Addressing Gaps in Our Understanding of the Epidemiology of Drowning at the Global, National, and Local Level
Clemens, Tessa Karin
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Introduction: The World Health Organization (WHO) estimates that there are at least 372,000 deaths by drowning each year, making drowning the third leading cause of unintentional injury death worldwide. Despite its global impact, drowning remains a neglected public health issue and relatively under-researched area. Objective: (1) To conduct a comprehensive epidemiological investigation and address gaps in our understanding of the drowning problem at the global, national, and local level; and (2) to provide policy-makers and advocates with comprehensive information to inform their drowning prevention efforts. Methods: This study involved retrospective reviews of five data sources: (1) global drowning data were extracted from the WHO mortality database for all countries that reported deaths using ICD-10 drowning codes; (2) data on non-fatal drowning victims who required hospital admission in Canada were obtained from the Canadian Institute for Health Information (CIHI)s Discharge Abstract Database; (3) data on non-fatal drowning victims who required an emergency department visit were obtained from CIHIs National Ambulatory Care Reporting System; (4) data on unintentional fatal drowning deaths in Canada were obtained from the Drowning Prevention Research Centre (DPRC) database; (5) data on child drowning fatalities in private backyard pools in Ontario were collected from the case files at the Office of the Chief Coroner for Ontario using a structured questionnaire. Results: The results presented in this dissertation can inform drowning prevention globally, nationally, and locally. Internationally, official data categorization methods contribute to an underestimation of the burden of fatal drowning. In Canada, fatal drowning is only part of the problem; non-fatal drowning presents a substantial burden and the characteristics of non-fatal drowning differ significantly from fatal drowning. Further, although bystander intervention plays an important role in the survival of a drowning person, non-professional bystanders often intervene with high-risk, contact rescues, or do not attempt a rescue at all. Finally, children who drown in private backyard pools in Ontario often access the pool directly from the residence, yet most municipalities have not enacted isolation fencing bylaws. Conclusion: Addressing gaps in epidemiological drowning research at the global, national, and local level revealed several recommendations for policy, prevention, and future research.