Adolescents are more prone for injuries. This first national survey conducted among school going adolescents after GSHS-2008, indicated that serious injuries requiring medical attention and missing out on daily activities, was a common finding in the study group. Approximately one in three children were seriously injured at least once within the 12 months prior to the survey. The prevalence of unintentional injuries has not changed over the years. Similar prevalence (37.2%) was found in GSHS-2008 (14). This indicate the necessity of novel public health approaches to combat this serious menace.
Unintentional injuries are a major contributor for adolescent mortality and morbidity. Globally, it is the second most common cause for Years Lost due to Disability (YLDs) among 12–24 years old population, causing 12% of YLDs (15). Though this parameter has not been calculated to Sri Lanka, this study indicates that it has the capacity to affect the daily activities of the school going adolescents.
Current study was conducted as a community-based study, which is able to paint a comprehensive picture of injuries compared to hospital based studies (16, 17). This is best described as an injury pyramid based on the level of medical treatment of injury victims (18). The apex of the pyramid represents the injuries requiring hospitalization which are relatively small in number, whereas lower parts of the pyramid represents the more numerous injuries which are of lesser severity. Since hospital-based studies can identify injuries that required hospitalization they will only address the apex of the injury pyramid which is the tip of the ice berg. Therefore, it is important conduct community-based studies on adolescents unintentional injuries to identify true magnitude of the problem.
Major limitation in comparing incidence data of unintentional injuries across studies, is the lack of consistency in its assessment, recall period and definitions. It has been found that there is a wide variation in incidence of injuries with varying recall periods. The results of studies using diverse recall periods, cannot be compared without considering the factors affecting such differences (19). However, since GSHS has been conducted in several countries and uses a consistent definition and a recall period, enables meaningful comparison across countries. Analysis of GSHS data of 13 to 15-year-old school students of Indonesia, Myanmar, Sri Lanka and Thailand to identify the burden of serious injuries among school students has reported a prevalence of 42.2% for all countries, ranging from 27.0% in Myanmar to 46.8% in Thailand (20). This indicate that the prevalence among low and middle-income countries is uniform across countries. However, relatively low figures have been reported from developed countries (9, 21).
Boys are more prone to serious injuries that require medical attention and/or leads to missing out on daily activities, which was re-instated by the current study. Male gender was found to be significantly associated with the occurrence of unintentional injuries in the present study. This was in line with some other studies which had shown that similar sex differences in injury rates (22–24). This might be explained by the fact that males have a higher probability of risk taking behavior, physically more active and more probability of engaging in competitive sports (25, 26). Several studies have demonstrated that old age groups are more prone for unintentional injuries (27, 28). However, similar to GSHS results in 2008, the present study failed to demonstrate this association.
Current study found that falls and motor vehicle accidents as most common causes of unintentional injuries among the school going adolescents and similar studies have found these two to be the most common etiologies for the injuries (20, 29, 30). Similarly, a large-scale household survey conducted to assess the epidemiology of unintentional injuries in Nepal has reported falls as the commonest cause for unintentional injuries among children (31). Analysis of data from the Thailand National Injury Surveillance System for the year 2005 has identified the motor vehicle accidents to be the leading cause of severe and fatal injury among children under 15 years. Further analysis has shown that the commonest vehicle involved in these accidents was the motor cycle and 95% of the injured children were not wearing a helmet at the time of injury (29). Riding motor cycle without wearing a helmet is common among adolescents. It is therefore depicted that this could indicate a serious public health problem among children that needs urgent attention (32). This study has also reported that fatal road traffic accidents are more commonly seen among boys than in girls.
Though physical attacks have contributed to only 2.7% of all injuries, being in a fight was significantly associated with being injured. Violence leads to 5.8% of injury related deaths among children below 17 years globally and is more commonly seen among older age groups (2). Therefore, more attention should be given to interpersonal violence among school children.
In addition to ill health, serious injuries also have dire effects on school performance. Thus proper attention should be given to impose remedial measures for this problem. Knowledge about the extent and correlates of the problem is a valuable asset when designing remedial measures. According to the current study, male sex, being bullied, being physically attacked or being in a physical fight were associated with obtaining serious injuries. Identification of such vulnerable populations should be targeted when planning interventions for injury prevention.
This study has several limitations. As the study was conducted among the school going adolescents, generalizing the findings to the entire adolescent population in Sri Lanka is not possible, as their circumstances may differ significantly. Further, recall bias is a possible limitation, as information were inquired regarding last 12 months, and participants may not remember the information accurately.