Fire deaths in Cape Town, South Africa: A retrospective review of medico-legal and toxicological findings (2006 - 2018)

BACKGROUND

In South Africa, fire-related deaths are common, particularly within dense informal housing settlements. Published data on deaths from fire incidents in Cape Town is sparse. Additionally, little emphasis has been placed on the role of toxicological investigations in these deaths, despite the known risk of alcohol and drug impairment to burn injury.

METHODS

A retrospective, descriptive analysis of post-mortem case reports from Salt River Mortuary was conducted to investigate all deaths in which fires were involved in the west metropole of Cape Town, between 2006 to 2018. Demographic, circumstantial, and toxicological data were analyzed using R software.

RESULTS

In total 1370 fire deaths occurred over 13 years, with a mean of 106 (SD ± 18) cases per annum (≈3% of the annual caseload and a mortality rate of 5.5 per 100,000). Males (70.4%), adults (mean=30.7 years), and toddlers (1-4 years old) were notably at risk. Deaths typically occurred in the early morning (00h00 - 06h00) (45.7%), during winter (32.1%), and in lower socioeconomic areas with highly dense informal settlements (65.6%), with 29% of deaths occurring in multi-fatality incidents. Ethanol was detected (≥0.01 g/100 mL) in 55.1% of cases submitted for analysis (71.5%), with a mean of 0.18 g/100 mL, and with 93.8% of positive cases > 0.05 g/100 mL. Carboxyhaemoglobin (COHb) analysis was requested in 76.4% of cases, with 57% of cases having a %COHb of ≥ 20%. Toxicology results (for drugs other than ethanol) from the national laboratory were outstanding in 34.4% of the cases at the conclusion of the study. BAC and %COHb were significantly higher in deaths from burns and smoke inhalation (usually accidents) than deaths from combined trauma and burns (typically homicides). Fire deaths with high COHb levels were more likely to display cherry-red discoloration (OR=3.1) and soot in the airways (OR=2.7) at autopsy.

CONCLUSION

This article provides an updated description of fire deaths in the west metropole of Cape Town. The importance of BAC and COHb testing in these cases was noted, and the authors call for an investigation of the role of drug impairment (specifically frequently misused drugs methamphetamine and methaqualone) as a risk factor in these deaths. Areas of high-density informal settlements, where open flames are used to heat, light, and cook, were noted as high risk.

Portion size matters: Carrion ecology lessons for medicolegal death investigations-A study in Cape Town, South Africa

Forensic taphonomic studies are regionally specific and improve time since death estimates for medico-legal casework. Within forensic taphonomy and carrion ecology, vertebrate scavengers are under-researched with many studies conducted using multiple, unclothed carcasses. This is a forensically unrealistic experimental design choice with unknown impact. The effect of variation in carrion biomass on the decomposition ecosystem, particularly where vertebrate scavengers are concerned, requires clarification. To assess the effect of carrion biomass load on vertebrate scavenging and decomposition rate, seasonal baseline data for single, clothed ~60 kg porcine carcasses were compared to clothed multiple-carcass deployments, in a forensically relevant habitat of Cape Town, South Africa. Decomposition was tracked via weight loss and bloat progression and scavenging activity via motion-activated cameras. The single carcasses decayed more quickly, particularly during the cooler, wetter winter, strongly correlated with concentrated Cape gray mongoose (Galerella pulverulenta) scavenging activity. On average and across seasons, the single carcasses lost 68% of their mass by day 32 (567 accumulated degree days [ADD]), compared to 80 days (1477 ADD) for multi-carcass deployments. The single carcasses experienced substantially more scavenging activity, with longer visits by single and multiple mongooses, totaling 53 h on average compared to 20 h for the multi-carcass deployments. These differences in scavenging activity and decay rate demonstrate the impact of carrion biomass load on decomposition for forensic taphonomy research. These findings need corroboration. However, forensic realism requires consideration in taphonomic study design. Longitudinally examining many single carcasses may produce more forensically accurate, locally appropriate, and usable results.

"Asthma is a very bully disease" - patient experiences of living with chronic respiratory diseases in Cape Town, South Africa

BACKGROUND

Chronic respiratory diseases are common in Cape Town, South Africa. Yet the experiences of how adults with these conditions, such as asthma or COPD (chronic obstructive pulmonary disease), negotiate the health system are poorly understood. Qualitative methodology lends itself to investigate this question.

AIM OF STUDY

To explore the "emic" experiences of adults with CRDs in Cape Town when they were negotiating the health system using semi-structured interviews.

METHODS

Interviews were conducted following informed consent with purposively sampled adults who had attended public hospitals in Cape Town with chronic respiratory disease flare-ups. This work was nested in the quantitative "Diagnosing Airways Disease" study. The topic guide explored patients' experiences of accessing healthcare including receiving and interpretations of the diagnosis and management, and impacts on daily life. Interviews were conducted in Afrikaans, isiXhosa, or English; transcribed, and translated into English and thematically analysed until saturation.

RESULTS

Thirty-two interviews (16 in Afrikaans, 8 in isiXhosa, 8 in English) were completed in 2022. 17 women and 15 men participated. Most participants were older than 50 years (25/32), and most were unemployed (13/32) or retired (11/32). The identified themes were: Perceived causes of illness; experiences of healthcare; perceived risks and barriers when accessing healthcare; and impact on earnings. The perceived causes of their illness and risks were structural, and included air pollution, poor quality housing, occupational exposures, limited healthcare services, and fear of violence. These factors led to self-treatment, sharing of medicines, and delay in receiving a diagnosis. Many paid privately for treatments or services to overcome identified shortcomings of the public healthcare system, and many reported additional significant indirect costs. Being ill had a profound impact on income. The identified themes were explored through the lens of "structural violence", where "social structures stop individuals … from reaching their full potential" (Galtung, 1969).

CONCLUSION

In Cape Town structural elements such as stretched healthcare professionals, insufficiently enforced policies on e.g., housing or work-place exposures, poverty and crime made it difficult for participants to successfully navigate their illness experience. It forced some to pay out of pocket to receive perceived better healthcare privately.

Severe efavirenz associated neurotoxicity: A retrospective cohort study

Background

Efavirenz (EFV) is associated with neuropsychiatric symptoms. Severe neurotoxicity has been reported but the clinical phenotype and risk factors are poorly defined.

Objectives

To characterise clinical presentations, risk factors and outcomes to help clinicians recognise severe neurotoxicity earlier.

Method

The authors retrospectively identified adults with supratherapeutic EFV concentrations (> 4 mg/L) obtained during routine clinical care in Cape Town, South Africa. Clinical and laboratory data at the time of EFV quantification were extracted from medical records. Logistic regression was performed to identify associations with neuropsychiatric symptoms, and with severe neurotoxicity.

