Pool fencing for preventing drowning of children: Cochrane systematic review

Abstract

Assessed as up to date: 2006/10/11

Background

In most industrialized countries, drowning ranks second or third behind motor vehicles and fires as a cause of unintentional injury deaths to children under the age of 15. Death rates from drowning are highest in children less than five years old. Pool fencing is a passive environmental intervention designed to reduce unintended access to swimming pools and thus prevent drowning in the preschool age group. Because of the magnitude of the problem and the potential effectiveness of fencing, we decided to evaluate the effect of pool fencing as a drowning prevention strategy for young children.

Objectives

To determine if pool fencing prevents drowning in children (under 14 years of age).

Search strategy

We searched the Cochrane Injuries Group's Specialised Register, CENTRAL, MEDLINE, EMBASE, National Research Register, Zetoc and other specialist databases. We searched reference lists of relevant articles and contacted relevant organisations and experts. The searches were last updated in October 2006.

Selection criteria

In order to be selected, a study had to be designed to evaluate pool fencing in a defined population and provide relevant and interpretable data that objectively measured the risk of drowning or near-drowning or provided rates of these outcomes in fenced and unfenced pools.

Data collection and analysis

Data were extracted by two authors using a standard abstract form. Odds ratios (OR) with 95% confidence intervals (CI), and incidence rates, were calculated for drowning and near-drowning.

Main results

Three case-control studies met the selection criteria. The results of these studies indicate that pool fencing significantly reduces the risk of drowning. The OR for the risk of drowning or near drowning in a fenced pool compared to an unfenced pool is 0.27 (95% CI 0.16 to 0.47). Isolation fencing (enclosing pool only) is superior to perimeter fencing (enclosing property and pool); the OR for the risk of drowning in a pool with isolation fencing compared to a pool with three-sided fencing is 0.17 (95% CI 0.07 to 0.44).

Authors' conclusions

Pool fences should have a dynamic and secure gate and should isolate the pool from the house (that is, four-sided fencing). Legislation should require isolation fencing with secure, self-latching gates for all pools, public, semi-public and private. Legislation should require fencing of both newly constructed and existing pools and include enforcement provisions, in order to be effective.

Author(s)

Thompson Diane C, Rivara Fred

Summary

Fencing which completely encloses all sides of a swimming pool and isolates it from the home is effective in preventing drowning of young children

In most industrialized countries, drowning is one of the top killers of children, especially young children. Medical care offers little to help drowning victims, and thus survival must rely on prevention of the drowning. The review found no trials of pool fencing. However evidence from other studies found that pool fencing that adequately prevents children reaching the pool unsupervised can prevent about three-quarters of all child drownings in pools. Fencing which completely encircles the pool and isolates it from the house is much more effective than methods where children can still gain access to the pool through the house.

Reviewer's Conclusions

Implications for practice

Isolation fencing with dynamic self-latching gates is an effective environmental intervention that reduces unintended access to pools and reduces the risk of drowning for preschool children. Legislation accompanied by educational campaigns should be implemented for all public, semi- private and private swimming pools. Legislation should require fencing of both newly constructed and existing pools and include enforcement provisions, in order to be effective.

Implications for research

Additional case-control studies are needed to provide a more precise estimate of the protective effect of fencing. The study design should use pools as the unit of analysis. Pools in which a young child drowns would be considered cases and other pools where no drowning occurred would be considered controls. Information would be collected on exposure to pools for children of various ages in the case and control groups. This would allow for controlling for the degree to which each pool is exposed to a young child in the home on the owner's property.

Studies examining fencing enforcement might allude to better fencing legislation. Specifically, a study comparing types of fencing legislation and their policies (fines, periodic inspections etc) would be important in determining the most effective and practical means of enforcement for a given community. Updating and maintenance of existing databases of drownings, near-drownings, number of private and public pools, fencing types, and regulations is the most important element in ascertaining the effectiveness of, not only fencing type, but also any other intervention.

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