Drowning--a major but neglected child health problem in rural Bangladesh: implications for low income countries

This study was intended to estimate the magnitude and explore the determinants of childhood drowning in rural Bangladesh. A cross-sectional survey as well as a population-based case - control study was conducted. By multistage cluster sampling 51 147 children aged 1 - 4 years were identified from 108 827 rural households. All drownings in children aged 1 - 4 years in the preceding 5 years were identified and recruited as cases and two living children of the same age group were selected from the same localities as controls. Socio-economic, demographic, environmental and other related information was collected from mothers of both cases and controls by face-to-face interview with the help of structured questionnaires. The incidence of drowning among children aged 1 - 4 years old was 156.4 per 100 000 children-year. The highest rate (328.1 per 100 000; 95% CI 254.8 - 421.7) was observed in 1 year old male children. The proportional mortality due to drowning in the children was 27.9%. Mothers' age and literacy and family income were identified as risk factors. Drowning is one of the major causes of 1 - 4 years childhood mortality in Bangladesh. One-year-old male children from poor families were at great risk of drowning in rural Bangladesh.     

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.     

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.     

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.     

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.     

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.     

Epidemiology of fatal and non-fatal drowning patients attended by paramedics in Victoria,Australia

Drowning is a major cause of injury and death worldwide. This study aims to expand the evidence in fatal and non-fatal drowning. A retrospective study was conducted to investigate fatal and non-fatal drowning incidents attended by ambulance paramedics in Victoria (Australia) from 2007 to 2012. A total of 509 drowning incidents were identified, 339 (66.6%) were non-fatal, with 170 (33.4%) resulting in death. Children aged 0–4 years had the highest crude drowning rate (7.95 per 100,000 persons). Non-fatal incidents were more likely to be witnessed by a bystander when compared with fatal incidents (43.7% vs. 20.0%, p < 0.001). Spatial analysis indicated that 35 (43.8%) local government areas (LGAs) were considered at ‘excess risk’ of a drowning event occurring. This study is the first to apply spatial analysis to determine relative risk ratios for fatal and non-fatal drowning. These findings will enable geographically targeted and age-specific drowning prevention activities.     

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.     

An analysis of stratagems to reduce drowning deaths of young children in private swimming pools and spas in Victoria,Australia

This population-based retrospective case series study examined the frequency and distribution of protective stratagems (legislatively compliant safety barrier, adequate caregiver supervision, water familiarisation and early administration of cardiopulmonary resuscitation [CPR]) amongst drowning deaths of young children (0–4 years) in private swimming pools or spas in Victoria, Australia. In 65.0% (52/80) of deaths, none of the four protective stratagems were known to be present and there was only one case where all four were known to be present. This indicates that if the presence of all four stratagems is increased, this may reduce drowning in this age group and setting. While these results are positive, further examination of the presence and interaction of these stratagems for effectiveness is required. Further research is also warranted to explore the impact of enforcement of pool fencing legislation and potential associations between water familiarisation and drowning risk. In addition, a consensus on the definition of adequate supervision in needed.     

Cost analysis of road traffic crashes in South Africa

Chaff cutter is an extensively used machine in Indian rural households to chop fodder for feeding draft and mulch to animals. A survey was conducted in five villages of Ghaziabad district of Uttar Pradesh (a northern state of India) to determine the causal factors responsible for chaff cutter injuries. It was observed that major injuries were caused during children playing with the machine and workers feeding the fodder in to the chute. Further, a survey of chaff cutter manufacturers was conducted to determine the critical dimensions of the machine so that safety interventions could be developed. Based on the survey results and mechanism of injuries, three safety interventions were developed to prevent the injuries. These interventions can be retrofitted on old machines and can be incorporated in new machines as well. Experiments were conducted using different fodder crops to observe difficulty in chaff cutting with the safety interventions. It was observed that incorporation of the interventions had no effect on performance of chaff cutting operation. These were retrofitted on existing machines at different locations and the response was very positive.     

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 beliefs about supervising children when crossing roads and cycling

Pedestrian and cyclist injuries are significant public health issues, together accounting for 11-30% of road deaths in highly motorised countries. Children are particularly at risk. In Australia in 2009 11.4% of pedestrian deaths and 6.4% of cyclist deaths comprised children aged 0-16 years. Parental attitudes and level of supervision are important to children's road safety. Results from a telephone survey with parents of children 5-9 years (N?=?147) are reported. Questions addressed beliefs about preventability of injury, appropriate ages for children to cross the road or cycle independently and the frequency of holding 5-9 year old children's hands while crossing the road. Results suggest that parents believe most injuries are preventable and that they personally can act to improve their own safety in the home, on the road, at work, as well as in or on the water. Most parents (68%) indicated children should be 10 years or older before crossing the road or cycling independently. Parents were more likely to report holding younger children's hands (5-6 years) when crossing the road and less likely to do so for 7- to 9-year olds. There was a small effect of child gender, with parents more likely to hold a boy's hand than that of a girl.     

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.     

Socio-economic analysis of U.K. home accidents

Abstract

Drowning is the third commonest cause of accidental death of children in the UK and many children drown in domestic swimming pools. Concern has been raised about the design and safety of the covers used on domestic swimming pools since the majority of drowning and near-drowning incidents occur in pools with covers on. Swimming pool covers are a diverse range of products and fulfil a number of functions. This diversity in their design and the associated hazards necessitated a multidisciplinary approach to their evaluation. A study of the epidemiology of drownings was carried out in order to specify the risks of swimming pool covers, together with a study of the market and a survey of pool owners and their attitudes to safety. The risks of swimming pool covers were then evaluated by engineering, materials and ergonomics testing which included simulation of both the user and the products. This study is an example of the need for a mix of test methods and types of simulations in order to provide an overall statement of the safety of some consumer products. Results showed that the floating, heat retaining covers used on the majority of UK domestic pools possibly add to the intrinsic risks of a swimming pool. Winter debris covers, although appearing to seal the pool and considered by the majority of owners to make pools safer, were shown to allow children relatively easy access under the cover.     