Results

Eighty one patients were included; 62 with neuropsychiatric manifestations (most frequently ataxia [n = 20] and psychomotor slowing [n = 24]); and 19 with hepatotoxicity. Overall, 28 (34.6%) were male, 49 (60.5%) had concomitant isoniazid exposure, and median EFV concentration was 12.1 mg/L (interquartile range [IQR]: 6.6-20.0). Neuropsychiatric symptoms were associated with longer duration of EFV therapy, adjusted odds ratio (aOR) 1.3/180-day increment (95% confidence interval [CI]: 1.0-1.7); higher EFV concentrations, aOR 1.2/1 mg/L increase (95% CI: 1.0-1.4) and isoniazid exposure, aOR 8.2 (95% CI: 2.5-26.7). Severe neuropsychiatric symptoms occurred in 47 (75%) patients at a median of 5.9 months (IQR: 2.1-40.8) after EFV initiation. Severe symptoms odds were 1.2-fold higher (95% CI: 1.1-1.4) per 1 mg/L increase in EFV concentration. Symptoms resolved completely within 1 month in 25 (76%) patients with severe neurotoxicity who discontinued EFV.

Conclusion

A concentration-effect relationship for severe neurotoxicity exists, which occurred late and resolved in most patients after EFV discontinuation.

Contribution

The authors highlighted clinical heterogeneity and morbidity of EFV-associated neurotoxicity.

Child and adolescent mortality associated with pesticide toxicity in Cape Town, South Africa, 2010-2019: a retrospective case review

BACKGROUND

Poisoning of children after exposure to pesticides is a major public health concern, particularly in countries with poorer urban populations, such as South Africa. This may stem from the illegal distribution and domestic use of street pesticides, which are highly hazardous agricultural pesticides. The aim of this study was to profile paediatric deaths due to acute pesticide poisoning in the west-metropole of Cape Town, South Africa; to identify whether the active ingredients were highly hazardous pesticides according to the FAO and WHO; and to inform policy and public health interventions to prevent future exposures and mortality.

METHODS

A retrospective and descriptive analysis of forensic post-mortem records (2010 to 2019) was conducted to identify cases of paediatric deaths (< 18 years old) in the west metropole of Cape Town, involving pesticide poisoning admitted to the Salt River mortuary (one out of 16 mortuaries in the Western Cape province). Demographic, circumstantial, autopsy, and toxicological information was captured. Descriptive statistics, together with chi-square tests, Fisher's probability tests, and Mann-Whitney U tests were used to analyse the data.

RESULTS

In total, 54 paediatric pesticide deaths were identified, including 22 (40.7%) males and 32 (59.3%) females, out of 5,181 paediatric unnatural deaths admitted over the 10-year period. The median age of the decedents was 8.3 years (range: 1 day to 17.9 years), with the majority under five years (42.6%) or between 15 and 18 years old (40.7%). All incidents occurred in peri-urban areas of Cape Town, with most individuals being admitted to hospital (88.9%) for a median survival time of 4.8 h. Toxicological analysis was requested in 50 cases (92.6%) with the organophosphate pesticides terbufos (n = 29), methamidophos (n = 2) and diazinon (n = 2) detected most frequently. Adolescent (15-18 years) suicides (29.6%) and accidental child deaths (< 4 years) (18.5%) were common.

CONCLUSIONS

Terbufos and methamidophos are highly hazardous pesticide (HHP) active ingredients registered in South Africa for agricultural uses, yet commonly sold as street pesticides for domestic use in lower socioeconomic areas. Reducing access and availability of toxic pesticides, especially through the illegal selling of street pesticides, and providing low toxic alternatives to poorer communities, may support mortality reduction initiatives. Mortality and toxicology data provide important, often overlooked, surveillance tools for informing policy and public health interventions to reduce toxic pesticide harm in local communities.

Health Sciences students' experience of COVID-19 case management and contact tracing in Cape Town, South Africa

BACKGROUND

COVID-19 has challenged health and higher education systems globally. Managing the epidemic in Cape Town, South Africa (SA), required partnerships with universities and setting up of de novo systems for mass case and contact tracing (C&CT). Health sciences, predominantly medical students, as well as social work and psychology students formed the core of this telephone-based work over the 18 months when SARS-CoV-2 caused severe disease.

METHODS

This qualitative study aimed to elicit students' motivations for becoming involved in C&CT, their experiences, and recommendations for C&CT and curricula. After Cape Town's first COVID-19 wave, six on-line focus groups comprising 23 students were conducted, and a further four were conducted with 13 students after the second wave. As the researchers were predominantly educators previously involved in undergraduate health sciences education, the study's purpose was to reflect on students' experiences to make educational and health system recommendations.

RESULTS

Students were largely motivated to mitigate the impact of the epidemic on society and support people affected by COVID-19, as well as hone their professional skills. While these motivations were realised, students also needed to learn new skills - to autonomously work remotely, using novel communication strategies to engage those affected and use virtual groups to connect with colleagues. They managed responsibilities within the healthcare systems that did not always work smoothly, distressed cases who were financially insecure, difficult employers, and language barriers. They were prepared through training, and supported by virtual, yet effective teamwork and debriefing opportunities. Although the work was sometimes physically and emotionally exhausting, students found the work personally meaningful. They embraced public health's role to protect population and individuals' health.

CONCLUSION

New teaching and learning practices adopted due to Covid-19 lockdowns enabled this digital C&CT project. It facilitated students to become confident, work autonomously and navigate challenges they will encounter as young professionals. The programme demonstrated that novel opportunities for rich student learning, such as in telehealth, can be embedded into public health and clinical functions of health services in contexts such as in SA, deepening partnerships between the health services and universities, to mutual benefit.

If You Build It Will They Come? Park Upgrades, Park Use and Park-Based Physical Activity in Urban Cape Town, South Africa-The SUN Study

The development and upgrade of recreational public spaces are key government strategies to increase opportunities for physical activity (PA) and enhance social interaction and community cohesion. This study aimed to evaluate differences in park use and park-based PA in recently upgraded/developed parks (intervention, n = 4) against established parks (control, n = 4) and in regional parks in high- and low-income settings (n = 2). Additionally, associations between target area features, park use and PA were identified. Direct observation of park use and attributes was conducted using the System for Observing Play and Recreation in Communities (SOPARC) over four months. Despite more park users in intervention parks (2519 vs. 1432), control park visitors were 48% more likely to be engaged in PA (p < 0.001). Similarly, while high-income park users attracted more visitors (2135 vs. 1111), they were 79% less likely to be engaged in any PA compared with low-income park visitors. The likelihood of both use of and PA by gender and age differed by features. Active recreation features in intervention parks attracted more users than the same features in control parks. In this study, upgraded or newly developed parks attracted more visitors but not necessarily overall greater levels of physical activity.

