Browsing by Author "Matzopoulos, Richard"

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    Alcohol as a risk factor for train commuting fatalities
    (2001) Matzopoulos, Richard; Peden, Margie; Bradshaw, Debbie
    Railway fatalities are an important subset of transport-related fatalities, which account for about 60% of the fatal unintentional injuries occurring in Cape Town. The Medical Research Council reviewed three and a half years of rail injury data and found that alcohol was one of the main risk factors. Furthermore, 33% of South Africa’s national rail fatalities tested positive for alcohol in 1999. Despite the links between alcohol and all types of transport- related injury, prevention efforts have targeted motor vehicle (MV) drivers exclusively. This study aimed to clarify the relationship between alcohol and the risk of all types of transport-related injury (particularly rail injury). Post mortem reports for transport fatalities were collected retrospectively from the two cape Town mortuaries at Salt River and Tygerberg for the period 1 January 1994 to 31 December 1996. A case control study design was used with the cases comprising rail passenger and rail pedestrian fatalities, while motor vehicle drivers and passengers were the controls for the passenger group and motor vehicle pedestrians were the controls for rail pedestrians. Blood alcohol concentration was the dependent variable, the independent variables were age, sex, race, date of death, day of week, time of injury and mechanism of death and the odds ratio was used as the measure of relative risk The study showed that alcohol consumption is an important risk-factor for rail fatalities. The odds ratios imply that rail passengers are 5.23 or 2.3 times as likely to be intoxicated than motor vehicle passengers or motor vehicle drivers respectively, while rail pedestrians are 1.44 times more likely to be intoxicated than motor vehicle pedestrian fatalities. Alcohol plays as important a role, if not more so, for drunken rail passengers and pedestrians as it does for drunken drivers and road pedestrians. The role of alcohol in rail pedestrian fatalities is significant when compared to motor-vehicle pedestrians as a control group. The study has also demonstrated that data provided by the National injury Mortality Surveillance System can form the basis for analytic studies on the risk-factors of injury. The results complement a growing body of research that documents the adverse health effects of excessive alcohol consumption and provide more evidence for public health campaigners to tackle endemic alcohol abuse in South Africa.
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    Alcohol policy and regulation: public opinion amongst young adults in Khayelitsha, South Africa
    (2016) Ferrell, Britany; Matzopoulos, Richard; Saban, Amina
    South Africa has one of the highest rates of alcohol consumption in the world. It is important to study public opinion of alcohol regulatory policies as it plays a crucial role in the success of policy measures. There is a dearth of research on public opinion of alcohol policies in developing countries. This study is the first to explore public opinion of older and young adults on alcohol policy in South Africa. In addition, the drinking behavior of young adults was also investigated along with its relationship with policy support. Methods: The study sample consisted of 1728 young (n=513) and older adults (n=1215). Demographic details and opinion on 15 policy measures (Yes/No) were recorded for both groups. The survey of young adults included additional questions on drinking patterns. Univariate analysis of opinion on policy measures was performed for each group and compared using chi-square tests. Logistic regression was used to find the relationship between policy support levels and demographic factors and drinking behavior of young adults. Results: Complete data were recorded for 567 older adults and 402 younger adults. The majority of the participants (75-80 percent) agreed on restricted availability, increased pricing and greater enforcement measures. In contrast, only 65% of the participants were in favor of increased restrictions on alcohol marketing. Older adults were more supportive of earlier closing times of bars, a raise in minimum purchasing age, as well as an increase in pricing and taxes of alcohol (p<0.001). Females and employed participants were found to be more likely to support alcohol policy measures. Drinking patterns and behavior of young adults significantly predicted most policy measures after controlling for demographic factors. For example, policies on restricted alcohol availability, increase in taxes, and raids were supported by participants who reported that they mostly drank at big events. In contrast, these policies were opposed by those who drink alcohol every day and almost every day along with those who drink during street bashes Support for restrictions on the purchase age of alcohol was not predicted by drinking patterns of young adults Conclusion: It is important to increase the understanding and support of vulnerable groups, especially males and young adults, for policy measures. The relationship between drinking patterns and policy support levels indicates that regular tracking of drinking behavior is necessary for the success of these policies. The results support previous findings indicating that young people are more likely to resist alcohol regulations.
