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BMC Public Health
Published in: BMC Public Health 1/2017

Open Access 01-12-2017 | Research article

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

Authors: Matthew D. Tyler, David B. Richards, Casper Reske-Nielsen, Omeed Saghafi, Erica A. Morse, Robert Carey, Gabrielle A. Jacquet

Published in: BMC Public Health | Issue 1/2017

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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.
Appendix
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Literature
1.
World Health Organization. Global report on drowning: preventing a leading killer. World Health Organization; 2014.
2.
3.
World Health Organization. World report on child injury prevention. World Health Organization; 2008.
4.
Linnan M, Anh LV, Cuong PV. Special series on child injury: child mortality and injury in Asia: survey results and evidence. UNICEF Innocenti Research Center: Florence, Italy; 2007.
5.
6.
Borse NN, Gilchrist J, Dellinger AM, Rudd RA, Ballesteros MF, Sleet DA. CDC childhood injury report: patterns of unintentional injuries among 0–19 year olds in the United States, 2000–2006. Atlanta: Centers For Disease Control and Prevention; 2008.
7.
Cummings P, Mueller BA, Quan L. Association between wearing a personal floatation device and death by drowning among recreational boaters: a matched cohort analysis of United States coast guard data. Injury prevention. 2011;17(3):156–9.CrossRefPubMed
8.
Peden M, McGee K, Sharma K. The injury chart book: a graphical overview of the global burden of injuries. Geneva: World Health Organization; 2002.
9.
Moran K, Quan L, Franklin R, Bennett E. Where the evidence and expert opinion meet: a review of open-water: recreational safety messages. Int J Aquatic Res Educ. 2011;5:251–70.
10.
Quan L, Bennett E, CM B. Interventions to prevent drowning. In: Haas EN, Doll LS, Bonzo SE, Sleet DA, Mercy JA, editors. Handbook of injury and violence prevention; 2007. p. 81–96.CrossRef
11.
Ramos W, Beale A, Chambers P, et al. Primary and Secondary Drowning Interventions: e American Red Cross Circle of Drowning Prevention and Chain of Drowning Survival. International Journal of Aquatic Research and Education. 2015;9(1):8.
12.
Szpilman D, Bierens JJ, Handley AJ, Orlowski JP. Drowning. The New England journal of medicine. May 31 2012;366(22):2102–2110.
13.
Hyder AA, Arifeen S, Begum N, Fishman S, Wali S, Baqui AH. Death from drowning: defining a new challenge for child survival in Bangladesh. Inj Control Saf Promot. 2003;10(4):205–10.CrossRefPubMed
14.
Leavy JE, Crawford G, Leaversuch F, Nimmo L, McCausland K, Jancey J. A review of drowning prevention interventions for children and young people in high, low and middle income countries. J Community Health. 2016;41(2):424–41.CrossRefPubMed
15.
16.
Prameprart M, Lim A, Tongkumchum P. Modeling unintentional drowning mortality rates in Thailand, 2000-2009. Asia Pac J Public Health. 2015;27(2):NP2471–9.CrossRefPubMed
17.
Canturk N, Es Iyok B, Ozkara E, Canturk G, Bulent Ozata A, Fatih YM. Medico-legal child deaths in Istanbul: data from the morgue department. Pediatrics international. 2007;49(1):88–93.CrossRefPubMed
18.
Davis S, Smith LS. The epidemiology of drowning in Cape Town--1980-1983. South African Medical Journal Nov 9 1985;68(10):739-742.
19.
Davoudi-Kiakalayeh A, Dalal K, Yousefzade-Chabok S, Jansson B, Mohammadi R. Costs related to drowning and near drowning in northern Iran (Guilan province). Ocean Coast Manag. 2011;54(3):250–5.CrossRef
20.
Davoudi-Kiakalayeh A, Mohammadi R, Yousefzade-Chabok S, Jansson B. Evaluation of a community-based drowning prevention programme in northern Islamic Republic of Iran. . Eastern Mediterranean Health Journal Jul 2013;19(7):629-637.
21.
22.
Halawa EF, Barakat A, Rizk HI, Moawad EM. Epidemiology of non-fatal injuries among Egyptian children: a community-based cross-sectional survey. BMC public health. Dec 17 2015;15:1248.
