Epidemiology of unintentional drowning in a metropolis of the French Mediterranean coast: a retrospective analysis (2000–2011)

Drowning affects more than 500,000 people worldwide and is responsible for at least 350,000 deaths each year. In France, 1235 drowning resulting in 496 deaths were recorded in the summer 2012. This retrospective study has investigated the epidemiology of drowning in the city of Marseille (South of France) between 2000 and 2011. We identified 449 cases of unintentional drowning. The highest incidence was found among males with a median age of 36 years. The incidence was 5.3 victims per 10,000 inhabitants with a mortality rate of 1.2 per 10,000. These accidents occurred mainly at sea (89%) and during the summer season. A majority of drowning victims (69%) were admitted in a hospital. This is the only study in France to analyse data on drowning throughout the year and over a long period. Drowning is a serious condition burdened by 22% of victims who die.     

Constant supervision of bathing in French public swimming pools: an unrealistic regulatory requirement?

In France, to prevent drowning accidents in public swimming pools (PSPs), bathing must be constantly supervised by qualified staff. However, fatal drowning regularly occurs in supervised aquatic facilities. A review of the literature shows that human supervision is a complex task. The aim of this research is to fully assess the periods during which supervision is not carried out, or carried out in an inadequate manner. The observations made in 108 French PSPs show that supervision is not carried out 18% of the time and that it is carried out inadequately 33% of the time. The medical literature shows that, in order to expect to survive without after-effects, an immersed victim requires intervention within a time limit of not more than three minutes; however, we noted, over a total observation time of 54 hours, 147 periods (29.8%) during which the supervision system was degraded for three minutes or more. This quantification research on the periods of degraded supervision is complemented by an identification of the causes leading to these degradations, from which we can draw interesting areas for improvement, particularly from an organizational point of view, in order to improve safety management in French PSPs.     

Swimming lessons,swimming ability,and the risk of drowning

Drowning is a leading cause of injury related death in many countries. Strategies to prevent these deaths depend upon characteristics of the victim and the specific circumstances surrounding the event. One preventive strategy that may be beneficial for persons of all ages and under nearly all circumstances is increased swimming ability, through some form of swimming instruction. However, a clear protective relationship between increased swimming ability and the risk of drowning has never been demonstrated. Studies focused on children, suggest that swimming ability may confer some protection, although the data are far from conclusive. This paper (1) reviews the current evidence regarding the relationship between swimming ability, swimming lessons and the risk of drowning, (2) reviews the past and present recommendations for swimming instruction and (3) outlines future research needs.     

Unhealthy and unsafe practices associated with symptoms of depression among injured patients

This study describes a process to explore factors which contribute to child-drowning deaths and allows the development of appropriate strategies to prevent similar deaths in a selected site in the Northern Philippines. Data collection techniques used in obtaining baseline data include: review of drowning mortality records; key informant interviews; focus group discussions; and community walk-throughs. Risk factors identified which could or did contribute to drowning events were: proximity to bodies of water; inadequate child supervision; lack of information/awareness of prevention strategies; and lack of drowning prevention programme(s). Measures on how to prevent drowning deaths were explored and initial interventions were implemented through a committee convened by the community. These interventions include: community education sessions; capability building measures; redesigning of community wells; development of playpens; and use of barriers. Community engagement is a crucial element in the development and implementation of any health programme. This study demonstrates that by engaging and working with the community action occurs, however, there is a need to conduct further evaluation activities to determine if the actions by the community continued beyond the project and have resulted in a decrease in drowning. One of the strengths of the process described is that it is culturally appropriate and site-specific and allows the community to find the solutions itself. Exploration and delivery of further projects in larger areas is required to reduce drowning in the Philippines. An imperative is the evaluation which will provide valuable information on whether barriers are a sustainable and acceptable means of prevention to the community in the long term.     

Parental perceptions of toddler water safety, swimming ability and swimming lessons

The primary objective of the study was to examine parental perceptions on the role of toddler swimming ability and pre-school swimming lessons in drowning prevention. A self-administered questionnaire was used to obtain information on toddler water safety from parents (n = 882) whose 2 - 4-year-old toddlers were either attending early childhood centres (n = 327) or who were enrolled in swim schools (n = 555). Differences in attitudes between two groups of parents were measured by frequency, with Mann-Whitney U tests used to discern significant differences between groups. More swim school parents believed that: swimming was best taught at 2 years of age or less (42% vs. 29%); swimming lessons were the best way to prevent toddler drowning (57% vs. 47%); toddlers could learn to save themselves if they fell into water (43% vs. 33%); and that it was better to develop swimming ability rather than rely on adult supervision (35% vs. 30%). Many parents have an overly optimistic view of the role of swimming ability and pre-school swimming lessons in drowning prevention. This was especially so for parents with toddlers enrolled in lessons. Swim schools in particular need to counter parental misconceptions of the protective role of swimming and reiterate the importance of close adult supervision of toddlers around water.     

