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Drowning deaths in a desert area following unusually heavy rains

In desert areas, surface water for recreation is scarce, but when it is available, local residents find it very attractive. When a newspaper reported a problem with drowning deaths in the Jizan region, southwestern Saudi Arabia (KSA), we began an investigation to determine the extent of and factors contributing to drowning deaths (DDs). A case-control study was conducted. Odds ratio (OR) was used to identify risk factors contributing to drowning, 95% confidence intervals (95%CI) were calculated and a P-value of 0.05 was considered statistically significant. During a 6-month period, from May to October, 1998, 38 DDs occurred in Jizan, including 24 (3.7 per 100,000) among documented persons (those having identification papers) and 14 among undocumented persons (those having no known relatives or companions and coming from a population of unknown size).
DDs occurred throughout the 6-month period but peaked in August. The 38 DDs can be described as 21 incidents involving from 1 to 5 persons. These incidents clustered on 17 days at 6 intermittent watercourses (Figure 1). Moreover, 21 DDs occurred on pairs or triplets of consecutive days.
Interviews with the family members and companions of the victims of 24 DDs (12 incidents) indicated that the drowning occurred after the flow from flash floods had stopped or greatly diminished. DDs in undocumented persons were most likely to occur on a Friday (5 of 9 incidents) than on other days of the week. In contrast, DDs in documented persons had a broader peak, from Friday through Sunday. Out of 12 DDs in undocumented persons, eight (61.5%) occurred on the same day as DDs among documented persons and four occurred on different days (33.3%). The greatest number of deaths (41%) occurred on August 16, with a mean rainfall of 95 mm. All 24 DDs in documented persons occurred during daylight hours. Most of those who drowned, 20 (83%) lived in various rural areas while four (17%) lived in urban areas of two cities in the region. The distance from the home village to the scene of the drowning incident was less than 700 m in 14 cases (58.3%) and more than 2 km in 10 cases (41.7%). The median age of the victims was 16 (range 8 to 55) and only two were female. Age/sex-specific mortality rates were highest, 14 (6.8%) among children more than 5 years of age. The highest drowning rate, 13 (12.5%) was for males more than 5 years of age.
Seventeen (70.8%) of the victims drowned with their relatives or immediate family members present and seven (29.2%) drowned alone. Twenty-one DDs occurred during recreational activities. These included 10 victims who were either swimming or wading and who fell into a hidden excavation in the watercourse and 11 were their would-be rescuers. In the other incident, a child fell into a small reservoir created by an earthen irrigation dam. He was on the dam when the earth below gave way. His two brothers also drowned trying to rescue him. This was the first visit to the wadi for seven victims (35%) and the first time alone for three victims (15%). Two (10%) had not been to a wadi for a long time, and eight (40%) went only during yearly floods. People who go to the wadis during floods frequently have a higher risk than others, (OR = 6.2, P<0.05).

Editorial note:

In KSA, rainwater is generally scarce; therefore, wherever it becomes available many people are unaware of its damaging effects. The present study has revealed that at least 38 deaths due to flash floods were recorded in the Jizan region within a 6-month period. The majority of the deaths occurred in the villages and small towns along the base of the foothills. Drowning rates are highest in rural areas [1]. In our study, males constituted over 92 % of the fatalities. The pattern of deaths may be attributable to the sociocultural lifestyle in KSA, where males are independently involved in most of the outdoor recreational activities. Therefore, risk factors include sex; boys under 20 years of age are 3 times more likely to drown than girls [2, 3]. Half of the documented victims were under 15 years of age. Most of the documented DDs happened during the school vacation.
Drowning is an important and potentially preventable cause of death in this desert area. Deaths from drowning should not be this high in a desert area where the height of rainfall even in the peak month of August, is below 100 mm. For example, the incidences of drowning in New Jersey, a coastal state in the United States, is approximately half the national incidence of 2.5 fatalities per 100,000 people per year [1].
Barriers or warning signs need to be placed around excavations and small irrigation dams before the rainy season. Education in prevention is the most effective method for reducing the incidences of drowning [4,5]. Information about flood hazards must be disseminated rapidly and widely to groups at increased risk for injury [6]. Surveillance of flood-related mortality should be initiated in order to monitor the circumstances of death.
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  2. Ellis AA, Trent RB. Hospitalizations for near drowning in California: incidence and costs. Am J Public Health. 1995;85(8):115-8.
  3. Bener A, Al-Salman KM, Pugh RN. Injury mortality and morbidity among children in the United Arab Emirates. Eur J Epidemiol. 1998;14(2):175-8.
  4. Centers for Disease Control. Health assessment of the population affected by flood conditions-Khartoum, Sudan. MMWR. 1989;73(51&52):785-8.
  5. Centers for Disease Control. Fatal injuries to children-United States 1986. MMWR. 1990;93(26):442-51.
  6. Centers for Disease Control. Flood-related mortality-Missouri, 1993. MMWR. 1993; 42(48):941-3.