Socio-ecological nature of drowning in low- and middle-income countries: A review to inform health promotion approaches

Most deaths by drowning (91%) have occurred in low- and middle-income countries (LMICs), particularly in Southeast Asia (35%) and Africa (20%), in proportion to total drowning deaths worldwide. Poor data collection in LMICs hinders the planning, implementation, and evaluation of prevention strategies. The objective of this study was to review the rates and risk factors of unintentional drowning in LMICs and to identify drowning prevention strategies within a socio-ecological health promotion framework. A systematic search, guided by PRISMA, was conducted on Ovid MEDLINE, CINAHL, Informit health, PsycINFO (ProQuest), Scopus, SafetyLit, Google Scholar, and BioMed Central databases for all relevant studies published between 2012 and 2017. McMaster appraisal guideline was used for critical review. The disparity of available drowning data was observed across selected countries. The highest rates were identified in low-middle income South-east Asian countries. The socio-economic background of the family, overcrowding, and living close to water bodies were important predictors for paediatric drowning in LMICs, while the presence of mother as caregiver was identified as a protective factor. The over-reliance on active injury prevention strategies was identified. Further research focusing on developing relevant upstream drowning prevention and water safety promotion is needed to ensure the sustainability of drowning prevention in LMICs.