How well does a national newspaper reporting system profile drowning?

In Finland, the Finnish Association for Swimming Instruction and Life Saving (SUH) and Statistics Finland (SF) both provide nationwide data on unintentional drowning. The SUH database relies on rapid reporting from a newspaper clipping service and additional local police information, whereas the SF database relies on the later release of the death certificate information, which is based on extensive medico-legal investigation. The aim of the study was to explore the main differences between the SUH and SF databases for drowning and to evaluate the capacity of the former to characterize drowning events in Finland from 1998 to 2000. Computerized files of death certificates tabulated by SF were linked with the SUH database by deterministic methods. SF and SUH databases allowed the identification of 704 and 567 unintentional drownings, respectively, giving an unintentional drowning rate of 4.5 and 3.6/100?000 per year. Of the 704 drownings described by SF, 418 (59.4%) were also found in the SUH database. The SUH database markedly underreported drowning fatalities in certain settings, such as bath, ditch and swimming pool drownings; fall- and land-traffic-related drownings; and drownings occurring in South Finland. The narrative text of SUH drownings contributed limited information to characterize the drowning events. It was concluded that the newspaper-based SUH data provide more timely data on individual drownings but are not representative of all drownings. Conversely, the SF vital statistics data are more accurate but may take up to 2 years to become available. Both SUH and SF data provide little detailed information on drowning events. A multidisciplinary national surveillance system for drowning is necessary to provide more accurate and timely drowning data, analyse risk factors and design follow-up studies for developing and monitoring prevention strategies.     

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.     

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.     

Supporting the UN Decade of Action for Road Safety 2011–2020

The Scottish Accident Prevention Council is responsible for promoting water safety in Scotland. It has long expressed concern that the number of reported drownings in Scotland underestimates the actual figures. The key aims of this study were to establish a valid database of water-based incidents in Scotland and test the under-reporting proposition.

A survey involving interviews and correspondence was undertaken to establish the sources of information on drownings. Once identified, a database was established and data for a 7-year period acquired.

The study identified the organizations essential to the establishment of a complete database. It also established protocols for gaining annual information. Data analysis confirmed a significant under-reporting of accident data and signalled a number of areas of concern with regard to those most at risk. The study produced, for the first time, a mechanism for recording complete details of drownings in Scotland.     

Drownings in Scotland: the real story

The Scottish Accident Prevention Council is responsible for promoting water safety in Scotland. It has long expressed concern that the number of reported drownings in Scotland underestimates the actual figures. The key aims of this study were to establish a valid database of water-based incidents in Scotland and test the under-reporting proposition. A survey involving interviews and correspondence was undertaken to establish the sources of information on drownings. Once identified, a database was established and data for a 7-year period acquired. The study identified the organizations essential to the establishment of a complete database. It also established protocols for gaining annual information. Data analysis confirmed a significant under-reporting of accident data and signalled a number of areas of concern with regard to those most at risk. The study produced, for the first time, a mechanism for recording complete details of drownings in Scotland.     

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.     

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.     

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.     

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.     

Challenges to elderly safety in Safe Community movements in Japan

In Japan, with the longest life expectancy in the world over the last two decades, a great emphasis has been placed on the safety of the elderly, which has in turn influenced their well-being. Meantime, the concept of Safe Community (SC) has drawn more attention as one of the potential measures to sustain and improve the health conditions of the elderly. In hope of improving the effectiveness and efficiency of current efforts for elderly safety, the SC model is expected to provide features with which communities can make the better use of current limited resources. This article examines how the SC model makes a difference in these efforts by utilising existing programmes and how elderly safety can be promoted at the community level. Six communities working safety promotion based on the SC model were selected for the study. Although there are limitations to the information due to the insufficient experience in SC in Japan, it was found that two features make SC significant in promoting safety: (1) systematic evidence-based plan-do-check-action processes and (2) a framework of cross-sectoral collaboration. However, to examine and identify the effectiveness of SC on elderly health, further observation is required to develop strategies while accumulating longitudinal data.     

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.     

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.     

