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Childhood Drownings: An Opportunity for Injury Prevention in a Resource-Limited Setting
Adesola C Akinkuotu1, Laura N Purcell1, Carlos Varela2
1Department of Surgery, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Insights
Pediatric drowning in Malawi disproportionately affects younger children, with most incidents occurring at home. Public space drownings increased mortality risk, highlighting the need for targeted water safety education and basic life support training.
Area of Science:
- Public Health
- Epidemiology
- Pediatric Medicine
Background:
- Drowning is a significant, under-reported public health issue in Africa.
- Understanding pediatric drowning epidemiology and risk factors in Malawi is crucial for targeted interventions.
Purpose of the Study:
- To evaluate the epidemiology and identify risk factors associated with pediatric drowning incidents in Malawi.
- To compare demographics and outcomes between drowning survivors and non-survivors.
Main Methods:
- Retrospective review of pediatric drowning patients (≤15 years) at Kamuzu Central Hospital, Malawi (2009-2019).
- Analysis of demographics, drowning locations, transport methods, and outcomes.
- Logistic multivariate regression to determine factors associated with mortality.
Main Results:
- 156 pediatric drowning victims were identified; median age was 3 years.
- Survivors were younger and more likely to have drowned at home compared to non-survivors.
- Drowning at public spaces increased mortality risk (OR 8.17), while transfer and other injuries decreased it.
Conclusions:
- Over half of pediatric drowning victims survived, with survivors being younger and more likely to have drowned at home.
- Drowning prevention strategies should focus on water safety education and community-based basic life support training.
- Addressing drowning requires scalable, cost-effective interventions tailored to local contexts.
Introduction:
Drowning is a public health problem that is under-reported in Africa. We sought to evaluate the epidemiology and risk factors for drownings in Malawi.
Methods:
We performed a retrospective review of all pediatric (≤15 years old) patients who presented following a drowning incident to Kamuzu Central Hospital in Lilongwe, Malawi, from 2009-19. Demographics and outcomes were compared between survivors and non-survivors. Logistic multivariate regression analysis was used to identify factors associated with increased odds of mortality.
Results:
There were 156 pediatric drowning victims during the study period. The median age at presentation was 3 (IQR: 2-7 years). Survivors were younger [median age: 2 years (IQR: 2-5) vs. 5 years (IQR: 2-10), p = 0.004], with a higher proportion of drownings occurring at home (85.6% vs. 58.3%, p = 0.001) compared to non-survivors. Patients who had a drowning event at a public space had increased odds of mortality (OR 8.17, 95% CI 2.34-28.6). Patients who were transferred (OR 0.03, 95% CI 0.003-0.25) and had other injuries (OR 0.20, 95% CI 0.06-0.70) had decreased odds of mortality following drowning.
Conclusion:
Over half of pediatric drowning victims at a tertiary-care facility in Malawi survived. Drowning survivors were significantly younger, more likely to have drowned at home, and transported by private vehicles and minibus than non-survivors. There is a need for scalable, cost-effective drowning prevention strategies that focus on water safety education and training community members and police officers in basic life support and resuscitation.
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