Estimating the changing burden of disease attributable to interpersonal violence in South Africa for 2000, 2006 and 2012
Keywords:interpersonal violence, burden of disease
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.
Norman R, Bradshaw D, Schneider M, et al. Estimating the burden of disease attributable to interpersonal violence in South Africa in 2000. S Afr Med J 2007;97(8):653-656.
NormanR,SchneiderM,BradshawD,etal.Interpersonalviolence:Animportantriskfactorfordisease and injury in South Africa. Popul Health Metr 2010;8:32. https://doi.org/10.1186/1478-7954-8-32
Norman R, Matzopoulos R, Groenewald P, et al. The high burden of injuries in South Africa. Bull World Health Organ 2007;85(9):695-702. https://doi.org/10.2471/blt.06.037184
South African Police Service. RSA: April to March 2004 - 2014: Crime categories figures and ratios 2014. https://www.saps.gov.za/resource_centre/publications/statistics/crimestats/2014/download/final_ tables_2014.xlsx (accessed 31 May 2017).
South African Police Service. Annual Crime Report 2015/2016: Addendum to the SAPS Annual Report. Pretoria, 2016. ISBN No. 978-0-621-44671-5.
Nicolson G. Crime stats: Murder rate remains ‘stable’ at around 58 deaths a day. Daily Maverick, 31 July 2020. https://www.dailymaverick.co.za/article/2020-07-31-crime-stats-murder-rate-remains- stable-at-around-58-deaths-a-day/ (accessed 28 January 2021).
World Health Organization. Global status report on violence prevention, 2014. Geneva: WHO, 2014. www.who.int/violence_injury_prevention/violence/status_report/2014 (accessed 10 July 2018).
Matzopoulos R, Prinsloo M, Pillay-van Wyk V, et al. Injury-related mortality in South Africa: A retrospective descriptive study of post-mortem investigations. Bull World Health Organ 2015;93(5):303-313. https://doi.org/10.2471/BLT.14.145771
United Nations Office on Drugs and Crime. Global Study of Homicide 2018: Gender-related killing of women and girls. Vienna: UNODC, 2018. https://www.unodc.org/documents/data-and-analysis/ GSH2018/GSH18_Gender-related_killing_of_women_and_girls.pdf (accessed 2 August 2021).
Abrahams N, Mathews S, Martin LJ, et al. Intimate partner femicide in South Africa in 1999 and 2009. PLoS Med 2013;10(4):e1001412. https://doi.org/10.1371/journal.pmed.1001412
Krug E, Dahlberg LL, Mercy JA, Zwi AB, Lozano R, eds. World report on violence and health. Geneva: World Health Organization, 2002. https://apps.who.int/iris/bitstream/ handle/10665/42495/9241545615_eng.pdf (accessed 12 April 2018).
World Health Organization. Understanding and addressing violence against women: Health consequences. Geneva: WHO, 2012. https://apps.who.int/iris/bitstream/handle/10665/77431/WHO_ RHR_12.43_eng.pdf;jsessionid=D6145444E19D2C3B89815EB35BE9F37C?sequence=1 (accessed 13 April 2021).
Jewkes RK, Dunkle K, Nduna M, et al. Intimate partner violence, relationship power inequity, and incidence of HIV infection in young women in South Africa: A cohort study. Lancet 2010;376(9734):41- 48. https://doi.org/10.1016/S0140-6736(10)60548-X
Machisa M, Jewkes R, Lowe-Morna C, et al. The war at home: Gender Based Violence Indicators Project, Gauteng Research Report, South Africa. Johannesburg: GenderLinks and South African Medical Research Council, 2011. https://www.saferspaces.org.za/uploads/files/GenderLinks-13452_ begin_war_at_home.pdf (accessed 16 February 2019).
