Childhood Drownings: An Opportunity for Injury Prevention in a Resource-limited Setting

Background: Drowning is a public health problem that is associated with significant mortality, especially in Africa. Drowning remains under-reported in Malawi. We sought to evaluate the epidemiology, risk factors, and current prevention strategies for drownings in Malawi

Methods: We performed a retrospective review of all pediatric (≤15 years of age) patients who presented following a drowning incident, to Kamuzu Central Hospital in Lilongwe, Malawi, from 2009 to 2019. Patient characteristics and outcomes were compared between pediatric drowning survivors and non-survivors. Logistic multivariate regression analysis was used to identify factors associated with increased odds of mortality.

Results: There were a total of 156 pediatric drowning victims during the study period, of which the majority (65.4%) were male. The median age of patients presenting with drowning was 3 IQR: 2-7 years). Drowning survivors were younger (median age: 2 years (IQR: 2-5) vs. 5 years (IQR: 2-10), p=0.004), with a higher proportion of drownings occurring at home (85.6% vs. 58.3%, p=0.001) compared to non-survivors. On multivariate logistic regression analysis, patients who had a drowning event at a public space had increased odds of mortality when compared to those who had drowning events at home (OR 7.63, 95% CI 2.17 – 28.86). Patients who were transferred (OR 0.02, 95% CI 0.002 – 0.22) and had other injuries (OR 0.20, 95% CI 0.06 – 0.22) had decreased odds of mortality following drowning.

Conclusion: Over half of pediatric drowning victims at a tertiary care facility in Malawi survived. Patients who survived were significantly younger, more likely to have drowned at home, and transported by private vehicles and minibus compared to non-survivors. There is a need for scalable, cost-effective prevention primary and secondary strategies that focus on water safety education and training of community members and police officers in basic life support and resuscitation.