Injury patterns of female homicide victims in South Africa

Medicolegal study of Egyptian unnatural female deaths in the childbearing period during 2019-2020

Violence against women is a global public health problem, especially in the childbearing period. However, it is considered as the least documented human rights violation worldwide which at its worst can result in femicide. This medico-legal study aims to explore the pattern of unnatural deaths among women in childbearing age group in the Egyptian community in recent years for early detection of women who are at risk and for establishment preventive measures. One hundred and one fifty of suspicious deaths of women in the reproductive age from 13 to 49 years were autopsied in Zeinhom Morgue (the Egyptian Forensic Medicine Authority) during 2019-2020. Demographic data, circumstances of death, causes and manner of death were defined and statistically analyzed. Unnatural death occurred during the 2nd -3rdh decades, 83.4 % were from urban residence, 40.4 % were single while 39.1 % of cases were married. In the majority of deaths, bodies were found at home. Regarding the manner of death, there were 38.4 % suicidal deaths and 38.4 % were homicidal death, while 19.2 % were accidental deaths. Sharp traumatic injuries were the most common pattern in homicidal cases mainly after domestic arguments by a spouse or relative while the most common suicidal and accidental pattern was jumping from height. The present study proved that violence against women resulting in unnatural deaths is very prevalent in Egypt with a rising rate in recent years. These findings could be useful for early identification of vulnerable women and for preventing woman deaths in the future.

Profile of Medicolegal Deaths in Females: An Autopsy-Based Study

BACKGROUND

The rate of female medicolegal deaths (MLD) due to homicides and road traffic accidents (RTAs) is the highest in Africa, compared to the rest of the world, though there is scanty literature locally on this subject.

MATERIALS AND METHODS

The major sources of information reviewed in this study were the autopsy registers and autopsy reports of the police clinic, Benin City, Edo State, over 10 years.

RESULTS

A total of 331 female medicolegal autopsies were performed, accounting for 21.8% of all cases. The mean age of cases was 40.11 ± 20.25. Age group of 30-39 years accounted for 22.1% (n = 73) of cases, closely followed by the age group of 20-29 years, which accounted for 20.5% (n = 68) of cases. Accidental deaths accounted for 36.9% (n = 122) of cases. RTA was the most common cause of accidental deaths (n = 105; 86%). The most common pattern of RTA was a vehicle knocking down a pedestrian as seen in 45 cases (42.9%). The most common age group involved in RTA was 20-29 years (n = 23; 22%). For homicides, shotguns were mainly used (n = 31; 31.6%), distantly followed by those caused by the use of sharp objects (n = 17; 17.3%) and most cases belonged to the age groups of 40-49 years and 30-39 years (21.5% and 19.5%, respectively). In 5 (71.4%) cases, hanging was the method of choice for suicide. A majority of suicide victims (n = 4; 57.1%) were aged between 30 and 39 years, with an average age of 36.3. Diseases of the cardiovascular system accounted for 41.8% (n = 41) of cases, whereas pregnancy-associated deaths (excluding criminal abortions) accounted for 29.6% (n = 29) of cases in the natural causes group. Preeclampsia/eclampsia (n = 9; 31%) followed by postpartum hemorrhage (n = 8; 27.6%) were the leading causes of maternal deaths.

CONCLUSION

There is a need to provide basic infrastructure, formulate policies, and implement them, to reduce female MLD, which a significant number of them are preventable.

A descriptive medico-legal study of female deaths in cairo governorate, Egypt

BACKGROUND

Mortality is conditioned by biological, political and social factors, as well as by culturally defined behaviors and attitudes that historically characterize the stage of development of a country or a region. Women are often in great danger, where they should be safest. Violence against women is the most pervasive yet the least recognized human rights violation in the world. It is a profound health problem and femicide, is often the tragic end-point of violence. Females represent more than half of the Egyptian population, however, they remain vulnerable.

AIM OF THE STUDY

To describe and analyze data obtained from Zeinhom Morgue records in Cairo, regarding female deaths, throughout two years. To evaluate female deaths regarding age, cause, manner of death, location, perpetrator and motive. To describe the incidence of female homicides and their related injury patterns. To identify the risk factors and nature of violence from victimologic point of view. Finally, to describe the manner of death whether natural, homicidal, suicidal or accidental aiming for early identification of vulnerable females so that actions can be taken to prevent further mortality.

SUBJECTS AND METHODS

This is a national two year retrospective descriptive mortuary based study. The study population comprised of all adult females, aged 18 years and older, whose death was suspicious and medico-legal examination was ordered. Each investigation included a detailed case history, investigation, gross examination, histo-pathological and toxicological examinations. Data was collected from autopsy reports, hospital records and police records. From the available data the victim profile was made.

