Fatal injuries among urban children in South Africa:

Table 1. Distribution of the population aged 0–14 years and of all fatal injuries in children across sociodemographic groups for six South African cities,^a 2001–2003 [html 3kb]

We first compared the leading causes of fatal injury in children for each city. We then calculated the age-adjusted rates and population attributable risks (PARs), by sex, population group and city, for each of the top five causes of fatal injury for all cities combined. The PAR was calculated by subtracting the incidence in the unexposed (I_u) from the incidence in the total population, exposed and unexposed (I_p), and dividing the result by the incidence in the total population:

PAR = (I_p − I _u)/I_pThis allowed us to assess the percentage reduction in fatal injuries that could be achieved among children aged 0–14 if all groups had the same exposure level as the group at lowest risk.¹³ In other words, they represent how many lives could be saved if approaches were found to reduce the safety divide.

The study was approved by the Ethics Committee of the Medical Research Council of South Africa.

Results

Approximately two-thirds of all children died from one of the top five causes of fatal injury (Fig. 1). Pedestrian injuries, drowning and burns ranked among the top three causes of death in all cities except Cape Town, where firearm-related deaths outnumbered those due to drowning. For Tshwane and Buffalo City, drowning deaths led, accounting for approximately one in four cases. For the other four cities, pedestrian deaths were most common. Firearm-related deaths were leading causes in Tshwane and Cape Town only, ranking fourth and third respectively. In the other cities, road traffic injuries with an unspecified road user (i.e. with no indication of whether the victim was a pedestrian, passenger or driver) contributed between 8.7% and 13.3% of fatally injured cases. In Buffalo City, sharp objects were among the top five leading causes of childhood fatal injuries (14.4% of cases)...

...

Conclusion

The five leading causes of fatal injury among children in urban South Africa include road traffic injuries, drowning, burns and, in some cities, firearm injuries. Among children, a high variability is observed between population groups and cities in the rates of fatal injury from the most common causes. There is a case for a safety agenda that combines safety-for-all counter-measures, aimed at lowering injury rates across the entire population, and targeted counter-measures that help reduce the burden for those at greatest risk. Tackling the five leading causes of fatal injury in childhood in urban South Africa could form part of the greater development agenda that the major cities have undertaken.

- WHO

Fatal injuries among urban children in South Africa: risk distribution and potential for reduction

Stephanie Burrows, Ashley van Niekerk & Lucie Laflamme

Volume 88, Number 4, April 2010, 267-272

Table 2. Number of events,^a age-adjusted death rates^b and population attributable risks^c for leading causes of fatal injury in children by sex, population group and city, South Africa, 2001–2003

	Pedestrian			Passenger			Drowning			Burn			Firearm
	No.	Rate		No.	Rate		No.	Rate		No.	Rate		No.	Rate
Sex
Female	300	6.1		86	1.7		108	2.1		153	3.0		63	1.3
Male	453	9.2		99	2.0		265	5.3		206	4.1		109	2.2
Population groupd
Indian/Asian	9	1.5		9	1.5		5	0.9		7	1.2		6	1.0
White	8	0.7		26	2.4		12	4.3		3	0.3		12	1.1
Coloured	138	7.9		38	2.1		35	2.0		47	2.7		34	1.9
African	600	9.4		111	1.7		281	4.3		305	4.5		121	1.9
City
Tshwane	37	2.5		12	0.8		43	2.9		27	1.8		14	1.0
Cape Town	204	8.8		42	1.8		52	2.2		85	3.6		55	2.4
Johannesburg	153	7.0		51	2.3		100	4.2		95	4.0		44	2.0
eThekwini	240	9.4		43	1.7		99	3.8		89	3.4		32	1.3
Nelson Mandela	78	10.0		26	3.1		29	3.7		36	4.6		12	1.5
Buffalo City	48	8.4		14	2.4		52	9.2		31	5.4		16	2.8
PAR
Sex	NA	20.5		NA	7.2		NA	42.2		NA	15.0		NA	26.9
Population group	NA	90.4		NA	16.9		NA	39.5		NA	47.5		NA	30.9
City	NA	67.0		NA	56.3		NA	40.6		NA	49.6		NA	45.1

NA, not applicable; PAR, population attributable risk.
^a Total numbers may vary across variables because of missing data for sex and population group.
^b Per 100 000.
^c PARs (shown as percentages) are calculated using the group with the lowest rate as the reference, i.e. females for all causes; Indian/Asian children for passenger, drowning and firearm-related deaths; white children for pedestrian and burn deaths; Tshwane for pedestrian, passenger, burn and firearm deaths; Cape Town for drowning deaths. The formula used to calculate PARs was (I_p − I _u)/I_p , where I_u is the incidence in the unexposed and I_p the incidence in the total population (exposed and unexposed).
^d Classification by population group as used by the South African government. Data source: National Injury Mortality Surveillance System, 2001–2003.