Received: December 04, 2005
Accepted: December 12, 2005
Ref: Alcohol-Related Traumatic Deaths in Transki Region, South Africa. Internet Journal of Medical Update 2006 Jan-Jun;1(1):14-9.

ALCOHOL-RELATED TRAUMATIC DEATHS IN TRANSKI REGION, SOUTH AFRICA

Dr. B L Meel MBBS, MD, DHSM (Natal), DOH (Wits), Dip HIV/AIDS (Stellenbousch)

Department of Forensic Medicine, Faculty of Health Sciences, University of Transkei, South Africa

(Corresponding Author: Dr B L Meel, Professor and Head, Department of Forensic Medicine, Faculty of Health Sciences, University of Transkei P/Bag X1 Unitra, Umtata 5100 South Africa. E-mail: meel@getafix.utr.ac.za)

INTRODUCTION

Alcohol is a socially accepted drink for partying, entertainment, bonding, and confidence boosting. Often alcohol abuse leads to drunkenness and violence. A strategy to reduce the crime and violence is to reduce the availability of alcohol [1]. World Health Organization (WHO) estimates that there are about 2 billion people who consume alcoholic beverages and 76.3 million with diagnosed alcohol use disorders.

Every day around the world, almost 16,000 people die from injuries. For every person that dies, several thousands more are injured, many of them with permanent sequelae of injuries [2]. One in four deaths of European men in the group aged 15-29 years is related to alcohol. In parts of Eastern Europe, the figure is as high as one in three [3].

South Africans consume well over 6 billion litres of alcohol beverages per year. The prevalence of misuse is likely to be as much as 30% among certain groups. Binge drinking among young people, especially males, is high. A high level of alcohol misuse has been reported among residents of disadvantaged communities. Adult per capita consumption of absolute alcohol in South Africa is between 9 and 10 liters per year which places the country among the higher alcohol consumption nations [4]. Alcohol abuse is estimated to cost South Africa in an excess of R9 billion per year. Excise duties on alcoholic beverages were approximately R4.2 billion in 2003/4. The social costs of alcohol-related trauma and accidents in South Africa far exceed the revenue collected. Intoxication is a major factor behind a high percentage of motor vehicle-related injuries and incidents of interpersonal violence [5]. Alcohol remains the substance most commonly abused by injured patients in Cape Town [6].

The misuse and abuse of alcohol is widespread in South African society and likely to have a large impact on the economy. A major burden is borne by the hospital care system; in particular the cost of alcohol-related trauma [7]. There has been an association between intoxication and both violent crime and suicide attempts. One hundred and four subjects (39%) had criminal convictions, the majority of which were committed while the subjects were intoxicated. The commonest alcohol-related crimes were driving related (17%) and crimes of violence (15%). Male gender and younger age at initiation of drinking, and earlier onset of problem drinking was significantly associated with criminal behavior [8]. Alcohol and cannabis are commonly misused by trauma patients in Johannesburg; the degree of misuse of other drugs appears to be low. Intoxication is a significant risk factor for violence and accidents and the resultant injuries are massive burden on our society. Doctors have the responsibility to highlight the association between substance misuse and trauma and should also attempt to persuade individual trauma patients to reduce future alcohol consumption [9].

In a recent study from Cape Town, 60% of trauma patients showed positivity to alcohol levels on breath analysis, 28% could be classified as problem drinkers, or possible chronic alcoholics, on the basis of questionnaires and, on urine analysis, 40% of patients were found to have used at least one illicit drug in the recent past [6].

In South Africa, 76% of all deaths after interpersonal violence have been shown to be alcohol related [10]. Alcohol and other forms of substance abuse are also major associated factors in the high trauma rates on South Africa’s roads. Seven percent of drivers with illegal blood alcohol levels account for nearly 30% of non-fatal and 47% of fatal driver deaths[10], but injury to drunken pedestrians show even greater alcohol relatedness, as pedestrian accidents account for 72% of adult traffic deaths [11]. There is hardly any statistics available on alcohol related traumatic deaths in Transkei area. There is a very high rate of (162 per 100,000 population) violent and/or traumatic deaths in Transkei [12]. The purpose of this study was to estimate the prevalence of alcohol related traumatic deaths.

METHODOLOGY

This is a descriptive study covering a period of two years (1997-98) carried out at Umtata General Hospital (UGH) mortuary. The latter is located in the hospital premises, the teaching hospital of the University Of Transkei Medical School in Eastern Cape Province of South Africa. The hospital mortuary provides services to Umtata and Nqeleni magisterial areas serving a population of about 400,000 and carries out about a thousand autopsies per year. This is the only medico legal center in this area. The information of 105 victims of trauma deaths was gathered by directly interviewing relatives who were present at autopsy. Information was collected on Tuesdays and Thursdays only. The demographic data, cause of death, and their personal habits such as smoking and alcohol consumption were recorded. The data were compiled and analyzed by Epi-Info 6.4 computer program.

RESULTS

The causes of deaths of all were motor vehicle accidents (MVA) 32%, gunshot 24%, stab injury 17%, blunt trauma 9%, and miscellaneous 18% (Figure 1). Out of 105 victims 71(68%) were less than 40years of age (Table 1 and Figure 2). A history of alcohol consumption was found in 49.5%. Eighteen of the alcoholic group (17.1%) were between 21 and 30 years of age and 11(10.5%) were between 31 and 40 years (Figure 3). Most 28(29.1%) were laborers (Figure 4 and Table 2). Fifty four (51.4%) were smokers.

