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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.

Background. South Africa (SA) faces multiple health challenges. Quantifying the contribution of modifiable risk factors can be used to identify and prioritise areas of concern for population health and opportunities for health promotion and disease prevention interventions. Objective. To estimate the attributable burden of 18 modifiable risk factors for 2000, 2006 and 2012. Methods. Comparative risk assessment (CRA), a standardised and systematic approach, was used to estimate the attributable burden of 18 risk factors. Risk exposure estimates were sourced from local data, and meta-regressions were used to model the parameters, depending on the availability of data. Risk-outcome pairs meeting the criteria for convincing or probable evidence were assessed using relative risks against a theoretical minimum risk exposure level to calculate either a potential impact fraction or population attributable fraction (PAF). Relative risks were sourced from the Global Burden of Disease, Injuries, and Risk Factors (GBD) study as well as published cohort and intervention studies. Attributable burden was calculated for each risk factor for 2000, 2006 and 2012 by applying the PAF to estimates of deaths and years of life lost from the Second South African National Burden of Disease Study (SANBD2). Uncertainty analyses were performed using Monte Carlo simulation, and age-standardised rates were calculated using the World Health Organization standard population. Results. Unsafe sex was the leading risk factor across all years, accounting for one in four DALYs (26.6%) of the estimated 20.6 million DALYs in 2012. The top five leading risk factors for males and females remained the same between 2000 and 2012. For males, the leading risks were (in order of descending rank): unsafe sex; alcohol consumption; interpersonal violence; tobacco smoking; and high systolic blood pressure; while for females the leading risks were unsafe sex; interpersonal violence; high systolic blood pressure; high body mass index; and high fasting plasma glucose. Since 2000, the attributable age-standardised death rates decreased for most risk factors. The largest decrease was for household air pollution (–41.8%). However, there was a notable increase in the age-standardised death rate for high fasting plasma glucose (44.1%), followed by ambient air pollution (7%). Conclusion. This study reflects the continued dominance of unsafe sex and interpersonal violence during the study period, as well as the combined effects of poverty and underdevelopment with the emergence of cardiometabolic-related risk factors and ambient air pollution as key modifiable risk factors in SA. Despite reductions in the attributable burden of many risk factors, the study reveals significant scope for health promotion and disease prevention initiatives and provides an important tool for policy makers to influence policy and programme interventions in the country.

Background. South Africa (SA)’s high rate of interpersonal violence persists as a leading public health problem for the country. The first South African Comparative Risk Assessment Study (SACRA1) in 2000 quantified the long-term mental and physical health burden attributable to interpersonal violence by supplementing the direct injury burden of disease attributable to interpersonal violence injuries with the substantial contribution of mental health, behavioural and reproductive health consequences accruing from exposure to intimate partner violence (IPV) and child sexual abuse. Objectives. To revise and improve these estimates by including the additional burden from other forms of child maltreatment, community violence, sexual violence by non-partners, and bullying victimisation in SA for 2000, 2006 and 2012, and trends over time. Methods. We used comparative risk assessment methods to calculate population attributable fractions (PAFs) for interpersonal violence. This method requires inputs on the prevalence of exposure to the interpersonal violence risk factor subtypes, namely child maltreatment, bullying, IPV, sexual violence by non-partners and other community violence; the burden of related health outcomes (mortality and morbidity); and relative risks of health outcomes in individuals exposed to the risk factor v. those unexposed. We estimated the PAF for the combinations of all interpersonal violence subtypes together to estimate the burden attributable to interpersonal violence overall for 2000, 2006 and 2012. Results. Between 2000 and 2012, there was a decrease in interpersonal violence age-standardised attributable death rates from 100 to 71 per 100 000. In the second South African Comparative Risk Assessment Study (SACRA2), estimates of the attributable disability-adjusted life years (DALYs) for interpersonal violence for the year 2000 were revised, from 1.7 million to 2 million DALYs, taking into account attributable mortality and disability from additional forms of violence. There was a decrease in DALYs attributable to interpersonal violence from 2 million in 2000 to 1.75 million in 2012, accounting for 8.5% of the total burden for SA, ranking second highest, after unsafe sex, among 18 risk factors evaluated in 2012. Conclusion. Overall, interpersonal violence-attributable DALYs decreased substantially but remain high. The reduction in age-standardised attributable death rates indicates that some policy and social intervention aspects are effective. Further strengthening of existing laws pertaining to interpersonal violence, and other prevention measures, are needed to intensify the prevention of violence, particularly gender-based violence. Additional forms of violence included in this analysis have improved our understanding of the interpersonal violence burden, but the attributable burden in males, although exceedingly high, remains an underestimate. There is a need to improve the epidemiological data on prevalence and risks for the different types of interpersonal violence, particularly for males.