23.
Iqbal A, Shirin T, Ahmed T, et al. Childhood mortality due to drowning in rural Matlab of Bangladesh: magnitude of the problem and proposed solutions. J Health Popul Nutr. 2007;25(3):370–6.PubMedPubMedCentral
24.
Kanchan T, Menezes RG. Mortalities among children and adolescents in manipal, southern India. J Trauma. 2008;64(6):1600–7.CrossRefPubMed
25.
Kiakalayeh AD, Mohammadi R, Ekman DS, Chabok SY, Janson B. Unintentional drowning in northern Iran: a population-based study. Accid Anal Prev. 2008;40(6):1977–81.CrossRefPubMed
26.
Martins CB, Mello-Jorge MH. Circumstances and factors associated with accidental deaths among children, adolescents and young adults in Cuiaba, Brazil. Sao Paulo Medical Journal. 2013;131(4):228–37.CrossRefPubMed
27.
28.
Racz E, Konczol F, Meszaros H, et al. Drowning-related fatalities during a 5-year period (2008-2012) in South-West Hungary--a retrospective study. J Forensic Legal Med. 2015;31:7–11.CrossRef
29.
Rahman A, Mashreky SR, Chowdhury SM, et al. Analysis of the childhood fatal drowning situation in Bangladesh: exploring prevention measures for low-income countries. Injury prevention. 2009;15(2):75–9.CrossRefPubMed
30.
Saberi Anary SH, Sheikhazadi A, Ghadyani MH. Epidemiology of drowning in Mazandaran province, north of Iran. Am. J. Forensic Med. Pathol. 2010;31(3):236–42.CrossRefPubMed
31.
Suresh Kumar Shetty B, Shetty M. Epidemiology of drowning in Mangalore, a coastal Taluk of South India. J Forensic Legal Med Oct 2007;14(7):410-415.
32.
Turgut A. A study on multiple drowning syndromes. Int J Inj Control Saf Promot. 2012;19(1):63–7.CrossRef
33.
Yayci N, Pakis I, Karapirli M, Celik S, Uysal C, Polat O. The review of autopsy cases of accidental childhood deaths in Istanbul. J Forensic Legal Med. 2011;18(6):253–6.CrossRef
34.
Yusuf HR, Akhter HH, Rahman MH, Chowdhury ME, Rochat RW. Injury-related deaths among women aged 10-50 years in Bangladesh, 1996-97. Lancet (London, England). Apr 8 2000;355(9211):1220-1224.
35.
Bose A, George K, Joseph A. Drowning in childhood: a population based study. Indian Pediatr. 2000;37(1):80–3.PubMed
36.
Chasimpha S, McLean E, Chihana M, et al. Patterns and risk factors for deaths from external causes in rural Malawi over 10 years: a prospective population-based study. BMC Public Health Oct 09 2015;15:1036.
37.
Dirlik M, Bostancioglu B. Child drowning deaths in Aydin province, western Turkey, 2002-2012. European Journal of Trauma And Emergency Surgery. 2015;41(6):683–8.CrossRefPubMed
38.
Donson H, Van Niekerk A. Unintentional drowning in urban South Africa: a retrospective investigation, 2001-2005. Int J Inj Control Saf Promot. 2013;20(3):218–26.CrossRef
39.
Fang Y, Dai L, Jaung MS, Chen X, Yu S, Xiang H. Child drowning deaths in Xiamen city and suburbs, People's Republic of China, 2001 5. Injury prevention. 2007;13(5):339–43.CrossRefPubMedPubMedCentral
40.
Gawryszeski VP. Injury mortality report for Sao Paulo state, 2003. Sao Paulo Medical Journal. May 3 2007;125(3):139-143.
41.
Kibel SM, Nagel FO, Myers J, Cywes S. Childhood near-drowning--a 12-year retrospective review. South African Medical Journal Oct 6 1990;78(7):418-421.
42.
Kim DR, Ali M, Thiem VD, Wierzba TF. Socio-ecological risk factors for prime-age adult death in two coastal areas of Vietnam. PLoS One. 2014;9(2):e89780.CrossRefPubMedPubMedCentral
43.
