foundations for the NIMSS were being established government was changing the requirements for death registration and since 1991 information on the external cause of death was no longer available in the death register for injury cases. Even before 1991 , the cause of death information for injury deaths was notoriously inaccurate with a large proportion assigned to undetermined causes. We’ll talk about undetermined injury deaths in a little more detail later on, but the important thing to note is that collecting cause of death information via forensic pathologists who are encouraged to express an opinion as to the cause of death for the purposes of research rather than a legally binding medical opinion on the death certificate is one way of ensuring that we get the most accurate assessment of cause of death and also minimise the number of deaths that are recorded as due to undetermined causes. In short the NIMSS provides the most detailed and we believe the most accurate figures for non-natural deaths in South Africa.

## Coverage

**Non-natural mortality **
- 	68 930 (MRC Burden of Disease, 2000)
- 	12 to 15 %of all mortality
**NIMSS **
- 	24 600 / 68930 = 36%
**	**Rural: 5-6%, Urban: 55-64%

**Notes:**
We collected a total of 25 361 cases in 2001. Now considering that there are estimated to be 
just over half a million deaths from all causes of mortality in South Africa every year, and 
that non-natural mortality is estimated to account for between 69 and 80 000 deaths, or 12 to
15 percent of mortality from all causes, we estimate that the by NIMSS data accounted for 
between  32 and 39 percent of all deaths due to non-natural causes. 

## Coverage

- Metros - Johannesburg, Durban, Cape Town, Pretoria, Port Elizabeth, Erkhuruleni
- Cities – East London/KWT/Bisho, Kimberley
- Rural towns
- Mpumalanga, Stellenbosch, Potchefstroom, Kroonstad, Nelspruit
- 7 out of 9 provinces represented
- Warehoused at MRC
- Report- generating software

**Coverage**

## External cause

**External cause**
- Firearm
- Sharp force
- Hanging
- Drowning

**Demographics**
- Age
- Population group
- Sex

**Event**
- Place
- Blood alcohol

**Forensic**
**info**

## External cause of death (N = 22 248) 

## External cause of death among males (N = 17 932) 

## External cause of death among females (N = 4076) 

## Overall apparent manner of 

**death (*****N***** = 22 248)**

- Source: National Injury Mortality Surveillance System, 2003

## Fatal injury rates / 100 000  population 

**Notes:**
So to bring things back to a Cape Town perspective again, how do we compare to the rest of the country. Well we can see that PE had the highest percentage of intoxicated cases for all categories of non-natural death, except for suicide where Cape Town was marginally higher. But it is no comfort to see that Cape Town was not far behind and had a much higher rate of alcohol intoxication than either Johannesburg and Durban. Clearly another important issue for law enforcement in this city.

## Transport User by BAC (n=2953)

**Transport User by BAC, NIMSS, 2003 **

## National Injury Mortality Surveillance System (NIMSS) 

**strengths and weaknesses**** **
**strategic challenges **
**future plans for the NIMSS**

## strengths and weaknesses

-  Detailed info on *who*, *what*, *when*, *where*
-  Mortuary catchment and population data questionable* *
- 	 	 (minimised by city coverage)
-  No *gold std* for apparent manner of death
-  Resource for specialised studies
- Mainly urban - complete datasets for major cities
- Rural sites difficult to establish and maintain
-   Representivity  Comparability (correlates with ICD coding)
- Sustainability
- 	  Standardised (manuals, procedures, storage, reporting)
- 	  Cost < $80 000 p.a. (incl staff, reports, media, etc)
- 	  widely used / generates considerable publicity
- 				– protective factors

**strengths and weaknesses**

## National Injury Mortality Surveillance System (NIMSS) 

**strengths and weaknesses **
**strategic challenges **
**future plans for the NIMSS**

## strategic challenges

- StatsSA – national (90%), 16+ yrs, no manner / external CoD
- police – national, underreporting, criminal justice, form-based
- transport – national, reliant on police, detailed info, substantial underreporting
- Sensationalism vs rationalism
- Media focus on high rates and not public health utility
- DoH and other govt depts feel threatened
- Sustainability
- Limited funding prevents expansion
- Relocation of mortuaries from police to health (turf ?)
- Data to action
- 3 tiers of government
- City focus for 2010 world cup

**strategic challenges**

## National Injury Mortality Surveillance System (NIMSS) 

**strengths and weaknesses **
**strategic challenges **
**future plans for the NIMSS**

## Focus on cities

- accessible
- responsive
- well established and centralised documentation of strategies and challenges
- coordinated information systems
- amenable to personal and consultative interaction
- 2003 annual report initial commitment to city focus
- National injury profile
- City specific rates (Jhb, Durb, CT, Pret)
- Separate city-reports (chapters 3-6)
- transfer to DoH?

**Focus on cities**

## Proposed future location of NIMSS

**Proposed future location of NIMSS**

## Thank You

**Notes:**
In  finishing off, I would like to thank the staff of all the mortuaries and forensic 
laboratories that participated in the compilation of the NIMSS data.

And we hope that the NIMSS will eventually play a part in reducing their 
considerable workload.

## 8th World Conference onInjury Prevention &Safety Promotion

- 8th World Conference onInjury Prevention &Safety Promotion

- ICC, Durban, South Africa
- 2 - 5 April 2006

- www.safety2006.info

**Data to Action** - Securing Safety as a right

## Co-hosts 

*Co-hosts *

*Sponsor*

**World****Health****Organization**

**Conference Profile:**2000 	Participants from  131 	Countries350 	Oral presentations1500 	Posters100	Exhibitors

**Data to Action** - Securing Safety as a right

## Conference Objectives:Translate injury data into prevention actions - Critical review of approachesFoster exchanges in all fields of injury prevention and safety promotionExamine critical applications of injury prevention and safety promotion practices for different regions of the worldStimulate/strengthen injury prevention and safety promotion as central to national, continental &  international public health policies and programmesCreate opportunities for multidisciplinary and cross-sectoral dialogue  Highlight international injury prevention milestones and possibilities for innovation

**Conference Objectives:****Translate injury data into prevention actions**** **- Critical review of approaches**Foster exchanges** in all fields of injury prevention and safety promotion**Examine critical applications** of injury prevention and safety promotion practices for different regions of the world**Stimulate/strengthen** injury prevention and safety promotion as central to national, continental &  international public health policies and programmes**Create opportunities** for multidisciplinary and cross-sectoral dialogue  **Highlight** international injury prevention milestones and possibilities for innovation

**Data to Action** - Securing Safety as a right

## See you at ICC, Durban, South Africa from
2 - 5 April 2006

- See you at ICC, Durban, **South Africa** from
- 2 - 5 April 2006

- For more information visit **www.safety2006.info**

**Data to Action** - Securing Safety as a right