Conceptual definition for drowning prevention: a Delphi study.

BACKGROUND: Expanding support for drowning prevention is evidenced by interlinked Resolutions at the United Nations (2021) and World Health Assembly (2023). While progress has accelerated, a universally agreed definition for drowning prevention remains absent. Here, we aim to develop a conceptual definition of drowning prevention using the Delphi method. METHODS: First, we conducted a document review to guide our development and consensus-building process. Then, we formed an advisory group and recruited participants with diverse expertise to contribute to Delphi-method surveys. In the first round, participants selected from draft concepts to build a definition and delineate between the terms drowning prevention and water safety. In the second round, we presented a codeveloped definition, and three statements based on first-round findings. We then sought participant feedback where ≥70% support was considered consensus-based agreement. RESULTS: Participants (n=134) were drawn from community (7.46%), policy (26.87%), research (40.30%) and technical backgrounds (25.37%), and low-income and middle-income countries (38.06%). In the first- round, half (50.74%) disagreed with the proposition that drowning prevention was synonymous to water safety, while 40.30% agreed. The second- round achieved consensus-based agreement (97.27%) for the definition: Drowning prevention is defined as a multidisciplinary approach that reduces drowning risk and builds resilience by implementing evidence-informed measures that address hazards, exposures and vulnerabilities to protect an individual, community or population against fatal and non-fatal drowning. CONCLUSION: The Delphi method enabled the codevelopment of our conceptual definition for drowning prevention. Agreement on the definition forms the basis for strengthened multisectoral action, and partnerships with health and sustainable development agendas. Defining drowning prevention in terms of vulnerability and exposure might increase focus on social determinants and other upstream factors critical to prevention efforts.

Identifying strategic priorities for advancing global drowning prevention: a Delphi method.

INTRODUCTION: The burden of drowning is gaining prominence on the global agenda. Two United Nations system resolutions in 3 years reflect rising political support, but priorities remain undefined, and the issue lacks a global strategy. We aimed to identify strategic priorities for advancing global drowning prevention using a modified Delphi method. METHODS: An advisory group was formed, and participants recruited with diverse expertise and backgrounds. We used document review, and data extracted from global health partnerships to identify strategic domains and draft priorities for global drowning prevention. Participants rated the priorities in two Delphi rounds, guided by relevance, feasibility and impact on equity, and where consensus was ≥70% of participants rating the priority as critical. RESULTS: We recruited 134 participants from research (40.2%), policy (26.9%), technical (25.4%) and community (7.5%) backgrounds, with 38.1% representing low- and middle-income countries. We drafted 75 priorities. Following two Delphi rounds, 50 priorities were selected across the seven domains of research and further contextualisation, best practice guidance, capacity building, engagement with other health and sustainable development agendas, high-level political advocacy, multisectoral action and strengthening inclusive global governance. Participants scored priorities based on relevance (43.2%), feasibility (29.4%) and impact on equity (27.4%). CONCLUSION: Our study identifies global priorities for drowning prevention and provides evidence for advocacy of drowning prevention in all pertinent policies, and in all relevant agendas. The priorities can be applied by funders to guide investment, by researchers to frame study questions, by policymakers to contrast views of expert groups and by national coalitions to anchor national drowning prevention plans. We identify agendas including disaster risk reduction, sustainable development, child and adolescent health, and climate resilience, where drowning prevention might offer co-benefits. Finally, our findings offer a strategic blueprint as the field looks to accelerate action, and develop a global strategy for drowning prevention.

Lessons learned through the 20-year development of a national fatal drowning database in Australia.

BACKGROUND: Co-ordinated, evidence-based policy and programmatic efforts are needed to respond to complex drowning prevention problems. Comprehensive, current, and robust data are vital for agenda setting, burden and risk factor identification, intervention design and evaluation, as well as setting policy. We aim to record methods used in, and identify impacts of, the development of a national fatal drowning database (NFDD) in Australia, including lessons learned across research, policy, and practice. METHODS: We employ a case study method using process mapping and document review to explore the evolution, drivers and impacts of the NFDD. We analyse methodological approaches including those relating to data definitions, drowning case collection, and management, as well as tracking the various outputs of the NFDD. We describe a development timeline that presents impact of drowning prevention policy, and research agendas on database development, and research investments more specifically. RESULTS: Our study identified that the collected variables grew 20-fold from 2002 to 2022, reaching 259 variables, and 5,692 unique cases of fatal drowning. The NFDD employs data triangulation methodology, combining keyword and targeted searches of coronial files, media report monitoring, and organisational data provision. Database development is influenced by the Australia Water Safety Strategy, policymaker and practitioner-initiated research agendas, and identification of knowledge gaps. We identified numerous outputs spanning publications, media, intervention development, and legislative submissions. CONCLUSION: A comprehensive and robust NFDD informed by policymaker and practitioner input can enhance surveillance, policy, and intervention development for drowning prevention. Employing mixed data collection and validation methods can supplement weaknesses in official data sources. There is a need for the NFDD to continue to evolve in its application while maintaining rigorous case identification and data quality assurance processes. Despite significant investment, the outputs and influence on drowning prevention practice in Australia has been extremely valuable and contributed to sizeable reductions in Australia's fatal drowning rate.

Identifying opportunities for multisectoral action for drowning prevention: a scoping review.

