Keeping our heads above water: A systematic review of fatal drowning in South Africa

Background. Drowning is defined as the process of experiencing respiratory impairment from submersion/immersion in liquid, and can have one of three outcomes ­ no morbidity, morbidity or mortality. The World Health Organization African region accounts for approximately 20% of global drowning, with a drowning mortality rate of 13.1 per 100 000 population. The strategic implementation of intervention programmes driven by evidence-based decisions is of prime importance in resource-limited settings such as South Africa (SA).Objective. To review the available epidemiological data on fatal drowning in SA in order to identify gaps in the current knowledge base and priority intervention areas. Methods. A systematic review of published literature was conducted to review the available epidemiological data describing fatal drowning in SA. In addition, an internet search for grey literature, including technical reports, describing SA fatal drowning epidemiology was conducted.Results. A total of 13 published research articles and 27 reports obtained through a grey literature search met the inclusion and exclusion criteria. These 40 articles and reports covered data collection periods between 1995 and 2016, and were largely focused on urban settings. The fatal drowning burden in SA is stable at approximately 3.0 per 100 000 population, but is increasing as a proportion of all non-natural deaths. Drowning mortality rates are high in children aged <15 years, particularly in those aged <5. Conclusions. This review suggests that SA drowning prevention initiatives are currently confined to the early stages of an effective injury prevention strategy. The distribution of mortality across age groups and drowning location differs substantially between urban centres and provinces. There is therefore a need for detailed drowning surveillance to monitor national trends and identify risk factors in all SA communities

Perfil epidemiológico dos afogamentos em praias de Salvador, Bahia, 2012* / Epidemiological profile of drowning on beaches in Salvador, Bahia, Brazil, 2012

Descrever o perfil epidemiológico e a frequência dos afogamentos em praias do município de Salvador, estado da Bahia, Brasil, cobertas pela Coordenadoria de Salvamento Marítimo de Salvador (Salvamar), em 2012. Métodos: foram descritos os dados obtidos do banco de informações sobre as vítimas atendidas pelo Salvamar. Resultados: foram registrados 733 afogamentos; houve predomínio do sexo masculino (65,5 por cento), adolescentes (40,8 por cento), estudantes (67,7 por cento) e moradores de Salvador (69,4 por cento); a idade média das vítimas era de 22,2 anos; quase todos os afogamentos foram não fatais (98,9 por cento), a maioria deles aconteceu entre 10 e 16 horas (89,5 por cento) e os meses com maior ocorrência foram janeiro (20,9 por cento) e fevereiro (16,4 por cento). Conclusão: predominaram, entre as vítimas, homens, jovens e estudantes, e os afogamentos não fatais; as ocorrências foram registradas, principalmente, nos meses do verão; as ações de prevenção a afogamentos deveriam focar os subgrupos identificados como mais vulneráveis...

To describe the epidemiological profile and the frequency of drowning on beaches in Salvador, Bahia, Brazil, covered by the Salvador Maritime Rescue Service (Salvamar) in 2012. Methods: the described data were obtained from the database of Salvamar on drowning accidents. Results: 733 people drowned in the period; victims were mostly male (65.5 per cent), adolescents (40.8 per cent), students (67.7 per cent) and inhabitants of Salvador (69.4 per cent). Mean age was 22.2 years. Almost all cases were not fatal (98.9 per cent) and the majority happened between 10 a.m. and 4 p.m. (89.5 per cent) in January (20.9 per cent) and February (16.4 per cent). Conclusion: this study indicated that Salvador had a high frequency of non-fatal drowning among males, youth and students. Summer time drowning prevention actions. should be focused on these vulnerable subgroups...

