Risk factors of injury among urban adolescent students

INTRODUCTION

An injury is defined as any physical damage to the body caused by Road Traffic Accident, sudden attack, fight, fall, falling objects, sharp objects, gunshot, attack with bombs, burn (fire, hot liquids), suffocation(drowning, asphyxiation), poisoning, machine or instruments, electric shock, animals and insects bite(dog, cat, snake, bee), suicide attempts etc.¹ Injury occurs when the amount of energy exceeds the physical threshold of tolerance.² Injury is a leading cause of death and disability in the world. For people ages 5-29 years, 3 of the top 5 causes of death are injury-related, namely road traffic injuries, homicide and suicide.³ Of the 4.4 million injury-related deaths, unintentional injuries take the lives of 3.16 million people every year, and violence-related injuries kill 1.25 million people every year. Intentional injuries such as child abuse and youth violence are also a leading cause of death, especially among adolescents.⁴ Injury is a major but under recognized public health problem in the developing countries including Bangladesh. The majority of disabilities in Bangladesh are caused by injuries resulting from different types of accidents (traffic accidents, burns, electrocution, animal attacks, acts of violence and conflict).⁵ The annual prevalence of medically treated injuries among youth aged 11-15 years in a total of 11 industrialized countries has been found to be 41.3%, and among 146440 adolescents in 35 industrialized countries it was found to be 33-64% for boys and 23-51% for girls.⁶ Adolescent risk-taking behavior can be seen as a focus for etiological studies. Pickett et al found that “multiple risk behaviors may play an important role in the social etiology of youth injury.” ⁷ The statistics on children’s injuries and accidents are astonishing, with an estimated 61 deaths per 100,000 population, causing 97.9 million ER visits every year.⁸ Unintentional injuries are the main cause of death in children. These statistics have led investigations by researchers on issues such as pedestrian safety, childhood drowning, bicycling safety, and children’s ability to operate motorized vehicles. Although some research has been carried out on the effects of behavioral, emotional, developmental, and physical characteristics on injury risk, there is an absence of studies on the multiple factors that contribute to injury risk, incidence, or prevalence in school-age children. Because of the lack of research in this field, further research is warranted.⁹ It has long been recorded in research that environmental factors influence injury risk and prevalence. Environmental factors consist of incidences, which take place at home and school. Children spend the majority of their day at school, so it is expected that most of their injuries will occur at school and more specifically on the playground and during physical education classes. Unintentional injury rates were higher among rural areas and intentional injuries were highest among urban dwellers.¹⁰ Previous research has shown demographic factors such as gender and age can lead to unintentional injuries. In terms of school environment, boys normally are injured during recess, whereas, girls are more likely injured during sports participation. This suggests that types of activities influence injury rates among gender.^11,12 While gender affects the prevalence of injuries, research on injuries show that age differences have been found to greatly affect the severity and prevalence of injuries. Children 4 years and under are more likely to sustain injury than older children due to an overestimation of their physical abilities. Children have yet to find what skill level they are capable of, so they tend to take more risks which accounts for their increased severity of their injuries. ¹³ Identification of the factors that might contribute to injuries among the children would allow parents and administrators to formulate preventive strategies that mitigate injury risk. There is considerable debate among researchers regarding which factors contribute to injury rates in children and to what extent each factor contributes. So, the present study was conducted with the aim to observe the incidence and risk factors of injury among urban adolescent students.

METHODS

This cross-sectional observational study was conducted at the Dhanmondi High School, Hatirpul, Dhaka-1205 under Kalabagn Thana of Dhaka district, to estimate the prevalence of injury, the pattern of injury, the socioeconomic and demographic characteristics, proportion of social determinants of injury among urban adolescent students. The study was conducted from January 2018 to June 2018, with data collected from a total of 325 adolescents attending the study place. A total of 325 students were selected from the selected high school attending grades 6-10 following their consent. Any student unwilling to participate in the study were excluded from the study. Purposive sampling was done to select the participants of urban adolescent students of the study place who were available at school during data collection. Data were collected by administrations through a written questionnaire. Informed consent was obtained from the participants and their legal guardians before data collection was done. Ethical approval for this study was obtained from the chairman of the education board of Dhanmondi high school. All collected data was analyzed using SPSS V.25 software. Analyzed data was presented as figures and tables in the results section. Pearson’s chi-square test was conducted where necessary for observation of significance, and a p value of ≤0.05 was considered statistically significant.

