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Abstract
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The COVID-19 pandemic has highlighted the importance of accurate and timely mortality data, particularly cause-of-death information, for monitoring not only natural deaths but also non-natural deaths due to injuries. The South African Medical Research Council (SAMRC)'s Rapid Mortality Surveillance system[1] provided near real- time measures of weekly excess mortality,[2] which for natural deaths coincided with COVID waves and, for injuries, with government- imposed lockdowns and alcohol sales bans.[3,4] The significant impact of alcohol bans on injury deaths provided a rare impetus for stakeholders to consider better alcohol policy to safeguard the post- COVID future of all South Africans.[5]
Yet, despite the value of the weekly death data, they only provide a composite measure of all injury deaths. Injuries and violence remain an enduring pandemic in South Africa (SA), and there is a need for reliable injury mortality statistics that describe the profiles and trends for major causes of intentional (homicide and suicide) and unintentional injuries (road traffic, falls, poisoning, drowning, etc.). Their importance as a prevention priority is highlighted with their inclusion across multiple Sustainable Development Goals (SDGs).[6] For example, SDG target 3.6 seeks to reduce road traffic injury and mortality, and SDG 5 seeks to achieve gender equality and empower all women and girls. Target 16.1 seeks the significant reduction of 'all forms of violence and related death rates everywhere'. This implicitly recognises men and boys as vulnerable and at risk, both as perpetrators and as victims, but also as worthy recipients of prevention efforts,[7] which is an important consideration in SA, where males contribute substantially to the fatal injury burden.
However, SA's vital statistics are currently not suitable for monitoring progress towards these targets.[8] For this reason, the SAMRC has undertaken intermittent nationally representative surveys of injury mortality in 2009,[9] 2017[10] and 2020/21 (forthcoming) to inform its National Burden of Disease estimates. The current study[11] (in this issue of SAMJ) suggests that this is a data source that could be harnessed to complement vital statistics to provide more regular, reliable information on the injury mortality profile. However, mortuary surveys are time consuming and costly in comparison with routine collection of these data at the time of certification of medical cause of death.
Routine collection of manner-of-death data through vital statistics in SA is currently not possible as, contrary to the World Health Organization (WHO)'s internationally recommended medical certificate of cause of death,[12] the death notification form (DNF) does not allow for the reporting of the manner of death. We consider that such a field would elicit relevant information and permit accurate coding of injury-related external causes of death. The Births and Deaths Registration Act 51 of 1992[13] requires a medical practitioner to issue a certificate (DNF) stating the cause of death, but not the manner of death. The Inquests Act 58 of 1959[14] assigns the responsibility of determining whether an act or omission amounting to an offence led to a death to the judicial officer presiding over an inquest into a death due to 'other than natural causes', which informs the manner of death. While neither Act prevents the inclusion of a presumptive manner of death on the DNF, some interpretative issues have led to a lack of clear guidance and prevented the reporting of the manner of death on the DNF (homicide, suicide, unintentional, disease). However, the perceived prohibition does not align with the systems in place. Forensic pathologists provide the courts with...
Language: en |