Prevalência de alcoolemia em óbitos por acidente de transporte e por outras causas externas / Prevalence of alcoholemy in deaths from traffic accidents and other external causes

Introdução: Trauma é a principal causa de óbitos em indivíduos entre 18 e 44 anos de vida no Brasil. Por mais de um século, o álcool tem sido reconhecido como um dos principais fatores de risco para acidentes fatais, desempenhando um importante papel na etiologia do trauma. O objetivo deste estudo foi comparar o diagnóstico de alcoolemia entre mortos por acidentes de trânsito e outras causas externas (afogamento, homicídio e suicídio). Métodos: Foi realizado um estudo transversal onde se utilizaram dados secundários do Departamento de Medicina Legal de Porto Alegre no período de janeiro a dezembro de 2001. As variáveis estudadas foram o nível de alcoolemia e óbitos por causas externas. Resultados: Foram analisados 1.588 óbitos. Os homicídios ocorreram na faixa etária entre 19 e 45 anos, representando 80% dos casos. As causas externas ocorrem com mais frequência em homens e a maior causa de óbitos entre mulheres foi por acidente de trânsito, com menor alcoolemia. Os pacientes que apresentam alcoolemia positiva tiveram uma razão de prevalência de 1,18 (IC 95%:1,05 a 1,32) em relação ao óbito por acidente de trânsito em comparação ao suicídio. Conclusão: Este estudo demonstra que o álcool é fator contribuinte de morte por causas externas, especialmente aquelas causadas por acidentes de trânsito e homicídio

Introduction: Trauma is the leading cause of death in individuals between 18 and 44 years of age living in Brazil. For over a century, alcohol has been recognized as a major risk factor for fatal accidents, playing an important role in the etiology of trauma. The aim of this study was to compare the diagnosis of alcoholemy in individuals who died in traffic accidents and from other external causes (drowning, homicide and suicide). Methods: We conducted a cross-sectional study based on secondary data from the Department of Forensic Medicine of Porto Alegre from January to December 2001. The variables were blood alcohol content (BAC) and deaths from external causes. Results: We analyzed 1,588 deaths. The murders occurred between the ages of 19-45 years, accounting for 80% of the cases. External causes occur more frequently in men, and traffic accidents are the leading cause of death among women, with lower blood alcohol levels. Patients with positive blood alcohol content had a prevalence ratio of 1.18 (95% CI: 1.05 to 1.32) in relation to death by traffic accidents as compared to suicide. Conclusion: This study demonstrates that alcohol is a contributing factor of death from external causes, especially those caused by traffic accidents and homicide

Ahogamiento incompleto, valoración de la injuria cerebral al ingreso: terapia intensiva pediátrica / Nearly drowning, valuation of the cerebral injury when entering the hospital: intensive pediatric therapy

Se realizó una investigación descriptiva retrospectiva que incluyó a todos los pacientes que fueron ingresados en el Servicio de Terapia Intensiva del Hospital Eliseo Noel Caamaño, en el período comprendido desde junio de 1982 hasta junio de 2004, con el diagnóstico de Ahogamiento Incompleto, con el propósito de determinar el estado neurológico y su relación con diferentes variables que pueden haber influido en la intensidad del daño, así como la sobrevivencia final de los mismos. Los resultados obtenidos nos permitieron conocer el manejo del paciente pediátrico que ha sufrido este tipo de accidentes, así como su estado a la llegada al Servicio. El 68 por ciento de los pacientes tuvieron una afección de moderada a severa según las escalas de Conn y Glasgow, además existió una correlación de hasta un 97 por ciento entre dichos métodos de evaluación. Dentro de las variables que influenciaron en el estado de los niños al ingreso se destacó un tiempo de inmersión mayor de 5 minutos para los clasificados como severos, 70 por ciento de la muestra, fallecieron el 7 por ciento de todos los pacientes estudiados, todos ellos clasificados como severos.

We carried out a descriptive retrospective study including all the patients that were entered in the Service of Intensive Therapy of the hospital Eliseo Noel Caamaño, in the period from June 1982 to June 2004, with the diagnosis of nearly drowning, with the purpose of determining the neurological state and its relation with different variables that might have influence in the intensity of the damage, as well as in the final surviving of the patients. The obtained results allowed us knowing the managing of the paediatrics patient that have suffered this kind of accidents, as well as their state at the arrival to the service; 68 percent of the patients had a moderated to severe affection according to the Conn and Glasgow scales; moreover, there was a correlation of up to 97 percent between these evaluation methods. Among the variables that influenced in the state of the children at the entering, there was an immersion time of more than 5 minutes for those classified as severe, 70 percent of the sample; 7 percent of all the studied patients died, all of them classified as severe.

