Substance use and adolescent injuries: a multi-country analysis of the association and mediating effect of interpersonal violence among 122,945 in-school paediatric populations in 29 countries

BackgroundAdolescent use of substances and injury experiences such as head injury have become increasingly prevalent. However, information regarding their association and the potential pathways linking them remains limited. This study examined the association between substance use and injuries, emphasizing the mediating role of interpersonal violence among adolescents.MethodsWe employed a multi-country analysis of Global School-based Health Surveys of 122,945 in-school adolescents aged 11–18 from 29 countries. This study was a cross-sectional school-based, nationally representative study developed by the World Health Organization and the United States Centers for Disease Control and Prevention, other United Nations allies, and country-specific institutions. Random-effects meta-analysis was performed to estimate the overall prevalence of injury and substance use and the I-square (I2) statistic was used to investigate the between-country heterogeneity. Logistic regression models were fitted to examine the association between substance use and injuries. A path analysis was used to examine the potential mediation effect of interpersonal violence and employed decomposition of effects into total, direct, and indirect.ResultsPrevalence of substance use and injuries were 33.6% (95%CI = 28.5, 38.6%) and 41.7% (95%CI = 37.3, 46.1%), respectively. Substance use (37.8% vs. 29.4%, p = 0.001) and injuries (47.3% vs. 36.4%, p = 0.001) were significantly higher among male adolescents than females, respectively. After adjustment, substance users had 40% higher odds of injuries. The path analysis showed a mediation effect of perpetration of and victimization by interpersonal violence on the association of substance use with injuries, with total positive effects of perpetration [β = 0.18; 95%CI = 0.16, 0.19; p = 0.001] and victimization on injuries [β = 0.22; 95%CI = 0.21, 0.24; p = 0.001]. In a further subgroup analysis, tobacco users were 3.98 times more likely to sustain a gunshot wound whiles marijuana users had 2.81 times higher odds of sustaining gunshot wounds. Cigarette smokers had 45% lower odds of sustaining cut/stab wounds. Alcohol users were 53% more likely to sustain concussion/head injury and two and half times more likely to sustain gunshot wound.ConclusionA significant association exists between substance use and severe injuries among adolescents, mediated by interpersonal violence exposure. Our findings may have utility in informing substance use and interpersonal violence control policies and interventions to address adolescent injuries

Prevalence, treatment outcomes and determinants of TB–HIV coinfection: a 10-year retrospective review of TB registry in Kwabre East Municipality of Ghana

Objective To assess the prevalence, treatment outcomes and determinants of tuberculosis (TB)–HIV coinfection in Ghana.Study design A retrospective review of TB case register for Kwabre East Municipality was conducted for the period 2010–2020 to identify TB–HIV coinfections.Setting 462 patients with TB from four sub-municipal treatment centres were included in the study.Primary outcome measure A logistic regression model was used to investigate the relationship between clinico-demographic factors (age, sex, type of patient, disease classification, treatment category and sputum smear microscopy) and TB–HIV coinfection.Results Of the 462 individual TB cases found in the TB register from 2010 to 2020, 286 (61.9%) were screened for HIV and the results showed that 18% had TB–HIV coinfection. TB–HIV coinfection was highest in 2015 with a prevalence of 40% among all registered TB cases. The likelihood of TB–HIV coinfection was highest among patients with TB aged 40–49 years (AOR=3.99, CI=1.3, 12.7). Those who tested negative for TB at the end of their treatment period had lower odds of HIV coinfection (AOR=0.27, CI=0.10, 0.72).Conclusion Nearly one out of every five (18%) patients with TB in the municipality were found to be coinfected with HIV. TB–HIV coinfection was significantly associated with patients' age and their TB treatment outcomes. Urgent interventions are needed to address these risk factors to promote optimal health for patients with TB in the municipality

Determinants of motorcycle helmet availability and cost in retail outlets: outcomes of a market survey in northern Ghana