Abrahams N, Mhlongo S, Dunkle K, et al. Increase in HIV incidence in women exposed to rape. AIDS 2021;35(4):633-642. https://doi.org/10.1097/QAD.0000000000002779
Lancet Global Health. No man left behind. Lancet Glob Health 2020;8(12):e1444. https://doi. org/10.1016/S2214-109X(20)30490-3
Levy JK, Greene ME. Pushing the boundaries of data to ensure gender equality across the life span. Lancet Glob Health 2020;8(12):e1445-e1446. https://doi.org/10.1016/S2214-109X(20)30487-3
Ward CL, Artz L, Leoschut L, et al. Sexual violence against children in South Africa: A nationally representative cross-sectional study of prevalence and correlates. Lancet Glob Health 2018;6(4):e460-e468. https://doi.org/10.1016/s2214-109x(18)30060-3
Abrahams N, Mathews S, Martin LJ, et al. Gender differences in homicide of neonates, infants, and children under 5 y in South Africa: Results from the Cross-Sectional 2009 National Child Homicide Study. PLoS Med 2016;13(4):e1002003. https://doi.org/10.1371/journal.pmed.1002003
Mathews S, Abrahams N, Jewkes R, et al. Child homicide patterns in South Africa: Is there a link to child abuse? Cape Town: South African Medical Research Council, 2012. http://www.mrc.ac.za/ policybriefs/childhomicide.pdf (accessed 9 March 2016).
Artz L, Burton P, Ward CL, et al. Optimus Study South Africa: Technical report. Sexual victimisation of children in South Africa: Final report of the Optimus Foundation Study. Zurich: UBS Optimus Foundation, 2016. https://www.saferspaces.org.za/uploads/files/08_cjcp_report_2016_d.pdf (accessed 2 May 2018).
Artz L, Ward CL, Leoschut L, et al. The prevalence of child sexual abuse in South Africa: The Optimus Study South Africa. S Afr Med J 2018;108(10):791-792. https://doi.org/10.7196/SAMJ.2018. v108i10.13533
Mathews S, Martin LJ, Coetzee D, et al. The South African child death review pilot: A multiagency approach to strengthen healthcare and protection for children. S Afr Med J 2016;106(9):895-899. https://doi.org/10.7196/SAMJ.2016.v106i9.11234
Jamieson L, Sambu W, Mathews S. Out of harm’s way? Tracking child abuse cases through the child protection system in five selected sites in South Africa. Cape Town: Children’s Institute, University of Cape Town, 2017. http://www.ci.uct.ac.za/overview-violence/reports/out-of-harms-way-tracking- child-abuse-cases-through-the-child-protection-system (accessed 4 June 2021).
GBD 2017 Risk Factor Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990 - 2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018;392(10159):1923-1924. https://doi.org/10.1016/S0140-6736(18)32225-6
Dahlberg LL, Krug EG. Violence – a global public health problem. In: World Report on Violence and Health. Geneva: World Health Organization, 2002:1-56. http://apps.who.int/iris/bitstream/ handle/10665/42495/9241545615_eng.pdf;jsessionid=64F72CE602719FAE07FBBCEE2D8B3A8D? sequence=1 (accessed 11 November 2017).
Mathers CD, Ezzati M, Lopez AD, et al. Causal decomposition of summary measures of population health. In: Murray CJL, Salomon J, Mathers CD, Lopez AD, eds. Summary Measures of Population Health. Geneva: World Health Organization, 2002. http://apps.who.int/iris/bitstream/ handle/10665/42439/9241545518.pdf;jsessionid=5B415800D5035D01A36713D1F0895536?sequen ce=1 (accessed 5 February 2018).
Moore SE, Scott JG, Ferrari AJ, et al. Burden attributable to child maltreatment in Australia. Child Abuse Negl 2015;48:208-220. https://doi.org/10.1016/j.chiabu.2015.05.006
Thomas HJ, Connor JP, Lawrence DM, et al. Prevalence and correlates of bullying victimisation and perpetration in a nationally representative sample of Australian youth. Aust N Z J Psychiatry 2017;51(9):909-920. https://doi.org/10.1177/0004867417707819
Statistics South Africa. Census 2011/2012. https://www.statssa.gov.za/?page_id=3839&gclid=CjwKCAjw9- KTBhBcEiwAr19ig66T8PT4I9owrIKm3VqNeWLtuaeZTqkKCrnpJeMy6_YqfK1_BcuoYhoCXugQAvD_ BwE (accessed 8 November 2012).
Statistics South Africa. Community Survey 2007: Key municipal data. Statistical release P03- 01-22. Pretoria: Stats SA, 2007. https://www.statssa.gov.za/publications/Report-03-01-21/ Report-03-01-212007.pdf (accessed 6 June 2018).
