Research data essential to drowning-prevention strategies

We take a look at a few of the key findings from a recently-published study of fatal drownings in South Africa, conducted by the NSRI in conjunction with UCT’s Faculty of Health Sciences and Department of Statistical Sciences.

There has been an increase in research into fatal drowning that has highlighted it as a major public health concern. The World Health Organisation is among a host of organisations that have weighed in on advocating for drowning-prevention strategies, but for any strategy to be effective, it has to be designed for the target population. In other words, drowning-prevention strategies recommended for one target population might not be applicable to low-middle-income countries (LMICs), which have been identified as having the highest burden globally of fatal drowning incidence (90%).

The study, titled ‘A South African Epidemiological Study of Fatal Drownings: 2016-2021’, aimed to provide an overview of fatal drownings in South Africa that could assist with developing future interventions or enhancing current ones in order to reduce the loss of life that affects families and communities so profoundly.

LMICs carry the highest burden

LMICs carry the burden of 90% of global fatal drowning incidence. Factors contributing to this include (but are not limited to):

• lack of drowning-prevention initiatives

• lack of regulations and policies relating to drowning prevention

• insufficient water-safety awareness and education campaigns

• lack of basic swimming skills

In LMICs, fatal drowning is most prevalent in children under the age of 5 years, with a 2013 report indicating that 50% of drowning deaths were in children between 1 and 4 years of age (a finding that is supported by international research). Often these incidents occurred within 3-20m from the home and where there was no adult supervision. In South Africa, the most vulnerable age groups in order of the number of fatal deaths are 0-4 years, then 5-9 years, 10-14 years and 15-19 years, indicating that the country’s youth are the most at risk of fatal drowning.

In addition, fatal drowning occurs more often in males than females. In South Africa, during the study period, 5 820 males succumbed to fatal drowning compared with 1357 females. Reasons include males being exposed to water more often; they feel more confident in their swimming abilities; and they are more likely to take risks. The study also revealed that more fatal drownings occurred in fresh water. Places where drowning occurs were categorised into freshwater (including canals, dams, dipping tanks, ditches, dongas, gully holes, lagoons, mineshafts, reservoirs, rivers, stormwater pipes, streams, swamps and wells), pools or swimming pools and the ocean (including harbours), and around the home (baths, bucket/drums of water, fish ponds, fountains, toilets, septic tanks).

In South Africa, the average number of fatal drownings per year for the period 2016 to 2021 was 1 477, with the highest incidence occurring in KwaZulu-Natal. Factors contributing to this higher number include the province having the most water-related environments; its sub-tropical climate allows for swimming all-year-round; and it also has the largest population of SA’s provinces. The second leading province is the Eastern Cape with 1 869 drownings reported for the period, followed by Gauteng, which had 1 006 reported drownings, and the fourth was the Western Cape with 864.

Interventions

Research findings also indicated that most fatal drownings took place in January and February (SA’s warmest months), with the day of the week reported for the most fatal drownings being Sunday (the day people are most likely to make use of water for recreational activities) between 4pm and 8pm.

Knowing the months, days and times when drownings occur more frequently is very useful information, as this can guide interventions towards deploying more resources, such as increasing the number of lifeguards on beaches during the months of January and February, especially on Sundays during the late afternoon.

In addition, due to the higher incidence of drowning in males, targeted education and behaviour modification interventions would be necessary for males of all ages. These could include swimming skills programmes, education in schools and promoting the use of personal flotation devices (e.g. life jackets).

Most at risk in South Africa are previously disadvantaged communities where drowning incidence is the highest. Poverty, education and infrastructure play a part, and specific interventions relevant and appropriate to at-risk categories are required.

The NSRI’s Drowning Prevention Department continues to extend its drowning-prevention interventions through water safety education in schools, its Survival Swimming programme and lifeguard initiative.

With the festive season upon us, Executive Director of Drowning Prevention Dr Jill Fortuin urges “extreme caution to South Africans who will be participating in activities, to avoid being intoxicated while swimming, supervising children in and around the water and ensuring that you know the number to call in an emergency”.

The data in the study is based on reported fatal drownings.

Study researchers: Dr Jill Fortuin, NSRI; Innocent Karangwa, UCT’s Department of Statistical Sciences; Nongcebo Mahlalela, UCT’s Faculty of Health Sciences; and Dr Cleeve Robertson, NSRI. For the full study:

‘A South African Epidemiological Study of Fatal Drownings: 2016-2021’