Background
Adolescence, a period of life spanning from 10 to 19 years age, is a unique stage of human development and a crucial time for setting the foundations for good health [
1]. According to the World Health Organization (WHO) [
1], injuries contribute significantly to the global burden of death and morbidity among children and adolescents [
1]. The incidence of injuries among adolescents has already gained much attention because it is classified among the leading factors of disability and death of adolescents in low- and middle-income countries (LMICs) [
1,
2]. Three types of injuries are among the top ten causes of disability-adjusted life years (DALYs) for people aged 10 to 24 years, according to the Global Burden of Diseases and Injuries [
2]. According to this report, in 2019, traffic injuries (ranked first), self-harm (ranked third), and interpersonal violence (ranked fifth) accounted for 6.6%, 3.7%, and 3.5% of DALYs, respectively.
Past epidemiological studies have shown a 50% reduction in injuries in some industrialized countries over the past 30 years after ‘multisectoral and multipronged approaches to child injury prevention’ were adopted and implemented [
3]. Studies have documented the prevalence of injuries among adolescents in several countries. For example, the prevalence of child/adolescent injuries in China was 38.0% [
4], 21% in Europe [
3], and 24% in Canada [
5]. Despite these variations, child injuries remain a problem in several countries [
1,
6].
Research report has shown that more than 95% of cases of adolescent injury occur in LMICs and this has negative implications on the physical and psychological health of the victims as well as economic consequences in treating the injury [
7]. Ruiz-Casares [
8] reported an estimated 53.1/100000 incidence of injuries among adolescents of school-going age in sub-Saharan Africa (SSA). Data from the WHO suggest that a greater proportion of mortality for adolescents aged 10-19 is concentrated in SSA [
1]. In the same report, for those aged 10 to 14, mortality ranged from 0.2 to 14.8 deaths per 1000 adolescents aged 10, and for those aged 15 to 19, mortality ranged from 0.8 to 24.9 deaths per 1000 adolescents aged 15, with the majority of these deaths occurring through injuries [
1].
To improve adolescent safety in SSA, injury prevention knowledge and practices must be properly integrated into mainstream child and adolescent health initiative programs and policy frameworks. There are multiple sections of the sub-Saharan African region with known high rates of adolescent injury, including Nigeria (74%) [
9], Djibouti (61.1%) [
10], and Ethiopia (62%) [
11], which could potentially adversely affect the rates in other parts of the sub-region.
With the high prevalence of serious injuries in these countries, a comprehensive study that examines the prevalence and correlates of serious injuries among adolescents across several countries in SSA will help to understand the between and within country variations. The present study investigated the prevalence and correlates of serious injuries among in-school adolescents in eight countries in SSA. It is anticipated that the findings would help direct policies aimed at reducing serious injuries among in-school adolescents in SSA.
Discussion
This study examined the occurrence of serious injury among in-school adolescents and its associated factors in eight countries in SSA. The prevalence of serious injuries among in-school adolescents in SSA was 45.3%. The reported prevalence is lower than what has been previously reported in Ghana (57.0%; 66%) [
20,
21], Liberia (71.6%) [
22], and Nigeria (73.6%) [
9], but higher than what was reported in four countries in Asia (36.9%) [
15]. A possible reason for this finding could be attributed to the sample size used for the study as well as the scope of the study area. However, there are variations between the country-specific prevalence of serious injuries among in-school adolescents. For instance, while Liberia recorded the highest (68.2%) prevalence, Mauritius on the other hand had the least (32.3%) prevalence. The high-risk violent behaviors among Liberian in-school adolescents which increase their risk of being seriously injured could account for this identified outcome [
22].
Corroborating the findings of previous studies [
17,
20,
23], the study found that adolescents who experienced bullying were more likely to experience serious injuries than those who were never bullied. From the frustration-aggression perspective, adolescents who are bullied are more likely to retaliate violent behaviors perpetrated against them, causing them to be physically attacked which subsequently increases their probability of sustaining injuries [
23‐
25]. For example, Dollard et al .[
26] stated that “the occurrence of aggressive behavior always presupposes the existence of frustration and, contrariwise, that the existence of frustration always leads to some form of aggression” (p. 1). Miller [
27] modified the earlier quote by reiterating that “frustration produces instigations to a number of different types of response, one of which is an instigation to some form of aggression” (p. 338).
