The abandonment of neonates in locations where discovery and survival is not intended is a global concern. These cases comprise non-viable foetuses and stillbirths (natural deaths), as well as abandoned live births (unnatural deaths); the latter having possible legal consequences. To describe the profile of abandoned neonates and obtain a global perspective of the post-mortem investigation in such cases, a systematic review of the literature on abandoned foetuses, concealed births and neonaticide was conducted. This revealed a paucity of research on the subject; only one published South African study and less than 30 studies from other parts of the world were obtained. While guidelines were available, a standard protocol for conducting the medico-legal investigation on abandoned neonates did not exist and the necessary extent of the investigation was debated. Furthermore, seemingly higher rates of abandoned neonates were observed in South Africa compared to elsewhere in the world, warranting investigation of these cases in a local setting. In an attempt to add to the data concerning abandoned neonates in South Africa, a case file review was carried out on abandoned live births, stillbirths and non-viable foetuses at Salt River Mortuary between 1 January 2012 and 31 December 2016 (n=249). Despite the majority of the cases being natural deaths, the cause of death frequently remained 'undetermined’ in these cases, often due to the presence of decomposition. Histological analyses were only performed in a small fraction of undetermined cases. Furthermore, the hypothesis that the prosecution rate of abandoned live births is extremely low was supported by this study, with only one case prosecuted in the 5- year period. For the remainder of the cases, the court status was given as either 'under investigation’ (47.8%) or 'case closed’ (47.8%). In the majority of the instances, the case was closed due to the unknown identity of the biological mother; however, DNA analyses were not performed in all of these cases. Overall, the data highlighted the need for the development and implementation of standard protocols, to ensure that cause of death and identification of the neonate can be established as far as possible.

In forensic entomology, determining species identity is a crucial step towards estimating post mortem interval. DNA barcoding can aid in the identification of unknown forensically relevant species, and this requires the comparison of DNA barcodes to reference data from known species. However, there is a lack of DNA barcode reference data of forensically relevant Calliphoridae species in the Western Cape (South Africa). DNA barcodes were generated for the COI and ITS2 markers for 41 forensically relevant Calliphoridae specimens, representing seven species from six localities in the Western Cape: Chrysomya albiceps (n = 3), Chrysomya chloropyga (n = 8), Chrysomya marginalis (n = 5), Chrysomya megacephala (n = 7), Hemipyrellia fernandica (n = 1), Lucilia cuprina (n = 8) and Lucilia sericata (n = 9). This data was combined with that from Cooke et al. (2018) (n = 40), and subjected to rigorous statistical and phylogenetic analyses. Phylogenetic analysis which combined data for both COI and ITS2 barcodes returned monophyletic clades for each species with increased support when compared to using each barcode individually. This combined dataset was able to discriminate between L. cuprina and L. sericata with full support (100% pP), which was not achieved previously. DNA barcodes were evaluated for intra- and inter-specific variance as well as haplotype patterning. No haplotype patterning was observed for either barcodes across sampled localities. Lastly, a single-blinded approach was used to assess the dataset, whereby DNA barcodes from ‘unknown’ specimens were correctly identified using this reference data. These identifications were more accurate than those using GenBank® or BOLD, highlighting the importance of using locally relevant reference data. This study has contributed new data pertaining to DNA barcodes for seven Calliphoridae species, which was previously scarce for the Western Cape, and this has directly contributed to an improvement in the accuracy of local species identification.

Death due to cranial blunt force trauma is a major issue not just in South Africa but worldwide. The vast majority of studies conducted on cranial blunt force trauma have analysed trauma to the frontal portion of the head. This is due to the involvement of the frontal portion of the head in automotive accidents. The lateral portion of the head is however no less important and is often impacted during homicidal assault. In cases involving cranial blunt force trauma, a common question asked of experts relates to the amount of force involved with a particular trauma. The goal of forensic science in general is to provide objective, repeatable results. At present, however, answering this question relies on a subjective rating scale of mild, moderate or severe force. Determining the severity of the force is also subjective, in that it relies heavily on the experience of the expert. Forensic anthropology by its nature is often subjective; however there is a need to move away from conducting analyses based predominantly on the experience of the investigator. With this in mind, this dissertation offers background information on fracture mechanics and impact biomechanics and provides a current review of the literature surrounding lateral impact to the skull. The research conducted as part of this dissertation attempts to quantify the force and energy involved with lateral impact to the skull due to a blow by a hammer, as well as describes the wound morphology associated with such impacts. Human tissue for experimentation is becoming increasingly difficult to acquire. There is therefore a need to determine suitable models for use in such testing. In the current study whole porcine heads were impacted on the fronto-parietal portion of the cranium. Half of the specimens were impacted with an implement resembling the shape and weight of a hammer. These hammer tests were conducted primarily to determine the type of trauma associated with such impacts and determine if a correlation exists between velocity or energy of impact and the level of trauma sustained. The remaining specimens were impacted with a Hopkinson pressure bar of the same diameter as the striker in the hammer tests. The Hopkinson pressure bar apparatus allows for the determination of the force of impact. The use of the Hopkinson pressure bar to determine fracture forces in whole specimens is novel. The fracture forces obtained in the current study agree considerably with the literature previously published on lateral, cranial blunt force trauma to both human and porcine specimens. The fractures produced, however, are atypical and may indicate a need to conduct further tests on other animal models.