Call for more research on injury from the developing world: Results of a bibliometric analysis.

Background & objectives: Injury prevention is a daunting health challenge as public health systems particularly in the developing world are least prepared to respond to this issue. In 2005, an estimated 5.4 million people worldwide died from injuries over 90 per cent in low- and middle-income countries. The main objective of this bibliometric analysis was to document injury literature published on low- and middle- income countries, and also to quantify literature on road traffic injuries by countries before and after the World Health Day on Road Safety celebrated in April 2004. Methods: A systematic search was done using MeSH terms on PubMed. Papers on road traffic injuries were assessed by country/cluster and by publication date for two periods (March 2001 - March 2004) and (April 2004 - April 2007). The rate of articles published per million population was calculated. Finally, a comparison was made between disease burden in disability adjusted life years (DALYs) and quantum of papers published. The search was performed on April 29, 2007. Results: PubMed had 8.26 million articles listed; of which, 72 per cent were in English and only 2 per cent were on unintentional injuries. For papers in all languages including English on road traffic injuries, 41 per cent were from US, 36 per cent from Europe (other than Eastern Europe). Two most populous countries, China and India contributed only 0.9 and 0.7 per cent papers on road traffic injuries, respectively. On neoplasm there were 280 articles published per million population whereas for road traffic injuries, rate was 4 articles per million population. Northern Africa, India and China had less than one article on road traffic injuries per 1,000 road traffic related deaths. The percentage change in English papers on road traffic injuries for the period 2004-2007 in comparison to period 2001-2004 was +191 per cent for China, +118 per cent for India, and +106 per cent for Middle East. Unintentional injuries overall represented 18 per cent of the burden in terms of DALYs and represented only 2 per cent of all published articles. Interpretation & conclusion: The results noticeably reflected the small proportion of papers on injuries, the dominance of US, and the apparent increase in percentage of road traffic injuries papers from low- and middle- income countries after World Health Day on Road Safety in 2004. Policies on injury prevention and safety in developing countries will be effective if based on local evidence and research, and designed to suit the social, political, and economic circumstances found in developing countries.

Dados médico-legais sobre afogamentos na região de Ribeirão Preto (SP, Brasil): um passo para a prevenção / Medico-legal data on drowning in Ribeirão Preto region (SP, brazil): a step for prevention

Este é um estudo de prevalência com a primeira descrição específica de casos de afogamento em uma área não-costeira do Brasil, em Ribeirão Preto, estado de São Paulo, uma região com padrão de vida comparável ao de países desenvolvidos, com o objetivo de estabelecer medidas preventivas para este tipo específico de trauma. Metodologia: Uma análise da documentação médico-legal de 89 casos de afogamento ocorridos entre 2001 e 2004. O padrão de mortes por afogamento foi estudado através de parâmetros como idade, sexo, características sócio-econômicas e avaliação do consumo de álcool. Resultados: um índice de 2,69 casos por 100.000 habitantes foi observado. O perfil predominante entre as vítimas de afogamento foi o do homem caucasiano em idade economicamente produtiva (15-59 anos), afogados acidentalmente em rios e represas na área rural durante o verão e o outono, sendo inviável a avaliação do consumo de álcool. Conclusão e Relevância: a observação do perfil da vítima de afogamento através dos relatórios médico-legais permitiu o desenvolvimento de um projeto piloto de sucesso na prevenção de afogamentos que pode ser expandido para outras áreas não-costeiras do Brasil, visando à redução do número de vítimas através da prevenção. As dificuldades de investigar a influência do consumo de álcool são discutidas.

