Background: Violence against women (VAW) is the most pervasive human rights abuse and a global health threat. The most extreme forms of physical and sexual violence are the intentional killing of a woman (femicide) and rape, or the combination of both in the form of r ape homicide, preferably termed 'sexual homicide' in this study. Motivation: Martin's research in 1999 reported a rape homicide incidence rate of 12.3/1000 female rapes reported to the police in Cape Town while the National study performed by Abrahams et al in 1999 reported an incidence rate of 10.9/1000 female rapes reported to the police in South Africa (SA). These high incidence rates, definitional problems, methodological limitations, changes in the law, and inconsistent management of suspected sexual homicides motivated the author to undertake this follow - up study. Objectives: To describe the epidemiology and pathology of femicides in Cape Town and thereby identify risk factors, magnitude and criteria for suspected sexual homicides. Design and Methodology : This is a retrospective descriptive study. Data was collected from autopsy reports of female bodies admitted at Salt River Forensic Pathology Laboratory in Cape Town from the years 2000 to 2009. A 10 - year period improves the sample size and the validity of the results. Limitations : Time constraints led to inadequate information on perpetrators of femicides and therefore a report on intimate femicide is limited in this study. Main findings and Discussion: Results showed an average femicide incidence rate of 12.4/100,000 female population in Cape Town Western Metropole which is half the South African national incidence for 1999, equates to the 2009 national rate and is almost five times the global average. Sexual homicide was suspected in 19.9% of all femicides, slightly higher than the 16.3% previously reported by Martin for Cape Town. The median age of victims was 32 years. Most femicide victims died from gunshot injuries (35.2%) followed by those who were stabbed (29.6%), while the majority (35.7 %) of victims of suspected sexual homicide died from asphyxial deaths, including strangulation. Taking specimens for the Sexual Assault Evidence Collection Kit correlated significantly with genital (77.7%) and anal injuries (64.5%), and 41% of femicide victims had alcohol levels above 0.05g%. Conclusion: The incidence of femicide and sexual homicide in Cape Town is higher than previously reported. Gun violence and alcohol abuse are persistent problems. Recommendations : Findings should be used to motivate for intersectoral collaboration in the form of female homicidal death review (FHDR) teams. These teams should aim to develop standardised guidelines for the forensic management, prosecution, prevention and monitoring strategies for femicides and sexual homicides in South Africa.

Includes bibliographical references / Background: The TMNP is one of the more famous of Cape Town's tourist attractions. Stretching across the Peninsula, this conservation site is home to rare indigenous flora and fauna, biodiverse habitats and the spectacular Table Mountain. Despite its seemingly safe infrastructure, there have been media reports of accidents and deaths that have occurred in the TMNP and on Table Mountain. Aim: To determine the number and types of fatalities in the TMNP from 2000-2011. Method: The Salt River Forensic Pathology Laboratory is a state mortuary which serves the Cape Peninsula. Included in its drainage area is the TMNP. Approximately 3000 medico legal investigations are performed per annum, the details of which are stored in databases at the SRFPL and at the Division of Forensic Medicine at the University of Cape Town. These and archival records were retrospectively searched for all deaths that occurred in the National Park between 2000 and 2011. The collected information was categorised and analysed according to the demographic profile of victims, cause and manner of death, blood alcohol levels and activities prior to death. Results: Between 2000 and 2011, there were 98 confirmed deaths in the TMNP. The deaths occurred mostly during the South African summer months and on Fridays and Sundays (weekends). The victims were predominantly Caucasian (59%) and male (90 %) with a mean age of 39.4 years. The majority of victims were local, while 15 % were foreign, European and tourists. Overall accidents contributed to 53% of all unnatural deaths with victims predominantly sustaining head injuries and polytrauma which occurred from falls (71%) during mountain recreational activities. 24% of victims who fell tested positive for alcohol (>0.01g/100ml). Body mass index (BMI) calculations of the 98 victims revealed that 53% had BMI above 25. A p re -existing medical condition (predominantly cardiac) was the cause of the natural deaths. 26 A significant finding of the study was that 22% of deaths were due to suicides that took place on or surrounding Table Mountain. Suicides occurred commonly during summer with Fridays and Mondays being the common suicide days. The victims, all men, in the age range of 30-39 years (mean age of 39 years) were predominantly Caucasian (68%) and used hanging (45%) and jumping (27%) off the mountain as the two most preferred methods of death. 22% of suicide victims tested positive for alcohol at time of death. Conclusion: The TMNP is one of South Africa's most popular tourist attractions, due largely in part to the presence of Table Mountain. A retrospective study of deaths that occurred within the Park and on the mountain range over a 12-year period identified a predominantly Caucasian male victim demographic and found that head and polytrauma sustained from falls while participating in mountain associated activities as the leading cause of death. A significant finding was the high percentage (22%) of suicide deaths that took place. This study has helped to identify Table Mountain as a possible local suicide hotspot and points to a need for TMNP authorities to include in their safety protocols, strategies for suicide prevention. Larger collaborative studies are recommended as this would significantly impact on public health through the improvement of Park and mountain safety.

