Table 3_Basic swimming or water safety skills training for drowning prevention in children: an updated systematic review.docx

BackgroundChild drownings constitute a major cause of mortality from unintentional injury worldwide. In 2021, the WHO issued a strong recommendation in favour of basic swimming skills and water safety training in children to prevent drowning. The systematic review conducted in support of this guideline, however, revealed evidence of overall very low certainty and illustrated a number of research gaps. Here, the evidence from this systematic review was updated.
MethodsFive scientific databases (PubMed, Embase, The Cochrane Library, Web of Science, ERIC) and two clinical trial registers (clinicaltrails.gov, WHO ICTRP) were searched for controlled experimental and observational studies. Interventions delivering basic swimming skills or water safety in children under the age of 18 years were included. Outcomes of interest included drowning-related mortality and morbidity, and water safety skills, knowledge and behaviour. Certainty of the evidence was appraised using the GRADE methodology.
ResultsA total of 33 studies were included, of which 21 were previously included in the original review and 12 were newly identified in the current update. Studies delivered either basic swimming skills (18 studies), isolated water safety training (6 studies), water safety training as part of an injury prevention programme (5 studies) or an intervention combining swimming and water safety (4 studies). Certainty of the evidence ranged from high to very low.
ConclusionSwim training may reduce drowning-related mortality and increase water safety skills in children. The used pedagogical approach (focus on familiarization and motor awareness), mode of delivery (using video-taped feedback) and setting (shallow water) may be determining factors for swimming skills acquisition. Water safety training is effective to enhance knowledge of and safe behaviour in/around water, and may reduce drowning mortality. These results, highlighting the importance of promoting swimming and water safety skills from an early age onward, could inform public health strategies and guide the development of sustainable interventions in communities at high risk of drowning.
Systematic review registrationPROSPERO registration CRD42020167437; https://www.crd.york.ac.uk/PROSPERO/view/CRD42020167437.

背景 儿童溺水是全球范围内非故意伤害致死的主要原因之一。2021年，世界卫生组织（WHO）发布强力推荐意见，支持为18岁以下儿童提供基础游泳技能与水上安全培训以预防溺水。然而，为支撑该指南所开展的原始系统综述显示，整体证据质量极低，同时揭示了多项研究空白。本研究对该系统综述的证据进行了更新。

方法 本研究检索了5个科学数据库（PubMed、Embase、The Cochrane Library、Web of Science、ERIC）以及2个临床试验注册库（clinicaltrials.gov、WHO ICTRP），纳入对照实验与观察性研究。纳入的干预措施为针对18岁以下儿童开展的基础游泳技能培训或水上安全培训。本研究关注的结局指标包括溺水相关死亡率、发病率，以及儿童的水上安全技能、知识与行为表现。证据质量采用分级推荐、评估、发展与评价（GRADE）方法进行评估。

结果 本研究共纳入33项研究，其中21项为原始综述已纳入的研究，12项为本次更新中新检索到的研究。纳入的干预措施可分为四类：基础游泳技能培训（18项研究）、单独水上安全培训（6项研究）、作为伤害预防项目组成部分的水上安全培训（5项研究），以及结合游泳与水上安全的综合干预（4项研究）。证据质量从高到极低不等。

结论 游泳培训可降低儿童溺水相关死亡率，并提升其水上安全技能水平。研究所采用的教学方法（侧重熟悉化训练与运动感知）、授课方式（使用录像反馈）以及训练环境（浅水区），可能是影响儿童掌握游泳技能的关键决定因素。水上安全培训可有效提升儿童对水上安全知识的掌握程度与水中及周边的安全行为表现，并可能降低溺水死亡率。本研究结果凸显了从儿童早期起推广游泳与水上安全技能的重要性，可为公共卫生策略制定提供参考，并指导溺水高风险社区制定可持续的干预措施。

系统综述注册 本研究已在PROSPERO平台完成注册，注册编号为CRD42020167437，访问网址：https://www.crd.york.ac.uk/PROSPERO/view/CRD42020167437。