Estimating the changing burden of disease attributable to interpersonal violence in South Africa for 2000, 2006 and 2012

Abstract


 
 
 
 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.
 
 
 

South Africa’s male homicide epidemic hiding in plain sight: exploring sex differences and patterns in homicide risk in a retrospective descriptive study of postmortem investigations

“…gastrointestinal, gynaecological and fatigue-related), absenteeism and loss of work - and, moreover, is a major impediment to social development. (31,32) Yet despite its importance among major causes of injury, there is no sense of urgency about addressing violence as a structural issue, and interventions and policies to reduce population-level homicide have been ineffective.…”

Patterns of on‐scene and healthcare system trauma deaths in the Western Cape of South Africa

“…Due to the high fatality rates associated with gunshot and stab wounds, multifaceted violence prevention strategies are urgently needed in the Western Cape. 6,29,30 Urban upgrading through infrastructural intervention has been shown to reduce the risk of interpersonal violence in the poorest and most violent townships of Cape Town. 31 Alcohol-ban initiatives have shown promise in reducing trauma admissions from interpersonal violence.…”

Overview

“…[21] • SA included HPV vaccination for girls in Grade 4 in the national vaccination programme in 2014 [46] but needs to increase the coverage [47] and urgently review the cervical cancer screening and treatment programme in light of the WHO goal to eliminate cervical cancer by the year 2030. [48] 2 Interpersonal violence [33] • The age-standardised attributable death rates for interpersonal violence decreased from 100 to 71 per 100 000 population between 2000 and 2012.…”

“…[30] In cases where the characteristics of the exposure and/or the availability of data made the meta-regression approach unsuitable or unnecessary (namely for low physical activity, childhood undernutrition, interpersonal violence, household air pollution, and unsafe water, sanitation and hygiene) we recovered the estimates of interest directly from data collected on, or close to, the reference years. [31][32][33][34][35] For the estimation of concentrations of ambient air pollution (particulate matter with an aerodynamic diameter ≤2.5 µm (PM 2.5 ) and ozone) in 2012, we employed a regionally optimised fully coupled climate-chemistry model along with locally informed model forcing datasets. [36] Fine-scale regional models allow for the generation of more realistic small-scale climate information, chemical processes and patterns compared with global coarseresolution models.…”

“…The detailed evaluation of each risk factor and the quantification of the resultant attributable burden [19][20][21][22][23][24][25][26][27][31][32][33][34][35][36] revealed insights into trends. Key observations for each risk factor are summarised in Table 3.…”