Browsing by Author "Prinsloo, Megan"

Now showing 1 - 2 of 2
  • Thumbnail Image
    Item
    Open Access
    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.
  • Thumbnail Image
    Item
    Open Access
    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.