Assault-injured youth in the emergency centres of Khayelitsha, South Africa: A prospective study of recidivism and mortality

Introduction: Violence is a major cause of death worldwide among youth. The highest mortality rates from youth violence occur in low and middle-income countries (LMICs). We sought to identify risk factors for violent reinjury and emergency centre (EC) recidivism among assault-injured youth in South Africa. Methods: A prospective follow up study of assault injured youth and controls ages 14-24 presenting for emergency care was conducted in Khayelitsha, South Africa from 2016 to 2018. Sociodemographic and behavioral factors were assessed using a questionnaire administered during the index EC visit. The primary outcomes were return EC visit for violent injury or death within 15 months. We used multivariable logistic regression to compute adjusted odds ratios (OR) and 95% confidence intervals (CI) of associations between return EC visits and key demographic, social, and behavioral factors among assault-injured youth. Results: Our study sample included 320 assault-injured patients and 185 non-assault-injured controls. Of the assault-injured, 80% were male, and the mean age was 20.8 years. The assault-injured youth was more likely to have a return EC visit for violent injury (14%) compared to the control group (3%). The non-assault-injured group had a higher mortality rate (7% vs 3%). All deaths in the control group were due to end-stage HIV or TB-related complications. The strongest risk factors for return EC visit were prior criminal activity (OR = 2.3, 95% CI = 1.1-5.1), and current enrollment in school (OR = 2.1, 95% CI = 1.0-4.6). Although the assault-injured group reported high rates of binge drinking (73%) at the index visit, this was not found to be a risk factor for violence-related EC recidivism. Discussion: Our findings suggest that assault-injured youth in an LMIC setting are at high risk of EC recidivism and several sociodemographic and behavioral factors are associated with increased risk. These findings can inform targeted intervention programs.