An Urgent Call to Include the Manner of Death on South Africa's Death Notification Form

Cape Town, South Africa | The critical need for accurate and timely mortality data, especially information regarding causes of death (COD) is essential not only for monitoring natural deaths but also for tracking non-natural deaths resulting from injuries. The South African Medical Research Council (SAMRC), through its Rapid Mortality Surveillance (RMS) system, has been instrumental in providing near real-time insights into weekly excess mortality during these challenging times.

In the peak of the COVID-19 pandemic the RMS system revealed that, while natural deaths saw spikes coinciding with COVID-19 waves, injuries were closely tied to government-imposed lockdowns and alcohol sales bans. Of particular concern is the significant impact of alcohol bans on injury-related deaths. This revelation presents a unique opportunity for stakeholders to re-evaluate alcohol policies and protect the future well-being of all South Africans.

However, the weekly death data provides only a composite measure of all injury-related deaths without indicating the external causes, such as road traffic injury, homicide, falls, and suicide. These statistics are crucial for the country to develop and monitor programs to reduce injuries and violence, as well as to track multiple Sustainable Development Goals (SDGs), including Target 3.6 for road traffic injury reduction, SDG5 for gender equality, and Target 16.1, which aims to reduce violence-related death rates everywhere.

Regrettably, South Africa's vital statistics do not currently suffice to inform policy or monitor progress toward these SDG targets. At present, the routine collection of the manner of death for injury-related causes is not feasible because the death notification form (DNF) in South Africa does not require the reporting of the manner of death. While neither the Births and Deaths Registration Act 51 of 1992 nor the Inquests Act 58 of 1959 explicitly prohibit the inclusion of a presumptive manner of death on the DNF, interpretative issues have hindered clear guidance and the reporting of the manner of death (e.g., homicide, suicide, unintentional, disease).

Recently published research by researchers from the SAMRC highlights the importance of this and the fact that the issue was identified more than 15 years ago, yet no action has been taken. To bridge this gap, SAMRC has conducted nationally representative surveys of injury mortality in 2009, 2017, and is planning another for the 2020/21 research period, data is being collected and written up. However, these surveys are time-consuming and costly compared to the routine collection of this data during the certification of the medical cause of death. Prof. Glenda Gray, President, and CEO of the South African Medical Research Council, calls upon the South African government to take immediate action to rectify this situation by enabling the inclusion of the manner of death on the death notification form. This crucial step will not only enhance public health planning and save lives by facilitating targeted injury prevention efforts but will also enable the country to monitor some important SDGs.

More information can be obtained from these research papers:

• Groenewald, P., Matzopoulos, R., Afonso, E., & Bradshaw, D. (2023). The importance of including manner of (injury) death on the death notification form. South African Medical Journal, 113(9), 11–12. https://doi.org/10.7196/SAMJ.2023.v113i9.915
• Groenewald, P., Kallis, N., Holmgren, C., Glass, T., Anthony, A., Maud, P., Akhalwaya, Y., Afonso, E., Niewoudt, I., Martin, L. J., de Vaal, C., Cheyip, M., Morof, D., Prinsloo, M., Matzopoulos, R., & Bradshaw, D. (2023). Further evidence of misclassification of the injury deaths in South Africa: When will the barriers to accurate injury death statistics be removed? South African Medical Journal, 113(9), 30–35. https://doi.org/10.7196/SAMJ.2023.v113i9.836

For media enquiries

1. Prof Debbie Bradshaw
   Chief Specialist Scientist: Burden of Disease Research Uni
   Email: Debbie.Bradshaw@mrc.ac.za
2. Prof Richard Matzopoulos
   Unit Director: Burden of Disease Research Unit
   Email: Richard.Matzopoulos@mrc.ac.za
3. Ms Yolanda Phakela
   Public Relations Manager
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   Email: Yolanda.Phakela@mrc.ac.za