The Burden of Drowning: Issues in Selected Countries – Africa
15
Olive Kobusingye and Brett Bowman
The data submitted to the World Health Organization (WHO) used to measure the burden of drowning on the health of the African region are limited. Of the 54 African countries represented in the WHO’s global burden of disease estimates for 2008, country-specific data were derived from cause of death modeling rather than direct reporting for every country except Egypt, Mauritius, the Seychelles, and South Africa [1]. Aside from this important caution, these data and models show that drowning is a significant health burden in Africa. Country-specific studies that could supplement these data remain scant. Much of what is known about the incidence, prevalence, and burden of drowning in Africa is grounded in a small number of fairly recent and well-represented studies undertaken in South Africa, Egypt, Tanzania, and Uganda. Much of the literature on injuries in Africa comes from hospital databases and therefore, tends to exclude drowning fatalities. Drowning victims in this region often die before reaching the hospital [2–4]. In this chapter, drowning in three countries on the continent of Africa is described: Tanzania, South Africa, and Uganda. In Tanzania, a population-based study in three communities, two rural and one urban, found that unintentional drowning was the leading cause of injury death in the rural areas (17.1 per 100,000 and 6.9 per 100,000 population, respectively) and the second leading cause of injury death in males ages 5 years and younger in the city of Dar es Salaam. Among the same ages in females, drowning is the leading cause of injury death in both of the rural communities (12 per 100,000 population).
O. Kobusingye (*) Makerere University of Public Health, University of South Africa, PO Box 7072, Kampala, Uganda e-mail:
[email protected] B. Bowman Department of Psychology, School of Human and Community Development, University of Witwatersrand, Private Bag 3, Wits, 2050 Johannesburg, South Africa e-mail:
[email protected] J. Bierens (ed.), Drowning, DOI 10.1007/978-3-642-04253-9_15, © Springer-Verlag Berlin Heidelberg 2014
111
112
O. Kobusingye and B. Bowman
In the same study, drowning was also the leading cause of injury death in all children ages 5–14 years in one of the rural areas and the second leading cause in Dar es Salaam. While the incidence in females dropped and stayed low after 5 years, in males there was a sustained high incidence with another peak (16.1 per 100,000 population) in rural males above 60 years [5]. A morbidity survey in the same areas 4 years later did not find any nonfatal drowning, suggesting that either people drowned fatally or fully recovered shortly after rescue, leaving no morbidity [6]. South Africa has the most advanced injury surveillance mechanism on the African continent and began reporting on national- and city-level fatal and nonfatal drowning patterns specifically or as part of broader injury profiles from the early 1980s [7–18]. Early studies found that drowning accounted for 19 % of all injury deaths nationally among white, colored, and Asian children ages 0–14 years [13]. A city-level study in Cape Town showed that the annual drowning mortality was approximately 6 per 100,000 population during 1980 through 1983 [7]. Furthermore, most childhood fatal and nonfatal drowning in the city occurred in residential swimming pools, and given the history of the country, the sites of drowning were related to population groupings [7, 8]. The majority of adult drowning victims were male, and the incidents most frequently occurred in the harbor areas and coastlines of the city [8]. Alcohol played a role in these fatal drownings with 64.6 % of all adult victims testing positive for blood alcohol content (BAC) [7]. The 2002 report of National Injury Mortality Surveillance System (NIMSS) confirmed the role of alcohol in drowning deaths when 41.7 % of the 108 fatal drowning cases that were screened for substances were returned positive for BAC [15]. The 2008 NIMSS report presenting city-level data showed that drowning was the leading cause of non-transport unintentional injury-related deaths among children in the coastal city of Durban during 2007 [16]. The data also indicated that most drowning occurred in the sea, lakes, and residential swimming pools. A recent city-level study found that fatal drowning was among the top three causes of injury death for children ages 0–14 years in all of South Africa’s metropolitan regions during 2001 and 2003 and that male age-adjusted rates for this injury type were higher for females during this period (5.3 respectively 2.1 per 100,000 population) [19]. In the rural Transkei region, a recent study indicated that drowning accounted for 39.4 % of all unintentional injury deaths among children during between 1996 and 2004 [9]. The most recent South African data indicate that drownings accounted for 14.4 % of all non-transport unintentional injury deaths captured by the NIMSS in 2008 [11]. In Uganda, major differences in the distribution of drowning by geographical area are evident. Results of a 1998 household survey showed that while drowning was the leading cause (27 %) of fatal injuries in a rural population, it did not feature among the ten leading causes of death in the urban comparison site. The authors attributed this difference to greater risk of exposure to bodies of water in rural sites in Uganda [20]. The relative absence of reported fatal drowning in urban Uganda is supported by the fact that not a single case of drowning was captured in the trauma registries of the five largest urban hospitals in the country 1997 and 1999 [21]. A recent study of all unintentional injury deaths in children ages 0–13 years recorded at a tertiary teaching hospital in Kampala once again emphasized the low frequency of fatal drowning in Ugandan hospital data. Not a single case of drowning was
15 The Burden of Drowning: Issues in Selected Countries – Africa
113
registered January and May 2008. While the authors suggested that this may point to limited access to water sources and, therefore, low exposure to risk for drowning in the city [3], poor community rescue skills and absence of pre-hospital care probably play a role as well. The public health burden of drowning on the African continent is being studied increasingly by small groups of researchers on the continent. Data generated from these studies consistently show that drowning accounts for a considerable share of unintentional injury. Without systematic population-based reporting, however, the true magnitude of this public health problem on the continent remains speculative.
