1
|
Işın A, Peden AE. The burden, risk factors and prevention strategies for drowning in Türkiye: a systematic literature review. BMC Public Health 2024; 24:528. [PMID: 38378496 PMCID: PMC10877921 DOI: 10.1186/s12889-024-18032-9] [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: 06/24/2023] [Accepted: 02/07/2024] [Indexed: 02/22/2024] Open
Abstract
INTRODUCTION Drowning is a public health problem in Türkiye, as in the rest of the world. This study aims to systematically review the literature on drowning in Türkiye with a focus on data sources, epidemiology, risk factors and prevention strategies. METHODS Literature searches were conducted using PubMed, SPORTSDiscus, Scopus, Web of Science, Turk MEDLINE, Google Scholar and Google Akademik (Turkish language). Studies (limited to original research written in English and Turkish) reporting drowning (unintentional and intentional; fatal and non-fatal) of residents and tourists in Türkiye were independently dual screened at the title and abstract and full text stages. Study quality was assessed using JBI checklists and evidence level assessed based on study design. RESULTS From a total of 917 studies, 49 met the inclusion criteria. Most (51%) focused on unintentional fatal drowning. Included studies were most commonly analytical cross-sectional studies (n = 23) and case series (n = 20) meaning the evidence level was low or very low for 48 (98%) studies. Fifteen studies examined drowning at the national level, while sub-national studies (n = 30) focused on urban areas across three provinces: Antalya (n = 6), Istanbul (n = 6), Izmir (n = 4). There was little consensus on risk factors beyond male drowning risk, and no data reported on implemented or evaluated drowning prevention interventions. DISCUSSION There is a need for more national-level studies to identify the causes of drowning and to guide intervention implementation and evaluation to inform policy makers and donors. Currently official data is limited in its detail, providing age and gender data only, hampering efforts to identify, and thus address, causal factors for drowning. PRACTICAL APPLICATIONS There is currently very little evidence to inform investment in effective drowning prevention interventions in Türkiye. To improve this, data collection systems on drowning in Türkiye need to be strengthened via the development a national drowning registry. TRIAL REGISTRATION #CRD42022382615.
Collapse
Affiliation(s)
- Ali Işın
- Department of Coaching Education, Faculty of Sports Sciences, Akdeniz University, 07070, Antalya, Türkiye.
| | - Amy E Peden
- School of Population Health, UNSW Sydney, Kensington, NSW, 2052, Australia
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, 4811, Australia
| |
Collapse
|
2
|
Işın A, Peden AE. Assessing variations in estimates of drowning mortality in Turkey from 2013 to 2019. Arch Public Health 2022; 80:178. [PMID: 35915470 PMCID: PMC9341097 DOI: 10.1186/s13690-022-00944-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/26/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Drowning is an under-recognised public health threat and a leading cause of injury-related mortality and morbidity. However, in many countries, including Turkey, limited data impair understanding of drowning burden and Global Burden of Disease (GBD) Study drowning estimates (defined using International Classification of Diseases [ICD] codes W65–74) do not include flood-related deaths (X38) and water transportation related drownings (V90, V92). A lack of accessible and reliable country-level data impacts a country’s ability to develop appropriate drowning prevention interventions and measure efficacy. This retrospective population-based study aimed to explore differences between two datasets in fatal drowning in Turkey between 2013 and 2019. Methods National, all-age data on fatal drownings (restrictive definition: ICD-10 codes W65–74) were sourced from the Turkish Statistical Institute (TurkStat) and the Global Burden of Disease (GBD) study. In addition, a broader definition of drowning including water transport, flood-related deaths and drowning due to undetermined intent (ICD-10 codes W65–74, V90, V92, X38, Y21, T751) were sourced from TurkStat. Numeric and percentage differences in number of drowning deaths were calculated overall and by sex, age group and death year. Chi square (p < 0.05) and relative risk (95% confidence intervals) using crude drowning rates per 100,000 population were also calculated for TurkStat data. Results From 2013 to 2019, TurkStat reported a total of 5004 drowning deaths (coded W65–74) were reported, compared to 5252 (5% difference; n = 248) using the broader definition. A restrictive definition underreported drowning most significantly in females (9.5%; n = 97), 5–9 year-olds (8.9%; n = 31) and in the 2015 calendar year (30.2%; n = 226). Males accounted for 78.8% of drowning in Turkey, with females significantly (p < 0.001) more at risk under 10 years of age (0–4 years X2 = 67.9; 5–9 years X2 = 23.9) and aged 65+ years (X2 = 29.7). GBD data overestimated a restrictive definition of drowning by 3.2% overall (7.6% for females, 52.5% for 0–4 year-olds) and underreported drowning for 65+ year-olds by 17% when compared to TurkStat restrictive definition of drowning. Conclusions Although a restrictive definition of drowning doesn’t greatly impact estimates at a population level in Turkey, there are variations. This highlights the importance of accurate country-level drowning data to guide decision making for prevention.