Drowning among the lakeside fishing communities in Uganda: results of a community survey

The study aimed to determine the drowning burden in four Ugandan lakeside districts; the prevalence of life jacket use, and community knowledge and attitudes regarding water safety. Subjects were recruited as they disembarked from boats. A structured questionnaire was used for demographics, experience on water, details of incidents in water, and awareness of drowning prevention measures. Focus group discussions (FGDs) and key informant interviews were held. The study interviewed 544 participants; 81.1% male, 86.8% below 45 years, and 51.1% involved in the fishing industry. A quarter (26.1%) of the respondents were observed wearing life jackets as they disembarked. Participants who had been in a boat that nearly capsized (57.8%), or that actually capsized (21.7%), were no more likely to wear life jackets than those who had not had these experiences. Three quarters (73.2%) did not know how to call for rescue, and only 48.7% could swim. There drowning fatality rate in this community was 502 deaths per 100,000 population. Majority of drowning events occurred during transportation (51.7%) or fishing (39.0%). The most frequently mentioned factors were stormy weather and overloading. Drowning is a common threat to young adults in the fishing communities around Lake Victoria. Few preventive interventions are in place.     

Death from drowning: defining a new challenge for child survival in Bangladesh

The study focuses on children less than 5 years old and explores the epidemiological profile and correlates of drowning as a challenge to child survival in Bangladesh. Two data sources from Bangladesh, a cohort of 8,070 children followed for 2 years in a rural area and a nation-wide survey conducted in 1996–97 have been used. In addition, a systematic review of the literature has been conducted spanning the past two decades for analysis of drowning in children. Seventy drowning deaths were reported in the cohort and 726 deaths were reported in the national survey. Verbal autopsy and semi-structured interviews were conducted on all deaths. Drowning accounted for 43% of deaths in the cohort and 20% of deaths in 1–4-year-old children in the national survey. Most drowning deaths were in 12–23 month old children from falling into ditches and ponds. Communities provided valuable insights on possible interventions to reduce deaths due to drowning. Drowning is a newly recognized challenge for Bangladesh. Considerable research and programmatic work is required to understand the nature of the problem and develop appropriate interventions. This paper calls on aid agencies to create opportunities for drowning research and action in their work plans for the country.     

Unintentional drowning in urban South Africa: a retrospective investigation, 2001–2005

Drowning is a major public health concern in low- and middle-income countries. In South Africa there is sound information and an emerging knowledge base for drowning prevention. However, there remains a scarcity of analyses of drowning in the country. The purpose of this analysis was to quantify the magnitude and describe occurrence of unintentional drowning deaths in five major South African cities, recorded between 2001 and 2005 by the National Injury Mortality Surveillance System. Drowning in South African cities occurred at rates of between 1.4 and 2.7/100,000 population. The majority of drowning occurred among males, while the highest rates were observed among 0–4 year olds. Most drowning deaths occurred during recreational periods, over weekends and in the afternoon. Of adult drowning victims, 41.5% were alcohol-positive at the time of death. This study is based on one of only two known systematic sources of drowning mortality in Africa. It provides an indication of drowning rates in South African cities with young children and males at considerably more risk. The most likely locations for drowning varied from city to city. Among adult victims, especially men, alcohol is an important risk factor.     

A document analysis of drowning prevention education resources in the United States

There have been long-standing calls to better educate the public at large on risks of drowning; yet limited evaluation has taken place on current resources in circulation. The purpose of this qualitative research is to develop an understanding of the content in currently circulated drowning prevention resources in the United States. Data points (n = 451) consisting of specific content within 25 different drowning prevention educational resources were analyzed using document analysis methods; a grounded theory approach was employed to allow for categorical development and indexing of the data. Results revealed six emerging categories, including safety precautions (n = 152), supervision (n = 109), preventing access (n = 57), safety equipment (n = 46), emergency procedures (n = 46), and aquatic education (n = 41). Results provide an initial insight into the composition of drowning prevention resources in the United States and provide a foundation for future research.     

Perceptions of the risk of drowning at surf beaches among New Zealand youth

ABSTRACT

In many countries, beaches are a high-risk location for drowning. In New Zealand, youth and young adults are particularly at risk of drowning at beaches, accounting for 17.4% of drowning deaths and 18.4% of rescues at surf beaches between 2008 and 2013, over 90% of fatalities were male. This study explored New Zealand youth risk perceptions of drowning and their coping appraisal processes at a surf beach. A cross-sectional survey of high school students (n = 599) was conducted between February and April 2014. Females and non-New Zealand European students reported higher levels of perceived vulnerability and severity of drowning risk, and New Zealand European students reported higher levels of self-efficacy of preventive actions. By addressing the underlying causes of underestimation of risk and overestimation of ability, these findings can be utilized to increase awareness and to enhance water safety risk strategies for youth, especially males, in the surf beach setting.     

