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Groenewald P, Kallis N, Holmgren C, Glass T, Anthony A, Maud P, Akhalwaya Y, Afonso E, Niewoudt I, Martin LJ, De Vaal C, Cheyip M, Morof D, Prinsloo M, Matzopoulos R, Bradshaw D. Further evidence of misclassification of the injury deaths in South Africa: When will the barriers to accurate injury death statistics be removed? S Afr Med J 2023; 113:30-35. [PMID: 37882130 PMCID: PMC11017197 DOI: 10.7196/samj.2023.v113i9.836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Contrary to the World Health Organization's internationally recommended medical certificate of cause of death, the South African (SA) death notification form (DNF) does not allow for the reporting of the manner of death to permit accurate coding of external causes of injury deaths. OBJECTIVES To describe the injury cause-of-death profile from forensic pathology records collected for the National Cause-of-Death Validation (NCoDV) Project and compare it with profiles from other sources of injury mortality data. In particular, the recording of firearm use in homicides is compared between sources. METHODS The NCoDV Project was a cross-sectional study of deaths that occurred during a fixed period in 2017 and 2018, from a nationally representative sample of 27 health subdistricts in SA. Trained fieldworkers scanned forensic records for all deaths investigated at the forensic mortuaries serving the sampled subdistricts during the study period. Forensic practitioners reviewed the records and completed a medical certificate of cause of death for each decedent. Causes of death were coded to the International Statistical Classification of Diseases, 10th revision (ICD-10), using Iris automated coding software. Cause-specific mortality fractions for injury deaths were compared with Injury Mortality Survey 2017 (IMS 2017) and Statistics South Africa 2017 (Stats SA 2017) datasets. The cause profile for all firearm-related deaths was compared between the three datasets. RESULTS A total of 5 315 records were available for analysis. Males accounted for 77.6% of cases, and most decedents were aged between 25 and 44 years. Homicide was the leading cause of death (34.7%), followed by transport injuries (32.6%) and suicide (14.7%). This injury cause profile was similar to IMS 2017 but differed markedly from the official statistics, which showed markedly lower proportions of these three causes (15.0%, 11.6% and 0.7%, respectively), and a much higher proportion of other unintentional causes. Investigation of firearm-related deaths revealed that most were homicides in NCoDV 2017/18 (88.5%) and IMS 2017 (93.1%), while in the Stats SA 2017 data, 98.7% of firearm deaths were classified as accidental. Approximately 7% of firearm-related deaths were suicides in NCoDV 2017/18 and IMS 2017, with only 0.3% in Stats SA 2017. CONCLUSION The official cause-of-death data for injuries in SA in 2017 differed substantially from findings from the NCoDV 2017/18 study and IMS 2017. Accurate data sources would ensure that public health interventions are designed to reduce the high injury burden. Inclusion of the manner of death on the DNF, as is recommended internationally, is critically important to enable more accurate, reliable and valid reporting of the injury profile.
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Affiliation(s)
- P Groenewald
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa.
| | - N Kallis
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa.
| | - C Holmgren
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa.
| | - T Glass
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa.
| | - A Anthony
- Department of Health and Wellness, Western Cape Department of Health, Cape Town, South Africa.
| | - P Maud
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa.
| | - Y Akhalwaya
- Family Centre for Research with Ubuntu (FAM-CRU), Department of Paediatrics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - E Afonso
- Division of Forensic Medicine, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - I Niewoudt
- Division of Forensic Medicine, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - L J Martin
- Division of Forensic Medicine, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; Forensic Pathology Service, Western Cape Department of Health, Cape Town, South Africa.
| | - C De Vaal
- Division of Forensic Medicine, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - M Cheyip
- US Centers for Disease Control and Prevention, Pretoria, South Africa.
| | - D Morof
- US Centers for Disease Control and Prevention, Pretoria, South Africa.
| | - M Prinsloo
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa; Institute for Lifecourse Development, Faculty of Education, Health and Human Sciences, University of Greenwich, London, UK; School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - R Matzopoulos
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa; School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - D Bradshaw
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa.
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Hoffmann CJ, Dayal D, Cheyip M, McIntyre JA, Gray GE, Conway S, Martinson NA. Prevalence and associations with hepatitis B and hepatitis C infection among HIV-infected adults in South Africa. Int J STD AIDS 2013; 23:e10-3. [PMID: 23104758 DOI: 10.1258/ijsa.2009.009340] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
We assessed prevalence and factors associated with hepatitis B in a cross section of HIV-infected primary care and antinatal clinic patients in South Africa and evaluated a rapid hepatitis B surface antigen (HBsAg) assay. We enrolled 998 patients; 88% were women, median age was 29 years and median CD4 count was 354 cells/mm(3). HBsAg enzyme-linked immunosorbent assay (ELISA), anti-hepatitis B core (HBc) antibodies and hepatitis C virus antibody were positive among 4.2%, 37% and 0.1% of subjects, respectively. Univariate and multivariate associations were assessed using logistic regression. Anti-HBc antibodies were associated with alcohol use, traditional medicines and higher CD4 counts; HBsAg positivity was associated with lower CD4. Compared with the HBsAg ELISA, a rapid HBsAg test had a sensitivity of 75.0% and specificity of 99.6%. In conclusion, we identified a moderate prevalence of both HBsAg and anti-HBc. Importantly, we found that subjects with HBsAg positivity had lower CD4 counts.
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Affiliation(s)
- C J Hoffmann
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
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