Urban community gardens in Cape Town, South Africa: navigating land access and land tenure security

Land tenure security continues to pose a significant challenge to the sustainability of urban community gardens in global South cities. However, a few studies have explored the mechanisms that urban gardeners employ to facilitate land access and variations in land tenure security arrangements made with land owners in South African cities. This paper employs a mixed-methods research approach involving quantitative and qualitative techniques to examine how urban community gardens access land and land tenure security arrangements thereof. The study is based on questionnaires, semi-structured interviews, and observations from 34 urban community food gardens in Cape Town selected through a combination of purposive and snowball sampling methods across selected low-income urban neighbourhoods. The findings reveal that although formalised land tenure security poses a sustainability threat to community gardens, perceived and de facto tenure present equally crucial forms of tenure which could be supported by state actors to promote urban agriculture. Reflecting on past efforts to formalise land tenure security, the article concludes that these efforts have failed due to poor coordination among government departments, and the complex and unclear processes of acquiring land. The paper recommends that while formalising land tenure arrangements may prove to be an effective solution, supporting institutions need to adopt a bottom-up approach to understand the gardener's needs and build on perceived and de facto land tenure security options to promote the sustainability of community gardening projects.

Association Between Weather Parameters and SARS-CoV-2 Confirmed Cases in Two South African Cities

Several approaches have been used in the race against time to mitigate the spread and impact of COVID-19. In this study, we investigated the role of temperature, relative humidity, and particulate matter in the spread of COVID-19 cases within two densely populated cities of South Africa-Pretoria and Cape Town. The role of different levels of COVID-19 restrictions in the air pollution levels, obtained from the Purple Air Network, of the two cities were also considered. Our results suggest that 26.73% and 43.66% reduction in PM2.5 levels were observed in Cape Town and Pretoria respectively for no lockdown (Level 0) to the strictest lockdown level (Level 5). Furthermore, our results showed a significant relationship between particulate matter and COVID-19 in the two cities. Particulate matter was found to be a good predictor, based on the significance of causality test, of COVID-19 cases in Pretoria with a lag of 7 days and more. This suggests that the effect of particulate matter on the number of cases can be felt after 7 days and beyond in Pretoria.

Pharmaceuticals and Personal Care Products in the Marine Environment Around False Bay, Cape Town, South Africa: Occurrence and Risk-Assessment Study

Pollution of the marine environment has been increasing as a result of anthropogenic activities. The preservation of marine ecosystems as well as the safety of harvested seafood are nowadays a global concern. In the present study, levels of pharmaceuticals and personal care products were assessed in different environmental compartments in the near-shore marine environment of False Bay, Cape Town, South Africa. The study revealed the presence of these persistent chemical compounds in different environmental samples from this location. Diclofenac was the most dominant compound detected, with higher concentration than the other pharmaceutical compounds, as well as being present in almost all the samples from the different sites (seawater, 3.70-4.18 ng/L; sediment, 92.08-171.89 ng/g dry wt; marine invertebrates, 67.67-780.26 ng/g dry wt; seaweed, 101.50-309.11 ng/g dry wt). The accumulation of pharmaceuticals and personal care products in the different species of organisms reflects the increasing anthropogenic pressure taking place at the sampling sites along the bay, as a result of population growth, resident lifestyle as well as poorly treated sewage effluent discharge from several associated wastewater-treatment plants. The concentration of these contaminants is in the order marine biota > sediments > seawater. The contaminants pose a low acute and chronic risk to the selected trophic levels. A public awareness campaign is needed to reduce the pollution at the source, as well as wastewater discharge limits need to be more stringent. Environ Toxicol Chem 2022;41:614-634. © 2021 SETAC.

Short-Term Joint Effects of PM10, NO2 and SO2 on Cardio-Respiratory Disease Hospital Admissions in Cape Town, South Africa

Background/Aim: In sub-Sahara Africa, few studies have investigated the short-term association between hospital admissions and ambient air pollution. Therefore, this study explored the association between multiple air pollutants and hospital admissions in Cape Town, South Africa. Methods: Generalized additive quasi-Poisson models were used within a distributed lag linear modelling framework to estimate the cumulative effects of PM₁₀, NO₂, and SO₂ up to a lag of 21 days. We further conducted multi-pollutant models and stratified our analysis by age group, sex, and season. Results: The overall relative risk (95% confidence interval (CI)) for PM₁₀, NO₂, and SO₂ at lag 0–1 for hospital admissions due to respiratory disease (RD) were 1.9% (0.5–3.2%), 2.3% (0.6–4%), and 1.1% (−0.2–2.4%), respectively. For cardiovascular disease (CVD), these values were 2.1% (0.6–3.5%), 1% (−0.8–2.8%), and −0.3% (−1.6–1.1%), respectively, per inter-quartile range increase of 12 µg/m³ for PM₁₀, 7.3 µg/m³ for NO₂, and 3.6 µg/m³ for SO₂. The overall cumulative risks for RD per IQR increase in PM₁₀ and NO₂ for children were 2% (0.2–3.9%) and 3.1% (0.7–5.6%), respectively. Conclusion: We found robust associations of daily respiratory disease hospital admissions with daily PM₁₀ and NO₂ concentrations. Associations were strongest among children and warm season for RD.

Flooding trends and their impacts on coastal communities of Western Cape Province, South Africa

Climate change-induced extreme weather events have been at their worst increase in the past decade (2010-2020) across Africa and globally. This has proved disruptive to global socio-economic activities. One of the challenges that has been faced in this regard is the increased coastal flooding of cities. This study examined the trends and impacts of coastal flooding in the Western Cape province of South Africa. Making use of archival climate data and primary data from key informants and field observations, it emerged that there is a statistically significant increase in the frequency of flooding and consequent human and economic losses from such in the coastal cities of the province. Flooding in urban areas of the Western Cape is a factor of human and natural factors ranging from extreme rainfall, usually caused by persistent cut off-lows, midlatitude cyclones, cold fronts and intense storms. Such floods become compounded by poor drainage caused by vegetative overgrowth on waterways and land pollution that can be traced to poor drainage maintenance. Clogging of waterways and drainage systems enhances the risk of flooding. Increased urbanisation, overpopulation in some areas and non-adherence to environmental laws results in both the affluent and poor settling on vulnerable ecosystems. These include coastal areas, estuaries, and waterways, and this worsens the risk of flooding. The study recommends a comprehensive approach to deal with factors that increase the risk of flooding as informed by the provisions of both the Sustainable Development Goals framework and the Sendai Framework for Disaster Risk Reduction 2015-2030 in a bid to de-risking human settlement in South Africa.

