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Rasolofoson RA, Onyango HO, Awuor FJ, Aura CM, Fiorella KJ. Climate change: A pointer to increased small-scale fisher drowning deaths. PLoS One 2024; 19:e0302397. [PMID: 38776265 PMCID: PMC11111062 DOI: 10.1371/journal.pone.0302397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 04/02/2024] [Indexed: 05/24/2024] Open
Abstract
Drowning is an overlooked public health concern and drowning risk is dependent on environmental risk factors. The preponderance of drowning deaths occurs in low- and middle-income countries. Small-scale fishers face high occupational risk of drowning. Climate change increases the frequency and intensity of storms, thereby exacerbating fishers' risks and creating a need to examine the contribution of storms to fisher drowning deaths for the development of mitigation strategies. We examined this relationship between weather and fisher drowning deaths in Lake Victoria, which is Africa's largest lake, a site of high fishing pressure, and where climate change is predicted to increase thunderstorms. We conducted a verbal autopsy with people knowledgeable about recent fatal fisher drowning incidents to collect information about the deceased fishers and circumstances surrounding the incidents across 43 landing sites in the Kenyan shore of Lake Victoria. Semi-structured interviews with stakeholders also elucidated community perspectives on drowning risks. Fatal drownings were often attributed to bad weather (41.8%). Other risk factors, such as non-use of life jacket and navigation equipment, co-occurred with bad weather at high rates (69.5% and 67.8%, respectively) to jointly contribute to fatal drowning incidents. Such co-occurrence of risk factors indicates that actions across multiple risk factors can help mitigate the issue. Stakeholder analysis revealed a range of opportunities for improved communication of risks and action to mitigate risks across boat operators and manufacturers, as well as multiple levels of management. Across global small-scale fisheries, limited use of safety equipment and intensive fishing pressure may coincide with increases in extreme weather events, necessitating action to address current and mitigate future drowning risks to small-scale fishers.
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Affiliation(s)
- Ranaivo A. Rasolofoson
- Duke University Marine Laboratory, Nicholas School of the Environment, Duke University, Beaufort, North Carolina, United States of America
- Department of Public and Ecosystem Health, Cornell University, Ithaca, New York, United States of America
- School of the Environment, University of Toronto, Toronto, Ontario, Canada
| | - Horace Owiti Onyango
- Department of Natural Resources and the Environment, Cornell University, Ithaca, New York, United States of America
- Kenya Marine and Fisheries Research Institute, Kisumu, Kenya
| | | | | | - Kathryn J. Fiorella
- Department of Public and Ecosystem Health, Cornell University, Ithaca, New York, United States of America
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Berger S, Siekmeyer M, Petzold-Quinque S, Kiess W, Merkenschlager A. Drowning and Nonfatal Drowning in Children and Adolescents: A Subsequent Retrospective Data Analysis. CHILDREN (BASEL, SWITZERLAND) 2024; 11:439. [PMID: 38671656 PMCID: PMC11049416 DOI: 10.3390/children11040439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 03/28/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024]
Abstract
Fatal and nonfatal drowning are among the leading causes of death and lifelong severe neurological impairment among children and adolescents. This study aimed to complement research from Leipzig 1994-2008 to seek trends within risk factors, treatments, and outcomes throughout the last decade. We retrospectively investigated data of 47 inpatients aged 0-18 admitted to Leipzig University Department of Pediatrics who matched ICD-10 code T75.1 from 2008 to 2020 and compared them to a preceding study at the same institution. We also examined the prognostic value of parameters regarding the patients' outcomes. There were three median incidents per annum. The median age was 2.75 years; 76% of incidents happened in males. An accumulation was seen during the summer months and weekends. Most drowning incidents occurred in private ponds or pools (48.9%). Thirty-nine children were discharged without resulting morbidity, four showed neurological impairment, and three died. Risk factors concerning age, sex, and incident characteristics were confirmed. Special supervision needs still apply to 1-3-year-old male children or children with pre-existing health conditions around private pools and ponds. Hospitalization duration shortened, and morbidity and lethality decreased since the previous study. There was structural improvement in primary care and medical documentation. Parameters suggesting good outcomes include a submersion time < 5 min, GCS > 3 points, spontaneous movement upon admission, remaining pupillary light response, the absence of cardiovascular arrest, body temperature ≥ 32 °C, pH > 7, blood glucose < 15 mmol/L, lactate < 14 mmol/L, base excess ≥ -15 mmol/L, and the absence of ARDS. Clear legislation can contribute to improved private home water safety. Further studies should include a broad in- and outpatient spectrum and standardized incident documentation presupposing Utstein-style reporting. Regular reinvestigation of consistent geographical regions facilitates process evaluations of drowning epidemiology and therapy evolution.
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Affiliation(s)
- Sebastian Berger
- Department of Women and Child Health, Hospital for Children and Adolescents, Division of Neuropediatrics, University of Leipzig, Liebigstraße 20a, 04103 Leipzig, Germany;
| | - Manuela Siekmeyer
- Department of Women and Child Health, Hospital for Children and Adolescents, Pediatric Intensive Care Unit, University of Leipzig, Liebigstraße 20a, 04103 Leipzig, Germany
| | - Stefanie Petzold-Quinque
- Department of Women and Child Health, Hospital for Children and Adolescents, Pediatric Intensive Care Unit, University of Leipzig, Liebigstraße 20a, 04103 Leipzig, Germany
| | - Wieland Kiess
- Department of Women and Child Health, Hospital for Children and Adolescents and Center for Pediatric Research, University Hospital Leipzig, Liebigstraße 20a, 04103 Leipzig, Germany
| | - Andreas Merkenschlager
- Department of Women and Child Health, Hospital for Children and Adolescents, Division of Neuropediatrics, University of Leipzig, Liebigstraße 20a, 04103 Leipzig, Germany;
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Jiang Z, Lin Z, Li Z, Yu M, He G, Hu J, Meng R, Hou Z, Zhu S, Zhou C, Xiao Y, Huang B, Xu X, Jin D, Qin M, Xu Y, Liu T, Ma W. Joint effects of heat-humidity compound events on drowning mortality in Southern China. Inj Prev 2024:ip-2023-045036. [PMID: 38443161 DOI: 10.1136/ip-2023-045036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 02/17/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND Several previous studies have examined the association of ambient temperature with drowning. However, no study has investigated the effects of heat-humidity compound events on drowning mortality. METHODS The drowning mortality data and meteorological data during the five hottest months (May to September) were collected from 46 cities in Southern China (2013-2018 in Guangdong, Hunan and Zhejiang provinces). Distributed lag non-linear model was first conducted to examine the association between heat-humidity compound events and drowning mortality at city level. Then, meta-analysis was employed to pool the city-specific exposure-response associations. Finally, we analysed the additive interaction of heat and humidity on drowning mortality. RESULTS Compared with wet-non-hot days, dry-hot days had greater effects (excess rate (ER)=32.34%, 95% CI: 24.64 to 40.50) on drowning mortality than wet-hot days (ER=14.38%, 95%CI: 6.80 to 22.50). During dry-hot days, males (ER=42.40%, 95% CI: 31.92 to 53.72), adolescents aged 0-14 years (ER=45.00%, 95% CI: 21.98 to 72.35) and urban city (ER=36.91%, 95% CI: 23.87 to 51.32) showed higher drowning mortality risk than their counterparts. For wet-hot days, males, adolescents and urban city had higher ERs than their counterparts. Attributable fraction (AF) of drowning attributed to dry-hot days was 23.83% (95% CI: 21.67 to 26.99) which was significantly higher than that for wet-hot days (11.32%, 95% CI: 9.64 to 13.48%). We also observed that high temperature and low humidity had an additive interaction on drowning mortality. CONCLUSION We found that dry-hot days had greater drowning mortality risk and burden than wet-hot days, and high temperature and low humidity might have synergy on drowning mortality.
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Affiliation(s)
- Zhiying Jiang
- Department of Public Health and Preventive Medicine, Jinan University, Guangzhou, China
| | - Ziqiang Lin
- Department of Public Health and Preventive Medicine, Jinan University, Guangzhou, China
| | - Zhixing Li
- Department of Public Health, Jinan University, Guangzhou, China
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Min Yu
- Division of NCD Control, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Guanhao He
- Department of Public Health and Preventive Medicine, Jinan University, Guangzhou, China
| | - Jianxiong Hu
- Department of Public Health and Preventive Medicine, Jinan University, Guangzhou, China
| | - Ruilin Meng
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Zhulin Hou
- Jilin Provincial Center for Disease Control and Prevention, Changchun, China
| | - Sui Zhu
- Department of Public Health and Preventive Medicine, Jinan University, Guangzhou, China
| | - Chunliang Zhou
- Hunan Provincial Center for Disease Control and Prevention, Changsha, China
| | - Yize Xiao
- Yunnan Provincial Center for Disease Control and Prevention, Kunming, China
| | - Biao Huang
- Jilin Provincial Center for Disease Control and Prevention, Changchun, China
| | - Xiaojun Xu
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Donghui Jin
- Hunan Provincial Center for Disease Control and Prevention, Changsha, China
| | - Mingfang Qin
- Yunnan Provincial Center for Disease Control and Prevention, Kunming, China
| | - Yiqing Xu
- Hunan Provincial Center for Disease Control and Prevention, Changsha, China
| | - Tao Liu
- Department of Public Health and Preventive Medicine, Jinan University, Guangzhou, China
| | - Wenjun Ma
- Department of Public Health and Preventive Medicine, Jinan University, Guangzhou, China
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Işın A, Peden AE. The burden, risk factors and prevention strategies for drowning in Türkiye: a systematic literature review. BMC Public Health 2024; 24:528. [PMID: 38378496 PMCID: PMC10877921 DOI: 10.1186/s12889-024-18032-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 02/07/2024] [Indexed: 02/22/2024] Open
Abstract
INTRODUCTION Drowning is a public health problem in Türkiye, as in the rest of the world. This study aims to systematically review the literature on drowning in Türkiye with a focus on data sources, epidemiology, risk factors and prevention strategies. METHODS Literature searches were conducted using PubMed, SPORTSDiscus, Scopus, Web of Science, Turk MEDLINE, Google Scholar and Google Akademik (Turkish language). Studies (limited to original research written in English and Turkish) reporting drowning (unintentional and intentional; fatal and non-fatal) of residents and tourists in Türkiye were independently dual screened at the title and abstract and full text stages. Study quality was assessed using JBI checklists and evidence level assessed based on study design. RESULTS From a total of 917 studies, 49 met the inclusion criteria. Most (51%) focused on unintentional fatal drowning. Included studies were most commonly analytical cross-sectional studies (n = 23) and case series (n = 20) meaning the evidence level was low or very low for 48 (98%) studies. Fifteen studies examined drowning at the national level, while sub-national studies (n = 30) focused on urban areas across three provinces: Antalya (n = 6), Istanbul (n = 6), Izmir (n = 4). There was little consensus on risk factors beyond male drowning risk, and no data reported on implemented or evaluated drowning prevention interventions. DISCUSSION There is a need for more national-level studies to identify the causes of drowning and to guide intervention implementation and evaluation to inform policy makers and donors. Currently official data is limited in its detail, providing age and gender data only, hampering efforts to identify, and thus address, causal factors for drowning. PRACTICAL APPLICATIONS There is currently very little evidence to inform investment in effective drowning prevention interventions in Türkiye. To improve this, data collection systems on drowning in Türkiye need to be strengthened via the development a national drowning registry. TRIAL REGISTRATION #CRD42022382615.
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Affiliation(s)
- Ali Işın
- Department of Coaching Education, Faculty of Sports Sciences, Akdeniz University, 07070, Antalya, Türkiye.
| | - Amy E Peden
- School of Population Health, UNSW Sydney, Kensington, NSW, 2052, Australia
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, 4811, Australia
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Peden AE, Williamson S, Fozard F, Hanly M, Möller H. The effect of the 'Swim Reaper' program on water safety awareness, drowning mortality and morbidity among males aged 15-34 years in Aotearoa, New Zealand. JOURNAL OF SAFETY RESEARCH 2024; 88:190-198. [PMID: 38485362 DOI: 10.1016/j.jsr.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 10/22/2023] [Accepted: 11/08/2023] [Indexed: 03/19/2024]
Abstract
BACKGROUND AND OBJECTIVE To increase water safety awareness among young males New Zealand introduced the Swim Reaper program in 2016. The program ran annually over summer and in 2018/19 an evaluation was conducted. The objective of this study was to evaluate the impact of the 2018/19 Swim Reaper social media-based campaign on self-reported water safety awareness and identify changes in fatal and nonfatal drowning rates for New Zealand resident males aged 15-34 years before and after the 2016 Swim Reaper program. METHODS Online surveys pre (December-2018) and post (February-March-2019) Swim Reaper campaign were used to estimate water safety awareness post-campaign relative to pre-campaign using negative binomial regression adjusted for potential confounders. Interrupted time series (ITS) analysis, adjusted for seasonality, explored changes in drowning mortality, hospital admissions and Accident Compensation Corporation (ACC) claims pre and post program introduction (2016). RESULTS A total of 518 males responded (50.6% post-campaign). There were significant improvements (post vs. pre-campaign) in self-reported water safety awareness. ITS analysis showed a reduction in drowning related hospital admissions post relative to pre-program (RR = 0.47; [95%CI: 0.24-0.90]; p = 0.02). DISCUSSION Young males are an at-risk cohort for drowning and creating behavior change among this group can be challenging. Using a unique, humor-based approach the Swim Reaper program appears to be having some impact on self-reported water safety behaviors, as well as unintentional drowning-related hospitalization rates. Further evaluation, more clearly linked to campaign themes, is required to ascertain direct impact of the program. CONCLUSION The novelty and reach of the campaign within the context of a prevailing downward trend in drownings may provide support for social media-based programs targeting this hard-to-reach demographic.
