Natural hazard risk analysis in the framework of water safety plans.

The available literature on natural hazard risk analysis focused on the implementation of water safety plans (WSPs) is surprisingly quite poor, despite the significant increase in the number and severity of disasters and adverse effects on drinking water supply systems generated by natural hazards. At the same time, WSPs that conveniently account for natural hazards with a comprehensive approach 'from source to tap' are still scarce as they typically occur at larger spatial scales and adequate prevention, mitigation and adaptation require efficient inter-institutional collaborations. The aim of this paper is to highlight the main bottlenecks for water utilities to include natural hazards in the development of their WSPs. The research adopted a stakeholders-oriented approach, involving a considerable number of water utilities (168), water sectoral agencies (15) and institutions (68) across the Adriatic-Ionian Region through a stepwise process that generated joint SWOT analysis, the development of a decision support system (DSS) focused on WSPs procedures and tabletop exercises. The final outcomes generated strategic documents (REWAS - Adrion Road map for resilient water supply) that highlighted the necessity for efficient cross-sectoral and inter-institutional cooperation in the development of well-founded and robust WSPs to address natural hazard risk analysis for water supply systems (DWSS).

Strengthening rural community water safety planning in Pacific Island countries: evidence and lessons from Solomon Islands, Vanuatu, and Fiji.

Pacific Island Countries (PICs) collectively have the lowest rates of access to safely managed or basic drinking water and sanitation globally. They are also the least urbanised, have dynamic socioeconomic and increasing climate-linked challenges. Community-based water managers need to respond to variability in water availability and quality caused by a range of hazards. Water Safety Planning (WSP), a widely adopted approach to assessing water supply, offers a risk-based approach to mitigating both existing and future hazards. WSP is adaptable, and making modifications to prescribed WSP to adapt it to the local context is common practice. Within the Pacific Community Water Management Plus research project, we used formative research and co-development processes to understand existing local modifications, whether further modifications are required, and, to develop additional modifications to WSP in Fiji, Vanuatu and Solomon Islands. The types of additional local modifications we recommend reflect the unique context of PICs, including adjusting for community management of water supplies and required collective action, community governance systems, levels of social cohesion in communities, and preferred adult-learning pedagogies. Incorporating modifications that address these factors into future WSP will improve the likelihood of sustained and safe community water services in Pacific and similar contexts.

Inexperienced water users can "Float to Live" in realistic open water conditions.

BACKGROUND: The RNLI "Float to Live" campaign is based on research conducted in indoor pools with experienced open water swimmers. Study 1 investigated whether the RNLI "Float to Live" guidance would enable less experienced individuals to float in realistic open water conditions. Study 2 examined the separate effects of practice and coaching on floating competence. METHODS: Study 1: Inexperienced water users conducted floats in either still, open fresh (n = 22) or open sea water (n = 13), followed by moving sea (n = 6) or fresh water (n = 5). Participants undertook three 2-min floats in still water wearing swimwear and one clothed float: 1) naïve; 2) following RNLI "Float to live" messaging; 3) individual float coaching; 4) simulated fall wearing summer clothing. In moving sea water, participants undertook two floats equivalent to Floats 3 and 4. In moving fresh water, participants undertook 3 floats: 1) naïve; 2) following "defensive floating" coaching; 3) simulated fall wearing summer clothing. Study 2: Two groups matched for skinfold thickness undertook three 2-min floats in a flume wearing swimwear. PRAC group (n = 12): 1) naïve; 2) following float practice; 3) float coaching; COACH group (n = 11) coaching followed by practice. Floating difficulty, confidence, competence, "efficiency" and perceived exertion were analysed using either a Friedman test or mixed model ANOVA. RESULTS: In both fresh water and sea water, participants' floating competence and confidence increased after viewing the RNLI messaging, it was further improved with individualised float coaching. The additional helpful instructions included: 1) "head back with ears submerged"; 2) "relax"; 3) "breathe normally"; 4) "it is OK if your legs sink"; 5) an accurate description of sculling for "active" floaters that needed it; 6) spread arms and legs for stability. The simulated fall with clothing did not impair floating competence. No difference in floating competence was seen between PRAC and COACH, though confidence may be increased sooner in COACH. CONCLUSIONS: The RNLI float advice can be applied in realistic open water settings by less experienced water users. Additional content could be included to make the messaging even more effective.

