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Background: Violence against women (VAW) is the most pervasive human rights abuse and a global health threat. The most extreme forms of physical and sexual violence are the intentional killing of a woman (femicide) and rape, or the combination of both in the form of r ape homicide, preferably termed 'sexual homicide' in this study. Motivation: Martin's research in 1999 reported a rape homicide incidence rate of 12.3/1000 female rapes reported to the police in Cape Town while the National study performed by Abrahams et al in 1999 reported an incidence rate of 10.9/1000 female rapes reported to the police in South Africa (SA). These high incidence rates, definitional problems, methodological limitations, changes in the law, and inconsistent management of suspected sexual homicides motivated the author to undertake this follow - up study. Objectives: To describe the epidemiology and pathology of femicides in Cape Town and thereby identify risk factors, magnitude and criteria for suspected sexual homicides. Design and Methodology : This is a retrospective descriptive study. Data was collected from autopsy reports of female bodies admitted at Salt River Forensic Pathology Laboratory in Cape Town from the years 2000 to 2009. A 10 - year period improves the sample size and the validity of the results. Limitations : Time constraints led to inadequate information on perpetrators of femicides and therefore a report on intimate femicide is limited in this study. Main findings and Discussion: Results showed an average femicide incidence rate of 12.4/100,000 female population in Cape Town Western Metropole which is half the South African national incidence for 1999, equates to the 2009 national rate and is almost five times the global average. Sexual homicide was suspected in 19.9% of all femicides, slightly higher than the 16.3% previously reported by Martin for Cape Town. The median age of victims was 32 years. Most femicide victims died from gunshot injuries (35.2%) followed by those who were stabbed (29.6%), while the majority (35.7 %) of victims of suspected sexual homicide died from asphyxial deaths, including strangulation. Taking specimens for the Sexual Assault Evidence Collection Kit correlated significantly with genital (77.7%) and anal injuries (64.5%), and 41% of femicide victims had alcohol levels above 0.05g%. Conclusion: The incidence of femicide and sexual homicide in Cape Town is higher than previously reported. Gun violence and alcohol abuse are persistent problems. Recommendations : Findings should be used to motivate for intersectoral collaboration in the form of female homicidal death review (FHDR) teams. These teams should aim to develop standardised guidelines for the forensic management, prosecution, prevention and monitoring strategies for femicides and sexual homicides in South Africa.

In South Africa, alcohol is a significant contributor to the burden of injury-related morbidity and mortality. Our understanding of its impact in injury-related mortality in the country is limited. The COVID-19 lockdown period in South Africa introduced restrictions that limited the legal access to the sale and on-site consumption of alcohol and presented a unique opportunity for examination of the impact of such restrictions on injury-related mortality. This study aimed to examine the relationship between blood alcohol concentrations (BAC) and injury-related deaths and to investigate the effect of the COVID-19 lockdown periods and alcohol restrictions on injury-related mortality and post-mortem BAC levels. A retrospective cross-sectional analysis of BACs in all injury-related death cases admitted to mortuaries in the Western Cape (WC) province between 1 January 2019 to 31 December 2020 (inclusive) was conducted. Descriptive and inferential statistics were performed using STATA 13 (StataCorp, TX, USA), to investigate BACs in injury deaths before and during the COVID19 lockdown periods in South Africa. A total of 16,027 injury-related cases were admitted to forensic mortuaries in the WC province in the study period out of a total of 21,797 cases, with significantly fewer cases admitted in 2020 during the first two COVID-19 lockdown periods compared to the same period in 2019 (p< 0.001). Samples were collected for BAC levels in 12,077 (75.4%) of injury-related cases and were most frequently requested in suspected homicide cases (85.2% of 8190). A positive BAC (≥0.01 g/100 mL) was found in 5,078 (42.2%) of the study sample. No significant difference was observed in the mean positive BAC between 2019 (0.18±0.1%) and 2020 (0.17±0.09%), except in the months of level 5 lockdown between April and May 2020, when there was a decrease in the mean positive BAC to 0.13g/dL in 2020 compared to 0.18g/dL for the same period in 2019. There was a 47.7% reduction in injury-related cases seen year on year in the WC during the period of level 5 lockdown and full alcohol restriction in 2020 compared to 2019 however trauma cases increased later in 2020 during full alcohol restrictions. The data presented in this study shows a decrease in injury-related deaths in the WC during the lockdown periods that coincided with alcohol bans and an increase following relaxation of restrictions on movement and alcohol sales. The data shows that the mean concentrations were similar between all periods of alcohol restriction compared to 2019, however, there were significantly fewer individuals with positive BACs in 2020 during complete alcohol sales restrictions than in 2019. This did, however, coincide with a smaller mortuary intake during the level 5 lockdown. The findings of fewer injury-related deaths and fewer positive BACs during lockdown periods coinciding with complete alcohol sales restrictions in 2020 should be taken into consideration to inform future decisions on alcohol control policy in the country.

Background: The Republic of South Africa (RSA) is facing a rape crisis, with women and children being the most vulnerable. DNA evidence is used to aid in suspect identification and to confirm sexual contact. The collection of biological forensic evidence after a rape incident is routine in RSA, however, its contribution to the outcome of rape cases is still unclear. This study aimed to investigate the use of Sexual Assault Evidence Collection Kits (SAECKs) and their impact on the outcome of rape cases. Methods: Data for this study was collected by conducting a retrospective review of rape cases (n=98) prosecuted and finalised at the Western Cape High Court between 1st January 2012 and 31st December 2016. Court dockets were examined, and data was collected using a set of predefined variables. Backward logistic regression was used to analyse whether there is an association between the accused being found guilty and the use of SAECKs and the presentation of DNA evidence. Main findings: In 61% (n=60/98) of the cases a SAECK was used during the medical examination and a DNA report was generated and available for use in 77% (n=46/60) of these cases. There was a higher conviction rate when a SAECK was used (88%, n=53/60) in comparison to when it was not used (53%, n=8/15). Contrary to our expectation, the use of SAECKs was not found to be positively associated with the conviction when using backward logistic regression. This means the use of a SAECK decreased the odds of finding the defendant guilty of rape, albeit by a small degree (OR=0.196, p-value=0.040). DNA was not associated with the case outcome. The majority of cases were stranger rapes (64%,n=63/98), that occurred outdoors (64%,n=61/95)and mostly in the township locations such as Khayelitsha, Philippi, Nyanga, areas located on the Cape Flats, with only a single perpetrator. Injuries were documented in 50% of the cases (n=49)and almost 48% (n=46/95) of the victims were coerced and threatened with a weapon. Our binary model found only the location of incidence (p-value= 0.006) to be significantly associated with case outcome with an odds ratio of 19.827. Conclusions: The findings from this study are significant as they point out that health care practitioners are adequately trained and equipped to provide quality health care responses and to work effectively with police officers. SAECKs are utilised routinely during rape investigations. However, there are various factors relating to the victim, perpetrator and assault characteristics that influence the judge's verdict. This study raised questions relating to how those factors are measured or weighed and are predictive of case outcome. Although we found no positive associations between the variables investigated (except the location of the incident) and court outcome, future research, including larger sample size, should investigate these variables in order to obtain true significance, especially concerning the use of SAECKs and its impact on the court outcome.