References 1. World Health Organization (2010) Causes of death 2008: data sources and methods. World Health Organization, Geneva. http://www.who.int/healthinfo/global_burden_disease/ cod_2008_sources_methods.pdf 2. Occupational Health Department (2007) Annual injury surveillance report. Ministry of Health & Population, Cairo 3. Mutto M, Lawoko S, Nansamba C et al (2011) Unintentional childhood injury patterns, odds, and outcomes in Kampala City: an analysis of surveillance data from the National Pediatric Emergency Unit. J Inj Violence Res 3:13–18. doi:10.5249/jivr.v3i1.56 4. Osime OC, Ighedosa SU, Oludiran OO et al (2007) Patterns of trauma deaths in an accident and emergency unit. Prehosp Disaster Med 22:75–78 5. Moshiro C, Mswia R, Alberti KG et al (2001) The importance of injury as a cause of death in sub-Saharan Africa: results of a community-based study in Tanzania. Public Health 115: 96–102. doi:10.1038/sj/ph/1900725 6. Moshiro C, Heuch I, Astrom AN et al (2005) Injury morbidity in an urban and a rural area in Tanzania: an epidemiological survey. BMC Public Health 5:11. doi:10.1186/1471-2458-5-11 7. Davis S, Smith LS (1985) The epidemiology of drowning in Cape Town – 1980–1983. S Afr Med J 68:739–742 8. Kibel SM, Nagel FO, Myers J, Cywes S (1990) Childhood near-drowning – a 12-year retrospective review. S Afr Med J 78:418–421 9. Meel BL (2008) Unnatural deaths among children in the Transkei region of South Africa. Med Sci Law 48:232–236 10. Donson H (2009) A profile of fatal injuries in South Africa 2008. Annual report for South Africa based on the National Injury Surveillance System (NIMSS). MRC: Cape Town 11. Donson H (2008) A profile of fatal injuries in South Africa 2007. Annual report for South Africa based on the National Injury Surveillance System (NIMSS). MRC: Cape Town 12. Kibel SM, Bass DH, Cywes S (1990) Five years’ experience of injured children. S Afr Med J 78:387–391 13. Kibel SM, Joubert G, Bradshaw D (1990) Injury-related mortality in South African children, 1981–1985. S Afr Med J 78:398–403 14. Lerer LB, Matzopoulos RG, Phillips R (1997) Violence and injury mortality in the Cape Town metropole. S Afr Med J 87:298–301 15. Matzopoulos R (2002) A profile of fatal injuries in South Africa 2001. Third annual report of the National Injury Mortality Surveillance System (NIMSS). MRC: Cape Town 16. Wyndham CH (1986) Cause- and age-specific mortality rates from accidents, poisoning and violence. S Afr Med J 69:559–562 17. Wyndham CH (1986) Deaths from accidents, poisoning and violence – differences between the various population groups in the RSA. S Afr Med J 69:556–558 18. Donson H, Van Niekerk A (2012) Unintentional drowning in urban South Africa: a retrospective investigation, 2001–2005. Int J Inj Contr Saf Promot 1–9. doi:10.1080/17457300. 2012.686041
114
O. Kobusingye and B. Bowman
19. Burrows S, van Niekerk A, Laflamme L (2010) Fatal injuries among urban children in South Africa: risk distribution and potential for reduction. Bull World Health Organ 88:267–272. doi:10.2471/BLT.09.068486 20. Kobusingye O, Guwatudde D, Lett R (2001) Injury patterns in rural and urban Uganda. Inj Prev 7:46–50 21. Kobusingye O (2006) The global burden of drowning: an African perspective. In: Bierens J (ed) Handbook on drowning: prevention, rescue and treatment. Springer, Berlin, pp 61–62