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Affiliation(s)
- Amy E Peden
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Kensington, NSW 2052, Australia; College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland 4811, Australia.
| | | | | | - Mark Hanly
- Centre for Big Data Research in Health, UNSW Sydney, Kensington, NSW 2052, Australia
| | - Holger Möller
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Kensington, NSW 2052, Australia; The George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia
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Hills SP, Hobbs M, Brown P, Tipton M, Barwood M. Association between air temperature and unintentional drowning risk in the United Kingdom 2012-2019: A nationwide case-crossover study. Prev Med 2024; 179:107832. [PMID: 38145877 DOI: 10.1016/j.ypmed.2023.107832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/18/2023] [Accepted: 12/20/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVE Drowning is a leading cause of death. The World Health Organization (WHO) and United Nations (UN) emphasise the need for population-level data-driven approaches to examine risk factors to improve water safety policies. Weather conditions, have the potential to influence drowning risk behaviours as people are more likely to spend time around water and/or undertake risky activities in aquatic spaces as a behavioural thermoregulatory response (e.g., seeking coolth). METHODS A case-crossover approach assessed associations between changes in daily maximum air temperature (data from the nearest weather station to each drowning event) and unintentional drowning risk using anonymous data from the validated UK Water Incident Database 2012-2019 (1945 unintentional deaths, 82% male). Control days were selected using a unidirectional time-stratified approach, whereby seven and 14 days before the hazard day were used as the controls. RESULTS Mean maximum air temperature on case and control days was 15.36 °C and 14.80 °C, respectively. A 1 °C increase in air temperature was associated with a 7.2% increase in unintentional drowning risk. This relationship existed for males only. Drowning risk was elevated on days where air temperature reached 15-19.9 °C (Odds Ratio; OR: 1.75), 20-24.9 °C (OR: 1.87), and ≥ 25 °C (OR: 4.67), compared with days <10 °C. The greatest elevations in risk appeared to be amongst males and when alcohol intoxication was suspected. Precipitation showed no significant association with unintentional drowning risk. CONCLUSIONS Identifying such relationships highlights the value of considering weather conditions when evaluating environmental risk factors for drowning, and may inform water safety policy and allocating resources to prevention and rescue.
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Affiliation(s)
- Samuel P Hills
- Faculty of Health and Social Sciences, Bournemouth University, United Kingdom.
| | - Matthew Hobbs
- Faculty of Health Sciences, University of Canterbury, Christchurch, Canterbury, New Zealand; GeoHealth Laboratory, University of Canterbury, Christchurch, Canterbury, New Zealand
| | - Paul Brown
- Faculty of Science and Technology, Bournemouth University, United Kingdom
| | - Mike Tipton
- The Extreme Environments Laboratory, School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom
| | - Martin Barwood
- Department of Sport and Wellbeing, Leeds Trinity University, Leeds, United Kingdom
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Masud S, Hyder AA, Khan UR, Khan NU, Raheem A, Petrucka P. Epidemiology of unintentional injuries among 15-24-year-old vocational school youth from Peshawar Pakistan: A cross-sectional survey. RESEARCH SQUARE 2024:rs.3.rs-2603081. [PMID: 36945639 PMCID: PMC10029088 DOI: 10.21203/rs.3.rs-2603081/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Background The burden of unintentional injuries among youth (15-24 years) is high. There is paucity of data on unintentional injuries in youth working in Vocational Training Institutes. Objective To determine the incidence, characteristics, and risk factors of unintentional injuries among youth. Methods Design:: A retrospective cross-sectional survey was conducted among select vocational school youth in Peshawar, Pakistan between February 2022 to October 2022.Participants:: A total of 547 study participants participated in the survey, 356 were males while 191 were females. Data were collected on using the World Health Organization community survey guide for injuries and violence. Multilevel Negative Binomial Regression model was used to report incidence rate ratios of all unitentional injuries. Results A total of 503 injuries were reported by the youth, with road traffic injuries being the most common (n=197, 39%), followed by burns (n=89, 18%), falls (n=79, 16%) and poisonings (n=15, 3%), drownings (n=23, 7.1%). Occupational injuries reported during vocational training were (n=95, 18%). Males had a higher incidence rates of RTI 3.24[2.35-5.3], falls 1.30 [0.74-2.27], poisonings 2.14 [0.57-7.58] and drownings 2.46(0.84-7.21), while females had a higher incidence rate of burns 2.19 [1.785-3.46].Lack of education 4.6 [1.12 -18.91] (p=0.034), smoking 1.25 [1.05 -2.69] (p=0.049), lack of fathers education 4.71 [2.12 -10.49] (p=<0.001), carrying a gun 6.59 [2.54 -17.11] (p=<0.001), crowded families 3.59 [3.11 -5.07] (p=<0.001), lower family income 2.04 [1.04 -4.02](p=0.039*), lack of helmet use 4.54 [2.12 -9.76] (p=<0.001) and lack of seat belt use 1.3 [1.14 -1.69] (p= <0.001) were significant risk factors for unintentional injuries in youth. Conclusion Added value of the study This study is one of the first research studies conducted in vocational school youth in Pakistan. It provides the recent rate of unintentional injuries among the youth of Pakistan. High occupational injuries among vocational school youth were reported which needs further research.
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Peden AE, Mason HM, King JC, Franklin RC. Examining the relationship between heatwaves and fatal drowning: a case study from Queensland, Australia. Inj Prev 2024; 30:7-13. [PMID: 37678903 DOI: 10.1136/ip-2023-044938] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 08/02/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Globally, drowning is a leading cause of injury-related harm, which is heavily impacted by environmental conditions. In Australia, fatal unintentional drowning peaks in summer, yet the impact of prolonged periods of hot weather (heatwave) on fatal drowning has not previously been explored. METHODS Using a case-crossover approach, we examined the difference in drowning risk between heatwave and non-heatwave days for the Australian state of Queensland from 2010 to 2019. Heatwave data, measured by the excess heat factor, were acquired from the Bureau of Meteorology. Incidence rate ratios (IRRs) were calculated by sex, age of drowning decedent, category of drowning incident (International Classification of Diseases-10 codes) and heatwave severity. Excess drowning mortality during heatwaves was also calculated. RESULTS Analyses reveal increased fatal drowning risk during heatwave for males (IRR 1.22, 95% CI 0.92 to 1.61), people aged 65+ years (IRR 1.36, 95% CI 0.83 to 2.24), unintentional drowning (IRR 1.28, 95% CI 0.98 to 1.69) and during severe heatwaves (IRR 1.26, 95% CI0.88 to 1.82). There were 13 excess drowning deaths due to heatwave over the study period. DISCUSSION The findings confirm an increased risk of fatal drowning during heatwaves. With increased likelihood and severity of heatwaves, this information should be used to inform drowning prevention, in particular the timing of public awareness campaigns and patrolling of supervised aquatic locations. CONCLUSIONS Water safety and patrolling organisations, as well as first responders, need to prepare for more drowning deaths during heatwave conditions. In addition, drowning prevention education ahead of heatwaves is needed for recreational swimmers, and older people, particularly those with comorbidities which may be further exacerbated by a heatwave.
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Affiliation(s)
- Amy E Peden
- School of Population Health, UNSW Sydney, Kensington, New South Wales, Australia
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Douglas, Queensland, Australia
| | - Hannah M Mason
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Douglas, Queensland, Australia
| | - Jemma Chandal King
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Douglas, Queensland, Australia
| | - Richard Charles Franklin
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Douglas, Queensland, Australia
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Jalalifar S, Belford A, Erfani E, Razmjou A, Abbassi R, Mohseni-Dargah M, Asadnia M. Enhancing Water Safety: Exploring Recent Technological Approaches for Drowning Detection. SENSORS (BASEL, SWITZERLAND) 2024; 24:331. [PMID: 38257424 PMCID: PMC10820385 DOI: 10.3390/s24020331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/17/2023] [Accepted: 12/26/2023] [Indexed: 01/24/2024]
Abstract
Drowning poses a significant threat, resulting in unexpected injuries and fatalities. To promote water sports activities, it is crucial to develop surveillance systems that enhance safety around pools and waterways. This paper presents an overview of recent advancements in drowning detection, with a specific focus on image processing and sensor-based methods. Furthermore, the potential of artificial intelligence (AI), machine learning algorithms (MLAs), and robotics technology in this field is explored. The review examines the technological challenges, benefits, and drawbacks associated with these approaches. The findings reveal that image processing and sensor-based technologies are the most effective approaches for drowning detection systems. However, the image-processing approach requires substantial resources and sophisticated MLAs, making it costly and complex to implement. Conversely, sensor-based approaches offer practical, cost-effective, and widely applicable solutions for drowning detection. These approaches involve data transmission from the swimmer's condition to the processing unit through sensing technology, utilising both wired and wireless communication channels. This paper explores the recent developments in drowning detection systems while considering costs, complexity, and practicality in selecting and implementing such systems. The assessment of various technological approaches contributes to ongoing efforts aimed at improving water safety and reducing the risks associated with drowning incidents.
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Affiliation(s)
- Salman Jalalifar
- School of Engineering, Macquarie University, Sydney, NSW 2109, Australia; (S.J.); (A.B.); (R.A.); (M.M.-D.)
| | - Andrew Belford
- School of Engineering, Macquarie University, Sydney, NSW 2109, Australia; (S.J.); (A.B.); (R.A.); (M.M.-D.)
| | - Eila Erfani
- School of Information Systems and Technology Management, University of New South Wales, Sydney, NSW 1466, Australia;
| | - Amir Razmjou
- School of Engineering, Edith Cowan University, Perth, WA 6027, Australia;
| | - Rouzbeh Abbassi
- School of Engineering, Macquarie University, Sydney, NSW 2109, Australia; (S.J.); (A.B.); (R.A.); (M.M.-D.)
| | - Masoud Mohseni-Dargah
- School of Engineering, Macquarie University, Sydney, NSW 2109, Australia; (S.J.); (A.B.); (R.A.); (M.M.-D.)
| | - Mohsen Asadnia
- School of Engineering, Macquarie University, Sydney, NSW 2109, Australia; (S.J.); (A.B.); (R.A.); (M.M.-D.)
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Della Bona M, Crawford G, Royce B, Jancey J, Leavy JE. Using ERIC to Assess Implementation Science in Drowning Prevention Interventions in High-Income Countries: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 21:45. [PMID: 38248510 PMCID: PMC10815182 DOI: 10.3390/ijerph21010045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/22/2023] [Accepted: 12/25/2023] [Indexed: 01/23/2024]
Abstract
This systematic review identifies and describes the use of the Expert Recommendation for Implementing Change (ERIC) concepts and strategies using public health approaches to drowning prevention interventions as a case study. International calls for action have identified the need to better understand the implementation of drowning prevention interventions so that intervention design and implementation is improved. In high-income countries (HICs), interventions are sophisticated but still little is known or written about their implementation. The review was registered on PROSPERO (number CRD42022347789) and followed the PRISMA guidelines. Eight databases were searched. Articles were assessed using the Public Health Ontario Meta-tool for quality appraisal of public health evidence. Forty-nine articles were included. Where ERIC strategies were reported, the focus was on evaluative and iterative strategies, developing partnerships and engaging the target group. The review identified few articles that discussed intervention development and implementation sufficiently for strategies to be replicated. Findings will inform further research into the use and measurement of implementation strategies by practitioners and researchers undertaking work in drowning prevention in HICs and supports a call to action for better documentation of implementation in public health interventions.
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Affiliation(s)
- Malena Della Bona
- Collaboration for Evidence, Research and Impact in Public Health (CERIPH), School of Population Health, Curtin University, Perth 6000, Australia
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Oporia F, Nuwaha F, Kobusingye O, Jagnoor J, Makumbi FE, Isunju JB, Kibira SPS. Development and validation of an intervention package to improve lifejacket wear for drowning prevention among occupational boaters on Lake Albert, Uganda. Inj Prev 2023; 29:493-499. [PMID: 37507211 DOI: 10.1136/ip-2022-044840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 07/13/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Occupational drowning is a growing public health concern globally. The human cost of fishing is highest in sub-Saharan Africa. Although lifejackets prevent drowning, the majority of boaters in Uganda do not wear them. We developed and validated a peer-to-peer training manual to improve lifejacket wear among occupational boaters on Lake Albert, Uganda. METHODS The intervention was developed in three stages. In stage one, we conducted baseline studies to explore and identify aspects of practices that need to change. In stage two, we held a stakeholder workshop to identify relevant interventions following the intervention functions of the behaviour change wheel (BCW). In stage three, we developed the content and identified its implementation strategies. We validated the intervention package using the Content Validity Index for each item (I-CVI) and scale (S-CVI/Ave). RESULTS Seven interventions were identified and proposed by stakeholders. Training and sensitisation by peers were unanimously preferred. The lowest I-CVI for the content was 86%, with an S-CVI/Ave of 98%. This indicates that the intervention package was highly relevant to the target community. CONCLUSION The stakeholder workshop enabled a participatory approach to identify the most appropriate intervention. All the proposed interventions fell under one of the intervention functions of the BCW. The intervention should be evaluated for its effectiveness in improving lifejacket wear among occupational boaters.
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Affiliation(s)
- Frederick Oporia
- Department of Disease Control and Environmental Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Fred Nuwaha
- Department of Disease Control and Environmental Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Olive Kobusingye
- Department of Disease Control and Environmental Health, Makerere University College of Health Sciences, Kampala, Uganda
- The George Institute for Global Health Injury Division, Camperdown, New South Wales, Australia
| | - Jagnoor Jagnoor
- The George Institute for Global Health, Camperdown, New South Wales, Australia
| | - Fredrick Edward Makumbi
- Department of Epidemiology and Biostatistics, Makerere University College of Health Sciences, Kampala, Uganda
| | - John Bosco Isunju
- Department of Disease Control and Environmental Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Simon P S Kibira
- Department of Community Health and Behavioural Sciences, Makerere University College of Health Sciences, Kampala, Uganda
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12
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Leavy JE, Crawford G, Scarr JP, Meddings DR. Drowning prevention: A global health promotion imperative, now more than ever. Health Promot J Austr 2023. [PMID: 38009891 DOI: 10.1002/hpja.830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 11/14/2023] [Indexed: 11/29/2023] Open
Affiliation(s)
- Justine E Leavy
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Gemma Crawford
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Justin P Scarr
- Royal Life Saving Society, Sydney, New South Wales, Australia
- Faculty of Medicine, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - David R Meddings
- Department of the Social Determinants of HealthDivision of UHC/Healthier Populations, World Health Organization (WHO), Geneva, Switzerland
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13
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Breindahl N, Wolthers SA, Jensen TW, Holgersen MG, Blomberg SNF, Steinmetz J, Christensen HC. Danish Drowning Formula for identification of out-of-hospital cardiac arrest from drowning. Am J Emerg Med 2023; 73:55-62. [PMID: 37619443 DOI: 10.1016/j.ajem.2023.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/10/2023] [Accepted: 08/12/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Accurate, reliable, and sufficient data is required to reduce the burden of drowning by targeting preventive measures and improving treatment. Today's drowning statistics are informed by various methods sometimes based on data sources with questionable reliability. These methods are likely responsible for a systematic and significant underreporting of drowning. This study's aim was to assess the 30-day survival of patients with out-of-hospital cardiac arrest (OHCA) identified in the Danish Cardiac Arrest Registry (DCAR) after applying the Danish Drowning Formula. METHODS This nationwide, cohort, registry-based study with 30-day follow-up used the Danish Drowning Formula to identify drowning-related OHCA with a resuscitation attempt from the DCAR from January 1st, 2016, through December 31st, 2021. The Danish Drowning Formula is a text-search algorithm constructed for this study based on trigger-words identified from the prehospital medical records of validated drowning cases. The primary outcome was 30-day survival from OHCA. Data were analyzed using multiple logistic regression. RESULTS Drowning-related OHCA occurred in 374 (1%) patients registered in the DCAR compared to 29,882 patients with OHCA from other causes. Drowning-related OHCA more frequently occurred at a public location (87% vs 25%, p < 0.001) and were more frequently witnessed by bystanders (80% vs 55%, p < 0.001). Both 30-day and 1-year survival for patients with drowning-related OHCA were significantly higher compared to OHCA from other causes (33% vs 14% and 32% vs 13%, respectively, p < 0.001). The adjusted odds ratio for 30-day survival for drowning-related OHCA and other causes of OHCA was 2.3 [1.7-3.2], p < 0.001. Increased 30-day survival was observed for drowning-related OHCA occurring at swimming pools compared to public location OHCA from other causes with an OR of 11.6 [6.0-22.6], p < 0.001. CONCLUSIONS This study found higher 30-day survival among drowning-related OHCA compared to OHCA from other causes. This study proposed that a text-search algorithm (Danish Drowning Formula) could explore unstructured text fields to identify drowning persons. This method may present a low-resource solution to inform the drowning statistics in the future. REGISTRATION This study was registered at ClinicalTrials.gov before analyses (NCT05323097).
