Accurate statistics are essential for policy guidance and decisions. However, the reported number of cases and COVID-19 deaths are known to be biased due to under-ascertainment of SARS-CoV-2 and incomplete reporting of deaths. Making use of death data from the National Population Register has made it possible to track in near-real time the number of excess deaths experienced in South Africa. These data reveal considerable provincial differences in the impact of COVID-19, likely associated with differences in population age structure and density, patterns of social mixing, and differences in the prevalence of known comorbidities such as diabetes, hypertension, and obesity. As the waves unfolded, levels of natural immunity together with vaccination began to reduce levels of mortality. Mortality rates during the second (Beta) wave were much higher than mortality in the third (Delta) wave, which were higher than in either the first or the fourth (Omicron) waves. However, the cumulative death toll during the second (Beta) wave was of a similar order of magnitude as that during the third (Delta) wave due to the longer duration of the Delta wave. Near-real time monitoring of all-cause deaths should be refined to provide more granular-level information to enable district-level policy support. In the meanwhile, there is an urgent need to re-engineer the civil registration and vital statistics system to enable more timely access to cause of death information for public health actions. SIGNIFICANCE: This study highlights that in South Africa there were about three times the number of excess deaths from natural causes during 2020 and 2021 than reported COVID-19 deaths. Although the cause of death remains unknown, the strong temporal correlation between excess deaths and reported COVID-19 deaths within each province indicates that the majority of excess deaths were associated with COVID-19. Many countries have found it difficult to estimate excess deaths, or to identify and report COVID-19 deaths accurately, demonstrating the value of near-real time monitoring of mortality through the use and demographic analysis of data obtained from the country's National Population Register.

Despite a high prevalence of alcohol and other drug use (AOD) in South Africa, little is known about AOD use among women, including those in treatment centres, and changes in use over time. This knowledge is important for the development of gender-sensitive interventions for the prevention and treatment of AOD problems. We aimed to describe changes in patterns of AOD use among women who accessed specialist AOD treatment centres in the Western Cape Province of South Africa. Data were collected from 51 specialist AOD treatment centres participating in the South African Community Epidemiology Network on Drug Use between 2000 and 2013. A total of 74 368 treatment episodes were recorded for the period, of which 22% involved women. The proportion of women seeking treatment increased from 4% to 11% over time. The most common primary substance of abuse among this sample was alcohol, followed by methamphetamine. Multinomial logistic regression analyses showed that young coloured (mixed race) women were almost 18 times more likely than other women to report methamphetamine as their primary substance of abuse (RRR=17.80; 95% CI=13.18-24.04). More than a quarter of women reported poly-substance abuse. Women treated for heroin were significantly more likely to be white and younger than 25 years old (RRR=1.62; 95% CI=1.19-2.21). These data portray an increasing use of AOD treatment services by women; particularly for alcohol and methamphetamine use disorders. Additional investigations into the service needs of women utilising AOD treatment is warranted. Significance: • The study provides the prevalence of AOD use disorders among women in substance abuse treatment facilities in the Western Cape. • The study reflects treatment admissions for poly-substance abuse and severe AOD problems among these women. • The findings highlight the importance of women-specific treatment programmes to encourage utilisation of substance abuse treatment services.

摘要目的 旨在采用具有全国代表性的样本调查南非境内与伤害有关的死亡率，并与之前的评估进行结果对比。方法我们按照城市和非城市区域以及停尸房的大小来分层，采用多级随机抽样法从停尸房处获得法医学尸检调查数据，从而开展了一项回溯式的描述性研究。我们针对外部原因致死的情况计算了特定年龄和标准化年龄的死亡率。结果 尸检报告显示 2009 年发生 52 493 起与伤害有关的死亡事件（95% 置信区间，CI：46 930-58 057）。其中几乎一半 (25 499) 为故意造成。每 100 000 人口的标准化年龄死亡率如下：所有受伤情况：109.0 (95% CI:97.1-121.0)；凶杀 38.4 (95% CI:33.8-43)；自杀 13.4 (95% CI:11.6-15.2)，以及因交通事故而受伤 36.1 (95% CI:30.9-41.3)。通过尸检报告，我们发现这个时期因凶杀和道路交通事故而死亡的事件是人口动态登记处所记录的三倍以上。凶杀率与全球分析中对南非的评估相似，但是道路交通事故死亡率和自杀率几乎高出四倍。结论 这是第一次采用具有全国代表性的样本调查南非境内与伤害有关的死亡率，从而提供了更加精确的评估和描述具体原因的文件，弥补了其他资料来源在这方面的不足。

