The spatial distribution of injury mortality of children in the western geographic service area, City of Cape Town (2011-2015)

Albertyn-Blanchard, Zulfah

The spatial distribution of injury mortality of children in the western geographic service area, City of Cape Town (2011-2015)

Thesis / Dissertation

2023

Abstract

Background: Child injury is a major global public health concern with accounting for nearly 300,000 deaths annually and non-fatal injuries resulting in long or short - disabilities. Young children are more likely to be involved in a non-fatal injury than adolescents, who are more likely to be involved in a fatal injury. Males are likely than females to suffer from a fatal or non-fatal injury. The likelihood to be injured has a spatial dimension with impoverished areas more likely to report injuries among adults and children compared to well-resourced areas. This differentiation is driven by inequality and social determinants which impacts the likelihood of implementing appropriate infrastructure and services to prevent these incidents, particularly in children. South Africa displays similar trends in the childhood injury pattern and the risks attributed to this burden. Method: This thesis retrospectively assesses the injury burden experienced by children aged 17 years and younger between 2011-2015 in the City of Cape Town (CoCT). Using routine mortuary data from Salt River Medico-legal Mortuary (SRM) across four sub-health districts of the CoCT namely Klipfontein, Mitchells Plain, Southern, and Western; the injury profile of children will be examined. The child death review (CDR) data will be used to determine the mortality profile of children aged 17 years and under. The Childsafe data will be used to determine the morbidity profile for children under 13 years, specifically RTCs. Exploratory analysis is used to describe demographic variables and create a heat map, and choropleth map of injury mortality, prior to a risk assessment of gender relative to various explanatory variables. Regression models adjusted for age, gender, time of day, and injury severity determined the likelihood of hospital admission for RTC injuries. Spatial regression models identified socioeconomic and geographical variables that influenced transportrelated injury mortality. Findings: This thesis found that more than 50 % of child injury deaths were unintentional (51.2%) across all age groups. Older male children (aged 15-17 years) mostly died from homicide, particularly due to sharp force injuries. This is the first study to report that most child injury deaths were located in the Klipfontein sub-health district, Nyanga has the highest prevalence ( give %) , with homicides more likely than any other form of injury death among children. We found that the injury mortality pattern for children differs dependent on their age, highest among ….. Most transport-related deaths occurred during daylight hours across all age groups. Utilising a heat map, cluster, and spatial regression analysis, this thesis found that Nyanga as the most deprived township also had the most transport-related injuries. Children aged 5-9 years contributed to the highest RTC premature mortality and non-fatal RCT incidents compared to other age groups. Males are more likely to be involved in both a fatal or non-fatal pedestrian RTC incident compared to females. Hospital admittance followed by a non-fatal RTC incident was mainly reported in children aged 5-9 years 2 compared to any other age group and was more likely to occur during afternoons or evenings over the weekend. Conclusion: Injuries are one of the leading causes of mortality and morbidity among children living in the CoCT, South Africa. This thesis provides insights to identify high-risk child populations through the use of a spatial conceptual framework the findings highlight factors that Increase risk for Injuries such as deprived suburbs, and the speed limit of the road, which has not been explored in other studies . This research highlights that children of a certain age are more vulnerable than others, especially males living in low socio-economic areas. There is an urgent need for more sustainable and representative national injury surveillance to be integrated with routine health information systems. The monitoring of child injury mortality in South Africa needs to be strengthened.

Keywords

Paediatrics

Reference:

Collections

PhD / Doctoral

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