Exploring Factors Associated with Diabetic Retinopathy Treatment Compliance Behaviour in Cape Town, South Africa

Complete patient adherence to treatment for diabetic retinopathy (DR) is critical to limit vision loss. There is a dearth of evidence regarding the reasons why South African patients referred for suspected vision-threatening DR stay compliant to or default their treatment. The current study sought to explore factors associated with treatment compliance among patients living with diabetes who have been referred for suspected vision-threatening DR in the Northern/Tygerberg sub-Structure (NTSS) public health care system of Cape Town, South Africa. A qualitative research approach was used where semi-structured in-depth interviews were conducted with 13 adult patients living with DR, and 2 key informants who are primary eye care providers. Thematic data analysis was conducted using taguette.org. Fear of going blind was the most notable patient-related factor associated with compliance. Notable patient-related barriers reported were forgetfulness and a poor state of health. Notable institution-related barriers included suboptimal information received from health care service providers, poor referral management by the organisation delivering retinal screening services, as well as the inaccessibility of the main NTSS hospital via telephone calls. All these factors were confirmed by the key informants of the current study. Finally, all patients and key informants agreed that SARS-CoV-2 negatively affected patients’ adherence to their DR treatment. Hence, scaling up of health care, referral, and appointment setting services could increase the uptake of treatment and retinal screenings among patients attending the Cape Town, NTSS public health care system.

Carriage of colistin-resistant Gram-negative bacteria in children from communities in Cape Town (Tuberculosis child multidrug-resistant preventive therapy trial sub-study)

Colistin is a last-resort antibiotic against multidrug-resistant, Gram-negative bacteria. Colistin resistance has been described in the clinical settings in South Africa. However, information on carriage of these bacteria in communities is limited. This study investigated gastrointestinal carriage of colistin-resistant Escherichia coli and Klebsiella spp. and mcr genes in children from communities in Cape Town. Colistin-resistant E. coli was isolated from two participants (4%, 2/50), and mcr-1-mcr-9 genes were not detected. Gastrointestinal carriage of colistin-resistant Enterobacterales was rare; however, continuous extensive surveillance is necessary to determine the extent of carriage and its contribution to resistance observed in clinical settings.

The dynamics of indiscriminate/ illegal dumping of waste in Fisantekraal, Cape Town, South Africa

Indiscriminate dumping may be considered a 'wicked problem', as it is regarded as a complex, intractable, open-ended problem and it includes rights-based and justice issues. An understanding of the dynamics of indiscriminate dumping may assist with improving the management of indiscriminate dumping. The results show that indiscriminate dumping in Fisantekraal is a serious threat. From the first round of data collection to the last, no dumpsite disappeared despite the efforts of the community to clean up each month. Rather, the formation of new dumpsites and the extension of a few existing ones were evident. The morphology composition of the waste suggests that the main dumpers are the households and spaza shop owners. Conversations and collaboration between the authorities and community are encouraged in order to explore solutions to indiscriminate dumping.

Abundance and characteristics of microplastics in retail mussels from Cape Town, South Africa

With the increased occurrence of plastics in the marine environment, ingestion of microplastics (MPs) by marine invertebrates such as mussels is increasing globally. This study investigated the occurrence of microplastics in mussels sold at supermarkets and wholesalers in Cape Town, South Africa. Soft tissue was extracted from mussels, digested and identified by microscopy and FTIR-ATR. MP filaments (70%) and fragments (30%) were the only types of MPs identified and an average of 0.04 MPs/g soft tissue and 3.8 MPs/mussel recorded. Blue/green (44%) and black/grey (40%), smaller than 2000 μm were the most prominent MPs recorded and the main polymer type was filamentous polyethylene terephthalate (PET). Our results suggest that retail mussels in Cape Town do not contain as high concentrations of MPs when compared to other investigations and routine monitoring of seafood in the country is suggested.

Multiple Early Introductions of SARS-CoV-2 to Cape Town, South Africa

Cape Town was the first city in South Africa to experience the full impact of the coronavirus disease 2019 (COVID-19) pandemic. We acquired samples from all suspected cases and their contacts during the first month of the pandemic from Tygerberg Hospital. Nanopore sequencing generated SARS-CoV-2 whole genomes. Phylogenetic inference with maximum likelihood and Bayesian methods were used to determine lineages that seeded the local epidemic. Three patients were known to have travelled internationally and an outbreak was detected in a nearby supermarket. Sequencing of 50 samples produced 46 high-quality genomes. The sequences were classified as lineages: B, B.1, B.1.1.1, B.1.1.161, B.1.1.29, B.1.8, B.39, and B.40. All the sequences from persons under investigation (PUIs) in the supermarket outbreak (lineage B.1.8) fall within a clade from the Netherlands with good support (p > 0.9). In addition, a new mutation, 5209A>G, emerged within the Cape Town cluster. The molecular clock analysis suggests that this occurred around 13 March 2020 (95% confidence interval: 9-17 March). The phylogenetic reconstruction suggests at least nine early introductions of SARS-CoV-2 into Cape Town and an early localized transmission in a shopping environment. Genomic surveillance was successfully used to investigate and track the spread of early introductions of SARS-CoV-2 in Cape Town.

A silver bullet? The role of radiology information system data mining in defining gunshot injury trends at a South African tertiary-level hospital

Background

South Africa (SA) has no national injury surveillance system, and hence, non-fatal gunshot injuries are not routinely recorded. Most firearm-related injuries require multi-detector computer tomography (MDCT) assessment at a tertiary-level facility. MDCT scanning for victims with gunshot injuries thus provide an indication of the societal burden of firearm trauma. The potential of the modern radiology information system (RIS) to serve as a robust research tool in such settings is not fully appreciated.

Objective

The aim of this study was to evaluate the use of institutional RIS data in defining MDCT scanning trends for gunshot victims presenting to a tertiary-level SA hospital.

Method

A single-institution, retrospective, comparative study was conducted at the Tygerberg Hospital (TBH) Trauma Unit for the years 2013 and 2018. Using data-mining software, customised RIS searches for information on all gunshot-related emergency computed tomography scans in the respective years were performed. Demographic, temporal, anatomical and scan-protocol trends were analysed by cross tabulation, Chi-squared and Fisher’s exact tests.

Results

Gunshot-related emergency MDCT scans increased by 62% (546 vs. 887) from 2013 to 2018. Lower-limb CT angiography was the commonest investigation in both periods. A higher proportion of victims in 2018 sustained thoracic injuries (12.5% vs. 19.8%; p < 0.01) and required imaging of more than two body parts (13.1% vs. 19.2%; p < 0.01).

