Colloquium Report on “Injury Mortality Surveillance 2018-2022: Provincial Expansion, Impact of COVID, and Show Casing Mpumalanga”

June 06, 2023

The University of South Africa (Unisa) and South African Medical Research Council (SAMRC) hosted a Colloquium on 25 May 2023 on Injury Mortality Surveillance 2018-2022 in Mpumalanga, South Africa.

The colloquium had several objectives: (a) to show case Mpumalanga as a demonstration site for injury mortality surveillance (IMS); (b) demonstrate the impact of COVID-19 on injury surveillance processes and injury trends in Mpumalanga; and (c) explore the enablers and barriers to provincial IMS consolidation and expansion.

There were sixty-three stakeholders primarily from Gauteng, Limpopo, Mpumalanga and North-West. The Colloquium Opening Addresses by Prof Z. Nkosi (Executive Dean, College of Human Sciences, Unisa), Prof L. Zuhlke (Vice President, SAMRC), and Dr M. Phalane (Mpumalanga’s Department of Health MEC Representative) foreground the positioning of IMS amidst South Africa’s 2030 National Development Plan.

Prof Zuhlke emphasised that “Injury surveillance is vital for identifying and monitoring the extent of this burden, emerging or new injury priorities, injury causes, the demographics of those affected, and the key circumstances, places and temporal patterns”. Despite this recognition, Prof Z. Nkosi noted that ‘the scarcity of comprehensive and timely injury mortality research in South Africa was amplified during the recent COVID lockdowns and remains a critical barrier to organising systematic support, prevention and policy strategies in the post lockdown period.”

Dr M. Phalane, on behalf of the MEC for Health in Mpumalanga S. Sanzini, emphasised an orientation towards “African solutions for African problems” and called on the Colloquium “to ensure that the information presented, analysed and discussed here get[s] disseminated into the communities in Nkomazi, Mdantsane, Pongola, Sekhukhune and all corners of South Africa”. A fitting start to a Colloquium hosted on the 60th Anniversary of Africa Day.

Dr L. Swart (Unisa-SAMRC) presented key injury mortality findings from the 2018-2022 National Injury Mortality Surveillance System, or NIMSS, which identified changes in Mpumalanga’s COVID-19 pandemic and post pandemic injury mortality burden. Dr Swart highlighted an overall upward homicide trend, and a marginally declining transport-related mortality trend over the last 5 years.

A Discussant Panel: Figuring Death through Race and Gender: Vulnerability and Prevention Implications had Panelists offering critical reflections on the injury mortality findings for Mpumalanga. Dr N. Malherbe (Unisa-SAMRC) reflected on the importance of the NIMSS data for activist community work especially as regards the structural influences on such deaths, and highlighted ways to create socio-structural systems that are founded on health and living, rather than death and dying.

Professor H. Canham (Unisa-SAMRC) reflected how the COVID-19 restrictions had changed patterns of death, but also disturbed patterns of life, markedly through mourning practices. The pandemic inhibited sacred African rituals and funerals and had disrupted the integration of rampant death into our everyday lives, affecting all other aspects of living. Dr Taliep (Unisa-SAMRC) foreground the utility of surveillance information for prevention initiatives, highlighting the centrality of community engagement to the formulation, implementation, and adoption of such interventions. Professor S.I. Bangdiwala (Population Health Research Institute, Canada) reaffirmed this globally recognised utility of surveillance, to identify and track emerging trends and problems, but also to enable effective intervention, with injury a health issue considered especially amenable to prevention.

A Panel on the User Experiences to Injury Mortality Surveillance in Gauteng Limpopo, North-West and Mpumalanga, was comprised of Ms B. Phakathi (Mpumalanga Forensic Pathology Services, or FPS), Dr T. Mamashela (Limpopo FPS), Dr S. Holland (Gauteng FPS), Mr S. Donovan (Teqcle), and Dr K. Kgoete (North-West FPS). Overall, the Panel highlighted the central importance of surveillance to support current local policy and intervention strategies; and, as presented by Dr Swart, they agreed that the COVID-19 lockdown restrictions had for a time reduced injury mortality. Dr Mamashela recognised these restrictive interventions and the social impact especially of alcohol control. He raised the possibilities of the injury prevention sector implementing such controls further while cautioning ‘how do we strike a balance between enforcement of existing laws and alcohol being a major driver of the economy, when alcohol played a significant role in these restrictions’.

Ms Phakathi noted the importance of available real-time data during the pandemic and for enabling responses to key stakeholders such as Parliament. She further called for the alignment of terminology used in surveillance by the system partners and within the FPS. Dr Holland highlighted the research benefits of systems such as the NIMSS and the support it provides to students at Honours, Masters, and PhD levels. The Panel congratulated Mpumalanga on their approach and the support provided for surveillance, however, all FPS Panelists reiterated the central importance of the administrative staff and the required physical resources (i.e., computers, network access) and physical space for surveillance work.

The FPS representatives called for the provision of electronic surveillance. Mr Donovan would later present a NIMSS Dashboard, as an illustration of a web-based dissemination platform to demonstrate the descriptive utility and the possibility for near real time access to NIMSS data. Dr N. Mayet (National Institute for Communicable Diseases of South Africa) served as Discussant to the User Experiences Panel. She acknowledged the FPS challenges and advocated for collaborating, sharing, and the harnessing of resources to ensure real-time data and a Surveillance Dashboard. Dr Mayet reiterated the need for further capacity building among FPS staff, national championship to represent all nine provinces, innovative solutions for data entry and storage, the integration of data systems, and possible support that could be provided by the private sector.

Professor M. Seedat (Unisa-SAMRC) closed the Colloquium and acknowledged the relevant contributions by the four provinces in furthering their surveillance systems. There is a need to strengthen the current collaborations to further the existing work. Prof Seedat called for provincial champions to be identified and more detailed analyses from the current surveillance systems to provide greater insights into the etiologies of injury and violence. We need to think creatively on how surveillance systems can be versatile and meet the needs of multi-sectorial groups. These final reflections echoed Prof L. Zuhlke’s opening note that “an efficient, well organised and supported injury surveillance system that uses core epidemiological data and well-trained staff would greatly enhance the injury knowledge required to improve our promotive health care services, and support and prevention strategies”.

For further details, contact:

Contact Details: Prof Ashley van Niekerk or Najuwa Arendse
Unisa Institute for Social and Health Sciences
Unisa-SAMRC Masculinity and Health Research Unit
vnieka4@unisa.ac.za or arendn@unisa.ac.za

Press Releases:

2020 NIMSS Report