Initial community response to a childhood drowning prevention programme in a rural setting in Bangladesh

Fatal drowning in Indonesia: understanding knowledge gaps through a scoping review

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.

Home environmental change for child injury prevention in Nepal: A qualitative study

In Nepal, unintentional home injury is a leading reason for death and disability among pre-school children. However, there is a lack of evidence to inform culturally appropriate interventions to reduce home injuries. This study explored the potential for home environmental change at a community level to prevent unintentional home injury in children and identified the barriers to, and facilitators of, such changes. Focus groups were conducted in the Nepali language with mothers, fathers, teachers, school students and community health volunteers in rural areas of Makwanpur district in Nepal. The discussions were audio-recorded, transcribed, translated into English and analysed thematically. NVivo software was used to support coding and identification of themes. Five focus groups, involving forty-seven participants, were completed leading to the development of four themes. Overall, the findings highlight that community people perceive injuries to be a normal part of childhood and, therefore, few prevention measures were considered. Parents were, however, able to identify ways to change their environment that made it safer. Changes included removing hazards or adding safety equipment, adapting the home or restricting access to potential hazards. Barriers to implementation included limited awareness about injury hazards and risk management, poor quality housing and financial constraint. Facilitators included raising community awareness, acquiring resources and financial support and involving the family and community. Development of interventions to prevent injuries at home in pre-school children should reflect local context and culture; this is best achieved through engagement with parents.

Caregivers’ Compliance and Perception of Daycare Centers—A Community-Based Childhood Drowning Prevention Intervention Implemented in Rural Bangladesh

Drowning was one of the most prevalent causes of death worldwide for children under five in 2020. Drowning was the second leading cause of death for children under five in Bangladesh, while 58% of all deaths in the 1–5 years old age group resulted from drowning. Adult supervision helps prevent child drowning in rural areas where water bodies are easily accessible and located very close to homes. This paper aims to assess caregivers’ compliance and perception of community daycare centers in rural Bangladesh, piloted as a child drowning prevention intervention. In this longitudinal study, each child enrolled in the daycare intervention was visited and data on compliance and satisfaction with the daycare were collected. Descriptive statistics on daycare attendance, patterns of supervision, and caregivers’ perceptions about daycare were reported. When inquired about daycare attendance (n = 226,552), a total of 77.4% of children (n = 175,321) were found to attend daycare. The distance from homes and an adult’s unavailability to take the child to daycare were the most common reasons for not attending or discontinuing enrollment. The majority of children (76.4%) were supervised by their mothers during daycare closures. A total of 67.7% of respondents perceived daycare to be a safe place, where children also developed cognitive (51.7%) and social skills (50.6%). There were no incidences of drowning among children while attending daycare. Rural families were found to be compliant with the daycare and professed it to be a safe place protecting children from drowning and other injuries, while allowing them to focus on household chores or income-generating activities. These findings indicate a potential for the expansion of this intervention in rural Bangladesh and similar settings.

Effectiveness of "Be SAFE Drowning Prevention and Water Safety Booklet" Intervention for Parents and Guardians

Background:

We aimed to assess the effectiveness of the health educational booklet intervention in improving parents/guardian’s knowledge on prevention of child drowning and, the perception of drowning risk and water safety practice.

Methods:

A quasi-experimental study was conducted in year 2017 in Selangor, Malaysia among 719 parents/guardians of primary school children. The parent/guardians were randomly assigned as the intervention groups and were given a health educational Be-SAFE booklet on drowning prevention and water safety. The pretest was conducted before the intervention and posttest was done one month of intervention. The data collection tool was using a validated questionnaire on knowledge, attitude and practice for drowning prevention and water safety.

Results:

There were 719 respondents (response rate of 89.9%) participated at baseline and 53.7% at end line (after the intervention). Significant differences found in knowledge, attitudes and practice on drowning prevention and water safety for the intervention and control groups after the intervention (P<0.001). There was a significant difference in mean scores for knowledge and attitude before and after the intervention, whereas no significant findings noted for practices (P<0.001).

Conclusion:

Be SAFE booklet contributed to the increase in parents/guardian’s knowledge and attitudes towards drowning prevention and water safety to prevent the risk of child drowning.

