Trends of drowning mortality in Vietnam: evidence from the national injury mortality surveillance system

Identifying strategic priorities for advancing global drowning prevention: a Delphi method

INTRODUCTION

The burden of drowning is gaining prominence on the global agenda. Two United Nations system resolutions in 3 years reflect rising political support, but priorities remain undefined, and the issue lacks a global strategy. We aimed to identify strategic priorities for advancing global drowning prevention using a modified Delphi method.

METHODS

An advisory group was formed, and participants recruited with diverse expertise and backgrounds. We used document review, and data extracted from global health partnerships to identify strategic domains and draft priorities for global drowning prevention. Participants rated the priorities in two Delphi rounds, guided by relevance, feasibility and impact on equity, and where consensus was ≥70% of participants rating the priority as critical.

RESULTS

We recruited 134 participants from research (40.2%), policy (26.9%), technical (25.4%) and community (7.5%) backgrounds, with 38.1% representing low- and middle-income countries. We drafted 75 priorities. Following two Delphi rounds, 50 priorities were selected across the seven domains of research and further contextualisation, best practice guidance, capacity building, engagement with other health and sustainable development agendas, high-level political advocacy, multisectoral action and strengthening inclusive global governance. Participants scored priorities based on relevance (43.2%), feasibility (29.4%) and impact on equity (27.4%).

CONCLUSION

Our study identifies global priorities for drowning prevention and provides evidence for advocacy of drowning prevention in all pertinent policies, and in all relevant agendas. The priorities can be applied by funders to guide investment, by researchers to frame study questions, by policymakers to contrast views of expert groups and by national coalitions to anchor national drowning prevention plans. We identify agendas including disaster risk reduction, sustainable development, child and adolescent health, and climate resilience, where drowning prevention might offer co-benefits. Finally, our findings offer a strategic blueprint as the field looks to accelerate action, and develop a global strategy for drowning prevention.

Change in global burden of unintentional drowning from 1990 to 2019 and its association with social determinants of health: findings from the Global Burden of Disease Study 2019

OBJECTIVE

To systematically analyse global, regional and national burden change of unintentional drowning from 1990 to 2019, and to further quantify the contribution of social determinants of health (SDH) on the change.

DESIGN

Data from the Global Burden of Disease Study 2019 were used in this study.

SETTING AND PARTICIPANTS

Individuals of all ages and genders from 204 countries and territories.

MAIN OUTCOME MEASURES

The main outcomes were the age-standardised rates (ASRs) of mortality and disability-adjusted life-years (DALYs) of unintentional drowning. The percentage change in the ASRs were used to estimate the joint effect of SDH on trends in global burden of drowning.

RESULTS

We observed that the global burden of unintentional drowning declined markedly from 1990 to 2019, with age-standardised mortality rate and DALYs rate decreasing by 61.5% and 68.2%, respectively. Women, children, middle Socio-Demographic Index (SDI) countries, South-East Asia and Western Pacific region had higher reduction. At national level, greater reductions were observed in Armenia and Republic of Korea, but significant increases in Cabo Verde and Vanuatu. We found that every one percentile increase in six SDHs (Gross Domestic Product (GDP) per person, SDI, educational attainment, health spending, health workers and urbanisation) was associated with a decrease of 0.15% and 0.16% in drowning age-standardised mortality rate and DALYs rate globally, respectively. Health spending and GDP per capita were the main contributors to the reduction of drowning globally.

CONCLUSIONS

The global burden of unintentional drowning significantly declined in the past three decades, and the improvement of SDHs such as GDP per capita and health spending mainly contributed to the decrease. Our findings indicate that improvement of SDHs is critical for drowning prevention and control.

Non-Fatal Drowning Risk Prediction Based on Stacking Ensemble Algorithm

Drowning is a major public health problem and a leading cause of death in children living in developing countries. We seek better machine learning (ML) algorithms to provide a novel risk-assessment insight on non-fatal drowning prediction. The data on non-fatal drowning were collected in Qingyuan city, Guangdong Province, China. We developed four ML models to predict the non-fatal drowning risk, including a logistic regression model (LR), random forest model (RF), support vector machine model (SVM), and stacking-based model, on three primary learners (LR, RF, SVM). The area under the curve (AUC), F1 value, accuracy, sensitivity, and specificity were calculated to evaluate the predictive ability of the different learning algorithms. This study included a total of 8390 children. Of those, 12.07% (1013) had experienced non-fatal drowning. We found the following risk factors are closely associated with the risk of non-fatal drowning: the frequency of swimming in open water, distance between the school and the surrounding open waters, swimming skills, personality (introvert) and relationality with family members. Compared to the other three base models, the stacking generalization model achieved a superior performance in the non-fatal drowning dataset (AUC = 0.741, sensitivity = 0.625, F1 value = 0.359, accuracy = 0.739 and specificity = 0.754). This study indicates that applying stacking ensemble algorithms in the non-fatal drowning dataset may outperform other ML models.