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Affiliation(s)
- Niklas Breindahl
- Prehospital Center Region Zealand, Ringstedgade 61, 13., 4700 Næstved, Denmark; Department of Neonatal and Pediatric Intensive Care, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Signe A Wolthers
- Prehospital Center Region Zealand, Ringstedgade 61, 13., 4700 Næstved, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Theo W Jensen
- Prehospital Center Region Zealand, Ringstedgade 61, 13., 4700 Næstved, Denmark; Copenhagen Emergency Medical Services, The Capital Region of Denmark, Telegrafvej 5, 2750 Ballerup, Denmark
| | - Mathias G Holgersen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Copenhagen Emergency Medical Services, The Capital Region of Denmark, Telegrafvej 5, 2750 Ballerup, Denmark; Department of Paediatrics and Adolescent Medicine, Paediatric Pulmonary Service, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Stig N F Blomberg
- Prehospital Center Region Zealand, Ringstedgade 61, 13., 4700 Næstved, Denmark
| | - Jacob Steinmetz
- Danish Air Ambulance, Brendstrupgårdsvej 7, 8200 Aarhus, Denmark; Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Helle C Christensen
- Prehospital Center Region Zealand, Ringstedgade 61, 13., 4700 Næstved, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Danish Clinical Quality Program (RKKP), National Clinical Registries, Ryesgade 53B, 3., 2100 Copenhagen, Denmark
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14
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Koon W, Stewart O, Brander R, Quan L, Peden AE. Burden of fatal drowning in California, 2005-2019. Inj Prev 2023; 29:371-377. [PMID: 37208006 PMCID: PMC10579480 DOI: 10.1136/ip-2023-044862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 05/07/2023] [Indexed: 05/21/2023]
Abstract
OBJECTIVE To characterise risk factors for fatal drowning in California, USA to inform priorities for prevention, policy and research. METHODS This retrospective population-based epidemiological review of death certificate data evaluated fatal drowning events in California from 2005 to 2019. Unintentional, intentional, and undetermined drowning deaths and rates were described by person (age, sex, race) and context-based variables (region and body of water). RESULTS California's fatal drowning rate was 1.48 per 100 000 population (n=9237). Highest total fatal drowning rates occurred in the lower population density northern regions, among older adults (75-84 years: 2.54 per 100 000 population; 85+: 3.47 per 100 000 population) and non-Hispanic American Indian or Alaska Native persons (2.84 per 100 000 population). Male drowning deaths occurred at 2.7 times the rate of females; drowning deaths occurred mainly in swimming pools (27%), rivers/canals (22.4%) and coastal waters (20.2%). The intentional fatal drowning rate increased 89% during the study period. CONCLUSIONS California's overall fatal drowning rate was similar to the rest of the USA but differed among subpopulations. These divergences from national data, along with regional differences in drowning population and context-related characteristics, underscore the need for state and regional level analyses to inform drowning prevention policy, programmes and research.
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Affiliation(s)
- William Koon
- School of Biological, Earth, and Environmental Sciences, University of New South Wales, Sydney, New South Wales, Australia
- California Water Safety Coalition, Huntington Beach, California, USA
| | - Orion Stewart
- Center for Healthy Communities, Injury and Violence Prevention Branch, California Department of Public Health, Sacramento, California, USA
| | - Robert Brander
- School of Biological, Earth, and Environmental Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Linda Quan
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
| | - Amy E Peden
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
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15
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Cenderadewi M, Devine SG, Sari DP, Franklin RC. Fatal drowning in Indonesia: understanding knowledge gaps through a scoping review. Health Promot Int 2023; 38:daad130. [PMID: 37851464 PMCID: PMC10583758 DOI: 10.1093/heapro/daad130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023] Open
Abstract
Little is known about unintentional drowning deaths in Indonesia, the world's fourth most populous and largest archipelagic country. This study aimed to describe the epidemiology and risk factors of unintentional drowning in Indonesia and explore existing health promotion and drowning prevention approaches in Indonesia within a socio-ecological health promotion framework. A scoping review, guided by PRISMA-ScR, was conducted to locate peer-reviewed studies and government reports/policy documents published until May 2023, in English or Indonesian language, using MEDLINE (Ovid), CINAHL, Informit, PsycINFO (ProQuest), Scopus, SafetyLit, BioMed Central and Google Scholar, Indonesian journal databases (Sinta, Garuda) and government agencies websites around the terms: drown, swim, flood, hurricane, cyclone, disaster, water rescue and maritime/boat safety. This review identified 32 papers. However, a paucity of information on unintentional drowning rates, risk factors and prevention in Indonesia was noted. The unavailability of a coordinated national drowning data collection system in Indonesia, from which national and subnational subcategory data can be collected, underlines the possibility of under-representation of drowning mortality. The association between various exposures and drowning incidents has not been fully investigated. An over-reliance on individual-focused, behaviour-based, preventive measures was observed. These findings highlight the need for improving drowning surveillance to ensure the availability and reliability of drowning data; and strengthening research to understand the risk factors for drowning and delivery of drowning prevention programs. Further policy development and research focusing on health promotion approaches that reflect a socio-ecological approach to drowning prevention in Indonesia is imperative.
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Affiliation(s)
- Muthia Cenderadewi
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Bebegu Yumba Campus, Douglas, QLD 4811, Australia
- Medical Faculty, University of Mataram, Mataram, West Nusa Tenggara 83126, Indonesia
| | - Susan G Devine
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Bebegu Yumba Campus, Douglas, QLD 4811, Australia
| | - Dian Puspita Sari
- Medical Faculty, University of Mataram, Mataram, West Nusa Tenggara 83126, Indonesia
| | - Richard C Franklin
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Bebegu Yumba Campus, Douglas, QLD 4811, Australia
- Royal Life Saving Society – Australia, Broadway, NSW 2007, Australia
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16
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Liu Y, Dong X, Li Z, Zhu S, Lin Z, He G, Gong W, Hu J, Hou Z, Meng R, Zhou C, Yu M, Huang B, Lin L, Xiao J, Zhong J, Jin D, Xu Y, Lv L, Huang C, Liu T, Ma W. The Combined Effects of Short-Term Exposure to Multiple Meteorological Factors on Unintentional Drowning Mortality: Large Case-Crossover Study. JMIR Public Health Surveill 2023; 9:e46792. [PMID: 37471118 PMCID: PMC10401198 DOI: 10.2196/46792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 05/05/2023] [Accepted: 06/15/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Drowning is a serious public health problem worldwide. Previous epidemiological studies on the association between meteorological factors and drowning mainly focused on individual weather factors, and the combined effect of mixed exposure to multiple meteorological factors on drowning is unclear. OBJECTIVE We aimed to investigate the combined effects of multiple meteorological factors on unintentional drowning mortality in China and to identify the important meteorological factors contributing to drowning mortality. METHODS Unintentional drowning death data (based on International Classification of Diseases, 10th Edition, codes W65-74) from January 1, 2013, to December 31, 2018, were collected from the Disease Surveillance Points System for Guangdong, Hunan, Zhejiang, Yunnan, and Jilin Provinces, China. Daily meteorological data, including daily mean temperature, relative humidity, sunlight duration, and rainfall in the same period were obtained from the Chinese Academy of Meteorological Science Data Center. We constructed a time-stratified case-crossover design and applied a generalized additive model to examine the effect of individual weather factors on drowning mortality, and then used quantile g-computation to estimate the joint effect of the mixed exposure to meteorological factors. RESULTS A total of 46,179 drowning deaths were reported in the 5 provinces in China from 2013 to 2018. In an effect analysis of individual exposure, we observed a positive effect for sunlight duration, a negative effect for relative humidity, and U-shaped associations for temperature and rainfall with drowning mortality. In a joint effect analysis of the above 4 meteorological factors, a 2.99% (95% CI 0.26%-5.80%) increase in drowning mortality was observed per quartile rise in exposure mixture. For the total population, sunlight duration was the most important weather factor for drowning mortality, with a 93.1% positive contribution to the overall effects, while rainfall was mainly a negative factor for drowning deaths (90.5%) and temperature and relative humidity contributed 6.9% and -9.5% to the overall effects, respectively. CONCLUSIONS This study found that mixed exposure to temperature, relative humidity, sunlight duration, and rainfall was positively associated with drowning mortality and that sunlight duration, rather than temperature, may be the most important meteorological factor for drowning mortality. These findings imply that it is necessary to incorporate sunshine hours and temperature into early warning systems for drowning prevention in the future.
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Affiliation(s)
- Yingyin Liu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Xiaomei Dong
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Zhixing Li
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
- Department of Nosocomial Infection Management, Affiliated Nanfang Hospital of Southern Medical University, Guangzhou, China
| | - Sui Zhu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Ziqiang Lin
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Guanhao He
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Weiwei Gong
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Jianxiong Hu
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Zhulin Hou
- Jilin Provincial Center for Disease Control and Prevention, Changchun, China
| | - Ruilin Meng
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Chunliang Zhou
- Hunan Provincial Center for Disease Control and Prevention, Changsha, China
| | - Min Yu
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Biao Huang
- Jilin Provincial Center for Disease Control and Prevention, Changchun, China
| | - Lifeng Lin
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Jianpeng Xiao
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Jieming Zhong
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Donghui Jin
- Hunan Provincial Center for Disease Control and Prevention, Changsha, China
| | - Yiqing Xu
- Hunan Provincial Center for Disease Control and Prevention, Changsha, China
| | - Lingshuang Lv
- Hunan Provincial Center for Disease Control and Prevention, Changsha, China
| | - Cunrui Huang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Tao Liu
- Disease Control and Prevention Institute of Jinan University, School of Medicine, Jinan University, Guangzhou, China
| | - Wenjun Ma
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
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Pellegrino F, Raffaldi I, Rossi R, De Vito B, Pagano M, Garelli D, Bondone C. Epidemiology, clinical aspects, and management of pediatric drowning. Ital J Pediatr 2023; 49:74. [PMID: 37316902 PMCID: PMC10268379 DOI: 10.1186/s13052-023-01464-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/28/2023] [Indexed: 06/16/2023] Open
Abstract
Drowning is the third leading cause of injury death in the pediatric population worldwide, with incidence peaking among those aged 1-4 years and again in adolescence.The purpose of this commentary is to review the basic pathophysiology of drowninginjury and factors that affect the outcome, such as submersion and hypothermia. We also discuss principles of prehospital and in-hospital management, comprising resuscitation and stabilization, administration of oxygen and intravenous liquids, and central reheating.Even though the mortality rate has decreased in recent years, further investments and safety measures are needed to prevent child drowning deaths.
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Affiliation(s)
- Francesco Pellegrino
- Department of Pediatric and Public Health Sciences, Postgraduate School of Pediatrics, Regina Margherita Children Hospital, University of Turin, Turin, Italy.
| | - Irene Raffaldi
- Department of Pediatric Emergency, Regina Margherita Children's Hospital - A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Roberta Rossi
- Department of Pediatric Emergency, Regina Margherita Children's Hospital - A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Barbara De Vito
- Department of Pediatric Emergency, Regina Margherita Children's Hospital - A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Manuela Pagano
- Department of Pediatric Emergency, Regina Margherita Children's Hospital - A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Davide Garelli
- Department of Pediatric Emergency, Regina Margherita Children's Hospital - A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Claudia Bondone
- Department of Pediatric Emergency, Regina Margherita Children's Hospital - A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
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18
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Stickley A, Baburin A, Jasilionis D, Krumins J, Martikainen P, Kondo N, Shin JI, Inoue Y, Leinsalu M. Sociodemographic inequalities in mortality from drowning in the Baltic countries and Finland in 2000-2015: a register-based study. BMC Public Health 2023; 23:1103. [PMID: 37286978 DOI: 10.1186/s12889-023-15999-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 05/27/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Drowning is an important public health problem. Some evidence suggests that the risk of drowning is not distributed evenly across the general population. However, there has been comparatively little research on inequalities in drowning mortality. To address this deficit, this study examined trends and sociodemographic inequalities in mortality from unintentional drowning in the Baltic countries and Finland in 2000-2015. METHODS Data for Estonia, Latvia and Lithuania came from longitudinal mortality follow-up studies of population censuses in 2000/2001 and 2011, while corresponding data for Finland were obtained from the longitudinal register-based population data file of Statistics Finland. Deaths from drowning (ICD-10 codes W65-W74) were obtained from national mortality registries. Information was also obtained on socioeconomic status (educational level) and urban-rural residence. Age-standardised mortality rates (ASMRs) per 100 000 person years and mortality rate ratios were calculated for adults aged 30-74 years old. Poisson regression analysis was performed to assess the independent effects of sex, urban-rural residence and education on drowning mortality. RESULTS Drowning ASMRs were significantly higher in the Baltic countries than in Finland but declined by nearly 30% in all countries across the study period. There were large inequalities by sex, urban-rural residence and educational level in all countries during 2000-2015. Men, rural residents and low educated individuals had substantially higher drowning ASMRs compared to their counterparts. Absolute and relative inequalities were significantly larger in the Baltic countries than in Finland. Absolute inequalities in drowning mortality declined in all countries across the study period except between urban and rural residents in Finland. Changes in relative inequalities were more variable during 2000-2015. CONCLUSION Despite a sharp reduction in deaths from drowning in the Baltic countries and Finland in 2000-2015, drowning mortality was still high in these countries at the end of the study period with a substantially larger risk of death seen among men, rural residents and low educated individuals. A concerted effort to prevent drowning mortality among those most at risk may reduce drownings considerably in the general population.
