In South Africa the leading cause of traumatic brain injury (TBI) is interpersonal violence, whereas in most countries motor vehicle accidents are the primary cause of TBI. A recently published study into TBI admissions at two state hospitals in the city of Pietermaritzburg found that 39.4% of cases were due to deliberate interpersonal violence, as compared to 30.8% due to motor vehicle accidents (MVAs). The data were obtained from 3,301 patients admitted between January 2012 and December 2014
Similar patterning of TBI aetiology was reported by Victor Nell and myself decades ago during the apartheid years when we examined TBI in Johannesburg and found that interpersonal violence comprised 42.01% of patients and MVAs 35.5% of cases. The demise of apartheid has led to a shift in the distribution of types of MVAs, such that pedestrians have gone from being the majority to the minority of MVA cases, perhaps because of changes in the distribution of wealth. However, that interpersonal violence remains the overriding cause of brain injury in South Africa is deeply troubling and is a reflection of the multiple societal ills that still beset the country. The dream of peaceful co-existence remains out of reach.