Masood Ali Shaikh  ( Independent Consultant, Block No. 7, Gulshan-e-Iqbal, Karachi. )

Madam, injuries impose a major morbidity and mortality burden globally with over two-third of injuries sustained in low and middle-income countries; smoking, low socio-economic status, age, sex, and psychological distress have been identified as risk factors.^1-4 To describe these factor associations with self-reported injuries and its prevalence in the past 12 months among Pakistani students of class 8-10, I used data from the two-stage cluster sample-based nationally representative Global School-Based Health Survey (GSHS) for Pakistan, conducted in 2009 by the Ministry of Health in collaboration with the World Health Organization and Centers of Disease Control and Prevention, United States.⁵ GSHS defined injury as requiring treatment by a doctor/nurse or necessitating missing at least one full day of usual activities for example, school, sports or a job. Design-based analysis using STATA-12 was done using bivariate analysis and multivariate logistic regression. Factors found statistically significant at p<0.1 level on simple logistic regression were used for multiple logistic regression.
The overall prevalence of one or more injuries in the past 12 months was 36.5% [95% confidence interval (CI): 30.6%, 42.2%] (n = 5147). In male students the prevalence was 42.2% (95% CI: 37.8%, 46.5%), while among females the prevalence was 27.2% (95% CI: 19.5%, 34.9%).


Table-1 provides the respondent\\\'s demographic and psychosocial factors description, as well as association with injuries in bivariate and multivariate analyses. Age was not found to be statistically significant in the simple logistic regression model, and hence was dropped from the final multivariate logistic regression model. Final model included statistically significant factors of sex, tobacco use, psychological distress, and being hungry owing to not enough food in one\\\'s home. Results of the goodness-of-fit-test concluded that this model was a good fit for the survey data.
Additionally, odds ratios (OR) were calculated for sustaining one or more injuries in the past 12 months, and having been physically attacked one or more times in the past one year [OR=2.78 (95% CI: 2.27, 3.41)]. Others included being involved in one or more physical fight in the past one year [OR=2.70 (95% CI: 2.16, 3.37)] and being bullied one or more times in the past 30 days [OR=2.83 (95% CI: 2.41, 3.32)].
Results indicate the need for identifying those students who use tobacco, come from poor socio-economic strata, and reporting psychological distress and directing injury prevention health education campaigns in schools towards them, specifically boys; while discouraging physical violence and bullying.

1. Smith GS, Barss PG. Unintentional injuries in developing countries: the epidemiology of a neglected problem. EpidemiolRev 1991, 13:288-66
2. Forjuoh SN, Gyebi-Ofosu E. Injury surveillance: should it be a concern to developing countries? J Public Health Policy 1993; 14: 355-9.
3. Deen JL, Vos T, Huttly SR, Tulloch J. Injuries and noncommunicable diseases: emerging health problems of children in developing countries. Bull Woorld Health Organ 1999; 77: 518-24.
4. Peltzer K, Pengpid S. Injury and social correlates among in-school adolescents in four southeast Asian countries. Int J Environ Res. Public Health 2012; 9: 2851-62.
5. Global School-based Student Health Survey (GSHS). (Online) (Cited 2013 March 1). Available from URL: http://www.cdc.gov/gshs/.