Investigating the role of alcohol in road traffic collision fatalities in Western Cape, South Africa

Master Thesis


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Road traffic collisions (RTCs) are a major contributor to unnatural death worldwide, but especially in low-to-middle-income countries (LMICs) where motorised transport has rapidly expanded. A literature review into RTCs and alcohol indicated that it is well recognised that alcohol intoxication is a key risk factor in RTCs and road traffic fatalities (RTFs). It also indicated that literature concerning the role of alcohol intoxication in RTFs in South Africa is limited. Hence, this study aimed to investigate alcohol in RTF victims in five of the major mortuaries (Salt River, Tygerberg, Paarl, Worcester and George) in the Western Cape Province between 1 January 2016 and 31 December 2017. Cases were extracted from the Western Cape Forensic Pathology Service (FPS) internal database, which included demographic and crash information, together with blood alcohol concentration (BAC) results. In total, 2079 cases over the two years were included in the study, with most cases admitted in the metropole of Cape Town (Salt River: n=838, Tygerberg: n=693). The proportion of unnatural deaths were greater outside the metropole (George, Worcester and Paarl) compared to the metropole (Salt River and Tygerberg) areas. The majority of fatalities were male individuals (male to female ratio of 3.52:1), with the average age of 35.2 ± 17.2 years. Most victims were pedestrians (n = 1106; 53.7%) and dark wet roads, and highways were noted as risk factors in RTFs. Blood was submitted for alcohol analysis in 1432 (68.9%) cases, and results were available for 1314 (91.8%) cases. Of the available results, 709 cases (54%) were positive for alcohol (BAC of ≥ 0.01g/100 mL). Of the positive cases, most had a BAC between 0.15 and 0.29 g/100mL and the overall average BAC was 0.20 g/100 mL. Pedestrians and drivers had the highest median BACs, and almost a third of all the positive BAC results were from pedestrian deaths. The findings of this dissertation can contribute to the growing research on alcohol and injury in South Africa, especially as it relates to RTFs. Insight into vulnerable populations within the province is highlighted, together with key risk factors associated with RTFs, as well as safety measures that may be targeted for improvement, especially with regards to driving and walking on the roads while intoxicated.