Statistics South Africa. Census 2001: Census in brief. Pretoria: Stats SA, 2003. http://www.statssa.gov. za/census/census_2001/census_in_brief/CIB2001.pdf (accessed 15 April 2021).
Monks CP, Robinson S, Worlidge P. The emergence of cyberbullying: A survey of primary school pupils’ perceptions and experiences. School Psych Int 2012;33(5):477-491. https://doi. org/10.1177/0143034312445242
Abrahams N, Jewkes R, Martin LJ, et al. Mortality of women from intimate partner violence in South Africa: A national epidemiological study. Violence Vict 2009;24(4):546-556.
Abrahams N, Mathews S, Jewkes R, et al. Every eight hours: Intimate femicide in South Africa, 10 years later! Cape Town: South African Medical Research Council, 2012. http://www.mrc.ac.za/policybriefs/ everyeighthours.pdf (accessed 9 March 2016).
Mathews B, Pacella R, Dunne MP, et al. Improving measurement of child abuse and neglect: A systematic review and analysis of national prevalence studies. PLoS ONE 2020;15(1):e0227884. https://doi.org/10.1371/journal.pone.0227884
World Health Organization and International Society for Prevention of Child Abuse and Neglect. Preventing child maltreatment: A guide to taking action and generating evidence. Geneva: WHO, 2006. https://apps.who.int/iris/handle/10665/43499 (accessed 4 May 2022).
Mathews B, Collin-Vézina D. Child sexual abuse: Toward a conceptual model and definition. Trauma Violence Abuse 2019;20(2):131-148. https://doi.org/10.1177/1524838017738726
Glaser D. How to deal with emotional abuse and neglect: Further development of a conceptual framework (FRAMEA). Child Abuse Negl 2011;35(10):866-875. https://doi.org/10.1016/j. chiabu.2011.08.002
Kairys SW, Johnson CF. The psychological maltreatment of children – technical report. Pediatrics 2002;109(4):e68. https://doi.org/10.1542/peds.109.4.e68
Dubowitz H, Newton RR, Litrownik AJ, et al. Examination of a conceptual model of child neglect. Child Maltreat 2005;10(2):173-189. https://doi.org/10.1177/1077559505275014
Hamby S, Finkelhor D, Turner H, et al. The overlap of witnessing partner violence with child maltreatment and other victimisations in a nationally representative survey of youth. Child Abuse Negl 2010;34(10):734-741. https://doi.org/10.1016/j.chiabu.2010.03.001
Ford-Gilboe M, Wathen CN, Varcoe C, et al. Development of a brief measure of intimate partner violence experiences: The Composite Abuse Scale (Revised) – Short Form (CASR-SF). BMJ Open 2016;6(12):e012824. https://doi.org/10.1136/bmjopen-2016-012824
Olweus D. Bullying at School: What We Know and What We Can Do. Oxford: Blackwell, 1993.
GBD 2017 Risk Factor Collaborators. Supplementary appendix 1: Methods appendix to Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990 - 2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018;392:S1-375. https://ars.els-cdn.com/content/image/1-s2.0-
S0140673618322256-mmc1.pdf (accessed 9 May 2022).
Jewkes RK, Dunkle K, Nduna M, et al. Associations between childhood adversity and depression, substance abuse and HIV and HSV2 incident infections in rural South African youth. Child Abuse Negl 2010;34(11):833-841. https://doi.org/10.1016/j.chiabu.2010.05.002
Pillay-van Wyk V, Msemburi W, Laubscher R, et al. Mortality trends and differentials in South Africa from 1997 to 2012: Second National Burden of Disease Study. Lancet Glob Health 2016;4(9):e642-e653. https://doi.org/10.1016/S2214-109X(16)30113-9
Barendregt JJ. Ersatz version 1.35. 2017. http://www.epigear.com (accessed 2 June 2021).
Barendregt JJ. The effect size in uncertainty analysis. Value Health 2010;13(4):388-391. https://doi.
South Africa. Firearms Control Act No. 60 of 2000 and Regulations 2004. https://www.saps.gov.za/
services/flash/firearms/legislation/gov_notice_english.pdf (accessed 31 May 2018).
