Skip to main content
SpringerLink
Log in

Childhood drowning in South Africa: local data should inform prevention strategies

  • Original Article
  • Published:
Pediatric Surgery International Aims and scope Submit manuscript

Abstract

Study objective

Drowning is an important cause of childhood injury, however, little is known about drowning in Africa. The aim of this study is to investigate submersion incidents in Cape Town, South Africa and provide specific prognostic factors as well as to develop age-appropriate prevention strategies.

Methods

A retrospective chart review performed at the Red Cross War Memorial Children’s Hospital in Cape Town, South Africa. Patients admitted because of ‘drowning’ or ‘near-drowning’ between January 2007 and April 2013 were included.

Results

75 children were included. 63 (84 %) survived without complications, 8 (10.7 %) died and 4 (5.3 %) had permanent neurological sequelae. The median age was 2.2 years (range 0.1–12.4). 46 (60.5 %) incidents happened in or around the home, only 14 (18.7 %) were witnessed. 42 (56 %) took place in a pool (29 private, 13 public). Significant predictors of the outcome were: estimated submersion time, duration of apnea, unresponsive and dilated pupils, intubation and use of inotropes. On arrival at the ER we found these significant predictors of the outcome: CPR, a GCS <5, hypothermia, bradycardia, asystole, as well as the PIM2-calculated mortality risk for patients admitted to the ICU.

Conclusion

The majority of incidents were unwitnessed and occurred in or around the home. Prevention programs should be focused on adult supervision for younger children and creating awareness on the dangers of drowning in the home environment. While bathing in baths or buckets, children should never be left alone and parents should be made aware of the dangers. In our study, the majority of incidents occurred in swimming pools and limiting access to these could prevent many incidents of drowning among older children. Although children of all language groups are at risk for drowning, English- or Afrikaans-speaking children were particularly at risk for drowning in private pools while Xhosa-speaking children mostly drowned in baths or buckets. We also report multiple prognostic factors for the outcome, but none of them were absolute predictive of the outcome, indicating that each victim of submersion deserves full resuscitative treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. van Beeck EF, Branche CM, Szpilman D, Modell JH, Bierens JJLM (2005) A new definition of drowning: towards documentation and prevention of a global public health problem. Bulletin of the World Health Organization 83:853–856

  2. WHO (2012) Drowning, fact sheet no 347. http://www.who.int/mediacentre/factsheets/fs347/en/. Accessed Oct 2012

  3. Nagel FO, Kibel SM, Beatty DW (1990) Childhood near-drowning–factors associated with poor outcome. S Afr Med J 78(7):422–425

    CAS  PubMed  Google Scholar 

  4. Idris AH et al (2003) Recommended guidelines for uniform reporting of data from drowning: the “Utstein style”. Circulation 108(20):2565–2574

    Article  CAS  PubMed  Google Scholar 

  5. Kliegman RNWE (2011) Nelson textbook of pediatrics. Elsevier/Saunders, Philadelphia

    Google Scholar 

  6. Shann F et al (1997) Paediatric index of mortality (PIM): a mortality prediction model for children in intensive care. Intensive Care Med 23(2):201–207

    Article  CAS  PubMed  Google Scholar 

  7. Burford AE et al (2005) Drowning and near-drowning in children and adolescents: a succinct review for emergency physicians and nurses. Pediatr Emerg Care 21(9):610–616; quiz 617–619

  8. Quan L, Cummings P (2003) Characteristics of drowning by different age groups. Inj Prev 9(2):163–168

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  9. Schnake EM, Peterson NM, Corden TE (2005) Promoting childhood water safety: the physician’s role. WMJ 104(2):45–49

    PubMed  Google Scholar 

  10. Davoudi-Kiakalayeh A, Mohammadi R, Yousefzadeh-Chabok S (2012) Prevention of drowning by community-based intervention: implications for low- and middle- income countries. Arch Trauma Res 1(3):112–117

    Article  PubMed Central  PubMed  Google Scholar 

  11. Rahman F et al (2012) Cost-effectiveness of an injury and drowning prevention program in Bangladesh. Pediatrics 130(6):e1621–e1628

    Article  PubMed  Google Scholar 

  12. Sansiritaweesook G et al (2013) Effectiveness of community participation in a surveillance system initiative to prevent drowning in Thailand. Asia Pac J Public Health

  13. Theurer WM, Bhavsar AK (2013) Prevention of unintentional childhood injury. Am Fam Physician 87(7):502–509

    PubMed  Google Scholar 

  14. Thompson DC, Rivara FP (2000) Pool fencing for preventing drowning in children. Cochrane Database Syst Rev (2):Cd001047

