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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 36  |  Issue : 2  |  Page : 65-68

A retrospective analysis of drowning deaths in Imphal


1 Department of Forensic Medicine and Toxicology, RIMS, Imphal, Manipur, India
2 Department of Forensic Medicine, Zoram Medical College, Falkawn, Mizoram, India

Date of Submission17-Jun-2022
Date of Decision04-Jul-2022
Date of Acceptance23-Jul-2022
Date of Web Publication16-Nov-2022

Correspondence Address:
Dr. Khangembam Pradipkumar Singh
Department of Forensic Medicine and Toxicology, RIMS, Imphal, Manipur
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jms.jms_46_22

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  Abstract 

Background: Drowning is a major cause of death worldwide and it is the third leading cause of unintentional injury deaths accounting for 7% of all injury-related deaths. Different factors are responsible for causing death due to drowning.
Objectives: The objective of this study was to find out the prevalence of death due to drowning in relation to epidemiological factors and to find out postmortem examination findings and manner of death of such cases.
Materials and Methods: A retrospective study of drowning deaths brought to the Department of Forensic Medicine and Toxicology of a tertiary care teaching hospital in Imphal was conducted for 10 years. Data obtained were entered in a pro forma and later analyzed statistically.
Results: In this study period, there were 110 cases of drowning cases. Male: female ratio was 10:1. The highest number of victims was observed in the age group of 21-30 years and the maximum number occurred in rivers, i.e., 54.54%. In 67.27% of the cases, there were signs of asphyxia and in 40% of the cases, froth was present around the mouth and nostrils. Cadaveric spasm which was considered the surest sign of antemortem drowning was observed in only 2.72%. Lungs were found to be voluminous in 77.27% of the cases. Maximum occurred in the rainy season.
Conclusion: The manner of death could not be ascertained in the present study however from history, most of the cases seem to be accidental. Public awareness and water safety measures need to be improved to prevent drowning deaths.

Keywords: Asphyxia, cadaveric spasm, drowning deaths, froth


How to cite this article:
Supriya K, Pabitramala N, Singh KP, James D W, Deepen C. A retrospective analysis of drowning deaths in Imphal. J Med Soc 2022;36:65-8

How to cite this URL:
Supriya K, Pabitramala N, Singh KP, James D W, Deepen C. A retrospective analysis of drowning deaths in Imphal. J Med Soc [serial online] 2022 [cited 2022 Dec 1];36:65-8. Available from: https://www.jmedsoc.org/text.asp?2022/36/2/65/361285




  Introduction Top


Drowning is the third leading cause of unintentional injury deaths accounting for 7% of all injury-related deaths worldwide. The latest WHO (2019) Global Health Estimates indicates that estimated 236,000 people died from drowning.[1] Drowning is a form of asphyxia due to the aspiration of fluid in the air passages caused by submersion in water or other fluid media. Complete submersion is not necessary for submersion of the nose and mouth for a sufficient period can cause death from drowning.[2] A significant number of water-related deaths are attributed to accidental drowning, whereas a smaller but still significant number represents suicidal or homicidal drowning. Death can occur in the ocean or water as shallow as 15 cm in the case of alcoholics, epileptics, or infants. Death is sure to occur even if the face alone is submersed because air is prevented from entering into the respiratory orifices.[3] The present study was undertaken to find out the prevalence of death due to drowning in this part of the country in relation to epidemiological factors such as age, sex, seasonal variation, and type of water and also to find out the external and internal findings during postmortem examination and manner of death of such cases.


  Materials and Methods Top


After obtaining approval from the institutional ethics committee, a 10-year retrospective study was carried out in the Department of Forensic Medicine and Toxicology of a tertiary care teaching hospital in Imphal, on all cases of fatal drowning brought in between January 2010 and December 2019. Detailed information pertaining to epidemiological factors, external and internal findings such as the presence of froth, signs of asphyxia, cadaveric spasm, presence of mud/sand in larynx and trachea, and lung changes were obtained and entered in a predesigned pro forma and data were analyzed using Microsoft Excel 2007.


  Results Top


Out of the 2675 medicolegal autopsies conducted during the study period, 110 (4.1%) victims were drowning cases. The majority of the victims were males (90.9%), the male: female ratio being 10:1 [Figure 1]. In this study, the highest number of victims was observed in the age group of 21-30 years (22.7%), followed by 31–40 years and 41–50 years with an equal incidence of 19.09% as shown in [Table 1]. As depicted in [Table 2], the maximum number of drowning occurred in rivers, i.e., 60 cases (54.54%), followed by drowning in ponds 37 cases (33.63%) and the least number of drowning occurred in the lakes, i.e., 5 cases (4.54%). Almost similar number of incidents were observed during the rainy season (40.90%) and summer months (40%) with slightly more cases in the rainy season and the least being seen in winter months (19.09%) [Figure 2].
Table 1: Age-wise distribution of victims

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Table 2: Distribution of cases based on type of water body

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Figure 1: The sex distribution of the victims

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Figure 2: Seasonal variation

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Most of the cases (67.27%) show signs of asphyxia. In 40% of the cases, froth was present around the mouth and nostrils. Moreover, the cadaveric spasm was found in only 2.72%. Mud/sand particles were seen on the body in 27.27% of cases, whereas 1.81% of cases have mud/sand particles in the fingernails. About 52.72% of the cases also show signs of injury [Table 3].
Table 3: Distribution of cases on external postmortem examination findings

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On internal examination, froth was found in the larynx/trachea in 35.45%, whereas mud/sand/silt in the larynx/trachea was seen in 53.63% of the cases. Lungs were found to be voluminous in 77.27% of the cases. Water was found in the stomach in 62.72%, and in only 10% of cases, there were some injuries [Table 4].
Table 4: Distribution of cases on internal postmortem examination findings

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  Discussion Top


In our present study, out of 2673 medicolegal autopsies conducted during the study period drowning contributed to 110 cases (4.1%) similar to the findings of a study conducted in various districts of Hariyana (Kumar et al.[4]). The male: female ratio in our study was 10:1 which is in accordance with studies done by various Kumar et al. and Chakraborty et al.[4],[5] This can be explained by the greater exposure of the male population to rivers and lakes for fisheries and other economic activities.

