Pool fencing for preventing drowning in children (Review)

Harborview Injury Prevention & Research Center, University of Washington, Box 359960, 325 Ninth Avenue, Seattle, WA 98104, USA.
Cochrane database of systematic reviews (Online) (Impact Factor: 5.94). 02/2000; 1(2):CD001047. DOI: 10.1002/14651858.CD001047
Source: PubMed

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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    • "Over the past 50 years, HICs such as Australia, New Zealand and the United Kingdom have achieved a reduction in child drowning through a combination of these approaches [11] [12]. These include the enforcement of residential pool fencing, large scale media campaigns and a continued focus on education and training [13]. This has resulted in improved skills in and around the water via use of: pool and beach lifeguards; development of swimming programs and training to improve the skills of first responders [14] [15]. "
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    ABSTRACT: Drowning is the leading cause of death from unintended injury in children globally. Drowning is preventable, and mechanisms exist which can reduce its impact, however the peer-reviewed literature to guide public health interventions is lacking. This paper describes a protocol for a review of drowning prevention interventions for children. Electronic searching will identify relevant peer-reviewed literature describing interventions to prevent child drowning worldwide. Outcome measures will include: drowning rates, water safety behaviour change, knowledge and/or attitude change, water safety policy and legislation, changes to environment and water safety skills. Quality appraisal and data extraction will be independently completed by two researchers using standardised forms recording descriptive and outcome data for each included article. Data analysis and presentation of results will occur after data have been extracted. This review will map the types of interventions being implemented to prevent drowning amongst children and identify gaps within the literature.
    Open Journal of Preventive Medicine 03/2014; 4(3):100. DOI:10.4236/ojpm.2014.43014
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    • "Despite these substantial risks, the majority of household injuries can be prevented. In developed countries, a variety of preventive approaches have been shown to be effective including legislative measures, modification of the home environment with provision of safety equipment, and focused injury prevention counseling [13] [14] [15] [16] [17]. In addition, studies utilizing home visitation programs that include education and advice have been undertaken to gauge the impact of such interventions on injury reduction [18] [19]. "
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    ABSTRACT: Background. A substantial proportion of the annual 875,000 childhood unintentional injury deaths occur in the home. Very few printed tools are available in South Asia for disseminating home injury prevention information. Methods. Three tools were planned: an injury hazard assessment tool appropriate for a developing country setting, an educational pamphlet highlighting strategies for reducing home injury hazards, and an in-home safety tutorial program to be delivered by a trained community health worker. Results. The three tools were successfully developed. Two intervention neighborhoods in Karachi, Pakistan, were mapped. The tools were pretested in this local setting and are now ready for pilot testing in an intervention study. Conclusion. Planning for an innovative, community-based pilot study takes considerable time and effort in a low-income setting like Pakistan. The primary outcome of the pre-testing phase of the study was the development of three important tools geared for low-income housing communities in Pakistan.
    International Journal of Pediatrics 04/2012; 2012:203204. DOI:10.1155/2012/203204
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    • "One recent review by Jacobs and Baeder [7] evaluated evidence of the effectiveness of particular home injury prevention interventions. There were few home safety measures for which an associated risk ratio or odds ratio was estimated, including: the provision of window guards [10]; installation of smoke detectors [11]; provision of fencing for swimming pools [12]; legislation to limit domestic hot water temperature settings [13]; air conditioning during heat waves [14]. There is also likely to be an injury burden attributable to many other home injury hazards, (such as inadequate handrails for steps, poor lighting, slippery surfaces, poor ergonomics), but statistically significant associations between such hazards and injury occurrence have only been shown in one observational study, to our knowledge [15]. "
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    ABSTRACT: The authors recently undertook a study for the World Health Organization estimating the European burden of injuries that can be attributed to remediable structural hazards in the home. Such estimates are essential for motivating injury prevention efforts as they quantify potential health gains, in terms of injuries prevented, via specific environmental interventions. We combined exposure estimates from existing surveys and scenarios with estimates of the exposure-risk relationship obtained from a structured review of the literature on injury in the home and housing conditions. The resulting attributable fractions were applied to burden of injury data for the WHO European Region. This analysis estimated that two specific hazards, lack of window guards at second level and higher, and lack of domestic smoke detectors resulted in an estimated 7,500 deaths and 200,000 disability adjusted life years (DALYs) per year. In estimating the environmental burden of injury associated with housing, important deficiencies in injury surveillance data and related limitations in studies of injury risk attributable to the home environment were apparent. The ability to attribute proportions of the home injury burden to features of the home were correspondingly limited, leading to probable severe underestimates of the burden. The burden of injury from modifiable home injury exposures is substantial. Estimating this burden in a comprehensive and accurate manner requires improvements to the scope of injury surveillance data and the evidence base regarding the effectiveness of interventions.
    Environmental Health 11/2011; 10:98. DOI:10.1186/1476-069X-10-98 · 2.71 Impact Factor
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