Kitulwatte ID, Edirisinghe PA. Study on unnatural childhood deaths presented to North Colombo teaching hospital, Sri Lanka. Med Sci Law. 2014;54(2):74–7.CrossRefPubMed
44.
Knobel GJ, de Villiers JC, Parry CD, Botha JL. The causes of non-natural deaths in children over a 15-year period in greater Cape Town. South African Medical Journal Nov 24 1984;66(21):795-801.
45.
Lerer LB, Matzopoulos RG, Phillips R. Violence and injury mortality in the Cape Town metropole. . South African medical Mar 1997;87(3):298-301.
46.
Plitponkarnpim A, Andersson R, Hörte LG, Svanström L. Trend and current status of child injury fatalities in Thailand compared with Sweden and Japan. J Saf Res. 1999;30(3):163–71.CrossRef
47.
Pretorius K, Van Niekerk A. Childhood psychosocial development and fatal injuries in Gauteng, South Africa. Child Care Health Dev. 2015;41(1):35–44.CrossRefPubMed
48.
Razzak JA, Luby SP, Laflamme L, Chotani H. Injuries among children in Karachi, Pakistan--what, where and how. Public Health. 2004;118(2):114–20.CrossRefPubMed
49.
Roudsari BS, Shadman M, Ghodsi M. Childhood trauma fatality and resource allocation in injury control programs in a developing country. BMC Public Health. 2006;6:117.CrossRefPubMedPubMedCentral
50.
51.
Turgut A, Turgut T. A population-based study on deaths by drowning incidents in Turkey. Int J Inj Control Saf Promot. 2014;21(1):61–7.CrossRef
52.
Weldearegawi B, Ashebir Y, Gebeye E, et al. Emerging chronic non-communicable diseases in rural communities of northern Ethiopia: evidence using population-based verbal autopsy method in Kilite Awlaelo surveillance site. Health Policy Plan. 2013;28(8):891–8.CrossRefPubMed
53.
Yang L, Nong QQ, Li CL, Feng QM, Lo SK. Risk factors for childhood drowning in rural regions of a developing country: a case-control study. Injury prevention. 2007;13(3):178–82.CrossRefPubMedPubMedCentral
54.
Zolala F, Nasehi MM, Moosazadeh M, Azadeh H, Mirzajani M. Epidemiology of drowning in Mazandaran, Iran: a population based study. Middle-East J Sci Res. 2012;11(7):969–73.
55.
Baqui AH, Sabir AA, Begum N, Arifeen SE, Mitra SN, Black RE. Causes of childhood deaths in Bangladesh: an update. . Acta paediatrica (Oslo, Norway : 1992) Jun 2001;90(6):682-690.
56.
Blum LS, Khan R, Hyder AA, Shahanaj S, El Arifeen S, Baqui A. Childhood drowning in Matlab, Bangladesh: an in-depth exploration of community perceptions and practices. . Soc Sci Med May 2009;68(9):1720-1727.
57.
Borse NN, Hyder AA, Streatfield PK, Arifeen SE, Bishai D. Childhood drowning and traditional rescue measures: case study from Matlab, Bangladesh. Arch Dis Child. 2011;96(7):675–80.CrossRefPubMed
58.
59.
Jagnoor J, Bassani DG, Keay L, et al. Unintentional injury deaths among children younger than 5 years of age in India: a nationally representative study. Injury prevention. 2011;17(3):151–5.CrossRefPubMed
60.
Mosayebi Z, Movahedian AH, Mousavi GA. Drowning in children in Iran: outcomes and prognostic factors. Med J Malaysia. 2011;66(3):187–90.PubMed
61.
Rahman A, Giashuddin SM, Svanstrom L, Rahman F. Drowning--a major but neglected child health problem in rural Bangladesh: implications for low income countries. Int J Inj Control Saf Promot. 2006;13(2):101–5.CrossRef
62.
63.
Wang Y, He C, Li X, Miao L, Zhu J, Liang J. Nationwide study of injury-related deaths among children aged 1-4 years in China, 2000-2008. J Paediatr Child Health. 2014;50(10):E94–E101.CrossRefPubMed
64.
Guzel A, Duran L, Paksu S, et al. Drowning and near-drowning: experience of a university hospital in the Black Sea region. Turk J Pediatr. 2013;55(6):620–7.PubMed
65.
