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Getting to the bottom of SL’s watery graves

01 Aug 2021

  • A case for public awareness and official intervention
By Sumudu Chamara The word “accident”, more often than not, immediately brings to mind the picture of road accidents, which have become the default due to their prevalence. However, people also fall victim to several other accidents that occur in houses, workplaces, and other settings, which unfortunately do not attract adequate attention, thus making their prevention more difficult. Drowning is one such type of accident Sri Lanka needs to pay more attention to – it is the second-leading cause of deaths in Sri Lanka, in terms of accidental deaths, according to the Health Ministry. As per reports, approximately 800 people die of drowning in Sri Lanka each year. On 28 July, at a press briefing convened by the Health Ministry, the need to pay more attention to drowning accidents and to raise awareness about the same was also emphasised, in a context where 97% of drowning deaths had been found to be caused due to the lack of awareness about the dangers posed by water bodies, and not due to suicide attempts. These deaths caused by drowning occur in many circumstances, including falling into unprotected wells, bathing or swimming while intoxicated, and entering water bodies during pilgrimages or for leisure-related activities. These disturbing facts were revealed by the Community Medicine Specialist attached to the Health Ministry Non-Communicable Diseases Unit National Accident Prevention and Management Programme Dr. Samitha Siritunga. He noted that the majority of these victims are between the ages of 21 and 60 years, and noted that people rescued after drowning incidents also tend to suffer from long-term injuries. According to Senior Deputy Inspector General of Police (SDIG) H.H. Chulasiri, while Guyana comes first and Singapore comes second in the ratings of drowning cases in the world, Sri Lanka holds the 23rd position. These incidents cost not only lives, but also a considerable amount of monetary resources. Drowning accidents in Sri Lanka In Sri Lanka, the majority of deaths caused by drowning are in fact accidents, while environmental factors and alcohol consumption may play contributory roles. Additionally, awareness programmes targeting young adults could minimise these accidental deaths, according to a study conducted by several local researchers, namely P. Paranitharan, W.N.S. Perera, S. Lakmal, D.C. Priyanath, T.A.A.W. Senanayake, and M.K.J.K. Kumari. The study titled “Deaths following drowning in Sri Lanka – A Retrospective Study” which was published recently in the Sri Lanka Journal of Forensic Medicine, Science, and Law – had analysed data, which was extracted from post-mortem reports, concerning a total of 59 deaths caused by drowning that occurred from 2008 to 2017. According to the study report, a majority of deaths caused by drowning were within the age group of 11-40 years (18.6% in the age group of 11-20, 18.6% in the group of 21-30, and 16.9% in the group of 31-40). It added that deaths caused by drowning were rare in the extremes of age, and added: “1.7% of persons were in the age group of less than 10 years, and 1.7% of persons were between 81-90 years.” The victims were predominantly males, and they constituted 81.4% of the persons whose data were analysed.  It described the nature of the deaths, thus: “While the commonest circumstance was accident (57.6%), followed by suicide (22%), in 20.3% of the cases, the circumstance was unascertainable. There were no homicides. When considering the age distribution in the accidental deaths, the majority were between 11-20 years (26.5%), followed by (17.6%) between the ages of 21-30 years, (17.6%) between 31-40 years and (17.6%) between 51-60 years. The 41-50 years age group represented 5.9%.” The extremes of age groups, such as less than 10 years and 61-70 years, in the case of accidental deaths, were 2.9% and 11.8%, respectively, the study noted. During the analysis of the factors contributing to these deaths, it had been concluded that the majority of deaths were due to environmental factors, which included rough seas, a sudden rise in water levels, and floods (41%). Alcohol consumption (21%) and the inability to swim (6%) were other major identifiable reasons, in addition to natural diseases, neurological impairments, and psychiatric illnesses. However, in 23% of analysed cases, the reason for death was not identified. Even though these factors directly affect deaths caused by drowning, social factors can also be a reason in some cases, the study noted. It elaborated: “The peer pressure may be so intense that groups of individuals seek to enter water for pleasure and fun related activities. Unforeseen natural calamities cause death due to drowning even in certain cases where the drowned individual can swim.  “Sri Lanka is a culturally sensitive country with a male preponderance for water related activities, whereas female children are restricted and often supervised by elders. They are not left alone frequently to indulge in swimming or bathing in open water sources. In schools with swimming pools, there is no gender bias, but, in other instances, there may be. Boys and young males are not supervised stringently and they are free to go on trips with their friends and swim at any place. The lack of awareness sometimes makes them vulnerable to swim in dangerous locations.” When it comes to deaths caused by drowning, survival is determined almost exclusively at the scene of the incident, and depends on two highly variable factors, i.e. how quickly the drowning person is removed from the water, and how swiftly proper resuscitation is performed. Although the occupation of a majority of drowning victims had not been included in the post-mortem reports, the unemployed and labourers constituted 32% and 21%, respectively, of the sample, while other occupation categories were Army soldiers, businessmen, and clerks. The study also paid attention to the relationship between a person’s ability to swim and drowning. Of the analysed cases, the study noted, 38.2% of the deaths caused by drowning were of individuals who could swim, while it was concluded that the others could not swim. However, the researchers had found it difficult to extract the information from the post-mortem reports regarding the swimming capabilities of most of the individuals in cases of accidental drowning, and details pertaining to swimming capabilities of the deceased had not been documented in half of the analysed cases.  