Drowning prevention: a key concern for researchers and major health bodies

Drowning remains one of the greatest threats to mankind to date. The vast majority of drowning, approximately 90%, occur in freshwater such as rivers, lakes and domestic swimming pools, while 10% occur in seawater such as oceans. While drowning in other fluids is rare, people have been known to drown in waters as little as 30 mm in depth usually lying face down and children have been found drowned in bathtubs, buckets and toilets. Unintentional drowning is the third leading cause of unintentional injury deaths worldwide. Globally, about 372,000 people die from drowning each year and more than 40 people die from drowning every hour of the day. Drowning is one of the top 10 leading causes of death for children in every region of the world. In the USA, drowning is the leading cause of injury deaths for young children ages 1–14 years, and three children die every day as a result of drowning (Centers for Disease Control and Prevention, 2017). In fact, drowning kills more children ages 1–4 years than anything else except birth defects. However, drowning is predictable and largely preventable.

In earlier issues of the Journal, two editorials discussed the importance of drowning, along with several important safety measures (Forjuoh, 2011, 2013). In the current issue, five original articles focus on various aspects of drowning using research from Australia, France, New Zealand and Uganda. The articles span from the epidemiology of drowning to safety education around bodies of water. In the first article, Matthews, Andrew, Andronaco, Cox, and Smith (2016) conducted a retrospective review of data from fatal and nonfatal drowning cases attended by Ambulance Victoria paramedics in the pre-hospital environment over a six-year period from 2007 to 2012. The findings revealed the lethality of drowning, with a case-fatality rate of 33.4%. In addition, children ages 0–4 years were observed to experience the highest fatality rate, corroborating earlier findings and the need to focus drowning preventive measures on children. The preponderance of drowning among children is grounded in their basic anatomy, physiology and developmental differences, for example, their lack of sense of fear.

Given the preponderance of drowning among children, the Centers for Disease Control and Prevention (2017) has appropriately formulated some key prevention tips for child drowning prevention:

○	Learn life-saving skills: Everyone should know the basics of swimming (floating, moving through the water) and cardiopulmonary resuscitation.
○	Fence it off: Install a four-sided isolation fence, with self-closing and self-latching gates, around backyard swimming pools. This can help to keep children away from the area when they are not supposed to be swimming. Pool fences should completely separate the house and play area from the pool.
○	Make life jackets a must: Make sure kids wear life jackets in and around natural bodies of water, such as lakes or the ocean, even if they know how to swim. Life jackets can be used in and around pools for weaker swimmers too.
○	Be vigilant and on the look-out: When kids are in or near water (including bathtubs), closely supervise them at all times. Because drowning happens quickly and quietly, adults watching kids in or near water should avoid distracting activities like playing cards, reading books, talking on the phone and using alcohol or drugs.

Kobusingye, Tumwesigye, Magoola, Atuyambe, and Olange (2016) also determined the drowning burden in four Ugandan lakeside districts in a community-based survey focusing on young adults and found similar results: a high fatality rate of 502 per 100,000 population, with the majority of drowning events occurring during transportation or fishing. Additional disturbing findings uncovered in this study included the fact that more than 50% of their respondents could not swim and the vast majority did not know how to call for rescue, while only 26.1% were observed wearing a life jacket during their disembarkation from their fishing boats. Indeed, few preventive interventions were found in place in these four Ugandan lakeside districts!

The study by Kobusingye et al. (2016) underscores the need to also focus drowning preventive efforts on other age groups. Therefore, in addition to the Centers for Disease Control and Prevention's key prevention tips for childhood drowning prevention, the World Health Organization's (2014) formulation on some 10 action items to help prevent drowning in all age groups including community-based actions, effective policies and legislation, and a consideration for further research is worth mentioning:

(1)	Install barriers controlling access to water.
(2)	Provide safe places (for example, a crèche) away from water for pre-school children, with capable child care.
(3)	Teach school-age children basic swimming, water safety and safe rescue skills.
(4)	Train bystanders in safe rescue and resuscitation.
(5)	Strengthen public awareness of drowning and highlight the vulnerability of children.
(6)	Set and enforce safe boating, shipping and ferry regulations.
(7)	Build resilience and manage flood risks and other hazards locally and nationally.
(8)	Coordinate drowning prevention efforts with those of other sectors and agendas.
(9)	Develop a national water safety plan.
(10)	Address priority research questions with well-designed studies.

The findings from the article by Vignac, Lebihain, and Soule (2016) reveal the lapses in supervision even at public swimming pools. They found that supervision was not carried out 18% of the time or was found to be inadequate 33% of the time. Aquatic education, particularly to the youth, has the potential to save lives. Simple basic beach safety education for school children has been found to improve children's ability to cope with drowning emergencies as shown by the study by Wilks, Kanasa, Pendergast, and Clark (2016). Similarly, educating the general public about aquatic safety may translate to health care cost savings as evidenced by the study by Moran, Webber, and Stanley (2016).