- ItemA descriptive analysis of unnatural deaths in the elderly population admitted to the Tygerberg Forensic Pathology Laboratory in South Africa from 2013 to 2017(Stellenbosch : Stellenbosch University, 2023-03) Mostert, Lambert Jacobus; Afonso, Estevao Bernardo; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Pathology. Division of Forensic Medicine.ENGLISH SUMMARY: Background: The elderly population is globally increasing. Frailty and associated comorbidities make this population group prone to accidents and vulnerable to injury. Considering a high level of violent unnatural deaths in South Africa, not much research has been done on unnatural deaths in the elderly population. Objectives: The purpose of our study was to describe the causes of unnatural deaths in the elderly population. Methods: A retrospective descriptive study was conducted on all unnatural cases aged 65 years and older, admitted to Tygerberg Forensic Pathology Laboratory, serving the eastern part of Cape Town Metropolitan region. The study included 400 cases of elderly unnatural deaths from 2013 to 2017. Results: The most common cause of death in the elderly was found to be falls (29.8%), followed by transport-related injuries (20%) and procedure-related deaths (15.3%). Accidents were found to be the most common manner of unnatural death (61%), followed by suicides (10.8%) and homicides (9.5%). A significantly larger proportion of the suicide cases were male (n=37 in males; n=6 in females). Conclusions: Accidental deaths, in particular fall-related incidents, were the main cause for mortality in the study population. Further assessment regarding the circumstances of the accidents in the elderly is necessary to determine whether preventative strategies may lessen this burden in our ageing population. Procedure-related deaths were also highlighted as an area of concern requiring an integrated approach to assessment and standardisation of the classification of the manner of these deaths.
- ItemAn investigation into the profile and temporal evolution of firearm-related fatalities at Tygerberg Forensic Pathology Service Laboratory(Stellenbosch : Stellenbosch University, 2023-03) Uren, Grace Amy; Dempers, Jacobus Johannes; Verster, Janette; Prinsloo, Megan; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Pathology. Division of Forensic Medicine.ENGLISH SUMMARY: Firearm-related violence and fatalities are a significant public health and safety concern, especially in the South African City of Cape Town Metropole. Access and availability of firearms have been identified as key factors influencing this burden of firearm violence in Cape Town. Limited published data exist regarding firearm-related fatalities in the Eastern, Northern, Tygerberg, and Khayelitsha health sub-districts of the City of Cape Town Eastern Metropole serviced by the Tygerberg Mortuary. This study aimed to provide insight into the profile and severity of the pathological characteristics of firearm-related fatality cases admitted to the Tygerberg Forensic Pathology Laboratory for medicolegal postmortem examination observed in three time periods (2001, 2009, and 2017), from which patients were randomly selected. A retrospective descriptive study was conducted by evaluating autopsy case files of individuals admitted to the Tygerberg Forensic Pathology Laboratory after sustaining fatal firearm-related injuries. A total of 420 firearm-related fatality cases were included within the three distinct years, 2001 (n=125), 2009 (n=75), and 2017 (n=220), with most of these fatalities evident in young adult males. The majority of firearm-related incidents occurred in sub-economic areas and during night-time. A significant increase in the number of gunshots and individually fatal gunshot wounds sustained in victims from 2001 to 2017 (p=0.001) and 2009 to 2017 (p=0.002) was evident. The pathological severity of firearm-injury fatalities has increased and adds to the immense workload of an already overburdened facility. Interventions are required to decrease the illegal sale and distribution of firearms and stricter enforcement of gun-control legislation.
- ItemFemicide in the Eastern Metropole of Cape Town : A 5-year retrospective analysis(Stellenbosch : Stellenbosch University, 2022-11) Wilscott-Davids, Candice; Afonso, Steven; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Pathology. Division of Forensic Medicine.ENGLISH ABSTRACT: Background: Violence against woman continues to be a global health problem with formicide being its most severe form, especially in a country with one of the world's highest homicide rates. Aim: To evaluate the female homicide cases at the Tygerberg Forensic Pathology Laboratory, identifying the demographic profile of victims, leading causes of death, patterns of injury and prevalence of sexual violence.
