Road traffic collisions (RTCs) are a major contributor to unnatural death worldwide, but especially in low-to-middle-income countries (LMICs) where motorised transport has rapidly expanded. A literature review into RTCs and alcohol indicated that it is well recognised that alcohol intoxication is a key risk factor in RTCs and road traffic fatalities (RTFs). It also indicated that literature concerning the role of alcohol intoxication in RTFs in South Africa is limited. Hence, this study aimed to investigate alcohol in RTF victims in five of the major mortuaries (Salt River, Tygerberg, Paarl, Worcester and George) in the Western Cape Province between 1 January 2016 and 31 December 2017. Cases were extracted from the Western Cape Forensic Pathology Service (FPS) internal database, which included demographic and crash information, together with blood alcohol concentration (BAC) results. In total, 2079 cases over the two years were included in the study, with most cases admitted in the metropole of Cape Town (Salt River: n=838, Tygerberg: n=693). The proportion of unnatural deaths were greater outside the metropole (George, Worcester and Paarl) compared to the metropole (Salt River and Tygerberg) areas. The majority of fatalities were male individuals (male to female ratio of 3.52:1), with the average age of 35.2 ± 17.2 years. Most victims were pedestrians (n = 1106; 53.7%) and dark wet roads, and highways were noted as risk factors in RTFs. Blood was submitted for alcohol analysis in 1432 (68.9%) cases, and results were available for 1314 (91.8%) cases. Of the available results, 709 cases (54%) were positive for alcohol (BAC of ≥ 0.01g/100 mL). Of the positive cases, most had a BAC between 0.15 and 0.29 g/100mL and the overall average BAC was 0.20 g/100 mL. Pedestrians and drivers had the highest median BACs, and almost a third of all the positive BAC results were from pedestrian deaths. The findings of this dissertation can contribute to the growing research on alcohol and injury in South Africa, especially as it relates to RTFs. Insight into vulnerable populations within the province is highlighted, together with key risk factors associated with RTFs, as well as safety measures that may be targeted for improvement, especially with regards to driving and walking on the roads while intoxicated.

Homicide is one of the leading causes of death in South Africa. Homicides as a result of a firearm, sharp instrument or blunt object, may all potentially inflict severe cranial trauma. Often the lateral aspect of the cranium is fractured in homicidal assaults, however, the focus of head injury biomechanics has been the frontal bone. This is due to automotive-related incidents. Thus it is important for researchers to broaden their knowledge on lateral head impacts. This data could ultimately act as a tool in making cranial bone trauma analysis less subjective in nature. This minor dissertation discusses human cranial bones and explores different types of cranial fractures. It further provides an in depth discussion on the different types of experimental tests and specimens used in biomechanical testing. A current review on the literature surrounding head impacts is also provided. The research conducted for this minor dissertation uses the Cape (Chacma) Baboon as a model to attempt to simulate cranial blunt trauma observed in human bone. Fifteen Cape (Chacma) Baboon head specimens were subjected to a single temporo-parietal impact. These specimens were impacted with an aluminium striker bar that resembles the dimensions of a hammer (length: 23cm, circumference: 40cm and weight: 200g). The aim of these hammer tests were to characterise soft and hard tissue wound morphology as a result of blunt cranial impacts. Resulting data was analysed to determine if a significant correlation existed between impact velocity or energy and the extent of trauma observed. The remaining twelve Cape (Chacma) Baboon specimens were all subjected to a single impact in the temporo-parietal region. These specimens were impacted with a Hopkinson pressure bar, which is manufactured from the same material as the striker bar. The aim of the Hopkinson pressure bar tests was to attempt to determine the force of impact. The use of the Hopkinson pressure bar to determine fracture forces in baboon head specimens is novel. The fracture forces obtained in the current study compare well with literature investigating lateral impacts. Furthermore, the fracture patterns obtained in the current study realistically simulate cranial trauma seen in humans. It would therefore be beneficial to advance research using the baboon model and Hopkinson pressure bar apparatus.

