Presented by Hilton Donson

SAFETY & PEACE PROMOTION

RESEARCH UNIT

National Injury Mortality Surveillance System

(NIMSS)

November 2010

A profile of non-natural death in Gauteng, 2009

Staff and pathologists at participating MLLs and Forensic Medicine departments.

National and Provincial Departments of Health

State Forensic Pathology Services

Members of the NIMSS team

Acknowledgements

LEADING GLOBAL CAUSES OF DEATH, 2004 AND 2030 COMPARED

Injuries are the 2nd leading cause of death and DALYs lost in South Africa

The overall injury death rate of 157.8 per 100 000 population is nearly twice the global average

Substantial burden of preventable mortality, physical and emotional disability, impacts on social and economic development, co-morbidity(HIV/AIDS, abuse of alcohol and illicit substances)

Mortality in South Africa

Females

Males

Mortality profile for Gauteng

Source: South African Burden of Disease Study 2000

Top 20 leading cause of premature mortality burden Gauteng 2000

Leading causes of mortality among children

Findings from death notification, 2007

0

1 –

4

5 –

9

10 –

14

15 –

19

20 –

24

25 –

29

30 –

34

35 –

39

40 –

44

45 –

49

50 –

54

55 –

59

60 –

64

65 –

69

70 –

74

75 –

79

80 –

84

85+

0

10000

20000

30000

40000

50000

60000

Natural deaths Non-natural deaths

Statistics South Africa, 2009. Mortality and causes of death in South Africa, 2007: Findings from death notification, Pretoria: Statistics South Africa. Available at: www.statssa.gov.za.

44%

31%

17%

The National Injury Mortality Surveillance System (NIMSS)

HistoryEstablished in 1999Includes all deaths due to external causesBased on information from existing medico-

legal investigative proceduresAttempts to attempts to address gaps in

information from existing systems, i.e. death notification and SAPS

Goals of the NIMSS Ongoing and systematic information about the incidence,

causes and consequences of all non-natural deaths at all levels

Identification of new injury trends and emerging problem areas

Priorities for injury and violence prevention action Evaluate direct and indirect violence and injury prevention

and control measures Monitor seasonal and longitudinal changes in the non-

natural death profile

Utility of the NIMSS

Medico-legal laboratory

management tool

Capacity Development

Media/public/ stakeholder

dissemination

Collaborative Research

Interventions with partners Policy

Nine participating medico legal

laboratories (MLLs) in Gauteng

Descriptive findings in this report are the

result of an automated report generating process – caution

relatively few cases of date and time of injury

were available, date and time of death have been reported instead

While death would have occurred at the time of injury for a

majority of cases, some victims will have died hours or days after the

injury itself

Participating Facilities and Data Representivity

City MLL TotalBronkhorstspruit Bronkhorstspruit 317

Ekurhuleni Springs 1235

Heidelberg Heidelberg 291

Johannesburg Diepkloof 1738

Ekurhuleni Germiston 2678

Johannesburg Johannesburg 2531

Johannesburg Roodepoort 1409

Johannesburg Sebokeng 1376

Tshwane Ga-rankuwa 1155

Total 12 730

Apparent manner of death, Gauteng 2009(N=11329)

Violence, 3671, 32%

Suicide, 1278, 11%

Undetermined; 2195; 19%

Other Unintentional, 937, 8%

Transport, 3248, 29%

Violence (n=3652) Suicide (n=1276) Transport (n=3237) Other Unintentional (n=932)

Undetermined (n=1950)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Female, \13.0%

Female, 15.8%

Female, 19.5%

Female, 26.7%

Female, 29.1%

Male, 87.0%Male, 84.2%

Male, 80.5%

Male, 73.3%Male, 70.9%

Apparent manner of death

Per

cen

tage

of

case

sApparent manner of death by sex

(N=11047)

0-4

5-9

10-1

4

15-1

9

20-2

4

25-2

9

30-3

4

35-3

9

40-4

4

45-4

9

50-5

4

55-5

9

60-6

4

65-6

9

70-7

4

75-5

9

80-8

485

+0%

10%

20%

30%

40%

50%

60%

70% Violence Suicide Transport Unintentional Undetermined

Age groups

Perc

en

tag

e o

f cases

Apparent manner of death by age (n=10817)