Collapse
|
3
|
Zaara M, Belhaj A, Naceur Y, Makni C, Gharbaoui M, Bellali M, Zhioua M, Allouche M. Patterns of unintentional fatal drowning among children in North Tunisia : A 10-year study. Rev Epidemiol Sante Publique 2022; 70:31-37. [DOI: 10.1016/j.respe.2021.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 10/23/2021] [Accepted: 11/02/2021] [Indexed: 10/19/2022] Open
|
4
|
Descriptive Epidemiology of Rescue-Related Fatal Drowning in Turkey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126613. [PMID: 34205391 PMCID: PMC8296404 DOI: 10.3390/ijerph18126613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 06/16/2021] [Accepted: 06/16/2021] [Indexed: 01/17/2023]
Abstract
Drowning is a public-health threat and a leading cause of injury-related death. In Turkey, drowning results in 900 fatalities annually, and the rate is rising. As data on rescue-related drowning are scarce, this retrospective study explores the epidemiology of fatal drowning among rescuers in Turkey. As there are no routinely collected death registry data on drowning in Turkey, data were sourced from media reports of incidents between 2015 and 2019. Rescuer fatalities were analysed by age, sex, activity prior to rescue, location, incident day of week and season, and place of death. Statistical analyses comprised X2 tests of significance (p < 0.05) and calculation of relative risk (95% confidence interval) using fatality rates. In total, 237 bystander rescuers drowned (90% male; 35% 15–24 years). In 33% of cases, the primary drowning victim (PDV) was successfully rescued, while in 46% of cases the rescue resulted in multiple drowning fatalities (mean = 2.29; range 1–5 rescuers). Rescues were more likely to be successful in saving the PDV if undertaken at the beach/sea (X2 = 29.147; p < 0.001), while swimming (X2 = 12.504; p = 0.001), or during summer (X2 = 8.223; p = 0.029). Risk of bystander rescue-related fatal drowning was twice as high on weekdays compared to on weekends (RR = 2.04; 95%CI: 1.56–2.67). While bystanders play an important role in reducing drowning, undertaking a rescue is not without risk and can lead to multiple drowning incidents. Training in rescue and resuscitation skills (especially the prioritization of non-contact rescues) coupled with increasing awareness of drowning risk, are risk-reduction strategies which should be explored in Turkey.
Collapse
|
5
|
Işın A, Akdağ E, Turgut A. The epidemiology of fatal drowning in children: a 13-year retrospective study in Turkey. Int J Inj Contr Saf Promot 2020; 27:465-471. [PMID: 32814483 DOI: 10.1080/17457300.2020.1810075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This retrospective study aimed to investigate the prevalence of unintentional fatal drowning in children aged 0-17 years in Turkey between 2005 and 2017 and to determine the risk factors in drowning. This study is based on media reports, and all data were obtained from the media. All data were presented in frequency and percentage. Relative risk and 95% confidence intervals were calculated using the relevant population data. A total of 3,419 children died by drowning in these 13 years. The unintentional fatal child drowning rates in Turkey were 1.16; 1.80 for males and 0.48 for females per 100,000 children, which means males drowned nearly four times more than females. In terms of season, the highest rate of unintentional fatal drowning was in summer (0.69 per 100,000 children), and the lowest rate in winter (0.05 per 100,000 children). The unintentional fatal drowning rate decreased after reaching a peak in 2010 (1.52 per 100,000 children). As of 2015, the rate of unintentional fatal drowning decreased every year and reached a minimum in 2017 (0.66 per 100,000 children). Even if the mortality rate in children has decreased in recent years, more measures are still needed to prevent drowning in children.
Collapse
Affiliation(s)
- Ali Işın
- Faculty of Sport Sciences, Akdeniz University, Antalya, Turkey
| | - Eren Akdağ
- Institute of Health Sciences, Akdeniz University, Antalya, Turkey
| | - Adnan Turgut
- Faculty of Sport Sciences, Akdeniz University, Antalya, Turkey
| |
Collapse
|
6
|
Peden AE, Franklin RC, Queiroga AC. Epidemiology, risk factors and strategies for the prevention of global unintentional fatal drowning in people aged 50 years and older: a systematic review. Inj Prev 2017; 24:240-247. [PMID: 28774894 DOI: 10.1136/injuryprev-2017-042351] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 06/14/2017] [Accepted: 07/05/2017] [Indexed: 01/10/2023]
Abstract
PURPOSE Drowning is a global public health issue and prevention poses an ongoing challenge for all countries. Many nations are experiencing ageing populations, and little is known about the epidemiology, risk factors and prevention of drowning deaths among older people. This paper reports on a systematic review of literature published on drowning among older people. METHODS A systematic literature review was undertaken using English-language, Portuguese-language and Spanish-language papers published between 1980 and 2015. The review explores gaps in the literature with a focus on the epidemiology, risk factors and strategies for the prevention of unintentional fatal drowning among people 50 years and over. RESULTS Thirty-eight papers were deemed relevant to the study design, including 18 (47%) on epidemiology, 19 (50%) on risk factors and 9 (24%) on strategies for prevention. Risk factors identified included male gender, ethnicity, rurality and increasing age. Prevention strategies commonly proposed were education and wearing life jackets. Gaps identified in the published literature include a lack of consistency around age groupings used for epidemiological studies; a lack of consensus on risk factors; a lack of total population, country-level analysis; and the need for older age-specific prevention strategies that have been implemented and their effectiveness evaluated. CONCLUSION This review identified drowning deaths among older people as a global issue. Further work is required to reduce drowning in this cohort. High-quality epidemiological studies identifying risk factors using standardised age groupings to allow for international comparisons are required, as are implementation and evaluation of older age-specific prevention strategies.
