The epidemiology of homicidal strangulation in the City of Johannesburg, South Africa.

Studies that provide accurate descriptions of the occurrence of fatal strangulation events are limited, both in South Africa and elsewhere in the world. The current study describes the extent and distribution of female and male homicidal strangulation in the City of Johannesburg for the period 2001-2010. The study is a register-based cross sectional study of homicidal strangulation that draws on data recorded by the National Injury Mortality Surveillance System. Crude, unadjusted strangulation rates, and proportions of strangulation across specific circumstances of occurrence were computed for each year and aggregated in some instances. Results indicated fatal strangulation to be the fourth leading cause of homicide in the City of Johannesburg. A total of 334 strangulation homicides were recorded, representing an average annual strangulation homicide rate of 0.90 per 100,000 population. Gender disproportionality in victimisation was reflected in the average annual rate of 1.03 per 100,000 population for females and 0.74 per 100,000 population for males. The highest rates were recorded among the elderly, and amongst coloured females and white males. Temporal and spatial descriptions indicated that victims were strangled primarily during the day, over the weekday period, and in private locations. When the scene of death was considered by race and age group, results indicated the victimisation of white females and males in private places, and the elderly in private settings. The majority of strangulation victims tested negative for alcohol. The results highlight the need for multi-level prevention strategies that target specific risk groups and situations.