Conclusion

By using RIS data to demonstrate the increasing gunshot-related MDCT workload in the review period, as well as a pattern of more complex and potentially life-threatening injury, this study highlights the burden of firearm trauma in the society and the potential role of the modern RIS as a robust research tool.

Family medicine internship support during the COVID-19 pandemic in Cape Town, South Africa - A narrative report

The health-service redesign that came with the preparation for the surge of COVID-19 had a potential of disrupting the Family Medicine internship programme like it did to many other health and academic programmes. A team of Cape-Town based Community Health Centre (CHC) doctors mitigated this challenge by designing an innovative tool that facilitated ongoing supervision of the interns in order to achieve the outcomes of the Health Professions Council of South Africa (HPCSA).

The Cape Town International Convention Centre from the inside: The family physicians' view of the ‛Hospital of Hope'

This short report captures the week-by-week reflections of a group of family physicians who joined the clinical and operational management teams tasked with providing the in-patient service of an 862-bed COVID-19 field hospital. The 'Hospital of Hope' at the Cape Town International Convention Centre (CTICC) was established as an intermediate care facility specifically to cope with the effects of the COVID-19 pandemic in Cape Town metropole. In an extraordinary feat of engineering, the conference centre floor was transformed within a matter of weeks into wards with piped oxygen at each bed. Whilst the emergency medicine specialists took the lead in designing and commissioning the facility, the medical management and staff were drawn mostly from family physicians. This report is a short reflection on the experience of the first 4 weeks of managing patients in this repurposed space. Our insights evolved during various formal and informal learning conversations as the in-patient service became more organised over time. We hope that these insights, as well as the process of reaching them, will assist other colleagues in serving their communities during this difficult moment in history; moreover, it may reflect a renewed appreciation for team-based interdisciplinary efforts in achieving person-centred care.

Provincial Veterinary Services respond to drought in South Africa

In 2018, Cape Town, South Africa, nearly ran out of water. That this has not yet happened is in large part due to the water-saving efforts of its citizens. It is highly likely that this situation will be repeated in Cape Town and that similar situations will be experienced by major cities in other parts of the world. Efforts to save water should thus continue and the lessons learned in Cape Town should be shared. The functioning of Veterinary Services during a drought is affected in the same way as any business, in terms of running an office, but veterinary professionals face an increased risk of exposure to pathogens, compared to that of many occupations, and of veterinary officials becoming disease vectors. One component of Veterinary Services is veterinary laboratory services. Laboratory procedures rely heavily on water and, without advance planning, a laboratory's function can be severely limited by a restricted water supply. In many cases, innovative water-saving techniques can be used to reduce water use substantially without compromising the quality of the services offered. Here, the authors share their experiences and some lessons learned while working in Veterinary Services in the Western Cape province of South Africa.

Turnaround times - the Achilles' heel of community screening and testing in Cape Town, South Africa: A short report

Early in the course of the coronavirus infection disease 2019 (COVID-19) pandemic in South Africa, the Department of Health implemented a policy of community screening and testing (CST). This was based on a community-orientated primary care approach and was a key strategy in limiting the spread of the pandemic, but it struggled with long turnaround times (TATs) for the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) reverse transcriptase polymerase chain reaction test. The local experience at Symphony Way Community Day Centre (Delft, Cape Town), highlighted these challenges. The first positive tests had a median TAT of 4.5 days, peaking at 29 days in mid-May 2020. Issues that contributed to long TATs were unavailability of viral transport medium, sample delivery and storage difficulties, staffing problems, scarcity of testing supplies and other samples prioritised over CST samples. At Symphony Way, many patients who tested COVID-19 positive had abandoned their self-isolation because of the delay in results. Employers were unhappy with prolonged sick leave whilst waiting for results and patients were concerned about not getting paid or job loss. The CST policy relies on a rapid TAT to be successful. Once the TAT is delayed, the process of contacting patients, and tracing and quarantining contacts becomes ineffective. With hindsight, other countries’ difficulties in upscaling testing should have served as warning. Community screening and testing was scaled back from 18 May 2020, and testing policy was changed to only include high-risk patients from 29 May 2020. The delayed TATs meant that the CST policy had no beneficial impact at local level.

Emergency centre reorganization in preparation to the COVID-19 pandemic: A district hospital's dynamic adaptation response

The COVID-19 global pandemic forced healthcare facilities to put special isolation measures in place to limit nosocomial transmission. Cohorting is such a measure and refers to placing infected patients (or under investigation) together in a designated area. This report describes the physical reorganisation of the emergency centre at Khayelitsha Hospital, a district level hospital in Cape Town, South Africa in preparation to the COVID-19 pandemic. The preparation included the identification of a person under investigation (PUI) room, converting short stay wards into COVID-19 isolation areas, and relocating the paediatric section to an area outside the emergency centre. Finally, we had to divide the emergency centre into a respiratory and non-respiratory side by utilising part of the hospital’s main reception. We are positive that the preparation and reorganization of the emergency centre will limit nosocomial transmission during the expected COVID-19 surge. Our experience in adapting to COVID-19 may have useful implications for ECs throughout South Africa and in low-and-middle income countries that are preparing for this pandemic.

Homosexual not Homogeneous: A Motivation-Based Typology of Gay Leisure Travelers Holidaying in Cape Town, South Africa

The gay traveler, a segment of the lesbian, gay, bisexual, and transgender (LGBT) travel market, is perceived to be a homogeneous market segment as a result of the assumption that gay men have a unique "homosexual lifestyle." This assumption is problematic as it conceals many other important variables, and it may hinder effective destination marketing. A Web-based electronic survey was completed by 469 gay male travelers, and attribute-based benefit segmentation was carried out by applying a hierarchical cluster analysis using Ward's procedure with Euclidean distances. The typology is based on the push and pull framework; the motivations of travelers were assessed both in terms of their socio-psychological motivations and destination attributes of Cape Town. The typology empirically suggests that gay travelers are not homogeneous, and that sexuality influences the travel behavior of a minority of gay men. Consequently, not all gay travelers or activities by these travelers can be labeled as "gay" tourism.

Novel Coronavirus in Cape Town Informal Settlements: Feasibility of Using Informal Dwelling Outlines to Identify High Risk Areas for COVID-19 Transmission From A Social Distancing Perspective

Background

The challenges faced by the Global South during the coronavirus disease (COVID-19) pandemic are compounded by the presence of informal settlements, which are typically densely populated and lacking in formalized sanitation infrastructure. Social distancing measures in informal settlements may be difficult to implement due to the density and layout of settlements. This study measures the distance between dwellings in informal settlements in Cape Town to identify the risk of COVID-19 transmission.

