SIGNIFICANCE: Alcohol is a major contributing factor to the burden of road traffic crashes and injuries in South Africa. There has been an increase in political interest and engagement on the issue of drink-driving in recent months following government restrictions on the sale and public consumption of alcohol during the COVID-19 lockdowns along with proposed zero-tolerance drink-driving legislation. In this paper, we critically examine global research and experiences with the adoption of zero-tolerance approaches to drink-driving along with key South African contextual considerations to provide evidence-based and contextually relevant recommendations for advancing zero-tolerance drink-driving legislation in the country. There is significant evidence to support the adoption of zero-tolerance legislation but at a blood alcohol concentration (BAC) threshold limit for the general driving population set at 0.02 g/100 mL (rather than the zero-BAC limit proposed through the Road Traffic Amendment Bill) to allow for variance in testing. Recommendations centre on the proposed legislation incorporating a gradualist approach and its location within a broader zero-tolerance approach that includes other complementary interventions to enable implementation. : •The recommended blood alcohol level of 0.02 g/100 mL is lower than the best practice limit recommended by the World Health Organization of 0.05 g/100 mL, following consideration of the road safety and general alcohol consumption challenges in South Africa and evidence of success from other similar country contexts. •Broad principles and recommendations are presented to support the sustainable adoption of zero-tolerance drink-driving legislation in the country

SIGNIFICANCE: Energy poverty is the constrained access to modern forms of energy. In South Africa, energy impoverished communities are dependent on a mixture of solid fuels (e.g. wood or coal) and hydrocarbons such as paraffin. These, especially paraffin use, are associated with significant negative health outcomes, particularly burns due to accidental fires and spillages, but also paraffin ingestion, and toxic fume inhalation. The energy-poor furthermore suffer disproportionate long-term social, economic and psychological impacts that entrench their impoverished conditions. There is both international and national recognition of these adverse effects of energy poverty and that the universal access to safe and sustainable energy is crucial for the attainment of health and other global social, economic and well-being goals. South Africa is called on to expedite access to modern energy usage, through the enactment of a substantive policy on the provision of safe, clean and affordable energy for energy-impoverished communities and households.

Burn injuries remain a significant cause of death and disability in the global south, with children amongst the most vulnerable. In South Africa, burns are a critical health and economic burden in densely populated and energy-impoverished communities. This study used secondary data on burn injuries from 19 health facilities to differentiate between risk for scalds and flame burns across three household energy sources (firewood, paraffin and electricity). The sample was 2 933 cases of child burn victims, with key analytical procedures being descriptive statistics and logistic regression analysis. Results showed that 52% of burn injury admissions reported electricity as the household energy source used at the time of injury. Most burn injuries were scalds (85.3%), with infants and toddlers at greatest risk. The differentiation between wood and paraffin was associated with a threefold increase in scalds relative to flame burns, while that between paraffin and electricity indicated a sevenfold increase in scalds and nineteen times such an increase between wood and electricity. This was an indication of continued challenges for the country in addressing paediatric burns despite, and in the context of, the continued electrification of poor households. The study recommends improved regulation of electrical appliances used by low-income households, and targeted household safety education initiatives.Highlights • Study differentiated the risk for scalds versus flame burns across fuels. • Most burn injuries were scalds, with toddlers at greatest risk. • Electricity was associated with most scalds relative to wood and paraffin. • Regulation of simple electrical appliances and safety education is recommended.

Energy-poor households in Africa's burgeoning urban informal settlements are especially likely to suffer from heatwaves because of thermally inefficient dwellings and lack of affordable cooling options. This study utilised a controlled experiment to assess the effectiveness of passive cooling through specially formulated paints (cool coatings) in standard informal structures. The test structures were built to simulate typical shack dwellings in South Africa's urban informal settlements. Results showed that the mean daily maximum temperatures of the coated structure were up to 4.3 °C lower than those in the uncoated structure. The same cooling trend was observed for the minimum daily temperatures, which were lower by an average of 2.2 °C. Besides, the annual frequency of maximum temperature exceedances beyond the critical heat stroke value of 40 °C dropped from 19% for the uncoated structure to 1% for the coated structure. These temperature differences were found to be statistically and subjectively significant, implying that cool coatings may be effective in promoting thermal comfort and climate resilience in poor urban communities. It is recommended that governmental authorities and relevant role players invest in the production and assisted application of cool coatings in urban informal settlements. The interventions promise hope of reduced energy burden on poor households and could be implemented in parallel with ongoing efforts focused on the design and implementation of low-cost, durable and thermally comfortable houses for indigent communities. Ultimately, the endeavours could be a potential policy change to assist in expanding poor households' access to alternative and green energy resources. HIGHLIGHTS: • Energy-poor shack dwellers are frequently exposed to elevated summertime heat. • Passive cooling technologies are perhaps one economically viable option. • Experimental shacks coated with cool coatings showed lower indoor heat. • Cool coatings intervention can greatly improve survivability of shack dwellings.

