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      Drowning prevention: turning the tide on a leading killer

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          Summary

          Drowning is a leading killer, particularly of children and young adults, yet has been greatly neglected. Despite accounting for a higher number of deaths than many other substantial public health issues, drowning has not benefitted from the targeted attention it requires, which is particularly tragic because low cost and effective drowning prevention interventions exist. Therefore, the recent UN General Assembly's adoption of a resolution on global drowning prevention is a historic first, and offers an exciting opportunity by providing a comprehensive framework and a practical roadmap that a range of actors and sectors, including governments, can follow to address the challenge of drowning prevention.

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          The Human Impact of Floods: a Historical Review of Events 1980-2009 and Systematic Literature Review

          Shannon Doocy, Amy M Daniels, Sarah H Murray … (2013)
          Background. Floods are the most common natural disaster and the leading cause of natural disaster fatalities worldwide. Risk of catastrophic losses due to flooding is significant given deforestation and the increasing proximity of large populations to coastal areas, river basins and lakeshores. The objectives of this review were to describe the impact of flood events on human populations in terms of mortality, injury, and displacement and, to the extent possible, identify risk factors associated with these outcomes. This is one of five reviews on the human impact of natural disasters Methods. Data on the impact of floods were compiled using two methods, a historical review of flood events from 1980 to 2009 from multiple databases and a systematic literature review of publications ending in October 2012. Analysis included descriptive statistics, bivariate tests for associations and multinomial logistic regression of flood characteristics and mortality using Stata 11.0. Findings. There were 539,811 deaths (range: 510,941 to 568,680), 361,974 injuries and 2,821,895,005 people affected by floods between 1980 and 2009. Inconsistent reporting suggests this is an underestimate, particularly in terms of the injured and affected populations. The primary cause of flood-related mortality is drowning; in developed countries being in a motor-vehicle and male gender are associated with increased mortality, whereas female gender may be linked to higher mortality in low-income countries. Conclusions. Expanded monitoring of floods, improved mitigation measures, and effective communication with civil authorities and vulnerable populations has the potential to reduce loss of life in future flood events.
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            Cost-effectiveness of an injury and drowning prevention program in Bangladesh.

            F. Rahman, S. Bose, M Linnan … (2012)
            Interventions that mitigate drowning risk in developing countries are needed. This study presents the cost-effectiveness of a low-cost, scalable injury and drowning prevention program called Prevention of Child Injuries through Social-Intervention and Education (PRECISE) in Bangladesh. Between 2006 and 2010, the 2 components of PRECISE (Anchal, which sequestered children in crèches [n = 18 596 participants], and SwimSafe, which taught children how to swim [n = 79421 participants]) were implemented in rural Bangladesh. Mortality rates for participants were compared against a matched sample of nonparticipants in a retrospective cohort analysis. Effectiveness was calculated via Cox proportional hazard analysis. Cost-effectiveness was estimated according to World Health Organization-CHOosing Interventions that are Cost Effective guidelines. Anchal costs between $50.74 and $60.50 per child per year. SwimSafe costs $13.46 per child. For Anchal participants, the relative risk of a drowning death was 0.181 (P = .004). The relative risk of all-cause mortality was 0.56 (P = .001). For SwimSafe, the relative risk of a drowning death was 0.072 (P < .0001). The relative risk of all-cause mortality was 0.750 (P = .024). For Anchal, the cost per disability-adjusted life-year (DALY) averted is $812 (95% confidence interval: $589\x{2013}$1777). For SwimSafe, the cost per DALY averted is $85 ($51\x{2013}$561). Combined, the cost per DALY averted is $362 ($232\x{2013}$1364). Based on World Health Organization criteria, PRECISE is very cost-effective and should be considered for implementation in other areas where drowning is a significant problem.
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              Unintentional drowning in Finland 1970-2000: a population-based study.

              Antti Penttila, Antti Sajantila, Philippe Lunetta … (2004)
              While standard data on drowning reported by the World Health Organization (WHO) fails to provide a reliable picture of the burden of drowning in Finland, they suggest that the rates are much higher than those of other industrialized countries. To determine the true burden of drowning in Finland and factors related to its high rates. Descriptive, retrospective, population-based analysis of all deaths by drowning, among residents of all ages. Finland, 1970-2000. Mortality and population data furnished by Statistics Finland (SF) were used to determine age- and sex-specific drowning mortality rates using both nature- and cause-of-injury codes. Individual-level data from the death certificates were analysed and cross-linked to a nationwide postmortem toxicology database. From 1970 to 2000, 9279 unintentional drownings occurred (mean: 299.3/year SD 84.3, rate 6.1/100 000/year; M:F ratio = 8.6:1), accounting for 11.7% of all unintentional injury deaths. Drowning rates overall have decreased from 9.9/100 000/year in 1970-1972, to 4.5 in 1998-2000 (-2.7%/year; 95% CL: -3.0; -2.5). The most frequent activities related to drowning included boating (29.8%), falling (26.1%), swimming (25.0%), and activities on ice (12.4%). In non-boating-related drownings, 74.5% of males and 67.4% of females tested had a blood alcohol concentration (BAC) >/=50 mg/dl, while in boating-related drownings, the respective values were 78.1% and 71.4%. WHO statistics underestimate the true burden of drowning in Finland by up to 40-50%. Drowning rates and alcohol involvement in drowning are much higher than in other comparable developed countries. Broad-based countermeasures to reduce alcohol use in water activities are needed as part of any strategy to reduce drowning rates.
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                Author and article information

                Contributors
                David R Meddings
                Journal
                Journal ID (nlm-ta): Lancet Public Health
                Journal ID (iso-abbrev): Lancet Public Health
                Title: The Lancet. Public Health
                Publisher: Elsevier, Ltd
                ISSN (Electronic): 2468-2667
                Publication date PMC-release: 24 July 2021
                Publication date Collection: September 2021
                Publication date (Electronic): 24 July 2021
                Volume: 6
                Issue: 9
                Pages: e692-e695
                Affiliations
                [a ]WHO, Geneva, Switzerland
                [b ]International Life Saving Federation, Leuven, Belgium
                [c ]Bloomberg Philanthropies, New York, USA
                [d ]Royal National Lifeboat Institution, Poole, UK
                Author notes
                [* ]Correspondence to: Dr David R Meddings, WHO, 1202 Geneva, Switzerland meddingsd@ 123456who.int
                Article
                Publisher Item ID: S2468-2667(21)00165-1
                DOI: 10.1016/S2468-2667(21)00165-1
                PMC ID: 8391011
                PubMed ID: 34310906
                SO-VID: 5e035e0b-622f-4fa3-849b-e43810cf8dff
                Copyright © © 2021 World Health Organization
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/).

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