Introduction

Introduction

Injuries are not synonymous with accidents; hence they are not a random phenomenon and are inherently preventable. The substantial burden of disease associated with injuries is “under-recognized” globally,¹ and in the United States, it is the “leading cause” of death in children and adolescents.² In United States, injuries are responsible for more deaths in adolescents than all other diseases combined and about fifteen thousand adolescents (10–19 years old) die each year as a result of injuries.^3-4 Injuries were responsible for over 70% of all deaths in 10–24 year olds in the year 2003.⁵ Globally, 14% of adult disease burden was attributed to injuries in 2002, while in the Eastern Mediterranean Region; injuries were responsible for over 30% of disease burden in 15–44 year old males.⁶

There is a little research conducted on unintentional injuries in Pakistani adolescents. Few studies that have been conducted are based on either case series or hospital based data.^7–9The primary objective of this study was to provide preliminary estimate of the magnitude and profile of medically attended injuries in the young adolescents girls in Islamabad.

MATERIAL and Methods

A cross-sectional survey with convenience sampling was conducted among the adolescent girls of class seven and eight in two girl’s middle schools in Islamabad. A structured, self-administered, anonym-ous and pre-tested questionnaire was used with both closed and open-end questions. Students were asked whether they have sustained any medically attended injuries in the past one year i.e. requiring treatment/visit to a physician/hospital; including number, type and site of these injuries. One school teacher from each school was approached and the objectives of the survey were explained to them. Both agreed to help in the conduct of data collection phase of this study by getting cooperation of other teachers of class seven and eight while emphasizing voluntary participation of students in this study. All the class seven and eight students attending the school on the day of study were distributed questionnaires in the classrooms, who handed-over the completed questionnaires to their designated teacher. Data was analyzed for frequencies and counts with STATA 8.

Results

One hundred eighty-two questionnaires were completed; response rate was hundred percent as none of the students declined to participate. However, the total number of students registered in class seven and eight in the two schools was 193. Average age of respondents was 12 years (range 11-14). Cumulatively, 78 (42.8%) students reported sustaining 93 unintentional injuries in the past year; among these 11 (14.1%) reported two injuries and 2 (2.6%) reported three injuries. Table-1 describes the place, type and site of these injuries. Home was the most common place where injuries occurred; with arms/hands as the most frequent site and falls as the most common type of injury reported.

Three (3.8%) students reported that treatment for their injury is ongoing, while 7 (9%) reported that although treatment for their injury has been completed but they still feel pain. Rest reported having been completely recuperated.

For 43 (46.2%) injuries, respondents consulted a general practitioner (Doctor practicing near home), while for the rest of injuries, students were taken to the hospital for treatment.

Table-1: Characteristics and number of injuries in the past year.

Characteristics of injury		Number (n = 93)	%
Place
	Home	53	57.0
	School	12	12.9
	Street/Road Traffic	16	17.2
	Other	12	12.9
Type
	Fall	81	87.1
	Burns	8	8.6
	Traffic accident	4	4.3
Site
	Face/Head	21	22.6
	Arms/Hand	38	40.9
	Legs/Feet	31	33.3
	Chest/Back/Abdomen	3	3.2

Discussion

This is the first study in Pakistan to document the self reported experience of medically attended unintentional injuries in the preceding twelve months, including number, type, site, and severity of injuries, in the adolescent school girls. About 43% of adolescent girls reported a medically attended injury in the past one year. This number although high, is an underestimate of the total burden of injuries in this demographic group, as injuries that were self treated or treated by the parents and other adults present in the respondent’s home were not inquired about in this study.

Home was the most frequent place where injuries were sustained, this augurs for the need of preventive health education of parents as well as school-based injury preventive health education to the students. Thirteen percent of injuries were sustained in the school; this number is substantially lower i.e. up to 46% in 7–19 years old school girls, than reported in other studies.^10,11 Most of the injuries were sustained owing to falls, whether the falls were due to sports related activities was not elucidated in this study.

However, results from this study need to be interpreted with caveats. The major limitation of this study was the use of convenience sampling, which limits generalizability of results as representative of either school girls in Pakistan or in the city in which this study was performed. As random sampling would have entailed active cooperation of all schools in order to access records of all enrolled students. Secondly, some students who had sustained more severe injuries requiring inpatient care at health facilities or those recuperating at home, at the time this study was being conducted, would not have been in school. Hence they would not have had a chance to take part in this study; this is referred to as “healthy worker effect” which tends to underestimate the prevalence of the condition being investigated.¹² There were eleven students, who owing to their absence from schools did not take part in this study.

Studies on injuries in adolescents have been limited to either one particular setting like schools, classrooms, playgrounds or particular body part.^13-17 These studies report overall injury rate of 3.98 per 100 children and adolescents, to prevalence of traumatic injuries of 20.4% to permanent molars. Hence their results are difficult to compare meaningfully with our study.

Injury surveillance and establishing injury prevention research units have been advocated, and found to be the effective means of preventing injuries.^{18, 19} Medical and public health colleges in the country need to establish effective research centers to prioritize injuries associated public health burden. There is also a need for nationwide population based survey on injuries in school aged population, using indigenously standardized instruments, for better understanding of the epidemiology and correlates if injuries in the country.

Conclusions

Medically attended injuries in the preceding one year were reported by over 40% of class 7 & 8 girls, with home being the most frequent place of injuries. Falls with injuries on hands and arms were the most common site of injuries. Preventive health education in schools would potentially reduce this public health problem.

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