Development and validation of a health educational booklet

Purpose

This study aimed to develop and validate a health education booklet (Be SAFE booklet) as a guide to improving knowledge, attitude, and practice toward drowning prevention and water safety among parents of primary school children in a local community in Selangor.

Design/methodology/approach

This methodological study was conducted in two phases: the development of the content, and validation of the educational material. Booklet development involved content survey and design development. These steps consisted of a content analysis method, information from current literature, document analysis from the stakeholder, and input from parents or guardians and children. The validation by nine panel experts and 15 parents/guardians involved both review, content validity, and face validity.

Findings

The booklet was developed by emphasizing on four main aspects related to drowning prevention and water safety; namely, supervision, alertness, first aid, and education. The assessment rated by the content validity index (CVI), resulted in an I-CVI ranging from 0.78 to 1 and S-CVI of 0.94; the face validity achieved a level of agreement with an average of 94 percent. The results indicated that the Be SAFE booklet was validated and could be considered useful in helping to promote drowning prevention and water safety among primary school pupils' parents.

Originality/value

This article contributed ideas for the concept and aspect of health messages to be incorporated into health education materials for drowning prevention and water safety.

Fatal drowning in the Western Cape, South Africa: a 7-year retrospective, epidemiological study

INTRODUCTION

Drowning is a neglected public health threat in low-income and middle-income countries where the greatest drowning burden is observed. There is a paucity of drowning surveillance data from low-resource settings, particularly in Africa. Understanding local epidemiological factors will enable the development of context-specific drowning prevention initiatives and the appropriate allocation of resources.

AIM

The primary aim of this study was to describe the epidemiology of fatal drowning in the Western Cape, South Africa.

METHOD

This retrospective study describes fatal drowning incidents captured in the Western Cape vital registration system between 2010 and 2016. Data were obtained from the Forensic Pathology Services of the Western Cape Government. One-way analysis of variance was performed to detect a trend in mean drowning mortality rates between 2010 and 2016. χ2 tests for independence were performed to detect differences in the distribution of variables between groups.

RESULTS

A total of 1391 fatal drownings occurred in the Western Cape between 2010 and 2016, with an age-adjusted drowning mortality rate of 3.2 per 100 000 population. Rates were fourfold higher in men compared with women. Children, particularly young children aged 0-4 years, and young adult men between 20 and 34 years of age were identified to be at high risk of fatal drowning. Drowning occurred predominantly in large, open bodies of water with concentrations in summer and public holidays.

CONCLUSIONS

The Western Cape drowning prevention strategy should prioritise interventions to reduce drowning in children and young adult men, with a targeted focus on festive periods such as public holidays.

Pediatric First Aid Practices in Ghana: A Population-Based Survey

INTRODUCTION

Children in low- and middle-income countries (LMIC) often receive care outside the formal medical sector. Improving pre-hospital first aid has proven to be highly cost-effective in lowering trauma mortality. Few studies in LMIC have examined home first aid practices for injured children.

METHODS

We conducted a representative population-based survey of 200 caregivers of children under 18 years of age, representing 6520 households. Caregivers were interviewed about their first aid practices and care-seeking behaviors when a child sustained an injury at home. Injuries of interest included burns, lacerations, fractures and choking. Reported practices were characterized as recommended, low-risk, and potentially harmful.

RESULTS

For common injuries, 75-96% of caregivers reported employing a recommended practice (e.g., running cool water over a burn injury). However, for these same injuries, 13-61% of caregivers also identified potentially harmful management strategies (e.g., applying sand to a laceration). Choking had the highest proportion (96%) of recommended first aid practice: (e.g., hitting the child's back) and the lowest percent (13%) of potentially harmful practices (e.g., attempting manual removal). Fractures had the lowest percent (75%) of recommended practices (e.g., immediately bringing the child to a health facility). Burns had the highest percent (61%) of potentially harmful practices (e.g., applying kerosene).

CONCLUSIONS

While most caregivers were aware of helpful first aid practices to administer for a child injury, many parents also described potentially harmful practices or delays in seeking medical attention. As parents are the de facto first responders to childhood injury, there are opportunities to strengthen pre-hospital care for children in LMICs.

Nationwide study of injury-related deaths among children aged 1-4 years in China, 2000-2008

AIMS

The aims of this study are to investigate injury mortality in children aged 1-4 years, to analyse prevalent mortality rates of childhood injury and to identify the leading causes of child injury deaths in China from 2000 to 2008.

