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Jalalifar S, Belford A, Erfani E, Razmjou A, Abbassi R, Mohseni-Dargah M, Asadnia M. Enhancing Water Safety: Exploring Recent Technological Approaches for Drowning Detection. SENSORS (BASEL, SWITZERLAND) 2024; 24:331. [PMID: 38257424 PMCID: PMC10820385 DOI: 10.3390/s24020331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/17/2023] [Accepted: 12/26/2023] [Indexed: 01/24/2024]
Abstract
Drowning poses a significant threat, resulting in unexpected injuries and fatalities. To promote water sports activities, it is crucial to develop surveillance systems that enhance safety around pools and waterways. This paper presents an overview of recent advancements in drowning detection, with a specific focus on image processing and sensor-based methods. Furthermore, the potential of artificial intelligence (AI), machine learning algorithms (MLAs), and robotics technology in this field is explored. The review examines the technological challenges, benefits, and drawbacks associated with these approaches. The findings reveal that image processing and sensor-based technologies are the most effective approaches for drowning detection systems. However, the image-processing approach requires substantial resources and sophisticated MLAs, making it costly and complex to implement. Conversely, sensor-based approaches offer practical, cost-effective, and widely applicable solutions for drowning detection. These approaches involve data transmission from the swimmer's condition to the processing unit through sensing technology, utilising both wired and wireless communication channels. This paper explores the recent developments in drowning detection systems while considering costs, complexity, and practicality in selecting and implementing such systems. The assessment of various technological approaches contributes to ongoing efforts aimed at improving water safety and reducing the risks associated with drowning incidents.
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Affiliation(s)
- Salman Jalalifar
- School of Engineering, Macquarie University, Sydney, NSW 2109, Australia; (S.J.); (A.B.); (R.A.); (M.M.-D.)
| | - Andrew Belford
- School of Engineering, Macquarie University, Sydney, NSW 2109, Australia; (S.J.); (A.B.); (R.A.); (M.M.-D.)
| | - Eila Erfani
- School of Information Systems and Technology Management, University of New South Wales, Sydney, NSW 1466, Australia;
| | - Amir Razmjou
- School of Engineering, Edith Cowan University, Perth, WA 6027, Australia;
| | - Rouzbeh Abbassi
- School of Engineering, Macquarie University, Sydney, NSW 2109, Australia; (S.J.); (A.B.); (R.A.); (M.M.-D.)
| | - Masoud Mohseni-Dargah
- School of Engineering, Macquarie University, Sydney, NSW 2109, Australia; (S.J.); (A.B.); (R.A.); (M.M.-D.)
| | - Mohsen Asadnia
- School of Engineering, Macquarie University, Sydney, NSW 2109, Australia; (S.J.); (A.B.); (R.A.); (M.M.-D.)
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Ross AG, Agresta B, McKay M, Pappas E, Cheng T, Peek K. Financial burden of anterior cruciate ligament reconstructions in football (soccer) players: an Australian cost of injury study. Inj Prev 2023; 29:474-481. [PMID: 37666517 DOI: 10.1136/ip-2023-044885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 08/02/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVES To estimate the financial burden of anterior cruciate ligament (ACL) reconstructions in amateur football (soccer) players in Australia over a single year, including both direct and indirect cost. METHODS Available national direct and indirect cost data were applied to the annual incidence of ACL reconstructions in Australia. Age-adjusted and sex-adjusted total and mean costs (ACL and osteoarthritis (OA)) were calculated for amateur football (soccer) players in Australia using an incidence-based approach. RESULTS The estimated cost of ACL reconstructions for amateur football players is $A69 623 211 with a mean total cost of $A34 079. The mean indirect costs are 19.8% higher than the mean direct costs. The mean indirect costs are lower in female (11.5%, $A28 628) and junior (15.3%, $A29 077) football players. The mean ACL costs are 3-4-fold greater than the mean OA costs ($A27 099 vs $A6450, respectively), remaining consistent when stratified by sex and age group. Our model suggests that for every 10% increase in adherence to injury prevention programmes, which equates to approximately 102 less ACL injuries per year, $A9 460 224 in ACL costs could be saved. CONCLUSION While the number of ACL reconstructions per year among football players in Australia is relatively small, the annual financial burden is high. Our study suggests that if injury prevention exercises programmes are prioritised by stakeholders in football, significant cost-savings are possible.