This is a prevalence study with the first specific description of drowning cases ina non-coastal area of Brazil, in the locality of Ribeirão Preto, State of São Paulo—a region with standards of living comparable to those in developed countries—regarding the establishment of preventative measures for this specific kind of injury. Methodology: An analysis of the forensic documentation of 89 drowning cases occurred between 2001 and 2004. The pattern of drowning fatalities was studied in relation to parameters like age, sex, socio-economic background and evaluation of alcohol consumption. Results: rate of 2.69 cases per 100,000 habitants per year was observed. The predominant profile among drowning victims was that of the Caucasian male of economically productive age (15 to 59 years), accidentally drowned in rivers and dams in rural areas during the summer and autumn, being impossible the evaluation of alcohol consumption. Conclusion and Relevance: the observation of the victim profile through the analysis of forensic reports allowed the development of a successful pilot program of drowning prevention that can be expanded to other non-coastal areas in Brazil, regarding the reduction of the number of victims by prevention. The difficulties in alcohol consumption analysis are discussed.

Childhood mortality due to drowning in rural Matlab of Bangladesh: magnitude of the problem and proposed solutions.

Drowning is an important cause of mortality among children in rural Bangladesh. Children aged 1-4 year(s) are at a high risk of death from drowning. Although deaths of children due to drowning in Bangladesh are acknowledged as an important cause of death, little effort has been made to address the issue of preventing deaths from this cause. This study has attempted to describe the problem and suggests possible prevention strategies, which may contribute to reducing childhood mortality from drowning. Data presented in this study were collected from Matlab where ICDDR,B has been maintaining a demographic surveillance since 1966. During the study period from 1985 to 2000, 989 deaths from drowning were reported, of which 796 (80.5%) were children in the age-group of 1-4 year(s), 48 (4.8%) were in the age-group of less than one year, and 145 (14.7%) in the age-group of 5-19 years. During 1985-2000, death rate per 1,000 children due to all causes among children of 1-4-year age-group decreased appreciably from 20.7% to 5.2%, while drowning-related deaths did not. Forty-five percent (n = 359) of drowning-related deaths occurred in ponds, 16.8% (n = 134) in ditches, 8.1% (n = 64) in canals, and 4.4% (n = 35) in rivers. The sites of more than 25% of drowning-associated deaths were not recorded. Analysis of seasonal variation revealed that most deaths due to drowning occurred during April-October, i.e. mostly during the monsoon months. It was also observed that the majority (67%) of mothers of victims had no formal education. Deaths due to drowning were mostly associated with children aged 1-4 year(s) and were 20% more common among boys than among girls (odds ratio = 1.2, 95% confidence interval 1.04-1.38, p < 0.012). The paper recommends some interventions to reduce the number of deaths due to drowning in rural Bangladesh, which include: (a) increasing awareness among mothers and close family members about the risk of drowning, (b) door-fencing, and (c) filling of unused ditches and water holes around households.

Prevention of drowning and its societal implications.

Death by drowning is not an uncommon phenomenon when stresses of the modern day life compel the person to end the life. In the regions where water sources are in abundance, e.g. rivers, canals, lakes, ponds and places near sea, these are readily available for such persons to end their lives. Homicides may also effected by pushing a person into well or canal. Accidents do occur when a person is walking or driving along a water source. We have to find out the reasons, by doing proper epidemiological studies, to find out ways to prevent such unnatural deaths. Daily we read some person committing suicide by one mean or other. In this ongoing study conducted in mortuary of Govt. Medical College, Patiala, relation of various factors like marital status, sex, age, etc with drowning were studied.

Afogamento na infância: epidemiologia, tratamento e prevenção / Drowning in childhood: epidemiology, treatment and prevention

Objetivo: fazer uma revisão crítica a respeito da epidemiologia e do tratamento do afogamento na população pediátrica. Fontes de dados: foram pesquisados todas as fontes bibliográficas do sistema Medline (internet), artigos apresentados em congressos, recomendações internacionais, bem como livros sobre emergência e terapia intensiva. Síntese dos dados: a cada ano, 500.000 pessoas morrem afogadas em todo o mundo. Os principais fatores de risco para o afogamento são: a idade, ser do sexo masculino, o uso de bebidas alcoólicas, a baixa condição socioeconômica e a falta de supervisão. Mundialmente, o afogamento constitui a primeira causa de morte do seo masculino na faixa et´[aria entre 5 e 14 anos, sendo a segunda causa no Brasil desse grupo. Em nosso país, há 7.210 mortes ao ano por afogamwento (5,2/100.000 habitantes), sendo mais frequentes os casos em água doce (rios, lagos e represas). Esta revisão procura difundir para os pediatras conceitos relativos a uma nova defenição do afogamento, sua nomenclatura e classificação; a cadeia de sobrevivência; as técnicas mais adequadas de resgate; o tratamento e as novas abordagens na ressuscitação da criança afogada. Conclusões: nos últimos 15 anos houve acentuada valorização do tema afogamento, resultando em redução da morbimortalidade por essa causa. Todavia, o afogamento ainda constitui grave e negligenciado problema de saúde pública, que necessita, com urgência, em âmbito nacional, de campnahas de prevenção que objetivem reduzir sua incidência n/ao só no litoral, mas principalmente np interior do país.