Fatal drowning statistics from the Netherlands - an example of an aggregated demographic profile

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.

Day care as a strategy for drowning prevention in children under 6 years of age in low- and middle-income countries

BACKGROUND

Drowning is responsible for an estimated 320,000 deaths a year, and over 90% of drowning mortality occurs in low- to middle-income countries (LMICs), with peak drowning rates among children aged 1 to 4 years. In this age group, mortality due to drowning is particularly common in rural settings and about 75% of drowning accidents happen in natural bodies of water close to the home. Providing adequate child supervision can protect children from drowning, and organized formal day care programs could offer a way to achieve this.

OBJECTIVES

Primary objective • To assess the effects of day care programs for children under 6 years of age on drowning-related mortality or morbidity, or on total drowning accidents (fatal and non-fatal), in LMICs, compared to no day care programs or other drowning prevention interventions Secondary objectives • To assess the effects of day care programs in LMICs for children under 6 years of age on unsafe water exposure • To assess safety within these programs (e.g. transmission of infection within day care, physical or sexual abuse of children within day care) • To assess the incidence of unintentional injury within these programs • To describe the cost-effectiveness of such programs, in relation to averted drowning-related mortality or morbidity SEARCH METHODS: On November 23, 2019, and for an update on August 18, 2020, we searched MEDLINE (PubMed), Embase, CENTRAL, ERIC, and CINAHL, as well as two trial registries. On December 16, 2019, and for an update on February 9, 2021, we searched 12 other resources, including websites of organizations that develop programs targeted to children.

SELECTION CRITERIA

We included randomized, quasi-randomized, and non-randomized controlled studies (with explicitly listed specific study design features) that implemented formal day care programs as a single program or combined with additional out-of-day care components (such as educational activities aimed at preventing injury or drowning or early childhood development activities) for children of preschool age (below 6 years of age) in LMICs for comparison with no such programs or with other drowning prevention interventions. Studies had to report at least one outcome related to drowning or injury prevention for the children enrolled.

DATA COLLECTION AND ANALYSIS

Two review authors independently performed study selection and data extraction, as well as risk of bias and GRADE assessment.

MAIN RESULTS

Two non-randomized observational studies, conducted in rural Bangladesh, involving a total of 252,631 participants, met the inclusion criteria for this review. One of these studies compared a formal day care program combined with parent education, playpens provided to parents, and community-based activities as additional out-of-day care components versus no such program. Overall we assessed this study to be at moderate risk of bias (moderate risk of bias due to confounding, low risk of bias for other domains). This study showed that implementation of a formal day care program combined with parent education, provision of playpens to parents, and community-based activities, in a rural area with a high drowning incidence, likely reduces the risk of death from drowning over the study period of 4 years and 8 months compared to no day care program (hazard ratio 0.18, 95% confidence interval [CI] 0.06 to 0.58; 1 study, 136,577 participants; moderate-certainty evidence). Drowning morbidity (non-fatal drowning resulting in complications), total drowning (fatal and non-fatal), unsafe water exposure, and program safety (e.g. transmission of infection within day care, physical or sexual abuse of children within day care) were not reported, nor was the incidence of other unintentional injuries. Cost-effectiveness was reported as 812 USD (95% CI 589 to 1777) per disability-adjusted life-year averted as a consequence of drowning (moderate-certainty evidence). The second study compared day care programs with or without playpens provided to parents as an additional component versus only playpens provided to parents as an alternative drowning prevention intervention. Overall we assessed the study to be at critical risk of bias because we judged bias due to confounding to be at critical risk. As the certainty of evidence was very low, we are uncertain about the effects on drowning mortality rate of implementing a day care program compared to providing playpens (rate ratio 0.25, 95% CI 0.15 to 0.41; 1 study; 76,575 participants; very low-certainty evidence). Likewise, we are uncertain about the effects of a day care program with playpens provided as an additional component versus playpens provided alone (rate ratio 0.06, 95% CI 0.02 to 0.12; 1 study, 45,460 participants; very low-certainty evidence). The other outcomes of interest - drowning morbidity, total drowning, unsafe water exposure, program safety, incidence of other unintentional injuries, and cost-effectiveness - were not reported.