Objective

The aim of this paper is to determine if social distancing measures are achievable in informal settlements in Cape Town, using two settlements as an example. We will first examine the distance between dwellings and their first, second, and third nearest neighbors and then identify clusters of dwellings in which residents would be unable to effectively practice social isolation due to the close proximity of their homes.

Methods

Dwellings in the settlements of Masiphumelele and Klipfontein Glebe were extracted from a geographic information system data set of outlines of all informal dwellings in Cape Town. The distance to each dwelling’s first, second, and third nearest neighbors was calculated for each settlement. A social distance measure of 2 m was used (buffer of 1 m, as dwellings less than 2 m apart are joined) to identify clusters of dwellings that are unable to effectively practice social distancing in each settlement.

Results

The distance to each dwelling’s first 3 nearest neighbors illustrates that the settlement of Masiphumelele is constructed in a denser fashion as compared to the Klipfontein Glebe settlement. This implies that implementing social distancing will likely be more challenging in Masiphumelele than in Klipfontein Glebe. However, using a 2-m social distancing measure, it was demonstrated that large portions of Klipfontein Glebe would also be unable to effectively implement social distancing.

Conclusions

Effectively implementing social distancing may be a challenge in informal settlements due to their density. This paper uses dwelling outlines for informal settlements in the city of Cape Town to demonstrate that with a 2 m measure, effective social distancing will be challenging.

The effect of clothing on decomposition and vertebrate scavengers in cooler months of the temperate southwestern Cape, South Africa

With research providing conflicting results from different habitats across the globe, the effect of clothing on decomposition is unclear; some studies indicate clothing increases decomposition rate by facilitating increased insect activity, and others conclude clothing prolongs the decay process. In South Africa, such research is lacking, with no data for the Western Cape Province, which suffers from a high murder rate with many unclaimed, unidentified bodies. Improving post-mortem interval (PMI) estimates will increase chances of correct forensic identification of decedents by narrowing the search window for police. Since no current PMI estimation method accounts for the possible influence of clothing, this study was designed to examine the effect of seasonally appropriate common clothing on decomposition rate in the thicketed Cape Flats Dune Strandveld, Cape Town, a forensically significant region. Four ∼60 kg domestic pig carcasses (Sus scrofa domesticus) were used as proxies for human decomposition, two were clothed and two unclothed. The clothing, altered by a seamstress to ensure an appropriate fit, caused a notable decrease in decay rate in this initial sample. Daily weight loss was used as a quantitative measure of decomposition progression, as the clothing prevented the use of visual decomposition scoring systems. Weight loss was closely associated with scavenging activity by the Cape grey mongoose (Galerella pulverulenta), with a clear scavenger preference for unclothed carcasses. This suggests that the effect of clothing on decomposition may be better assessed in this environment by examining how scavengers interact with only a single clothed carcass.

Baseline levels of antioxidant activities in Mytilus galloprovincialis along the coast of Cape Town, South Africa

Antioxidant activities in Mytilus galloprovincialis were determined from samples collected at Scarborough, Hout Bay, Green Point, Milnerton and Bloubergstrand in Cape Town, South Africa. Antioxidant enzyme activity was determined by measuring CAT, SOD and GSH. The total antioxidant capacity was measured using FRAP and ORAC, while the content and lipid peroxidation marker levels of CDs and TBARS. Antioxidant activities and responses in mussels varied between sites with significant correlations for 85% and 71% of all antioxidant measurements made for Fe and Zn, respectively. The oxidative stress results reported here are novel for the region and indicated that mussels in Cape Town do not have (relatively) high levels of antioxidant activities as a result of exposure to metals. The research undertaken suggests that antioxidant responses was an appropriate biomarker of exposure to metals but more environmental parameters should be considered when interpreting antioxidant responses in the natural environment.

Forensic taphonomy: Vertebrate scavenging in the temperate southwestern Cape, South Africa

Vertebrate scavenging can significantly accelerate the rate of decomposition, which can hinder estimating the post-mortem interval (PMI). Patterns of decomposition and scavenging are highly specific to different environments in a forensic context, with no known data for South Africa. A better understanding of local decomposition patterns, taking scavenging into account, could increase the accuracy of PMI estimation and improve identification of human remains. Using a porcine model in the forensically significant thicketed Cape Flats Dune Strandveld habitat, the effect of vertebrate scavenging on the decomposition process was examined. This part of Cape Town suffers from poor socioeconomic conditions and a high murder rate, which is due in part to the dense population. Human decomposition was simulated using three small (∼20kg) domestic pig (Sus scrofa domesticus) carcasses, with ethical clearance. One pig served as a control and was caged to prevent vertebrate but not invertebrate access; the other two served as experimental treatments. They were deployed in Delft, Cape Town, and observed by motion-activated, time-lapse remote photography to record scavenger species and activity. A rapid increase in the decomposition rate was observed due to Cape grey mongoose (Galerella pulverulenta) scavenging, with early skeletonisation reached by both experimental pigs by day 14, compared to the control remaining in advanced decomposition after 93 days. Mongoose is the primary scavenger in this habitat, and showed notable patterns of feeding behaviour, exclusively within daylight hours. Scavenging activity was only influenced by rainfall later in the cycle. This research provides knowledge on locally relevant decomposition patterns and highlights the necessity for PMI estimation methods to consider vertebrate scavengers. This may improve human skeletal identification in forensic cases. There is scope for expansion of this study, with an investigation of seasonal effects, the interaction between invertebrate and vertebrate activity, as well as, the effect of clothing on scavenger access.

Forensic taphonomy: Scavenger-induced scattering patterns in the temperate southwestern Cape, South Africa - A first look

The effect of vertebrate scavenging can drastically alter the rate of decomposition and cause skeletal scatter, which hinders human forensic recovery and identification. Patterns of scavenging, disarticulation and scatter in a forensic context are specific to different environments with no known data for South Africa. A better understanding of these patterns can increase the chances of full body recovery and improve identification of human remains. In this preliminary study, the effect of wild vertebrate scavenging on skeletal scatter was examined using a porcine model in the forensically significant thicketed Cape Flats Dune Strandveld habitat. This area is a densely populated part of Cape Town, which suffers from poor socioeconomic conditions and a high murder rate. Ethics was granted for the use of three small (∼20kg) domestic pig (Sus scrofa domesticus) carcasses as proxies for human decomposition. They were deployed in Delft, Cape Town, and observed by motion-activated cameras to record wild scavenger activity. One pig served as a control and was caged to prevent vertebrate but not invertebrate access; the other two served as experimental treatments. Scatter was recorded every second day by marking the location of skeletal elements and measuring the distance and angle from the centre of each deposition site. No scattering was observed in the control, but notable scattering patterns were observed in the experimental pigs due to Cape grey mongoose (Galerella pulverulenta) scavenging, the only vertebrate scavenger species observed. No clear pattern of scatter distance over time was followed. Scatter began in the skeletonisation phase (day 25-30), resulting in a maximum distance of 12.67m and scatter/search area of 504.32m². Mongoose-induced skeletal scatter followed a distinct pattern of movement into dense undergrowth, a previously unobserved behaviour and a key finding of this study. These results provide baseline data for sub-adult human scatter, or scatter of smaller components of an adult human skeleton, as demonstrated in the forensic case example provided. Knowledge is provided on locally relevant decomposition patterns and informs search methods for improved human skeletal recovery in forensic cases. There is scope for expansion of this study, with an investigation of seasonal effects, the interaction between invertebrate and vertebrate activity, as well as, the effect of clothing on scavenger access.