DISCUSSION

Trauma is the leading cause of death in the Transkei region of South Africa, one of the least developed parts of the country, and violence contributes substantially to these traumatic deaths. The unusually high level of crime in this area is a reflection of massive unemployment poverty, and a low level of education. The commonest cause of death in this study is MVA (32%), firearm injuries (24%), stab wounds (24%), and blunt trauma (9%) (Figure1). The observed rate of violent and/or traumatic deaths in Transkei region of South Africa from 1993 to 1999 is 2.4 times higher than in Cape Town, and that of homicidal deaths is 1.3 times higher [12].

Alcohol misuse is one of the most significant public health problems in South Africa today [13]. The family members who were interviewed confirmed that about half the victims were under the influence of alcohol at the time of the assault (Table 1). Alcohol and traumatic deaths is a major concern in many studies. A study carried out by Peden in 2000 in South Africa, showed that alcohol remains the most commonly abused substance among trauma patients6. Alcohol-related crime is increasingly being recognized as a problem in cities and towns with popular entertainment districts [14]. Alcohol has found to play a major role in commission of murder in Soweto, in that in 48% of the cases either both or one of the parties was under the influence of alcohol [15]. Another South African study showed that the majority of traumatic deaths were associated with positive alcohol levels in the victims [16]. Unfortunately, from 1993 the level of per capita adult absolute alcohol consumption appears to be rising, after a decrease in 1990 and 19914. Alcohol misuse also impacts on the criminal justice system, with evidence of association between drinking at risky levels, committing crime, or being a victim of crime [17].

The role of alcohol misuse has always been inextricably entwined with crime; the nature of the relationship is not a simplistic one. To assume that the relationship is causal is to oversimplify the issue, as other factors associated with the murder will be negated. Alcohol is but one, albeit an important, link in the over all chain of causative factors [18].

There are only very few studies carried out in South Africa, a country where the incidence rates of crime and alcohol abuse are unacceptably high. There was an association between crime and suicide8. The victims were predominantly male (4:1), and under 40 years (68%) in this study (Figure 2). The findings were similar to those in the National Injury Mortality Survey System report [19]. The victims of traumatic death in this study were typically young male, a finding in line with what has been reported from most studies [1].

There were 28 in the 21 to 30 year age group of whom 18 were alcoholic (Figure 3). Thus alcohol could be contributory to violence by young people. Youth violence deeply harms not only its victims, but also their families, friends and communities. Its effects are seen not only in death, illness and disability, but also in terms of the quality of life [1]. Twenty four of the victims were under 20years of age. Of them 5 were supposed to have consumed alcohol and were in the 11 to 20 year age group (Figure 3). Binge drinking, and especially male binge drinking, among 18 to 24 years olds is statistically related to offending behavior. In the 12 months prior to interview, 39% of binge drinkers admitted to committing an offence and 60% admitted criminal behavior during or after drinking alcohol [14]. In a survey of 1378 African young persons aged 10-21 years from urban and rural areas of South Africa, Rocha Silva et al found that 11.3% of urban and 19.6% of rural males consumed on an average almost five, 340ml beers per day [20]. Levels of binge drinking are clearly higher in the drop-out males than school going, and it is high in Xhosa speaking [7].

greater than chance level and at a significantly higher level than it is associated with nonviolent crime. Heavy drinking and a verbal argument usually precede the violent act and the victim as likely as the offender, to initiate an altercation. When intoxicated a simple altercation may turn up violent [21]. The link between alcohol and violence is also culturally dependent, and exists only in settings where the collective expectation is that drinking causes or excuses certain behaviors [22]. In South Africa, for example, men speak of using alcohol in a premeditated way to gain the courage to give their partners the beatings they feel are socially expected of them [23]. There were 28 labourers among the victims, with a low level of education (Table 2 and Figure 4). Alcohol consumption is prevalent in all class of societies. Numerous studies have indicated that consumption of alcohol in small to moderate amounts every week can reduce ischemic strokes [24]. The cost-benefit on health by consumption of alcohol is not assessed, and probably it will cause more harm than good. Public should also be aware of the long term consequences. Many studies have shown that alcohol abuse is a leading cause of morbidity and mortality throughout the world, causing acute and chronic liver disease. One in 10 patients with liver cirrhosis results from alcohol abuse [25]. There were 54 victims who were confirmed smokers. Generally, two commonly used legal drugs, alcohol and tobacco smoke, are more frequently consumed than all other illegal drugs combined, with disastrous consequences of health [26]. In middle age group, economically active men, the probability of premature deaths is high in sub-Saharan Africa. Among men, tobacco is responsible for one-third of all male deaths [27].

CONCLUSION

South Africa has been carrying a triple burden of poverty, chronic diseases, and injuries, and now a fourth has been added due to HIV/AIDS pandemic [12]. These conditions are interrelated. Alcohol is an underlying factor in this interrelationship, and to break this cycle the consumption of alcohol need to be reduced. The strategy recommended by WHO [1] to reduce the crime and violence, is to reduce the availability of alcohol. This was compared in two experimental and four control towns, and it was observed that there was a decrease in offences in the experimental towns [1].

ACKNOWLEDGEMENT

The author wishes to thank Dr. George Rupesinghe, Senior Specialist, Family Medicine, Umtata General Hospital, for the assistance given during the preparation of this manuscript.

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