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Affiliation(s)
- Andrew George Ross
- Discipline of Physiotherapy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Blaise Agresta
- Health Economics and Health Technology Assessment, NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Marnee McKay
- Discipline of Physiotherapy, The University of Sydney, Sydney, New South Wales, Australia
| | - Evangelos Pappas
- School of Medicine and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Tegan Cheng
- Faculty of Medicine and Health & Children's Hospital at Westmead, University of Sydney School of Health Sciences, Sydney, New South Wales, Australia
| | - Kerry Peek
- Discipline of Physiotherapy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Koon W, Peden AE, Brander RW. Impact of a surfer rescue training program in Australia and New Zealand: a mixed methods evaluation. BMC Public Health 2023; 23:2193. [PMID: 37940894 PMCID: PMC10631059 DOI: 10.1186/s12889-023-17057-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 10/24/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Surfers play a critical role in coastal drowning prevention, conservatively estimated to make as many rescues as beach lifeguards. The Surfer Rescue 24/7 (SR24/7) program is a coastal safety intervention in Australia and New Zealand that teaches surfers safe rescue skills and promotes prevention activities. This multi-part, mixed-methods study aimed to evaluate the impact of the SR24/7 program. METHODS The study consisted of three parts employing quantitative and qualitative methods: a retrospective survey of course participants, in-depth interviews with course participants who had conducted rescues, and an analysis of self-reported skills confidence ratings before and after the program. RESULTS Triangulated results from the three study components indicated that after the course, participants exhibited high levels of satisfaction with their experience in the program and would encourage others to attend, were more observant and aware of safety concerns while surfing, had a better understanding of ocean conditions and hazards, learned new rescue techniques and skills, grasped important course concepts related to their own personal safety, and improved their confidence in responding to an emergency situation. Several participants had conducted rescues in real life and indicated that the course was effective in providing them with the baseline knowledge and skills to keep safe while helping others in the ocean. This study also provides new insight on the role of surfers in coastal safety, specifically that surfers are engaged in a range of prevention activities before rescue is required. CONCLUSIONS Despite persistent challenges in combating coastal drowning rates, the SR24/7 program is an effective intervention that helps save lives. Importantly, this study provides evidence that the course successfully equips surfers with techniques to act responsibly and safely. Expanding coastal safety focus and resources towards surfers, an often-overlooked demographic in beach safety strategies, could substantially enhance community-level capacity to prevent and respond to ocean emergencies.
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Affiliation(s)
- William Koon
- School of Biological Earth and Environmental Sciences, University of New South Wales, Kensington NSW 2052, Sydney, NSW, Australia.
- Beach Safety Research Group, University of New South Wales, Sydney, NSW, Australia.
| | - Amy E Peden
- Beach Safety Research Group, University of New South Wales, Sydney, NSW, Australia
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Robert W Brander
- School of Biological Earth and Environmental Sciences, University of New South Wales, Kensington NSW 2052, Sydney, NSW, Australia
- Beach Safety Research Group, University of New South Wales, Sydney, NSW, Australia
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Yadav J, Tripathi N, Menon GR, Nair S, Singh J, Singh R, Rao MVV. Measuring the financial impact of disabilities in India (an analysis of national sample survey data). PLoS One 2023; 18:e0292592. [PMID: 37824482 PMCID: PMC10569625 DOI: 10.1371/journal.pone.0292592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 09/25/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND People with disabilities are vulnerable because of the many challenges they face attitudinal, physical, and financial. The National Policy for Persons with Disabilities (2006) recognizes that Persons with Disabilities are valuable human resources for the country and seeks to create an environment that provides equal opportunities, and protection of their rights, and full. There are limited studies on health care burden due to disabilities of various types. AIM The present study examines the socioeconomic and state-wise differences in the prevalence of disabilities and related household financial burden in India. METHODS Data for this study was obtained from the National Sample Survey (NSS), 76th round Persons with Disabilities in India Survey 2018. The survey covered a sample of 1,18,152 households, 5,76,569 individuals, of which 1,06,894 of had any disability. This study performed descriptive statistics, and bivariate estimates. RESULTS The finding of the analysis showed that prevalence of disability of any kind was 22 persons per 1000. Around, one-fifth (20.32%) of the household's monthly consumption expenditure was spent on out-of-pocket expenditure for disability. More than half (57.1%) of the households were pushed to catastrophic health expenditure due to one of the members being disabled. Almost one-fifth (19.1%) of the households who were above the poverty line before one of members was treated for disability were pushed below the poverty line after the expenditure of the treatment and average percentage shortfall in income from the poverty line was 11.0 percent due to disability treatment care expenditure. CONCLUSION The study provides an insight on the socioeconomic differentials in out-of-pocket expenditure, catastrophic expenditure for treatment of any kind of disability. To attain SDG goal 3 that advocates healthy life and promote well-being for all at all ages, there is a need to recognize the disadvantaged and due to disability.
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Affiliation(s)
- Jeetendra Yadav
- ICMR-National Institute of Medical Statistics (NIMS), New Delhi, India
| | - Niharika Tripathi
- Department of Sociology, Indraprastha College for Women, University of Delhi, New Delhi, India
| | - Geetha R. Menon
- ICMR-National Institute of Medical Statistics (NIMS), New Delhi, India
| | - Saritha Nair
- ICMR-National Institute of Medical Statistics (NIMS), New Delhi, India
| | - Jitenkumar Singh
- ICMR-National Institute of Medical Statistics (NIMS), New Delhi, India
| | - Ravinder Singh
- Indian Council of Medical Research (ICMR), New Delhi, India
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Peden AE, Willcox-Pidgeon S, Scarr JP, Franklin RC. Lessons learned through the 20-year development of a national fatal drowning database in Australia. BMC Public Health 2023; 23:1499. [PMID: 37550757 PMCID: PMC10408144 DOI: 10.1186/s12889-023-16392-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/26/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Co-ordinated, evidence-based policy and programmatic efforts are needed to respond to complex drowning prevention problems. Comprehensive, current, and robust data are vital for agenda setting, burden and risk factor identification, intervention design and evaluation, as well as setting policy. We aim to record methods used in, and identify impacts of, the development of a national fatal drowning database (NFDD) in Australia, including lessons learned across research, policy, and practice. METHODS We employ a case study method using process mapping and document review to explore the evolution, drivers and impacts of the NFDD. We analyse methodological approaches including those relating to data definitions, drowning case collection, and management, as well as tracking the various outputs of the NFDD. We describe a development timeline that presents impact of drowning prevention policy, and research agendas on database development, and research investments more specifically. RESULTS Our study identified that the collected variables grew 20-fold from 2002 to 2022, reaching 259 variables, and 5,692 unique cases of fatal drowning. The NFDD employs data triangulation methodology, combining keyword and targeted searches of coronial files, media report monitoring, and organisational data provision. Database development is influenced by the Australia Water Safety Strategy, policymaker and practitioner-initiated research agendas, and identification of knowledge gaps. We identified numerous outputs spanning publications, media, intervention development, and legislative submissions. CONCLUSION A comprehensive and robust NFDD informed by policymaker and practitioner input can enhance surveillance, policy, and intervention development for drowning prevention. Employing mixed data collection and validation methods can supplement weaknesses in official data sources. There is a need for the NFDD to continue to evolve in its application while maintaining rigorous case identification and data quality assurance processes. Despite significant investment, the outputs and influence on drowning prevention practice in Australia has been extremely valuable and contributed to sizeable reductions in Australia's fatal drowning rate.