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    Assessing quality of existing data sources on road traffic injuries (RTIs) and their utility in informing injury prevention in the Western Cape Province, South Africa
    (2011) Chokotho, Linda Carolyn; Matzopoulos, Richard; Myers, Jonny
    The aim of this study was to assess whether the quality of the RTI data collected by the South African Police Service (SAPS) and mortuaries was sufficient for determining the burden of RTIs in the Western Cape province, and for implementing and monitoring road safety interventions.
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    The body count : using routine mortality surveillance data to drive violence prevention
    (2012) Matzopoulos, Richard; Myers, J E; Thompson, Mary Lou
    This thesis describes the conceptualisation, development and implementation of a mortuary-based system for the routine collection of information about homicide. It traces the evolution of the system from its conceptualisation in 1994, through various iterations as a city-level research tool, to a national sentinel system pilot, as a multicity all-injury surveillance system, and finally its institutionalisation as a provincial injury mortality surveillance system in the Western Cape. In so doing, it demonstrates that the data arising from medico-legal post-mortem investigations described in this thesis were an important source of descriptive epidemiological information on homicide. The 37,037 homicide records described in the thesis were drawn from Cape Town, Durban, Johannesburg, Port Elizabeth and Pretoria, for which the surveillance system maintained full coverage from 2001 to 2005. The aim was to apply more complex statistical analysis and modelling than had been applied previously.
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    COVID-19 alcohol availability and suicide rates in South Africa
    (2024) Hodgson, Anthony; Matzopoulos, Richard
    Investigations into COVID-19 and suicide have predominantly found no significant evidence of increased suicide rates, but few studies have been conducted in low- and middle-income countries and none in Sub-Saharan Africa. We used data from two nationally representative surveys of post-mortem investigations to estimate changes in suicide rates in South Africa associated with the COVID-19 pandemic and related events. We specifically explored variance in suicide rates coinciding with lockdown stages and periods of alcohol prohibition. We found no significant differences between suicide rates during the pandemic period (April 2020 to March 2021) compared to the prior survey period of 2017, but significant variation within the pandemic period. Periods of alcohol prohibition were protective with an estimated 5.82 [5.78, 5.86] fewer suicide deaths per day compared to periods of no or partial alcohol restriction. This constituted a 30% decrease in expected suicides under normal trading conditions. Cessation of alcohol prohibition had a negative effect and suicide rates during periods of no or partial alcohol restriction were significantly higher than in 2017. We conclude that in South Africa the observed null effect of the COVID-19 pandemic on annual suicide rates masks considerable temporal variation associated with restrictions, and periods of alcohol prohibition in particular.
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    Early life lead exposure as a risk factor for aggressive and violent behaviours in young adults: A retrospective systematic review
    (2020) Obamuyide, Henry; Matzopoulos, Richard; Kredo,Tamara
    Over 1.3 million individuals die each year from preventable violence. Many of these violent acts are perpetrated by youths. Despite several initiatives, the prevalence of youth violence remains high. Early life lead exposure is a possible cause of aggressive and violent behaviour in young adults. Several aggregate-level and individual-level studies report an increase in risk of violent behaviour with increasing lead exposure. However, the evidence base for the role of lead in violence is conflicting as many other studies did not support this claim. No systematic synthesis of current evidence at the individual level exists to critically assess this association. Therefore, we planned to conduct a systematic review and meta-analysis of studies examining the relationship between lead exposure in early life and the later development of aggressive and violent behaviour in young adulthood at the individual level. Extensive literature searches, including of grey literature, were performed to identify potentially relevant