Drowning in Aboriginal and Torres Strait Islander children and adolescents in Queensland (Australia).
BACKGROUND
Aboriginal and Torres Strait Islander (Indigenous) children are at greater risk of drowning than other children, however little is known about drowning of Indigenous children. This study identifies the previously unpublished incidence and characteristics of fatal and non-fatal drowning in Indigenous children and adolescents.


METHODS
Retrospective data (Jan 2002-Dec 2008) on fatal and non-fatal drowning events among Indigenous and Non-Indigenous Queensland residents aged 0-19 years were obtained from multiple sources across the continuum of care (pre-hospital; emergency department; admitted patients; fatality) and manually linked. Crude incidence rates for fatal and non-fatal events were calculated using population data from the Australian Bureau of Statistics.


RESULTS
There were 87 (6.7 % of all events) fatal and non-fatal (combined) Indigenous drowning events yielding a crude Incidence Rate of 16.8/100,000/annum. This is 44 % higher than the incidence rate for Non-Indigenous children. For every fatality, nine others were rescued and sought medical treatment (average 12 per year). There were no significant changes in Indigenous drowning incidents over the study period. Drowning rates were higher for Indigenous females than males. Overall incidence was higher among Indigenous children and adolescents than Non-Indigenous children for every calendar year and age-group (0-4 years; 5-9 years; 10-14 years) except those aged 15-19 years where no drowning events were recorded for males. Location of drowning sites was similar in both populations 0-19 years, however there were slight differences in frequency at each of the locations. The three leading drowning locations for Indigenous 0-19 years olds were pool (48 %), bath (21 %) and natural water (16 %), and for non-Indigenous 0-19 years the leading locations were pool (66 %), natural water (13 %) and bath (12 %) (p < .01). Except for pool drowning, Indigenous drowning occurred more often in geographic areas of relative disadvantage. Among Indigenous children drowning location varied with age (p < .001). Most frequent locations by age were: <1 year bath (71 %); 1-4 years pools (80 %); 5-9 years pools (75 %) and 10-19 years beach/ocean (36 %). Severity of event differed statistically with Indigenous status and by remoteness with all fatal drowning events occurring in Regional or Remote areas, and none in Major Cities.


CONCLUSIONS
For every fatal drowning among Indigenous children in Queensland aged 0-19 years there are nine non-fatal events. This previously unreported survival ratio of 9:1 indicates the non-fatal injury burden in Indigenous children aged 0-19 years. Although higher Indigenous drowning rates prevailed, no significant changes over time are concerning. Equally the apparent over-representation of Indigenous adolescent females should be weighed against the absence of drowning among Indigenous male adolescents in the same age group in consecutive years of the study. Further investigation around behaviour and culture may highlight protective factors. Culturally specific prevention strategies which take into account social and demographic indicators identified in this study should be delivered to carers and peers of vulnerable age groups who frequent specific locations. Females, swimming ability, supervision and the young are areas which need to be incorporated into Indigenous-specific interventions for drowning prevention.
Queensland Children's Medical Research Institute, Brisbane, Australia. Belinda.Wallis@uqconnect.edu.au.|University of Queensland, Brisbane, Australia. Belinda.Wallis@uqconnect.edu.au.|Royal Children's Hospital, Brisbane, Australia. Belinda.Wallis@uqconnect.edu.au.
Belinda A
BA
Wallis
Queensland Children's Medical Research Institute, Brisbane, Australia. Kerrianne.Watt@jcu.edu.au.|University of Queensland, Brisbane, Australia. Kerrianne.Watt@jcu.edu.au.|College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia. Kerrianne.Watt@jcu.edu.au.
Kerrianne
K
Watt
College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia. Richard.Franklin@jcu.edu.au.|Royal Life Saving Society Australia, Sydney, Australia. Richard.Franklin@jcu.edu.au.
Richard C
RC
Franklin
Queensland Children's Medical Research Institute, Brisbane, Australia. Royk@uq.edu.au.|University of Queensland, Brisbane, Australia. Royk@uq.edu.au.|Royal Children's Hospital, Brisbane, Australia. Royk@uq.edu.au.
Roy M
RM
Kimble
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000706:statistics & numerical data; D004332:Drowning / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D006303:Health Services, Indigenous / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D011159:Population Surveillance; D011793:Queensland / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D000095283:Australian Aboriginal and Torres Strait Islander Peoples