The identification of bodily fluids for forensic purposes is typically classified as either presumptive or confirmatory. Presumptive tests (PT) are conducted first to screen for certain compounds which are relatively specific to particular fluids. Confirmatory tests are used to confirm the identity of a body fluid. Semen is one of the most common bodily fluids encountered in sexual assault cases and contains high concentrations of the acid phosphatase (AP) enzyme. The brentamine FB reagent reacts with the AP that is present in semen, and turns purple. If the colour change is observed within a specific time threshold, it is considered presumptively positive for semen. Cut-off time varies considerably between forensic laboratories, but in South Africa, the cut-off time is defined as 65 seconds. Additionally, semen may be considered to be from human origin if it reacts within 50 seconds. These cut off times have been arbitrarily defined, and there is little research in a local context to substantiate or inform the threshold time for the brentamine FB test for semen. Therefore this study assessed the sensitivity, specificity and kinetics of the brentamine FB test on semen from South African male volunteers (n=15), canines (n=2) and various fruit extracts and compared these results to purified human AP. Each semen sample was subjected to the PT in an indirect and direct method, and these tests were performed both on fresh and aged samples. The majority of fruit extracts yielded a distinctly different colour change compared to the purple that was produced from semen except for mushroom which also turned purple. Absorbance spectroscopy was used to determine the rate of the reaction at 525 nm. There were no significant differences between the rate of reaction for fresh and aged samples using both direct and indirect testing.

Molecular phenotyping is the use of informative genetic variation to estimate appearance. This concept can be applied in a forensic context to predict the appearance of suspects or decayed deceased individuals, which would otherwise remain unidentifiable. This concept has importance in a local context, as approximately 300 individuals remain unidentified, after conventional identification techniques, at Salt River Mortuary, every year. Ancestry Informative Markers (AIMs) are genetic variants with DNA which have been commonly associated with pigmentation phenotypes, and thus has value in predicting skin tone, hair colour and eye colour. This research study aimed to design and optimise an assay to genotype 13 AIMs associated with pigmentation, and then demonstrate the value of this assay by applying it to a case example and qualitatively predicting appearance. Primers were designed and PCR assays optimised to amplify each region, followed by Sanger sequencing on a case example. The case was that of an abandoned neonate, with unknown sex and ancestry. A comparison of the obtained genotypes to previous literature was performed to qualitatively estimate the skin tone, eye colour and hair colour of the decedent, which was not only in agreement with the forensic pathologist’s interpretation of sex and ethnicity, but provided richer detail with regards to ancestry, skin tone, eye colour and hair colour. The PCR assays were then further optimised into four multiplex assays with the intention of genotyping these AIMs by two SNaPshot® PCR assays (Applied Biosystems) in a larger control cohort to model the relationship between these AIMs and melanin index more objectively. Unfortunately, the scope of this research project did not allow for the completion of this additional aspect. Overall, these results indicate that these 13 AIMs have potential to predict pigmentation phenotypes of South African individuals. However, genotyping and modelling of the effects of these AIMs should be performed on a large cohort to further strengthen this conclusion.

Pesticide-related poisonings place a burden on the public health system in low- and middleincome countries. Notification of pesticide poisonings and deaths is a legal requirement in South Africa, however, our understanding of the prevalence and type of pesticides involved in poisoning cases remains limited. This is further complicated by the emergence of ‘street pesticides', which are unlabelled and illegally sold toxic pesticides. It is important to understand the role of these and other pesticides in local poisonings, and mortuary data provides an important resource to be able to investigate pesticide-related mortality specifically. This study aimed to build on previous research conducted at the Salt River mortuary (SRM) by expanding and updating our understanding of pesticide-related fatalities within the West Metropole of Cape Town. A retrospective, cross-sectional review of all unnatural death cases admitted to the SRM between January 2016 and December 2019 (inclusive) was conducted so as to identify pesticide-related deaths for further investigation. A total of 15 761 cases were admitted to SRM over the 4-year study period (mean: 3941 cases per annum). From this total, 92 cases (0.58%) were identified as pesticide related. Most decedents were male (59.8%), with the cohort's mean age being 26.2 years (range: 2 months to 66 years). The majority of cases were suicides (60.8%), and terbufos (an organophosphate) was detected in 50 cases (54.3%). Pesticiderelated fatalities were found to predominately occur in lower socio-economic areas. According to the data adults and adolescents are most at risk of being exposed to the harmful effects of these harmful compounds. Using a holistic approach to investigating pesticide-related fatalities could provide important clues that assist in gaining a better understanding of the factors that influence pesticide-related incidents. Combined efforts from healthcare practitioners and forensic investigators could help inform policy-makers on ways to minimise the use or distribution of pesticide compounds.