Casi-Ahogamiento en niños de Cartagena, 1994-1995

En un estudio retrospectivo revisamos 49 casos de ahogamiento en niños presentados en la ciudad y playas de Cartagena entre Enero de 1994 y Diciembre de 1995. Evaluamos por un lado el perfil epidemiológico de la población afectada y por el otro el tratamiento de emergencia administrado a los pacientes. Se presentaron 49 casos en un periodo de 24 meses lo que significa un paciente cada 2 semanas. la edad promedio fue de 7.9 años, siendo el grupo escolar el más afectado; destacamos sin embargo la presencia de 9 pacientes por debajo de 2 años de edad. Aunque Cartagena es un importante centro centro turistico, alrededor de tres cuartas partes de los pacientes eran habitantes de la ciudad. En relación con el tratamiento encontramos una utilización frecuentemente inadecuada de antibioticos, diureticos y corticoides. La incidencia de casi ahogamiento en la población de Cartagena es alta, constituyendose en un problema de salud pública. Las medidas preventivas deben ser mejoradas para evitar esta clase de accidentes

Casi-Ahogamiento en niños de Cartagena, 1994-1995 / Near drowning in children in Cartagena, 1994-1995

En un estudio retrospectivo revisamos 49 casos de ahogamiento en niños presentados en la ciudad y playas de Cartagena entre enero de 1994 y diciembre de 1995. Evaluamos por un lado el perfil epidemiológico de la población afectada y por otro lado el tratamiento de emergencia administrado a los pacientes. Se presentaron 49 casos en un período de 24 meses lo que significa un paciente cada 2 semanas. La edad promedio fue de 7.9 años siendo el grupo escolar el más afectado; destacamos, sin embargo la presencia de 99 pacientes por debajo de 2 años de edad. Aunque Cartagena es un importante centro turístico, alrededor de 3/4 partes de los pacientes eran habitantes de la ciudad. En relación con el tratamiento encontramos una utilización frecuentemente inadecuada de antibióticos, diuréticos y corticoides. La incidencia de casi ahogamiento en la población de Cartagena es alta constituyéndose en un problema de salud pública. Las medidas preventivas deben ser mejoradas para evitar esta clase de accidentes

Accidentes por inmersión: ahogamiento y casi-ahogamiento: presentación de 38 casos