The burden, risk factors and prevention strategies for drowning in Türkiye: a systematic literature review.

INTRODUCTION: Drowning is a public health problem in Türkiye, as in the rest of the world. This study aims to systematically review the literature on drowning in Türkiye with a focus on data sources, epidemiology, risk factors and prevention strategies. METHODS: Literature searches were conducted using PubMed, SPORTSDiscus, Scopus, Web of Science, Turk MEDLINE, Google Scholar and Google Akademik (Turkish language). Studies (limited to original research written in English and Turkish) reporting drowning (unintentional and intentional; fatal and non-fatal) of residents and tourists in Türkiye were independently dual screened at the title and abstract and full text stages. Study quality was assessed using JBI checklists and evidence level assessed based on study design. RESULTS: From a total of 917 studies, 49 met the inclusion criteria. Most (51%) focused on unintentional fatal drowning. Included studies were most commonly analytical cross-sectional studies (n = 23) and case series (n = 20) meaning the evidence level was low or very low for 48 (98%) studies. Fifteen studies examined drowning at the national level, while sub-national studies (n = 30) focused on urban areas across three provinces: Antalya (n = 6), Istanbul (n = 6), Izmir (n = 4). There was little consensus on risk factors beyond male drowning risk, and no data reported on implemented or evaluated drowning prevention interventions. DISCUSSION: There is a need for more national-level studies to identify the causes of drowning and to guide intervention implementation and evaluation to inform policy makers and donors. Currently official data is limited in its detail, providing age and gender data only, hampering efforts to identify, and thus address, causal factors for drowning. PRACTICAL APPLICATIONS: There is currently very little evidence to inform investment in effective drowning prevention interventions in Türkiye. To improve this, data collection systems on drowning in Türkiye need to be strengthened via the development a national drowning registry. TRIAL REGISTRATION: #CRD42022382615.

Swimming and water safety delivery for newly arrived Australians.

In Victoria, Australia, culturally and linguistically diverse communities are more than twice as likely to drown than their Australian-born counterparts. One explanation is the lack of feasible, community-led approaches to water safety and swimming education. A community engagement framework was used to develop and implement a 5-day pool program to teach swimming and water safety to newly arrived migrant children attending an English language school in Victoria. Socio-cultural needs of the predominantly Afghan cohort were incorporated through in-language consultation with parents who requested males and females be educated separately. Participants were assessed against Victorian aquatic competency benchmark standards at pre- and post-program, however, there was no expectation to achieve these competencies within the 5 days due to a lack of prior aquatic exposure. Independent and paired samples t-tests determined changes in skills, including by sex and number of lessons attended. Forty-one participants completed all assessments. Excluding lifesaving skills, there was a significant increase in total competency attainment overall from pre- to post-program (p < 0.001), and for each competency (p's ≤ 0.002)-predominantly knowledge and rescue skills. Improvements were mostly recorded among males, demonstrating that females may require more specialized support to achieve similar outcomes. Improvements in rescue skills and knowledge indicate the program's effectiveness in increasing newly arrived migrant children's awareness of, and exposure to, foundations of safe aquatic behaviours. Future programs tailored to newly arrived migrant communities should consider implementing water familiarization activities as a stepping stone to engagement with structured swimming and water safety education.

Enhancing Water Safety: Exploring Recent Technological Approaches for Drowning Detection.

