Estimating the changing burden of disease attributable to interpersonal violence in South Africa for 2000, 2006 and 2012

Authors

  • M Prinsloo Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa; Institute for Lifecourse Development, Faculty of Education, Health and Human Sciences, University of Greenwich, London, UK
  • M Machisa Gender and Health Research Unit, South African Medical Research Council, Cape Town, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
  • R Kassanjee Centre for Infectious Disease Epidemiology and Research, University of Cape Town, South Africa
  • C L Ward Department of Psychology, Faculty of Humanities, University of Cape Town, South Africa; Safety and Violence Initiative, University of Cape Town, South Africa
  • I Neethling Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa; Institute for Lifecourse Development, Faculty of Education, Health and Human Sciences, University of Greenwich, London, UK
  • L Artz Gender, Health and Justice Research Unit, University of Cape Town, South Africa; Department of Pathology, Division of Forensic Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
  • R Jewkes Gender and Health Research Unit, South African Medical Research Council, Cape Town, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Office of the Executive Scientist, South African Medical Research Council, Pretoria, South Africa
  • N Abrahams Gender and Health Research Unit, South African Medical Research Council, Cape Town, South Africa; School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
  • V Pillay van-Wyk Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
  • R Matzopoulos Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa; School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
  • D Bradshaw Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa; School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
  • R Pacella Institute for Lifecourse Development, Faculty of Education, Health and Human Sciences, University of Greenwich, London, UK

DOI:

https://doi.org/10.7196/SAMJ.2022.v112i8b.16512

Keywords:

interpersonal violence, burden of disease

Abstract

Background. South Africa (SA)’s high rate of interpersonal violence persists as a leading public health problem for the country. The first South African Comparative Risk Assessment Study (SACRA1) in 2000 quantified the long-term mental and physical health burden attributable to interpersonal violence by supplementing the direct injury burden of disease attributable to interpersonal violence injuries with the substantial contribution of mental health, behavioural and reproductive health consequences accruing from exposure to intimate partner violence (IPV) and child sexual abuse.

Objectives. To revise and improve these estimates by including the additional burden from other forms of child maltreatment, community violence, sexual violence by non-partners, and bullying victimisation in SA for 2000, 2006 and 2012, and trends over time.

Methods. We used comparative risk assessment methods to calculate population attributable fractions (PAFs) for interpersonal violence. This method requires inputs on the prevalence of exposure to the interpersonal violence risk factor subtypes, namely child maltreatment, bullying, IPV, sexual violence by non-partners and other community violence; the burden of related health outcomes (mortality and morbidity); and relative risks of health outcomes in individuals exposed to the risk factor v. those unexposed. We estimated the PAF for the combinations of all interpersonal violence subtypes together to estimate the burden attributable to interpersonal violence overall for 2000, 2006 and 2012.

Results. Between 2000 and 2012, there was a decrease in interpersonal violence age-standardised attributable death rates from 100 to 71 per 100 000. In the second South African Comparative Risk Assessment Study (SACRA2), estimates of the attributable disability-adjusted life years (DALYs) for interpersonal violence for the year 2000 were revised, from 1.7 million to 2 million DALYs, taking into account attributable mortality and disability from additional forms of violence. There was a decrease in DALYs attributable to interpersonal violence from 2 million in 2000 to 1.75 million in 2012, accounting for 8.5% of the total burden for SA, ranking second highest, after unsafe sex, among 18 risk factors evaluated in 2012.

Conclusion. Overall, interpersonal violence-attributable DALYs decreased substantially but remain high. The reduction in age-standardised attributable death rates indicates that some policy and social intervention aspects are effective. Further strengthening of existing laws pertaining to interpersonal violence, and other prevention measures, are needed to intensify the prevention of violence, particularly gender-based violence. Additional forms of violence included in this analysis have improved our understanding of the interpersonal violence burden, but the attributable burden in males, although exceedingly high, remains an underestimate. There is a need to improve the epidemiological data on prevalence and risks for the different types of interpersonal violence, particularly for males.

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Published

2022-09-30

How to Cite

1.
Prinsloo M, Machisa M, Kassanjee R, Ward CL, Neethling I, Artz L, et al. Estimating the changing burden of disease attributable to interpersonal violence in South Africa for 2000, 2006 and 2012. S Afr Med J [Internet]. 2022 Sep. 30 [cited 2023 Nov. 30];112(8B):693-704. Available from: https://samajournals.co.za/index.php/samj/article/view/205

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