  15. Hatfield J et al (2012) Development and evaluation of an intervention to reduce rip current related beach drowning. Accid Anal Prev 46:45–51

    Article  PubMed  Google Scholar 

  16. Sherker S et al (2010) Beachgoers’ beliefs and behaviours in relation to beach flags and rip currents. Accid Anal Prev 42(6):1785–1804

    Article  PubMed  Google Scholar 

  17. Giustini M et al (2003) Accidents in recreational waters. Ann Ist Super Sanita 39(1):69–76

    PubMed  Google Scholar 

  18. Lindholm P, Steensberg J (2000) Epidemiology of unintentional drowning and near-drowning in Denmark in 1995. Inj Prev 6(1):29–31

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  19. Mosayebi Z, Movahedian AH, Mousavi GA (2011) Drowning in children in Iran: outcomes and prognostic factors. Med J Malaysia 66(3):187–190

    CAS  PubMed  Google Scholar 

  20. Quan L et al (1990) Outcome and predictors of outcome in pediatric submersion victims receiving prehospital care in King County, Washington. Pediatrics 86(4):586–593

    CAS  PubMed  Google Scholar 

  21. Al-Mofadda SM et al (2001) Pediatric near drowning: the experience of King Khalid University Hospital. Ann Saudi Med 21(5–6):300–303

    CAS  PubMed  Google Scholar 

  22. Eich C et al (2007) Outcome of 12 drowned children with attempted resuscitation on cardiopulmonary bypass: an analysis of variables based on the “Utstein Style for Drowning”. Resuscitation 75(1):42–52

    Article  PubMed  Google Scholar 

  23. Hon KL et al (2008) Indoor versus outdoor childhood submersion injury in a densely populated city. Acta Paediatr 97(9):1261–1264

    Article  PubMed  Google Scholar 

  24. Gilbert M et al (2000) Resuscitation from accidental hypothermia of 13.7 degrees C with circulatory arrest. Lancet 355(9201):375–376

    Article  CAS  PubMed  Google Scholar 

  25. Huckabee HC, Craig PL, Williams JM (1996) Near drowning in frigid water: a case study of a 31-year-old woman. J Int Neuropsychol Soc 2(3):256–260

    Article  CAS  PubMed  Google Scholar 

  26. Salomez F, Vincent JL (2004) Drowning: a review of epidemiology, pathophysiology, treatment and prevention. Resuscitation 63(3):261–268

    Article  PubMed  Google Scholar 

  27. Suominen PK et al (1997) Does water temperature affect outcome of nearly drowned children. Resuscitation 35(2):111–115

    Article  CAS  PubMed  Google Scholar 

  28. Orlowski JP (1979) Prognostic factors in pediatric cases of drowning and near-drowning. JACEP 8(5):176–179

    Article  CAS  PubMed  Google Scholar 

  29. Suominen P et al (2002) Impact of age, submersion time and water temperature on outcome in near-drowning. Resuscitation 52(3):247–254

    Article  CAS  PubMed  Google Scholar 

  30. Oehmichen M, Hennig R, Meissner C (2008) Near-drowning and clinical laboratory changes. Leg Med (Tokyo) 10(1):1–5 Epub 2007 Jul 6.

    Article  CAS  Google Scholar 

  31. Noonan L, Howrey R, Ginsburg CM (1996) Freshwater submersion injuries in children: a retrospective review of seventy-five hospitalized patients. Pediatrics 98(3 Pt 1):368–371

    CAS  PubMed  Google Scholar 

  32. Pratt FD, Haynes BE (1986) Incidence of “secondary drowning” after saltwater submersion. Ann Emerg Med 15(9):1084–1087

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. ErasmusMC, Room SK1276, Dr. Molewaterplein 60, 3015 GJ, Rotterdam, The Netherlands

    L. Joanknecht & M. van Dijk

  2. Red Cross War Memorial Children’s Hospital, Cape Town, South Africa

    A. C. Argent & A. B. van As

Authors
  1. L. Joanknecht
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. C. Argent
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. van Dijk
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. B. van As
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to L. Joanknecht.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Joanknecht, L., Argent, A.C., van Dijk, M. et al. Childhood drowning in South Africa: local data should inform prevention strategies. Pediatr Surg Int 31, 123–130 (2015). https://doi.org/10.1007/s00383-014-3637-0

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00383-014-3637-0

Keywords

Search

Navigation