METHODS

The data were obtained from a nationwide mortality surveillance system for children under 5 years of age in China. The injury mortality rates of children aged 1-4 years were compared between rural and urban areas, boys and girls and among five major injury types between 2000 and 2008.

RESULTS

During the 9-year study period, the injury mortality rates for children aged 1-4 years declined significantly by an average of 5.4% each year (P < 0.001; 95% confidence interval (CI): 3.6-7.0%) overall in China, with a decrease of 4.8% (P < 0.001; 95% CI: 2.5-7.1%) and 9.9% (P < 0.001; 95% CI: 4.9-14.7%) in rural and urban areas, respectively. The proportion of injury-related deaths to total mortality rates dropped from 32.9% in 2000 to 18.8% in 2008 in urban areas but increased from 45.6% to 56.9% in rural areas. The injury mortality rates in both boys and girls decreased significantly by an average of 5.4% each year (P < 0.001; 95% CI: 2.6-8.0%) and 6.1% (P < 0.001; 95% CI: 2.7-9.4%), respectively. Drowning and traffic accidents were the most prevalent causes of injury-related deaths in children aged 1-4 years.

CONCLUSION

Childhood injury is still the leading cause of death in children aged 1-4 years in China. Drowning and traffic accidents were the most prevalent causes of childhood deaths in this study. Boys living in rural areas are at a higher risk and therefore require increased attention to help control and prevent childhood injury.

Child injury control: trends, themes, and controversies

Injury is a major cause of morbidity and mortality among US children, and an important driver of health status globally. Despite its enormous burden, injury is preventable. Over the last 10 years, significant progress has been made in the reduction of unintentional injury among US children. However, aggregate trends mask important disparities by age group, region, and injury mechanism. Basic and translation research is needed to develop and test prevention strategies to address these new or recalcitrant problems. Motor vehicle occupant injury has fallen to historic lows, but challenges remain in protecting novice drivers and managing the distraction of new technologies. Injury to pedestrians has also declined, but likely as a result of decreased exposure as fewer children walk. This calls for a broader public health perspective to promote activity while enhancing safety. Deaths due to drowning are common and illustrate the difficulty in measuring and promoting appropriate supervision. Environmental modification and use of protective products may be a more appropriate response. Concussion in sport is another challenging issue: public health laws promote identification and appropriate management of concussed athletes, but less progress has been made on primary prevention of these injuries. Unintentional poisoning is on the rise, attributable to misuse of, and overdose with, prescription opioids. Injury deaths to infants are also increasing. This trend is driven in part by better death investigation that classifies more sleep-related deaths as suffocation events. Finally, we examine a sample of cross-cutting themes and controversies in injury control that might be amenable to empiric evaluation.

Effectiveness of community participation in a surveillance system initiative to prevent drowning in Thailand

This study had a 2-group pre-post quasiexperimental design and was conducted in 2 selected areas of Ubon Ratchathani province, Thailand. The objective was to evaluate the extent to which the surveillance system that was developed helped in drowning prevention. The development process involved extensive participation from the community. System efficiency was evaluated, and the drowning rates were compared. The system demonstrated 82.8% system sensitivity and 87% positive-predictive value. There were 90.0% rescues with no injury during the study period. The relative risk of drowning injury suggests that the control area was at 5.6 times more at risk for drowning injury than the intervention area (95% CI = 1.58, 20.12). Local knowledge and participation from the community were found to be key issues in the success of the surveillance system, and such systems can be applied to other areas with similar problems.

Current trends and update on injury prevention

Injuries are a major and growing public health problem, a leading cause of death and disabilities among people aged 1-44 years around the world. Each year, 5.8 million people die from injuries, accounting for 10% of the world's deaths. Road traffic injuries (RTIs), self-inflicted injuries and violence are the top three leading causes of all injury deaths, while RTIs, falls and drowning are the top three leading causes of unintentional injury death. In many high-income countries, trends of injury death have been decreasing as a result of prevention measures. In contrast, trends in low- and middle-income countries have been rising. In this article, we review the prevention strategies for RTIs, violence, falls and drowning developed over decades to disseminate the knowledge and inform health care providers, especially acute care physicians, about the importance of injury prevention.