Healthcare workers' beliefs, motivations and behaviours affecting adequate provision of sexual and reproductive healthcare services to adolescents in Cape Town, South Africa: a qualitative study

Background

Adolescents’ sexual and reproductive healthcare (SRH) needs have been prioritized globally, and they have the rights to access and utilize SRH services for their needs. However, adolescents under-utilize SRH services, especially in sub-Saharan Africa. Many factors play a role in the under-utilization of SRH services by adolescents, such as the attitude and behaviour of healthcare workers. The aim of this study therefore, was to explore and gain an in-depth understanding of healthcare workers’ beliefs, motivations and behaviours affecting adequate provision of these services to adolescents in South Africa.

Methods

Twenty-four healthcare workers in public SRH services in Cape Town, South Africa participated in this qualitative study through focus group discussions. To fulfill the aims of this study, nine focus group discussions were conducted among the SRH nurses.

Results

SRH nurses indicated that they are experiencing challenges with the concept and practice of termination of pregnancy. They explained that this practice contradicted their opposing beliefs and values. Some nurses felt that they had insufficient SRH skills, which hinder their provision of adequate SRH services to adolescents, while others described constraints within the health system such as not enough time to provide the necessary care. They also explained having limited access to schools where they can provide SRH education and pregnancy prevention services in the surrounding area.

Conclusions

Nurses are faced with numerous challenges when providing SRH services to adolescents. Providing the nurses with training programmes that emphasize value clarification may help them to separate their personal beliefs and norms from the workplace practice. This may help them to focus on the needs of the adolescent in a way that is beneficial to them. At the health systems level, issues such as clinic operating hours need to be structured such that the time pressure and constraints upon the nurse is relieved.

Electronic supplementary material

The online version of this article (10.1186/s12913-018-2917-0) contains supplementary material, which is available to authorized users.

A descriptive study of treatment provision for problem alcohol drinking in adult males in Khayelitsha, Cape Town, South Africa

BACKGROUND

Poor, Black African males are underrepresented as patients in facilities that treat problem drinking in Cape Town, South Africa. Reasons for this remain unclear, but factors such as the kinds of treatment provided, perceptions of treatment efficacy, social stigma and traditional treatment beliefs have been suggested as possible barriers to treatment seeking. This descriptive study examined the availability and nature of problem drinking treatment facilities in Khayelitsha, a largely poor township of Black, Xhosa-speaking Africans, on the outskirts of Cape Town.

METHODS

Seven treatment facilities for problem drinking in adult males were identified using data from the Department of Social Development in the City of Cape Town. Staff members were identified as key informants at each of the treatment facilities, and were interviewed using a structured questionnaire. Twelve interviews were conducted.

RESULTS

Findings indicated that the available alcohol treatment facilities were relatively new, that treatment modalities varied both across and within treatment facilities, and that treatment was provided largely by social workers. Treatment facilities did not accommodate overnight stay for patients, operated during weekday office hours, and commonly referred patients to the same psychiatric hospital.

DISCUSSION

The study provides a baseline for assessing barriers to treatment for problem drinking in Khayelitsha by highlighting the nature of available facilities as playing a predominantly screening role with associated social work services, and a point of referral for admission to a psychiatric institution for treatment. The social and financial implications of such referral are pertinent to the discussion of treatment barriers.

CONCLUSIONS

Recommendations are made to inform policy towards locally-provided integrated care to improve treatment provision and access.

Local responses to global sustainability agendas: learning from experimenting with the urban sustainable development goal in Cape Town

The success of the Sustainable Development Goal 11 (SDG 11) depends on the availability and accessibility of robust data, as well as the reconfiguration of governance systems that can catalyse urban transformation. Given the uneven success of the Millennium Development Goals, and the unprecedented inclusion of the urban in the SDG process, the feasibility of SDG 11 was assessed in advance of its ratification through a series of urban experiments. This paper focusses on Cape Town's participation in piloting SDG 11, in order to explore the role of urban experimentation in highlighting the partnership arrangements necessary to allow cities to meet the data and governance challenges presented by the SDG 11. Specifically, we focus on the relationship between data and governance that lie at the heart of the SDG 11. The urban experiment demonstrates the highly complex and multi-level governance dynamics that shape the way urban experiments are initiated, executed and concluded. The implications of these dependencies illustrate that more attention needs to be paid at the global level to what data are important and how and where the data are generated if SDG 11 is to be met. Overall, this paper makes the case that the success of SDG 11 rests on effecting local level change and enabling real opportunities in cities.

Exploring urban health in Cape Town, South Africa: an interdisciplinary analysis of secondary data

BACKGROUND

With modern information technology, an overwhelming amount of data is available on different aspects of societies. Our research investigated the feasibility of using secondary data sources to get an overview of determinants of health and health outcomes in different population strata of Cape Town, a large city of South Africa.

METHODS

The methodological approach of secondary-data analysis was similar in the different disciplines: Biological Anthropology, Public Health, Environmental Health, Mental Health, Palliative Care, Medical Psychology and Sociology at the University of Freiburg and Public Health at the University of Cape Town. The teams collected information on Cape Town through Internet searches and published articles. The information was extracted, analyzed, condensed, and jointly interpreted.

RESULTS

Data show the typical picture of a population in epidemiological and demographic transition exposed to often difficult social, mental, and physical environmental conditions. Comparison between low and higher socioeconomic districts demonstrated that the former had higher air pollution, poorer water quality, and deficient sanitary conditions in addition to sub-optimal mental health services and palliative care.

CONCLUSION

Although important information gaps were identified, the data draw attention to critical public health interventions required in poor health districts, and to motivate for pro-equity policies.