Background. In South Africa (SA), road traffic injuries, homicides and burns are the leading causes of injury-related deaths among children. Injury-related deaths are well documented for SA, but this is not the case for non-fatal injuries. Objectives. To describe the non-fatal injuries sustained among children aged 0 - 13 years, to identify any significant sex differences by age group, cause of injury, admission status and injury severity. Methods. The trauma unit database from 1997 to 2016 at Red Cross War Memorial Children’s Hospital, Cape Town, was utilised for this analysis. The prevalence of injuries and the boy/girl ratios with 95% confidence intervals (CIs) were reported. Results. Analysis indicated significant differences by sex for individual injury causes (transport, assault, burns, falls and other injuries), age group, injury severity and admission status. Moderately severe injuries were largely caused by burns, while severe injuries were mostly transport related. Boys had significantly higher proportions of all injury causes. The boy/girl ratio was lowest for assault (1:18), where significantly more girls aged 1 - 3 and 4 - 6 years were injured. Rape/sexual assault was 5.5 times higher for girls, with a significantly higher proportion of moderate-severity injuries (87%; 95% CI 84.7 - 89.4). Conclusion. The study findings call for a more targeted prevention response for boy and girl children. Interventions should be targeted at the prevention of burns, traffic collisions and interpersonal violence, in particular sexual assaults against girls.

Background. Gunshot injuries from interpersonal violence are a major cause of mortality. In South Africa (SA), the Firearms Control Act of 2000 sought to address firearm violence by removing illegally owned firearms from circulation, stricter regulation of legally owned firearms, and stricter licensing requirements. Over the last few years, varied implementation of the Act and police corruption have increased firearm availability.Objectives. To investigate whether changes in firearm availability in SA were associated with changes in firearm homicide rates.Methods. This was a retrospective time trend study (1994 - 2013) using postmortem data. Time trends of firearm and non-firearm homicide rates were analysed with generalised linear models. Distinct time periods for temporal trends were assigned based on a priori assumptions regarding changes in the availability of firearms.Results. Firearm and non-firearm homicide rates adjusted for age, sex and race exhibited different temporal trends. Non-firearm homicide rates either decreased or remained stable over the entire period. Firearm homicide increased at 13% annually from 1994 through 2000, and decreased by 15% from 2003 through 2006, corresponding with changes in firearm availability in 2001, 2003, 2007 and 2011. A 21% annual increase in firearm homicide after 2010 coincided with police fast-tracking new firearm licence applications. Cape Town’s coloured population experienced a significantly greater increase than other population groups following additional exposure to illegal firearms from 2007.Conclusions. The strong association between firearm availability and homicide, and the reversal of a decreasing firearm homicide trend during a period of lax enforcement, provide further support for the association between reduced firearm homicide and stricter regulation.Â