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Affiliation(s)
- Andrew Stickley
- Stockholm Centre for Health and Social Change, Södertörn University, Huddinge, 141 89, Sweden
- Department of Social Epidemiology, Graduate School of Medicine, School of Public Health, Kyoto University, Kyoto, Japan
| | - Aleksei Baburin
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - Domantas Jasilionis
- Max Planck Institute for Demographic Research, Rostock, Germany
- Demographic Research Centre, Vytautas Magnus University, Kaunas, Lithuania
| | - Juris Krumins
- Demography Unit, Faculty of Business, Management and Economics, University of Latvia, Riga, Latvia
| | - Pekka Martikainen
- Max Planck Institute for Demographic Research, Rostock, Germany
- Population Research Unit, University of Helsinki, Helsinki, Finland
| | - Naoki Kondo
- Department of Social Epidemiology, Graduate School of Medicine, School of Public Health, Kyoto University, Kyoto, Japan
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Yonsei-ro 50, Seodaemun- gu, Seoul, Korea
| | - Yosuke Inoue
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Mall Leinsalu
- Stockholm Centre for Health and Social Change, Södertörn University, Huddinge, 141 89, Sweden.
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia.
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Davoudi-Kiakalayeh A, Barshan J, Emami Sigaroudi F, Mirak HM, Naseri Alavi SA. The application of the Haddon matrix in identifying drowning prevention solutions in the north of Iran. Heliyon 2023; 9:e16958. [PMID: 37484249 PMCID: PMC10361018 DOI: 10.1016/j.heliyon.2023.e16958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 05/05/2023] [Accepted: 05/11/2023] [Indexed: 07/25/2023] Open
Abstract
The application of the Haddon matrix in identifying drowning prevention solutions in the north of Iran is necessary. We dealt with drownings on three levels of prevention including before, during, and after the injury in northern Iran (Guilan province). This study aimed to investigate the use of Haddon's matrix in preventing three-level drowning cases before, during, and after the accident in the north of Iran. This qualitative study consisted of 9 focus groups with a sample size of 78 people including 48 nursing staff, 21 emergency medicine specialists, and 30 people from non-medical personnel (local community leaders, executive officials of relevant organizations, lifeguards, staff working in health centers, and families of victims). All group discussions were recorded and the questions were based on the focus group table. According to Haddon's table of results, the major risk group was the young and adolescent boys and more in the area of neglect in culture-building and education. In this study, the role of factors was investigated separately and the necessary solutions were presented that can be used as a scientific and practical basis to achieve the main goal of drowning prevention. These strategies require cross-sectoral collaboration, which seems to be a strong interaction with a greater focus on major risk groups to address deficiencies and prevent the recurrence of potential accidents. The study aimed to investigate the use of Haddon's matrix in the prevention of three-level drowning cases before the event, during the event, and after the event in northern Iran.
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Affiliation(s)
| | - Jalal Barshan
- Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Hamed Mousavi Mirak
- Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran
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Santos C, Burnay C, Button C, Cordovil R. Effects of Exposure to Formal Aquatic Activities on Babies Younger Than 36 Months: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5610. [PMID: 37107892 PMCID: PMC10138400 DOI: 10.3390/ijerph20085610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 04/16/2023] [Accepted: 04/19/2023] [Indexed: 05/07/2023]
Abstract
This systematic review investigated the possible effects of exposing infants to formal activities in aquatic environments. A literature search of eight databases was concluded on 12 December 2022. Studies were eligible if they: (i) focused on 0-36 months of age infants, (ii) addressed the exposure of infants to formal aquatic activities, and (iii) compared the 'same condition of aquatic exposure with the control' or 'before and after exposure'. The PRISMA protocol was used. Articles considered for inclusion (n = 18) were clustered in the health, development, and physiological outcome domains. The results show that research is focused on indoor activities, mainly in baby swimming programs and baby aquatic therapy interventions. Swimming and aquatic therapy practices are generally safe for babies' health, and there are benefits to preterm and newborns exposed to aquatic therapy once the physiological parameters are maintained in normal and safe patterns. A positive effect is also suggested in general gross and fine motor skills, visual motion perception, cognitive flexibility, and response selection accuracy for infants who participated in aquatic programs. Further investigation with high-quality experimental designs is required to establish the effect of exposure of infants to formal aquatic activities (Systematic Review Registration: CRD42021248054).
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Affiliation(s)
- Carlos Santos
- Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, 1499-002 Cruz Quebrada, Portugal
| | - Carolina Burnay
- Interdisciplinary Center for the Study of Human Performance (CIPER), Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, 1499-002 Cruz Quebrada, Portugal
- School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin 9016, New Zealand
| | - Chris Button
- School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin 9016, New Zealand
| | - Rita Cordovil
- Interdisciplinary Center for the Study of Human Performance (CIPER), Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, 1499-002 Cruz Quebrada, Portugal
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Tan H, Lin Z, Fu D, Dong X, Zhu S, Huang Z, Liu Y, He G, Yang P, Liu T, Ma W. Change in global burden of unintentional drowning from 1990 to 2019 and its association with social determinants of health: findings from the Global Burden of Disease Study 2019. BMJ Open 2023; 13:e070772. [PMID: 37045572 PMCID: PMC10106071 DOI: 10.1136/bmjopen-2022-070772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
OBJECTIVE To systematically analyse global, regional and national burden change of unintentional drowning from 1990 to 2019, and to further quantify the contribution of social determinants of health (SDH) on the change. DESIGN Data from the Global Burden of Disease Study 2019 were used in this study. SETTING AND PARTICIPANTS Individuals of all ages and genders from 204 countries and territories. MAIN OUTCOME MEASURES The main outcomes were the age-standardised rates (ASRs) of mortality and disability-adjusted life-years (DALYs) of unintentional drowning. The percentage change in the ASRs were used to estimate the joint effect of SDH on trends in global burden of drowning. RESULTS We observed that the global burden of unintentional drowning declined markedly from 1990 to 2019, with age-standardised mortality rate and DALYs rate decreasing by 61.5% and 68.2%, respectively. Women, children, middle Socio-Demographic Index (SDI) countries, South-East Asia and Western Pacific region had higher reduction. At national level, greater reductions were observed in Armenia and Republic of Korea, but significant increases in Cabo Verde and Vanuatu. We found that every one percentile increase in six SDHs (Gross Domestic Product (GDP) per person, SDI, educational attainment, health spending, health workers and urbanisation) was associated with a decrease of 0.15% and 0.16% in drowning age-standardised mortality rate and DALYs rate globally, respectively. Health spending and GDP per capita were the main contributors to the reduction of drowning globally. CONCLUSIONS The global burden of unintentional drowning significantly declined in the past three decades, and the improvement of SDHs such as GDP per capita and health spending mainly contributed to the decrease. Our findings indicate that improvement of SDHs is critical for drowning prevention and control.
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Affiliation(s)
- Haomin Tan
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong, China
- China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou, China
| | - Ziqiang Lin
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong, China
- China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou, China
| | - Di Fu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong, China
- China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou, China
| | - Xiaomei Dong
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong, China
- China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou, China
| | - Sui Zhu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong, China
- China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou, China
| | - Zhongguo Huang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong, China
- China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou, China
| | - Yingyin Liu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong, China
- China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou, China
| | - Guanhao He
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong, China
- China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou, China
| | - Pan Yang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong, China
- China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou, China
| | - Tao Liu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong, China
- China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou, China
| | - Wenjun Ma
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong, China
- China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou, China
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22
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Koon WA, Peden AE, Lawes JC, Brander RW. Mortality trends and the impact of exposure on Australian coastal drowning deaths, 2004-2021. Aust N Z J Public Health 2023; 47:100034. [PMID: 36963121 DOI: 10.1016/j.anzjph.2023.100034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 09/29/2022] [Accepted: 02/09/2023] [Indexed: 03/26/2023] Open
Abstract
OBJECTIVE The aim of this study is to characterise Australian coastal drowning trends and evaluate impact of exposure on drowning risk. METHODS Descriptive epidemiological analysis of unintentional fatal drowning occurring July 2004-June 2021 at Australian coastal sites (beaches, rock platforms, bays, harbours, offshore locations etc.). Total population, exposed-person and exposed-person-time rates per 100,000 population were calculated by age, sex, socio-economic status, remoteness category and pre-submersion activity. Annual trends were assessed using joinpoint regression. Exposure-based rates used estimates from Surf Life Saving Australia's National Coastal Safety Survey. RESULTS The cumulative unintentional coastal fatal drowning rate was 0.43 per 100,000 Australian residents (95%CI: 0.41-0.45) and did not change throughout the study period (p=0.289). The exposed-person rate was 0.67 per 100,000 coastal visitors (95%CI: 0.62-0.72), and there were 0.55 coastal drowning deaths per 10 million coastal visitor hours (95%CI: 0.51-0.59). Men, older people and residents of lower socio-economic and remote areas had higher drowning rates; rock fishing and scuba diving had the highest activity exposure-based rates. CONCLUSIONS Education- and policy-based coastal safety interventions should focus on identified risk factors to reduce annual coastal drowning rates. IMPLICATIONS FOR PUBLIC HEALTH Exposure-based risk measurements are important for developing and prioritising interventions; assessments based on counts or total population measures alone may misinform prevention efforts.
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Affiliation(s)
- William A Koon
- School of Biological Earth and Environmental Sciences, University of New South Wales, Sydney, New South Wales, Australia; Beach Safety Research Group, University of New South Wales, Sydney, New South Wales, Australia.
| | - Amy E Peden
- Beach Safety Research Group, University of New South Wales, Sydney, New South Wales, Australia; School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Jasmin C Lawes
- Beach Safety Research Group, University of New South Wales, Sydney, New South Wales, Australia; Surf Life Saving Australia, Sydney, New South Wales, Australia
| | - Robert W Brander
- School of Biological Earth and Environmental Sciences, University of New South Wales, Sydney, New South Wales, Australia; Beach Safety Research Group, University of New South Wales, Sydney, New South Wales, Australia
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Thom O, Roberts K, Leggat PA, Devine S, Peden AE, Franklin RC. Addressing gaps in our understanding of the drowning patient: a protocol for the retrospective development of an Utstein style database and multicentre collaboration. BMJ Open 2023; 13:e068380. [PMID: 36759033 PMCID: PMC9923278 DOI: 10.1136/bmjopen-2022-068380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
INTRODUCTION This retrospective observational study aims to create a comprehensive database of the circumstances of drowning (including care provided and outcomes of care) to report against the Utstein style for drowning (USFD) for patients presenting to the emergency department (ED). Four areas will be examined: a feasibility study of the USFD; a comparison of classification and prognostication systems; examination of indications and efficacy of different ventilation strategies; and differences in the circumstances, severity, treatment and outcomes of drowning by sex and gender. METHODS AND ANALYSIS This protocol outlines retrospective data collection for all patients presenting to EDs of the Sunshine Coast Hospital and Health Service in Queensland, Australia with the presenting problem or discharge diagnosis of drowning or immersion between 2015 and 2022. Patients computerised health records (emergency medical service record, pathology, radiology results, medical and nursing notes for ED, inpatient units and intensive care units) will be used to extract data for entry into an USFD database. Descriptive (eg, median, IQR) and inferential statistical analyses (eg, analysis of variance) will be used to answer the separate research questions. Development of an International Drowning Registry using the USFD dataset and the Research Electronic Data Capture (REDCap) web application is discussed. ETHICS AND DISSEMINATION This study has been approved by Metro North Human Research and Ethics Committee (Project No: 49754) and James Cook University Human Research Ethics Committee (H8014). It has been endorsed by national drowning prevention organisations Royal Life Saving Society Australia (RLSSA) and Surf Life Saving Australia (SLSA). Study findings will provide data to better inform clinical management of drowning patients and provide an evidence base on sex and gender differences in drowning. Results will be disseminated through peer review publications, conference presentations and media releases. Results will also be disseminated through RLSSA and SLSA membership of the Australian and New Zealand Resuscitation Council and the Australian Water Safety Council.
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Affiliation(s)
- Ogilvie Thom
- Department of Emergency Medicine, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia
- Public Health and Tropical Medicine, College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Kym Roberts
- Department of Emergency Medicine, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia
- Public Health and Tropical Medicine, College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Peter A Leggat
- Public Health and Tropical Medicine, College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
- College of Medicine, Nursing & Health Sciences, University of Galway, Galway, UK
| | - Susan Devine
- Public Health and Tropical Medicine, College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Amy E Peden
- Public Health and Tropical Medicine, College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
- School of Population Health, University of New South Wales, Kensington, New South Wales, Australia
- Royal Life Saving Society Australia, Broadway, New South Wales, Australia
| | - Richard Charles Franklin
- Public Health and Tropical Medicine, College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
- Royal Life Saving Society Australia, Broadway, New South Wales, Australia
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Kushitor MK, Bour H, Nyame P, Yabila S. Context of boat drowning in Ghana: a mixed qualitative research study. Inj Prev 2023; 29:8-15. [PMID: 36697022 DOI: 10.1136/ip-2022-044567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 08/05/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Drowning is a significant public health challenge globally. In Africa and Ghana, drowning has remained a silent epidemic among poor communities. Limited evidence has challenged advances in drowning knowledge and prevention. While drowning deaths are often widely circulated in the newspapers, drowning data are not systematically organised to constitute a body of evidence sufficient for scientific exploration. Although drowning was frequent, they were poorly understood. We explore the context of drowning from multiple perspectives from the Volta-basin where the largest man-made lake in the world has become a hotspot for drowning. METHOD This study adopts a sequential-mix-qualitative study comprising content analysis of newspaper reports on drowning, structured-observations and in-depth interviews with boaters and fisherfolk. We first explored, the content of newspapers over a 10-year period. This information provided the context of drowning. We followed up with extensive observation of activities on the lake by a team of five. Photovoice qualitative interviews were conducted with 22 boaters, fishers and community members. Thematic content analysis was applied to both the newspaper reports and the in-depth interviews. RESULTS Drowning was attributed to both proximate and distal causes. Distal causes were the reasons for movement, while proximate causes were the immediate cause of the drowning. Travelling to farm, market, hospital, church, sell were important distal causes of drowning. Proximate determinants included strong winds, tree stumps, overcrowding, no-adherence to safety procedures, spiritual reasons and high tides. Four types of boat accidents were observed: boat-capsizing, boat-sinking, boat-splitting and boat-catching-fire. Ideas converged and diverged in comparing the newspaper content analysis to the photovoice interviews.
