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      The epidemiology of drowning in low- and middle-income countries: a systematic review

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          Abstract

          Background

          According to the World Health Organization, drowning is the 3rd leading cause of unintentional injury-related deaths worldwide, accounting for 370,000 annual deaths and 7% of all injury-related deaths. Low- and middle-income countries are the most affected, accounting for 91% of unintentional drowning deaths.

          Methods

          The authors performed a systematic review of literature indexed in EMBASE, PubMed, Web of Science, Cochrane Library, and Traumatology journals formerly indexed in PubMed in January 2014 and again in September 2016. Abstracts were limited to human studies in English, conducted in low- and middle-income countries, and containing quantitative data on drowning epidemiology.

          Results

          A total of 62 articles met inclusion criteria. The majority of articles originate from Asia (56%) and Africa (26%). Risk factors for drowning included young age (<17–20 years old), male gender (75% vs. 25% female), rural environment (84% vs. 16% urban), occurring in the daytime (95% vs. 5% night time), lack of adult supervision (76% vs. 18% supervised), and limited swimming ability (86% vs. 10% with swimming ability). There was almost equal risk of drowning in a small body of water versus a large body of water (42% ponds, ditches, streams, wells; 46% lakes, rivers, sea, ocean).

          Conclusion

          Drowning is a significant cause of injury-related deaths, especially in LMICs. Young males who are unsupervised in rural areas and have limited formal swimming instruction are at greatest risk of drowning in small bodies of water around their homes. Preventative strategies include covering wells and cisterns, fencing off ditches and small ponds, establishing community daycares, providing formal swimming lessons, and increasing awareness of the risks of drowning.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s12889-017-4239-2) contains supplementary material, which is available to authorized users.

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          Most cited references77

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          Drowning.

          David Szpilman, Joost J.L.M. Bierens, Anthony J Handley … (2012)
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            Injury patterns in rural and urban Uganda.

            O Kobusingye, R Lett, D Guwatudde (2001)
            To describe and contrast injury patterns in rural and urban Uganda. One rural and one urban community in Uganda. Community health workers interviewed adult respondents in households selected by multistage sampling, using a standardized questionnaire. In the rural setting, 1,673 households, with 7,427 persons, were surveyed. Injuries had an annual mortality rate of 92/100,000 persons, and disabilities a prevalence proportion of 0.7%. In the urban setting 2,322 households, with 10,982 people, were surveyed. Injuries had an annual mortality rate of 217/100,000, and injury disabilities a prevalence proportion of 2.8%. The total incidence of fatal, disabling, and recovered injuries was 116/1,000/year. Leading causes of death were drowning in the rural setting, and road traffic in the city. Injuries are a substantial burden in Uganda, with much higher rates than those in most Western countries. The urban population is at a higher risk than the rural population, and the patterns of injury differ. Interventions to control injuries should be a priority in Uganda.
            Article 0 comments Cited 63 times – based on 0 reviews     Review now
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              Association between swimming lessons and drowning in childhood: a case-control study.

              Ruth A Brenner, Gitanjali Saluja Taneja, Denise L Haynie … (2009)
              To estimate the association between swimming lessons and the risk of drowning among children aged 1 to 19 years. Case-control study. Cases were identified from medical examiners'/coroners' offices between mid-2003 and mid-2005. Jurisdictions included the states of Maryland and North Carolina, 14 districts (33 counties) in Florida, 3 counties in California, 1 county in Texas, and 1 county in New York. Cases were children and adolescents aged 1 to 19 years who died of unintentional drowning. Interviews were conducted with 88 families of children who drowned and 213 matched controls. Main Exposure Swimming lessons. Main Outcome Measure Death due to unintentional drowning. Drownings that were intentional, of undetermined intent, or that occurred under conditions in which swimming ability was unlikely to impact risk (eg, in ice water or bathtubs) were excluded. Of the 61 cases in the 1- to 4-year age group, 2 (3%) had participated in formal swimming lessons vs 35 of 134 matched controls (26%) (adjusted odds ratio [OR], 0.12; 95% confidence interval [CI], 0.01-0.97). Among the 27 cases aged 5 to 19 years, 7 (27%) had ever taken formal swimming lessons vs 42 of 79 matched controls (53%) (adjusted OR, 0.36; 95% CI, 0.09-1.51). In adjusted analyses, there was no statistically significant association between informal instruction and drowning risk. Participation in formal swimming lessons was associated with an 88% reduction in the risk of drowning in the 1- to 4-year-old children, although our estimates were imprecise and 95% CIs included risk reductions ranging from 3% to 99%.
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                Author and article information

                Contributors
                Matthew D. Tyler: mdtyler4@gmail.com
                David B. Richards: david.richards@dhha.org
                Casper Reske-Nielsen: creskeni@gmail.com
                Omeed Saghafi: osaghafi@gmail.com
                Erica A. Morse: ericaashleymorse@gmail.com
                Robert Carey: carey.bobby@gmail.com
                Gabrielle A. Jacquet: gabrielle.jacquet@gmail.com
                Journal
                Journal ID (nlm-ta): BMC Public Health
                Journal ID (iso-abbrev): BMC Public Health
                Title: BMC Public Health
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1471-2458
                Publication date (Electronic): 8 May 2017
                Publication date PMC-release: 8 May 2017
                Publication date Collection: 2017
                Volume: 17
                Electronic Location Identifier: 413
                Affiliations
                [1 ]ISNI 0000 0001 2183 6745, GRID grid.239424.a, , Boston Medical Center, ; Boston, USA
                [2 ]ISNI 0000 0001 0369 638X, GRID grid.239638.5, , Denver Health Medical Center, ; Denver, USA
                [3 ]ISNI 0000 0004 0367 5222, GRID grid.475010.7, , Boston University School of Medicine, ; Boston, USA
                Article
                Publisher ID: 4239
                DOI: 10.1186/s12889-017-4239-2
                PMC ID: 5423024
                PubMed ID: 28482868
                SO-VID: ca3e097b-769b-4e48-bb5b-c50286ab63ba
                Copyright © © The Author(s). 2017
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 11 August 2016
                Date accepted : 6 April 2017
                Categories
                Subject: Research Article
                Custom metadata
                issue-copyright-statement © The Author(s) 2017

                ScienceOpen disciplines: Public health
                Keywords: drowning,injury,epidemiology,low and middle-income countries,systematic review,drowning prevention,public health
                Data availability:
                ScienceOpen disciplines: Public health
                Keywords: drowning, injury, epidemiology, low and middle-income countries, systematic review, drowning prevention, public health

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