Campylobacter jejuni Isolation/Enumeration from Environmental Samples

Currently, there is no universally accepted standard media or method for the recovery of Campylobacter species. This is likely due to the ubiquity of the organism in nature, the complex sample matrices from which the organism is often recovered, as well as the fragile/viable-but nonculturable state the organism assumes in response to stress. The use of a sterile filter placed upon a nonselective Brucella Agar Blood Plate (BAB), followed by incubation at 37 °C in a hydrogen-containing atmosphere (Campycheck), is one method to recover stressed and emerging Campylobacter spp. from complex environmental matrices; however, this technique does not currently allow for the enumeration of the recovered organisms. Enumeration is performed using serial dilutions of sample homogenate plated onto modified Campy-Cefex media followed by incubation at either 37 °C or 42 °C in a microaerobic atmosphere.

Making unhealthy places: The built environment and non-communicable diseases in Khayelitsha, Cape Town

In this paper, we examine how economic, social and political forces impact on NCDs in Khayelitsha (a predominantly low income area in Cape Town, South Africa) through their shaping of the built environment. The paper draws on literature reviews and ethnographic fieldwork undertaken in Khayelitsha. The three main pathways through which the built environment of the area impacts on NCDs are through a complex food environment in which it is difficult to achieve food security, an environment that is not conducive to safe physical activity, and high levels of depression and stress (linked to, amongst other factors, poverty, crime and fear of crime). All of these factors are at least partially linked to the isolated, segregated and monofunctional nature of Khayelitsha. The paper highlights that in order to effectively address urban health challenges, we need to understand how economic, social and political forces impact on NCDs through the way they shape built environments.

Tuberculosis in Cape Town: An age-structured transmission model

BACKGROUND

Tuberculosis (TB) is the leading cause of death in South Africa. The burden of disease varies by age, with peaks in TB notification rates in the HIV-negative population at ages 0-5, 20-24, and 45-49 years. There is little variation between age groups in the rates in the HIV-positive population. The drivers of this age pattern remain unknown.

METHODS

We developed an age-structured simulation model of Mycobacterium tuberculosis (Mtb) transmission in Cape Town, South Africa. We considered five states of TB progression: susceptible, infected (latent TB), active TB, treated TB, and treatment default. Latently infected individuals could be re-infected; a previous Mtb infection slowed progression to active disease. We further considered three states of HIV progression: HIV negative, HIV positive, on antiretroviral therapy. To parameterize the model, we analysed treatment outcomes from the Cape Town electronic TB register, social mixing patterns from a Cape Town community and used literature estimates for other parameters. To investigate the main drivers behind the age patterns, we conducted sensitivity analyses on all parameters related to the age structure.

RESULTS

The model replicated the age patterns in HIV-negative TB notification rates of Cape Town in 2009. Simulated TB notification rate in HIV-negative patients was 1000/100,000 person-years (pyrs) in children aged <5 years and decreased to 51/100,000 in children 5-15 years. The peak in early adulthood occurred at 25-29 years (463/100,000 pyrs). After a subsequent decline, simulated TB notification rates gradually increased from the age of 30 years. Sensitivity analyses showed that the dip after the early adult peak was due to the protective effect of latent TB and that retreatment TB was mainly responsible for the rise in TB notification rates from the age of 30 years.

CONCLUSION

The protective effect of a first latent infection on subsequent infections and the faster progression in previously treated patients are the key determinants of the age-structure of TB notification rates in Cape Town.

Making unhealthy places: The built environment and non-communicable diseases in Khayelitsha, Cape Town

In this paper, we examine how economic, social and political forces impact on NCDs in Khayelitsha (a predominantly low income area in Cape Town, South Africa) through their shaping of the built environment. The paper draws on literature reviews and ethnographic fieldwork undertaken in Khayelitsha. The three main pathways through which the built environment of the area impacts on NCDs are through a complex food environment in which it is difficult to achieve food security, an environment that is not conducive to safe physical activity, and high levels of depression and stress (linked to, amongst other factors, poverty, crime and fear of crime). All of these factors are at least partially linked to the isolated, segregated and monofunctional nature of Khayelitsha. The paper highlights that in order to effectively address urban health challenges, we need to understand how economic, social and political forces impact on NCDs through the way they shape built environments.

Intentional injury and violence in Cape Town, South Africa: an epidemiological analysis of trauma admissions data

Background

Injury is a truly global health issue that has enormous societal and economic consequences in all countries. Interpersonal violence is now widely recognized as important global public health issues that can be addressed through evidence-based interventions. In South Africa, as in many low- and middle-income countries (LMIC), a lack of ongoing, systematic injury surveillance has limited the ability to characterize the burden of violence-related injury and to develop prevention programmes.

Objective

To describe the profile of trauma presenting to the trauma centre of Groote Schuur Hospital in Cape Town, South Africa – relating to interpersonal violence, using data collected from a newly implemented surveillance system. Particular emphasis was placed on temporal aspects of injury epidemiology, as well as age and sex differentiation.

Design

Data were collected prospectively using a standardized trauma admissions form for all patients presenting to the trauma centre. An epidemiological analysis was conducted on 16 months of data collected from June 2010 to October 2011.

Results

A total of 8445 patients were included in the analysis, in which the majority were violence-related. Specifically, 35% of records included violent trauma and, of those, 75% of victims were male. There was a clear temporal pattern: a greater proportion of intentional injuries occur during the night, while unintentional injury peaks late in the afternoon. In total, two-third of all intentional trauma is inflicted on the weekends, as is 60% of unintentional trauma. Where alcohol was recorded in the record, 72% of cases involved intentional injury. Sex was again a key factor as over 80% of all records involving alcohol or substance abuse were associated with males. The findings highlighted the association between violence, young males, substance use, and weekends.

Conclusions

This study provides the basis for evidence-based interventions to reduce the burden of intentional injury. Furthermore, it demonstrates the value of locally appropriate, ongoing, systematic public health surveillance in LMIC.

An analysis of historical Mussel Watch Programme data from the west coast of the Cape Peninsula, Cape Town

The concentrations of metals in the mussel Mytilus galloprovincialis (Lamarck, 1819) prevalent along the west coast of the Cape Peninsula, Cape Town are presented. The mussels were sampled during the routine "Mussel Watch Programme" (MWP) between 1985 and 2008. Levels of Cu, Cd, Pb, Zn, Hg, Fe and Mn at Cape Point, Hout Bay, Sea Point, Milnerton and Bloubergstrand were analysed for autumn and spring and showed consistent similar mean values for the five sites. There was a highly significant temporal (annual and seasonal) difference between all metals as well as a significant difference in metal concentrations between the five sites. The concentrations of Zn, Fe, Cd and Pb were higher than previous investigations and possibly indicative of anthropogenic sources of metals. The results provide a strong motivation to increase efforts in marine pollution research in the area.