OBJECTIVE: To develop a standardized method for calculating years lived with disability (YLD) after injury. METHODS: The method developed consists of obtaining data on injury cases seen in emergency departments as well as injury-related hospital admissions, using the EUROCOST system to link the injury cases to disability information and employing empirical data to describe functional outcomes in injured patients. FINDINGS: Overall, 87 weights and proportions for 27 injury diagnoses involving lifelong consequences were included in the method. Almost all of the injuries investigated (96-100%) could be assigned to EUROCOST categories. The mean number of YLD per case of injury varied with the country studied. Use of the novel method resulted in estimated burdens of injury that were 3 to 8 times higher, in terms of YLD, than the corresponding estimates produced using the conventional methods employed in global burden of disease studies, which employ disability-adjusted life years. CONCLUSION: The novel method for calculating YLD after injury can be applied in different settings, overcomes some limitations of the method used to calculate the global burden of disease, and allows more accurate estimates of the population burden of injury.

Psalms 111 and 112 are “twin” poems displaying similar characteristics such as the superscript הללו יה, an acrostic form, and shared vocabulary. Surprisingly, the shared characteristics are noted, but the poems often interpreted in isolation. Ps 111 is classified as a hymn or a song of thanksgiving and Ps 112 as a wisdom poem. The prominent presence of so-called “wisdom terminology” in Ps 112 plays a major role in its classification, while the presence of similar terminology in Ps 111 is ignored. The present study engages in an intertextual reading of the two poems. They are read as an intentional, artistic literary composition. Following Michael Fishbane’s notion of inner-biblical exegesis, I argue that Ps 112 is an intentional “midrash” on Ps 111, and that the pair should be read as a composition in the context of the late Torah-wisdom redaction of the Psalter in general and Book V of the Psalter in particular.

https://doi.org/10.17159/2312-3621/2019/v32n2a2

Objectives: Communications skills (CS) training for medical interviewing is increasingly being conducted in English at medical schools worldwide. In this study, we sought to identify whether Arabic-speaking medical students experienced difficulty with the different components of the CS training that were conducted in English. Methods: Individual third-year preclinical medical students (N = 45) were videotaped while interviewing simulated patients. Each student assessed his/her performance on a 13-item (5-point scale) assessment form, which was also completed by the tutor and other students in the group. Results: Of the 13 components of their CS training, tutors awarded the lowest marks for students’ abilities to express empathy, ask about patients’ feelings, use transition statements, ask about functional impact, and elicit patients’ expectations (P

Background and purpose: Physiotherapists frequently use central posterior-anterior (PA) joint mobilization techniques for assessing and managing spinal disorders. Manual examination findings provide the basis for the selection of treatment techniques. From the literature it is evident that the level of reliability varies when physiotherapists perform different mobilization techniques. Repeatability of mobilization techniques is important for better physiotherapy management. The aim of the study was to determine whether experienced physiotherapists apply equal magnitude of force during a grade I central PA mobilisation technique on the cervical spine. Another aim was to determine the variation in the magnitude of force applied by each individual physiotherapist. Subjects: Sample of convenience, consisting of sixteen (n=16) selected qualified physiotherapists with experience in Orthopaedic Manual Therapy. Methods: A grade I central PA was performed on the Flexiforce TM sensors positioned on C6 of the same asymptomatic model to measure the applied magnitude of force. Two separate measurements, each lasting 30-seconds, were obtained. Results: The average maximum peak force applied by the majority of physiotherapists (87.5%) was between 10.95g and 72g. The difference in the forces applied for the two measurements ranged between 0.64g and 24.4g. The Bland Altman scatterplot determined the mean of the difference between measurement one and two, calculated for the group, was zero. When comparing the two measurements, little variation was noted in the forces applied, as well as the coefficient of variation for each physiotherapist. Conclusion and Discussion: Current results demonstrated good intra-therapist and moderate to good inter-therapist repeatability. Further research is required to generalize results.

The function of Old Testament Theology in preachingWhile preparing a sermon from the Old Testament, pastors often tend to neglect the important role that Old Testament Theology can play in assisting them to apply the ancient text to modern circumstances. In this paper, two reasons for this neglect is discussed, namely the problems concerning the method, task and scope of Old Testament Theology on the one hand and the inadequate historical and literary skills of the exegete on the other hand. Solutions to both problem areas are proposed.