Drowning poses a significant threat, resulting in unexpected injuries and fatalities. To promote water sports activities, it is crucial to develop surveillance systems that enhance safety around pools and waterways. This paper presents an overview of recent advancements in drowning detection, with a specific focus on image processing and sensor-based methods. Furthermore, the potential of artificial intelligence (AI), machine learning algorithms (MLAs), and robotics technology in this field is explored. The review examines the technological challenges, benefits, and drawbacks associated with these approaches. The findings reveal that image processing and sensor-based technologies are the most effective approaches for drowning detection systems. However, the image-processing approach requires substantial resources and sophisticated MLAs, making it costly and complex to implement. Conversely, sensor-based approaches offer practical, cost-effective, and widely applicable solutions for drowning detection. These approaches involve data transmission from the swimmer's condition to the processing unit through sensing technology, utilising both wired and wireless communication channels. This paper explores the recent developments in drowning detection systems while considering costs, complexity, and practicality in selecting and implementing such systems. The assessment of various technological approaches contributes to ongoing efforts aimed at improving water safety and reducing the risks associated with drowning incidents.

A survey on hydration and use of plastic water bottles among Italian health sector workers.

Background: Modena's Local Health Authority (AUSL) is a public service with more than 5,000 employees. In its facilities, drinking water is available as tap water. However, disposable plastic bottles are also widely used, thus increasing plastic waste. Study design and methods: In the present study, we aimed to investigate employees' drinking habits through an ad hoc 10-item online questionnaire, which was administered in spring 2023. Results: Of the 584 participants (10.8% response rate), 75% of workers reported drinking less than 1.5 liters of water per day. In addition, 74% of workers brought water from home, while 62% used disposable plastic containers bought in the workplace or outside. When asked if they would appreciate a water refilling station in the workplace, whether that would induce them to consume less plastic and to drink more water, 91%, 82%, and 72% of workers said "yes", respectively. By installing water coolers, the estimated mean number of plastic bottles spared every day at the AUSL would be about 6,000. Conclusions: Our data shed light on most employees' perceived need for alternative sources of drinking water, not only in order to drink more for health benefits, but also to reduce plastic usage in favor of reusable, more environmentally friendly materials.

Friends or Foes? Emerging Impacts of Biological Toxins.

Toxins are substances produced from biological sources (e.g., animal, plants, microorganisms) that have deleterious effects on a living organism. Despite the obvious health concerns of being exposed to toxins, they are having substantial positive impacts in a number of industrial sectors. Several toxin-derived products are approved for clinical, veterinary, or agrochemical uses. This review sets out the case for toxins as 'friends' that are providing the basis of novel medicines, insecticides, and even nucleic acid sequencing technologies. We also discuss emerging toxins ('foes') that are becoming increasingly prevalent in a range of contexts through climate change and the globalisation of food supply chains and that ultimately pose a risk to health.

Public Concern about Water Safety, Weather, and Climate: Insights from the World Risk Poll.

Water safety refers to the quality of one's drinking water and whether it lacks dangerous contaminants. Limited access to safe water is projected to impact approximately 5 billion people worldwide by 2050. Climate change and worsening severe weather events pose increasing threats to global water safety. However, people may not perceive links between climate change and water safety, potentially undermining their willingness to implement behaviors that improve water safety. Existing studies on water safety risk perceptions have mostly been conducted in single-country contexts, which limits researchers' ability to make cross-national comparisons. Here, we assessed the extent to which people's severe weather concern and climate change concern predict their water safety concern. Our analyses used survey data from the 142-country 2019 Lloyd's Register Foundation World Risk Poll, including 21 low-income and 34 lower-middle-income countries. In mixed-effects models, severe weather concern was significantly more predictive of water safety concern than was climate change concern, although both resulted in positive associations. Worldwide, this finding was robust, insensitive to key model specifications and countries' varying protection against unsafe drinking water. We suggest communicators and policymakers improve messaging about water safety and other environmental threats by explaining how they are impacted by worsening severe weather.

Survival behavior of six enterotoxigenic Escherichia coli strains in soil and biochar-amended soils.

