Abstract
Abstract
Injuries are the leading cause of mortality among 10-19 years old children and adolescents globally. This study reports on correlates of injuries using multivariate analysis and compares trends in injury from 2006 to 2010 in Morocco. For the prevalence of all cause injury, there was a statistically significant decrease between year 2006 and 2010, cumulatively, as well as for each sex. Within same years, boys reported having sustained more injuries than girls, and this difference was found to be statistically significant. Within same years, boys reported having sustained more fall injuries than girls; however this was statistically significant for year 2006 only. All cause injuries were also found to be statistically significantly more common in boys compared to girls in the year 2010, in the multiple logistic regression model. To further mitigate the burden of injury malady in Morocco among adolescents; all stakeholders i.e. health policymakers, paediatricians, psychiatrists, general practitioners, teachers, and parents need to choreograph their moves in concert.
Keywords: Injury, Adolescents, Morocco.
Introduction
Injuries are the leading cause of mortality among 10 to 19 years old children and adolescents globally; with over 830,000 under the age of 18 years dying yearly due to unintentional injuries, mostly in low and middle income countries like Morocco.1 The \'Convention on the Rights of the Child\' obligates signatory countries — including Morocco — to take measures for protecting children from injury as part of ensuring survival and development of the child.2 In Morocco, injuries are responsible for 11% of the total disease burden.3
Several risk factors have been reported to be associated with injuries among adolescents; being male, smoking, low socio-economic status, age, and psychological distress.4-9 There are no nationally representative studies on the prevalence and correlates of injury among adolescents in Morocco, describing the correlates of injury in a multivariate analysis.
In 2006, a nationally representative survey was conducted among school attending adolescents, which was subsequently repeated in 2010; providing a unique opportunity to compare prevalence of injuries among adolescents between these two survey years. This study reports on correlates of injuries using multivariate analysis and compares trends in injury from 2006 to 2010 in Morocco.
Methods and Results
The Moroccan national authorities, Centers for Disease Control and Prevention (USA), and the World Health Organization have conducted Global School-based Student Health Surveys (GSHS) in Morocco, in 2006 and 2010. Both surveys used similar methodology i.e. by employing a two-stage cluster sample design to produce nationally representative estimates for all students in the 1st, 2nd, and 3rd Prep. Schools. They were selected using probability proportional to size during the first stage, while classes were randomly selected in the second stage; with all students being eligible to participate in the selected classes. The detailed descriptions of both surveys as well as data are available, and were accessed from the CDC\'s GSHS website.10 To describe factors associated with self-reported serious injury — defined as an injury that makes one "miss at least one full day of usual activities (such as school, sports, or a job) or requires treatment by a doctor or nurse" — in the past twelve months, in Moroccan school attending adolescents aged 13 to 15 year old, data for 2010 GSHS were used. Comparisons were made between the prevalence of serious injury owing to any cause, as well as injuries sustained specifically due to falls, between boys and girls and between the two GSHS surveys of 2006 and 2010. Psychological index was created to determine psychological distress comprising of four questions.4 For questions: during the past 12 months how often one felt lonely, or having been worried about something that one could not sleep at night; responses of \'most of the time\' and \'always\' were coded as 1 while responses of \'never\', \'rarely\', and \'sometimes\' were coded as 0. Having no close friends was coded as 1 while having one or more close friends was coded as 0. Finally, for having ever seriously considered attempting suicide in the past 12 months was coded as 1 for affirmative answer and 0 for negative answer. Maximum possible score was 4 i.e. one for each question, while minimum possible score was zero. Design-based analysis using STATA-13 was done using simple and multivariate logistic regression; factors found to be statistically significant at p