Comment: Adolescent injuries in developing countries
17 Feb 2013
Adolescent injuries in developing countries: how much do we actually know?
An article which analyses data on injuries among children in developing countries has just been published by Young Lives colleagues. This prompted a couple of thoughts and reflections.
First, injuries should be of considerable policy concern. But how much do we know about the prevalence or who is most likely to experience injury? The authors quote WHO figures which suggest that almost half the deaths of 15 to19 year olds are injury-related, and 95% of those deaths occur in low- and middle-income countries. UNICEF has made a similar point in relation to the under-recognition of children drowning, arguing that poor recording of drowning accidents holds back an understanding of the preventative steps that could enable more children to survive.
Second, the article uses mixed methods to look at accidental injuries, as reported by 14 to 15 year olds, and – uniquely –what young people themselves say about the when and how their injuries happened. It also uses survey data to estimate risks. Young people talk about the effects of an injury on their households, as well as the direct impact on themselves and on the family unit – the cost of treatment, time lost, and the impact on other family members, including brothers and sisters who have to take on the responsibilities the injured young person is not able to perform. All of which helps demonstrate the critical importance of good health, with poor health (injury-related or otherwise) a day-to-day reality for children living in chronic poverty, and one which poses a considerable threat to families’ ability to cope. The article also demonstrates that the costs of healthcare often mean treatment is delayed, with the risk of worsening the problem.
Third, between 8% of young people in Vietnam and 19% of the young people we interviewed in India reported an injury in the previous three years. Injuries happened at work, but just as many (or in some countries, more) injuries were reported from travel, and leisure.
Fourth, the paper includes some analysis which helps to show the likelihood of different groups reporting injuries. Boys seemed to be more vulnerable to accidents than girls, and growing up in poverty increased the risk for injuries at work further in most countries. Putting figures on this suggested that poorer children were between around 1.8 times more likely in Ethiopia and 2.9 times more likely in Vietnam to report a work-related injury than their better-off peers. In India, young people who lived in rural areas were more likely to be injured than their urban counterparts.
So what are the implications? The article makes important points about how injuries are recorded (if you rely on hospital statistics, you miss all the information from children and young people who never go to hospital). It demonstrates the importance of health in explaining some of the ‘tipping point’ pressures on poorer households. High upfront costs reduce access and delay treatment – which is neither just nor likely to generate good outcomes for children.
The article also tells a story about how injuries happen that isn’t just about (dangerous) paid work but also about the safety of their everyday physical environments. It is notable, for instance, that many of the reported accidents happen during leisure time. Since children are bound to play somewhere, there is a point to be made about improving access to safer places to play. And maybe that first statistic is the most telling – if 95% of the world’s injuries happen to young people occur in low- and middle-income countries, this is strongly suggestive that more could be done to prevent these injuries and deaths. Maybe if we knew more we’d have more (and better) options.
Paul Dornan, Senior Policy Officer, Young Lives
Virginia Morrow, Inka Barnett and Danuel Vujcich (2013) 'Understanding the Causes and Consequences of Injuries to Adolescents Growing up in Poverty in Ethiopia, Andhra Pradesh (India), Vietnam and Peru: A mixed-method study', Health Policy and Planning (early online publication: doi: 10.1093/heapol/czs134)