On the epidemiology of injury in developing countries: A one-year emergency room-based surveillance experience from León,Nicaragua

Background Regularly available data has been shown to be inadequate for developing, implementing, and evaluating injury prevention and control programs in Nicaragua. A specific prevention-oriented local injury surveillance system has therefore been set up in the city of León. Objectives The aim of this paper is to describe the epidemiology of fatal and non-fatal injuries over a one-year period in a well-defined local population in Nicaragua, as emerging from the perspective of emergency room and inpatient treatments over a one-year period. Methods A hospital-based injury surveillance system was established to collect data for different levels of severity. All treated unintentional and intentional injuries were registered, including information on the external causes according to the ICD-9. Results Of all emergency room visits, 15.9% (9,970) were injuries. For every death due to injuries, there were 31 hospital admissions and 253 emergency room visits. Home and street/roads were the main arenas for the accidents. The estimated underreporting rate was about 6%, and in 20.3% of the cases, no E-code was assigned. The overall incidence and mortality rates were 56.2 per 1,000 and 20 per 100,000 inhabitants, respectively. However, comparison with a parallel household survey showed that the reporting rate of the surveillance system is only about 9%. The overall ratio of male to female injury rates was 2.1 to 1. The main causes of non-fatal injuries were falls, whereas the main cause of death was traffic accidents. Conclusions Hospital discharge and emergency room data systems are effective and feasible means for collecting the data needed to prevent injuries. However, in a country like Nicaragua with limited access to hospital health services, it is necessary to supplement such a system with additional sources of information in order to gain a more comprehensive picture of injury occurrence.     

True burden of drowning: compiling data to meet the new definition

The objective and aim of the study was to compile empirical data to quantify the underestimation of the true burden of drowning and to compare drowning rates using commonly reported codes compared with those revealed by use of the full range of drowning codes in ICD version 10. The authors reviewed mortality data (1999-2002) from Australia and the USA and compiled data to compare the burden of 'unintentional drowning' with that of 'all drowning'. In both Australia and the USA, drowning mortality is more than 35% higher when a full range of codes is examined. A more comprehensive representation of the drowning problem is needed to assist in strengthening prevention activities.     

A study on multiple drowning syndromes

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.     

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.     

Rapid assessment procedures in injury control

Injuries are among the leading causes of death and disability worldwide. The burden caused by injuries is even greater among the poorer nations and is projected to increase. Very often the lack of technical and financial resources, as well as the urgency of the problem, preclude applying sophisticated surveillance and research methods for generating relevant information to develop effective interventions. In these settings, it is necessary to consider more rapid and less costly methods in applying the public health approach to the problem of injury prevention and control. Rapid Assessment Procedures (RAP), developed within the fields of epidemiology, anthropology and health administration, can provide valid information in a manner that is quicker, simpler, and less costly than standard data collection methods. RAP have been applied widely and successfully to infectious and chronic disease issues, but have not been used extensively, if at all, as tools in injury control. This paper describes Rapid Assessment Procedures that (1) are useful for understanding the scope of the problem and for identifying potential risk factors, (2) can assist practitioners in determining intervention priorities, (3) can provide in-depth knowledge about a specific injury-related problem, and (4) can be used in surveillance systems to monitor outcomes. Finally, the paper describes some of the caveats in using RAP.     

The pattern and predictors of intentionally inflicted injuries on Greek adults; data from an Emergency Injury Surveillance System (EDISS)

Background Intentional injuries due to violence are both a social and a public health problem in most societies. This study assesses the patterns and some of the sociodemographic determinants of violence-related injuries among Greek adults. Methods Data recorded by the Emergency Department Injury Surveillance System (EDISS) during the two-year period 1996-1997 were used. This database relies on all age injury data collected in the emergency departments of three sentinel hospitals, covering both urban and rural population areas. Results Among 52026 recorded injuries, 1322 (3%) were violence related, excluding self-inflicted injuries, while the majority of injuries (28269) were attributed to home and leisure accidents. Weapons of any type were used only in 5% of violence-related injuries. In comparison to home and leisure injuries, the intentionally inflicted injuries occurred more frequently among men, among those 25-54 years old, and were particularly common among migrants and during late night and early morning hours. Violence-related injuries frequently occur in pubs, restaurants, cafeterias and other places of entertainment. However, 52% of violence-related injuries among women occurred at home. Intentional injuries were generally more severe than unintentional ones. Conclusions We conclude that violence is not a negligible public health problem in the Greek population, but is considerably less serious than in most other developed countries. In particular, firearms-related injuries represent a very small fraction of the generally low incidence of violence-related injuries in this Mediterranean country.     

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.