Exploring social and gender inequities of intentional injury-related mortality in Botswana: surveillance solutions to support national prevention strategies

Intentional injury mortality, including suicide and homicide/femicide, is an increasingly serious yet understudied public health problem in lower-middle-income countries (LMICs). In Botswana, preliminary data reveal alarming rates of 7.46 suicides and 14.79 homicides per 100,000 people annually—comparable to the global suicide rate of 9 per 100,000 but significantly higher than the global homicide rate of 6.2 per 100,000. Between 2018 and 2022, men accounted for 88.2% of 746 suicides, with deaths disproportionately concentrated in the 18-45 age group (79.6%), while women represented 37.3% of 1,479 homicides spanning all age groups. Evidence suggests both suicide and femicide are worsening problems in Botswana, with significant COVID-19 pandemic impacts on mortality trajectories. These deaths are suspected to have strong urban-rural and socioeconomic status (SES) inequities, as urbanization and economic development introduce new social challenges while raising household affluence. However, a critical obstacle to identifying and addressing these inequities is the lack of digital tools to support retrospective data analysis and prospective surveillance for areas requiring urgent attention, as well as systems to bring attention to populations at highest risk, including the extremely poor and women. 

This project aims to quantify the nature and magnitude of intentional injury mortality in Botswana and engage diverse stakeholders—including policy makers in the Botswana National Government and Botswana Police Service (BPS)—to adapt and implement evidence-based prevention strategies. By creating a REDCap-based data entry system to digitize existing paper records from BPS investigations and enable ongoing data capture, the project will establish a comprehensive database of intentional injury-related deaths. Locally hired staff will manually enter current records, maintain the system for future entries, and ensure data quality for use by government public health groups and Botswana-based researchers. Through spatial/temporal and hierarchical clustering analyses merged with census, survey, and geographic datasets, the project will determine epidemiology and typologies of suicide and femicide, identify social, environmental, household, and individual risk factors, and reveal the most common decedent profiles to which evidence-based interventions can be tailored based on demographics, methods, timing, and location variations across the country. Expected outcomes include a pilot-tested surveillance system with demonstrated feasibility for maintaining ongoing BPS information access, data entry, and annual reporting; spatial/temporal analyses identifying intentional mortality patterns and health inequities between gender and socioeconomic groups disseminated through peer-reviewed manuscripts; an Evidence and Gap Map displaying available interventions for preventing suicide in LMICs and high-income countries; and dashboard-based reporting tools that alert municipal bodies such as BPS and the Ministry of Health to geographic "hot spots" and at-risk populations. The project seeks to contribute to health equity by empowering women in a patriarchal society where domestic abuse often goes unaddressed, creating cross-communication systems between government bodies including police, public health, and university researchers, and informing new laws, programs, and strategies that provide resources to local bodies for identifying and supporting those at risk for intentional mortality, ultimately helping prevent deaths and reduce gender-based and socioeconomic health inequities in Botswana.