title: High rates of homicide in a rural South African population (2000-2008): findings from a population-based cohort study.
abstract: BACKGROUND
  South Africa has continued to receive increasing attention due to unprecedented high levels of violence. Homicide-related violence accounts for a significant proportion of unnatural deaths and contributes significantly to loss of years of expected life. We investigated levels and factors associated with homicide-related deaths and identify communities with excessively high homicide risk in a typical rural South African population.
  
  
  METHODS
  Data drawn from verbal autopsies conducted on all deaths recorded during annual demographic and health surveillance in KwaZulu Natal, South Africa were used to derive the cumulative probability of death from homicide over a nine-year period (2000-2008). Weibull regression methods were used to investigate factors associated with homicide deaths. A Kulldorff spatial scan statistic was used to identify spatial clusters of homicide-related deaths.
  
  
  RESULTS
  With 536 homicide-related deaths, and a median seven years of follow-up, the study found an overall homicide incidence rate of 66 deaths per 100, 000 person-years of observation (PYOs) (95 % CI 60-72) for the period under study. Death related to the use of firearms was the leading reported method of homicide (65 %) and most deaths occurred over weekends (43 %). Homicides are the second-most common cause of death in men aged 25-34 after HIV-related deaths (including TB) in this community, at 210 deaths per 100,000 PYOs, and was highest among 55-64 year old women, at 78 deaths per 100,000 PYOs. Residency status, age, socioeconomic status, and highest education level attained independently predicted the risk of homicide death. The spatial distribution of homicide deaths was not homogenous and the study identified two clear geographical clusters with significantly elevated homicide risk.
  
  
  CONCLUSIONS
  The high rates of homicide observed in this typical rural South African population - particularly among men - underscore the need for urgent interventions to reduce this tragic and theoretically preventable loss of life in this population and similar South African settings.
authors: Kenya Medical Research Institute, P.O Box 1578, 40100 Kisumu, Kenya ; Centre for Disease Control and Prevention, Atlanta, GA USA ; School of Public Health, University of Witwatersrand, 7 York Road, Parktown, 2193 Johannesburg, South Africa.
authors: George
authors: G
authors: Otieno
authors: School of Public Health, University of Witwatersrand, 7 York Road, Parktown, 2193 Johannesburg, South Africa.
authors: Edmore
authors: E
authors: Marinda
authors: Wellcome Trust Africa Centre for Health and Population Studies, P.O Box 198, Mtubatuba, South Africa ; Department of Global Health and Population, Harvard School of Public Health, Boston, USA.
authors: Till
authors: T
authors: Bärnighausen
authors: Wellcome Trust Africa Centre for Health and Population Studies, P.O Box 198, Mtubatuba, South Africa.
authors: Frank
authors: F
authors: Tanser