In the aftermath of the 1980s legislation introduced under the "total strategy" of the South African government under then president PW Botha, critical social scientist groupings reflected on the intellectual and programmatic responses required to counter the racist and undemocratic policies of the time. Since the formal demise of these polices and despite the profound political shifts in 1994 to representative government, questions that reflect on the contemporary role of critical social science are still considered pertinent. We reflect on what the orientations of social science to government in our new and evolving democratic dispensation should be, and whether critical scientists can remain critical and work with government, or whether engagement with the state, of necessity, compromises criticality. The extensive and sustained nature of violence and injury, a leading contributor to South Africa's social and health malaise, has suggested that a coordinated, multi-sectoral and evidence-led partnership is required for its reduction. Our engagement with this issue has been through the development of a Strategic Framework for Violence and Injury Prevention, which we regard as indicative of some recognition by government of the inclusion of critical voices for an effective collective response. However, the critical scholars in this engagement process faced multiple challenges, including contrasting understandings of violence and injury, which may have diluted the contributions of critical scholarship.

OBJECTIVE: To determine the leading causes of fatal injury for urban South African children aged 0-14 years, the distribution of those causes and the current potential for safety improvements. METHODS: We obtained injury surveillance data from the National Injury Mortality Surveillance System 2001-2003 for six major South African cities varying in size, development and sociodemographic composition. We calculated age-adjusted rates, by sex, population group and city, for death from the five leading causes of fatal injury as well as population attributable risks (PARs). FINDINGS: The leading causes of fatal injury in childhood included road traffic injuries - among vehicle passengers and especially among pedestrians - drowning, burns and, in some cities, firearm injuries. Large differences in PARs were observed, particularly for population groups and cities. Disparities between cities and between population groups were largest for deaths from pedestrian injuries, while differences between boys and girls were greatest for drowning deaths. CONCLUSION: In the face of the high variability observed between cities and population groups in the rates of the most common types of fatal injuries, a safety agenda should combine safety-for-all countermeasures - i.e. lowering injury rates for all - and targeted countermeasures that help reduce the burden for those at greatest risk.

OBJETIVO: Determinar las principales causas de lesiones mortales entre niños urbanos de Sudáfrica de 0 a 14 años, así como la distribución de esas causas y las posibilidades actuales de introducir mejoras en la seguridad. MÉTODOS: Obtuvimos datos de vigilancia de lesiones a partir del Sistema Nacional de Vigilancia de la Mortalidad 2001-2003 para seis grandes ciudades de Sudáfrica de diverso tamaño, desarrollo y composición sociodemográfica. Calculamos las tasas de mortalidad ajustadas por edad, sexo, grupo de población y ciudad correspondientes a las cinco causas principales de lesiones mortales, así como los riesgos atribuibles poblacionales (RAP). RESULTADOS: Las causas principales de lesiones mortales en la infancia abarcan los traumatismos causados por el tránsito -entre los pasajeros de vehículos y sobre todo entre los peatones-, los ahogamientos, las quemaduras y, en algunas ciudades, las lesiones por arma de fuego. Se observaron grandes diferencias entre los RAP, especialmente en lo que atañe a los grupos de población y las ciudades. Las mayores disparidades entre ciudades y entre grupos de población correspondieron a las muertes de peatones, mientras que las mayores diferencias entre niños y niñas correspondieron a las defunciones por ahogamiento. CONCLUSIÓN: Considerando la enorme variabilidad observada entre las ciudades y entre los grupos de población al estudiar las tasas de los tipos más comunes de accidentes mortales, las actividades orientadas a mejorar la seguridad deberían combinar contramedidas de seguridad para todos -esto es, reducir las tasas de lesiones en general- y contramedidas focalizadas que ayuden a reducir la carga entre quienes corren más riesgo.

OBJECTIF: Déterminer les principales causes de traumatismes fatals pour les enfants urbains d'Afrique du Sud appartenant à la tranche d'âges 0-14 ans, la distribution de ces causes et les possibilités actuelles d'améliorer la sécurité. MÉTHODES: Nous avons obtenu des données de surveillance des traumatismes auprès du Système national de surveillance de la mortalité par traumatisme concernant la période 2001-2003 pour six grandes villes d'Afrique du Sud, différant par le nombre d'habitants, le stade de développement et la composition sociodémographique. Nous avons calculé les taux de mortalité ajustés pour l'âge par sexe, groupe de population et ville pour les cinq principales causes de traumatismes fatals, ainsi que les risques attribuables (RA) en population. RÉSULTATS: Parmi les principales causes de traumatismes fatals chez l'enfant, figuraient les accidents de la route - comme passagers de véhicules et surtout comme piétons- les noyades, les brûlures et, dans certaines villes, les blessures par arme à feu. De grandes différences ont été observées dans les valeurs du RA en population, notamment entre certains groupes de population et la population des grandes villes concernées. Ces écarts atteignaient une valeur maximale pour les décès résultant de traumatismes chez des piétons, tandis que les disparités entre filles et garçons étaient les plus fortes pour les décès par noyade. CONCLUSION: Compte tenu des grandes variations relevées entre la population des villes et certains groupes de population dans la fréquence des types les plus courants de traumatismes fatals, un programme en faveur de la sécurité devrait combiner des contre-mesures visant la sécurité pour tous, c'est-à-dire la réduction des fréquences de traumatisme pour tous - et des contremesures ciblées, destinées à réduire la charge d'accidents pour les plus exposés.