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Affiliation(s)
- Mawuli Komla Kushitor
- School of Public Health, Department of Health Policy Planning and Management, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Helen Bour
- School of Public Health, Department of Health Policy Planning and Management, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Prince Nyame
- School of Public Health, Department of Health Policy Planning and Management, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Solomon Yabila
- School of Public Health, Department of Health Policy Planning and Management, University of Health and Allied Sciences, Ho, Volta Region, Ghana
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25
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Thom O, Roberts K, Leggat PA, Devine S, Peden AE, Franklin R. Cervical spine immobilisation is only required in drowning patients at high risk of axial loading of the spine. Emerg Med Australas 2023; 35:18-24. [PMID: 35878883 PMCID: PMC10087421 DOI: 10.1111/1742-6723.14036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/22/2022] [Accepted: 06/03/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Wave forced impacts are known to result in cervical spine injuries (CSI) and approximately 20% of drownings in Australia occur at the beach. The most common mechanism of injury in studies examining the frequency of CSI in drowning patients is shallow water diving. The aim of the present study was to determine what proportion of CSIs occurring in bodies of water experienced a concomitant drowning injury in a location where wave forced impacts are likely to be an additional risk factor. METHODS Electronic medical records at the Sunshine Coast Hospital and Health Service EDs, Queensland Ambulance Service case records and Surf Life Saving Queensland data between 1 January 2015 and 21 April 2021 were manually linked. Outcomes recorded included victim demographics, scene information, hospital course and patient disposition. RESULTS Ninety-one of 574 (15.9%) CSIs occurred in a body of water with risk of drowning. However, only 4 (4.3%) had a simultaneous drowning injury, representing 0.8% (4/483) of drowning presentations. Ten (10.9%) patients reported loss of consciousness, including the four with drowning. The principal mechanism of CSI was a wave forced impact (71/91, 78%). Most injuries occurred at the beach (79/91, 86.8%). Delayed presentation was common (28/91, 31%). A history of axial loading was 100% sensitive when indicating imaging. CONCLUSIONS The combination of CSI and drowning is uncommon. Cervical spine precautions are only required in drowning patients with signs or a history, or at high risk of, axial loading of the spine. This paper supports the move away from routine cervical spine precautions even in a high-risk population.
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Affiliation(s)
- Ogilvie Thom
- Department of Emergency Medicine, Sunshine Coast Hospital and Health Service, Sunshine Coast, Queensland, Australia.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.,Surf Life Saving Queensland, Brisbane, Queensland, Australia
| | - Kym Roberts
- Department of Emergency Medicine, Sunshine Coast Hospital and Health Service, Sunshine Coast, Queensland, Australia.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Peter A Leggat
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.,School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Susan Devine
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Amy E Peden
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.,Royal Life Saving Society Australia, Sydney, New South Wales, Australia.,School of Population Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Richard Franklin
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.,Royal Life Saving Society Australia, Sydney, New South Wales, Australia
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26
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Leavy JE, Gray C, Della Bona M, D'Orazio N, Crawford G. A Review of Interventions for Drowning Prevention Among Adults. J Community Health 2023; 48:539-556. [PMID: 36653593 DOI: 10.1007/s10900-023-01189-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2023] [Indexed: 01/20/2023]
Abstract
Adult drowning is a complex and multifactorial public health challenge requiring community, national and global efforts to mitigate impacts. This study updates the evidence base for public health interventions that address adult fatal and non-fatal drowning. A systematic review was undertaken of the peer-reviewed literature for English-language primary studies published between 2011 and 2021describing a drowning intervention with adults. Twenty-two studies were included. Most studies (n = 16) were conducted in high-income countries. Yearly trends in drowning prevention intervention publications were analysed with 2015 (n = 6) the peak publishing year. Over half of the study designs were pre-post (n = 15). Intervention duration ranged from 4 hours to 11 years. Ten studies described either behaviour change theory or formative evaluation to inform design. Thirteen studies targeted interventions at a population level, seven at a group level and two at individual level. Studies identified a range of prevention strategies, categorised as behavioural (n = 9) (e.g., swimming lessons), socio-ecological (n = 8) (e.g., mandatory personal flotation devices) and mixed (n = 5) (e.g., awareness campaign and barriers to prevent access to water). A range of outcomes were described including changes in awareness, water safety knowledge, attitudes, water safety behaviours and skills, environmental, policy and regulation changes and drowning rates. Findings indicate a small but important increase in the evaluation and publication of effective interventions to prevent adult drowning. The complexity of the issues surrounding drowning requires multi-strategy and context -specific adult focused prevention interventions. Contemporary evidence that identifies effective interventions that contribute to prevention efforts is an essential first step in addressing the challenge.
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Affiliation(s)
- Justine E Leavy
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Perth, WA, Australia.
| | - Corie Gray
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Perth, WA, Australia
| | - Malena Della Bona
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Perth, WA, Australia
| | - Nicola D'Orazio
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Perth, WA, Australia
| | - Gemma Crawford
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Perth, WA, Australia
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27
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Real ÁD, Sanchez-Lorenzo A, Lopez-Bustins JA, Zarrabeitia MT, Santurtún A. Atmospheric circulation and mortality by unintentional drowning in Spain: from 1999 to 2018. Perspect Public Health 2023; 143:34-42. [PMID: 34284665 DOI: 10.1177/17579139211007181] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
AIMS Drowning deaths are a leading cause of unintentional deaths worldwide. Few studies have analysed the role of meteorology in drowning, and with inconclusive results. The aim of this work is to analyse the temporal and geographical distribution of deaths by accidental drowning and submersion in Spain over 20 years, and to assess the relationship between accidental drowning and main atmospheric circulation patterns. METHODS An ecological study was performed, in which drowning and submersion mortality data from 1999 to 2018, considering demographic variables, were analysed. To study the association with atmospheric circulation we used an ERA5 reanalysis product over the whole European continent and the Climatic Research Unit Time Series (CRU TS) data set. RESULTS The annual average rate of deaths by accidental drownings was 11.86 deaths per million of habitants in Spain. The incidence in males was four times higher than in females, and when comparing age groups, the rate in the eldest group was the highest. Unintentional drowning deaths were not equally distributed around the country; the provinces with the highest registered standardized drowning death rates were touristic waterfront provinces either in Eastern Spain or in one of the archipelagos. There was a significant relationship between accidental drowning and meteorological variables during summer months, and drowning deaths were spatially correlated with sea-level pressure over the Mediterranean basin. CONCLUSION Although the mortality rate registered a statistically significant decreasing tendency over the studied period, our results must be taken into consideration to improve the prevention strategies in the country since most of these deaths are avoidable.
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Affiliation(s)
- Á Del Real
- Unit of Legal Medicine, Department of Physiology and Pharmacology, University of Cantabria, Santander, Spain
| | | | - J-A Lopez-Bustins
- Climatology Group, Department of Geography, University of Barcelona, Barcelona, Spain
| | - M T Zarrabeitia
- Unit of Legal Medicine, Department of Physiology and Pharmacology, University of Cantabria, Santander, Spain
| | - A Santurtún
- Unit of Legal Medicine, Department of Physiology and Pharmacology, University of Cantabria, C/ Cardenal Herrera Oria s/n, 39011 Santander, Spain
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Lawes JC, Koon W, Berg I, van de Schoot D, Peden AE. The epidemiology, risk factors and impact of exposure on unintentional surfer and bodyboarder deaths. PLoS One 2023; 18:e0285928. [PMID: 37200297 DOI: 10.1371/journal.pone.0285928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 05/04/2023] [Indexed: 05/20/2023] Open
Abstract
Surfing and bodyboarding (SAB) are popular activities, but not without risk. Limited SAB mortality and exposure risk explorations exist, so this cross-sectional study explores epidemiology and risk factors for SAB deaths (1 July, 2004-30 June,2020) in Australia: including decedent and incident profiles, causes of death, differences between fatalities during SAB and other coastal activities; and the impact of exposure on SAB mortality risk. Fatality data were sourced from the National Coronial Information System, incident and media reports. Tide-state data, population data and participation data were sourced from relevant authorities. Analyses included chi-square testing and simple logistic regression with odds ratios. There were 155 SAB deaths (80.6% surfing; 96.1% male; 36.8% aged 55+years; 0.04/100,000 residents; 0.63/100,000 surfers). Drowning was the most common cause of death (58.1%; n = 90), but higher in bodyboarding, with bodyboarders 4.62 times more likely to drown than surfers (95%CI: 1.66-12.82; p = 0.003). Almost half (44.5%; n = 69; χ22 = 9.802; p = 0.007) were with friends/family, and the largest proportion occurred during a rising tide (41.3%; n = 64; χ23 = 180.627; p<0.001) followed by a low tide (36.8%;n = 57). Australians surf 45.7 times each year, for 1.88 hours each visit equalling 86.1 'exposed' hours. With exposure-time considered, exposure-adjusted surfer mortality rate (0.06/1 million hours) is lower than other in-water activities (0.11/1 million hours). Younger surfers (14-34 years) surfed more yet had the lowest mortality rate (114.5 hours/year; 0.02/1 million hours). Older surfers (55+ years) had a lower SAB mortality rate (0.052) than the all-cause crude mortality rate of their average population counterparts (1.36). Cardiac conditions were identified in 32.9% (n = 69) of SAB deaths. SAB are relatively safe, with lower exposure mortality rates than other activities. Prevention should target older surfers, inland residents, and identification of surfers with risk factors for cardiac events.
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Affiliation(s)
- Jasmin C Lawes
- Surf Life Saving Australia, Sydney, New South Wales, Australia
- Beach Safety Research Group, UNSW Sydney, Sydney, New South Wales, Australia
- School of Biological, Environmental and Earth Sciences, UNSW Sydney, Sydney, New South Wales, Australia
| | - William Koon
- Beach Safety Research Group, UNSW Sydney, Sydney, New South Wales, Australia
- School of Biological, Environmental and Earth Sciences, UNSW Sydney, Sydney, New South Wales, Australia
| | - Ingvar Berg
- Surfing Medicine International, The Hague, The Netherlands
- Emergency Department, Haaglanden Medical Centre, The Hague, The Netherlands
| | - Dion van de Schoot
- Surfing Medicine International, The Hague, The Netherlands
- Emergency Department, Te Whatu Ora Waikato, Hamilton, New Zealand
| | - Amy E Peden
- Beach Safety Research Group, UNSW Sydney, Sydney, New South Wales, Australia
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
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Corkery JM, Martinotti G, Schifano F. Contribution of Drugs to Drowning in Scotland from 1996 to 2020. Curr Neuropharmacol 2023; 21:2217-2226. [PMID: 36043796 PMCID: PMC10556394 DOI: 10.2174/1570159x20666220830110758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/10/2022] [Accepted: 08/01/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Psychoactive substance use (including alcohol) can affect risk perception, leading to accidents and deaths. There is little detailed or up-to-date information on the role of drugs in drownings in the United Kingdom (UK). This Scottish case-study aimed to fill this knowledge gap. METHODS Anonymised data for individual drug-poisoning-related drowning registered from 1996 to 2020 were provided by the National Records of Scotland. Statistical analyses were performed for socio-demographics, ICD coding, cause of death, and substances implicated. RESULTS It has been reported that death registrations increased from 7 in 2017 to over 20 during 2019-20. These deaths (n=160) accounted for <1% of all drug-related poisoning deaths; this proportion rose to record levels (c.1.5%) during 2019-20. Most deaths (69%) involved males. The mean age was 39.8 (range 16-81, SD 15.0) years. The main drug classes implicated were: opiates/opioids (41%), benzodiazepines (31%), stimulants (19%), and antidepressants (14%). Moreover, 57% of benzodiazepines were 'designer' drugs. CONCLUSION Scottish drownings associated with drug consumption are increasing rapidly. It has been observed that central nervous system depressant drugs (e.g., opioids, benzodiazepines, alcohol) are often involved in drowning. 'Designer' benzodiazepines are a principal factor in increasing Scottish drug-related poisoning deaths; they may be partially responsible for increasing numbers of related drownings. Evidence-based strategies to further reduce the number of preventable drownings should include reference to the dangers of drugs.
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Affiliation(s)
- John Martin Corkery
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, AL10 9AB, United Kingdom
| | - Giovanni Martinotti
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, AL10 9AB, United Kingdom
| | - Fabrizio Schifano
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, AL10 9AB, United Kingdom
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Landolt J, Olumbe A, Thompson M. Comparing drowning (unintentional and intentional) and immersion deaths, Gold Coast, Queensland, Australia: a 6-year retrospective study. AUST J FORENSIC SCI 2022. [DOI: 10.1080/00450618.2022.2152095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Jairus Landolt
- School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia
- Haskayne School of Business, University of Calgary, Calgary, Alberta, Canada
| | - Alex Olumbe
- School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia
- Forensic and Scientific Services, Health Support Queensland, Brisbane, Queensland, Australia
| | - Melissa Thompson
- School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia
- Forensic and Scientific Services, Health Support Queensland, Brisbane, Queensland, Australia
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Oporia F, Nuwaha F, Kibira SPS, Kobusingye O, Makumbi FE, Nakafeero M, Ssenyonga R, Isunju JB, Jagnoor J. Lifejacket wear and the associated factors among boaters involved in occupational boating activities on Lake Albert, Uganda: a cross-sectional survey. Inj Prev 2022; 28:513-520. [PMID: 35636933 PMCID: PMC9726957 DOI: 10.1136/injuryprev-2022-044608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/12/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Drowning death rates in lakeside fishing communities in Uganda are the highest recorded globally. Over 95% of people who drowned from a boating activity in Uganda were not wearing a lifejacket. This study describes the prevalence of lifejacket wear and associated factors among boaters involved in occupational boating activities on Lake Albert, Uganda. METHODS We conducted a cross-sectional survey, grounded on etic epistemology and a positivist ontological paradigm. We interviewed 1343 boaters across 18 landing sites on Lake Albert, Uganda. Lifejacket wear was assessed through observation as boaters disembarked from their boats and self-reported wear for those who 'always wore a life jacket while on the lake'. We used a mixed-effects multilevel Poisson regression, with landing site-specific random intercepts to elicit associations with lifejacket wear. We report adjusted prevalence ratios (PRs) at 95% confidence intervals. RESULTS The majority of respondents were male, 99.6% (1338/1343), and the largest proportion, 38.4% (516/1343) was aged 20-29 years. Observed lifejacket wear was 0.7% (10/1343). However, self-reported wear was 31.9% (428/1343). Tertiary-level education (adjusted PR 1.57, 95% CI 1.29- 1.91), boat occupancy of at least four people (adjusted PR 2.12, 95% CI 1.28 - 3.52), big boat size (adjusted PR 1.55, 95% CI 1.13 - 2.12) and attending a lifejacket-use training session (adjusted PR 1.25, 95% CI 1.01 - 1.56) were associated with higher prevalence of self-reported lifejacket wear. Self-reported wear was lower among the 30-39 year-olds compared to those who were aged less than 20 years (adjusted PR 0.66, 95% CI 0.45 - 0.99). CONCLUSION Lifejacket wear was low. Training on lifejacket use may improve wear among boaters involved in occupational boating activities on Lake Albert.