Some Escherichia coli serotypes are important human pathogens causing diarrhea or in some cases, life threatening diseases. E. coli is also a typical indicator microorganism, routinely used for assessing the microbiological quality of water especially to indicate fecal contamination. The soil is a sink and route of transmission to water and food resources and it is thus important to understand the survival of enterotoxigenic E. coli strains in soil. This study monitored the survival of six E. coli strains in sandy and loam soil. Furthermore, since biochar is a commonly used soil conditioner, the study investigated the impact of biochar amendment (15%) on the survival of the E. coli strains in (biochar-amended) sandy and loam soils. Addition of biochar affected the physicochemical properties of both soils, altering potassium levels, calcium, magnesium, sodium as well as levels of other metal ions. It increased the organic matter of loam soil from 44 g/dm3 to 52 g/dm3, and increased the pH of both sandy and loam soils. Survival and persistence of the E. coli strains generally varied according to soil type, with strains generally surviving better (P ≤ 0.05) in loam soil compared to in sandy soil. In loam soil and biochar amended loam soils, E. coli strains remained culturable until the 150th day with counts ranging between 3.00 and 5.94 ± 0.04 log CFU/g. The effects of biochar on the physicochemical properties of soil and the response of the E. coli strains to biochar amendment was variable depending on soil type.

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.

Effect of baby swimming lessons on infants' avoidance of bodies of water.

Despite the popularity of infant swimming programs, no evidence exists to determine whether they influence infants' judgments and behavior when confronted with bodies of water. We conducted two separate studies examining if the total number of swimming sessions an infant participated in predicted whether they avoided a body of water they could enter via an edge (Study 1-Water Cliff: n = 101 infants) or a slope (Study 2-Water Slope: n = 77 infants). The results revealed a significant interaction between number of sessions and type of entry into the water. Infants who participated in 10 or more sessions were more likely to avoid falling on the edge leading into the water but entered the water significantly more if they could access it via a slope. These findings suggest that while experience in baby swimming programs can promoted more adaptive behaviors on drop-offs leading into bodies of water, sloped entries may heighten drowning risks for young children with greater familiarity with water. Because we tested the two groups of infants in different countries, further research is warranted to determine if cultural differences in child rearing practices or variations in the content and/or teaching of the swimming programs might explain these intriguing findings.

Evaluation of Escherichia coli Inactivation at High Altitudes Using Solar Water Disinfection.

INTRODUCTION: Solar disinfection (SODIS) is an effective method for microbiologic inactivation of contaminated water using ultraviolet rays at low elevations. The aim of this study was to determine the effectiveness of SODIS at higher elevations. METHODS: The ability of SODIS to inactivate Escherichia coli bacteria was evaluated at an altitude of ≥1600 m using Nalgene bottles, disposable plastic water bottles, and Ziploc plastic bags. Bacterial viability was determined through measurement of colony forming units (CFUs). Decreases in CFUs were determined at each time point relative to those at the baseline, and a multivariable regression analysis was used to assess significant changes in CFUs. RESULTS: Bacterial CFUs in exposed containers decreased by >5 log after 6 h of exposure to sunlight. In contrast, the CFUs remained nearly unchanged in unexposed containers, showing a mean decrease of 0.3 log. By 2 h, bacterial inactivation at high altitudes was 1.7-fold greater than that at lower altitudes (P<0.05). By 6 h, nearly all bacteria were inactivated at high or low altitudes. At 6 h, no statistical difference was observed in the efficiency of inactivation between elevations. Compared with Nalgene bottles, plastic bottles had a 1.4-fold greater decrease in CFUs (P<0.05). No statistical difference in bacterial inactivation was found between plastic bottles and plastic bags. CONCLUSIONS: At high altitudes, SODIS is an effective method for inactivating E coli. Further research investigating other microorganisms is warranted to determine whether SODIS is suitable for disinfecting contaminated water at high altitudes.

Lessons learned from co-designing a high school beach safety education program with lifeguards and students.