RESULTS

All female deaths aged 18 years and older were retrospectively reviewed for 2 years at Zeinhom morgue of Medico-legal Authority from a total of 1858 autopsy cases. The most common manner of death was homicide. The commonest cause of death in homicides was due to sharp traumatic injuries. Natural death was the least common manner of death and ischemic heart disease constituted the commonest cause. Falling from height was the most common method of suicidal related deaths. Regarding poisoned cases, insecticides and carbon monoxide were the most common detected poisons. According to the cause of death (trauma), blunt trauma injuries were the most common. Falling from height constituted the largest percent of cases under this group.

CONCLUSION AND RECOMMENDATIONS

Females in the third decade of life with blunt injuries to the head and neck were the majority of adult female autopsies. Homicide was the most common manner of female death using sharp instruments after domestic arguments mainly by a spouse or relative. Accidental death came second mainly due to post-operative complications. In cases of suicide, falling from height was the commonest cause followed by poisoning. These findings could be useful for forensic pathologists and healthcare promoters in predicting and preventing female deaths. Moreover, this emphasizes the need for raising public awareness about the scale of female violence problem in our society. The results of this study indicates that, by not only a strong legal support network, but also by opportunities for economic independency, essential education and awareness, alternative accommodation and a change in attitude and mindset of society, judiciary, legislature, executive, men and most importantly women themselves can lower or even prevent such deaths specially suicidal.

Twenty-three-year trend in firearm deaths in the Transkei subregion of South Africa (1993-2015)

Background Firearm-related deaths are a serious public-health problem in South Africa, which has the second-highest rate of firearm-related deaths in the world. Objective The aim of this study was to examine the trend in firearm deaths in the Transkei subregion of South Africa. Method An autopsy record review study was conducted at the Forensic Pathology Laboratory at Mthatha over a period of 23 years (1993-2015). Results Over a 23-year period (1993-2015), 27,036 autopsies were performed at the Mthatha Forensic Pathology Laboratory on people who had died from unnatural causes. Of these, 3935 (14.2%) deaths were related to firearm injuries. The average gunshot death rate during the study period was 29/100,000 of the population annually. The majority (3236; 82%) were males, among whom the death rate was 24.4/100,000 of the population per year. The rate of gunshot deaths was 27/100,000 of the population in 1993, while in 2015 it was 12.8/100,000. About a third (1207; 31%) of victims were between 21 and 30 years of age. Conclusion The gunshot death rate is at an unacceptably high level in the Transkei subregion of South Africa, especially among young people.

Twenty-three years (1993-2015) of homicide trends in the Transkei region of South Africa

Background Transkei is regarded as a rural part of South Africa. It was one of the black homelands where rigorous apartheid was practised. The incidence of firearm-related deaths used to be very high, but after the implementation of the Firearm Control Act in 2002, the trend changed. However, the murder rate is still a major public-health problem in this region of South Africa. Objective The aim of this study was to investigate 23 years (1993-2015) of homicide trends in the Transkei region of South Africa. Method A review of records of medico-legal autopsies performed at Mthatha Forensic Pathology Laboratory from 1993 to 2015 was undertaken. Results Between 1993 and 2015, the number of autopsies performed on people who had died unnatural deaths was 24,693. The records of 12,618 (51%) autopsies on victims of homicide between 1993 and 2015 were available for study. The average rate of murder was 85/100,000 of the population in this region. Of these deaths, on average 34/100,000 were caused by sharp-edged instruments, 30/100,000 by gunshot wounds and 21/100,000 by blunt trauma. The rate of murder of males was significantly higher than that of females, with a ratio of 5.7:1, and over the period of 23 years covered by this study, the incidence was highest (30.5/100,000) in the young age group between 21 and 30 years. Conclusion The rate of homicide is very high in the Transkei region of South Africa. It needs urgent intervention to curb unnecessary deaths.

Risk factors for homicide victimization in post-genocide Rwanda: a population -based case- control study

BACKGROUND

Homicide is one of the leading causes of mortality in the World. Homicide risk factors vary significantly between countries and regions. In Rwanda, data on homicide victimization is unreliable because no standardized surveillance system exists. This study was undertaken to identify the risk factors for homicide victimization in Rwanda with particular attention on the latent effects of the 1994 genocide.

