57% of drowning deaths accidental: Make swimming mandatory at schools: Researchers

By Ruwan Laknath Jayakody


In Sri Lanka, the majority of deaths due to drowning are accidental and mandatory swimming lessons must be included in the school curriculum to minimise drowning-related deaths, a group of researchers have pointed out.

In a research article, they stressed that children of school going age could be trained in swimming as a life skill, on water safety and training, as 57.6% of all cases of drowning were found to be accidental.
The research article is titled “Deaths following drowning in Sri Lanka – a retrospective study” and was authored by researchers P. Paranitharan, W.N.S. Perera, S. Lakmal, D.C. Priyanath, T.A.A.W. Senanayake, and M.K.J.K. Kumari. It was published recently in the Sri Lanka Journal of Forensic Medicine, Science, and Law.

However, it was also observed that 38.2% of those who died due to drowning could swim. Sometimes, the authors observed, the ability to swim may encourage risky behaviour.

The authors point out that environmental factors such as the high altitude of sea waves, rough seas, a sudden rise in the water level or floods, along with circumstantial factors, such as alcohol consumption, play contributory roles in accidental drowning deaths.

A majority of drowning deaths were of those in the age groups of 11-40 years, especially adolescents and young adults between 11-20 years, while the victims were predominantly males.

A total of 59 deaths due to drowning that occurred from 2008 to 2017 were included in the study for which data was extracted from post-mortem reports.

Suicidal drowning made up 22% of all drowning-related deaths, with the majority of the people who died by suicide choosing natural and manmade wells for this purpose.

In terms of the employment demographics, the majority who died thus were for the most part unemployed or labourers. According to the authors, this group needs special attention. They however noted that it is not obvious as to whether the lack of literacy has any preponderance towards accidental drowning.

The sea, irrigation tanks and large reservoirs, canals and rivers, followed also by lakes and wells, were the common locations of accidental drowning deaths while the majority of suicidal drowning had taken place in wells and canals. The majority of such drowning incidents had occurred between 12 noon and 6 p.m. while 29 of the deaths had taken place between 6 a.m. and 12 noon.

With regard to related casualties among adolescents and young adults, the researchers noted that peer pressure may be so intense that groups of individuals seek to enter water for pleasure and fun-related activities. Boys and young males are not supervised stringently and they are free to go on trips with their friends and to swim at any place, they observed, noting also that this factor, coupled with the lack of awareness, sometimes makes them vulnerable to swim in dangerous locations. The lack of environmental signs indicating dangerous areas may make persons more prone to enter harmful water sources. They further noted that unlike in beaches, irrigation tanks do not have warning signs with the risk level graded. Moreover, lifeguards are only available at a few beaches.

Psychiatric illnesses and neurological disabilities were miscellaneous reasons identified in the course of this study by the authors, but their exact contribution to the deaths is difficult to prove.

Survival in the case of drowning due to bathing, swimming, or travelling in water depends on how quickly the person is removed from the water and how swiftly proper resuscitation is performed. Further, the researchers pointed out that near-drowning cases may go largely unnoticed but that they often result in the lifelong impairment of functions and make victims heavily dependent on healthcare facilities.

As a way forward to minimise drowning deaths, preventive measures should be initiated starting from the schools, the researchers explained. Citizens of all ages must be educated of the dangers of swimming in unknown and dangerous water resources. Lifesaving associations should be established in towns and villages, and mandatory swimming lessons must be included in the school curriculum, the authors emphasised, through which children of school going age must be trained in swimming as a life skill, on water safety and training, to prevent drowning-related deaths.

Additionally, the authors recommended that it is important to strengthen the role of a national governing entity to finalise the national action plan for water safety and the prevention of drowning deaths and establish a national governing entity for drowning prevention and water safety. The perspective of the authorities tasked with handling disaster management too should be incorporated in this exercise. The relevant national advisory committee appointed in this regard could develop a proposal on the risk profile, customise beach/pool operational guidelines, improve the swim for safety curriculum, identify and promote safe bathing and swimming zones, and develop a surveillance system to be framed into the national action plan. The role of the national governing entity would be to implement the national action plan and monitor progress, while assigning steering and technical committees to decentralise the solutions.

Finally, governments and other non-governmental organisations should prioritise the prevention of drowning deaths and integrate such with other public health issues, the authors opined.

However, data based on the surveillance of drowning deaths in Sri Lanka is minimal and since data collection and recording is limited, this hampers and limits the planning, implementation, and monitoring of drowning prevention measures. There was a lack of information in 50% of the cases regarding the background of the victims, important demographic factors, circumstances, and the in-depth analysis of contributory factors.

It is imperative therefore, the authors pointed out, to carry out an islandwide research, analysing all the drowning deaths with possible contributory factors. A suitable database covering the whole island related to drowning deaths must be maintained and national data surveillance on drowning deaths must be done by an established authority, the researchers noted. In this regard, national funding for research targeting morbidity and mortality due to drowning is required and a government mechanism should be established to collect data on drowning-related incidents and to maintain the aforementioned national database. In a similar vein, it was proposed that a study be conducted regarding drowning deaths involving all provinces, as identifying the trends in accidental and suicidal drowning deaths will help in order to take preventive measures in the future and also to sensitise the authorities as to the importance of preventive measures.

Drowning is the process of experiencing respiratory impairment from submersion/immersion in a liquid, according to the World Health Organisation’s (WHO) World Congress on Drowning. Death, morbidity, and no morbidity following immersion are the common outcomes of drowning.

Statistically, drowning is one of the 10 leading causes of death for people aged one to 24 years in every region of the world, while low and middle-income countries contribute to more than 90% of unintentional drowning deaths. Moreover, globally, more than half of the drowning deaths involve victims who are less than 25 years. The Life Saving Association of Sri Lanka, in 2014, developed a report in collaboration with Life Saving Victoria and the WHO Country Office for Sri Lanka, according to which, Sri Lanka has one of the highest drowning rates internationally, ranking as the 12th highest in a comparison of 61 countries, and the 10th highest when compared to 35 low and middle-income countries. On average, 855 people drown in Sri Lanka each year, the authors noted, a drowning rate of 4.4 deaths per 100,000 persons (in 2001, 2006, 2009) with the North Western (6.3%) and North Central (5.4%) Provinces recording a higher drowning death rate than that of the national average.

Death following drowning is considered a serious and neglected public health issue. However, no significant efforts have been taken to prevent drowning in comparison to the preventative mechanisms adopted for non-communicable diseases.