ISSUE ADDRESSED: School-based beach safety education programs are common, but best practice guidance and information on their design and development is limited. METHODS: Researchers, professional ocean lifeguards and students participated in a co-design process to inform a lifeguard-delivered, school-based beach safety education program for a coastal community in New South Wales, Australia. Lifeguards and researchers (experts) provided structured feedback about the program in a survey and facilitated workshop; students (n = 26) aged 11 to 13 years participated in focus group sessions intended to garner in-depth understanding of their experiences at the beach and knowledge of, and attitudes towards, beach safety. RESULTS AND DISCUSSION: The co-design process provided a novel and inclusive model for beach safety education program development, and valuable lessons for future efforts. Specifically, student focus groups identified several facets of pre-teens and younger teenagers' beach experience that prompted revision of the education program, primarily framing of program content and safety messages. Peers are a primary motivator for this age group and students' burgeoning independence emerged as an important theme. While knowledgeable about beach hazards and risks, students conveyed mixed safety attitudes and self-reported safety practices, highlighting the importance of designing programs to motivate behaviour and promote safe decision-making vs raising awareness alone. Findings illustrate the value of adopting co-design processes for all beach safety programs, school or otherwise. SO WHAT?: Beach safety programs may not be delivering information that is needed, wanted or useful. Structured consultation with the priority population must become standard practice in beach safety and drowning prevention education program development.

Energetic and Cognitive Demands of Treading Water: Effects of Technique and Expertise.

Being able to tread water effectively can improve the likelihood of survival following accidental immersion. People tread water in various ways, ranging from rudimentary 'doggy-paddle' to more elaborate techniques like the eggbeater, but little is known about the energetic and cognitive requirements of treading water. We therefore aimed to measure the demands of treading water techniques for people of different experience levels. Three cohorts, comprising 21 adult water treading experts (water polo players), 15 intermediate swimmers and 16 inexperienced swimmers, treaded water for 3 min each using four different techniques while cognitive and energetic economy measures were taken. For inexperienced swimmers, the flutter kick and breaststroke patterns produced the lowest self-reported physical and task load (rating of perceived exertion, NASA task load index), while cognitive (probe reaction time), cardiac (heart rate) and metabolic (oxygen consumption) load did not differ between techniques. In contrast, for expert water treaders, both breaststroke and eggbeater patterns produced lower cognitive, cardiac and metabolic loads. For intermediate swimmers, breaststroke resulted in the lowest cardiac and metabolic loads, as well as self-reported task load. Probe reaction time was highest while performing the eggbeater technique, indicating that this technique was challenging to coordinate and cognitively demanding. While the energetic demands of antiphase kicking patterns (such as eggbeater in experts or flutter kick in beginners) may be similarly low, the symmetric coordination of upright breaststroke may explain why this pattern's cognitive economy was favourable for all groups. As the eggbeater can be challenging to perform for many people, an upright breaststroke technique is an adequate alternative to adopt in survival situations.

Water safety, antifungal-resistant aflatoxigenic aspergillus flavus and other pathogenic fungi in a community hand-dug wells.

AIM: To investigate hand-dug well water used for drinking and domestic purposes in a rural community in Southwest Nigeria for water safety and fungal presence as well as to determine the antifungal resistance and aflatoxigenic potentials of isolated fungi. METHODS AND RESULTS: Water samples were analysed for risk of contamination, bacteriological and mycological parameters using a standard sanitary survey checklist and microbiological culturing. Isolates were identified and subjected to antifungal resistance profiling using the diffusion method for susceptibility testing of filamentous fungi. Multidrug-resistant strains were confirmed with DNA barcoding identification. Fungal isolates were screened for aflatoxigenic potentials by culture methods and confirmed by densitometric analysis. From the 23 hand-dug wells assessed, 56.52% had a high risk of contamination (ROC) score, nitrate >50 mg/L (73.9%), and the presence of total coliforms (100%), Escherichia coli (43.48%) and fungi (91.3%). Spearman rank correlation coefficient gave a positive and strong correlation between Total Fungi and Faecal Coliform (r = 0.701; p = 0.016; n = 23) at 0.05 significance level (2-tailed). Aspergillus sp. (34%), Penicillium sp. (18%) and Rhizopus sp. (17%) were the most dominant fungal genera. Isolates were resistant to fluconazole (76.19%), ketoconazole (73.80%), clotrimazole (92.86%), griseofulvin (88.09%) and nystatin (100%). Penicillium and Aspergillus (50%) were positive for cultural mycotoxin screening. A strain of antifungal-resistant A. flavus produced aflatoxin B1 (752 ppb) and B2 (15 ppb). SIGNIFICANCE OF THE STUDY: The existence of antifungal-resistant and aflatoxigenic fungi in water used for drinking and domestic purposes shows that filamentous fungi constitute greater threats than previously recognized and this call for a paradigm shift from the perceived safety of untreated hand-dug well-water.