Risk factors associated with life jacket wear among adult canoeists and kayakers in the United States, 1999–2017

Abstract

Drowning is the most common cause of death in recreational boating. Life jackets prevent drowning, yet adult wear rates remain relatively low on most types of boats. Canoes and kayaks are among the least used boat types, yet maintain the third and first highest annual boating-related drowning rates in 2012, respectively. This 1999–2017 study collected data from 124 study sites across the US. Life jacket wear was calculated for 13 dichotomized risky and non-risky variables, using Chi-square tests. A count variable based on number of risks was created, and Cochran-Armitage trend tests examined linearity in life jacket use. Three illustrative variables for each boat type were represented in tree diagrams. Kayakers had higher wear rates than canoeists among all variables observed. For both boats, the majority of risky conditions had higher life jacket wear rates than their non-risky alternatives. As the number of risks increased, life jacket wear rate increased. Boaters seemingly conduct a mental assessment of risk to determine whether to wear a life jacket.     

Beach safety education for primary school children

Childhood drowning remains a serious public health problem worldwide. The Australian Water Safety Council has set as one of its highest priorities the reduction of drowning deaths in children aged 0–14 years. However, concerns have recently been raised that many students completing primary school still lack the ability to recognize potential aquatic risks, cope with emergencies or assist someone else in danger. In this study, 107 primary school children aged 11–12 completed a one day training programme led by surf lifesaving instructors. Pre, post and eight week follow-up measures showed statistically significant improvements in recognition of the red ‘beach closed’ flag, aquatic safety signs, how to identify a rip current and choosing the safest place to swim at a beach that included a rip current in the picture. Following training students were more willing to provide first aid assistance to family members and friends in an emergency situation. Findings reinforce the value of school-based training that provides a general foundation for aquatic safety, with the caveat that current programmes must be evaluated to ensure their content has a robust prevention focus.     

Dishwasher-related injuries: survey and literature review

Domestic injuries are quite common among children aged 0–4 years old. Hazards lurking in the kitchen area can cause serious injuries in children. Through this study, we aim to raise public awareness of the potential and underreported risk of injuries related to dishwashers. Anonymous questionnaires consisting of 12 questions were distributed to adult females with children under 5 years old, including nurses, secretarial staff and outpatients. Commonly used dishwashers were surveyed by visiting high-street stores, and each brand's user manual was studied. A literature search using Medline and Pubmed was conducted for examining reported dishwasher-related sharp injuries. Forty households filled out survey questionnaires. Their responses indicated that 10% and 12.5% of children participate in unloading or loading dishwashers, respectively. Results showed that the incidence of related injuries was 12.5% among adults and 5% among children, and young children are at risk of sharp injuries in households with dishwashers. The dangerous loading and unloading of sharp objects and the direct involvement of toddlers should be discouraged, with the help of manufacturers.     

National burden of road traffic injuries in Argentina

More than 1.2 million people die and as many as 50 million people are injured or disabled due to road traffic injuries (RTIs) every year worldwide. The lack of reliable data hinders efforts to describe the characteristics of the issue and prioritise prevention activities. The objective was to provide a snapshot of fatal and non-fatal RTI in Argentina. We used the methodology proposed by the Global Burden of Disease Injury Expert group. External causes of deaths with unknown codes were proportionately redistributed over the known categories. In 2007 in Argentina, we estimated 5915 RTI deaths, compared with 3983 RTI deaths reported previously by the Ministry of Health, accounting for 1931 additional cases. The highest number of deaths occurred in young men (15-29 years old), although the highest RTI death rates were in the age group of 55 years and older. Four-wheeled vehicle occupants were the most common road user type killed (59.1%); vulnerable road users represented one third (29.5%) of deaths and 64% of non-fatal RTI. The national and regional estimates of RTI in Argentina should help policy makers and public-health researchers to understand the importance of RTI prevention and design specific interventions to further reduce these preventable deaths and injuries.     

Prevention of drowning in home pools – lessons from Australia

As an affluent and warm weather country, Australia faced an epidemic of drowning in children under five as the popularity of home pools increased in the late 1960s and early 1970s. In one state child drowning rose by 6.62 per 100,000 in the five years from 1968. Variation across jurisdictions in actions to regulate domestic pools has resulted in Australia representing an unfortunate natural experiment in interventions to prevent child drowning in pools. Mechanisms adopted by various authorities were analysed in detail to identify factors that contributed to success and failure in regulating domestic pools. Despite early identification of the problem and development of what were later demonstrated to be effective interventions, best practice solutions were not established in any jurisdiction until 2002, 25 years after identification of the problem. Key failures in intervention were found to be: failure to act in a timely way, flawed regulation, blockage of timely action and repeal of effective state regulation under political pressure, and blockage of effective standards. Lessons are identified as: inherent weaknesses in the standard setting process, failure of interventions to address major risk categories, failure to act before the hazard grew, failure to consider lesser interventions for tactical reasons, failure to pay attention to advocates, and the need for continuing effort. The paper argues that analysis of the identification of the problem, development of interventions and implementation of mechanisms of prevention illustrate where systemic changes are required and indicate lessons that should be applied in developing and implementing future interventions.