 |
Brief Reports |
Indian Pediatrics 2000;37: 80-83 |
Drowning in Childhood: A Population Based Study |
Anuradha Bose, Kuryan George, Abraham Joseph From the Department of Community Health, Christian Medical
College, Vellore 632 002, Tamil Nadu, India. With the conquest of infectious diseases, uninitentional injury is assuming importance as a leading cause of death in childhood. Each year more children die of injuries than all childhood diseases combined(1). Drowning is the leading cause of unintentional injury death in the under-5 age group in Australia(2) and ranks second in the USA(3). Yet relatively little is known of the epidemiology of childhood drowning in this country. This communication presents the results of a population based study of deaths due to drowning, involving children in the 1-12 year age group in Kaniyambadi block, in Vellore District in Tamil Nadu. Subjects and Methods Kaniyambadi block is the geographical area served by the Community Health Department of Christian Medical College, Vellore. It is a predominantly rural area with a population of 106,000 (1996 census). It is a drought prone area. Open wells and tanks form the major source of irrigation. There are abandoned rock quarries, with no drainage facilities, where rain water collects, and forms small ponds. The Community Health Department of Christian Medical College has information relating to all births and deaths, with causes, collected prospectively, in the database for Kaniyambadi Block. In this study, the term drowning refers to immediate and delayed immersion deaths. The duration of immersion was not known in most instances. Final case certification was done after ascertaining the cause of the death, and was done by the Medical Officer in charge. No autopsies were recorded The Health Aide, who is the equivalent of the Village Health Nurse, reports the deaths in the villages. A death report is filed with the details of the illness or the details of the events leading to the death of the patient. The Medical Officer or the Nurse incharge of the village ascertains the cause of death. The details of the cause of death, the site of drowning and other details were obtained from the death reports. There are weekly area meetings and one monthly meeting for the whole block, wherein inaccuracies or gaps in reporting are corrected. Annually, a 10% sample is independently verified, in order to check the validity of the reporting system. A review of all deaths in the 1-12 year age group and a review of deaths due to drowning, code 994.1(4), produced a list of residents of Kaniyambadi block, age 1-12, who died between 1991-1997. The 0-1 year age group was not included. The life expectancy at birth in India was taken to be 60 years(5). The census in the block was taken in 1996 and the population in the other years was calculated assuming a growth rate of 12 per 1000. The crude birth rate in the block is 20 per 1000 and the crude death rate in Kaniyambadi Block is 8 per 1000. All collections of water such as pits and ponds were grouped together under "ponds". The other sources of water were vessels in which water is stored, and wells, which are large open irrigation wells, which do not have a protective wall around. Results There were a total of 288 deaths in the 1-12 age group and drowning was the single largest cause of death in this group, with a total of 56 deaths (19.4%), (Table I). All drownings occurred in fresh water. Deaths were considered unintentional in all cases. The average annual drowning rate for the 1-12 year age group was 25.9 per 100,000- study population. It was 36.8 for males and 14.4 for females. The annual drowning rates per 100,000 of study population for the years 1991 to 1997 were 30.7, 33.7, 33.3, 19.7, 16.2, 3.2 and 44.1, respectively. The deaths resulted in 3071.8 years of potential life lost. Table I__ Total Deaths and Deaths Due to Drowning
At every age, males numbered more than females (41 victims were male and 15 female) (p <0.05). The under fives form 17.5% of the whole population but accounted for 46% (n=26) of the drowning in the 1-12 year age group. There were no deaths due to drowning in July and a maximum of 10 in November. There was an even distribution of immersion deaths in the other months. Table II shows the sites of drowning. The sites of drowning were in water containers at home, open unprotected wells, and ponds. In some instances the source of water was not documented in the death report. Table II__Distribution of Cases by Age and Place of Drowning
