Background: Sharp instrument injury is a preventable public health problem in South Africa. The Transkei region is not only different geopolitically from the rest of South Africa, but also in terms of injury patterns. It experiences a high rate of injuries, which is generally underestimated and underreported. Objective: To study the incidence of stab injury related deaths in the Transkei sub-region of South Africa over a period of 23 years (1993-2015). Method: A record review from 1993 to 2015 was undertaken of 24 419 medico-legal autopsies performed at Mthatha Forensic Pathology Laboratory. Results: Between 1993 and 2015 autopsies were performed on 26 855 victims of unnatural death, of these, 5 205 (19.38%) were victims of stab injury, which ranked second among all causes of unnatural death in the Transkei sub-region of South Africa. The average death rate as a result of stab injury was 33.1 per 100 000 of the population annually. Males outnumbered females (ratio 9.7:1). Most stabbings (2118 - 40.92%) occurring in the study period of 23 years were recorded among young adults between 21 and 30 years of age. Conclusion: The stab injury death rate is increasing in the Transkei sub-region of South Africa. The situation needs urgent intervention to save lives.

Keywords: Stab injury; Sharp penetrating objects; Homicide; Murder.