Introduction
Drowning is the third leading cause of unintentional death worldwide. In many developed countries, it is the second leading cause of death in children under 15 years of age, following traffic accidents. The incidence of drowning in children varies across countries. Previous studies have shown that most fatal drownings occur in low- and middle-income countries.  In Iran, the annual incidence of drowning deaths in children under 15 years of age is 6.12 per 100000 population, although this may be underestimated. The common locations of drowning vary by age. In children under one year of age, home swimming pools, especially bathtubs, are common sites, while in adolescents aged 15-19, natural waters such as streams, rivers, and lakes are more frequent locations for drowning. Drowning occurs most frequently on weekends and in the summertime months. The aim of this study is to determine the regional burden of child drowning in Guilan Province, Iran, that occurred during 2017-2021.

Methods
This descriptive and retrospective study was conducted using the data obtained from the national drowning registration system. The data of children under 15 years of age who experienced drowning events (fatal and non-fatal) were extracted using a checklist and analyzed using the autoregressive moving average (ARMA) time series model. Fatal drowning data was collected from the death certificates, local police stations, and hospitals. Non-fatal drowning data were obtained from the emergency medical services (EMS) center, the Red Crescent Society, the municipality, fire departments, and the Lifesaving Society.

Results
In this study, data from 106 children who experienced drowning events during the study period were analyzed. In terms of gender, 71 were boys (67%) and 35 were girls (30%). The majority was in the age group of 11-15 years (54.7%), followed by age groups of 6-10 (27.3%) and <5 (18%) years. Regarding the drowning location, the most prevalent site was the sea (66%), followed by rivers (11.3%). Out of 106 drowning cases, 51 (48.1%) were treated by the EMS, 34 (32%) by the Red Crescent Society, 20 (19%) by the Legal Medicine Organization, and only one case by the fire departments. Also, most of drowning accidents occurred in the summertime months (July, July, and August), while the least occurred in the wintertime months (December, January, and February). Regarding the time of drowning incidents, the highest number of incidents occurred from 12:00 to 20:00 (56.6%), followed by 20:00 to 8:00 ( 32.1%) and 8:00 to 12:00 (11.3%). During the five years of study, 63 (59.5%) children died due to drowning, of whom 39 died at the scene. Analysis of the data using the ARMA model plotted in Figure 1 for drowning incidents in children under 15 years revealed a slow decrease in the number of drowning deaths during the study period.



Conclusion
There were 106 drowning cases among children in Guilan Province, Iran, during 2017-2021, including 67% boys and 33% girls, mostly aged 11-15 years (54.7%). Most drowning accidents occurred in the sea (66%) and rivers (11.3%). This highlights the importance of increasing the number of lifeguards on beaches and providing continuous training to them. Additionally, developing pre-hospital emergency centers and Red Crescent facilities on beaches and in natural aquatic environments is essential in Guilan province. The time-series analysis indicated that the number of drowning deaths in children had a downward trend from 2017 to 2021. This suggests that the COVID-19 pandemic did not affect the death trend. 

Ethical Considerations

Compliance with ethical guidelines
This study was approved by the Ethics Committee of Guilan University of Medical Sciences, Rasht, Iran (Code: IR.GUMS.REC.1401.278).

Funding
This study was financially supported by the Guilan University of Medical Sciences, Rasht, Iran.

Authors contributions
Conceptualization, methodology, editing & review, and validation: Ali Davoudi Kiakalayeh and Nazanin Noori Roodsari; Data collection and data analysis: Ali Davoudi Kiakalayeh, Mohammad Javad Taromi, and Leila Kouchakinejad; Drafting of the manuscript: Ali Davoudi Kiakalayeh and Sajad Davoudi Kiakalayeh; visualization and supervision: Enayatollah Homaie Rad and Sajad Davoudi Kiakalayeh; Funding acquisition, and project management: Ali Davoudi Kiakalayeh and Leila Kouchakinejad.

Conflicts of interest
The authors declare no conflict of interest.

Acknowledgments
The authors would like to thank the staff of the Guilan Red Crescent Society, the National Emergency Medical Organization, and the Legal Medicine Organization for their assistance, and the Vice-Chancellor for Research and Technology of Guilan University of Medical Sciences for the financial support.



 

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