Los accidentes por inmersión se presentan en más de 8.000 personas por año en los Estados Unidos. La verdadera incidencia del casi-ahogamiento todavía no se ha precisado, pero se supone que es dos a 10 veces mayor que el número real de ahogados que se públican. En nuestro medio la situación es más complicada ya que no existen estudios que definan la magnitud del problema. En el presente trabajo se revisaron las historias clínicas de 38 pacientes, con accidentes por inmersión en agua salada, manejados en el Hospital Universitario de Cartagena y en el Hospital Bocagrande durante los últimos dos años. Se trataba de 23 hombres (65 por ciento) y 15 mujeres (35 por ciento), con una edad promedio (x) de 18.5 años. El tiempo de inmersión fue, en promedio, de 18.1 (s=16.89) minutos. En 12 pacientes se practicaron maniobras de Reanimación Cardiopulmonar; en 9 fueron exitosas y la duración de tales maniobras fue de 26.6 (s=12.1) minutos. Al ingreso los signos vitales en promedio fueron: frecuencia cardíaca de 117 (s=14.3), frecuencia respiratoria de 31.5 (s=7.5), presión arterial media de 59.2 (s=9.6). El ionograma fue normal; con un sodio sérico de 139 (s=3.4) y Potasio de 3.9 (s=0.3). 10 pacientes ingresaron a la Unidad de Cuidado Intensivo y tuvieron una estancia en ella de 3.6 (s=1.3) días. De estos pacientes 6 requirieron Ventilación Mecánica durante 1.5 (0.5) días. Ningún paciente recibió corticoides y sólo 5 recibieron antibióticos, y en todos los casos se hicieron con la indicación de "profilaxis". No se presentaron infecciones en los pacientes que no recibieron antibióticos. De la presente revisión podemos resumir que: 1: No hay justificación para el uso de esteroides o antibióticos profilácticos en este tipo de pacientes. 2. Las alteraciones electrolíticas no son tan frecuentes ni severas como se consideraba. 3. Si bien el tiempo de inmersión fue prolongado, la eficacia y rapidez de la reanimación y la respuesta neurológica inicial son los mejores parámetros para establecer pronóstico en casiahogamiento. " La desición de reanimar un paciente con accidente de inmersión es ética más que médica y si existe la posibilidad de salvar una vida, el número de fracasos es una situación específica no debe ser tenido en cuenta". 4. Las medidas preventivas son primordiales para reducir la morbimortalidad derivada de los accidentes por inmersión.

Asfixia por inmersión en Jalisco: 1983-1989 / Drowning in Jalisco: 1983-1989

El objetivo de este trabajo fue identificar a los factores prevenibles que intervienen en la muerte a causa de asfixia por inmersión. Se revisaron los expedientes de 895 autopsias realizadas de 1983 a 1989 por el Departamento Médico Forense de la Procuraduría General de Justicia del estado de Jalisco. Durante estos siete años, la tasa anual de mortalidad por esta causa se mantuvo alrededor de 2.6 por 100 000 habitantes. El sexo masculino mostró una mayor tasa anual de mortalidad (4.2 por 100 000) que el femenino (1.1 por 100 000). El grupo etario con mayor mortalidad fue el de uno a cuatro años (7.6 por 100 000). Las muertes estudiadas mostraron una clara agrupación estacional durante verano. El mayor número de ahogamientos ocurrió en aljibes (19.3%), presas-lagos (16.9%), ríos-canales (14.3%), pozos-norias (12.5%) y albercas (10.1%). El 30 por ciento de las muertes ocurrió en el hogar. El 63.0 por ciento de los mayores de 14 años tenía alguna cantidad de alcoholemia y la mayor proporción la encontramos entre los 35 y 44 años (77%). Se identifican dos aspectos que se pueden destacar: la asfixia por inmersión en el hogar y la relación que esta causa de muerte tiene con la ingesta de alcohol.

The objective of this work was to identify which preventive factors are involved in drowning. Files of 895 autopsies from 1983 through 1989 by the coroner sue office were reviewed During this seven year period the annual mortality for drowing was 2.6 per 100 000 population. Males had a higher annual mortality rate (4.2 per 100 000) than females (1.1 per 100 000). The age group between one and four years old had the highest mortality rate (7.6 per 100 000). Deaths tend to cluster around summer. Most of the deaths occurred in house cisterns (19.3%), dams/lakes (16.9%), riverslcanals (14.3%), water wells (12.5%) and swimming pools (10.1%). A third of the deaths occurred at home. The relationship alcohol-drowning starts to stand out in the age group between 10 and 14 years old but get its highest percentge in the age group 35-39 (74%). There are two important findings that is necessary to point out: drowning occurring at home and the relationship between drowning and alcohol ingestion.

Near drowning in Puerto Rican children

Se revisa la experiencia con 40 niños víctimas de sumersión, admitidos al Hospital Pediátrico Universitario durante los últimos 16 años. Se recalcan los datos epidemiológicos de la condición y la fisiopatología de la misma, así como en los factores determinantes del pronóstico. La prevalencia y mortalidad de ahogamiento en Puerto Rico parecen ser comparables con las de otras comunidades del exterior. Hay necesidad de e más estudios sobre la epidemiología y secuelas de este problema en nuestro ambiente