Fire-related fatalities pose many investigative challenges, in part due to their fragility. This can be managed with the creation of protocols, specific to the environment in which they are implemented. Currently, no protocol for the recovery and handling of fire-related fatalities exists in Cape Town, South Africa. Additionally, the challenges, risk factors, and resources present at forensic scenes in the area have not been documented. From April to December of 2015, fire-related death scenes were attended with Salt River Forensic Pathology Laboratory, which serves the West Metropole of Cape Town. Details of the fatal fire scenes were noted, including the challenges faced, and the settings in which the fires occurred. Emphasis was placed on methodologies used to recover, handle, and transport remains, and the availability and utilisation of resources. The affect these methodologies had on the condition of the remains between scene and autopsy was assessed. In total 32 fire-related death scenes were attended, with 48 decedents recovered. Males predominated (64.6%), and the majority were young adults (75%). Accidental deaths were most prevalent (79.2%), however a fire-related suicide and homicides highlighted the importance of thorough investigation. Informal housing constituted 68.8% of the fatal fire scenes and presented unique scene constraints, including no direct road access at 50% of these scenes. Investigative limitations included: inadequate interagency communication, resulting in a lack of collateral information available at autopsy; deficient scene and contextual documentation; non-standardised recovery methodologies; insufficient availability and utilisation of resources (including safety equipment); and no specialised personnel (e.g. forensic pathologists/ anthropologists) conducting scene recovery. The majority of cases (60.4%) were further fragmented or fractured by time of autopsy, illustrating the necessity for improvement of current methodologies and the importance of the involvement of forensic anthropologists in recovery of fragmentary remains.

Background: Complementary and Alternate Medicines (CAMs) in South Africa are not yet subjected to the same rigorous testing required for allopathic (prescription) medication, yet they are freely available as over-the-counter medicines. Past research has shown the presence of a banned drug, sibutramine in natural anorectics and a schedule 6 prescription drug, sildenafil, found in natural erectile dysfunction preparations. Methods: Initially, 26 exhibits (18 erectile dysfunction medicines and 8 anorectics) were screened for active pharmaceutical ingredients using high performance liquid chromatography tandem mass spectrometry. An AB SCIEX 3200 TRAP® linear ion-trap quadrupole mass spectrometer was used to detect and subsequently quantitate these active pharmaceutical ingredients using a targeted multiple reaction monitoring mode. Samples were extracted with 50% v/v methanol in water. A method for the quantitation of sildenafil was subsequently partially validated. The intra- and inter-assay precisions were evaluated and the linearity of the method was investigated in the range of 20 ng/mL to 2000 ng/mL. The method was then successfully applied to a random selection of CAMs. A random sample (n=61) of erectile dysfunction CAMs were selected for quantitation from two different clusters. Cluster 1 comprised of supermarkets and cluster 2 of pharmacies. Results: The validation method for sildenafil showed that the limit of detection was 1.09 ng/mL and the limit of quantitation was 20 ng/mL. The correlation co-efficient and bias were less than 20%. Initial screening of the 26 exhibits indicated that sildenafil was present in 12 of the 18 samples tested and sibutramine in 6 of the 8 anorectics. Of the later 61 exhibits tested, 43 tested positive for sildenafil. The mass of sildenafil per sample ranged from 1.09 ng/mL to 123.7 mg/sample. Conclusion: The lack of label content, regulation and legislation exposes the consumer to the risk of consuming an active pharmaceutical ingredient which may very likely have an adverse effect on their health. There is a need to raise public awareness to the potential dangers of unregulated CAMs, encourage doctors to become more aware of their patients' consumption of CAMs and to motivate the Medicines Control Council to follow through with their deadlines for the regulation of CAMs.