RésuméObjectif Enquêter sur la mortalité par traumatisme en Afrique du Sud à partir d'un échantillon nationalement représentatif et comparer les résultats avec les estimations antérieures.Méthodes Nous avons réalisé une étude descriptive rétrospective des données de rapports médico-légaux obtenus auprès de morgues, en utilisant une technique d'échantillonnage aléatoire à plusieurs degrés, stratifié en fonction des critères suivants : zone urbaine, zone non urbaine et taille de la morgue. Nous avons calculé les taux de mortalité par âge et les taux de mortalité standardisés selon l'âge, pour les différentes causes externes de décès.Résultats Les dossiers d'autopsie font état de 52.493 décès par traumatisme en 2009 (intervalle de confiance de 95 %, IC : 46.930-58.057). Quasiment la moitié (25.499 décès) correspond à des blessures infligées intentionnellement. Taux de mortalité standardisé selon l'âge pour 100.000 personnes : Tous types de blessures : 109,0 (IC 95 % : 97,1-121,0) ; Homicides 38,4 (IC 95% : 33,8-43) ; Suicides 13,4 (IC 95% : 11,6-15,2) ; Blessures liées à des accidents de transport 36,1 (IC 95% : 30,9-41,3). Les rapports d'autopsie indiquent un nombre de décès par homicide et accident de la route plus de trois fois supérieur aux chiffres recensés dans les registres d'état civil pour la même période. Le taux d'homicide a confirmé les estimations préalablement faites pour l'Afrique du Sud dans une analyse internationale. En revanche, les taux correspondant aux accidents de la route et aux suicides se sont avérés près de quatre fois plus élevés.Conclusion Il s'agit du tout premier échantillon nationalement représentatif pour la mortalité par traumatisme en Afrique du Sud. Cette étude offre des estimations plus précises et des profils détaillés par causes, qui ne sont disponibles dans aucune autre source.

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AbstractObjective To investigate injury-related mortality in South Africa using a nationally representative sample and compare the results with previous estimates.Methods We conducted a retrospective descriptive study of medico-legal postmortem investigation data from mortuaries using a multistage random sample, stratified by urban and non-urban areas and mortuary size. We calculated age-specific and age-standardized mortality rates for external causes of death.Findings Postmortem reports revealed 52 493 injury-related deaths in 2009 (95% confidence interval, CI: 46 930-58 057). Almost half (25 499) were intentionally inflicted. Age-standardized mortality rates per 100 000 population were as follows: all injuries: 109.0 (95% CI: 97.1-121.0); homicide 38.4 (95% CI: 33.8-43.0; suicide 13.4 (95% CI: 11.6-15.2) and road-traffic injury 36.1 (95% CI: 30.9-41.3). Using postmortem reports, we found more than three times as many deaths from homicide and road-traffic injury than had been recorded by vital registration for this period. The homicide rate was similar to the estimate for South Africa from a global analysis, but road-traffic and suicide rates were almost fourfold higher.Conclusion This is the first nationally representative sample of injury-related mortality in South Africa. It provides more accurate estimates and cause-specific profiles that are not available from other sources.

الغرضاستقصاء الوفيات المرتبطة بالإصابات في جنوب أفريقيا باستخدام عينة ممثلة على المستوى الوطني ومقارنة النتائج بالتقديرات السابقة.الطريقةأجرينا دراسة وصفية استعادية لبيانات الاستقصاء التشريحية على مستوى الطب الشرعي، من مستودعات الجثث باستخدام عينة عشوائية متعددة المراحل، مقسمة تبعاً للمناطق الحضرية وغير الحضرية وحجم مستودع الجثث. وقمنا بحساب معدلات الوفيات النوعية للعمر، والمقيّسة بالعمر للأسباب الخارجية للوفاة.النتائجأظهرت التقارير التشريحية أن 52493 حالة وفاة مرتبطة بالإصابات في 2009 (بنسبة أرجحية مقدارها 95%، نسبة الأرجحية: (46930 إلى 58057). وأُصيب النصف تقريباً (25499) عن عمد. وجاءت معدلات الوفيات المقيّسة بالعمر لكل 100000 نسمة كما يلي: جميع الإصابات: 109.0 (بنسبة أرجحية مقدارها 95%: 97.1 إلى 121.0)؛ والقتل 38.4 (بنسبة أرجحية مقدارها 95%: 33.8 إلى 43؛ والانتحار 13.4 (بنسبة أرجحية مقدارها 95%: 11.6 إلى 15.2) والإصابات المرتبطة بالنقل 36.1 (بنسبة أرجحية مقدارها %95: (30.9 إلى 41.3). باستخدام التقارير التشريحية، وجدنا أن الوفيات الناتجة عن القتل والإصابات المرورية على الطرق كانت أكثر من التي تم تسجيلها في السجلات المدنية في هذه الفترة بأكثر من ثلاثة أمثال. كان معدل القتل مشابهاً للتقدير الخاص بجنوب أفريقيا من التحليل العالمي، ولكن ازدادت معدلات الحوادث المرورية على الطرق والانتحار بأربعة أمثال تقريباً.الاستنتاجهذه أول عينة ممثلة على المستوى الوطني للوفيات المرتبطة بالإصابات في جنوب أفريقيا. وتوفر العينة تقديرات أكثر دقة ومرتسمات خاصة بالأسباب غير متاحة في مصادر أخرى.

