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Editor,—We read the editorial on “The challenge of drowning prevention” with great interest.1 There is no doubt that drowning is a major but under recognised cause of premature loss of life and disability. This has been borne out by the Global Burden of Disease Study which highlights the scale of the problem, by region and by age and sex characteristics.2 It is worth examining their findings further.
At a worldwide level, Murray and Lopez estimated that drowning was responsible for about half a million deaths in 1990 and ranked 20th as a leading single cause of mortality, after road traffic accidents (9th), self inflicted injuries (12th), and violence (17th) as the other injury related causes.3 Mortality rates from drowning were highest for children under 5 in China, followed by countries belonging to the “other Asia and islands” region, and sub-Saharan Africa, with the lowest rates in the “established market economies” (EME).* In this age group, the mortality rate ratio between China and the EME was 13:1 in boys and 22:1 in girls.
The large degree of variation between the different regions in the study must belie an even greater variation, both between and within countries, given the different geography and populations. There is great diversity in the circumstances in which drowning occurs in these different areas. Whereas swimming pools, sailing, and water sports may be priority areas in the EME, in low income countries attention must need to be paid to drowning in streams, wells, dams, cisterns, and while fishing.1, 4 Clearly there are a huge range of different environmental and behavioural circumstances. The obvious intervention to keep the child who cannot swim away from water must have a different interpretation in the different regions. Although swimming pools could be fenced in EME countries, the fencing of waterways would be impractical in countries where this runs into thousands of kilometres. This is not to say that there are no common approaches. As the editorial rightly points out, education about the risks, closer supervision, and training in resuscitation are important first steps which could be applied globally. Researchers also need to study the circumstances under which drowning occurs and the first aid and health care response, within countries and cross nationally. Data on good practice need to be collated so that appropriate interventions which are transferable to other low and middle income countries can be easily identified. Whatever the intervention there is an urgent need to get drowning higher on the agenda for policy makers and researchers.
↵* The Global Burden of Disease Study used the eight global regions identified by the World Bank for the World Development Report 1993 with similar levels of socioeconomic development, epidemiological homogeneity, and geographical contiguity: the EME, former socialist economies of Europe, India, China, other Asia and islands, sub-Saharan Africa, Latin America and the Caribbean, and the Middle East crescent (which includes North Africa, the Middle East, Pakistan, and the Central Asian republics of the former Soviet Union).
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