Pedestrian vehicle injuries are a growing public health threat worldwide. In South Africa, pedestrian accidents are the leading cause of injury related deaths in children younger than 15 years. There is international and national research looking at various aspects of pedestrian vehicle accidents. Previous studies have highlighted the general distribution of injuries sustained in paediatric pedestrian accidents. However, the specific types of injuries sustained by children pedestrians in different age groups have not been widely researched. We conducted a retrospective review of children involved in road traffic accidents as pedestrians in the greater Cape Town area from 2011 to 2015. The study population included patients below the age of 13 years that were admitted to Red Cross Children's Hospital (RCCH), as well as those subjects that died and presented to the Forensic Pathology Laboratory in Salt River also known as Salt River Mortuary (SRM). The age group 0-12 years was selected because RCCH is a referral paediatric hospital that only admits children under the age of 13 years. Data obtained from the study population were analysed according to age, gender, time, date (day of week and month) and area of accident, as well as injuries sustained. Cases were grouped according to age in order to analyse and compare changes in injury patterns for different groups. Age groups 0-4 years, 5-9 years and 10-12 years were selected. Further comparison of the injuries sustained was made between children admitted to RCCH (survivors) and subjects admitted to SRM (deceased). During the 5-year period 552 children were admitted to RCCH and 109 cases were admitted to SRM with 2:1 male to female predominance in both study groups. In our study, the group with the highest number/percentage of deaths was children aged 0 – 4 years, which contrasts with previous research. Most of the accidents (75-80%) occurred in lower socioeconomic areas. Significantly more head injuries occurred in children who died from their injuries than those who survived (96% versus 18%) (p < 0.0001). Out of the children who demised, 27% had spinal injuries, 61% had chest injuries and 43% had abdominal injuries, all of which were significantly higher than children who survived (p < 0.0001 for each). Upper limb injuries were equal between the two groups (12% vs 13%) and lower limb injuries were more common in the survivors (46% vs 24%). These results are the first to be documented in Cape Town and provide insight into the nature of injuries sustained by children involved in pedestrian vehicle accidents.

Background Weighing of organs is a necessary part of every autopsy and provides objective evidence of pathology, especially in forensic cases where histology is not always taken. Reference ranges must be locally applicable, accurate, and regularly defined. Aims The primary aim was generation of post-mortem organ weight reference ranges for use in South African mortuaries. Secondary aims were analysing factors influencing organ weights, and comparison of data to those from international populations. Methods A retrospective study was conducted using autopsy reports from the Salt River medico-legal mortuary in Cape Town, South Africa between 2013 and 2016. Disproportionate randomized stratified sampling was used to obtain sufficient cases from males and females; White, Coloured, and African racial groups; and decedents both older and younger than 50 years. Observations from 1262 decedents >18 years old dying traumatic on-scene deaths were recorded, excluding organs with macroscopic evidence of disease or destructive injury. The organs considered were the brain, heart, both lungs, liver, spleen, and both kidneys, and the variables collected were sex, race, age, height and body weight. This study was approved by the University of Cape Town Human Research Ethics Committee. Results Sampled decedents are described and excluded organs accounted for. Descriptive statistics are presented for each of the stratified subsamples. After assumption testing, multiple linear regression models are built, including interaction terms. Factors influencing organ weights are discussed and results compared to selected studies. Ideal organ weight reference ranges are proposed, based on 95% inclusion data from decedents aged 18-35 years with normal body mass indices. A smartphone application is offered, which calculates prediction intervals for individual decedents based on the multiple linear regression models. Conclusion This is the first study on post-mortem organ weights in South Africa, and despite limitations it provides useful locally derived population estimates.