AUTHORS' CONCLUSIONS

This review provides evidence suggesting that a day care program with additional out-of-day care components such as community-based education, parent education, and playpens provided to parents likely reduces the drowning mortality risk in regions with a high burden of drowning compared to no intervention.

Preventing Child Drowning in the Philippines: The Need to Address the Determinants of Health

Drowning is a public health issue in the Philippines, with children at significantly increased risk. Determinants of health (DoH) such as education, socio-economic status, ethnicity, and urbanization are factors that impact drowning risk. As drowning is a multisectoral issue, a national drowning prevention plan can drive collaboration with relevant stakeholders. This study reports trends in unintentional child (0-14 years) drowning in the Philippines (incidence, rates, and trends over time for fatal and non-fatal (years lived with a disability (YLDs) and disability adjusted life years (DALYs) from 2008-2017 and conducts an analysis of the Philippines' Multisector Action Plan (MSAP) on Drowning Prevention. From 2008-2017, 27,928 (95%UI [Uncertainty Interval]: 22,794-33,828) children aged 0-14 years died from drowning (52.7% aged 5-14 years old). Rates of drowning have declined among both age groups, with greater reductions seen among 0-4 year olds (y = -0.3368x + 13.035; R² = 0.9588). The MSAP has 12 child drowning-specific activities and 20 activities were identified where DoH will need to be considered during development and implementation. The MSAP activities, and work done to prevent drowning more generally, must consider DoH such as education, urbanization, water and sanitation health, and safe water transportation. A national drowning surveillance system and investment in research in the Philippines are recommended.

Fatal injuries and economic development in the population sample of Central and Eastern European Countries: the perspective of adolescents

Objectives

Researches consider the young generation (adolescents) to be the population group whose mortality from injury has the lowest effect on economic growth. The objective was to evaluate the relations between economic indicators and preventable injury mortality in Central and Eastern European Countries (CEECs), with a primary focus on adolescents.

Methods

The analyses included health indicators of preventable injury mortality and economic indicators that represent human development and economic growth in the CEECs from 1990 to 2016. The analytical process involved a population group divided by age (0–14 years: children, 15–24 years: adolescents, 25–74 years: adults) and gender. Descriptive analysis, cluster analysis and primarily panel regression analysis were used.

Results

Significant effects of economic indicators on drowning were found in all analysed relations. In the group of adolescents, significant effects of fatal falls were found. Overall, it can be concluded that the effects of fatal injuries are not homogenous between age and gender groups.

Conclusions

The effects of years and individual countries should be taken into account in the cross-sectional analyses. In terms of economic growth, public policies should focus on drowning in children, on falls in adolescents and on transport accidents, fire injuries and poisoning in adults.

Enabling factors and barriers to the sustainability and scale-up of drowning reduction interventions in Vietnam: a qualitative assessment

BACKGROUND

Vietnam has some of the highest rates of drowning deaths in the Western Pacific Region, particularly among children aged 19 years or younger. Several policies aimed at drowning prevention have been developed over the last decade; however, despite policy support, generally these have not been sustained beyond a pilot phase or have been limited to small geographical regions. The present study aims to explore barriers and facilitators for sustainability and scale-up of drowning prevention initiatives in Vietnam, identifying ways forward for future implementation.

METHODS

This was a qualitative study using semistructured indepth interviews with key stakeholders (n=12) engaged in drowning prevention in Vietnam. The Framework Method was used to analyse the data drawing on Schell's theoretical framework for public health programme sustainability. The Framework Method is most commonly used for the thematic analysis of semistructured interview transcripts, particularly as the data were fairly homogeneous.

RESULTS

Four key factors were identified that facilitated implementation of drowning reduction activities in Vietnam. Strong political support at all levels, underpinned by policy; effective partnerships with the community; widespread communication; and programme adaptation to local contexts and application of innovative approaches, for example, strengthening organisational capacity in limited resource settings, were the key enablers. Barriers include the instability of the funding sources; inadequate programme evaluations to generate evidence of effectiveness and lack of consistent and timely data collection; and insufficient strategic planning for long-term implementation of drowning prevention interventions.

CONCLUSION

Ensuring the sustainability and scale-up of drowning prevention programmes in Vietnam requires a continued focus on enablers such as on community engagement, communication activities and partnership approaches, and importantly concerted efforts to mobilise resources for continued long-term funding, improvements in planning and intersectoral coordination, and ensuring that future programmes are robustly evaluated for effectiveness.