articles. Studies for inclusion were screened by two reviewers and selected using pilot-tested eligibility form. The two reviewers independently assessed risk of bias and carried out data extraction before analysis. A systematic review and meta-analysis of currently available evidence was carried out. Searches were conducted between September 2019 and October 2019. We identified a total of 2182 reports, out of which six studies in 7 publications were eligible. All of the studies were conducted in high income countries, though a few recruited participants from low-income communities. There were varying definitions of violence, ranging from very narrow to wide and the outcomes were measured as either a count or binary variable. Despite the diversity in study settings, the direction of findings was remarkably homogenous. For studies reporting dichotomous variable, the odds of being arrested or convicted for violent behaviour increases with increasing blood lead level (OR 1.13 to 1.16 with each 5µg/dl rise in blood lead) after controlling for other variables. For the studies reporting count outcome, blood lead may explain up to 63% of the variability in arrest or conviction rates after adjusting for co-variates (IRR for each 5µg/dl rise in blood lead level:1.1 to 1.13). Overall, using a random-effect model with restricted maximum likelihood estimation method, blood lead was associated with a higher risk of exhibiting violent behaviour (OR 1.16; 95% CI 1.10 – 1.23). There was insufficient data to perform sensitivity analyses based on study design, quality of studies or conduct a dose response meta-analysis. We found that an increased exposure to lead in childhood is associated with a higher risk of being arrested or convicted for violent behaviour in young adulthood. In this context, environmental lead control may help to reduce the prevalence of aggressive and violent behaviour in young adults and should be integrated into violence prevention strategies. Despite the ubiquity of environmental lead, the importance of violence as a public health and social concern and the considerable debate their association has generated, we found very few good quality studies that reported enough methodological detail for evidence synthesis. More studies with better quality and from different settings need to be conducted.
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    The effect of the Violence Prevention through Urban Upgrading (VPUU) intervention on violence-related injuries presenting to health facilities in Khayelitsha and Nyanga
    (2016) Trupe, Lydia; Matzopoulos, Richard; Bloch, Kimberly
    Background: Violence is one of the leading causes of morbidity and mortality in South Africa's Western Cape province. Recent efforts, both globally and locally, have focused on using emergency room surveillance systems to collect data on violent injuries and to use these data to inform comprehensive, sustainable interventions such as urban upgrading. Drawing on insights from criminology, these urban upgrading interventions have sought to use environmental design to ameliorate socio-ecological factors related to violence. Objective: To use injury surveillance data in order to describe the pattern of violent injuries presenting to health facilities in the communities of Khayelitsha and Nyanga and to assess the effect of the Violence Prevention through Urban Upgrading programme (VPUU) on risk of violent non-fatal injury in these two areas. Methods: We conducted a case-control study using data from a series of semi-annual rapid assessments to compare violent and non-violent injuries in adults presenting to five heath facilities in Khayelitsha and Nyanga between September 2013 and October 2015. Multivariable logistic regression was used to assess the risk of violent injury with respect to demographic and behavioural characteristics and exposure to the VPUU intervention. Results: Multivariable analysis of 1,753 complete cases revealed that living in a VPUU intervention area was protective against presentation for violent injury when controlling for other risk factors (OR=0.75, p=0.022). Age, gender, race, and alcohol consumption were also found to be significantly associated with presentation for violent injury. There was a statistically significant interaction effect between alcohol and gender; the association between alcohol consumption and violent injury was stronger in women than in men. Conclusion: This study highlights the demographic and behavioural factors associated with violent injury and provides preliminary evidence of the reduction of violent injury risk in VPUU intervention areas.