The epidemiology of drowning worldwide

The purpose of this analysis was to quantify the magnitude of death and disability from drowning and near-drowning worldwide and to provide epidemiological data on which to base prevention efforts. All data are from the Global Burden of Disease 2000 (Version 1) estimates in which deaths and disabilities are based on the WHO International Classification of Diseases. Extrapolations were made by age, sex, and WHO region. The six WHO regions of the world were further divided into high-income, and low- and middle-income based on the 1998 World Development indicators. According to the GBD 2000 data, an estimated 449,000 people drowned worldwide (7.4 per 100,000 population) and a further 1.3 million Disability Adjusted Life Years (DALYs) were lost as a result of premature death or disability from drowning. 97% of drownings occurred in low- and middle-income countries. Although 38% of drownings occurred in the Western Pacific Region, Africa had the highest drowning mortality rate (13.1 per 100,000 population). Males had higher drowning mortality rates than females for all ages and in all regions. Children under the age of 5 years had the highest drowning mortality rate for both sexes in all of the WHO regions except for Africa, where children aged 5 to 14 years had the highest mortality rate. World-wide, for children under the age of 15 years, drowning accounted for a higher mortality rate than any other cause of injury. Drowning is a significant problem worldwide particularly for children under the age of 15 years. Low- and middle-income countries have the highest rates of drowning and account for more than 90% of such fatalities. Primary prevention efforts should thus be focused on these countries where many children who cannot swim drown in large bodies of water.     

Preventing drowning through design – the contribution of human factors

A number of routes can be followed towards the prevention of drowning, such as educating on water safety, installing barriers between non-intended users and water, mitigating the consequences of submersion incidents, and design. The human factor approach to safety is that design should always be the primary route. Human factors can be applied to the design of personal protective equipment such as buoyancy aids, barriers such as pool fencing, ancillary equipment such as swimming pool covers through to information and organisational factors such as safety signs and swimming campaigns. Design should consider all potential drowning scenarios and accommodate the characteristics of those at risk. A framework is presented with examples on how human factor principles can be applied to the design of potential drowning sites and products, with suggestions for methods and techniques that can be used in the key stages of predicting potential hazards and assessing risk.     

Toddler drowning prevention: teaching parents about water safety in conjunction with their child's in-water lessons

The primary objective of the study was to develop a parent education programme that addressed parental misconceptions of toddler water safety previously identified by the authors. Parents (n = 106) of 2-4-year-old toddlers enrolled in swim school lessons completed a self-directed questionnaire before and after a 10-week poolside water safety programme. Differences in pre- and post-programme knowledge and beliefs were measured by frequency and chi-square tested to identify significant changes in parental comprehension of toddler water safety after the programme. Statistically significant improvements in parental understanding were evident after the programme. More parents were aware of the family or friend's swimming pool as the primary site of toddler drowning (59% vs. 78%). More parents agreed that their toddler required more, not less, adult supervision after swimming lessons (85% vs. 97%) and more disagreed that swimming lessons were the best way to prevent toddler drowning (65% vs. 74%). Parental understanding of child cardiopulmonary resuscitation (CPR), however, did not improve after the programme. This study suggests that toddler lessons in swim schools provide a valuable opportunity to address parental misconceptions about toddler water safety. Further research is required to determine how parents whose toddlers do not attend swimming lessons might similarly benefit from such a programme.     

Toddler drowning prevention: Teaching parents about water safety in conjunction with their child's in-water lessons

The primary objective of the study was to develop a parent education programme that addressed parental misconceptions of toddler water safety previously identified by the authors. Parents (n = 106) of 2 – 4-year-old toddlers enrolled in swim school lessons completed a self-directed questionnaire before and after a 10-week poolside water safety programme. Differences in pre- and post-programme knowledge and beliefs were measured by frequency and chi-square tested to identify significant changes in parental comprehension of toddler water safety after the programme.

Statistically significant improvements in parental understanding were evident after the programme. More parents were aware of the family or friend's swimming pool as the primary site of toddler drowning (59% vs. 78%). More parents agreed that their toddler required more, not less, adult supervision after swimming lessons (85% vs. 97%) and more disagreed that swimming lessons were the best way to prevent toddler drowning (65% vs. 74%). Parental understanding of child cardiopulmonary resuscitation (CPR), however, did not improve after the programme.

