Injury and social determinants among in-school adolescents in six African countries

Background: There is a lack of data on injury and its social correlates among in-school adolescents in Africa. Objectives: To estimate the prevalence of injury among adolescents in six African countries, and to examine the consistency of associations cross-nationally between sociodemographics, social risk factors, and the occurrence of adolescent injury in Africa. Design: Cross-sectional national data from the Global School-based Health Survey (GSHS) conducted in six African countries between 2003 and 2004. Setting: Surveys administered in classrooms. Subjects: The sample included 20 765 students aged 13-15 years from six African countries (Kenya, Namibia, Swaziland, Uganda, Zambia, Zimbabwe) chosen by a two-stage cluster sample design to represent all students in grades 6, 7, 8, 9, and 10 in each country. Results: The mean percentage over all the countries of adolescents reporting one or more serious injuries within the past 12 months was 68.2%, ranging from 38.6% in Swaziland to 71.5% in Zambia. In multivariate regression analysis, risk behaviors were associated with annual injury prevalence, with the highest odds for loneliness, followed by hunger, truancy, depression, smoking, and drug use. The observed risk for all injuries, as well as injuries related to sports, motor vehicles, fighting, and burns, increased consistently with increasing number of risk behaviors. Conclusions: A high annual injury prevalence was found, and risk-taking played a role in the etiology of injury. There is a need to consider an integrated approach to injury etiology in planning injury prevention and safety promotion activities for schoolchildren, paying particular attention to lifestyle factors that have the potential to influence risk of injury.