The incidence and severity of community assault in Khayelitsha, South Africa
Community assault (CA) or vigilantism is widespread in the township of Khayelitsha, Cape Town, South Africa. Anecdotal evidence suggests that victims of CA are worse off than other assault cases, but scientific data on the rate and severity of CA cases are lacking for SA. We therefore conducted a case count study to estimate the rate of CA among adults in Khayelitsha and comparing the injury severity and survival probability between cases of CA and other assault (non-CA) cases.
A consecutive case series was conducted in four healthcare centres in Khayelitsha during July - December 2012 to capture all CA cases during this period. A retrospective folder review was performed on all cases of CA and on a control group of non-CA cases to compare injury severity and estimate survival probability.
A total of 148 adult cases of CA occurred over the study period. Based on an estimate population of 275 300 adults in Khayelitsha of ≥18 years, the rate of adult cases of CA that received healthcare in Khayelitsha was 1.1/1 000 person-years. For non-CA, the estimated rate was 19/1 000 person-years. The Injury Severity Scores in the CA group were significantly higher than in the non-CA group (p<0.001), with a median Injury Severity Score of 3 in CA cases versus 1 in non-CA cases. Comparison between the CA and non-CA groups showed that a Glasgow Coma Scale <15 (20.1% versus 5.4%, respectively), referral to the tertiary hospital (33.8% versus 22.6%, respectively), and crush syndrome (25.7% versus 0.0%, respectively) were all more common in CA cases. Survival probabilities were similar in both groups (99.2% in CA cases versus 99.3% in non-CA cases).
This study confirms that the rate of CA among adults in Khayelitsha is high, and the severity of injuries sustained by CA victims is substantially higher than in other assault cases. Our findings beg for multi-sectoral action to curb the medical and social consequences of assault in SA. Furthermore, social science research is needed to improve our understanding of the psychology and sociology behind CAs and to develop evidence-led prevention strategies, the feasibility and effectiveness of which also require further investigation.
Forgus S, Delva W, Hauptfleisch C, Govender S and Blitz J. Community v. non-community assault among adults in Khayelitsha, Western Cape, South Africa: A case count and comparison of injury severity. S Afr Med J 2014;104(4):299-301. DOI:10.7196/SAMJ.7615