Top 10 scenes of injury, Gauteng 2009n=8292

Farm

Lake/river/dam

Industrial area

Medical service area

Railway

Open land

Informal settlements

Residential Institute

Private homes

Roads

0 500 1000 1500 2000 2500 3000 3500 4000

Violence Suicide Transport Other unintentional Undetermined

Number of deaths

Sce

ne

of in

jury

Apparent manner of death by time of death(n=11025)

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 230

50

100

150

200

250Violence Suicide Transport Other Unintentional Undetermined

Time of death

Nu

mb

er o

f d

eath

s

Blood Alcohol Levels (n= 2519)

Zero55.7%

0-4mg/100ml4.4%

5-14mg/100ml13.4%

15-24mg/100ml16.3%

25+mg/100ml10.2%

Day of death, Gauteng 2009 (n=11223)

Monthly variation, Gauteng 2009 (n=11223)

Top 10 external causes of injury, Gauteng 2009 (n = 8660)

Passenger

MVA unspecified

Driver

Burns

Poisoning

Hanging

Blunt force

Sharp force

Pedestrian

Firearm

0 200 400 600 800 1000 1200 1400 1600 1800

Number of deaths

Ext

ern

al

cxa

use

of

inju

ry

Blood alcohol findings by apparent manner of death

Apparent mannerBAC's done

n(%)BAC positive

n(%)Mean BAC

Std. Dev.

Violence (3671) 953 (26.0) 463 (48.6) 0.16 0.09

Suicide (1278) 394 (30.8) 134 (34.1) 0.16 0.11

Transport (3248) 833 (25.7) 407 (48.9) 0.19 0.1

Other unintentional injury (937)

95 (10.1) 29 (30.5) 0.16 0.08

Undetermined (2195) 244 (11.1) 84 (34.4) 0.15 0.11

Total 2519 1117 0.16 0.1

Blood alcohol findings by transport user

Transport user BAC's done n(%)

BAC positive n(%)

Mean BAC Std. Dev.

Driver (542) 178 (32.8) 103 (57.9) 0.17 0.09

Passenger (522) 148 (28.4) 64 (43.2) 0.17 0.09

Pedestrian (1333) 290 (21.8) 153 (52.8) 0.23 0.11

Railway case (162) 38 (23.5) 10 (26.3) 0.12 0.08

Cyclist (151) 46 (30.5) 15 (32.6) 0.15 0.07

Unspecified (533) 132 (24.8) 62 (47.0) 0.16 0.09

Aviation (5) 1(20.0%) 0 0 0

Total 833 407 0.2 0.11

Year 2008 2009

Population# 7627922 7659017

Total deaths 

Rate/ 100 000 pop.

Total deathsRate/ 100000

pop.

Violence 4223 51.7 3671 45.1- firearm 1700 20.6 1374 16.4- sharp force 1239 15.1 1074 13.1- blunt force 1068 13.3 971 12.4Suicide 1350 17.4 1278 16.5- firearm 240 3.3 219 3.0- hanging 738 9.2 676 8.5- poisoning 233 3.0 249 3.1Transport 3578 46.3 3248 41.6- road traffic 3405 44.2 3081 39.5- pedestrian 1441 18.9 1333 17.2- driver 592 7.5 542 6.8- passenger 649 8.5 522 6.6- railway 147 1.9 162 2.1Unintentional 1222 16.2 937 12.6- burns 338 4.2 336 4.4- drowning 207 2.6 134 1.7- falls 112 1.7 94 1.5ALL INJURIES 11565 147.1 11329 144.4

Age-adjusted mortality rates for Gauteng

Mpumalanga South Africa

Violence 33.2 64.8

- firearm 9.6

- sharp object 10.7

Suicide 17.1 14

- firearm 2.1

- hanging 11.6

ALL INJURIES 147.9 157.8

Mpumalanga South Africa

Transport 68.4

- road traffic 68.1 39.7

driver 19.4

pedestrian 20.9

passenger 21.3Other Unintentional

12.3

- burns 2.6

- drowning 3.0

ALL INJURIES 147.9 157.8

The way forwardA permanent, nationwide system that registers all

non-natural deaths in South AfricaAutomated NIMSS

InnovativeFunded by UNISAMpumalanga & GautengProject concludes in 2011

Thank You

Website: MRC-UNISA Crime, Violence and Injury Lead

Programme/Safety and Peace Promotion Research Unit (SAPPRU)

http://www.mrc.ac.za/crime/nimms.htm

Staff and pathologists at participating MLLs

and Forensic Medicine departments.

National and Provincial Departments of Health

State Forensic Pathology Services

Members of the NIMSS team

Acknowledgements