Introduction: In South Africa (SA), the forensic sector faces significant challenges including how to meet increasing public expectations for high quality, reliable and valid scientific and medico legal results, whilst dealing with increasing caseloads and restricted resources in a developing country. Internationally, lean six-sigma and/or business-based frameworks have been developed to define, measure and analyse the efficiency, effectiveness and output of forensic laboratories, so as to assess performance to meet such challenges. Aim: This pilot project aimed to investigate the effectiveness and efficiency of forensic pathology practice at Salt River Mortuary (SRM) by applying lean six sigma principles (define, measure, analyse and improve) and FORESIGHT metric analyses to retrospective case and staffing data, as well as prospective observational analyses. Methods: A retrospective analysis of cases admitted to Salt River Mortuary in 2015 was conducted to define and measure a snapshot of forensic pathology practice in Cape Town. In addition, observations of autopsy processes were conducted to identify bottlenecks in the system and provide suggestions for improvement. Results: An analysis of post-mortem report turn-around for 3567 cases admitted to SRM in 2015 showed that approximately 10% of cases were closed (cause of death was determined) on the day of the post-mortem, 65% within 14 days and 80% closed within a 30 day period. Certain requested ancillary investigations delayed the finalisation of cause of death; for example, only 8.33% of carbon monoxide testing and 30.31% of histological examinations were completed within the year. A process map outlining autopsy practices at SRM was generated through observational data, which also identified key bottlenecks in the process (e.g.: equipment issues). Preliminary financial data suggested that it cost on average R16 155.03 per case. Staff data demonstrated a lack of pathologists compared to other staff categories and high case load requirements. Discussion: This pilot study investigates the utilization of metrics and strategic frameworks to assess forensic pathology processes in Cape Town. This study offers a cross-sectional insight into financial performance, efficiency and effectiveness of post-mortem investigations at SRM, highlighting bottlenecks and inefficiencies, and providing suggestions for improvement. The findings will assist in forming a basis for future work into the development of a framework for monitoring performance and progress, and developing benchmark standards for the death investigation system in South Africa

Introduction: Pesticides offer great benefits in the agricultural sector, but exposure may pose both acute and chronic health risks to humans. In developing countries, morbidity and mortality rates related to pesticide exposure are high and in certain areas (such as in rural, lower socioeconomic and/or agricultural-dependent communities), pesticides may be stored in and around homes, which may increase the risk of accidental exposure as well as intentional poisoning. In Cape Town, South Africa, this public health issue is exacerbated by the informal selling of street pesticides. These are pesticides that usually comprise of a mixture of these chemicals, sold unregistered as liquids or granules in bottles or packages without clear identification labels, for domestic use. While cheap and widely available in informal settlements; these pesticide formulations are not regulated and extremely toxic. Data illustrating the extent and nature of fatalities related to acute and chronic pesticide exposure in Cape Town, particularly as related to street pesticides, is limited. This dissertation provides an overview of the literature associated with pesticide toxicity and related mortality, paying particular attention to available South African research. This is followed by a study investigating pesticide deaths at Salt-River Mortuary over a period of five years. Aim: The aim of this study was to determine the prevalence and characteristics of deaths associated with suspected acute pesticide toxicity, to broaden the spectrum of knowledge concerning pesticide-related deaths in Cape Town, South Africa. Methods: A retrospective analysis of cases admitted to Salt River Mortuary (SRM) from 2011 to 2015 (inclusive) was conducted. Demographic, autopsy, investigative and toxicological data (where available) were collected from post-mortem and other investigative reports. Results: Of the total of 16,453 cases admitted to SRM over a five-year period from January 2011 until December 2015, 104 (0.63%) were deemed to be acutely pesticide-related based on available autopsy data. There was an equal number of male (n=52; 50%) and female (n=52; 50%) victims. Most deaths (n=74; 71%) occurred at medical centres following exposure, and Terbufos was found to be the common pesticide detected analytically (n=42, 61%) in toxicology reports available (76%). Results revealed that (60%) of acute pesticide toxicity cases were suspected suicides, while (6%) of cases were suspected accidents and (3%) cases were suspected homicides, while the remainder were still undetermined pending toxicological investigations. Conclusion: A history of ingestion, autopsy findings and toxicological results (if available) assisted in identification of these cases, most of which came from lower socio-economic communities. While the number of overall cases is low, it is evident that these deaths are a public health burden, and may be preventable through improved notification and policy development. Challenges with this study involved the inability to distinguish mortality associated with chronic pesticide exposure, the lack of toxicological results available, limited scene investigation information to identify street pesticide contributions, and that the study was limited to one mortuary in Western Cape. An extension of this research to other mortuaries in Western Cape as well as collaborative work with community and public health sectors on availability and toxicity of street pesticides will assist in strategic intervention methods and policy reform to reduce accidental and suicidal mortality associated with acute pesticide exposure.