c2 = 20.06; df = 6; p = 0.003. Two of the children were under the supervision of their mothers at the time of drowning. However the mothers were in another room, and the children, both aged 1.5 years had been attempting to scoop water to drink out of the vessel and had toppled in and drowned. Apart from these two children, only one other child was under the supervision of an adult at the time of drowning. In two instances, deaths were recorded of siblings, where one sibling was under 5, and the other in the 5-9 age group. All children were presumed dead at the time of retrieval. No record is available of attempts at resuscitation. The duration of immersion is not known in the majority of cases. There was a history of antecedent medical problems in 2 of the 55 children. Both were develomentally delayed and one had hearing impairment. Discussion Drowning is a serious public health problem in Kaniyambadi block. The overall-drowning rate of 25.9 per 100,000 person years document-ed here is higher than that reported in the literature(6). The increased drowning rate in males observed by us is consistent with other reports(7). Vessels containing water and open wells were the site of the majority of drownings in this study, in the under-fives, and the 10-12 year age group respectively. In the 5-9 age group, the site of drowning is not known for 6 children, and no conclusion can be reached as to the site of the majority of drownings in this age group. It is a common practice in villages, where there is no piped water supply, to store water in large pots. These pots are often left open and serve as collections of water in which toddlers drown. In the 10-12 year age group, 80% of the drownings were in wells. The wells are large open irrigation wells, with no protective wall. In addition to using the water for domestic purposes, children in villages use the wells for swimming. Risk of drowning is known to be greater where there is a well near the place of dwelling(8). Childhood drowning and near drowning is lower where fencing around the body of water is a legal requirement(9). Such a legal restraint may be required to alleviate this problem. Survival following an immersion incident is critically dependent on the rapidity with which effective resuscitation can be delivered (10). No attempts at resuscitation have been recorded in all the cases reported here. Even where such resuscitative facilities are readily available and accessible, the cost of near-drowning, in terms of morbidity and financial outlay, is very high(11). Prevention is therefore a better strategy. Drowning is one of the leading causes of unintentional injury in childhood. Primary care physicians have a leading role to play in care of near drowning victims. They need knowledge of local risks of drowning(12). Pediatricians are ideally suited to incorporate injury prevention programs into primary care(13). They are likely to talk about prevention strategies if exposed to injury prevention in Residency programs(14). As unintentional injury is a leading cause of childhood deaths, injury prevention should be incorporated into pediatric training programs. References 1. Crawley T. Childhood injury: Significance and prevention strategies. J Pediatr Nurs. 1996; 11: 225-232. 2. Silva DT, Ruben AR, Wronski I, Stronach P, Woods M. Excessive rates of childhood mortality in the northern Territory, 1985-94. J Pediatr Child Health, 1998; 34: 63-68. 3. Baker SP O' Neill, Karpf RS. The Injury Fact Book. Lexington, Ma, DC Heath, 1984. 4. International Classification of Diseases, 9th Revision, Volume 2. Geneva, World Health Organization, 1987; p 168. 5. Park K. Textbook of Preventive and Social Medicine, 15th eds Jabalpur, Banarsidas Bhanot Publishers, 1997; p 316. 6. Wintemute GJ, Kraus JF, Teret SP. Drowning in childhood and adolescence. Am J Pub Health 1987; 77: 830-832. 7. Pearn J, Nixon J, Wilkey I. Freshwater drowning and near-drowning: A five-year total population study. Med J Aust 1976; 2: 942-946. 8. Celis A. Home drowning among preschool age Mexican children. Inj Prev 1997; 3: 252-256. 9. Milliner N, Pearn J, Guard R. Will fenced pools save lives? A 10-year study. Med J Aust 1980; 2: 510-511. 10. DeNicola LK, Falk CE, Swanson ME. Submersion injuries in children and adults. Crit Care Clin 1997; 13: 477-502. 11. Joseph MM, King WD. Epidemiology of hospitalization for near-drowning. South Med J 1998; 91: 253-255. 12. Tahnel F. Near drowning. Rescuing patients through education as well as treatment. Postgrad Med 1998; 103: 141-153. 13. Gofin R, Leon D, Knishkowy B. Injury prevention program in primary care: Process evaluation and surveillance. Inj Prev 1995; 1: 35-39. 14. O' Flaherty-JE, Pirie PL. Prevention of pediatric drowning and near drowning: A survey of AAP. Pediatrics 1997; 99: 169-174. |
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