Table 3

Effectiveness of drowning interventions using pool fencing (included studies)

Study characteristics (quality)Intervention descriptionKey elementsMeasuresResults
Morgenstern et al20 Pool deaths and the effect of local ordinances
Retrospective cohort and case–control

Evidence level: III-2

Pool deaths matched to pools with no deaths

<10 years

Incidence of drowning deaths in residential swimming pools (N=146) matched to pools with no drowning (1:5) between 1 January 1990 and 31 December 1995.

Cases stratified to age and location for comparison that included housing and property characteristics.
Whether a pool fencing ordinance was in effect when pool was built and the effect on pool drowning fatalities.Outcome: incidence of fatal pool drowning.
Exposure: presence or absence of pool fencing ordinance when pool built or altered.

Other: Demographic and other potential confounders also investigated.
Pool fencing ordinances and drowning not significantly associated RR=1.27 (95% CI 0.72 to 2.25)*.
Incidence rate 1.77/100 000/year 1–9 years for fatal drowning. 1–4 years 3.61/100 000
81% of all drowning occurred in pools in areas regulated by pool fencing ordinances.
Possible explanations: ineffective building codes for pool isolation, insufficient ordinance enforcement and/or inadequate operation or maintenance of fencing equipment by pool owners. Ordinance did not specify four-sided fencing.

Other risk factors:
Positive associations were observed between drowning and:
Age 1–4 years; male; ethnicity (Hispanic/Latino and white non-Hispanic); summer season; high and medium pool density; low parental education; high family income (none significant in adjusted analyses).
Pitt and Balanda 21 Domestic pool drowning (fatal and non-fatal) and the effect of pool fencing
Case–control population-based

Evidence level: III-2
Domestic pool fatal and non- fatal drowning and pool fencing

0–13 years

Risk of drowning in fenced or unfenced pool calculated through ratio of immersions to fenced and unfenced pools. Immersion cases (n=139) presenting to ED July 1984–June 1989. Controls (n=204) randomly selected from Home Safety Survey conducted in July 1989. Stratified by existence of pool fencing.
Drowning death certificates accessed for 1984–1989.
Pool fencing defined as four-sided vs unfenced/three-sided. Survey of pool fencing conducted by interviewers on-site.
Telephone interview for retrospective pool/patient information.
fatal and non-fatal drowning
Fatal and non-fatal drowning where unintended pool access was gained.

fenced vs unfenced pools.
Pool type: above ground, in ground and spas.
Fencing configuration: 4-sided vs unfenced, which includes three-sided fencing.
Incidence rates calculated for drowning in different pool types.
Compared to fenced domestic pools:
RR=3.76 all unfenced domestic pools (95% CI 2.14 to 6.62)†
RR=4.10 unfenced in-ground pools (95% CI 2.11 to 8.00)†
RR=4.30 unfenced above-ground pools (95% CI 1.09 to 16.97†

Incidence rates:
Overall 0–13 years fatal and non-fatal 3.3/100 000
Non-fatal 0–13 years 15.5/100 000. Non-fatal 1–3 years 64.9/100 000.

Other descriptive risk factors
71% child and family unfamiliar with hazard; 28% of children granted access.
0–13 years: 72% of drowning locations in domestic pools; 72% of all pool drowning cases had unintended pool access
1–3 years: 89% of pool drowning;
  • *No association and not statistically significant.

  • †Statistically significant association.

  • ED, emergency department.