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Affiliation(s)
- Amy E Peden
- Royal Life Saving Society - Australia, Broadway, NSW, 2007, Australia.
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Kensington, NSW, 2052, Australia.
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, 4811, Australia.
| | - Stacey Willcox-Pidgeon
- Royal Life Saving Society - Australia, Broadway, NSW, 2007, Australia
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, 4811, Australia
| | - Justin-Paul Scarr
- Royal Life Saving Society - Australia, Broadway, NSW, 2007, Australia
| | - Richard C Franklin
- Royal Life Saving Society - Australia, Broadway, NSW, 2007, Australia
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, 4811, Australia
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Stickley A, Baburin A, Jasilionis D, Krumins J, Martikainen P, Kondo N, Shin JI, Inoue Y, Leinsalu M. Sociodemographic inequalities in mortality from drowning in the Baltic countries and Finland in 2000-2015: a register-based study. BMC Public Health 2023; 23:1103. [PMID: 37286978 DOI: 10.1186/s12889-023-15999-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 05/27/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Drowning is an important public health problem. Some evidence suggests that the risk of drowning is not distributed evenly across the general population. However, there has been comparatively little research on inequalities in drowning mortality. To address this deficit, this study examined trends and sociodemographic inequalities in mortality from unintentional drowning in the Baltic countries and Finland in 2000-2015. METHODS Data for Estonia, Latvia and Lithuania came from longitudinal mortality follow-up studies of population censuses in 2000/2001 and 2011, while corresponding data for Finland were obtained from the longitudinal register-based population data file of Statistics Finland. Deaths from drowning (ICD-10 codes W65-W74) were obtained from national mortality registries. Information was also obtained on socioeconomic status (educational level) and urban-rural residence. Age-standardised mortality rates (ASMRs) per 100 000 person years and mortality rate ratios were calculated for adults aged 30-74 years old. Poisson regression analysis was performed to assess the independent effects of sex, urban-rural residence and education on drowning mortality. RESULTS Drowning ASMRs were significantly higher in the Baltic countries than in Finland but declined by nearly 30% in all countries across the study period. There were large inequalities by sex, urban-rural residence and educational level in all countries during 2000-2015. Men, rural residents and low educated individuals had substantially higher drowning ASMRs compared to their counterparts. Absolute and relative inequalities were significantly larger in the Baltic countries than in Finland. Absolute inequalities in drowning mortality declined in all countries across the study period except between urban and rural residents in Finland. Changes in relative inequalities were more variable during 2000-2015. CONCLUSION Despite a sharp reduction in deaths from drowning in the Baltic countries and Finland in 2000-2015, drowning mortality was still high in these countries at the end of the study period with a substantially larger risk of death seen among men, rural residents and low educated individuals. A concerted effort to prevent drowning mortality among those most at risk may reduce drownings considerably in the general population.
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Affiliation(s)
- Andrew Stickley
- Stockholm Centre for Health and Social Change, Södertörn University, Huddinge, 141 89, Sweden
- Department of Social Epidemiology, Graduate School of Medicine, School of Public Health, Kyoto University, Kyoto, Japan
| | - Aleksei Baburin
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - Domantas Jasilionis
- Max Planck Institute for Demographic Research, Rostock, Germany
- Demographic Research Centre, Vytautas Magnus University, Kaunas, Lithuania
| | - Juris Krumins
- Demography Unit, Faculty of Business, Management and Economics, University of Latvia, Riga, Latvia
| | - Pekka Martikainen
- Max Planck Institute for Demographic Research, Rostock, Germany
- Population Research Unit, University of Helsinki, Helsinki, Finland
| | - Naoki Kondo
- Department of Social Epidemiology, Graduate School of Medicine, School of Public Health, Kyoto University, Kyoto, Japan
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Yonsei-ro 50, Seodaemun- gu, Seoul, Korea
| | - Yosuke Inoue
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Mall Leinsalu
- Stockholm Centre for Health and Social Change, Södertörn University, Huddinge, 141 89, Sweden.
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia.