With regard to the place of drowning, it said that 20% of those who died due to drowning had died in the sea, while the same percentage had died in tanks. Other common places where such incidents had been reported were canals (18%), rivers (15%), wells (9%), and flooded areas (6%). Pits, lagoons, streams, and unknown water bodies had also caused deaths, but were not as prominent as the aforementioned places. The study presented several recommendations to reduce deaths caused by drowning – conducting a national data surveillance on deaths caused by drowning (by an established authority), establishing lifesaving associations in towns and at the village level, including mandatory swimming lessons in the school curriculum, providing national funding for research targeting morbidity and mortality due to drowning, and establishing a Governmental mechanism to collect data on drowning related incidents. It also recommended providing water safety and training to prevent drowning-related deaths, developing an action plan for water safety and the prevention of drowning deaths, initiating a prospective study regarding the deaths caused by drowning across all Provinces, and Governmental and other non Governmental organizations prioritising the prevention of drowning deaths, and integrating drowning with other public health issues. Risks and prevention According to the World Health Organisation (WHO), there are several risk factors contributing to drowning, including age, which is often associated with a lapse in supervision. Globally, the highest drowning rates are among children between 1-4 years, followed by children between 5-9 years. Alarmingly, in the WHO Western Pacific Region, children aged 5-14 years die more frequently from drowning than from any other cause.  The 2014 Global Report on Drowning noted that drowning is one of the top five causes of death for people aged 1-14 years in 48 of the 85 countries that provided data meeting inclusion criteria. It detailed that in Australia, drowning is the leading cause of unintentional injury death in children aged 1-3 years; in Bangladesh, drowning is the cause of 43% of all deaths in children aged 1-4 years; in China, drowning is the leading cause of injury death in children aged 1-14 years; and in the US, drowning is the second-leading cause of unintentional injury death in children aged 1-14 years. When it comes to the gender of drowning victims, the global situation resembles Sri Lanka’s situation (which was described above based on the local study): Globally, males are especially at risk of drowning, with twice the overall mortality rate of females, and are more likely to be hospitalised than females for non-fatal drowning. Quoting global studies, the WHO claimed that the higher drowning rates among males are due to increased exposure to water, and riskier behaviour such as swimming alone, drinking alcohol before swimming alone, and boating. Floods have become another major cause of drowning, as drowning accounts for 75% of deaths in flood disasters. The WHO warns that in a context where flood disasters are likely to become more frequent and severe owing to climate change, drowning risks may increase with floods especially in low and middle-income countries, where the ability to warn, evacuate, or protect communities from floods is weak or still developing. Other factors contributing to increased risk of drowning are increased access to water, travelling on water, alcohol use, living near or in the water, medical conditions such as epilepsy, tourists unfamiliar with local water risks, and infants being left unsupervised or alone with another child around water. Other socio-economic factors include lower socio-economic status, being a member of an ethnic minority, and the lack of higher education. With regard to steps that can be taken to reduce and prevent drowning incidents, the WHO recommends practical as well as policy-level changes. As far as the physical settings of water bodies are concerned, it is recommended to install barriers by covering wells, using doorway barriers and playpens, and fencing swimming pools, in order to control access to water hazards, or removing water hazards entirely, which would reduce water hazard exposure and risk. To develop individual skills as a way of addressing deaths caused by the lack of ability to swim – which was the issue in a majority of drowning victims in Sri Lanka’s case – the WHO recommends teaching school-age children basic swimming, water safety, and safe rescue skills. These efforts must however be undertaken with an emphasis on safety, and overall risk management that includes safety-tested curricula, a safe training area, screening and student selection, and student-instructor ratios established for safety. The policy-level steps the WHO recommended include establishing effective policies and legislation aimed at preventing drowning, and setting and enforcing safe boating, shipping, and ferry regulations. With a focus on addressing flood-related drowning incidents, it was recommended to build resilience to flooding and managing flood risks through better disaster-preparedness planning, land-use planning, and early warning systems. These recommendations also included developing a national water safety strategy, building consensus around solutions, providing strategic direction and a framework to guide multi sectoral action, and to allow for the monitoring and evaluation of efforts. The global situation  A problem Sri Lanka shares with many countries around the world is that drowning is not seen as an issue that requires more attention, despite it being a major cause of accidental deaths. The WHO even warned that global estimates may significantly underestimate the actual public health problem related to drowning, and that children, males, and individuals with increased access to water are most at risk. Drowning is the third-leading cause of unintentional injury death worldwide, accounting for 7% of all injury-related deaths, and there are an estimated 236,000 annual drowning deaths worldwide. Adding that deaths caused by drowning are reported in all economies and from all regions, the WHO says that low and middle-income countries, however, account for more than 90% of unintentional drowning deaths, and over half of the world’s drowning occurs in the WHO Western Pacific Region and WHO South East Asia Region. Drowning death rates are highest in the WHO Western Pacific Region, and are 27-32 times higher than those seen in the UK or in Germany, respectively. As per the data mentioned in this article, drowning is an issue that results from diverse factors. However, ignorance, or the lack of action to raise awareness, is one of the leading factors that make people victims of such accidents, and being unaware of the nature, prevalence and warning signs of the dangers around us is an issue that can be addressed at many levels, starting from schools and homes. In fact, in a context where knowledge about these factors often forms the basis of steps taken to prevent accidents, the lack of knowledge is perhaps the most prominent aspect that requires attention, and not only the public, but the authorities too, who are responsible for taking preventive measures, should also be made aware in order to tackle this issue.


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