Browsing by Author "Molefe, Itumeleng"

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    Effect of the COVID-19 national lockdown on road traffic accident fatalities involving traumatic brain injury: A retrospective review of Salt River Mortuary cases
    (2025) Mokgotho, Mahlatse; Abrahams, Shameemah; Mole, Calvin; Molefe, Itumeleng
    Background: Low- and middle-income countries have reported higher traumatic brain injury (TBI) incidence and mortality rates in cases involving road traffic collisions (RTCs). In South Africa, RTCs are commonly reported as contributors to death; however, the current burden of TBI attributable to these deaths is unknown. Additionally, movement restrictions and behavioural changes introduced during the COVID-19 nationwide lockdown have been shown to affect injury patterns in general, but their impact on TBI is undocumented. This study aimed to investigate the epidemiology and patterns of TBI-associated deaths attributable to RTCs before and during the nationwide lockdown in South Africa. Methods: Autopsy reports of TBI-associated deaths due to RTCs, reported to Salt River Mortuary between 1 January 2019 and 31 December 2020, were reviewed. Results: A total of 616 RTCs, from the 7694 total caseload, were included with RTC-related TBIs accounting for 6.51% of the caseload across two years. Males were three times more likely to present with RTC-related TBIs compared to females. Individuals aged 30-39 years were at the highest risk of RTCs, and the median age of those with TBI (34 years) was significantly younger than those without (39 years, p < 0.001). Furthermore, the proportions of the TBI cases were comparable across all road user groups, all were equally likely to sustain TBI in an RTC. Two-thirds (66.18%) of individuals died before hospital admission. Of the 47.16% deceased individuals whose alcohol concentration was detectable, 92.96% had an alcohol level of ≥ 0.05 g/100 mL however we found no significant association between alcohol consumption and sustaining a TBI. Conclusion: These findings indicated that younger individuals are at a higher risk of TBI in RTC-related deaths. Furthermore, injury patterns did not seem to differ between the periods before compared to during the COVID-19 lockdown.
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    Exploring the potential for biomarkers to aid forensic diagnosis of traumatic brain injury (TBI) – a systematic literature review and meta-analysis
    (2024) Velcich, Carly; Abrahams, Shameemah; Heathfield, Laura; Molefe, Itumeleng
    Background: Traumatic brain injury (TBI) is a prevalent condition worldwide. Understanding its pathophysiology is imperative for clinical diagnosis, treatment, and cause of death determination. Biomarkers could offer potential insight. Proteins involved in neuroinflammation, such as systemic inflammatory biomarkers interleukin (IL)-1β, IL-6, and IL-10 and astroglia-associated biomarkers S100 Calcium-Binding Protein B (S100β) and Glial Fibrillary Acidic Protein (GFAP), have been assessed as potential TBI biomarkers. The aim of this review was to evaluate recent articles that investigated these biomarkers in relation to TBI and relate this to a forensic diagnostic context. Methods: This review included 44 peer-reviewed articles from three major literature databases published from 2018 onwards, that investigated either IL-1β, IL-6, IL-10, GFAP, S100β, or a combination thereof, in relation to TBI. Studies conducted in a clinical or forensic setting were included. A meta-analysis was conducted on a subset of these studies. Results: Majority of the biomarkers were elevated in TBI versus control groups. The most promising biomarkers were GFAP and S100β, which in addition to being elevated also correlated with unfavourable outcomes and TBI severity. GFAP alone was increased in TBI patients with positive CT scans. The ILs had inconclusive results due to minimal studies and inconsistent study designs. A wide range of biomarker expression levels were noted across all articles (from 0.01 to 1.5 million pg/mL). The meta-analysis yielded a pooled effect size of 0.97. Discussion: Inconsistencies in results could potentially be explained by heterogenous TBI and control groups, various body specimens, and different immunoassays used. Thus, each biomarker should be investigated systematically whilst keeping other variables consistent to ensure definitive conclusions. Overall, none of the proteins could function as biomarkers of TBI alone. However, the meta-analysis did indicate a moderately significant association between biomarker levels and TBI occurrence. Future studies are needed to corroborate the findings.