Hossain M, Mani KK, Sidik SM, Hayati KS, Rahman AK. Socio-demographic, environmental and caring risk factors for childhood drowning deaths in Bangladesh. BMC Pediatr Sep 10 2015;15:114.
66.
Joanknecht L, Argent AC, van Dijk M, van As AB. Childhood drowning in South Africa: local data should inform prevention strategies. Pediatr Surg Int. 2015;31(2):123–30.CrossRefPubMed
67.
Garrib A, Herbst AJ, Hosegood V, Newell ML. Injury mortality in rural South Africa 2000-2007: rates and associated factors. Tropical medicine & international health : TM & IH. 2011;16(4):439–46.CrossRef
68.
Kozik CA, Suntayakorn S, Vaughn DW, Suntayakorn C, Snitbhan R, Innis BL. Causes of death and unintentional injury among schoolchildren in Thailand. Southeast Asian J Trop Med Public Health. 1999;30(1):129–35.PubMed
69.
Siddique AK, Baqui AH, Eusof A, Zaman K. 1988 floods in Bangladesh: pattern of illness and causes of death. J Diarrhoeal Dis Res. 1991;9(4):310–4.PubMed
70.
Soori H, Naghavi M. Deaths from unintentional injuries in rural areas of the Islamic Republic of Iran. . Eastern Mediterranean health journal Jan 1999;5(1):55-60.
71.
Azmak D. Asphyxial deaths: a retrospective study and review of the literature. Am J Forensic Med Pathol. 2006;27(2):134–44.CrossRefPubMed
72.
Burrows S, van Niekerk A, Laflamme L. Fatal injuries among urban children in South Africa: risk distribution and potential for reduction. Bull World Health Organ. 2010;88(4):267–72.CrossRefPubMed
73.
Ma W, Xu Y, Xu X. Is drowning a serious public health problem in Guangdong Province, People's Republic of China?--results from a retrospective population-based survey, 2004-2005. Int J Inj Control Saf Promot. 2010;17(2):103–10.CrossRef
74.
Wyndham CH. Deaths from accidents, poisoning and violence--differences between the various population groups in the RSA. South African medical journal Apr 26 1986;69(9):556-558.
75.
Won KC, Mok RM, Kuo RS. The distribution of injury mortality of children aged 1 to 14 in GeeChen County. Chin J Prev Med. 1995:2958–60.
76.
77.
Bierens JJLM, editor. Handbook on drowning: prevention, rescue and treatment. Germany: Springer-Verlag; 2006.
78.
Ahmed MK, Rahman M, van Ginneken J. Epidemiology of child deaths due to drowning in Matlab, Bangladesh. Int J Epidemiol. 1999;28(2):306–11.CrossRefPubMed
79.
Susiva C, Boonrong T. Near-drowning in pediatric respiratory intensive care unit, Siriraj hospital. Journal of the Medical Association of Thailand Nov 2005;88 Suppl 8:S44-S47.
80.
Lunetta P, Smith GS, Penttila A, Sajantila A. Unintentional drowning in Finland 1970-2000: a population-based study. Int J Epidemiol. 2004;33(5):1053–63.CrossRefPubMed
81.
Present P. Child drowning study. A report on the epidemiology of drowning in residential pools to children under five.. Washington, DC: United States Consumer Prodict Safety Commission;1987.
82.
Brenner RA, Taneja GS, Haynie DL, et al. Association between swimming lessons and drowning in childhood: a case-control study. Arch Pediatr Adolesc Med. 2009;163(3):203–10.CrossRefPubMedPubMedCentral
83.
Idris AH, Berg RA, Bierens J, et al. Recommended guidelines for uniform reporting of data from drowning: the "Utstein style". Circulation. Nov 18 2003;108(20):2565-2574.
84.
Zhang PB, Chen RH, Cheng JY. An evaluation of the effectiveness of health education on drowning among children aged 0-4 in rural regions. Chin J Paediatri. 2003;41:498–500.
Metadata
Title
The epidemiology of drowning in low- and middle-income countries: a systematic review
Authors
Matthew D. Tyler
David B. Richards
Casper Reske-Nielsen
Omeed Saghafi
Erica A. Morse
Robert Carey
Gabrielle A. Jacquet
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2017
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-017-4239-2

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