A comparative assessment of road traffic injury patterns in KwaZulu-Natal and the Western Cape before, during and after COVID-19 (2019–2023)

Road traffic injuries (RTIs) are a significant cause of death in South Africa; however, the effects of the COVID-19 pandemic on provincial RTI patterns remain insufficiently explored. This systematic review compared RTI patterns in KwaZulu-Natal and the Western Cape across pre-COVID-19 (2019), during-COVID-19 (2020-2021), and post-COVID-19 (2022-2023) periods. A systematic search of five electronic databases and grey literature sources was conducted, with 90 sources included following an adapted PRISMA 2020 framework. Findings were analysed using a descriptive comparative approach and synthesised through narrative synthesis guided by the framework proposed by Popay et al. (2006). In KwaZulu-Natal, fatalities declined from 2,331 in 2019 to 2,031 in 2020 before returning to slightly below baseline levels (2,229) in 2023. In contrast, fatalities in the Western Cape increased from 1,013 in 2019 to 1,158 in 2020, declined slightly in 2021, and increased further to 1,371 in 2023. Males aged 25-39 years and pedestrians remained the most affected groups across all study periods. The findings suggest that both pandemic-related behavioural changes and persistent structural and system-level factors may have contributed to the observed provincial differences in RTI patterns.