The revised European Directive 2020/2184 on the quality of water intended for human consumption. A step forward in risk assessment, consumer safety and informative communication.

Water is an indispensable element for humankind and indeed all living beings; as such it is essential that it be supplied in adherence with safety and security criteria so as to fulfill its primordial role in community development. Therefore, the European Union has issued a new Directive on drinking water, updating the previous one (98/83/EC). The main new features of the updated Directive issued on January 12, 2021 include: • The adoption of a risk-based approach, in accordance with the principles of the Water Safety Plan, along the entire supply chain including the domestic system from the meter to the tap; • The updating of some quality standards, mainly related to the introduction of new parameters and the modification of parameter values for some in a more restrictive sense and for others in more permissive terms; • The identification of possible emerging pollutants present in supply sources (catchment areas); • The demand for effective and transparent communication to citizens on the quality of the water supplied, necessary to foster consumer confidence in the mains water supply. The Directive is the first European legislation adopted following a European Citizens' Initiative (ECI), a European Union participatory democracy tool launched through the "Right2Water" initiative aiming to positively affect the environment. Indeed, the increased consumer confidence in tap water resulting from the desired improvement in communication to citizens should lead to a gradual reduction in the use of plastic water bottles. In addition, the Directive confirms what WHO has been reporting for some time through its Water Safety Plans. It is not limited to monitoring activities but also reproposes and promotes a generalised safety approach based on risk identification and management along the entire drinking water supply chain (from the catchment area to extraction, treatment, storage including distribution). The revised Directive will become the reference standard for the quality of water intended for human consumption in EU countries, and its entry into force will make it possible to minimise the harmful impacts of pollution on human health.

Drowning in the Eastern Mediterranean region: a systematic literature review of the epidemiology, risk factors and strategies for prevention.

INTRODUCTION: Globally, drowning is a significant cause of preventable mortality and morbidity. The Eastern Mediterranean region (EMR) comprises 22 countries of extreme disparity in income and is a region impacted by conflict and migration. We systematically review literature published on drowning in the EMR. METHODS: Peer-reviewed literature (limited to original research) was identified using Embase, PubMed, Scopus, SportsDiscus, and Web of Science databases. Literature was independently dual screened at title/abstract and full text stages with dual data extraction (20% of included studies). Studies were included if they reported epidemiology, risk/protective factors and/or prevention strategies for drowning (unintentional and intentional; fatal and non-fatal) of residents, tourists or migrants in the EMR. Literature was assessed against the [Australian] National Health and Medical Research Council's Levels of Evidence. RESULTS: Seventy-two studies were included in this review (epidemiology 68 studies; risk/protective factor 13 studies; prevention strategies 19 studies). Iran (n = 27), Saudia Arabia (n = 11) and Pakistan (n = 10) recorded the largest number of dedicated studies. Studies predominately focused on unintentional drowning. Ninety-two percent of included studies (n = 66) were ranked as being low evidence (level IV). The majority of studies explored drowning among children and adolescents (0-19 years). All-age fatal drowning rates varied from a low of 0.48 per 100,000 (United Arab Emirates; 2002; Ministry of Health death registry data) to a high of 18.5 per 100,000 (Egypt; 2014-15; WHO mortality database). Commonly identified risk factors included being male, young age, submersion time and resident status. Common prevention strategies public education, lifeguard supervision, and cardiopulmonary resuscitation. DISCUSSION: Gaps in understanding of drowning burden in some countries within the region, as well as region-wide risk factor identification for adult drowning, intentional and migration-related drowning, impair the ability of nations to advance drowning prevention. There is a need for investment in implementation and evaluation of drowning prevention interventions in the EMR. CONCLUSION: Drowning is a significant cause of mortality and morbidity in the EMR. The recent UN declaration on global drowning prevention may provide the impetus to invest in drowning prevention research, policy, and advocacy with the aim of reducing drowning-related harms in the EMR. TRIAL REGISTRATION: Registration number: # CRD42021271215 .