The wealth of publications on matters relating to Old Testament poetry is witness to the fact that this subject has become a focal point in Old Testament studies. In this paper, an overview of contemporary publications is given. The basic issues, both on the level of poetic theory and practical application, are pointed out. A tendency towards a comprehensive literary approach is definitely present and should be encouraged. Only when a poem is analysed on all levels and by all means, will the richness of its meaning be appreciated.

Background: Injuries, often preventable, prompted urgent action within the United Nations' 2030 Agenda for Sustainable Development Goals (SDGs) to improve global health. South Africa (SA) has high rates of injury mortality, but accurate reporting of official national data is hindered by death misclassification., Objective: Two nationally representative surveys for 2009 and 2017 are utilised to assess SA's progress towards SDG targets for violence and road traffic injuries, alongside changes in suicide and under-5 mortality rates for childhood injuries, and compare these estimates with those of the Global Burden of Disease for SA., Methods: The surveys utilised multi-stage, stratified cluster sampling from eight provinces, with mortuaries as primary sampling units. Post-mortem files for non-natural deaths were reviewed, with additional data from the Western Cape. Age-standardised rates, 95% confidence intervals (CIs), and incidence rate ratios (IRRs) were calculated for manner of death rate comparisons and for age groups., Results: The all-injury age-standardised mortality rate decreased significantly between 2009 and 2017. Homicide and transport remained the leading causes of injury deaths, with a significant 31% decrease in road traffic mortality (IRR = 0.69), from 36.1 to 25.0 per 100 000 population., Conclusions: Despite a reduction in SA's road traffic mortality rate, challenges to achieve targets related to young and novice drivers and male homicide persist. Achieving SA's injury mortality SDG targets requires comprehensive evaluations of programmes addressing road safety, violence reduction, and mental well-being. In the absence of reliable routine data, survey data allow to accurately assess the country's SDG progress through commitment to evidence-based policymaking.

Background: Lifestyle factors of medical doctors are essential to their health and well-being. Previous studies omitted factors that constituted a healthy lifestyle and did not differentiate between various medical specialties or level of seniority which may expose doctors to different stress levels, workload and responsibility. The study assessed the lifestyle factors of medical doctors and compared them between departments, levels of seniority, years of experience and gender according to globally recognised health standards., Methods: This descriptive cross-sectional study collected data using a questionnaire created by the researchers based on healthy lifestyle factors and was administered online. Access was given to all doctors from four large departments, employed at two academic hospitals in Bloemfontein, Free State who agreed to participate in the study., Results: Consultants from paediatrics, with 6+ years in medical practice, had the healthiest lifestyles. Registrars and interns from surgical disciplines such as obstetrics and gynaecology and surgery, with 1-5 years of medical practice, showed unhealthy lifestyles with inadequate sleep and exercise., Conclusion: The challenge remains how medical doctors can live a healthy lifestyle while managing a demanding schedule. This may impact on the management of their patients and the doctors' overall health and well-being. We recommend improving the working conditions by providing healthy meals on-site at hospitals with adequate breaks, reducing the heavy workload and providing exercise facilities.Contribution: The findings from this article may help improve the lifestyles of the identified groups of at-risk doctors and assist them in seeking ways to improve upon this.

