Violence is a leading cause of death worldwide for youth 15-29. A growing body of literature describes assault-injured youth in United States emergency departments, identifying risk factors for re-injury and mortality, and developing targeted interventions. Low- and middle-income countries are disproportionately affected by violence, but little research on assault-injured youth exists in these settings. This study aims to describe the population of assault-injured youth in the emergency centers of Khayelitsha township, South Africa. Survey and chart review of 14 to 24-year-old assault-injured patients and non-assault-injured sex-matched controls presenting to the two 24-hour emergency centers in Khayelitsha (Khayelitsha Hospital Emergency Center and Site B Community Health Center) between August - November 2016. Enrollment occurred Fridays at 7pm to Mondays at 7am. Multivariable logistic regression was used to estimate associations of behavioral and other factors with assault injury. In total 513 patients were enrolled: 324 assault-injured patients and 189 controls (131 medical, 58 accidental injuries). Overall 28% were female (n=146) and 72% were male (n=367). The mean age was 20.5 years. Compared to male controls, assault-injured males were more likely to report carrying a knife in the past 30 days (OR 2.6), and threatening/injuring someone else with a weapon in the past 6 months (OR 3.4). Compared to female controls, assault-injured females were more likely to report homelessness in the past 30 days (OR 2.6). Assault-injured patients of both sexes were more likely than controls to give a 30-day history of drinking any alcohol (OR 6.3), binge drinking (OR 6.7) and smoking cigarettes (OR 4.0). They were also significantly more likely to report any physical fight (OR 4.4) or any physical fight requiring medical care in the past 6 months (OR 5.08), and lifetime history of arrest (OR 5.1) or conviction (OR 6.7). Assault-injured patients were significantly less likely to endorse enrollment in an educational institution (OR 0.5) and membership in a religious group (OR 0.1). Significant differences were NOT found for: current employment; household poverty; or 6-month history of depression or suicide attempt. Assailants were frequently known to the victim - 20% family/friend, 15% acquaintance, 6% romantic partner. Gang members comprised 11% of assailants. One quarter of patients anticipate violent retaliation as a consequence of their injury. Drugs and/or alcohol were used by victims prior to 78% of the assaults. Significant differences were not detected between females (76%) and males (79%). Assault-injured females were significantly more likely than males to report assaults at home, with a “struck by/against” mechanism, and without weapons used. They were also more likely to list “romantic partner” as the assailant. Overall, 47% of assault-injured youth and 15% of controls reported a history of a fight requiring medical treatment in the past 6 months. Assault-injured males (259) greatly outnumbered non-assault-injured males (108) presenting for care, so it was not possible to enroll male controls on a 1-1 basis. Violence is a chronic and recurring disease, suggesting opportunities for interventions during health care contacts. Based on these data, future secondary violence prevention initiatives should target drug and alcohol use, as well as criminal behavior.
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