This study suggests that toddler lessons in swim schools provide a valuable opportunity to address parental misconceptions about toddler water safety. Further research is required to determine how parents whose toddlers do not attend swimming lessons might similarly benefit from such a programme.     

Drowning deaths among anglers: Are waders a contributing factor?

Recreational fishing has been a popular activity for Australians over at least the past two centuries. While the use of waders for recreational fishing is widely adopted by participants, there is considerable speculation as to whether waders are contributing to fishing-related drowning deaths. This study involved a comprehensive search of peer-reviewed and grey literature to identify relevant information and a pilot investigation in a swimming pool to understand the accuracy of the currently available information. Extensive searching indicated that there is no published peer-reviewed evidence on the contribution of waders to drowning deaths, although the grey literature and personal communication with fishers offer a range of opinions, some that aim to discredit the claim that waders contribute to drowning, and others that support it. Improved understanding of the actual effect of waders based on biomechanical buoyancy principles and a pilot study of submersion in controlled conditions contributes to enhanced safety of fishers who choose to wear waders, dispels current myths and informs future studies of fishers wearing waders.     

Trends in fatal motorcycle injuries in the Americas, 1998–2010

Injuries, disabilities and deaths among motorcyclists have been rising worldwide but what is happening in the American Continent is not completely known. Deaths from motorcycle crashes of the Pan American Health Organization database (PAHO/WHO, 1998–2010) were included in an ecologic multi-national study to quantify the temporal trends and to estimate the association between motorcycle riders’ deaths and selected socio-economic indicators. Mortality rates increased in all sub-regions. The highest increase was reported in the countries of the Andean sub-region (Ecuador, 78.3%) and Mesoamerica (Costa Rica, 60.0%). Poorer countries fared worse in terms of motorcycle mortality relative to richer countries, as did more unequal ones. Recent economic changes, rapid increment of motorisation rates, affordability of motorcycles over public transportation, lack of adequate public transportation policies and other insufficient measures aimed at improving safety can explain these trends.     

Unintentional injury mortality trends in children and adolescents in Lithuania between 1971 and 2005

The objectives of the study were to estimate mortality rate trends due to road traffic, drowning and fire/burns in children aged 0-14 years and in adolescents aged 15-19 years in Lithuania between the years 1971-2005. The data were obtained from Statistics Lithuania and the Health Information Centre. Trends were estimated by linear and polynomial regression. The study revealed that the child and adolescent unintentional injury mortality rates show declining trends. For children, the significant decreasing trends of mortality rates due to road traffic, drowning and fire/burns were observed. For adolescents there were significant decreasing trends for drowning deaths, and insignificant decreasing tendencies for deaths from fire/burns. There was an insignificant increased road traffic mortality rate trend for adolescent girls. For the adolescent boys group and for boys and girls together from the beginning of the study period there were increasing trends, followed by declining trends. In the last years, the increase was observed again.     

The 4Rs of Aquatic Rescue: educating the public about safety and risks of bystander rescue

From 1980 to 2014, 87 persons drowned in New Zealand while attempting to rescue others; all incidents occurred in open water and most (80%) fatalities were male. While bystander rescue has been promoted as a way of preventing drowning, little is known about the knowledge base that informs potential rescuers. This study utilized a family water safety programme to promote a resource entitled the 4Rs of Aquatic Rescue. Participants (n = 174) completed a pre-intervention survey and were then provided with information and access to electronic resources on safe bystander rescue techniques. Most respondents (71%) had never been taught rescue techniques, and males were more confident of their rescue ability. Upon completion of the programme, significant differences were evident in respondents’ understanding of rescue safety, but this did not translate to greater confidence or disposition towards performing a rescue. Ways of promoting bystander safety around water are discussed and recommendations for future studies are made.     

Injury minimization in construction projects

Non-intentional drowning incidents remain a leading cause of mortality in Turkey as well as all over the world. A following related secondary syndrome is composed of those who drown during altruistic attempts to rescue a drowning person. Such ‘rescuers’ who attempt to rescue a drowning person, may themselves drown, resulting in a tragic multiple death. This study covers the year 2009, and necessary data was found by using internet search engines to identify cases in which a potential rescue attempt resulted with the rescuer's fatal drowning. Thirty-one ‘rescuers’ and 20 primary drowning victims (PDV) drowned in 28 incidents in which 80% of drowned primary victims (DPV) were children, and 48.4% of the ‘rescuers’ were children. In 48.4% of the ‘rescuers’ succeeded in rescuing the PDV's life. Out of them, 38.7% of the ‘rescuers’ and PDVs were friends/colleagues. The aim of this study is to define and examine multiple drowning syndromes (MDSs) and to suggest preventative measures. An increased awareness of such risks as promotion of swimming and rescue skills could help reducing the MDSs.