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    Estimating injury mortality in South Africa and identifying urban-rural differences
    (2019) Prinsloo, Megan; Myers, Jonathan; Bradshaw, Debbie; Matzopoulos, Richard
    The overarching aim of this thesis is to utilise national data on injury mortality in South Africa, to conduct advanced statistical analyses to identify urban-rural differences for injury deaths, and to gain insight into the explanatory variables for homicide in metropolitan- and non-metropolitan (metro- and non-metro) areas. The literature review describes the global and national estimates of injury mortality and reports higher rural than urban injury mortality rates for high-income countries. It further discusses a framework for assessing data quality and reviews South Africa’s fatal and non-fatal injury data sources, issues of under-reporting and misclassification of deaths. The risk factors for violence are reviewed, which inform particular hypotheses on the role of age, sex, race, day of week and firearms with regard to homicide. The Injury Mortality Survey (IMS) data, which estimated 52 493 injury deaths nationally in 2009, is utilised for this PhD study. Data quality is assessed using an internationally developed conceptual framework for mortality data. Exploratory and multiple correspondence analysis identified possible associations between metro/nonmetro and other explanatory variables, prior to more sophisticated multinomial logistic regression analysis, which adjusted for age, sex, race and metro/non-metro for each manner of death (homicide, suicide, transport-related and other unintentional injury deaths) to explore particular hypotheses for the differences in the metro/non-metro injury mortality profile. Age-standardised injury mortality rates were calculated to take into account the effects of different age structures for metro- and non-metro populations. Generalized linear models were fitted in relation to particular hypotheses to determine the explanatory variables for homicide deaths in both metro and nonmetro areas. Main findings include a significantly higher likelihood for homicide in metro areas compared to non-metro areas, while transport-related deaths were significantly lower in metro areas. The risk of homicide for Coloureds was higher than Blacks in metro areas, while Blacks, Coloureds and Asians had similar risks of homicide in non- metro areas. Whites had a similar risk and Asians a higher risk of homicide in nonmetro areas compared with metro areas. Firearm use was shown to significantly explain metro/non-metro differences in homicide risks. This study’s most significant knowledge contribution includes the identification of metro/non-metro as a significant predictor of the injury mortality profile in South Africa. The association of metro/non-metro differences in the pattern of homicide for Blacks and Coloureds, also resolved conflicting statements found in the literature regarding race and homicide in South Africa. The results are of considerable significance to national and provincial policy makers. Recommendations are made in relation to the main findings of this study.
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    My name is South Africa and I have a drinking a problem: a multicentre quasi-experimental analysis on alcohol regulation and injury presentations to emergency centres.
    (2023) Ismail, Muzzammil; Matzopoulos, Richard; Davies Mary-Ann
    Background The South African COVID-19 experience included several national regulatory changes to manage the additional demand placed on the healthcare platform. Since alcohol-related injury contributes a significant acute healthcare burden in South Africa, regulations to limit alcohol availability were also instituted. In this study we aimed to determine the impact of changing alcohol regulations (full availability, partial availability, and a complete ban on alcohol sales), across three time periods, on injury presentations to emergency centres in the Western Cape, South Africa using a quasi-experimental interrupted time series (ITS) design. Methods The study population included all patients who presented to a public sector emergency centre in the Western Cape with injury identified by a trained nurse on triage and identified by an emergency centre clinician by final ICD-10 code in facilities using routine real time electronic capture of emergency centre visits. Since the study design was a quasi-experimental ITS, we used an autoregressive integrated moving average (ARIMA) model with the level and slope of the model in the pre-intervention period being the counterfactual against the observed actual post-intervention level and slope. The primary outcome was the relative percent increase or decrease in the level and slope of injury presentations. Findings A total of 31,151 injury patients across the three periods were included in the analyses. A shift from full availability to partial (Monday to Thursday) retail alcohol availability resulted in an overall step reduction in daily injury presentations of 29·0% (absolute reduction [95% CI]: -71·7 [-102·9, -40·4]). A shift from partial to a complete ban resulted in a further step reduction of 26·2% in daily injury presentations (absolute reduction [95% CI]: -4·5 [20·6, -8·4]). This impact was consistent in terms of direction but ranged in magnitude across various sub-populations. Interpretation Our findings reflect the considerable impact of alcohol regulation on injury presentations to emergency centres. Partial retail alcohol restrictions, particularly in the South African context, could be considered for longer term, sustainable alcohol regulation policies to reduce the considerable burden of injuries on health services and society.
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    Strengthening public health in South Africa: building a stronger evidence base for improving the health of the nation
    (2007) Bradshaw, Debbie; Norman, Rosana; Lewin, Simon; Joubert, Jané; Schneider, Michelle; Nannan, Nadine; Groenewald, Pam; Laubscher, Ria; Matzopoulos, Richard; Nojilana, Beatrice; Pieterse, Desiréé; Steyn, Krisela
    An assessment of the relative burden attributable to selected risk factors provides an important evidence base for prioritising risk factors that should be targeted for public health interventions. Selecting interventions should be based on a robust and transparent process of scientific evaluations of their effectiveness, as well as assessment of their cost effectiveness, local applicability and appropriateness, and likely effects on health inequalities. Establishing such an evidence base is an ongoing process that is still at an early stage in South Africa. A recent review of disease control priorities for developing countries (DCPP) examined the global evidence regarding the effectiveness of interventions for major health burdens. Despite acknowledging the lack of intervention trials in developing countries, this DCPP review provides a unique resource for identifying interventions that might be useful in South Africa.
