ISS: Health professionals can help prevent violence in South Africa

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A mass shooting in Khayelitsha in the Western Cape on May 8 and another on May 21 drew attention to high levels of violence in the province and in South Africa. New official crime statistics for the first quarter of 2022 show a 22% increase in murders compared to the same period last year.

The crime crisis in the country underscores the urgency of using all possible means, including data, to prevent violence. A closer look at figures from medical centers in the Western Cape clearly shows how violence occurs at different stages of life. Statistics can enable a more targeted and nuanced response and prevention plan.

The Provincial Health Data Center of the Western Cape Department of Health and Welfare recently launched a Western Cape Trauma and Injury Report. This “safety dashboard” aims to provide easy and quick access to data on injuries and fatalities in the province.

Just over half of recorded injuries among pregnant women were caused by assault
The Safety Dashboard information is largely drawn from the HECTIS (Hospital and Emergency Center Tracking Information System) application. Nurses, doctors and administrators enter data into HECTIS in real time to produce a detailed electronic record of all patients presenting to emergency centers in the Western Cape.

System champions such as Dr Moosa Parak, Head of Mitchells Plain District Hospital and Heideveld Emergency Centers, have ensured that HECTIS is used in all public emergency centers in Cape Metro and in several establishments in the rural districts of the province.

Data, from January 1, 2021 to April 23, 2022, shows that 44% of injuries treated in emergency centers result from interpersonal violence. Most victims (72%) of interpersonal violence were male, mostly between the ages of 20 and 40. Over the weekend, the number of violence-related injuries per day more than doubled compared to weekdays. These injuries tended to occur at night, unlike unintentional injuries (eg, accidents), which occurred mostly during the day.

The proportion of injuries due to interpersonal violence increases rapidly from early adolescence

These results may seem obvious, but others are of particular concern. First, an analysis of all injury data by gender shows that 34% of injuries suffered by women resulted from assault and that pregnant women were more likely to be assaulted – 52% of injuries to pregnant women were caused by assaults.

Nearly half of assaults against pregnant women took place in the second trimester of pregnancy (47%). Since January 1, 2022, 295 pregnant women have been recorded as having sought medical attention at emergency centers following assault injuries. While the data doesn’t reveal the reason for the spike in assaults during the second trimester of pregnancy, the timing suggests it could be when women disclose their pregnancy to their partners.

The second disturbing finding of the HECTIS data is that the proportion of injuries due to interpersonal violence begins to increase rapidly from early adolescence. The total number of injuries also increases with age.

These two results, combined with other evidence, suggest that many children in the Western Cape were born to abused mothers – and may be the result of unwanted pregnancies. It also tells us that many children become victims of violence themselves, contributing to cycles of violence that are passed down from generation to generation.

The data reflects an urgent need to intervene early, even before babies are born, to mitigate the risk of violence in the home. The World Health Organization has identified domestic violence as one of the main drivers of intergenerational violence. When a pregnant woman is assaulted or there is violence in the home, the trauma impacts everyone involved and their family and community systems.

Long-term interventions that address violence at all stages of life are a key part of the Western Cape security plan. In the short term, the Safety Dashboard is a valuable tool to understand trends and help monitor the impact of initiatives such as restrictions on alcohol-related sales.

Safety dashboard data can also be used for more effective police deployment based on knowledge of when, where and how injuries occur. This has already been tried in the Western Cape.

In the past, more law enforcement officers were deployed on weekdays than on weekends. When health data showed most injuries occurred on weekends, more officers were assigned weekend duties. This may have been one of the factors behind the 372% increase in the firearms recovery rate after the change in deployment, compared to the average for the past 17 months.

Health data can make an important contribution to evidence-based violence prevention strategies. Combined with police statistics and local knowledge, they can be used to optimize law enforcement deployment, design appropriate prevention programs and track trends in violence over time. The HECTIS system could also be used by the South African Police Service to guide policing strategies, as in the Cardiff model.

Interpersonal violence – and the fear of such violence – not only leads to poor physical and mental health, but also compromises job opportunities and the possibility of leading a happy and productive life. Exposure to trauma, especially at a young age, is associated with an increased risk of mental illness, suicide and substance abuse, which reinforce cycles of violence.

Data sharing across sectors is key to addressing the violence crisis in the Western Cape and the country. The social and structural determinants of violence are complex, making its reduction the responsibility of the whole of government and society.

Written by Inneke Laenen, Registrar of Public Health Medicine and Melvin Moodley, Director, Health Intelligence Branch, Western Cape Department of Health and Welfare; and Chandré Gould, Senior Researcher, Justice and Violence Prevention, ISS.

Republished with permission from ISS Africa. The original article can be found here.

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