Next steps for drowning prevention in rural and remote Australia: A systematic review of the literature

Abstract

SPORTDiscus and Google Scholar were searched for studies exploring fatal and non-fatal unintentional drowning by remoteness. Epidemiological data, common factors and prevention strategies were extracted and mapped to Australian standard geographical classifications (major cities, inner regional, outer regional, remote and very remote). Level of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation and prevention strategies aligned to the hierarchy of control. Result: Thirty-two studies satisfied inclusion criteria (66% reporting epidemiology; 59% risk factors; and 44% prevention strategies). All (100%) included studies were assessed very low against Grading of Recommendations Assessment, Development and Evaluation. Findings indicate rural populations (ie, excluding major cities) have higher rates of drowning positively correlated with increasing remoteness. Common factors included age (child), natural water bodies, undertaking boating and watercraft activities and alcohol consumption. While a range of prevention strategies has been proposed, only one study outlined a rural drowning prevention strategy which had been implemented and evaluated. Strategies were generally low on the hierarchy of control. Conclusion: Rural populations are proportionately overrepresented in drowning statistics. Proposed prevention strategies have unknown efficacy. Greater research into rural drowning of Australians is needed especially exploring behavioural motivations, program delivery, cost-effectiveness and evaluation. Development and use of a standard definition for remoteness are recommended. Rural populations use water extensively; therefore, there is an urgent need to keep them safe. K E Y W O R D S education/training, policy, public health, remote health, rurality Other 32 Metropolitan Country Other 34 Rural water hazards Other 37 Metropolitan Country Abbreviations: ARIA, Accessibility/Remoteness Index of Australia; ASGS, Australian Statistical Geography Standard; M, Modified; RRMA, rural, remote and metropolitan areas.

Exploring the Impact of Remoteness and Socio-Economic Status on Child and Adolescent Injury-Related Mortality in Australia

“…A range of upstream factors also impact drowning risk, with less pools, seasonal facilities and a lack of instructors impacting ability to learn to swim in regional and remote areas [ 59 ], and the limited provision of school-based lessons and the high cost of private lessons a barrier for low-socio economic families [ 63 ]. Unpatrolled inland waterways used for recreation [ 60 ] and higher rates of alcohol consumption combined with aquatic activity [ 64 ], are also factors increasing drowning risk in regional and remote areas.…”

“…Social determinants, such as remoteness and socio-economic disadvantage, are important factors impacting drowning risk and must be considered by drowning prevention practitioners. Very few drowning prevention initiatives targeting regional and remote communities have been evaluated [ 59 ], providing meagre evidence to direct limited funding to the most effective strategies.…”

Application of the PRECEDE–PROCEED model in the development of evidence-informed interventions for drowning prevention: a mixed-methods study protocol

“…ONEISS data can be used as the source of information in determining primary cause and risk factors for drowning. 16 20 However, there are limitations for using the ONEISS data as 1 the data are collected by selected hospitals, 2 the system is web based and hospitals with no or poor access to the internet will have problems in using the system, 3 drowning events captured by local health clinics are not usually reported, 4 cataclysmic events and water transport incidents are not included, and, 5 like other countries in Asia, misclassification of cases could be a problem. As such, a multisector action plan for drowning prevention in the Philippines identifies the need to strengthen drowning surveillance systems including disaggregated, regularly collected data and improving the evidence base through research.…”

“…The list of volunteers, health workers and resort owners will be requested from the local government unit. From this list, four 4 focus groups will be formed consisting of about six to eight participants per group. The information that can be gathered from the focus group participants will enhance the data derived from the key informant interviews.…”

“…1 This need spans epidemiological data on the burden associated with drowning, risk factor identification and the development, implementation and evaluation of preventive strategies to better guide future effort and investment. [2][3][4][5] Drowning is defined as the process of experiencing respiratory impairment from submersion or immersion in liquid with outcomes classified as death, morbidity or no morbidity. 6 Across the full spectrum of drowning outcomes, 7 a strengthened evidence base is required including improving data collection, quality and analyses.…”