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Macniven R, Angell B, Srinivasan N, Awati K, Chatman J, Peden AE. Evaluation of the First Lap learn to swim voucher programme: protocol. Inj Prev 2023; 29:188-194. [PMID: 36344270 DOI: 10.1136/ip-2022-044711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 10/19/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Swimming skills are an evidence-based component of drowning prevention. However, in Australia, many children miss out on learn to swim education. Voucher programmes may reduce swimming lesson cost and increase participation, especially among priority populations. The First Lap voucher programme provides two New South Wales state government-funded $100 vouchers for parents/carers of preschool children to contribute to swimming lesson costs. This evaluation aims to determine the effectiveness of the programme in meeting objectives of increasing preschool-aged children participating in learn to swim programmes and building parent/carer knowledge and awareness of the importance of preschool-aged children learning to swim. METHODS AND ANALYSIS A programme logic model was developed to explain the inputs, activities and intended outputs, and outcomes, which guided this mixed-methods evaluation design of quantitative and qualitative analysis within an impact/outcome evaluation. Baseline sociodemographic registration data will be provided by the parent/carer of each child participant and linked to swim school provider data on voucher redemption. Data will be collected on voucher use, knowledge, and attitudes to swimming lessons at registration and across two surveys. An economic evaluation will assess programme cost-effectiveness. CONCLUSION This evaluation will determine impacts on participation rates in learn to swim programmes, particularly within priority populations. It will examine whether the programme has influenced attitudes and motivations of parents and carers toward learn to swim programmes and water safety, whether the programme has impacted or enhanced the ability of the aquatics sector to deliver learn to swim programmes and assess its cost-effectiveness.
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Affiliation(s)
- Rona Macniven
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Blake Angell
- The George Institute for Global Health, Newtown, New South Wales, Australia
| | - Nivi Srinivasan
- New South Wales Government, Sydney, New South Wales, Australia
| | - Kailash Awati
- New South Wales Government, Sydney, New South Wales, Australia
| | - James Chatman
- New South Wales Government, Sydney, New South Wales, Australia
| | - Amy E Peden
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
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Leavy JE, Gray C, Della Bona M, D'Orazio N, Crawford G. A Review of Interventions for Drowning Prevention Among Adults. J Community Health 2023; 48:539-556. [PMID: 36653593 DOI: 10.1007/s10900-023-01189-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2023] [Indexed: 01/20/2023]
Abstract
Adult drowning is a complex and multifactorial public health challenge requiring community, national and global efforts to mitigate impacts. This study updates the evidence base for public health interventions that address adult fatal and non-fatal drowning. A systematic review was undertaken of the peer-reviewed literature for English-language primary studies published between 2011 and 2021describing a drowning intervention with adults. Twenty-two studies were included. Most studies (n = 16) were conducted in high-income countries. Yearly trends in drowning prevention intervention publications were analysed with 2015 (n = 6) the peak publishing year. Over half of the study designs were pre-post (n = 15). Intervention duration ranged from 4 hours to 11 years. Ten studies described either behaviour change theory or formative evaluation to inform design. Thirteen studies targeted interventions at a population level, seven at a group level and two at individual level. Studies identified a range of prevention strategies, categorised as behavioural (n = 9) (e.g., swimming lessons), socio-ecological (n = 8) (e.g., mandatory personal flotation devices) and mixed (n = 5) (e.g., awareness campaign and barriers to prevent access to water). A range of outcomes were described including changes in awareness, water safety knowledge, attitudes, water safety behaviours and skills, environmental, policy and regulation changes and drowning rates. Findings indicate a small but important increase in the evaluation and publication of effective interventions to prevent adult drowning. The complexity of the issues surrounding drowning requires multi-strategy and context -specific adult focused prevention interventions. Contemporary evidence that identifies effective interventions that contribute to prevention efforts is an essential first step in addressing the challenge.
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Affiliation(s)
- Justine E Leavy
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Perth, WA, Australia.
| | - Corie Gray
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Perth, WA, Australia
| | - Malena Della Bona
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Perth, WA, Australia
| | - Nicola D'Orazio
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Perth, WA, Australia
| | - Gemma Crawford
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Perth, WA, Australia
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Peden AE, Daw S, Lawes JC. Preliminary evaluation of the impact of mandatory life jacket laws at declared high-risk rock platforms on unintentional rock fishing drowning deaths. Inj Prev 2022; 28:560-563. [DOI: 10.1136/ip-2022-044724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 09/04/2022] [Indexed: 11/05/2022]
Abstract
ObjectivesTo explore the impact of mandatory lifejacket wear legislation on unintentional rock fishing-related drowning fatalities at declared high-risk rock platforms in New South Wales (NSW; Australia).MethodsRock fishing-related drownings for the five years pre-legislation enactment (23 November 2011 to 22 November 2016) and five years post-legislation enactment (23 November 2016 to 22 November 2021) were compared. Google Earth was used to assess if drowning deaths occurred at declared areas under legislation. Binary logistic regression was used to analyse change in the number of deaths in declared areas pre-legislation/post-legislation.ResultsOver the 10 years, 80 rock fishing drowning deaths occurred in New South Wales; 23 in declared areas pre-legislation and 13 post-legislation (−43.5%). The odds of a rock fishing drowning death occurring in a declared area pre-legislation was 2.3 times higher (95% CI 0.942 to 5.752; p=0.067).ConclusionReductions in rock fishing deaths at declared areas were observed since the legislation’s introduction, but were not significant. Greater enforcement and extension to other high-risk platforms may reduce deaths further.