Collapse
Affiliation(s)
- Amy E Peden
- Royal Life Saving Society - Australia, Broadway, New South Wales, Australia.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Richard C Franklin
- Royal Life Saving Society - Australia, Broadway, New South Wales, Australia.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Ana Catarina Queiroga
- Royal Life Saving Society - Australia, Broadway, New South Wales, Australia.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.,EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| |
Collapse
|
7
|
Tyler MD, Richards DB, Reske-Nielsen C, Saghafi O, Morse EA, Carey R, Jacquet GA. The epidemiology of drowning in low- and middle-income countries: a systematic review. BMC Public Health 2017; 17:413. [PMID: 28482868 PMCID: PMC5423024 DOI: 10.1186/s12889-017-4239-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 04/06/2017] [Indexed: 12/03/2022] Open
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.
Collapse
Affiliation(s)
| | | | | | | | | | - Robert Carey
- Boston University School of Medicine, Boston, USA
| | - Gabrielle A Jacquet
- Boston Medical Center, Boston, USA.,Boston University School of Medicine, Boston, USA
| |
Collapse
|
8
|
Jennissen CA, Harland KK, Denning GM. Characteristics of Side-by-Side Vehicle Crashes and Related Injuries as Determined Using Newspaper Reports from Nine U.S. States. SAFETY 2016; 2:10.3390/safety2020010. [PMID: 35979514 PMCID: PMC9380433 DOI: 10.3390/safety2020010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024] Open
Abstract
Side-by-side (SxS) vehicles have become increasingly popular, but there are few reports on injury epidemiology. Newspaper reports of SxS and all-terrain vehicle (ATV) crashes were analyzed for nine U.S. states from 2009 to 2011, including comparisons between the two vehicle types. Seventy-nine SxS crashes involving 104 injured victims were identified; three-fourths were males. There was a relatively high percentage of injured passengers (37%), and a higher proportion of female victims were passengers as compared to males (p = 0.015). Children <16 years of age were 44% of those injured and had the highest proportion of both passenger and operator victims as compared to other age groups. Over half of the crashes occurred on roadways; nearly two-fifths occurred at night. As compared to adults, a lower percentage of crashes involving youth were at night (p = 0.0037) but the percentages on roadways were similar. Only one in five roadway SxS crashes involved a collision with a motorized vehicle. Rollovers were the most common mechanism (50%). Two-thirds of victims were ejected, and one-half were struck or pinned by the vehicle. Twenty-eight deaths (27%) were reported. Although most current SxSs have roll bars, lack of safety belt use has likely reduced their benefit. Children should be prohibited from operating SxSs.
Collapse
Affiliation(s)
- Charles A. Jennissen
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Karisa K. Harland
- Department of Emergency Medicine, University of Iowa Hospital and Clinics, Iowa City, IA, 52242, USA
| | - Gerene M. Denning
- Department of Emergency Medicine, University of Iowa Hospital and Clinics, Iowa City, IA, 52242, USA
| |
Collapse
|
9
|
Dirlik M, Bostancıoğlu B. Child drowning deaths in Aydin province, western Turkey, 2002-2012. Eur J Trauma Emerg Surg 2015; 41:683-8. [PMID: 26038014 DOI: 10.1007/s00068-015-0493-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 01/05/2015] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Drowning, a major public health problem worldwide, occurs as an accident, suicide, or homicide. Deaths with an accidental origin are common in childhood in the 0-18 age group. In our study, pediatric drowning cases for whom a postmortem examination and an autopsy were conducted by Adnan Menderes University Department of Forensic Medicine were evaluated. The characteristics were determined and compared with domestic and foreign studies. MATERIALS AND METHODS A total of 39 cases in the 0-18 age group in Aydın between 2002 and 2012 were analyzed regarding age, gender, cause of death, origin, the accident scene, and the month in which the death occurred. RESULTS Of the drowning cases, 33 (84.6 %) were male, and 6 (15.4 %) were female. The average age was 9.08 years, and drowning is most common in the 0-4 age group (33.3 %). The scene of the accident was an irrigation channel in 43.5 % of the cases, a river in 15.3 %, a sea in 12.8 %, a pool in 10.2 %, and a lake or pond in 7.69 %. CONCLUSION Drowning deaths are a serious and preventable public health problem worldwide. There are strong correlations among lack of adult supervision, lack of precautions, and neglect.
Collapse
Affiliation(s)
- M Dirlik
- Department of Forensic Medicine, Faculty of Medicine, Adnan Menderes University, Aydın, 09100, Turkey.
| | - B Bostancıoğlu
- Ministry of Justice, Forensic Science Institute, Antakya, Hatay, Turkey
| |
Collapse
|