Water Sanitation Health

Water-related Diseases

Drowning

The disease and how it affects people

Drowning is defined as death by suffocation due to being immersed in water. There are two classifications of drowning: wet and dry. In wet drowning, the person has inhaled water which interferes with respiration and causes the circulatory system to collapse. In the less common instance of dry drowning, the airway closes up due to spasms caused by the presence of water. Near drowning may result in neurological damage and successful recovery depends on prompt rescue and resuscitation.

The cause

In children, a lapse in adult supervision is the single most important contributory cause for drowning. Children can drown not only in pools, lakes and the sea, but also in other bodies of water such as bathtubs, buckets of water, etc. Children with some swimming skills can get into trouble if they attempt activity beyond their capabilities, or if they are injured due to unsafe behavior in the water.

Alcohol consumption prior to swimming or falling into water is the most common contributory factor in drowning for children and adolescents in many countries. The non-use of life jackets has been linked to drowning accidents related to yacht, boat and canoe use.

In open waters, people can drown if their swimming skills are insufficient to deal with adverse situations, such as large waves, outgoing tides and offshore winds.

In swimming pools, hot tubs, spas and other such enclosed recreational areas, a variety of scenarios can come into play. Strong suction at inlets and outlets of pools can entrap body parts or hair and hold the victim's head under water, causing drowning. The clarity of the water in pools can also be a factor. In turbid water, the lifeguard may not be able to identify someone in need of help. Overcrowded swimming areas present a similar problem.

Scope of the Problem

Information on drowning is not collected uniformly in all countries but according to the Global Burden of Disease the overall death rate by drowning is estimated to be 8.4/100,000 population[1]. Drowning statistics include accidental drownings as well as those due to deliberate acts such as suicides and homicides. Males and children are disproportionately represented in drowning statistics. Among children aged 5 to 14 years, drowning is the fourth leading cause of death, while in children under 5 years old it is the 11th. Among males aged 5-14 years, drowning is the leading cause of death. The higher risk in males is attributed to the greater recreational and occupational exposure to drowning risk. Among adults aged 15-44 years, drowning is the 10th leading cause of death (same ref as [1]). In the USA, alcohol use is involved in about 25-50% of adolescent and adult deaths associated with water recreation. It is a major contributing factor in up to 50% of drownings among adolescent boys.[2]

Interventions

Teaching children and adults to swim is an important intervention in the prevention of drowning; education about the risks of swimming in particular conditions is also essential to reduce the risk of drowning.

Other interventions include:

  • Refraining from swimming beyond skill level.
  • Constant uninterrupted adult supervision of children around all forms of water including open bodies of water and buckets, etc.
  • Never swimming alone or in unsupervised places. Teach children to always swim with a friend.
  • Lifeguards on duty at public swimming areas.
  • Inflatable life jackets for children and adults with low swimming skills, when bathing or swimming in open waters.
  • Refraining from alcohol consumption before and while swimming.
  • Ensuring that suction outlets in pools, hot tubs and spas are safely constructed and maintained at a safe level.
  • Ensuring the presence of isolation fences and locked door around pools.
  • Adequate rescue aids on boats and ships, training of crew in rescue procedures and clear information to passengers.
  • Learning CPR (cardio-pulmonary resuscitation). This is particularly important for pool owners and individuals who regularly participate in water recreation.
  • Check the water depth before entering.

References

Krug E (Ed). 1999. Injury. A leading cause of the global burden of disease. Geneva: WHO.

Howland J, Hingson R. “Alcohol as a risk factor for drowning: a review of the literature (1950-1985)”. Accident Analysis and Prevention 1988;20:19-25.

Prepared for World Water Day 2001. Reviewed by staff and experts from the Injuries and Violence Programme (VIP) and the Water and Sanitation Unit (WSH), World Health Organization (WHO), Geneva.

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