Demographic and contextual infl uences in injury risk among adolescents in a low-income country setting: Results from a school-based survey in Tanzania

Objective: This study investigated the social, demographic and contextual factors associated with injury among adolescents in a low-income urban sub-Saharan African setting.Methods: Data on 2 176 adolescents aged 11–16 years were divided into three groups: Those that reported not being injured, those that had been injured once, and those that had been injured multiple times within a 12-month recall period. We conducted bivariate analyses to screen for associations with several social, demographic and contextual factors. Then a multinomial logistic regression was performed to examine associations while adjusting for covariates.Results: Within the recall period, 22.14% of participants reported one serious injury and 10.96% reported multiple injuries. Compared with non-injured participants, those injured two or more times were mainly male (relative risk ratio (RRR) = 1.71 [1.27–2.31]), younger (RRR = 0.77 [0.68–0.86]), depressed (RRR = 1.98 [1.43–2.74]) and had high rates of truancy (RRR = 2.56; CI = 1.71–3.84). A travel time of more than 30 minutes to and from school was also associated with increased rates of injury (RRR = 1.61; CI = 1.13–2.29).Conclusions: Injuries are an important source of morbidity among school-attending adolescents in Dar es Salaam. The findings support more research into the contextual factors that predispose adolescents to excessive injury in the region. School settings have the potential to provide safety education in the region.Keywords: injury, sub-Saharan Africa, urban setting, school healt

Effects of non-health-targeted policies on migrant health: a systematic review and meta-analysis

Summary Background Government policies can strongly influence migrants' health. Using a Health in All Policies approach, we systematically reviewed evidence on the impact of public policies outside of the health-care system on migrant health. Methods We searched the PubMed, Embase, and Web of Science databases from Jan 1, 2000, to Sept 1, 2017, for quantitative studies comparing the health effects of non-health-targeted public policies on migrants with those on a relevant comparison population. We searched for articles written in English, Swedish, Danish, Norwegian, Finnish, French, Spanish, or Portuguese. Qualitative studies and grey literature were excluded. We evaluated policy effects by migration stage (entry, integration, and exit) and by health outcome using narrative synthesis (all included studies) and random-effects meta-analysis (all studies whose results were amenable to statistical pooling). We summarised meta-analysis outcomes as standardised mean difference (SMD, 95% CI) or odds ratio (OR, 95% CI). To assess certainty, we created tables containing a summary of the findings according to the Grading of Recommendations Assessment, Development, and Evaluation. Our study was registered with PROSPERO, number CRD42017076104. Findings We identified 43 243 potentially eligible records. 46 articles were narratively synthesised and 19 contributed to the meta-analysis. All studies were published in high-income countries and examined policies of entry (nine articles) and integration (37 articles). Restrictive entry policies (eg, temporary visa status, detention) were associated with poor mental health (SMD 0·44, 95% CI 0·13–0·75; I2=92·1%). In the integration phase, restrictive policies in general, and specifically regarding welfare eligibility and documentation requirements, were found to increase odds of poor self-rated health (OR 1·67, 95% CI 1·35–1·98; I2=82·0%) and mortality (1·38, 1·10–1·65; I2=98·9%). Restricted eligibility for welfare support decreased the odds of general health-care service use (0·92, 0·85–0·98; I2=0·0%), but did not reduce public health insurance coverage (0·89, 0·71–1·07; I2=99·4%), nor markedly affect proportions of people without health insurance (1·06, 0·90–1·21; I2=54·9%). Interpretation Restrictive entry and integration policies are linked to poor migrant health outcomes in high-income countries. Efforts to improve the health of migrants would benefit from adopting a Health in All Policies perspective