Adolescents who engaged in a physical fight had a higher tendency of experiencing serious injuries than those who never engaged in a fight. The current finding supports previous studies [
20,
23]. Perhaps, the strong association between indulging in aggressive behaviors such as engaging in physical fights and injury sustenance could account for this noted finding [
23]. This finding also provides evidence of the strong linkage between physical fights and injury occurrence.
Akin to the findings of other previous studies [
18,
20], the study found that adolescents who experienced physical attacks had a higher likelihood of experiencing serious injuries than those who were not physically attacked. It is possible that adolescents who were physically attacked also responded with violent behaviors such as fighting back, making them more likely to sustain serious injuries [
18].
The experience of serious injuries was higher among adolescents who felt anxious than those who did not feel anxious. The finding of this study is in line with that of a previous study [
21]. Usually, adolescents who are anxious are psychologically distressed and might attempt committing certain self-destructing harm, thus increasing their likelihood of been injured [
21,
28]. Such self-destructing harmful behaviors may include suicidal attempt which was also found to increase the likelihood of serious injuries. Similar findings were obtained in previous studies [
13,
14,
21]. Smith et al .[
29] affirmed that a failed suicide attempt is more likely to result in severe injuries. We also speculate that there is a possibility of bidirectional relationship between anxiety and serious injury in that adolescents that are injured might be more anxious as a result of their injury.
Supporting several previous studies [
17,
20‐
22,
28,
14‐
16], the current study found that truant adolescents have higher odds of experiencing serious injuries than those who are not truant. Normally, truant adolescents engage in irresponsible behaviors such as street fighting, drug, and alcohol use which increase their likelihood of sustaining injuries [
13,
14,
28]. The use of tobacco and marijuana increased the likelihood of serious injuries as corroborated by previous studies [
13‐
15,
17,
21,
22]. An explanation for this finding could be that adolescents who use marijuana or tobacco often engage in violent and aggressive behaviors that predispose them to sustain injuries [
22]. It could also be that marijuana has some adverse therapeutic effects that trigger violent and aggressive behaviors among its users, increasing their likelihood of being injured [
21].
Parental or guardian respect for privacy was protective against serious injuries among in-school adolescents in SSA. To the best of our knowledge, this is the first study that has found a negative significant association between parental or guardian respect for privacy and serious injuries among in-school adolescents. The observed association could be that the adolescents whose parents respect their privacy might not be anxious that their parents might invade their privacy. As a result, such adolescents are more likely to stay at home and in turn minimize their likelihood of getting injured. Future studies should consider examining why this negative association possibly exists.
Strengths and limitations
Analyzing data from nationally representative surveys of eight countries in SSA supports the comprehensiveness of the study. Moreover, the secondary data were collected via questionnaires, which allowed many parameters linked with serious injuries to be assessed. Again, the analysis was carried out on a large sample of in-school adolescents and this ensured the accuracy, reliability, and generalizability of the findings. However, there are some limitations to this research that need to be acknowledged. First, the likelihood of social desirability and recall bias cannot be avoided since the assessment of serious injury was based on self-reports. Also, due to the cross-sectional nature of the GSHS, the findings cannot be interpreted using cause and effect. Finally, combining datasets with varying publication years may limit comparisons across countries.
Conclusion
A relatively high prevalence of serious injuries among in-school adolescents was identified. The factors associated with serious injuries include bullying, engaging in physical fights, experiencing an attack, anxiety, suicidal attempt, truancy, and substance use. Programs and interventions that target the reduction of injuries in educational institutions should take a keen interest in the factors identified in this study. To deal with injured victims, first aid services should be provided in school settings. Future studies could employ longitudinal designs to assess the association between psychosocial factors and injury.
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