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    Investigating blood alcohol concentrations in injury-related deaths before and during the covid-19 national lockdown in Western Cape, South Africa: a cross-sectional retrospective review
    (2022) Bachan, Varushka; Molefe, Itumeleng; Davies, Bronwen
    In South Africa, alcohol is a significant contributor to the burden of injury-related morbidity and mortality. Our understanding of its impact in injury-related mortality in the country is limited. The COVID-19 lockdown period in South Africa introduced restrictions that limited the legal access to the sale and on-site consumption of alcohol and presented a unique opportunity for examination of the impact of such restrictions on injury-related mortality. This study aimed to examine the relationship between blood alcohol concentrations (BAC) and injury-related deaths and to investigate the effect of the COVID-19 lockdown periods and alcohol restrictions on injury-related mortality and post-mortem BAC levels. A retrospective cross-sectional analysis of BACs in all injury-related death cases admitted to mortuaries in the Western Cape (WC) province between 1 January 2019 to 31 December 2020 (inclusive) was conducted. Descriptive and inferential statistics were performed using STATA 13 (StataCorp, TX, USA), to investigate BACs in injury deaths before and during the COVID19 lockdown periods in South Africa. A total of 16,027 injury-related cases were admitted to forensic mortuaries in the WC province in the study period out of a total of 21,797 cases, with significantly fewer cases admitted in 2020 during the first two COVID-19 lockdown periods compared to the same period in 2019 (p< 0.001). Samples were collected for BAC levels in 12,077 (75.4%) of injury-related cases and were most frequently requested in suspected homicide cases (85.2% of 8190). A positive BAC (≥0.01 g/100 mL) was found in 5,078 (42.2%) of the study sample. No significant difference was observed in the mean positive BAC between 2019 (0.18±0.1%) and 2020 (0.17±0.09%), except in the months of level 5 lockdown between April and May 2020, when there was a decrease in the mean positive BAC to 0.13g/dL in 2020 compared to 0.18g/dL for the same period in 2019. There was a 47.7% reduction in injury-related cases seen year on year in the WC during the period of level 5 lockdown and full alcohol restriction in 2020 compared to 2019 however trauma cases increased later in 2020 during full alcohol restrictions. The data presented in this study shows a decrease in injury-related deaths in the WC during the lockdown periods that coincided with alcohol bans and an increase following relaxation of restrictions on movement and alcohol sales. The data shows that the mean concentrations were similar between all periods of alcohol restriction compared to 2019, however, there were significantly fewer individuals with positive BACs in 2020 during complete alcohol sales restrictions than in 2019. This did, however, coincide with a smaller mortuary intake during the level 5 lockdown. The findings of fewer injury-related deaths and fewer positive BACs during lockdown periods coinciding with complete alcohol sales restrictions in 2020 should be taken into consideration to inform future decisions on alcohol control policy in the country.
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    Violence against women : epidemiology and pathology of femicides and suspected sexual homicides in Cape Town : a 10-year follow-up study
    (2016) Molefe, Itumeleng; Martin, Lorna J; Artz, Lillian
    Background: Violence against women (VAW) is the most pervasive human rights abuse and a global health threat. The most extreme forms of physical and sexual violence are the intentional killing of a woman (femicide) and rape, or the combination of both in the form of r ape homicide, preferably termed 'sexual homicide' in this study. Motivation: Martin's research in 1999 reported a rape homicide incidence rate of 12.3/1000 female rapes reported to the police in Cape Town while the National study performed by Abrahams et al in 1999 reported an incidence rate of 10.9/1000 female rapes reported to the police in South Africa (SA). These high incidence rates, definitional problems, methodological limitations, changes in the law, and inconsistent management of suspected sexual homicides motivated the author to undertake this follow - up study. Objectives: To describe the epidemiology and pathology of femicides in Cape Town and thereby identify risk factors, magnitude and criteria for suspected sexual homicides. Design and Methodology : This is a retrospective descriptive study. Data was collected from autopsy reports of female bodies admitted at Salt River Forensic Pathology Laboratory in Cape Town from the years 2000 to 2009. A 10 - year period improves the sample size and the validity of the results. Limitations : Time constraints led to inadequate information on perpetrators of femicides and therefore a report on intimate femicide is limited in this study. Main findings and Discussion: Results showed an average femicide incidence rate of 12.4/100,000 female population in Cape Town Western Metropole which is half the South African national incidence for 1999, equates to the 2009 national rate and is almost five times the global average. Sexual homicide was suspected in 19.9% of all femicides, slightly higher than the 16.3% previously reported by Martin for Cape Town. The median age of victims was 32 years. Most femicide victims died from gunshot injuries (35.2%) followed by those who were stabbed (29.6%), while the majority (35.7 %) of victims of suspected sexual homicide died from asphyxial deaths, including strangulation. Taking specimens for the Sexual Assault Evidence Collection Kit correlated significantly with genital (77.7%) and anal injuries (64.5%), and 41% of femicide victims had alcohol levels above 0.05g%. Conclusion: The incidence of femicide and sexual homicide in Cape Town is higher than previously reported. Gun violence and alcohol abuse are persistent problems. Recommendations : Findings should be used to motivate for intersectoral collaboration in the form of female homicidal death review (FHDR) teams. These teams should aim to develop standardised guidelines for the forensic management, prosecution, prevention and monitoring strategies for femicides and sexual homicides in South Africa.