Unintentional Injury and Violence Among Adolescents in Low- and Middle-Income Countries

Abstract

Background: Injuries and violence account for a substantial proportion of the burden of disease in adolescents globally, especially among low- and middle-income countries (LMICs), and prevention is still a public health priority. We compared unintentional injuries and violence among young adolescents in LMICs using data from the Global School-based Student Health Surveys (GSHS). Methods: This study analyzed the GSHS data for adolescents aged 12-15 years from 68 LMICs. Data were collected between 2009 and 2015 using a standardized questionnaire. This report focuses on four survey questions that assessed the frequency of injuries and violence-related variables (physical attack, physical fighting, and bullying), and we also used questions on the types and causes of injuries or bullying. The weighted prevalence and 95% confidential intervals (95% CIs) were calculated for each country, as were the overall and regional prevalence estimates. Findings: A total of 164,633 young adolescents (47·2% boys) were included in this study. The overall prevalence of injuries, physical attack, and physical fighting during the past 12 months were 42·9% (95% CI 39·0- 46·9), 35·6% (95% CI 30·7-40·5), and 36·4% (95% CI 29·9-42·9), respectively. These prevalence varied among regions, with significantly higher prevalence of physical attack, physical fight, and bullying among the African and Western Pacific regions generally than the Americas and Southeast Asia regions. Prevalence rates were higher among boys than girls for injuries (47.9% vs. 37·6, p<0·001), physical attack (41·0% vs. 29·4%, p=0·001), and physical fighting (45·5% vs. 26·9%, p<0·001). The overall prevalence of bullying occurring at least once during the past 30 days was 34·4% (95% CI 27·1-41·7), irrespective of age and sex. Among those adolescents suffering injuries, the most common type of serious injuries included fractures (22·6%, 19·1-26·1) and cuts (21·8%, 16·8- 26·8), and causes were mainly falls (33·1%, 30·2-35·9). The most common types of bullying were physical (18·3%, 13·7-23·0), verbal (13·2%, 10·2- 16·2), and racial (11·6%, 9·2-14). Significantly decreased trends in the prevalence rates across time were observed for injuries from physical attack and bullying (p-values <0·001). Interpretation: Despite an apparent decrease, the prevalence of violence and unintentional injuries among young adolescents in LMICs remains high. These high rates require LMICs to prioritize anti-violence and anti-injury programs to achieve improvements in population health. Funding Statement: This study received funding from the National Natural Science Foundation of China (81602853), National Key R&D Program of China (2017YFC1310902), Natural Science Foundation of Zhejiang Province (LY17H260002), K.C. Wong Magna Fund in Ningbo University, China Postdoctoral Science Foundation funded project (156458), Jiangsu Postdoctoral Science Foundation funded project (1601121B), and Ningbo Scientific Innovation Team for Environmental Hazardous Factor Control and Prevention (2016C51001). Declaration of Interests: The authors confirm that this article content has no conflict of interest. Ethics Approval Statement: All GSHS surveys were approved in each country by both a national government administration, most often the Ministry of Health or Education, and an institutional review board or ethics committee. Verbal or written consent was also obtained from the participants and their parents.