RESULTS

The socio-demographic characteristics of 325 participants are shown in the table. The largest age group was those aged 12 or younger (36.62%), followed by those aged 13-14 (38.77%). The average age was 13.29 years. The majority of participants were male (57.23%) and the fathers of most participants were in non-government/private jobs (33.54%). Most fathers were literate (87.69%) and the majority of participants were Muslim (93.23%). The mothers of most participants were housewives (75.38%) and literate (63.08%). The largest group of participants was in Class 6 (27.69%) and most came from families with a monthly income of 10,000 Taka or less (53.85%). The average monthly family income was 13840 Taka. Most participants came from nuclear families (55.69%). Out of 325 participants, 195 (60%) reported having an injury in the last 6 months, while 130 (40%) reported not having an injury. Out of the 195 participants who reported having an injury in the last 6 months, the majority (45.64%) reported having 2 injuries. The degree of injury was moderate for the largest group (63.59%), while 9.23% of the injuries were severe and 27.18% were mild. 18 participants (9.23%) required hospitalization. The most common pattern of seeking care after injury was visiting a doctor (28.72%), followed by visiting a hospital (33.33%). The majority of injuries occurred at home (33.33%) or in an institution of education (31.28%). The most common site of injury was the hand (39.49%), followed by the leg (24.62%).

The most common mode of injury was sudden attack or fighting (28.21%), followed by playing games (26.15%). Road traffic accidents accounted for 7.69% of the injuries, while falling down accounted for 9.23%. A small number of injuries were caused by cutting by sharp objects (4.10%) or by electric shock (3.08%). Biting by insects or other animals accounted for only 1.03% of the injuries.

The findings showed that there was a significant association between the occurrence of injury and the sex of the respondents (χ²=5.66, p=0.017). In particular, 62.56% of male respondents reported having suffered an injury, whereas only 37.44% of female respondents reported the same.

Furthermore, there was a significant association between the occurrence of injury and the grade of the students (χ²=44.80, p<0.001), with higher rates of injury reported among students in grades six and seven compared to those in the other grades. Additionally, the results revealed a significant association between the occurrence of injury and the age of the students (χ²=14.23, p=0.001), with higher rates of injury reported among younger students. However, no significant association was found between the occurrence of injury and monthly income, the education level of the father, the occupation of the mother, or the number of family members. The data shows that a high percentage of respondents engage in activities that carry a risk of injury, such as cooking food (78.15%), ironing clothes (72.92%), chopping vegetables and fruits with sharp objects (64.31%), and using risky objects (61.85%). The data also shows that some activities carry a higher risk of injury than others, such as standing under a risky wall, tree, or building (38.46%) and violating traffic laws (34.15%). A relatively lower percentage of respondents engage in activities that carry a lower risk of injury, such as using self-defense materials during play (20.31%) and finding any leaks or defects in gas lines (22.46%).

The results indicate that individuals who engaged in activities such as fighting, violating traffic laws, and taking risks while getting into a vehicle were more likely to have experienced injury compared to those who did not. The results of the significance tests (χ²) reveal that these findings were statistically significant (p<0.05), with the exception of the use of electric tools or machinery. The results also showed that there was no significant association between playing with risky or sharp objects and occurrence of injury.

