Abstract
BACKGROUND: Road traffic accidents (RTAs) are a major public health concern, disproportionately affecting low- and middle-income countries. Despite having fewer vehicles per capita, Africa experiences the highest global road traffic fatality rates. This study examines demographic, temporal, and geographic patterns of fatal RTAs in Cape Town to inform targeted safety interventions. METHODS: A retrospective analysis of Western Cape Government Health and Wellness Emergency Medical Services (WCGHW EMS) data (January 2021-May 2024) was conducted. Data included patient demographics, location, time, and accident type. Geospatial mapping using QGIS identified hotspots, and statistical analyses assessed relative risk and mortality trends. RESULTS: Of 784 RTA cases, 167 resulted in fatalities. Males accounted for 70.7% of deaths, and pedestrians comprised 65.3% of fatalities. Nighttime fatalities (51.5%) were significantly higher, with hotspot areas showing a two-fold increased mortality risk (RR = 2.09, 95% CI: 1.61-2.72, p < 0.001). CONCLUSION: This study highlights demographic and pedestrian vulnerabilities, the heightened risk of nighttime fatalities, and the geographic concentration of fatal RTAs in Cape Town. Findings underscore the urgent need for improved pedestrian infrastructure, enhanced street lighting, and optimised emergency medical response strategies. Targeted safety interventions in high-risk areas can significantly reduce RTA fatalities. Further research should explore behavioural and environmental factors over longer timeframes to inform policy and practice.