Complete suicides and parasuicides are a major cause of death and disability in South Africa and the rest of the world. The epidemiology, pathology and toxicology of complete suicides were investigated in this study. All the complete suicide cases, which were presented to Salt River Medicolegal Laboratory over a period of one year (1 January 1997 - 31 December 1997), were analysed. The candidate personally conducted 148 of the alleged 180 suicide cases that presented in this time period (82%). The candidate did all the follow up investigations herself. The main findings were: 1. The male to female ratio was 5: 1. (131: 26) 2. Shooting and hanging were the most commonly used methods. 3. The racial distribution of violent deaths showed a high rate of suicides amongst the White population. 4. Suicides accounted for the Joss of young lives, the average age being 37,8 years. The mean age was 34 years. 5. Most victims committed suicide in and around their own homes. 6. The majority did not leave suicide notes. 7. Psychiatric disorders, poor health, arguments with close family members and friends, financial problems and long-standing relationship problems were the most common reasons for the suicides. 8. Suicides by prisoners accounted for 3,8% of the study (6 cases). 9. Two cases of double suicide (group suicide) were identified. 10. Five cases of homicide-suicide were identified in the study material. 11. One case of an attempted suicide by means of a high-speed motor vehicle accident, followed by the successful suicide by other means, was identified.

Violence against women is an important cause of morbidity and mortality in South Africa and indeed the of world. Women and men are equal and must have equal guarantees of economic, social, civil, political cultural rights. Women who are denied basic right security cannot participate equally in society. Violence denies this basic human right. This study is descriptive and a retrospective analysis of rape survivors in Johannesburg from 1992, a prospective analysis of homicide victims from Cape from mid-1996 to end 1998. The results have been analysed into demographic variables and compared to trends from the rest of the world. The epidemiology and pattern of injury violent crimes have specifically targeted. The main findings were: 1. incidence of rape in Johannesburg in 1992 was 165 per 100 000 women. 2. Rape in Johannesburg is seasonable and occur mainly in young African women, by strangers. 3. Approximately one third of survivors sustain non-genital as well as genital injury. 4. Most injuries can be classified as minor or moderate and comprise contusion, abrasions and lacerations. 5. The incidence of rape homicide in Town is 7.2 per 100 000 women, which represents a fatal sexual rate 1.23%. 6. The majority of rape homicide victims were coloured women in the group 26 to 45 years. 6. Of those murdered by people known to them, a current or ex-intimate partner murdered 18.6%. 7. 98.3% of rape victims had non-genital injury, and 55.9% had evidence of genital injury. 9. Most rape homicides have evidence of mechanical asphyxiation included in the mechanism of death. 10. The body areas most targeted by perpetrators in sexual assault are the head, neck and upper limbs. 11. The majority of the minor genital injuries comprise abrasions and lacerations to the posterior fourchette and introitus.

Includes bibliographical references / Deaths in police custody are a global phenomenon which continues to beset policing services worldwide. Research into these deaths has provided insight into the complexity of detention and led to the institution of preventative strategies which have seen a reduction in mortality internationally. An improved understanding of the South African detention milieu may similarly assist in reducing the mortality burden in this country. This study retrospectively reviewed deaths in custody in the Cape Town Western Metropole between 2000 and 2009, with the aim of identifying local, modifiable factors to aid in death prevention. Sixty two (62) cases were reviewed. Males predominated (90.3%) in the sample, with the racial profile mirroring that of the general population. The median age of the detainees was 30.5 years. Unnatural causes of death accounted for 82% (n=51) of cases, with suicidal hanging the commonest cause (n=40). Items of clothing were used as ligatures in 80% of hangings, with gate and window bars the most common points of suspension. Time in detention averaged 863 minutes for the sample. Clinical signs of intoxication at the time of arrest was identified as a statistically significant determinant (p=0.02) of a shorter detention time (446 minutes). Ten (10) detainees were identified as either injured at the time of arrest or physically ill during detention, of which 9 succumbed to their injuries or disease. Only three of these detainees received medical attention. These findings highlight the need for urgent review of local police cell architecture to ensure an environment conducive to safe detention, with particular attention to reducing potential points of suspension for hangings. Further, the healthcare needs of detainees must be prioritised through effective training of police personnel with regard to the assessment and management of ill detainees, particularly those intoxicated at the time of arrest.

Source: Masters Abstracts International, Volume: 47-06, page: 3546. Adviser: Beth Quill. Includes bibliographical references.

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Thesis (Ph. D.)--Open University. BLDSC no. DX175924.