BACKGROUND: Drowning is a complex health issue, where global agendas call for greater emphasis on multisectoral action, and engagement with sectors not yet involved in prevention efforts. Here, we explored the conceptual boundaries of drowning prevention in peer-review and grey literature, by reviewing the contexts, interventions, terminologies, concepts, planning models, and sector involvement, to identify opportunities for multisectoral action. METHODS: We applied scoping review method and have reported against Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews checklist. We searched four electronic databases for peer-reviewed articles published on 1 January 2005 and 31 December 2020 and five databases for grey literature published on 1 January 2014 and 31 December 2020. We applied the search term "drowning," and charted data addressing our research questions. RESULTS: We included 737 peer-reviewed articles and 68 grey documents. Peer-publications reported situational assessments (n=478, 64.86%) and intervention research (n=259, 35.14%). Drowning was reported in the context of injury (n=157, 21.30%), commonly in childhood injury (n=72, 9.77%), mortality studies (n=60, 8.14%) and in grey documents addressing adolescent, child, environmental, occupational and urban health, refugee and migrant safety and disaster. Intervention research was mapped to World Health Organization recommended actions. The leading sectors in interventions were health, leisure, education and emergency services. CONCLUSION: Although drowning is often described as a major health issue, the sectors and stakeholders involved are multifarious. The interventions are more often initiated by non-health sectors, meaning multisectoral action is critical. Framing drowning prevention to reinforce cobenefits for other health and development agendas could strengthen multisectoral action. Greater investment in partnerships with non-health sectors, encouraging joint planning and implementation, and creating systems for increased accountability should be a priority in future years.

Tracing the emergence of drowning prevention on the global health and development agenda: a policy analysis.

Drowning has been a neglected health issue, largely absent from the global health and development discourse, until the UN General Assembly adopted its first resolution on global drowning prevention in 2021. This policy analysis examines the role of issue characteristics, actor power, ideas, and political contexts in the emergence of drowning prevention, and it also identifies opportunities for future actions. We identified three factors crucial to enhancing prioritisation: (1) methodological advancements in population-representative data and evidence for effective interventions; (2) reframing drowning prevention in health and sustainable development terms with an elevated focus on high burdens in low-income and middle-income contexts; and (3) political advocacy by a small coalition. Ensuring that the UN resolution on global drowning prevention is a catalyst for action requires positioning of drowning prevention within global health and sustainable development agendas; strengthening of capacity for multisectoral action; expansion of research measuring burden and identifying solutions in diverse contexts; and incorporation of inclusive global governance, commitments, and mechanisms that hold stakeholders to account.

Drowning prevention: turning the tide on a leading killer.

Drowning is a leading killer, particularly of children and young adults, yet has been greatly neglected. Despite accounting for a higher number of deaths than many other substantial public health issues, drowning has not benefitted from the targeted attention it requires, which is particularly tragic because low cost and effective drowning prevention interventions exist. Therefore, the recent UN General Assembly's adoption of a resolution on global drowning prevention is a historic first, and offers an exciting opportunity by providing a comprehensive framework and a practical roadmap that a range of actors and sectors, including governments, can follow to address the challenge of drowning prevention.

Analysis of fatal unintentional drowning in Australia 2008-2020: implications for the Australian Water Safety Strategy.

OBJECTIVE: To examine temporal trends in drowning in Australia against targets set in the Australian Water Safety Strategy (AWSS) 2008-2020 and to inform the development of the next iteration of the Strategy. METHODS: A national analysis of unintentional fatal drowning rates per 100,000 population over 16 years (2004/05-2019/20) was conducted. Baseline rates (three-year average 2004/05-2006/07) were compared to the current three-year average (2017/18-2019/20) by sex, age group, drowning location and jurisdiction. RESULTS: The overall rate of unintentional fatal drowning during the period decreased by 28%. Substantial reductions were observed in children 0-4 years (-63%) and 5-14 years (-56%). Progress has been less pronounced among people aged 75 years and over (-11%) and 15-24-year-olds (-14%). All locations and jurisdictions recorded reductions, aside from rocks (+46%). CONCLUSIONS: Although the strategy fell short of its aspirational target of a 50% reduction in drowning by the year 2020, this target was exceeded in key age groups, including children. Implications for public health: The AWSS is a powerful tool to align drowning prevention sector actions to agreed objectives. Forthcoming strategies must take into consideration demographic and social change, areas where limited progress has been made and the latest evidence to guide future priorities.

Mapping Trends in Drowning Research: A Bibliometric Analysis 1995-2020.

Drowning is public health issue requiring global, national and community responses. The multisectoral nature of drowning prevention reinforces the need for multidisciplinary research, which can play a key role in identifying patterns, factors and interventions and contributes to evidence-informed prevention. This study presents a biometric analysis of drowning research published in 1995-2020 and identifies temporal trends in research themes, journals, countries and authorship to assist in the planning of future research. This study identified 935 studies, representing authors from 80 countries. Publications grew 103-fold, and 41.2% (n = 385) were published since 2014. The top 20 journals are all injury prevention, public health, or medical journals. The top 5 accounted for 24.5% (n = 229) of total publications (TP). Research from the United States (TP = 313, 25.0%) and Australia (TP = 192, 15.3%) dominates the field. Growth is highest in low-middle-income countries (LMICs) including China (TP = 54, 4.3%, 32-fold), India (TP = 30, 2.4%, 17-fold) and Bangladesh (TP = 47, 3.7%, 7-fold). The study identifies significant growth in epidemiologic studies reporting burden and risk factors. Research in LMICs is increasing but lags relative to the burden. The role of multilateral and nongovernment organisations in evidence generation is evident and needs investigation, as do gaps in evidence for interventions and partnerships to progress the drowning prevention field.