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    Substance abuse programs that reduce violence in a youth population : systematic review
    (2013) Jabar, Ardil; Matzopoulos, Richard
    The systematic review undertaken for this MPH dissertation examines the existing evidence for youth violence interventions involving substance abuse intervention programs. Part A is the review protocol which outlines the background and process of the review. Search strategies combined related terms for youth, violence and a broad combination of terms for the intervention. Inclusion criteria were broad enough to include a wide range of study designs, given the large heterogeneity of outcomes and the paucity of randomised controlled trials (RCTs). Abstracts were screened by two reviewers, as were selected full texts articles. These were evaluated using the EPHPP questionnaire, a quantitative study assessment tool to identify methodological issues.
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    The Cape Town Violence and Injury Observatory (VIO) Validity and utility of data sources for a prevention-oriented VIO in urban Cape Town, South Africa
    (2021) Jabar, Ardil; Matzopoulos, Richard; London, Leslie; Engel, Mark; Oni, Tolullah
    Background The Cardiff model purports that the true burden of violence within a community can only be quantified by the addition of violence-related data from health services to violence data reported to the police. This thesis describes the conceptualisation, development and implementation of a violence and injury observatory for the routine collection of violence-related data for the City of Cape Town. The observatory model, which was conceptualised in the early 1990s in Colombia, has gone through various iterations as a municipality-level research tool, to a city-level tool and thereafter as a national and transnational tool. Aims of this thesis The thesis aimed to assess the utility of clinical and non-clinical data sources in constituting a prevention-oriented violence and injury observatory (VIO) in urban Cape Town, South Africa. The specific objectives of each study component were as follows: • To describe the objectives of the pilot VIO, potential violence-related datasets for collection, data analysis and research dissemination plan (Study One) • To assess the validity and utility of VIOs in reducing violence and violencerelated harms in adult populations (Study Two) • To identify the optimal data elements for inclusion in a VIO according to expert consensus (Study Three) • To determine the concordance between violent crimes reported to the police with violence-related injuries presenting at health facilities in Khayelitsha (Study Four). Methods The systematic review method was used to determine whether the introduction of violence and injury observatories was associated with a reduction in violence in adult populations (Study Two). A modified two-round Delphi study (Study Three) determined the optimal data elements (including violence and injury indicators, datasets and research priorities) for inclusion in a pilot violence and injury observatory in Cape Town. The Delphi panel of 21 participants included one Provincial Head of Emergency Medicine, one Provincial Head of Disaster Medicine, several Heads of Department of Emergency Medicine across hospitals in Cape Town, and representatives from relevant data stakeholders, including the Forensic Pathology Services (FPS), South African Police Services (SAPS), Health Systems Trust (HST) and the Violence Prevention through Urban Upgrading (VPUU). This was to ensure that decisions were made by persons in senior posts to facilitate subsequent implementation of the recommendations. Khayelitsha, a peri-urban mixed informal township of Cape Town, was the setting for the final study (Study Four), which included a retrospective analysis of secondary cross-sectional health and police data, from three health facilities and three police stations in the community of Khayelitsha, Cape Town. A case-matching study, using personal identifier matching, was employed to determine the concordance between reports of violent crimes to police stations with reports of injuries arising from interpersonal violence at health facilities within the community of Khayelitsha in Cape Town, South Africa. Results and Discussion Subgroup analyses according to the two types of models implemented in the systematic review (Study Two), namely, the VIO and the injury surveillance system (ISS), provided evidence for an association between the implementation of the VIO model and a reduction in homicide count in high-violence settings (incidence rate ratio [IRR]=0.06; 95% CI 0.02 to 0.19; four studies), while the introduction of ISS showed significant results in reducing assault (IRR=0.80; 95% CI 0.71 to 0.91; three studies). Following expert consultation through a Delphi process (Study Three), this study identified 14 violence and injury indicators and 12 violence-related datasets for inclusion in the pilot VIO. Additionally, research priorities within 