Drowning in LMIC Settings
By Mr Lasith Dissanayake
Drowning is a serious and neglected public health threat, causing morbidity and mortality worldwide. According to the World Health Organization (WHO), drowning is the third leading cause of unintentional injury death, accounting for 7% of all injury-related deaths (WHO, 2021). An estimated 236,000 fatal drownings took place in 2019, and 90% of these deaths occurred in low- and middle-income countries (LMICs), where the number of drowning deaths is even considered underreported (Linnan et al., 2007; Tyler et al., 2017).
To identify evidence related to this major public health problem in LMICs, in August 2023, the Royal National Lifeboat Institution (RNLI) commissioned ADN to carry out a project to, “review gaps in drowning data collection in LMICs”. ADN’s Research Evidence Synthesis team, in collaboration with three experts on injury-related deaths/drowning from the University of Cape Town in South Africa, Makerere University School of Public Health in Uganda, and the Centre for Injury Prevention and Research, Bangladesh, successfully conducted a scoping review (SR) followed by consultations with experts in the field.
The scoping review mainly focused on the use of the Verbal Autopsy (VA) instrument to identify risk factors for injury deaths related to drowning. VA Instrument is commonly used to determine the cause of death in LMICs (WHO, 2023), either as part of large-scale household surveys or within geographically specific health and demographic surveillance systems (WHO, 2024). As the project’s second phase, consultations were conducted with five experts from the Public Health Foundation of India, INDEPTH Network, and the Centre for Injury Prevention and Research, Bangladesh.
The review findings indicated that more studies are needed to capture the “causes and circumstances” of both fatal and nonfatal drowning using VA instruments so that context-specific interventions can be implemented and the actual burden of severe injury and lifelong disability can be understood. The findings have implications for WHO, INDEPTH Network, and PHMRC to update their VA instruments to address the identified challenges and improve local-level qualitative data collection procedures.
The final report was submitted to the RNLI in August 2024. The project findings were presented at the 15th World Conference on Injury Prevention and Safety Promotion, held in New Delhi, India.
ADN will continue collaborating with the RNLI to conduct further projects on drowning.
The conference abstract can be accessed via – How drowning data is collected in low- and middle-income countries (LMICs): a scoping review | Injury Prevention.
References
Linnan, M. et al. (2007) ‘Child Mortality and Injury in Asia: Survey Results and Evidence’. Available at: https://doi.org/10.18356/F28CFFE5-EN.
Tyler, M.D. et al. (2017) ‘The epidemiology of drowning in low- and middle-income countries: a systematic review’, BMC Public Health, 17(1), pp. 1–7. Available at: https://doi.org/10.1186/s12889-017-4239-2.
WHO (2021) Drowning – Key facts. Available at: https://www.who.int/news-room/fact-sheets/detail/drowning (Accessed: 22 July 2023).
WHO (2023) Verbal autopsy standards. Available at: https://www.who.int/standards/classifications/other-classifications/verbal-autopsy-standards-ascertaining-and-attributing-causes-of-death-tool (Accessed: 10 August 2023).
WHO (2024) Civil registration: why counting births and deaths is important, Media Centre. Available at: https://www.who.int/news-room/fact-sheets/detail/civil-registration-why-counting-births-and-deaths-is-important (Accessed: 8 August 2023).