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Yadav J, John D, Menon GR, Franklin RC, Peden AE. Nonfatal drowning-related hospitalizations and associated healthcare expenditure in India: An analysis of nationally representative survey data. JOURNAL OF SAFETY RESEARCH 2022; 82:283-292. [PMID: 36031256 DOI: 10.1016/j.jsr.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 01/11/2022] [Accepted: 06/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Drowning is a global public health challenge, with significant burden in low- and middle-income countries. There are few studies exploring nonfatal drowning, including the economic and social impacts. This study aimed to quantify unintentional drowning-related hospitalization in India and associated healthcare expenditure. METHOD Unit level data on unintentional drowning-related hospitalization were obtained from the 75th rounds of the National Sample Survey of Indian households conducted in 2018. The outcome variables were indices of health care cost such as out of pocket expenditure (OOPE), health care burden (HCB), catastrophic health expenditure (CHE), impoverishment, and hardship financing. Descriptive statistics and multivariate analysis were conducted after adjusting for inflation using the pharmaceutical price index for December 2020. The association of socio-demographic characteristics with the outcome variable was reported as relative risk with 95% CI and expenditure reported in Indian Rupees (INR) and United States dollars (USD). RESULTS 174 respondents reported drowning-related hospitalization (a crude rate of 15.91-31.34 hospitalizations per 100,000 population). Proportionately, more males (63.4%), persons aged 21-50 years (44.9%) and rural dwelling respondents (69.9%) were hospitalized. Drowning-related hospitalization costs on average INR25,421 ($345.11USD) per person per drowning incident. Costs were higher among older respondents, females, urban respondents, and longer lengths of hospital stays. About 14.4% of respondents reported hardship financing as a result of treatment costs and 9.0% of households reported pushed below the poverty line when reporting drowning-related hospitalization. CONCLUSIONS Drowning can be an economically catastrophic injury, especially for those already impacted by poverty. Drowning is a significant public health problem in India. Investment in drowning prevention program will reduce hospitalization and economic burden. PRACTICAL APPLICATIONS This study provides support for investment in drowning prevention in India, including a need to ensure drowning prevention interventions address the determinants of health across the lifespan.
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Affiliation(s)
- Jeetendra Yadav
- ICMR-National Institute of Medical Statistics, Ansari Nagar, New Delhi 110029, India
| | - Denny John
- Faculty of Life and Allied Health Sciences, Ramaiah University of Applied Sciences, Bangalore - 560054, Karnataka, India; Department of Public Health, Amrita Institute of Medical Sciences & Research Centre, Amrita Vishwa Vidyapeetham, Kochi 682041, Kerala, India; Center for Public Health Research, MANT, Kolkata-700078, West Bengal, India
| | - Geetha R Menon
- ICMR-National Institute of Medical Statistics, Ansari Nagar, New Delhi 110029, India.
| | - Richard C Franklin
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia; Royal Life Saving Society - Australia, Sydney, New South Wales, Australia.
| | - Amy E Peden
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia; Royal Life Saving Society - Australia, Sydney, New South Wales, Australia; School of Population Health, Faculty of Medicine, UNSW Sydney, Kensington, New South Wales, Australia.
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11
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Bierens J, Hoogenboezem J. Fatal drowning statistics from the Netherlands - an example of an aggregated demographic profile. BMC Public Health 2022; 22:339. [PMID: 35177025 PMCID: PMC8851711 DOI: 10.1186/s12889-022-12620-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 01/14/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Incompleteness of fatal drowning statistics is a familiar problem impeding public health measures. Part of the problem may be that only data on accidental drowning are used and not the full potential of accessible data. Methods This study combines cause-of-death certificates and public prosecutor’s court documents between 1998 and 2017 to obtain an aggregated profile. Data are also used as a basis for a trend analysis. Results The dataset includes 5571 drowned persons (1.69 per 100,000). The highest risk group are persons above the age of 50. Demographic differences are observed between suicide by drowning, accidental drowning, and drowning due to transportation (0.72, 0.64, 0.28 per 100.000) and between native Dutch, and Dutch with western and non-western background (1.46, 1.43, 1.76 per 100.000). Non-residents account for another 12.2%. When comparing the periods 1998–2007 with 2008–2017, the Standard Mortality declines for suicide drowning and accidental drowning among persons with a native Dutch and non-western background. Single regression analysis confirms a decrease of drowning over the full period, breakpoint analysis shows an increase in the incidence of the total number of drowning, suicide by drowning and accidental drowning starting in 2007, 2008 resp. 2012. Discussion Compared to the formal number of fatal accidental drowning in the Netherlands (n = 1718; incidence 0.52 per 100,000), the study identifies 350% more drowning. Differences in demographic data and the recent increase needs to be explored for public health interventions. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12620-3.