16 research themes across five different types of violence were identified including: elder abuse, youth violence, intimate partner violence, sexual violence, and armed violence. Key findings from these thematic priorities included: (1) formal methods to define and measure violence, identification of violence-related risk factors; (2) evaluation of the effectiveness of promising programmes that target violence-related risk factors; and (3) evidence-based recommendations on scaling up programmes that were shown to be effective in reducing interpersonal violence. With regard to the key findings around data sharing, the majority of the panelists (>55%) thought that: (1) violence-related data from health services should be shared with Policing Services; (2) the data model employed should go beyond the Cardiff model (policing and health data) and also include violence-related data from the Fire and Rescue Services (FARS) and the Emergency Medical Services (EMS); and (3) the functions of a local observatory should include a civilian spatial data observatory, an information technology division, a predictive analytics division, a historical data repository and a systematic review repository. The expert-identified violence and injury indicators, datasets and research priorities provide a research framework for interpersonal violence and injury prevention work within South Africa. The findings have theoretical implications and build up evidence-based data for the general field, and they have a practical outcome in recommendations that are both general and specific for implementation in South Africa. They may also serve to guide the development of additional VIOs locally. In the final study (Study Four), with regard to concordance between the datasets, among the 708 patients being treated for violence-related injuries at health facilities, only 104 reported the incident to the police which equates to a matching ratio of 14.7%. Combining health and police data revealed an 81.7% increase in potential total violent crimes over the reporting period. Compared to incidents reported to the police, those not reported were more likely to involve male patients (difference: +47.0%; p< 0.001), and sharp object injuries (difference: +24.7%; p< 0.001) and less likely to report blunt trauma i.e., push/kick/punch injuries (difference: -17.5%; p< 0.001). These findings suggest that the majority of injuries arising from interpersonal violence presenting at health facilities in Khayelitsha are not reported to the police. Conclusion This research provides an evidence-based model for the development and implementation of a VIO, and the Cardiff model, to reduce interpersonal violence. It is supported by the evidence from the systematic review of the effectiveness of VIOs in reducing violence outcomes among adults in high-violence settings. This pilot VIO represents the first attempt to collect contemporary and comprehensive data on violence and injury in the Western Cape Province and South Africa. The implementation of VIOs should be considered in high-violence communities where the collation and integration of violence-related data and violence stakeholders, may guide violence reduction. The Delphi study provided indicators, datasets and research priorities to (1) inform the basic research infrastructure of a VIO, and (2) serve as part of a regional standardised data collection framework to guide the development of other local violence and injury observatories. This is consistent with the aims of the South African National Development Plan 2030 to ‘improve the health information system; to prevent and reduce the disease burden and promote health and to improve quality by using evidence'. Finally, the research further shows a clear benefit in combining data on violence from different settings as demonstrated in our analysis of data in the Cape Town suburb of Khayelitsha, where the overwhelming majority of injuries arising from interpersonal violence presenting at health facilities in Khayelitsha are not reported to the police. This study has broader implications regionally and nationally for the surveillance of injuries arising from interpersonal violence, for the police definition and surveillance of community interpersonal violence, for community policing intelligence development (improving the configuration of violence heat maps on a real time basis) and finally for police resource utilisation and distribution, which should, in turn, impact positively on reducing crime and violence in the community, and reduce the burden on the health services. The Western Cape Safety Plan, a policy document developed by the Western Cape Government, advocates the use of data and technology to understand violent crime patterns to inform the deployment of law enforcement resources and investigators accordingly and furthermore acknowledges research and analysis as an important component of its evidence-based policing (EBP) strategy. The policy document and study findings provide support to the implementation of the Cardiff Model locally.