Abdool Karim SS, Churchyard GJ, Abdool Karim Q, et al. HIV infection and tuberculosis in South Africa: An urgent need to escalate the public health response. Lancet 2009;374(9693):921-933. https://
De Vries KM, Mak J, Bacchus LJ, et al. Intimate partner violence and incident depressive symptoms and suicide attempts: A systematic review of longitudinal studies. PLoS Med 2013;10(5):e1001439. https:// doi.org/10.1371/journal.pmed.1001439
De Vries KM, Child JC, Bacchus LJ, et al. Intimate partner violence victimisation and alcohol consumption in women: A systematic review and meta-analysis. Addiction 2013;109(3):379-391. https://doi.org/10.1111/add.12393
Fergusson DM, Horwood LJ, Woodward LJ. The stability of child abuse reports: A longitudinal study of the reporting behaviour of young adults. Psychol Med 2000;30(3):529-544. https://doi.org/10.1017/ s0033291799002111
Dunkle KL, Jewkes RK, Murdock DW, et al. Prevalence of consensual male-male sex and sexual violence, and associations with HIV in South Africa: A population-based cross-sectional study. PLoS Med 2013;10(6):e1001472. https://doi.org/10.1371/journal.pmed.1001472
Jewkes R, Sikweyiya Y, Morrell R, et al. The relationship between intimate partner violence, rape and HIV amongst South African men: A cross-sectional study. PLoS ONE 2011;6(9):e24256. https://doi. org/10.1371/journal.pone.0024256
Norman RE, Byambaa M, De R, et al. The long-term health consequences of child physical abuse, emotional abuse, and neglect: A systematic review and meta-analysis. PLoS Med 2012;9(11):e1001349. https://doi.org/10.1371/journal.pmed.1001349
Moore SE, Norman RE, Suetani S, et al. Consequences of bullying victimisation in childhood and adolescence: A systematic review and meta-analysis. World J Psychiatry 2017;7(1):60-76. https://doi. org/10.5498/wjp.v7.i1.60
Garcia-Moreno C, Jansen HA, Ellsberg M, et al. Prevalence of intimate partner violence: Findings from the WHO multi-country study on women’s health and domestic violence. Lancet 2006;368(9543):1260- 1269. https://doi.org/10.1016/S0140-6736(06)69523-8
Ellsberg M, Heise L, Peña R, et al. Researching domestic violence against women: Methodological and ethical considerations. Stud Fam Plann 2001;32(1):1-16. https://doi.org/10.1111/j.1728- 4465.2001.00001.x
Jewkes R, Watts C, Abrahams N, et al. Ethical and methodological issues in conducting research on gender-based violence in southern Africa. Reprod Health Matters 2000;8(15):93-103. https://doi. org/10.1016/s0968-8080(00)90010-7
National Department of Health (NDoH), Statistics South Africa (Stats SA), South African Medical Research Council (SAMRC), and ICF. South Africa Demographic and Health Survey 2016. Pretoria, South Africa, and Rockville, Md, USA: NDoH, Stats SA, SAMRC, and ICF, 2017. www.statssa.gov.za/ publications/Report%2003-00-09/Report%2003-00-092016.pdf (accessed 5 July 2021).
Johnson SD, Cunningham-Williams RM, Cottler LB. A tripartite of HIV-risk for African American women: The intersection of drug use, violence, and depression. Drug Alcohol Depend 2003;70(2):169- 175. https://doi.org/10.1016/s0376-8716(02)00345-9
Wingood GM, DiClemente RJ. Rape among African American women: Sexual, psychological, and social correlates predisposing survivors to risk of STD/HIV. J Womens Health 1998;7(1):77-84. https:// doi.org/10.1089/jwh.1998.7.77
Coovadia H, Jewkes R, Barron P, et al. The health and health system of South Africa: Historical roots of current public health challenges. Lancet 2009;374(9692):817-834. https://doi.org/10.1016/s0140- 6736(09)60951-x
Delius P, Glaser C. Sexual socialisation in South Africa: A historical perspective. African Studies 2002;61(1):27-54.
Gibbs A, Abdelatif N, Washington L, et al. Differential impact on men in an IPV prevention intervention: A post hoc analysis using latent class analysis of the Stepping Stones and Creating Futures intervention in South Africa. Soc Sci Med 2020;265:113538. https://doi.org/10.1016/j. socscimed.2020.113538
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