METHODS

A population-based matched case-control study was conducted, with subjects enrolled prospectively from May 2011 to May 2013. Cases of homicide victimization were identified via police reports, and crime details were provided by law enforcement agencies. Three controls were matched to each case by sex, 5-year age group and village of residence. Socioeconomic and personal background data, including genocide exposure, were provided via interview of a family member or through village administrators. Conditional logistic regression, stratified by gender status, was used to identify risk factors for homicide victimization.

RESULTS

During the study period, 156 homicide victims were enrolled, of which 57 % were male and 43 % were female. The most common mechanisms of death were wounds inflicted by sharp instruments (knives or machetes; 41 %) followed by blunt force injuries (36.5 %). Final models indicated that risk of homicide victimhood increased with victim alcohol drinking patterns. There was a dose response noted for alcohol use: for minimal drinking versus none, adjusted odds ratio (aOR) = 3.1, 95%CI: 1,3-7.9; for moderate drinking versus none, aOR = 10.1, 95%CI: 3.7-24.9; and for heavy drinking versus none, aOR = 11.5, 95%CI: 3.6-36.8. Additionally, having no surviving parent (aOR = 2.7, 95%CI: 1.1-6.1), previous physical and/or sexual abuse (aOR = 28.1, 95%CI: 5.1-28.3) and drinking illicit brew and/or drug use (aOR = 7.7, 95%CI: 2.4-18.6) were associated with a higher risk of being killed. The test of interaction revealed that the variables that were significantly associated with a higher risk of homicide victimhood, did not exhibit any difference according to sex of the victim. However, the effect of belonging to a religion differed between women and men, but was significantly protective for both (aOR = 0.002, 95%CI: 0.001-0.054 and aOR = 0.20, 95%CI: 0.052-0.509, respectively).

CONCLUSION

Homicide victims in Rwanda are relatively young and the proportion of female victims is one of the highest globally. Contrary to the initial study considerations, genocide exposure (either as a survivor or perpetrator) was not a significant predictor of homicide victimization. Rather, risk factors were similar to those described in other countries, regardless of gender status. Sensitizing communities against alcohol heavy drinking, and illicit brew drinking and/or drug abuse and physical or sexual violence could reduce the homicide rate in Rwanda.

The use of dental putty in the assessment of hard surfaces within paved urban areas that may leave defined or patterned marks on bodies

The identification of a patterned skin or scalp mark at autopsy can provide key forensic evidence in identifying an injury that may have been left by an assailant's footwear. It is also important to consider whether such a mark could alternatively have been left by the deceased coming into forceful contact with a hard surface at the scene of an incident, for example by falling. This study was designed to demonstrate how variable surfaces are within paved urban areas, including those which might leave marks resembling footwear patterns, and to evaluate whether dental putty impression lifting is a practical and effective adjunct to photography in assessing patterned surfaces. Eighteen 'scenes' of approximately 50 m² were assessed for different hard surfaces by photography and by the production of dental putty impression lifts. The number of hard surfaces varied between 4 and 12 per scene, with 90% (122/135) of all hard surfaces deemed likely to leave distinct marking on skin with forceful contact and 46% (62/135) a defined/regular mark potentially similar to a footwear injury (mean = 3.4 per scene). Dental putty proved to be an excellent tool in characterising hard surfaces, producing firm but slightly flexible lifts that can be used in combination with a commercially available inkless footwear impression kit to generate transparencies that help facilitate detailed comparison work. Whenever a potential footwear mark is identified at autopsy, a systematic examination of all hard surfaces at the scene is mandatory, and this process will be significantly strengthened by the use of dental putty.

Forensic medicine in South Africa: associations between medical practice and legal case progression and outcomes in female murders

Background

Forensic medicine has been largely by-passed by the tide of health systems research and evidence based medicine. Murder victims form a central part of forensic medical examiners' case load, and women murdered by intimate partners are an important subgroup, representing the most severe form and consequence of intimate partner violence. Our aim was to describe the epidemiology of female murder in South Africa (by intimate and non-intimate partners); and to describe and compare autopsy findings, forensic medical management of cases and the contribution of these to legal outcomes.

Methods

We did a retrospective national study in a proportionate random sample of 25 medico-legal laboratories to identify all homicides in 1999 of women aged 14 years and over. Data were abstracted from the mortuary file and autopsy report, and collected from a police interview.

Findings

In 21.5% of cases the perpetrator was convicted. Factors associated with a conviction for the female murders included having a history of intimate partner violence 1.18 (95%CI: 0.16–2.20), weapon recovered 1.36 (95% CI:0.58–2.15) and a detective visiting the crime scene 1.57 (95% CI:0.14–3.00). None of the forensic medical activities increased the likelihood of a conviction.

Conclusion

The findings raise important questions about the role of forensic medicine in these cases.