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    The impact of alcohol-related risk-taking behaviour on younger driver deaths in the Western Cape Province: a retrospective cross-sectional study
    (2021) Gerber, Carmen; Matzopoulos, Richard; Prinsloo, Megan
    Drunk driving is a public health threat, endangering the lives of all road users. Younger drivers are inclined to engage in risk-taking behaviour, such as drunk driving with BAC levels exceeding the legal limit. The prevalence of drunk driving in the country has increased among the youth, with children starting to drink alcohol under the age of 13 year in the country. In the Western Cape province, alcohol consumption and risk-taking behaviour were prevalent among school-going children. Younger drivers (15 to 19 years) had the highest driver mortality rates per registered driver, compared to older drivers in the province. Graduated driver license (GDL) programmes provide a supervised learning opportunity for younger drivers to gain driving skills and include a zero-alcohol tolerance restriction. The usefulness of implementing a GDL programme in the country needs to be explored. It is therefore important to understand the impact of alcohol-related risk-taking behaviour among younger drivers. This retrospective cross-sectional study measured alcohol-attributable crash risk by age and sex, from a sample of 921 driver fatalities from Western Cape mortuary records (2009 to 2011). Poisson regression was used to ascertain whether the mortality risk profile for young drivers was differentially affected by alcohol. Female drivers aged 15 to 24 years with zero or low BAC levels (<0.05 g/100ml) were the reference category. Statistical significance was set at p< 0.05. The median age for all driver deaths in the sample was 37 years (IQR 27-49), with 820 males representing 89% of the sample. BAC levels tested among 351 driver fatalities represented 38.1% of the study sample. The median BAC level among all tested driver deaths was zero, with more than half of the sample having BAC levels less than 0.05 g/100ml. The median age for 150 driver deaths with BAC levels ≥ 0.05 g/100ml, was 32.5 years (IQR 26–42). Among 140 male driver deaths testing positive for alcohol, the median BAC level was 0.18 (IQR 0.13- 0.23) and among ten female drivers 0.2 g/100ml (0.11-0.21). Male drivers were five times more likely to die from a fatal alcohol-related crash (IRR 5.02; p< 0.001; 95% CI: 3.86-6.53). The relative mortality rate was highest among drivers aged 25 to 34 years (IRR 1.54; 95%CI 1.43-1.66; p< 0.001). The findings from this study highlights the need for continued and improved BAC surveillance and indicates the need for the broader application of alcohol interventions and development of a GDL programme.
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    The role of rural electrification in promoting health in South Africa: Medical Research Council
    (1997) Ross, Fiona; Matzopoulos, Richard; Phillips Rozett
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    Violence, alcohol and symptoms of depression and in Cape Town's poorest communities: results of a community survey
    (2018-04-20) Cassidy, Tali; Lloyd, Sam; Bowman, Brett; Myers, J E; Parry, Charles; Makanga, Tatenda; Corrigall, Joanne; Thompson, Mary Lou; Matzopoulos, Richard
    Introduction This paper summarises key findings from the first of three household surveys conducted in three high-violence areas in the Cape Town, investigating community members’ experiences of alcohol use, their built environment, violence and symptoms of depression, together with their views on alcohol and other interventions. Methods A stratified random sample of 1500 dwellings, 1200 in Khayelitsha and 300 in Gugulethu and Nyanga (“Gunya”) was selected using GIS address data for formal areas and aerial photography for informal areas. Fieldwork took place from July to November 2013. Responses to questions were summarized by area, gender, age and formal vs. informal settlement type. Results After substitution and data cleaning, 1213 Khayelitsha households and 286 Gunya households were included. In Gunya, 29% of respondents reported that they or their family members had been affected by at least one violent crime (murder, assault, domestic violence, rape) in the past year, compared with 12% in Khayelitsha. Using a CES-D-10 cut-off of 10, 44% of respondents were classified as depressed. More than half the respondents reported having experienced some form of alcohol nuisance. Respondents were supportive of alcohol interventions such as increased taxes and police regulation of outlets, particularly in Gunya (87%) and amongst female respondents (76%). Satisfaction with infrastructure such as street lighting and drainage was generally low. Conclusions The results describe the co-occurring burdens of alcohol and drug use, violence, depression and deprivation in our study populations.