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Affiliation(s)
- Joost Bierens
- Research Group Emergency and Disaster Medicine, Vrije Universiteit Brussels, Laarbeeklaan 103, 1090, Brussels, Belgium.
| | - Jan Hoogenboezem
- Centraal Bureau voor de Statistiek (Statistics Netherlands), Department of Causes of Death Statistics, Henri Faasdreef 312, 2492, JP, Den Haag, the Netherlands
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Peden AE, Franklin RC, Clemens T. Can child drowning be eradicated? A compelling case for continued investment in prevention. Acta Paediatr 2021; 110:2126-2133. [PMID: 33043488 DOI: 10.1111/apa.15618] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/27/2020] [Accepted: 10/08/2020] [Indexed: 11/30/2022]
Abstract
AIM To explore temporal trends in fatal child drowning and benchmark progress across three high-income countries to provide prevention and future investment recommendations. METHODS A total population analysis of unintentional fatal drownings among 0- to 19-year-olds in Australia, Canada and New Zealand from 2005 to 2014 was undertaken. Univariate and chi-square analyses were conducted, age- and sex-specific crude rates calculated and linear trends explored. RESULTS A total of 1454 children drowned. Rates ranged from 0.92 (Canada) to 1.35 (New Zealand) per 100 000. Linear trends of crude drowning rates show both Australia (y = -0.041) and Canada (y = -0.048) reduced, with New Zealand (y = 0.005) reporting a slight rise, driven by increased drowning among females aged 15-19 years (+200.4%). Reductions of 48.8% in Australia, 51.1% in Canada and 30.4% in New Zealand were seen in drowning rates of 0- to 4-year-olds. First Nations children drowned in significantly higher proportions in New Zealand (X2 = 31.7; P < .001). CONCLUSION Continual investment in drowning prevention, particularly among 0- to 4-year-olds, is contributing to a reduction in drowning deaths; however, greater attention is needed on adolescents (particularly females) and First Nation's children. Lessons can be learned from each country's approach; however, further investment and evolution of prevention strategies will be needed to fully eradicate child drowning deaths.
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Affiliation(s)
- Amy E. Peden
- Royal Life Saving Society—Australia Broadway NSW Australia
- School of Population Health Faculty of Medicine UNSW Sydney Sydney NSW Australia
- College of Public Health, Medical and Veterinary Sciences James Cook University Townsville Qld Australia
| | - Richard C. Franklin
- Royal Life Saving Society—Australia Broadway NSW Australia
- College of Public Health, Medical and Veterinary Sciences James Cook University Townsville Qld Australia
| | - Tessa Clemens
- Drowning Prevention Research Centre Canada Toronto ON Canada
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13
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Peden AE, Scarr JP, Mahony AJ. Analysis of fatal unintentional drowning in Australia 2008-2020: implications for the Australian Water Safety Strategy. Aust N Z J Public Health 2021; 45:248-254. [PMID: 34028908 DOI: 10.1111/1753-6405.13124] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 03/01/2021] [Accepted: 04/01/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To examine temporal trends in drowning in Australia against targets set in the Australian Water Safety Strategy (AWSS) 2008-2020 and to inform the development of the next iteration of the Strategy. METHODS A national analysis of unintentional fatal drowning rates per 100,000 population over 16 years (2004/05-2019/20) was conducted. Baseline rates (three-year average 2004/05-2006/07) were compared to the current three-year average (2017/18-2019/20) by sex, age group, drowning location and jurisdiction. RESULTS The overall rate of unintentional fatal drowning during the period decreased by 28%. Substantial reductions were observed in children 0-4 years (-63%) and 5-14 years (-56%). Progress has been less pronounced among people aged 75 years and over (-11%) and 15-24-year-olds (-14%). All locations and jurisdictions recorded reductions, aside from rocks (+46%). CONCLUSIONS Although the strategy fell short of its aspirational target of a 50% reduction in drowning by the year 2020, this target was exceeded in key age groups, including children. Implications for public health: The AWSS is a powerful tool to align drowning prevention sector actions to agreed objectives. Forthcoming strategies must take into consideration demographic and social change, areas where limited progress has been made and the latest evidence to guide future priorities.
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Affiliation(s)
- Amy E Peden
- Royal Life Saving Society - Australia, New South Wales.,School of Population Health, Faculty of Medicine, UNSW Sydney, New South Wales
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Peden AE, Sarrami P, Dinh M, Lassen C, Hall B, Alkhouri H, Daniel L, Burns B. Description and prediction of outcome of drowning patients in New South Wales, Australia: protocol for a data linkage study. BMJ Open 2021; 11:e042489. [PMID: 33452197 PMCID: PMC7813289 DOI: 10.1136/bmjopen-2020-042489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Despite being a preventable cause of death, drowning is a global public health threat. Australia records an average of 288 unintentional drowning deaths per year; an estimated annual economic burden of $1.24 billion AUD ($2017). On average, a further 712 hospitalisations occur due to non-fatal drowning annually. The Australian state of New South Wales (NSW) is the most populous and accounts for 34% of the average fatal drowning burden. This study aims to explore the demographics and outcome of patients who are admitted to hospitals for drowning in NSW and also investigates prediction of patients' outcome based on accessible data. METHODS AND ANALYSIS This protocol describes a retrospective, cross-sectional data linkage study across secondary data sources for any person (adult or paediatric) who was transferred by NSW Ambulance services and/or admitted to a NSW hospital for fatal or non-fatal drowning between 1/1/2010 and 31/12/2019. The NSW Admitted Patient Data Collection will provide data on admitted patients' characteristics and provided care in NSW hospitals. In order to map patients' pathways of care, data will be linked with NSW Ambulance Data Collection and the NSW Emergency Department Data Collection. Finally patient's mortality will be assessed via linkage with NSW Mortality data, which is made up of the NSW Register of Births, Deaths and Marriages and a Cause of Death Unit Record File. Regression analyses will be used to identify predicting values of independent variables with study outcomes. ETHICS AND DISSEMINATION This study has been approved by the NSW Population & Health Services Research Ethics Committee. Results will be disseminated through peer-reviewed publications, mass media releases and at academic conferences. The study will provide outcome data for drowning patients across NSW and study results will provide data to deliver evidence-informed recommendations for improving patient care, including updating relevant guidelines.
