Unintentional injuries and violence among adolescents aged 12-15 years in 68 low-income and middle-income countries: a secondary analysis of data from the Global School-Based Student Health Survey

Abstract

Background: Injuries and violence account for a substantial proportion of the global burden of disease in adolescents, especially among low-income and middle-income countries (LMICs). We aimed to compare the prevalence of unintentional injuries and violence among young adolescents in LMICs.

Methods: We did a secondary analysis of data from the Global School-based Student Health Survey (GSHS) for adolescents aged 12-15 years from LMICs collected between 2009 and 2015. Survey data was collected using a standardised questionnaire. We used survey data to calculate the overall prevalence of serious injuries and violence (eg, physical attack, physical fighting) and bullying per country. We did a random-effects meta-analysis to calculate pooled overall and regional estimates. We also did subgroup analyses stratified by sex, age (12-13 years vs 14-15 years), and time period (2009-11 vs 2012-15). Logistic regression models adjusted for sex, weights, stratum, and primary sampling unit were used to analyse the differences in prevalence of serious injuries, violence, and bullying.

Findings: We included data from 68 LMICs, including 164 633 young adolescents (77 707 [47·2%] boys; 86 926 [52·8%] girls). The overall prevalence of physical attack, physical fighting, and serious injuries during the past 12 months were 35·6% (95% CI 30·7-40·5), 36·4% (29·9-42·9), and 42·9% (39·0-46·9), respectively. Prevalence varied by WHO region and was higher among boys than girls for injuries (47·8% vs 37·5%, p=0·00094), physical attack (41·0% vs 29·4%, p=0·001), and physical fighting (45·5% vs 26·9%, p<0·0001). Fractures (22·6%, 95% CI 19·1-26·1) and cuts (21·8%, 16·8-26·8) were the most common types of serious injury, and falling was the main cause of these injuries (33·1%, 30·2-35·9). The overall prevalence of bullying at least once in the past 30 days was 34·4% (27·1-41·7), irrespective of age and sex. The most common types of bullying were physical (18·3%, 13·7-23·0), verbal-sexual (13·2%, 10·2-16·2), and racial-ethnic (11·6%, 9·2-14·0).

Interpretation: The prevalence of unintentional injuries and violence remain high among young adolescents in LMICs. These countries should prioritise the development of anti-violence and anti-injury programmes to improve health in their young adolescent populations.

Funding: National Natural Science Foundation of China, National Key R&D Program of China, Natural Science Foundation of Zhejiang Province, Sanming Project of Medicine in Shenzhen, K.C. Wong Magna Fund in Ningbo University, and Ningbo Scientific Innovation Team for Environmental Hazardous Factor Control and Prevention.