In 2000, an estimated 409,272 people drowned, which makes drowning the second leading cause of unintentional injury death globally after road traffic injuries.

In 2000, an estimated 409,272 people drowned, which makes drowning the second leading cause of unintentional injury death globally after road traffic injuries. This total includes only “accidental drowning and submersion. The problem is even greater.

These Global Burden of Disease (GBD) figures are an underestimate of all drowning deaths, since they exclude drowning due to cataclysms (floods), water and other transport accidents, assaults and suicide. Also during 2000, injuries accounted for over 9 % of total global mortality. Of these injury-related deaths, 8 % were from unintentional drowning. Of these unintentional drowning deaths, 97 % occurred in low- and middle-income countries.

“Drowning is the process of experiencing respiratory impairment from submersion-immersion in liquid. Drowning outcomes are classified as death, morbidity and no morbidity.

Agreed terminology is essential to describe the problem and allow effective comparisons of drowning trends.

For this reason, the definition of drowning ” adopted by the 2002 World Congress on Drowning ” should be widely used.

Risk factors

Major risk factors for drowning by all causes include:

Sex

Males are more likely to die or be hospitalised due to drowning than females. Males in the African and Western Pacific Region have the highest drowning-related mortality rates worldwide. Studies suggest males have higher drowning rates than females due to increased exposure to water and riskier behaviour, such as swimming alone, drinking alcohol before swimming alone and boating.

Age

Among the various age groups, children under five years of age have the highest drowning mortality rates worldwide. Canada and New Zealand are exceptions, where adult males have the highest rates. Drowning is the leading cause of injury death to children aged 1-14 years in China. In Bangladesh, 20% of all deaths in children aged 1-4 years are due to drowning. Drowning was the second leading cause of unintentional injury death in children aged 1-14 in the United States in 2000. Drowning is the leading cause of unintentional injury death in children aged 1-3 in every Australian state. Drowning in young children is often associated with a lapse in supervision.

Occupation

The occupational mortality rate in Alaskan commercial fishermen is 116 per 100,000. Approximately 90% of these deaths are by drowning. Small-boat subsistence fishing in low-income countries is associated with many drowning deaths.

Floods

Large numbers of drowning deaths are associated with floods worldwide, including thousands of deaths in single countries, such as China.

Transportation

Vessels that may be unsafe or overcrowded (including refugee boats), and poor weather conditions are associated with large, though unknown, numbers of drowning deaths every year. 90% of Canadian boating victims of drowning were not wearing a floatation device.

Alcohol

Alcohol is a risk factor for drowning among adolescents and adults, though the proportion of drowning victims testing positive for blood alcohol concentration levels depends on the country reported. Alcohol may impair parental supervision of children near water. Alcohol or drug use was implicated in 14% of unintentional drowning fatalities in Australia in persons greater than 14 years, of whom 79% were male.

Epilepsy

Children with epilepsy are at significantly greater risk of bath and pool drowning, compared to children without epilepsy. In Sweden, drowning was the cause of death in approximately 10% of people with a history of epilepsy (1975″1995). In Canada, most epilepsy-associated drowning deaths occur to a dults in bathtubs.

Socio-economic status

Ethnic minority groups generally have higher drowning death rates, possibly due to differences in opportunities to learn to swim. In Bangladesh, children whose mothers have only primary education are at significantly greater risk of drowning compared with children whose mothers have secondary or higher education.

Access to water

• In Bangladesh, most young children who die from drowning are aged 12-23 months, with most fatalities occurring as a result of falling into ditches and ponds.
• For young children in the United States, the presence of a residential pool, particularly when inadequately fenced, is the greatest risk factor.
• In an Australian farm injury study, drowning accounted for over 58% of deaths in children aged less than five years, and 78% of those deaths were associated with access to farm dams and irrigation channels.
• In Mexico, children of parents with a water well at home are at significantly greater risk of drowning compared with children of parents with no well.

Notably higher rates of drowning deaths in rural versus urban areas in some low- and middle-income countries are directly related to access to water.

Infants left alone or with another child in an adult bathtub are at significant risk of drowning.

Unfenced homes in proximity to bodies of water increase the risk of drowning.

Tourists may be at unacceptably high risk of drowning.

Reprinted from the World Health Organisation.