ResumenObjetivo Investigar la mortalidad relacionada con los traumatismos en Sudáfrica utilizando una muestra representativa a nivel nacional y comparar los resultados con estimaciones anteriores.Métodos Se llevó a cabo un estudio retrospectivo y descriptivo de datos médico-legales de investigaciones post mortem utilizando una muestra aleatoria en varias etapas, estratificado por zonas urbanas y zonas no urbanas y el tamaño de la morgue. Se calcularon las tasas de mortalidad específicas y normalizadas por edades de causas de muerte externas.Resultados Los informes post mortem revelaron 52.493 muertes relacionadas con traumatismos en 2009 (intervalo de confianza, IC, del 95%: 46.930-58.057). Casi la mitad (25.499) fueron infligidas intencionadamente. Las tasas de mortalidad normalizadas por edades por 100.000 habitantes fueron las siguientes: todos los traumatismos: 109,0 (IC del 95%: 97,1-121,0); homicidio 38,4 (IC del 95%: 33,8-43); suicidio 13,4 (IC del 95%: 11,6-15,2) y traumatismos relacionados con el transporte 36,1 (IC del 95%: 30,9-41,3). Utilizando informes post mortem, se observaron tres veces más casos de muertes por homicidio y traumatismos por accidentes de tráfico que la cantidad registrada en el registro civil para este periodo. La tasa de homicidio fue similar a la estimación para Sudáfrica desde una perspectiva global, pero las tasas de accidentes de tráfico y suicidios fueron casi cuatro veces superiores.Conclusión Esta es la primera muestra representativa a nivel nacional de mortalidad relacionada con los traumatismos en Sudáfrica. Proporciona estimaciones más precisas y perfiles por causas específicas que no pueden obtenerse de otras fuentes.

The South African citrus industry is strongly focused on exports and South Africa is a signatory member of both the World Trade Organisation Agreement on the application of Sanitary and Phytosanitary Measures and the International Plant Protection Convention. Citrus black spot, caused by Guignardia citricarpa, does not occur in all the South African citrus production areas and, therefore, South Africa has a responsibility to provide those trading partners that have identified G. citricarpa as a regulated pest with reliable information about the distribution of citrus black spot within South Africa. Detection surveys were conducted in citrus production areas in the Western Cape, Northern Cape and Free State Provinces and appropriate diagnostic protocols were used to ensure reliable detection of G. citricarpa. Trees in commercial orchards and home gardens on farms and in towns of 17, 9 and 5 magisterial districts in the Western Cape, Northern Cape and Free State Provinces, respectively, were sampled between 1995 and 2010. Fruit samples were taken during June and July, and leaf samples from November to January. None of the 3060 fruit and leaf samples collected during these surveys tested positive for G. citricarpa. Phyllosticta capitalensis, a non-pathogenic, ubiquitous, endophytic species was, however, detected during these surveys. In compliance with relevant International Standards for Phytosanitary Measures and based on the outcome of these official surveys, these three provinces in South Africa can be recognised as citrus black spot pest free areas.

INTRODUCTION: Since peaking in the early 1990s in South Africa, tobacco use has declined significantly. The reduction has been attributed to the government's comprehensive tobacco control policies that were introduced at the time. OBJECTIVE: To assess the pattern of tobacco use in the South African Demographic and Health Surveys of 1998 and 2003. METHODS: Multi-stage sampling was used to select approximately 11 000 households in cross-sectional national surveys. Face-to-face interviews, conducted with 13 826 adults (41% men) aged >15 years in 1998, and 8 115 (42% men) in 2003, included questions on tobacco use according to the WHO STEP-wise surveillance programme. Logistic regression analysis was used to assess the independent effects of selected characteristics on smoking prevalence. RESULTS: Daily or occasional smoking prevalence among women remained unchanged at 10 - 11%; it decreased among men from 42% (1998) to 35% (2003). The decline for men was significant among the poorest and those aged 25 - 44 years. Strong age patterns were observed, peaking at 35 - 44 years, which was reduced among men in 2003. Higher income and education were associated with low prevalence of smoking, while living in urban areas was associated with higher rates. Black men and women smoked significantly less than other population groups. CONCLUSION: Despite decreased smoking rates in some subgroups, a lapse exists in the efforts to reduce tobacco use, as smoking rates have remained unchanged among women, and also among young adults aged 15 - 24 years.

OBJECTIVES: To identify the groups of patients with high prevalence and poor control of hypertension in South Africa. METHODS: In the first national Demographic and Health Survey, 12 952 randomly selected South Africans aged 15 years and older were surveyed. Trained interviewers completed questionnaires on socio-demographic characteristics, lifestyle and the management of hypertension. This cross-sectional survey included blood pressure, height and weight measurements. Logistic regression analyses identified the determinants of hypertension and the treatment status. RESULTS: A high risk of hypertension was associated with less than tertiary education, older age groups, overweight and obese people, excess alcohol use, and a family history of stroke and hypertension. Hypertension risk was lowest in rural blacks and significantly higher in obese black women than in women with a normal body mass index. Improved hypertension control was found in the wealthy, women, older persons, Asians, and persons with medical insurance. CONCLUSIONS: Rural black people had lower hypertension prevalence rates than the other groups. Poorer, younger men without health insurance had the worst level of hypertension control.