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Affiliation(s)
- Frederick Oporia
- Department of Disease Control and Environmental Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Fred Nuwaha
- Department of Disease Control and Environmental Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Simon P S Kibira
- Department of Community Health and Behavioural Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Olive Kobusingye
- Department of Disease Control and Environmental Health, Makerere University College of Health Sciences, Kampala, Uganda
- The George Institute for Global Health, Camperdown, New South Wales, Australia
| | - Fredrick Edward Makumbi
- Department of Epidemiology and Biostatistics, Makerere University College of Health Sciences, Kampala, Uganda
| | - Mary Nakafeero
- Department of Disease Control and Environmental Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ronald Ssenyonga
- Department of Epidemiology and Biostatistics, Makerere University College of Health Sciences, Kampala, Uganda
| | - John Bosco Isunju
- Department of Disease Control and Environmental Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Jagnoor Jagnoor
- George Institute for Global Health, Camperdown, New South Wales, Australia
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Varner JD, Liu A. Pediatric Drowning: In Deep Water. Pediatr Ann 2022; 51:e450-e455. [PMID: 36476198 DOI: 10.3928/19382359-20221006-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Drowning is one of the most common causes of death globally. The current literature identifies risk factors associated with pediatric drowning and strategies to prevent its occurrence. This article seeks to equip pediatricians with the appropriate education and guidance to provide targeted counsel to parents with children of different age groups, as well as medical management, when faced with a drowning victim. [Pediatr Ann. 2022;51(12):e450-e455.].
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Işın A, Peden AE. Assessing variations in estimates of drowning mortality in Turkey from 2013 to 2019. Arch Public Health 2022; 80:178. [PMID: 35915470 PMCID: PMC9341097 DOI: 10.1186/s13690-022-00944-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/26/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Drowning is an under-recognised public health threat and a leading cause of injury-related mortality and morbidity. However, in many countries, including Turkey, limited data impair understanding of drowning burden and Global Burden of Disease (GBD) Study drowning estimates (defined using International Classification of Diseases [ICD] codes W65–74) do not include flood-related deaths (X38) and water transportation related drownings (V90, V92). A lack of accessible and reliable country-level data impacts a country’s ability to develop appropriate drowning prevention interventions and measure efficacy. This retrospective population-based study aimed to explore differences between two datasets in fatal drowning in Turkey between 2013 and 2019. Methods National, all-age data on fatal drownings (restrictive definition: ICD-10 codes W65–74) were sourced from the Turkish Statistical Institute (TurkStat) and the Global Burden of Disease (GBD) study. In addition, a broader definition of drowning including water transport, flood-related deaths and drowning due to undetermined intent (ICD-10 codes W65–74, V90, V92, X38, Y21, T751) were sourced from TurkStat. Numeric and percentage differences in number of drowning deaths were calculated overall and by sex, age group and death year. Chi square (p < 0.05) and relative risk (95% confidence intervals) using crude drowning rates per 100,000 population were also calculated for TurkStat data. Results From 2013 to 2019, TurkStat reported a total of 5004 drowning deaths (coded W65–74) were reported, compared to 5252 (5% difference; n = 248) using the broader definition. A restrictive definition underreported drowning most significantly in females (9.5%; n = 97), 5–9 year-olds (8.9%; n = 31) and in the 2015 calendar year (30.2%; n = 226). Males accounted for 78.8% of drowning in Turkey, with females significantly (p < 0.001) more at risk under 10 years of age (0–4 years X2 = 67.9; 5–9 years X2 = 23.9) and aged 65+ years (X2 = 29.7). GBD data overestimated a restrictive definition of drowning by 3.2% overall (7.6% for females, 52.5% for 0–4 year-olds) and underreported drowning for 65+ year-olds by 17% when compared to TurkStat restrictive definition of drowning. Conclusions Although a restrictive definition of drowning doesn’t greatly impact estimates at a population level in Turkey, there are variations. This highlights the importance of accurate country-level drowning data to guide decision making for prevention.
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Awan B, Wicks S, Peden AE. A qualitative examination of causal factors and parent/caregiver experiences of non-fatal drowning-related hospitalisations of children aged 0-16 years. PLoS One 2022; 17:e0276374. [PMID: 36417407 PMCID: PMC9683605 DOI: 10.1371/journal.pone.0276374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 10/06/2022] [Indexed: 11/24/2022] Open
Abstract
Fatal and non-fatal drowning is a significant public health issue, which disproportionately impacts children and young people. In Australia, the highest fatal and non-fatal drowning rates occur in children under five years of age. To date, little qualitative research has been conducted on non-fatal drowning, with causal factor analysis generally conducted using coronial and hospital data. This study's aim was to identify causal factors in hospital treated cases of non-fatal drowning in children as qualitatively self-reported by parents and caregivers. Cases of unintentional child (0-16 years) non-fatal drowning admissions and Emergency Department presentations to three tertiary care paediatric hospitals in New South Wales, Australia were identified via International Classification of Diseases (ICD) coding. Parents and caregivers of drowning patients were invited to participate in a semi-structured interview. Data were thematically coded using an inductive approach, with a focus on causal factors and recommendations for preventive approaches. Of 169 incidents, 86 parents/caregivers were interviewed. Children hospitalised for drowning were more often male (59.3%), aged 0-4 years (79.1%) and 30.2% were from household who spoke a language other than English. Qualitative incident descriptions were coded to five themes: lapse of supervision, unintended access (commonly in home swimming pools), brief immersion (usually young children bathing), falls into water and ongoing impacts. Drowning prevention recommendations were grouped under supervision, pool barriers and maintenance, cardiopulmonary resuscitation (CPR) training and emergency response, drowning is quick and silent, and learning swimming. Parents and caregivers of young children require ongoing education regarding supervision distractions and pool barrier compliance. Additional challenges are faced by those in rental properties with pools, parents/caregivers who cannot swim, and parents/caregivers from culturally and linguistically diverse backgrounds. Affordable, accessible, and culturally appropriate swimming lessons, water safety education and CPR training should be made more available for adult caregivers, particularly in languages other than English.
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Affiliation(s)
- Boshra Awan
- Kids Health Promotion Unit, Sydney Children’s Hospitals Network, Westmead, New South Wales, Australia,* E-mail:
| | - Suzanne Wicks
- Kids Health Promotion Unit, Sydney Children’s Hospitals Network, Westmead, New South Wales, Australia
| | - Amy E. Peden
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Kensington, New South Wales, Australia,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
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Fortuin J, Karangwa I, Mahlalela N, Robertson C. A South African Epidemiological Study of Fatal Drownings: 2016-2021. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15121. [PMID: 36429836 PMCID: PMC9690020 DOI: 10.3390/ijerph192215121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/03/2022] [Accepted: 11/14/2022] [Indexed: 06/16/2023]
Abstract
Drowning is a serious public health concern. Low-and-middle-income countries are the most affected by drowning, as they carry 90% of the global drowning burden. The purpose of this retrospective epidemiological study is to provide an overview of fatal drownings in South Africa between 2016 and 2021. The data used for the study were obtained from the South African Police Service. Descriptive statistics were used to summarize the data. Statistical analyses included a t-test and chi-square test. The results indicate that the average number of fatal drownings per annum is 1477 in South Africa, with an average drowning rate of 2.54 per 100,000 population for the period 2016 to 2021. The KwaZulu-Natal province had the highest incidence of drowning. The 0-4-year-age group has the highest prevalence of drowning among all the age categories. More males drowned in South Africa compared to females.
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Affiliation(s)
- Jill Fortuin
- National Sea Rescue Institute, Cape Town 7441, South Africa
- Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town 7701, South Africa
| | - Innocent Karangwa
- Department of Statistical Science, University of Cape Town, Cape Town 7701, South Africa
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36
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Buyinza Mugeere A, Oporia F, Kobusingye O. A qualitative study of the causes and circumstances of drowning in Uganda. BMC Public Health 2022; 22:2024. [PMCID: PMC9636780 DOI: 10.1186/s12889-022-14461-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 10/13/2022] [Indexed: 11/07/2022] Open
Abstract
Abstract
Background
Drowning is a serious worldwide and preventable injury problem, especially in low- and middle-income countries (LMICs). The aim of this paper is to draw on the results of semi-structured interviews with witnesses, family members and friends of persons involved in fatal and nonfatal drowning incidents to describe the circumstances of drowning in both lakeside and non-lakeside districts and to identify potential contextually appropriate interventions for drowning prevention and surveillance in Uganda.
Methods
The findings presented in this study were based on data collected from study participants selected through purposive sampling comprising 324 individual face-to-face interviews with drowning witnesses, family members, friends of and survivors of drowning and ten (10) focus group discussions held with community members in 14 districts in Uganda. Data analysis was done using the Framework Analysis Approach with the aid of the Microsoft Atlas ti software (version 8) program.
Results
The study results reveal a range of circumstances under which drowning occurs in Uganda, poor record keeping of drowning incidents, fear of reporting drowning incidences to the authorities, challenges in preventing drowning and proposed strategies for mitigating the problem.
Conclusions
This study found that there is no specialized record keeping system for drowning cases in Uganda and where such records are kept, the system is entirely manual (in hard copy form) with no electronic storage of data. Secondly, the drowning cases reported to police posts and stations in various parts of the country are not transmitted to the district headquarters and national database. These and other conclusions not only provide valuable insights into understanding of drowning circumstances but also the key policy and programme interventions for water-based economic activities such as fishing and public water transportation in Uganda and other LMICs.
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Affiliation(s)
- Deborah C Girasek
- From the Uniformed Services University of the Health Sciences, Bethesda, MD (D.C.G.); and the Medical College of Wisconsin, Milwaukee (S.H.)
| | - Stephen Hargarten
- From the Uniformed Services University of the Health Sciences, Bethesda, MD (D.C.G.); and the Medical College of Wisconsin, Milwaukee (S.H.)
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38
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Xie X, Li Z, Xu H, Peng D, Yin L, Meng R, Wu W, Ma W, Chen Q. Non-Fatal Drowning Risk Prediction Based on Stacking Ensemble Algorithm. CHILDREN 2022; 9:children9091383. [PMID: 36138692 PMCID: PMC9498184 DOI: 10.3390/children9091383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/06/2022] [Accepted: 09/10/2022] [Indexed: 11/16/2022]
Abstract
Drowning is a major public health problem and a leading cause of death in children living in developing countries. We seek better machine learning (ML) algorithms to provide a novel risk-assessment insight on non-fatal drowning prediction. The data on non-fatal drowning were collected in Qingyuan city, Guangdong Province, China. We developed four ML models to predict the non-fatal drowning risk, including a logistic regression model (LR), random forest model (RF), support vector machine model (SVM), and stacking-based model, on three primary learners (LR, RF, SVM). The area under the curve (AUC), F1 value, accuracy, sensitivity, and specificity were calculated to evaluate the predictive ability of the different learning algorithms. This study included a total of 8390 children. Of those, 12.07% (1013) had experienced non-fatal drowning. We found the following risk factors are closely associated with the risk of non-fatal drowning: the frequency of swimming in open water, distance between the school and the surrounding open waters, swimming skills, personality (introvert) and relationality with family members. Compared to the other three base models, the stacking generalization model achieved a superior performance in the non-fatal drowning dataset (AUC = 0.741, sensitivity = 0.625, F1 value = 0.359, accuracy = 0.739 and specificity = 0.754). This study indicates that applying stacking ensemble algorithms in the non-fatal drowning dataset may outperform other ML models.
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Affiliation(s)
- Xinshan Xie
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou 510200, China
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Zhixing Li
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
- Department of Public Health, School of Medicine, Jinan University, Guangzhou 510630, China
| | - Haofeng Xu
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Dandan Peng
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Lihua Yin
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Ruilin Meng
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Wei Wu
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou 510200, China
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
- Correspondence:
| | - Wenjun Ma
- Department of Public Health, School of Medicine, Jinan University, Guangzhou 510630, China
| | - Qingsong Chen
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou 510200, China
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Yadav J, John D, Menon GR, Franklin RC, Peden AE. Nonfatal drowning-related hospitalizations and associated healthcare expenditure in India: An analysis of nationally representative survey data. JOURNAL OF SAFETY RESEARCH 2022; 82:283-292. [PMID: 36031256 DOI: 10.1016/j.jsr.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 01/11/2022] [Accepted: 06/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Drowning is a global public health challenge, with significant burden in low- and middle-income countries. There are few studies exploring nonfatal drowning, including the economic and social impacts. This study aimed to quantify unintentional drowning-related hospitalization in India and associated healthcare expenditure. METHOD Unit level data on unintentional drowning-related hospitalization were obtained from the 75th rounds of the National Sample Survey of Indian households conducted in 2018. The outcome variables were indices of health care cost such as out of pocket expenditure (OOPE), health care burden (HCB), catastrophic health expenditure (CHE), impoverishment, and hardship financing. Descriptive statistics and multivariate analysis were conducted after adjusting for inflation using the pharmaceutical price index for December 2020. The association of socio-demographic characteristics with the outcome variable was reported as relative risk with 95% CI and expenditure reported in Indian Rupees (INR) and United States dollars (USD). RESULTS 174 respondents reported drowning-related hospitalization (a crude rate of 15.91-31.34 hospitalizations per 100,000 population). Proportionately, more males (63.4%), persons aged 21-50 years (44.9%) and rural dwelling respondents (69.9%) were hospitalized. Drowning-related hospitalization costs on average INR25,421 ($345.11USD) per person per drowning incident. Costs were higher among older respondents, females, urban respondents, and longer lengths of hospital stays. About 14.4% of respondents reported hardship financing as a result of treatment costs and 9.0% of households reported pushed below the poverty line when reporting drowning-related hospitalization. CONCLUSIONS Drowning can be an economically catastrophic injury, especially for those already impacted by poverty. Drowning is a significant public health problem in India. Investment in drowning prevention program will reduce hospitalization and economic burden. PRACTICAL APPLICATIONS This study provides support for investment in drowning prevention in India, including a need to ensure drowning prevention interventions address the determinants of health across the lifespan.
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Affiliation(s)
- Jeetendra Yadav
- ICMR-National Institute of Medical Statistics, Ansari Nagar, New Delhi 110029, India
| | - Denny John
- Faculty of Life and Allied Health Sciences, Ramaiah University of Applied Sciences, Bangalore - 560054, Karnataka, India; Department of Public Health, Amrita Institute of Medical Sciences & Research Centre, Amrita Vishwa Vidyapeetham, Kochi 682041, Kerala, India; Center for Public Health Research, MANT, Kolkata-700078, West Bengal, India
| | - Geetha R Menon
- ICMR-National Institute of Medical Statistics, Ansari Nagar, New Delhi 110029, India.
| | - Richard C Franklin
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia; Royal Life Saving Society - Australia, Sydney, New South Wales, Australia.
| | - Amy E Peden
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia; Royal Life Saving Society - Australia, Sydney, New South Wales, Australia; School of Population Health, Faculty of Medicine, UNSW Sydney, Kensington, New South Wales, Australia.
