Data collection and management in medico-legal death investigation in South Africa : an exploratory study

Abstract

Mortality data are a cornerstone of public health initiatives and interventions and has been used to implement preventative strategies to reduce the burden of diseases and injuries in society. A subset of mortality data is non-natural mortality data, which can be used to reduce the burden of violence and injuries in a country. However, the benefits of such data cannot be fully utilised if there are not appropriate data collection, management, and dissemination protocols in place. South Africa is a country with a high level of violence and non-natural deaths; however, current sources of non-natural mortality data have received criticisms in scientific publication for not being accurate. Initiatives to address this problem, most notably the National Injury Mortality Surveillance System, have been undertaken since the 90’s, by making use of state mortuaries as a source of non-natural mortality data. While these initiatives were able to introduce a new era of epidemiological study in the country, they were not sustainable in the long-term. These initiatives collected and disseminated data from state mortuaries in South Africa, but they did not work to implement standardised data collection and management protocols or a database that could collect and store data from the various state mortuaries. In the United States of America, Australia, and New Zealand data collection and dissemination databases have been implemented, the National Vital Statistics System in the United States of America, and the National Coronial Information System in Australia and New Zealand. These initiatives show that it is possible to successfully implement a data collection and dissemination system for non-natural mortality data in countries that have varying medico-legal death investigation systems in different jurisdictions, and therefore that it should be possible to implement such a system in a country like South Africa where there is only one medico-legal death investigation system. The aim of this study was to establish what data elements are and should be collected as part of a medico-legal death investigation service in South Africa and how the data can be routinely and systematically captured and utilised to be of benefit to society. Specifically, this research focused on the current data elements as well as data flow, collection, and management at a single urban mortuary in South Africa. The study endeavoured to identify the data elements that are and could be collected for medico-legal death investigation in South Africa, assess the current storage, archiving, and management of data in medico-legal death investigation, identify the legal and ethical considerations pertaining to medico-legal death investigation, and to identify technical software that can be used to capture and manage medico-legal death investigation data. To determine this, a three-part study was undertaken, a scoping review of available literature relating to data collection, capture, and management in medico-legal death investigation, as well as any related fields such as informatics and public health, a retrospective descriptive analysis of data from a single urban mortuary in South Africa for a period from 2017 to 2019, generating a three-year profile of cases at a typical urban mortuary in South Africa, and a fieldwork component to outline the flow of data and identify the key elements and categories of data that are routinely collected for non-natural deaths in South Africa. Findings from this research showed that there is significant benefit in routinely collecting and disseminating non-natural death data from state mortuaries in South Africa. It also found that data collection and management practices from fields outside of medico-legal death investigation, specifically public health, can be adapted to suit the needs of medico-legal death investigation data. Significant findings from the retrospective review include the increasing proportion of suicides for the three-year period, as well as accidental deaths being the most common manner of death, road traffic fatalities being the most common external cause of death, and homicide numbers overtaking accidental deaths for the months of October to December. The fieldwork component of the study contextualised the current flow of data in medico-legal death investigation in South Africa and identified common data elements that are collected. This research found that commonly collected data elements for medico-legal death investigation are important for the generation of statistics related to non-natural deaths, but the lack of a routinised systematised data collection and management platform impacts the quality of data. Overall, the results of this research suggest that the implementation of routinised and systematised data collection practices within the field of medico-legal death investigation would benefit the quality of non-natural mortality data in South Africa, however, what data elements and who owns the data needs to be agreed on before implementation can go forward. While this study utilised a single urban mortuary as a pilot for the exploratory study, it is suggested that further study into the current data practices in other mortuaries be conducted, to identify problems and opportunities that may be unique to different areas. It also is recommended that further in-depth study is undertaken into the observations that the retrospective analysis found, and that accurate and relevant denominators for specific areas be utilised so that future studies can be used as epidemiologic information.