Background: Population-based statistics on deaths from child abuse and neglect are only routinely available in countries that have reliable national statistics on child murder. For low-income and middle-income countries, relatively little is known about prevalence trends of child murder. South Africa is an exception, having conducted dedicated national studies on child murders for 2009 and 2017 to provide data on child murders overall and on child abuse and neglect-related murders. We aimed to compare child abuse and neglect-related murders in South Africa across two surveys to determine any change between 2009 and 2017., Methods: We conducted two retrospective national mortuary-based surveys on murder of children aged 0-17 years for 2009 and 2017 from a proportionate random sample of medico-legal laboratories in South Africa. A sampling frame of medico-legal laboratories for each study year was prepared with stratification by medico-legal laboratory size. A minimum of 2 years after the crime was allowed before data collection to enable progression of the investigation process. Child abuse and neglect-related murders were identified using both medico-legal laboratory post-mortem autopsy reports and police data. To identify a child abuse and neglect-related murder, we primarily used the framework of abuse happening within the context of responsibility of care arrangements but broadened this to include all perpetrators and abuse identified from the data. We stratified age into 0-4, 5-9, 10-14, and 15-17 years and further stratified children younger than 5 years into early neonates (newborns killed within 6 days of birth), 7 days to 11 months, and 1-4 years. We calculated incidence rate ratios (IRR) with 95% CIs to compare rates between 2009 and 2017., Findings: An estimated 458 (95% CI 377-539) children in 2009 and 213 (179-247) children in 2017 were murdered in circumstances of child abuse and neglect. The percentage of all child murders that were child abuse and neglect-related declined from 2009 to 2017 (458 [45·0%] of 1018 in 2009 vs 213 [25·0%] of 851 in 2017), with the overall age-standardised rate decreasing from 2·6 to 1·1 per 100 000 children aged 0-17 years (IRR 0·43 [95% CI 0·35-0·54]). Girls represented 276 (60·3%) of 458 murders in 2009, which declined to 96 (45·1%) of 213 murders in 2017, and boys represented 178 (38·9%) of 458 murders in 2009 and 109 (51·4%) of 213 murders in 2017. The decrease was statistically significant for girls in the 0-4 year (IRR 0·33 [0·22-0·49]) and 5-9 year (0·33 [0·15-0·73]) age groups and for boys in the 0-4 year age group (0·49 [0·33-0·71]). Among early neonates (within 6 days of birth), the decrease in child abuse and neglect-related murders was more pronounced among girls than among boys (IRR 0·33 [95% CI 0·19-0·56] vs 0·46 [0·28-0·77])., Interpretation: Child abuse and neglect-related murders are common in South Africa but our study shows that they can be reduced. The high rate of these murders points to the need to continue research and monitoring to inform priority targeted interventions and to better understand the impact of child support policies., Funding: Ford Foundation and South African Medical Research Council., Competing Interests: Declaration of interests RM has received grants from Back of the Yards Algae Sciences. All other authors declare no competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.)

Not much is known about the perpetrators of male homicide in South Africa, which has rates seven times the global average. For the country's first ever male homicide study we describe the epidemiology of perpetrators, their relationship with victims and victim profiles of men killed by male versus female perpetrators. We conducted a retrospective descriptive study of routine data collected through forensic and police investigations, calculating victim and perpetrator homicide rates by age, sex, race, external cause, employment status and setting, stratified by victim-perpetrator relationships. For perpetrators, we reported suspected drug and alcohol use, prior convictions, gang-involvement and homicide by multiple perpetrators. Perpetrators were acquaintances in 63% of 5594 cases in which a main perpetrator was identified. Sharp objects followed by guns were the main external causes of death. The highest rates were recorded in urban informal areas among unemployed men across all victim-perpetrator relationship types. Recreational settings including bars featured prominently. Homicides clustered around festive periods and weekends, both of which are associated with heavy episodic drinking. Perpetrator alcohol use was reported in 41% of homicides by family members and 50% by acquaintances. Other drug use was less common (9% overall). Of 379 men killed by female perpetrators, 60% were killed by intimate partners. Perpetrator alcohol use was reported in approximately half of female-on-male murders. Female firearm use was exclusively against intimate partners. No men were killed by male intimate partners. Violence prevention, which in South Africa has mainly focused on women and children, needs to be integrated into an inclusive approach. Profiling victims and perpetrators of male homicide is an important and necessary first step to challenge prevailing masculine social constructs that men are neither vulnerable to, nor the victims of, trauma and to identify groups at risk of victimisation that could benefit from specific interventions and policies., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)