Pool fencing for preventing drowning in children.
ABSTRACT In most industrialized countries, drowning ranks second or third behind motor vehicles and fires as a cause of unintentional injury deaths to children under the age of 15. Death rates from drowning are highest in children less than five years old. Pool fencing is a passive environmental intervention designed to reduce unintended access to swimming pools and thus prevent drowning in the preschool age group. Because of the magnitude of the problem and the potential effectiveness of fencing we decided to evaluate the effect of pool fencing as a drowning prevention strategy for young children.
To determine if pool fencing prevents drowning in young children.
We used Cochrane Collaboration search strategy of electronic databases, searched reference lists of past reviews and review articles, Cochrane International Register of RCT's, studies from government agencies in the United States and Australia, and contacted colleagues from International Society for Child and Adolescent Injury Prevention, World Injury Network, and CDC funded Injury Control and Research Centers.
In order to be selected a study had to be designed to evaluate pool fencing in a defined population and provide relevant and interpretable data which objectively measured the risk of drowning or near drowning or provided rates of these outcomes in fenced and unfenced pools. The completed studies meeting selection criteria employed a case-control design. No randomized controlled studies have been identified.
Three published studies met selection criteria. Data were extracted by two reviewers using standard abstract form. Odds ratios with 95% CI, and incidence rates, were calculated for drowning and near-drowning. Attributable Risk percent (AR%) was calculated to report the reduction in drowning due to pool fencing.
Case control studies which evaluate pool fencing interventions indicate that pool fencing significantly reduces the risk of drowning. Odds ratio for the risk of drowning or near drowning in a fenced pool compared to an unfenced pool is 0.27 95%CI (0.16, 0.47). Isolation fencing (enclosing pool only) is superior to perimeter fencing (enclosing property and pool) because perimeter fencing allows access to the pool area through the house. Odds ratio for the risk of drowning in a pool with isolation fencing compared to a pool with three sided fencing is 0.17 95%CI (0.07, 0.44)
Pool fences should have a dynamic and secure gate and isolate (i.e., four-sided fencing) the pool from the house. Legislation should require isolation fencing with secure, self-latching gates for all pools, public, semi-public and private.
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ABSTRACT: Worldwide, epidemiological data indicate that children are a high-risk group for drowning and while progress has been made in understanding toddler drownings, there is a lack of empirical evidence regarding the drowning risk and protective factors inherent for adolescents and young adults. This study used a self-report questionnaire to establish swimming and water safety knowledge and attitudes of young adults and objectively measured their actual swimming ability using formal practical testing procedures. Participants then completed a short, 12-week intervention that encompassed swimming, survival and rescue skills, along with water safety knowledge applicable to a range of aquatic environments. Knowledge, attitudes and swimming ability were then re-measured following the intervention to evaluate its effectiveness. The Wilcoxon matched pairs signed ranks test was performed to detect whether there were significant differences between knowledge, attitude and swim ability scores pre-intervention and post-intervention. A total of 135 participants completed the baseline and follow up questionnaire and all practical testing. Results indicated that these young adults had a very low level of water safety knowledge pre-intervention, although the majority had sound swimming and water safety skills and attitudes. Overall, significant improvements were evident in knowledge (p<0.001) and swim ability (p<0.001) post-intervention, although no changes were observed in attitudes (p=0.079). Previous participation in formal swimming lessons and/or swimming within the school curriculum had no significant impact on water safety knowledge, skills or attitudes of these young adults, and there were few significant gender differences. While it is important to conduct further studies to confirm that these findings are consistent with a more representative sample of young adults, our findings are the first to provide empirical evidence of the value of a comprehensive aquatic education program as a drowning prevention strategy for young adults.Accident; analysis and prevention 05/2014; 70C:188-194. DOI:10.1016/j.aap.2014.04.006 · 1.65 Impact Factor
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ABSTRACT: To redress the lack of Queensland population incidence mortality and morbidity data associated with drowning in those aged 0-19yrs, and to understand survival and patient care. Retrospective population-based study used data linkage to capture both fatal and non-fatal drowning cases (N = 1299) among children aged 0-19years in Queensland, from 2002-2008 inclusive. Patient data were accessed from pre-hospital, emergency department, hospital admission and death data, and linked manually to collate data across the continuum of care. Incidence rates were calculated separately by age group and gender for events resulting in death, hospital admission, and non-admission. Trends over time were analysed. Drowning death to survival ratio was 1:10, and two out of three of those who survived were admitted to hospital. Incidence rates for fatal and non-fatal drowning increased over time, primarily due to an increase in non-fatal drowning. There were non-significant reductions in fatal and admission rates. Rates for non-fatal drowning that did not result in hospitalisation more than doubled over the seven years. Children aged 5-9yrs and 10-14yrs incurred the lowest incidence rates 6.38 and 4.62 (expressed as per 100,000), and the highest rates were among children aged 0-4yrs (all drowning events 43.90; fatal 4.04; non-fatal 39.85-comprising admission 26.69 and non-admission 13.16). Males were over-represented in all age groups except 10-14yrs. Total male drowning events increased 44% over the seven years (P<0.001). This state-wide data collection has revealed previously unknown incidence and survival ratios. Increased trends in drowning survival rates may be viewed as both positive and challenging for drowning prevention and the health system. Males are over-represented, and although infants and toddlers did not have increased fatality rates, they had the greatest drowning burden demonstrating the need for continued drowning prevention efforts.PLoS ONE 02/2015; 10(2):e0117948. DOI:10.1371/journal.pone.0117948 · 3.53 Impact Factor