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Affiliation(s)
- Amy E Peden
- School of Population Health, Faculty of Medicine, UNSW Sydney, Kensington, New South Wales, Australia
- Royal Life Saving Society Australia, Broadway, New South Wales, Australia
| | - Pooria Sarrami
- NSW Institute of Trauma and Injury Management, NSW Agency for Clinical Innovation, St Leonards, New South Wales, Australia
- South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
| | - Michael Dinh
- NSW Institute of Trauma and Injury Management, NSW Agency for Clinical Innovation, St Leonards, New South Wales, Australia
- The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
| | - Christine Lassen
- NSW Institute of Trauma and Injury Management, NSW Agency for Clinical Innovation, St Leonards, New South Wales, Australia
| | - Benjamin Hall
- NSW Institute of Trauma and Injury Management, NSW Agency for Clinical Innovation, St Leonards, New South Wales, Australia
| | - Hatem Alkhouri
- Emergency Care Institute, Agency for Clinical Innovation, St Leonards, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Lovana Daniel
- South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Brian Burns
- The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
- Greater Sydney Area Helicopter, Emergency Medical Service, NSW Ambulance, Sydney, New South Wales, Australia
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Peden AE, Willcox-Pidgeon SM, Scarr JP, Franklin RC. Comparing rivers to lakes: Implications for drowning prevention. Aust J Rural Health 2020; 28:568-578. [PMID: 33231359 DOI: 10.1111/ajr.12679] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 09/16/2020] [Accepted: 09/21/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To contrast unintentional fatal drowning in rivers with lakes to determine appropriateness for application of existing river drowning prevention strategies. DESIGN A total population retrospective cross-sectional analysis using coronial data. SETTING Australia, 1 July 2013 to 30 June 2018. PARTICIPANTS Children and adults (n = 342) who died from unintentional drowning in a river or lake. MAIN OUTCOME MEASURES Incidence, crude fatality rates, relative risk (95% confidence interval) and chi-square tests of independence for risk factors for unintentional fatal drowning. Subset analysis of land management for lake drowning locations. RESULTS Four-fifths (82%) occurred in rivers. Lake drowning was more likely among 0- to 17-year-olds, Aboriginal and Torres Strait Islander people and when swimming or using watercraft. River drowning most commonly occurred following a fall into water and with alcohol involvement. Drowning risk in very remote areas was elevated for both lakes (relative risk = 18.34; 95% confidence interval: 1.61-209.44) and rivers (relative risk = 15.89; 95% confidence interval: 5.56-45.37) compared to major cities. Those responsible for land and water management at lakes were primarily local government (59%), water authorities (32%) and parks and wildlife authorities (7%). CONCLUSIONS In contrast to a focus on adults and alcohol in existing river drowning prevention strategies, lake interventions must target children, Aboriginal and Torres Strait Islander peoples and recreational lake users. Fatal drowning rates are high for remote rivers and lakes, necessitating focused effort. There are opportunities to embed drowning prevention strategies within land and water management plans. Lake drowning prevention requires broader engagement with land and water managers and Aboriginal and Torres Strait Islander peoples.
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Affiliation(s)
- Amy E Peden
- Royal Life Saving Society-Australia, Broadway, NSW, Australia.,School of Population Health, Faculty of Medicine, UNSW Sydney, Kensington, NSW, Australia.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
| | - Stacey M Willcox-Pidgeon
- Royal Life Saving Society-Australia, Broadway, NSW, Australia.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
| | - Justin P Scarr
- Royal Life Saving Society-Australia, Broadway, NSW, Australia
| | - Richard C Franklin
- Royal Life Saving Society-Australia, Broadway, NSW, Australia.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
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Peden AE, Willcox-Pidgeon S. Autism spectrum disorder and unintentional fatal drowning of children and adolescents in Australia: an epidemiological analysis. Arch Dis Child 2020; 105:869-874. [PMID: 32169851 DOI: 10.1136/archdischild-2019-318658] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study explored unintentional fatal drowning among children and adolescents (0-19 years) diagnosed with autism spectrum disorder (ASD) in Australia. DESIGN This total population, cross-sectional audit used data from the Royal Life Saving National Fatal Drowning Database to explore demographic and causal factors in ASD drowning cases between 1 July 2002 and 30 June 2018. Rates and relative risk (RR) with a 95% confidence interval (CI) were calculated for drowning cases with and without ASD, using estimated population-level prevalence data. RESULTS Of the 667 cases of drowning among 0-19 year olds with known medical history, 27 children and adolescents (4.0%) who drowned had an ASD diagnosis. Children and adolescents with ASD were three times more likely to drown than those without ASD (RR=2.85; CI 0.61 to 13.24). Among those with ASD, 0-4 year olds record the highest rate (11.60/100 000 diagnosed). Children and adolescents with ASD were significantly more likely to drown when compared with those without ASD: if aged 5-9 years (44.4% of ASD-yes cases; 13.3% of ASD-no cases); in a lake or dam (25.9% vs 10.0%) and during winter (37.0% vs 13.1%). CONCLUSION Heightened awareness of drowning risk for children and adolescents with ASD is required, including adult supervision and barriers restricting water access. Further evaluation of the effectiveness of personal alarms to alert caregivers to an unsupervised child is warranted. Challenges exist regarding accurate estimates of population-level ASD prevalence and identification of ASD in coronial files. As the diagnosis of ASD does not often occur until age five, results may be an underestimate.