Drowning prevention counselling by paediatricians to educate caregivers on water safety.

AIM: Drowning is the leading cause of unintentional injury death for children 1-4 years of age in the USA. Texas, a southeastern state, is disproportionately burdened by paediatric drowning. The aim of this project was to increase drowning prevention counselling provided during well-child visits to families with children aged 0-10 years. METHODS: We developed and implemented a water safety counselling programme for paediatricians to impart to families during well child, urgent care and ED visits for 0-10 year age group. Physicians completed and self-reported demographic, pre- and post-intervention, counselling rate and project evaluation surveys, while caregivers completed post-intervention surveys only. Both physicians and caregivers were surveyed on evidence-based drowning prevention strategies (four-sided fencing of pools, touch supervision, life jackets and swim/cardio-pulmonary resuscitation classes). RESULTS: Thirty-three physicians and 1934 caregivers participated in the project. Physicians demonstrated statistically significant improvement in discussing drowning prevention with patients (3.5 vs. 4 on Likert scale; P = 0.002) in 2018 versus 2019. The counselling frequency in primary care settings increased from 54% to 70% from year 1 to 2. 100% of physicians correctly identified the best drowning prevention strategy and 80.6% of caregivers reported learning new water safety information in 2019 versus 68.8% in 2018 (P value < 0.001). CONCLUSIONS: This water safety education programme demonstrated increased drowning prevention counselling during well-child visits. The counselling was effective as demonstrated by increased caregiver acquisition of new water safety information. Paediatricians had adequate drowning prevention knowledge; an efficient counselling strategy helped them impart this knowledge to their patients.

Bush Nippers: Evaluating the effectiveness of the Nipper education program in regional inland Victoria, Australia.

ISSUE ADDRESSED: Internationally, inland waterways are identified as leading locations for drowning. 'Nippers' programs provide coastal lifesaving and water safety knowledge and skills to children aged 5-14 years in Australia. However, a 49% increase in Victorian inland waterway drowning compared with the 10-year average, necessitated adapting the Nippers water safety program to inland regions: Bush Nippers. METHODS: Overall, 105 participants from two age groups (under 9 and under 12) were involved across three Bush Nippers programs delivered at river and/or pool locations in regional Victoria, Australia. Surveys and observations assessed participants' water safety knowledge and competencies, and used alongside interviews to obtain program feedback from parents, instructors and communities. Costs were compared to other aquatic programs to determine feasibility of replicating the program. RESULTS: Significant increases in knowledge from pre to immediate posttest were recorded (P < .05) and water competencies were high posttest. Communities were grateful for the regional program delivery and understood the necessity of learning lifesaving skills, particularly in open water environments. Costs were akin to other similar programs indicating program replicability and enhancing likelihood of uptake. CONCLUSIONS: Bush Nippers increased water safety knowledge in children and was well received by the community. Wider uptake of the program is encouraged to diversify aquatic education for regional Victorian children. SO WHAT?: Given the high regard and demand for the program, and importance of learning lifesaving skills, provision of a scalable lifesaving program in inland regions may address the drowning trend and improve aquatic participation.