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40
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Charalampous P, Pallari E, Gorasso V, von der Lippe E, Devleesschauwer B, Pires SM, Plass D, Idavain J, Ngwa CH, Noguer I, Padron-Monedero A, Sarmiento R, Majdan M, Ádám B, AlKerwi A, Cilovic-Lagarija S, Clarsen B, Corso B, Cuschieri S, Dopelt K, Economou M, Fischer F, Freitas A, García-González JM, Gazzelloni F, Gkitakou A, Gulmez H, Hynds P, Isola G, Jakobsen LS, Kabir Z, Kissimova-Skarbek K, Knudsen AK, Konar NM, Ladeira C, Lassen B, Liew A, Majer M, Mechili EA, Mereke A, Monasta L, Mondello S, Morgado JN, Nena E, Ng ESW, Niranjan V, Nola IA, O'Caoimh R, Petrou P, Pinheiro V, Ortiz MR, Riva S, Samouda H, Santos JV, Santoso CMA, Milicevic MS, Skempes D, Sousa AC, Speybroeck N, Tozija F, Unim B, Uysal HB, Vaccaro FG, Varga O, Vasic M, Violante FS, Wyper GMA, Polinder S, Haagsma JA. Methodological considerations in injury burden of disease studies across Europe: a systematic literature review. BMC Public Health 2022; 22:1564. [PMID: 35978333 PMCID: PMC9382747 DOI: 10.1186/s12889-022-13925-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 08/01/2022] [Indexed: 11/10/2022] Open
Abstract
Background Calculating the disease burden due to injury is complex, as it requires many methodological choices. Until now, an overview of the methodological design choices that have been made in burden of disease (BoD) studies in injury populations is not available. The aim of this systematic literature review was to identify existing injury BoD studies undertaken across Europe and to comprehensively review the methodological design choices and assumption parameters that have been made to calculate years of life lost (YLL) and years lived with disability (YLD) in these studies. Methods We searched EMBASE, MEDLINE, Cochrane Central, Google Scholar, and Web of Science, and the grey literature supplemented by handsearching, for BoD studies. We included injury BoD studies that quantified the BoD expressed in YLL, YLD, and disability-adjusted life years (DALY) in countries within the European Region between early-1990 and mid-2021. Results We retrieved 2,914 results of which 48 performed an injury-specific BoD assessment. Single-country independent and Global Burden of Disease (GBD)-linked injury BoD studies were performed in 11 European countries. Approximately 79% of injury BoD studies reported the BoD by external cause-of-injury. Most independent studies used the incidence-based approach to calculate YLDs. About half of the injury disease burden studies applied disability weights (DWs) developed by the GBD study. Almost all independent injury studies have determined YLL using national life tables. Conclusions Considerable methodological variation across independent injury BoD assessments was observed; differences were mainly apparent in the design choices and assumption parameters towards injury YLD calculations, implementation of DWs, and the choice of life table for YLL calculations. Development and use of guidelines for performing and reporting of injury BoD studies is crucial to enhance transparency and comparability of injury BoD estimates across Europe and beyond. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13925-z.
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Affiliation(s)
- Periklis Charalampous
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
| | - Elena Pallari
- Health Innovation Network, Minerva House, Montague Close, London, UK
| | - Vanessa Gorasso
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Elena von der Lippe
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium.,Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
| | - Sara M Pires
- National Food Institute, Technical University of Denmark, Lyngby, Denmark
| | - Dietrich Plass
- Department for Exposure Assessment, and Environmental Health Indicators, German Environment Agency, Berlin, Germany
| | - Jane Idavain
- Department of Health Statistics, National Institute for Health Development, Tallinn, Estonia
| | - Che Henry Ngwa
- School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Isabel Noguer
- National School of Public Health, Carlos III Institute of Health, Madrid, Spain
| | | | - Rodrigo Sarmiento
- National School of Public Health, Carlos III Institute of Health, Madrid, Spain.,Medicine School, University of Applied and Environmental Sciences, Bogota, Colombia
| | - Marek Majdan
- Department of Public Health, Faculty of Health Sciences and Social Work, Trnava University, Trnava, Slovakia
| | - Balázs Ádám
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.,Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Ala'a AlKerwi
- Directorate of Health, Service Epidemiology and Statistics, Luxembourg, Luxembourg
| | | | - Benjamin Clarsen
- Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway.,Department of Disease Burden, Norwegian Institute of Public Health, Bergen, Norway.,Department of Health and Functioning, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Barbara Corso
- Institute of Neuroscience, National Research Council, Rome, Italy
| | - Sarah Cuschieri
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Keren Dopelt
- Department of Public Health, Ashkelon Academic College, Ashkelon, Israel.,Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Mary Economou
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Florian Fischer
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Alberto Freitas
- CINTESIS - Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
| | | | | | - Artemis Gkitakou
- Department of Internal Medicine and Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Hakan Gulmez
- Department of Family Medicine, Faculty of Medicine, İzmir Democracy University, Izmir, Turkey
| | - Paul Hynds
- Environmental Sustainability and Health Institute, Technological University Dublin, Dublin, Ireland
| | - Gaetano Isola
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Catania, Italy
| | - Lea S Jakobsen
- National Food Institute, Technical University of Denmark, Lyngby, Denmark
| | - Zubair Kabir
- Public Health & Epidemiology, School of Public Health, University College Cork, Cork, Ireland
| | - Katarzyna Kissimova-Skarbek
- Department of Health Economics and Social Security, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Ann Kristin Knudsen
- Department of Disease Burden, Norwegian Institute of Public Health, Bergen, Norway
| | - Naime Meriç Konar
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Kirsehir Ahi Evran University, Kirsehir, Turkey
| | - Carina Ladeira
- H&TRC - Health & Technology Research Center, Escola Superior de Tecnologia da Saúde (ESTeSL), Instituto Politécnico de Lisboa, Lisbon, Portugal.,Comprehensive Health Research Centre (CHRC), Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Brian Lassen
- National Food Institute, Technical University of Denmark, Lyngby, Denmark
| | - Aaron Liew
- Clinical Sciences Institute, School of Medicine, National University of Ireland, Galway, Galway City, Ireland
| | - Marjeta Majer
- Andrija Štampar School of Public Health, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Enkeleint A Mechili
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Crete, Greece.,Department of Healthcare, Faculty of Public Health, University of Vlora, Vlora, Albania
| | - Alibek Mereke
- Al-Farabi Kazakh National University, Almaty, Kazakhstan
| | - Lorenzo Monasta
- Institute of Maternal, Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Stefania Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Joana Nazaré Morgado
- Environmental Health and Nutrition Laboratory, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Evangelia Nena
- Laboratory of Social Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | | | - Vikram Niranjan
- School of Public Health, Physiotherapy and Sport Sciences, University College Dublin, Dublin, Ireland
| | - Iskra Alexandra Nola
- Andrija Štampar School of Public Health, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Rónán O'Caoimh
- Department of Geriatric Medicine, Mercy University Hospital, Grenville Place, Cork City, Ireland
| | - Panagiotis Petrou
- Pharmacoepidemiology-Pharmacovigilance, Pharmacy School, School of Sciences and Engineering, University of Nicosia, Nicosia, Cyprus
| | - Vera Pinheiro
- CINTESIS - Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal
| | | | - Silvia Riva
- Department of Psychology and Pedagogic Science, St Mary's University, London, UK
| | - Hanen Samouda
- Population Health Department, Luxembourg Institute of Health, Nutrition and Health Research Group, Luxembourg, Luxembourg
| | - João Vasco Santos
- CINTESIS - Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal.,Public Health Unit, ACES Grande Porto VIII - Espinho/Gaia, ARS Norte, Lisbon, Portugal
| | | | | | | | - Ana Catarina Sousa
- Department of Biology, School of Science and Technology, University of Évora, Évora, Portugal.,Comprehensive Health Research Centre (CHRC), University of Évora, Évora, Portugal
| | - Niko Speybroeck
- Institute of Health and Society (IRSS), Université Catholique de Louvain, Brussels, Belgium
| | - Fimka Tozija
- Institute of Public Health of Republic of North Macedonia, Saints Cyril and Methodius University of Skopje, Skopje, North Macedonia.,Faculty of Medicine, Saints Cyril and Methodius University of Skopje, Skopje, North Macedonia
| | - Brigid Unim
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore Di Sanità, Rome, Italy
| | - Hilal Bektaş Uysal
- Department of Internal Medicine, Adnan Menderes University School of Medicine, Aydin, Turkey
| | | | - Orsolya Varga
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Milena Vasic
- Faculty of Dentistry Pancevo, University Business Academy in Novi Sad, Pancevo, Serbia.,Institute of Public Health of Serbia Dr Milan Jovanović Batut, Belgrade, Serbia
| | - Francesco Saverio Violante
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.,Unit of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Grant M A Wyper
- Place and Wellbeing Directorate, Public Health Scotland, Glasgow, Scotland, UK
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Juanita A Haagsma
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Drowning in the Eastern Mediterranean region: a systematic literature review of the epidemiology, risk factors and strategies for prevention. BMC Public Health 2022; 22:1477. [PMID: 35922840 PMCID: PMC9351066 DOI: 10.1186/s12889-022-13778-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Globally, drowning is a significant cause of preventable mortality and morbidity. The Eastern Mediterranean region (EMR) comprises 22 countries of extreme disparity in income and is a region impacted by conflict and migration. We systematically review literature published on drowning in the EMR. METHODS Peer-reviewed literature (limited to original research) was identified using Embase, PubMed, Scopus, SportsDiscus, and Web of Science databases. Literature was independently dual screened at title/abstract and full text stages with dual data extraction (20% of included studies). Studies were included if they reported epidemiology, risk/protective factors and/or prevention strategies for drowning (unintentional and intentional; fatal and non-fatal) of residents, tourists or migrants in the EMR. Literature was assessed against the [Australian] National Health and Medical Research Council's Levels of Evidence. RESULTS Seventy-two studies were included in this review (epidemiology 68 studies; risk/protective factor 13 studies; prevention strategies 19 studies). Iran (n = 27), Saudia Arabia (n = 11) and Pakistan (n = 10) recorded the largest number of dedicated studies. Studies predominately focused on unintentional drowning. Ninety-two percent of included studies (n = 66) were ranked as being low evidence (level IV). The majority of studies explored drowning among children and adolescents (0-19 years). All-age fatal drowning rates varied from a low of 0.48 per 100,000 (United Arab Emirates; 2002; Ministry of Health death registry data) to a high of 18.5 per 100,000 (Egypt; 2014-15; WHO mortality database). Commonly identified risk factors included being male, young age, submersion time and resident status. Common prevention strategies public education, lifeguard supervision, and cardiopulmonary resuscitation. DISCUSSION Gaps in understanding of drowning burden in some countries within the region, as well as region-wide risk factor identification for adult drowning, intentional and migration-related drowning, impair the ability of nations to advance drowning prevention. There is a need for investment in implementation and evaluation of drowning prevention interventions in the EMR. CONCLUSION Drowning is a significant cause of mortality and morbidity in the EMR. The recent UN declaration on global drowning prevention may provide the impetus to invest in drowning prevention research, policy, and advocacy with the aim of reducing drowning-related harms in the EMR. TRIAL REGISTRATION Registration number: # CRD42021271215 .
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Adolescent transport and unintentional injuries: a systematic analysis using the Global Burden of Disease Study 2019. THE LANCET PUBLIC HEALTH 2022; 7:e657-e669. [PMID: 35779567 PMCID: PMC9329128 DOI: 10.1016/s2468-2667(22)00134-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 01/22/2023] Open
Abstract
Background Globally, transport and unintentional injuries persist as leading preventable causes of mortality and morbidity for adolescents. We sought to report comprehensive trends in injury-related mortality and morbidity for adolescents aged 10–24 years during the past three decades. Methods Using the Global Burden of Disease, Injuries, and Risk Factors 2019 Study, we analysed mortality and disability-adjusted life-years (DALYs) attributed to transport and unintentional injuries for adolescents in 204 countries. Burden is reported in absolute numbers and age-standardised rates per 100 000 population by sex, age group (10–14, 15–19, and 20–24 years), and sociodemographic index (SDI) with 95% uncertainty intervals (UIs). We report percentage changes in deaths and DALYs between 1990 and 2019. Findings In 2019, 369 061 deaths (of which 214 337 [58%] were transport related) and 31·1 million DALYs (of which 16·2 million [52%] were transport related) among adolescents aged 10–24 years were caused by transport and unintentional injuries combined. If compared with other causes, transport and unintentional injuries combined accounted for 25% of deaths and 14% of DALYs in 2019, and showed little improvement from 1990 when such injuries accounted for 26% of adolescent deaths and 17% of adolescent DALYs. Throughout adolescence, transport and unintentional injury fatality rates increased by age group. The unintentional injury burden was higher among males than females for all injury types, except for injuries related to fire, heat, and hot substances, or to adverse effects of medical treatment. From 1990 to 2019, global mortality rates declined by 34·4% (from 17·5 to 11·5 per 100 000) for transport injuries, and by 47·7% (from 15·9 to 8·3 per 100 000) for unintentional injuries. However, in low-SDI nations the absolute number of deaths increased (by 80·5% to 42 774 for transport injuries and by 39·4% to 31 961 for unintentional injuries). In the high-SDI quintile in 2010–19, the rate per 100 000 of transport injury DALYs was reduced by 16·7%, from 838 in 2010 to 699 in 2019. This was a substantially slower pace of reduction compared with the 48·5% reduction between 1990 and 2010, from 1626 per 100 000 in 1990 to 838 per 100 000 in 2010. Between 2010 and 2019, the rate of unintentional injury DALYs per 100 000 also remained largely unchanged in high-SDI countries (555 in 2010 vs 554 in 2019; 0·2% reduction). The number and rate of adolescent deaths and DALYs owing to environmental heat and cold exposure increased for the high-SDI quintile during 2010–19. Interpretation As other causes of mortality are addressed, inadequate progress in reducing transport and unintentional injury mortality as a proportion of adolescent deaths becomes apparent. The relative shift in the burden of injury from high-SDI countries to low and low–middle-SDI countries necessitates focused action, including global donor, government, and industry investment in injury prevention. The persisting burden of DALYs related to transport and unintentional injuries indicates a need to prioritise innovative measures for the primary prevention of adolescent injury. Funding Bill & Melinda Gates Foundation.
