Injuries among adolescents living in
poverty in Ethiopia, India, Vietnam and
Peru: a mixed method study
Inka Barnett (IDS)
Virginia Morrow
UEA/IDS workshop
2nd July
Global burden of injuries
• Leading cause of premature death and disability
among adolescents
• 95% of fatal injuries in low income countries
• Number of injuries is expected to rise
• Most injuries are preventable & not random events!
• Problem: Lack of injury prevention programmes
• Reasons: lack of evidence and available evidence
focuses on children < 5yrs, political will, competing
health problems
Aim and design
To examine patterns, causes &
consequences of injuries among poor
adolescents in the context of their daily
lives.
To address this aim we integrated
quantitative and qualitative data,
seeking to expand our understanding.
Setting: Young Lives Study
• Interdisciplinary cohort study of childhood poverty
• 20 sites in each Ethiopia, India (Andhra Pradesh), Peru &
Vietnam
• Quantitative surveys with adolescents
• Qualitative interviews with a subset of adolescents
Sample and data
12,000 children over 15 years period.
Method
• Mixed method design that integrated:
 Cross-sectional survey data from adolescents
 Qualitative interviews with a ‘nested’ sub-set
• Complementary use of quantitative & qualitative research
in which the two approaches:
“ talk to each other and ... [develop] a negotiated account
of what they mean together”
(Bryman 2007)
Step-by-step account
Integration of quantitative & qualitative data in the analysis
and interpretation phase
Step 1: Parallel initial analyses of both data sets separately and
identification of key themes related to injuries
Step 2: Quantitative analysis finding (work, recreation, transportinjuries) as starting point for integration
Step 3: Initiation of two-way process in which quantitative and
qualitative data ‘talk to each other’ for deeper insights
Step 4: ‘Back and forth’ between data sets to follow-up themes
Iterative approach
Key types for injury
Quantitative analysis
Descriptive statistics
Multivariate regressions
Qualitative analysis
Meta-theme analysis
Coding framework
Living context & risk factors
In reality...
• Data were collected as part of multi-disciplinary
research study on poverty (not injury!)
• Only limited integration during method development
 Qualitative data focussed on experience of ill health
 Quantitative survey had general section on health
Results: Patterns
• Injuries emerged as major concern in both data sets
•
Quantitative data (occurrence of injury in last 3 years):
• Qualitative data expanded on quantitative findings and
suggested a much higher burden!
 Self-treatment and delayed medical treatment
frequently aggravate minor injuries
Results: Patterns
Delay in health care seeking due to poverty can aggravate
minor injuries:
“An axe hit me on my leg when I was chopping wood. The
wound was not bad.[...] First, my parents put chilli and
alcohol on the sore.... I was treated in this way for one
month. However, I was seriously sick and I was taken to the
modern health centre. I had one medicine by injection and
another medicine which was taken in the form of
fluid....Then I recovered from the injury.”
(15 year-old boy, Ethiopia)
Results: Risk factors for injury (I)
Quantitative analysis:
 Injuries occurred at work, during recreation and transport
Qualitative follow-up found context-specific injury risks:
 Dangerous work environments (e.g. stone crushing, sunexposure, traffic)
 Unsafe recreational and living environments (e.g. poor
roads, no safe space)
 Unsafe public transport (e.g. overcrowded busses)
Results: Risk factors for injury (II)
Quantitative follow-up:
 Living in a poor household was significantly
associated with reporting an injury
Qualitative follow-up:
 Necessity of poorer adolescents to work to support
household
 Work in often hazardous conditions and without
protective gear (e.g. gloves, shoes)
Consequences of injuries
Quantitative analysis:
 Between 5% (Vietnam) and 14% (Peru) of adolescents
reported long-term health problems
• Qualitative follow-up suggests consequences beyond these:
 Drop-out of school
 Loss of job
 Reduced income of entire household
Lessons learned...
• Use of quantitative & qualitative data provided more
comprehensive insights into realities of injuries in poverty
• Lack of integration in method development phases made it
often challenging to integrate and follow-up emerging
themes (reality of multi-disciplinary studies?)
• Team working (qualitative & quantitative researchers)
 Different methodological languages, structures and
reporting styles
 Importance of lead on integration
 Journal and audience identification
• Timeliness of data analysis (qualitative more timeconsuming)
Future ideas...
• Case-by-case integration of quantitative and qualitative data
for the same individual
• Integration of quantitative and qualitative approaches in
design and method development phase to make sure the
different data really ‘speak to each other’
• Integration of longitudinal quantitative data with qualitative
data to ‘follow-up’ consequences, the impact of
improvements in living conditions, etc.
Publication
Health Policy and Planning (2013)
Thank you & Questions…
Email: [email protected]