DISCUSSION

The present study aimed to observe the incidence of injury and various associated risk factors of such injuries among urban adolescent students. Initially, a total of 325 adolescent students attending the study place for education from grades 6-10 were included on the study. The baseline sociodemographic characteristics of the participants were recorded, which provided a base-level understanding of the study area’s social structure. The study found that 60% of the participants reported having an injury in the last 6 months. Out of these 195 participants, the majority reported having 2 injuries (45.64%) and the degree of injury was moderate for the largest group (63.59%). The most common pattern of seeking care after injury was visiting a doctor (28.72%), followed by visiting a hospital (33.33%). The majority of injuries occurred at home (33.33%) or in an institution of education (31.28%). The most common site of injury was the hand (39.49%), followed by the leg (24.62%). The mode of injury among 195 participants was also analyzed in the study. The results showed that the most common mode of injury was sudden attack or fighting (28.21%), followed by playing games (26.15%) and falling down (9.23%). The least common mode of injury was being hit by falling objects (1.03%). Overall, it can be observed that almost all the injuries were caused unintentionally, which was similar to the findings of other similar studies.^14,15 The findings of the present study also suggests that the occurrence of injury among the participants was relatively high, with moderate degree of injury being the most common. The most common mode of injury was sudden attack or fighting, followed by playing games and falling down, highlighting the need for injury prevention strategies in these specific settings. In terms of association with sociodemographic factors, the present study observed a significant association between the occurrence of injury and the sex of the respondents, grade of the students, and age of the students. In particular, the data revealed that male respondents reported a higher rate of injury compared to female respondents. This finding is consistent with previous studies that have reported higher injury rates among males than females.¹⁴ The results also revealed that students in grades six and seven reported a higher rate of injury compared to those in other grades. This is possibly due to factors such as increased physical activity, sports participation, or other school-related activities.^16,17 On a similar note, younger aged students also showed a highly significant association with occurrence of injury. However, no significant association was found between the occurrence of injury and monthly income, the education level of the father, the occupation of the mother, or the number of family members. This suggests that socio-economic status and family background may not play a significant role in the occurrence of injuries. This was contradictory to the findings of other studies where socioeconomic status had a significant impact on the occurrence of injury in adolescents.^18,19 This disparity might be due to the difference of demographics, selection of the study place and location, overall social status of the study area etc. Among the total 325 participants, overlapping risk factors for injury were observed. The highest percentage of respondents reported engaging in activities such as cooking food (78.15%), ironing clothes (72.92%), and chopping vegetables and fruits with sharp objects (64.31%).

It is notable that the use of any risky objects (61.85%) is also relatively high, indicating a broader range of activities that may result in injury. The data also highlights some specific activities that carry a higher risk of injury, such as standing under a risky wall, tree, or building (38.46%) and violating traffic laws (34.15%). It is concerning that a significant percentage of respondents engage in these activities, as they can lead to serious injuries or even fatalities. Association of certain risky activities was made with the occurrence of injury within the last 6 months. It was observed that respondents who had fought someone within the last 6 months (64.10%), violated traffic laws (40.00%), or took risks while getting into a vehicle (44.10%) were more likely to have experienced an injury compared to those who did not engage in these activities. The results of the statistical tests indicated that these associations were significant (p<0.05), except for the use of electric tools or machinery. Surprisingly, it was observed that laying with risky or sharp objects was not significantly associated with occurrence of injury.

Limitations

Limitation of current investigation was that the study was conducted in a single hospital with a small sample size. So, the results may not represent the whole community.

CONCLUSION

In conclusion, this study aimed to explore the prevalence of injuries and their associated risk factors among adolescents in a rural area of Bangladesh. The results of the study reveal that a high percentage of respondents engage in activities that carry a risk of injury, such as cooking food and ironing clothes, which may indicate a need for safety education and awareness in these areas. The findings also suggest that engaging in certain high-risk activities, such as fighting and violating traffic laws, increases the likelihood of experiencing injury. This highlights the need for interventions and programs that target these specific risk factors to reduce the prevalence of injuries among adolescents. Further research could explore the impact of such interventions and programs on injury rates in this population.

Recommendations

Based on the data presented, it is recommended that measures be taken to reduce the occurrence of injuries resulting from engaging in risky activities. This could involve educating individuals, especially children and young adults, on the potential dangers of such activities, and promoting safer alternatives. Efforts should also be made to enforce traffic laws and discourage risky driving behaviors, as well as promoting safe use of household tools and appliances. By taking these steps, it is possible to help reduce the incidence of injuries and create a safer environment for all.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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