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Affiliation(s)
- Amy E Peden
- Royal Life Saving Society - Australia, Broadway, New South Wales, Australia .,School of Public Health and Community Medicine, University of New South Wales Faculty of Medicine, Kensington, New South Wales, Australia.,College of Public Health, Medical and Veterinary Sciences, Discipline of Public Health and Tropical Medicine, James Cook University, Townsville, Queensland, Australia
| | - Stacey Willcox-Pidgeon
- Royal Life Saving Society - Australia, Broadway, New South Wales, Australia.,College of Public Health, Medical and Veterinary Sciences, Discipline of Public Health and Tropical Medicine, James Cook University, Townsville, Queensland, Australia
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Peden AE, Franklin RC, Pearn JH. The prevention of child drowning: the causal factors and social determinants impacting fatalities in portable pools. Health Promot J Austr 2019; 31:184-191. [PMID: 31369689 DOI: 10.1002/hpja.282] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 07/28/2019] [Indexed: 11/06/2022] Open
Abstract
ISSUE ADDRESSED There is a scarcity of research into portable pool drowning and its prevention. This total population study examines fatal drowning among children under five in portable pools in Australia. METHODS All child drowning deaths in portable pools for the period 1 July 2002 to 30 June 2018 were identified. A portable pool was defined as any structure used for swimming and wading which, when emptied, can be moved. RESULTS Twenty-three children (aged 0-17 years) drowned in portable pools. The drowning rate for children less than 5 years of age was 0.09 per 100 000 population. The peak age of death was 12-23 months (RR = 2.99; CI: 1.09-8.23), with the majority (n = 20 deaths) aged 16-31 months. Ninety per cent followed a fall into water. None were supervised. Children commonly resided in areas classified as socially and economically disadvantaged (85%; n = 17). Drowning rates in very remote areas were 15 times greater (RR = 15.41; CI: 0.03-7579.65) than city children. Eleven (55%) drowning deaths occurred in pools with a depth >300 mm, of which 10 (91%) were known to be unfenced. CONCLUSIONS Social determinants impact child drowning in portables pools, which can occur quickly and in just 150 mm of water. Active supervision and a regulation-compliant barrier are effective prevention stratagems, factors which were absent from the deaths in this study. SO WHAT?: Portable pool drowning disproportionately impacts those aged 16-31 months who reside in very remote areas and areas classified as having high socio-economic disadvantage. Education for these groups on fencing and supervision of children must be provided.
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Affiliation(s)
- Amy E Peden
- Royal Life Saving Society - Australia, Sydney, NSW, Australia.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Richard C Franklin
- Royal Life Saving Society - Australia, Sydney, NSW, Australia.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
| | - John H Pearn
- Royal Life Saving Society - Australia, Sydney, NSW, Australia.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia.,Senior Paediatrician, Queensland Children's Hospital, South Brisbane, QLD, Australia
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Exploring Flood-Related Unintentional Fatal Drowning of Children and Adolescents Aged 0–19 Years in Australia. SAFETY 2019. [DOI: 10.3390/safety5030046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Disasters, such as flooding, are predicted to increase. Drowning is one of the leading causes of death during times of flood. This study examined the little explored topic of child drowning during floods, with the aim of identifying risk factors to inform prevention strategies. A retrospective, total population examination of cases of children and adolescents aged 0–19 years who died from unintentional flood-related drowning in Australia for the 16-year period 1 July 2002 to 30 June 2018 was undertaken. Univariate and chi-square analysis was conducted, with Fisher’s exact test used for cell counts <5. Across the study period, 44 flood-related drowning deaths occurred among children and adolescents (63.6% male; 34.1% aged 10–14 years). Almost all (84.1%) occurred in rivers, creeks, or streams in flood, with the remaining incidents occurring in storm water drains (n = 7). Leading activities immediately prior to drowning were non-aquatic transport (40.9%), swimming in floodwaters (25.0%), and falls into floodwaters (15.9%). Flood-related fatal drowning among children and adolescents is rare (0.05 per 100,000 population), however flood-drowning risk increases as remoteness increases, with children and adolescents drowning in floodwaters in very remote areas at a rate 57 times that of major cities. All drownings are preventable, and this study has identified key causal factors that must be considered in advocacy and prevention efforts. These include: the importance of adult supervision, avoiding flooded waterways when driving or for recreational purposes, and the increased risks for those residing in geographically isolated and socially disadvantaged areas. Findings must be considered when developing interventions and advocacy for the purposes of the reduction of child and adolescent drowning during times of flood.
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