- ItemA retrospective review of railway-associated deaths in the Cape Town Metro East region over a two-year period.(Stellenbosch : Stellenbosch University, 2021-03) Okkers, Heidi Lee; Afonso, Estevao; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Pathology: Forensic Medicine.Background: Railway travel is an integral part of the daily transport of people and cargo worldwide, and no less so in South Africa. Generally considered safer than road transport, rail travel is still associated with risk and railway-related deaths attract significant media attention. There is limited local research into the epidemiology and pathology of these deaths. An improved understanding of these cases will assist in preventative strategies to minimise fatalities. Objectives: The aim of this study was to investigate railway-associated fatalities in the Cape Town Metro East region over two years, from 2016 to 2017. The objectives were to obtain a demographic profile of victims, characterise injury patterns, identify the temporal and geographical distribution of deaths and, where possible, the causes of death. Methods: A retrospective descriptive review of all railway-associated fatalities admitted to the Tygerberg Forensic Pathology Laboratory between 1 January 2016 and 31 December 2017 was performed. Data were collected from autopsy reports and available contemporaneous notes for each case, including South African Police documents and hospital notes, where relevant. Results: There were 104 cases of railway-associated deaths during the two-year period under study. Males accounted for 87 cases, while there were only 17 female victims. The mean age of all cases was 34.8 years. Most incidents occurred between the morning hours of 8 am and 10 am and in the evening from 7 pm to 10 pm, and a midweek peak of 62.5% of cases were reported as pedestrians who were struck whilst crossing the railway tracks. Khayelitsha was the suburb where the highest number of cases were recorded. Multiple blunt force injuries as the terminal cause of death accounted for 81.7% of cases. One case of electrocution and one of downing were reported. Two cases of alleged assault were recorded. Head injuries accounted for 91 cases with only five decapitations. Transection of the thorax occurred in eight cases and multiple rib fractures were also recorded. Multiple organs were disrupted and the upper limbs on the right were predominantly injured. 17 victims had blood alcohol levels above the legal limit of 0.05 g/100ml. Conclusion: More than half of the cases died as a result of multiple traumatic injuries after crossing the railway tracks as pedestrians. This study emphasizes the importance of adequate contemporaneous documentation of the cases. The background information and scene investigation play a significant role in determining factors assisting in the determination of the cause and manner of death. Optimal security can aid in the decline of unnecessary railway incidents and death. It is recommended that the investigation of railway-associated fatalities become a priority to prevent circumstances in which these cases occur.
- ItemA critical review of sudden unexpected deaths at Tygerberg Hospital Forensic Pathology Laboratory over a one-year period in 2016(Stellenbosch : Stellenbosch University, 2021-03) Roman, Jill; Verster, J.; Dempers, J. J.; Osman, Muhammad; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Pathology: Forensic Medicine.Background In South Africa, admissions of sudden and unexpected deaths to large Forensic Pathology Laboratories (FPL) for medicolegal post-mortem examination are generally on the increase. Research in this field is useful to identify disease patterns and to reduce unnecessary admissions to forensic pathology services. Objectives Our main aim was to determine the recent epidemiological profile of sudden and unexpected deaths admitted to Tygerberg FPL from 1 January to 31 December in 2016, compared to a past similar study that evaluated similar data of 2001 to 2005. A secondary objective was to ascertain the contribution of respiratory disease. Method A retrospective study was conducted. Anonymized data were obtained from post-mortem case files for analysis and comparison, using an electronic Open Data Kit application, Red Cap electronic database and Windows Excel for secure storage, and Statistical Package for Social Sciences for biostatistical analyses. Results The total number of cases that were admitted to Tygerberg FPL in 2016 for medicolegal post-mortem examination were 3766. The past epidemiological study at the same facility evaluating the data of 2001 to 2005, showed an annual average of approximately 2700 admissions. Admissions of more than 1000 above the previous annual average was thus demonstrated. Of the 3766 admissions in 2016, a sum of 770 cases comprised the study population of sudden and unexpected deaths, of which 539 (70%) were adults and 231(30%) children. All cases that were known to have an unnatural cause of death upon admission were excluded A younger average age of 34 years and continued male predominance was demonstrated in the study population. The manner of death was presumably natural in 496 (64.4%) cases, unnatural in 60 (7.8%) cases and undetermined in 214 (27.8%) cases. In the population of minors (<18 years of age), presumed natural deaths accounted for 145/231 (62.8%) cases. Diseases of the respiratory and cardiovascular systems continued to be the leading natural causes of death in the overall study population. Pneumonia was the most prevalent cause of death in the population of minors (<18 years of age) and ischaemic heart disease in adults. Lower socio-economic status areas were more significantly affected. Conclusion Regular epidemiologic studies of sudden and unexpected deaths are needed in Cape Town’s Eastern Metropole for disease prevention and health promotion. Training of medical professionals and the South African Police Services is vital to better understand what a sudden and unexpected death is and when medico-legal referral is warranted. [370 words]