Blunt force trauma may result from homicide and assault cases, child abuse and motor vehicle accidents. Such incidents often result in skeletal trauma. Trauma to the lower limbs due to bending forces often involves a fracture pattern known as a butterfly or wedge fracture. Forensic analysis of the butterfly fracture aids in the establishment of directionality of the force applied. Currently, forensic anthropologists employ a method dictating that the base of the butterfly fragment pertains to the side of impact, while the apex of the fragment pertains to the opposite side of impact. Recent studies have demonstrated that this theory leads to erroneous forensic reconstructions as it assumes that all butterfly fractures are produced due to bone failing in tension. Furthermore, it requires the presence of a detached piece in order to be applicable, which is also the case for other proposed methods. The current study explores the biomechanics involved in the production of butterfly fractures by conducting 3-point bending impacts through a drop apparatus. It also investigates the accuracy of current and proposed forensic methods and aims at establishing a more reliable method of inferring directionality from the fracture pattern. From the sample fractured in this study, 11.8% of the fractures produced were tension wedges and 14.7% were compression wedges. When applying the existing methods of inferring directionality to the fractured sample, the accuracies ranged from 5.9% to 59%, while the method developed during this study achieved an accuracy of 97.1%. These results highlight the need of considering compression wedges during forensic reconstructions and understanding the impact of employing methods conceptualised on the assumption that all butterfly wedges are produced in tension.

Includes bibliographical references / There is currently a paucity of information regarding the prevalence and characteristics associated with blunt force trauma related homicides in South Africa. Information relating to the patterns of blunt force trauma could assist in the implementation of appropriate interventions targeted at specific areas or individuals. Furthermore, it can direct research toward topics in blunt force trauma which are in need of investigation. As such the primary objective of this study was to determine the prevalence of blunt force trauma related homicides in the West Metropole of the City of Cape Town, South Africa. The secondary objective was to describe the characteristics associated with blunt force trauma related homicides in the West Metropole of the City of Cape Town, South Africa. This thesis begins by defining blunt force wounds and comparing and contrasting the prevalence and documented characteristics associated with blunt force trauma nationally as well as internationally. Blunt force wounds occur when the body comes into contact with a blunt object at great force. Homicides by blunt force trauma are usually the result of assaults with fists, feet, bats or clubs, etc. Common wounds associated with blunt force assaults are contusions, lacerations and in some cases, bone fractures. In fatal blunt force assaults, these wounds tend to be located primarily on the head region. Salt River Mortuary receives cases from the West Metropole of the City of Cape Town, hence the results of this thesis are considered in the context of this area. This region is comprised of areas with diverse socio-economic status' and heterogeneous crime rates. The study was a retrospective review of autopsy reports obtained from Salt River mortuary from 1 January 2013 to 31 December 2014. The prevalence of blunt force trauma was considered for unnatural deaths with a focus on homicide. The inclusion criteria were cases where the cause of death was blunt force trauma as determined by the pathologist. Cases in which the death was not caused solely by blunt force trauma were classified as combination deaths, and cases involving deaths due to blunt force trauma as a result of falling from a height, train-related, pedestrian or motor vehicle accidents were excluded. A total of 3346 and 3461 cases of unnatural deaths occurred in the West Metropole of the City of Cape Town in 2013 and 2014 respectively. 247 (7.4%) cases in 2013 and 277 (8%) cases in 2014 involved blunt force injuries, and of these cases 183 (5.5%) in 201 3 and 201 (5.8%) in 2014 were classified as homicides. The results of the characteristics of blunt force homicide analysed in this study broadly concur with previous studies undertaken in South Africa, with some areas of divergence. Additional features that have not been extensively covered in previous studies also emerged, which could possibly form the basis for future investigations.

The results from this study show the value of good basic medical practices in documentation of injuries, rather than more costly DNA evidence, in assisting courts in rape cases. However, the researchers do argue that in South Africa, as a middle-income country with a high percentage of non-intimate partner rapes, there would be an advantage in improving the system to collect and analyse DNA evidence rather than abandoning it completely. These results taken together suggest that DNA evidence can assist in signifying that sexual act has transpired however it is more likely that convictions will occur if evidence of physical injury is available, as DNA evidence cannot reveal if consent was obtained or not. As stated above South Africa has one of the highest rates of rape worldwide.