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Dunne CL, Sweet J, Clemens T. The link between medical conditions and fatal drownings in Canada: a 10-year cross-sectional analysis. CMAJ 2022; 194:E637-E644. [PMID: 35534027 PMCID: PMC9259405 DOI: 10.1503/cmaj.211739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Drowning accounts for hundreds of preventable deaths in Canada every year, but the impact of preexisting medical conditions on the likelihood of death from drowning is not known. We aimed to describe the prevalence of pre-existing medical conditions among people who fatally drowned in Canada and evaluate the risk of fatal drowning among people with common pre-existing medical conditions. METHODS We reviewed all Canadian unintentional fatal drownings (2007-2016) in the Drowning Prevention Research Centre Canada's database. For each fatal drowning we established whether the person had pre-existing medical conditions and whether those conditions contributed to the drowning. We calculated relative risk (RR) of fatal drowning stratified by age and sex for each pre-existing medical condition using data from the Canadian Chronic Disease Surveillance System. RESULTS During 2007-2016, 4288 people fatally drowned unintentially in Canada, of whom one-third had a pre-existing medical condition. A pre-existing medical condition contributed to drowning in 43.6% (n = 616) of cases. Fatal drowning occurred more frequently in people with ischemic heart disease (RR 2.7, 95% confidence interval [CI] 2.5-3.0) and seizure disorders (RR 6.3, 95% CI 5.4-7.3) but less frequently in people with respiratory disease (RR 0.12, 95% CI 0.10-0.15). Females aged 20-34 years with a seizure disorder had a 23 times greater risk than their age- and sex-matched cohort (RR 23, 95% CI 14-39). In general, fatal drowning occurred more often while people were bathing (RR 5.9, 95% CI 4.8-7.0) or alone (RR 1.99, 95% CI 1.32-2.97) and less often in males (RR 0.92, 95% CI 0.88-0.95) or in those who had used alcohol (RR 0.72, 95% CI 0.65-0.80), among those with pre-existing medical conditions. INTERPRETATION The risk of fatal drowning is increased in the presence of some preexisting medical conditions. Tailored interventions aimed at preventing drowning based on pre-existing medical conditions and age are needed. Initial prevention strategies should focus on seizure disorders and bathtub drownings.
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Affiliation(s)
- Cody L Dunne
- Department of Emergency Medicine (Dunne), University of Calgary, Calgary, Alta.; International Drowning Researchers' Alliance (Dunne, Clemens), Kuna, Idaho; Faculty of Medicine (Sweet), University of Ottawa, Ottawa, Ont.; Drowning Prevention Research Centre Canada (Clemens), Toronto, Ont.
| | - Julia Sweet
- Department of Emergency Medicine (Dunne), University of Calgary, Calgary, Alta.; International Drowning Researchers' Alliance (Dunne, Clemens), Kuna, Idaho; Faculty of Medicine (Sweet), University of Ottawa, Ottawa, Ont.; Drowning Prevention Research Centre Canada (Clemens), Toronto, Ont
| | - Tessa Clemens
- Department of Emergency Medicine (Dunne), University of Calgary, Calgary, Alta.; International Drowning Researchers' Alliance (Dunne, Clemens), Kuna, Idaho; Faculty of Medicine (Sweet), University of Ottawa, Ottawa, Ont.; Drowning Prevention Research Centre Canada (Clemens), Toronto, Ont
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Burnay C, Anderson DI, Button C, Cordovil R, Peden AE. Infant Drowning Prevention: Insights from a New Ecological Psychology Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:4567. [PMID: 35457435 PMCID: PMC9029552 DOI: 10.3390/ijerph19084567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 12/10/2022]
Abstract
Drowning causes significant mortality and morbidity globally, and infants (0-4 years of age) are disproportionately impacted. In a groundbreaking approach to pediatric drowning prevention, ecological psychology has been used to investigate the relationship between infants' perceptual-motor development and their behavior around bodies of water. In this review, we summarize recent research findings in the field of ecological psychology and apply these to the prevention of infant drowning. Studies have linked infants' avoidance of falls into the water with locomotor experience and type of accessway into bodies of water. Through crawling experience, infants learn to perceive the risk of falling into water and start adapting their behavior to avoid drop-offs leading into water. Infants tend to enter deep water more when the access is via a slope than via a drop-off. We propose that ecological psychology can enhance infant drowning prevention interventions. The aim is to create an additional layer of protection, the perceptual information layer, in addition to existing strategies, such as supervision and barriers. This new protective layer can be a powerful tool to further highlight the risk of entering the water and reduce infant drowning-related mortality and morbidity.
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Affiliation(s)
- Carolina Burnay
- School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin 9016, New Zealand;
| | - David I. Anderson
- Marian Wright Edelman Institute, San Francisco State University, San Francisco, CA 94132, USA;
| | - Chris Button
- School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin 9016, New Zealand;
| | - Rita Cordovil
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, 1495-751 Cruz Quebrada, Portugal;
| | - Amy E. Peden
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Kensington, NSW 2052, Australia;
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4811, Australia
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Scarr JP, Buse K, Norton R, Meddings DR, Jagnoor J. Tracing the emergence of drowning prevention on the global health and development agenda: a policy analysis. THE LANCET GLOBAL HEALTH 2022; 10:e1058-e1066. [PMID: 35461520 PMCID: PMC9197772 DOI: 10.1016/s2214-109x(22)00074-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 01/07/2022] [Accepted: 02/14/2022] [Indexed: 11/16/2022] Open
Abstract
Drowning has been a neglected health issue, largely absent from the global health and development discourse, until the UN General Assembly adopted its first resolution on global drowning prevention in 2021. This policy analysis examines the role of issue characteristics, actor power, ideas, and political contexts in the emergence of drowning prevention, and it also identifies opportunities for future actions. We identified three factors crucial to enhancing prioritisation: (1) methodological advancements in population-representative data and evidence for effective interventions; (2) reframing drowning prevention in health and sustainable development terms with an elevated focus on high burdens in low-income and middle-income contexts; and (3) political advocacy by a small coalition. Ensuring that the UN resolution on global drowning prevention is a catalyst for action requires positioning of drowning prevention within global health and sustainable development agendas; strengthening of capacity for multisectoral action; expansion of research measuring burden and identifying solutions in diverse contexts; and incorporation of inclusive global governance, commitments, and mechanisms that hold stakeholders to account.
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Sindall R, Mecrow T, Queiroga AC, Boyer C, Koon W, Peden AE. Drowning risk and climate change: a state-of-the-art review. Inj Prev 2022; 28:185-191. [PMID: 35197275 PMCID: PMC8938664 DOI: 10.1136/injuryprev-2021-044486] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/01/2022] [Indexed: 11/05/2022]
Abstract
Drowning and climate change are both significant global health threats, yet little research links climate change to drowning risk. Research into the epidemiology, risk factors and preventive strategies for unintentional drowning in high-income and in low-income and middle-income countries has expanded understanding, but understanding of disaster and extreme weather-related drowning needs research focus. As nation states and researchers call for action on climate change, its impact on drowning has been largely ignored. This state-of-the-art review considers existing literature on climate change as a contributor to changes in drowning risks globally. Using selected climate change-related risks identified by the World Meteorological Organization and key risks to the Sustainable Development Goals as a framework, we consider the drowning risks associated with heat waves, hydrometeorological hazards, drought and water scarcity, damaged infrastructure, marine ecosystem collapse, displacement, and rising poverty and inequality. Although the degree of atmospheric warming remains uncertain, the impact of climate change on drowning risk is already taking place and can no longer be ignored. Greater evidence characterising the links between drowning and climate change across both high-income and low-income and middle-income contexts is required, and the implementation and evaluation of drowning interventions must reflect climate change risks at a local level, accounting for both geographical variation and the consequences of inequality. Furthermore, collaboration between the injury prevention, disaster risk reduction and climate change mitigation sectors is crucial to both prevent climate change from stalling progress on preventing drowning and further advocate for climate change mitigation as a drowning risk reduction mechanism.
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Affiliation(s)
- Rebecca Sindall
- International Department, Royal National Lifeboat Institution, Poole, UK .,International Drowning Prevention Researchers Alliance (IDRA), Kuna, Idaho, USA
| | - Thomas Mecrow
- International Department, Royal National Lifeboat Institution, Poole, UK.,International Drowning Prevention Researchers Alliance (IDRA), Kuna, Idaho, USA
| | - Ana Catarina Queiroga
- International Drowning Prevention Researchers Alliance (IDRA), Kuna, Idaho, USA.,ITR Laboratory for Integrative and Translational Research in Population Health, Institute of Public Health University of Porto, Porto, Portugal.,Drowning Prevention Commission, International Lifesaving Federation, Leuven, Belgium
| | - Christopher Boyer
- Centre for Health and the Global Environment, University of Washington, Seattle, Washington, USA
| | - William Koon
- International Drowning Prevention Researchers Alliance (IDRA), Kuna, Idaho, USA.,School of Biological, Earth and Environmental Sciences, University of New South Wales Faculty of Science, Sydney, New South Wales, Australia
| | - Amy E Peden
- International Drowning Prevention Researchers Alliance (IDRA), Kuna, Idaho, USA.,Drowning Prevention Commission, International Lifesaving Federation, Leuven, Belgium.,School of Population Health, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
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Bierens J, Hoogenboezem J. Fatal drowning statistics from the Netherlands - an example of an aggregated demographic profile. BMC Public Health 2022; 22:339. [PMID: 35177025 PMCID: PMC8851711 DOI: 10.1186/s12889-022-12620-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 01/14/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Incompleteness of fatal drowning statistics is a familiar problem impeding public health measures. Part of the problem may be that only data on accidental drowning are used and not the full potential of accessible data. Methods This study combines cause-of-death certificates and public prosecutor’s court documents between 1998 and 2017 to obtain an aggregated profile. Data are also used as a basis for a trend analysis. Results The dataset includes 5571 drowned persons (1.69 per 100,000). The highest risk group are persons above the age of 50. Demographic differences are observed between suicide by drowning, accidental drowning, and drowning due to transportation (0.72, 0.64, 0.28 per 100.000) and between native Dutch, and Dutch with western and non-western background (1.46, 1.43, 1.76 per 100.000). Non-residents account for another 12.2%. When comparing the periods 1998–2007 with 2008–2017, the Standard Mortality declines for suicide drowning and accidental drowning among persons with a native Dutch and non-western background. Single regression analysis confirms a decrease of drowning over the full period, breakpoint analysis shows an increase in the incidence of the total number of drowning, suicide by drowning and accidental drowning starting in 2007, 2008 resp. 2012. Discussion Compared to the formal number of fatal accidental drowning in the Netherlands (n = 1718; incidence 0.52 per 100,000), the study identifies 350% more drowning. Differences in demographic data and the recent increase needs to be explored for public health interventions. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12620-3.
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Affiliation(s)
- Joost Bierens
- Research Group Emergency and Disaster Medicine, Vrije Universiteit Brussels, Laarbeeklaan 103, 1090, Brussels, Belgium.
| | - Jan Hoogenboezem
- Centraal Bureau voor de Statistiek (Statistics Netherlands), Department of Causes of Death Statistics, Henri Faasdreef 312, 2492, JP, Den Haag, the Netherlands
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Hamilton K, Keech JJ, Willcox - Pidgeon S, Peden AE. An evaluation of a video-based intervention targeting alcohol consumption during aquatic activities. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2022. [DOI: 10.1080/00049530.2022.2029221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Kyra Hamilton
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sippy Downs, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- Health Sciences Research Institute, University of California, Merced, CA, USA
| | - Jacob J. Keech
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sippy Downs, Australia
- School ofApplied Psychology, Griffith University, Brisbane, Australia
| | - Stacey Willcox - Pidgeon
- Royal Life Saving Society – Australia, Broadway, Sydney, Australia
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
| | - Amy E. Peden
- Royal Life Saving Society – Australia, Broadway, Sydney, Australia
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
- School of Population Health, University of New South Wales, Sydney, Australia
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Cox KL, Bhaumik S, Gupta M, Jagnoor J. Facilitators and barriers of life jacket use for drowning prevention: Qualitative evidence synthesis. JOURNAL OF SAFETY RESEARCH 2022; 80:135-147. [PMID: 35249594 DOI: 10.1016/j.jsr.2021.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 06/15/2021] [Accepted: 11/19/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Drowning is a public health problem globally. Despite substantial evidence on the effectiveness of life jackets, their use for drowning prevention has remained low. This study aims to understand the barriers and facilitators of life jacket use. METHODS We searched four major electronic databases, contacted experts, hand-searched conference abstracts and screened reference lists to identify primary qualitative studies. We used the Critical Appraisal Skills Programme Checklist for quality appraisal and the PROGRESS Plus framework to understand equity issues. Thematic analysis was conducted. RESULTS We retrieved 1153 records and finally included ten studies that met eligibility criteria. All except two studies were from high-income countries. Four key themes were identified. Firstly, life jacket use was shaped through complex interactions between lived experience and cultural norms which influenced the risk-perception of life jacket utility in preventing deaths. Secondly, the high cost of life jackets was almost always a barrier for its usage. Thirdly, adoption of laws and its subsequent enforcement was perceived to be an important facilitator for life jacket use. Lastly, design issues around comfort, fashion-sense, and shelf life influenced usage. CONCLUSION The results of this qualitative evidence synthesis should be considered for health promotion, legal and policy interventions to promote the uptake of life jackets. There is a need for better understanding of perceptions and their role in the uptake of safety behaviours in different countries including the role of equity issues on the use of life jackets.
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Affiliation(s)
- Katherine L Cox
- Injury Division, The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Soumyadeep Bhaumik
- Injury Division, The George Institute for Global Health, University of New South Wales, Sydney, Australia; Injury Division, The George Institute for Global Health, New Delhi, India
| | - Medhavi Gupta
- Injury Division, The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Jagnoor Jagnoor
- Injury Division, The George Institute for Global Health, University of New South Wales, Sydney, Australia; Injury Division, The George Institute for Global Health, New Delhi, India.
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Velasco B, Galanis DJ, Bronstein AC, Downs M. Public rescue tube deployment in Hawaii: protective association with rescuer drownings. Inj Prev 2022; 28:330-334. [DOI: 10.1136/injuryprev-2021-044467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/10/2022] [Indexed: 11/05/2022]
Abstract
ObjectiveTo describe the association between public rescue tube (PRT) flotation devices and fatal rescuer drownings in Kauai, Hawaii.MethodsWe reviewed Hawaii death certificate data from 1993 to 2017, sometimes supplemented with autopsy and emergency medical service reports, to identify fatal rescuer drownings. Incidents were analysed in relation to the initial 2008 deployment of PRT.ResultsOver the 25-year period, only 13% (228) of the 1750 identified drownings occurred in Kauai, but nearly half (46%, or 13) of the 28 rescuer deaths occurred there. However, only 1 of the 13 rescuer deaths in Kauai occurred after the 2008 deployment of PRT. The state-wide proportion of rescuer deaths in Kauai decreased significantly from 60% (12 of 20) from 1993 to 2007 to 13% (1 of 8) from 2008 to 2017. There were no apparent changes in the proportions of rescuer drownings in the other three counties of the state, where PRTs were essentially non-existent.ConclusionDespite valid concerns, we found no fatal rescuer drownings related to PRT use after their 2008 introduction in the county of Kauai. Instead, we observed a reduction in the number of rescuer drownings, and in their proportion of total drownings in association with the deployment of PRT. The findings of this study have the potential to directly impact ocean and other open water environment-related fatal drowning prevention policy and practice.
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