The highest number of victims was observed in the age group of 21–30 years (22.72%) similar to the findings observed by Kanchan et al.[6] and Chidanand et al.[7] as this age group is the most active stage in society. Manipur is traversed by major rivers and their tributaries, namely the Imphal River, Nambul River, Iril River, Khuga River, etc., Hence, the higher incidence of drowning in rivers, i.e., 54.54% could be attributed to the fact of several rivers flowing through the state. The second highest incidence of drowning in ponds, i.e., 33.63% could be due to the presence of community ponds in almost all the localities of the state which are used for storing water for household purposes. These findings are comparable with other authors.[2],[6] Rainy season has the maximum number of cases, i.e., 45 cases (40.90%) followed by the summer season in 44 cases (40%). This finding is in concordance with the data reported by Vikram et al.,[8] Pathak et al.,[9] and Mahabalesh[10] where most of the drowning cases happen in the rainy season which can be explained by the fact that most of the rivers and lakes swell up during the rainy season.

As observed in a study conducted by Tanuj and Monterio[11] in our study also signs of asphyxia were seen in most of the cases (67.27%) as asphyxia is the most common mode of death in drowning. In the present study, froth was found in and around the mouth and nostrils in 44 cases (40%) which is in contrast to the study conducted by Sugantha and Parwathi[12] where 22.6% of cases were seen with froth in and around the mouth and nostrils. In this study, cadaveric spasm which is the surest sign of antemortem drowning was seen in only three cases (2.72%).

On internal examination, froth was found in the larynx/trachea in 35.45%, whereas mud/sand/silt in the larynx/trachea was seen in 53.63% of the cases. Lungs were found to be voluminous in 77.27% of the cases. Water was found in the stomach in 62.72% and in only 10% of cases, there were some injuries. This finding is in concordance with the study done by Patel et al.[13]


  Conclusion Top


Drowning is a major cause of death in this part of the country, especially during the rainy season. The manner of death could not be ascertained in the present study as crime scene was not properly investigated however from the history, most of the cases seem to be accidental. Moreover, since alcohol consumption in water recreation activities predisposes to drowning, strict action against alcohol consumption in picnic spots and near water bodies should be initiated. Public awareness and water safety measures need to be improved to prevent drowning deaths.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization, Drowning, 2019. Available from: https://www.who.int/news-room/fact-sheets/details/drowning. [Last accessed on 2022 Feb 18].  Back to cited text no. 1
    
2.
Reddy KS, Murty OP. The Essentials of Forensic Medicine and Toxicology. 33rd ed. New Delhi: Jaypee Brothers (P) Ltd.; 2014. p. 364-75.  Back to cited text no. 2
    
3.
Miller Coyle H, Ladd C, Palmbach T, Lee HC. The green revolution: Botanical contributions to forensics and drug enforcement. Croat Med J 2001;42:340-5.  Back to cited text no. 3
    
4.
Kumar A, Malik Manoj K, Kadrian A, Sangwan SK, Kumar S. Reported drowning cases from various districts of Haryana. N Y Sci J 2015;2:39-44.  Back to cited text no. 4
    
5.
Chakraborty P, Singh PK, Chatterjee A, Bhattacharya P, Das S. Histological changes in lungs and spleen in cases of drowning with demographic variability. European J Biomed Pharm Sci 2015;2:479-85.  Back to cited text no. 5
    
6.
Kanchan T, Rastogi P, Mohanty MK. Profile of drowning victims in a coastal region of Karnataka. J Indian Acad Forensic Med 2007;29:52-4.  Back to cited text no. 6
    
7.
Chidanand C, Satish KV. Study of incidence of middle ear hemorrhages in drowning. J Evid Based Med Healthc 2015;2:626-28.  Back to cited text no. 7
    
8.
Vikram P. Drowning deaths in Manipal. Int J Med Toxicol Legal Med 2010;12:41-3.  Back to cited text no. 8
    
9.
Pathak A, Mangal HM. Decomposition: Cast a shadow over the drowning deaths. J Indian Acad Forensic Med 2009;31:112-7.  Back to cited text no. 9
    
10.
Mahabalesh S. Profile of drowning deaths in Mangalore, a coastal city in Karnataka. Ind Med 2005;5:39-42.  Back to cited text no. 10
    
11.
Tanuj K, Monterio FN. An analysis of drowning in Manipal, South India. Inj Prev 2012;18:A132.  Back to cited text no. 11
    
12.
Sugantha M, Parwathi K. Analysis of death due to drowning: A retrospective study. Int J Contemp Med Res 2019;6:15-9.  Back to cited text no. 12
    
13.
Patel AP, Bhoot RR, Patel DJ, Patel KA. Study of sudden violent asphyxia death. Int J Med Toxicol Forensic Med 2013;3:48-57.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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Abstract
Introduction
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