In South Africa, there is a burden of unidentified deceased individuals in forensic mortuaries. When human remains are severely compromised, hard tissues may provide the only DNA source for identification. The QIAamp® DNA Investigator Kit is used in forensic laboratories worldwide, including in South Africa, to extract DNA for identification purposes. However, in local forensic casework, the DNA recovered from teeth is often of insufficient quantity and quality for generating a DNA profile. The phenol-chloroform DNA extraction method has demonstrated improved, yet inconsistent results, when used on hard tissues. Therefore, this study assessed DNA recovery from 52 human control teeth from three deceased individuals, using an optimised phenol-chloroform method. This method involved an overnight demineralisation, two additions of phenol/chloroform/isoamyl alcohol (25:24:1) and an ethanol precipitation, as used by the Australian Federal Police. Quantitative PCR (Quantifiler™ Trio DNA Quantification Kit) and DNA profiling (PowerPlex® ESI 16 System) were then used to assess DNA quantity and quality. Results were compared to those obtained from the same teeth but extracted using the QIAamp® DNA Investigator Kit. The phenol-chloroform method recovered DNA with significantly higher yields (p = 0.0454) and significantly less degradation (p < 0.0001). Despite this improvement, there was no significant difference in DNA profiling success. This study also did a preliminary analysis of other factors affecting results and suggested that premolars might be the best tooth type with regards to DNA quantity, quality and profiling. Furthermore, dental disease and jawbone had a significant impact on results from teeth. Lastly, the phenol-chloroform method was applied to six teeth from a marine decomposition case to assess its performance in a local forensic setting. DNA metrics were particularly poor in this casework example, highlighting how different forensic and control environments are and the need for further optimisation. Overall, this study supports the use of the phenol-chloroform method and has provided a preliminary suggestion of the best tooth type, jawbone and tooth condition for DNA analysis for forensic human identification.

Insects play an essential role in the resolution of medico-legal investigations. For various insects, like necrophagous flies, it is vital for their survival to find and inhabit a food source such as a decomposing body. This makes it possible to use these insects as evidence in medico-legal investigations. A crucial part of any medico-legal investigation is estimating the time that has elapsed since death, otherwise known as the post-mortem interval (PMI). The age of the oldest insects can provide the most precise estimation of the PMI. Flies undergo different stages of development. All the immature stages can be utilized as evidence at death scenes. Out of all the immature stages, pupae represent the oldest specimens, which makes them valuable in establishing a minimum time since death. Identification and aging of pupae is currently a challenging process since they all look similar in appearance. Few studies have been done on pupae for PMI estimation. This study aims to identify reliable morphological markers to aid in a more accurate age estimation of Lucilia sericata during the pupal stage. A total of 145 pupae were collected and examined for external morphological changes over time. Five pupae were collected at each time point. A total of six external morphological characteristics of the puparium and twenty external morphological characteristics of the pupae were initially examined. These characteristics were linked to age in accumulated degree hours (ADH), with the aim of creating a timeline that can aid in the estimation of pupal age. The pupal ADH ranges from the youngest being 6550 ADH and the oldest being 11300 ADH. The timelines identified several characteristics that develop during the early or late stages of development. Multiple linear regression analysis was performed to assess characteristics which were useful for estimating the age of the pupae (ADH) and develop a regression equation based on the data collected. The regression analysis identified 10 characteristics that are the most significant in aging pupae. They were the colour and shape of the labellum, leg length, leg width at full length, thoracic setae, facial setae, abdominal macrosetae, palp shape, genal setae and labrum colour. Some of these characteristics like the leg length and width and abdominal macrosetae did provide important time-breaks on their respective timelines. However, the development and the pigmentation of the compound eye also provided valuable time-breaks it's timeline.

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