Abstract Background Morbidity and mortality from road traffic crashes are steadily increasing globally and they remain a major public health challenge. This burden is disproportionately borne by low-and middle-income countries, especially Sub-Saharan Africa where motorcycle helmet use is low and where there are challenges of affordability and availability of standard helmets. We sought to assess the availability and cost of helmets in retail outlets in northern Ghana. Methods A market survey of 408 randomly sampled automobile-related retail outlets in Tamale, northern Ghana was conducted. Multivariable logistic regression was used to identify factors associated with helmet availability and gamma regression was used to identify factors associated with their cost. Results Helmets were available in 233 (57.1%) of surveyed retail outlets. On multivariable logistic regression, street vendors were 48% less likely and motorcycle repair shops 86% less likely to sell helmets than automobile/motorcycle shops. Outlets outside the Central Business District were 46% less likely to sell helmets than outlets inside that district. Nigerian retailers were five times more likely to sell helmets than Ghanaian retailers. Median helmet cost was 8.50 USD. Helmet cost decreased by 16% at street vendors, 21% at motorcycle repair shops, and 25% at outlets run by the owner. The cost increased by older age of retailer (1% per year of age), education level of retailer (12% higher for secondary education, 56% higher for tertiary education, compared to basic education), and sex (14% higher for male retailer). Conclusion Motorcycle helmets were available in some retail outlets in northern Ghana. Efforts to improve helmet availability should address outlets in which they are less commonly sold, including street vendors, motorcycle repair shops, outlets run by Ghanaians, and outlets outside the Central Business District

Association of food insecurity and sleep difficulty among 189,619 school-going adolescents: a study from the global in-school students survey

Introduction: Adolescents’ sleep disturbances are associated with chronic and dramatic physical, emotional, and mental development and school performance consequences. Although food insecurity could significantly contribute to these effects, few studies have explored the effect of food insecurity on sleep disturbances among adolescents. The study aimed to examine the relationship between adolescents’ food insecurity and sleep disturbance. Methods: Data on 189,619 adolescents were drawn from the cross-sectional global adolescent health surveys conducted between 2015 and 2018 in 35 countries and territories. Univariate and multivariable multinomial regression models were fitted to examine the hypothesized associations. Results: Overall pooled prevalence of moderate [45.2% (95%CI = 43–47)] and severe [5.8% (95%CI = 5–6)] food insecurity levels were reported. About [52.6% (95%CI = 51–54)] moderate and [8.6% (95%CI = 8–9)] severe worry-induced sleep disturbances were found. Considering the fully adjusted multinomial logistic model, moderate food insecurity was significantly associated with moderate (AOR = 1.70 CI = 1.59–1.81; p < 0.0001) and severe (AOR = 1.63 CI = 1.42–1.87; p < 0.0001) sleep disturbances. Also, adolescents reporting severe levels of food insecurity had moderate (AOR = 1.88 CI = 1.68–2.11; p < 0.0001) and severe (AOR = 4.07 CI = 4.74–6.11; p < 0.0001) sleep disturbances. Females and those aged between 15 and 17 years and 18 or more were at higher risk of moderate and severe sleep disturbances in the context of food insecurity. Conclusion: Reducing food insecurity could be an effective policy strategy for enhancing adolescent sleep quality

Prevalence and determinants of caesarean section deliveries in the Kintampo Districts of Ghana

Abstract Background Globally, the increasing rate of caesarean section (CS) delivery has become a major public health concern due to its cost, maternal, neonatal, and perinatal risks. In Ghana, the Family Health Division of the Ghana Health Service in 2016 opted to initiate a program to prevent the abuse of CS and identify the factors contributing to its increase in the country. This study aimed to determine the prevalence and factors influencing CS deliveries in the Kintampo Districts of Ghana. Methods The current study used secondary data from the Every Newborn–International Network for the Demographic Evaluation of Populations and their Health (EN-INDEPTH) project in Kintampo, Ghana. The outcome variable for this study is CS delivery. The predictor variables were socio-demographic and obstetric factors. Results The prevalence of CS delivery in the study area was 14.6%. Women with secondary education were 2.6 times more likely to give birth by CS than those with primary education. Unmarried women were about 2.5 times more likely to deliver by CS compared to those who were married. There was an increasing order of CS delivery among women in the wealthy quintiles from poorer to richest. The likelihood of women with gestational ages from 37 to 40 weeks to give birth by CS was about 58% less compared to those with less than 37 gestational weeks. Women who had 4–7 and 8 or more antenatal care (ANC) visits were 1.95 and 3.5 times more likely to deliver by CS compared to those who had less than 4 ANC visits. The odds of women who have had pregnancy loss before to deliver by CS was 68% higher compared to women who have not lost pregnancy before. Conclusions Caesarean section delivery prevalence in the study population was within the Ghana Health Service and World Health Organization ranges. In addition to known socio-demographic and obstetric factors, this study observed that a history of pregnancy loss increased the chances of a woman undergoing a CS. Policies should aim at addressing identified modifiable factors to stem the rise in CS deliveries