Uncovering variations in drowning mortality in Fiji between Indigenous iTaukei and Fijians of Indian descent during 2016-2022: a national retrospective population-based study.

Background: The prevention of drowning, a leading cause of injury-related mortality and morbidity, benefits from epidemiological identification of at-risk demographics and incident factors. Empirical data are vital for this purpose, yet no studies have utilised such data in Fiji in the past decade. Methods: Using unit record mortality data from Fiji's Ministry of Health and Medical Services (medical certificates of cause of death) and the Fiji Police Force (forensic pathology autopsy reports), a national retrospective population-based analysis of unintentional drowning in Fiji during the period 2016-2022 was conducted. Analysis comprised drowning rates by sex, ethnicity, age group, location of drowning and seasonality. Results: During the period 2016-2022, the unintentional drowning mortality rate for Fiji (per 100 000 population) was 5.9 (95% CI 5.3 to 6.5), with a higher rate in males at 9.3 (8.2 to 10.4) compared with females at 2.4 (1.8 to 2.9). Drowning risk differentials were identified by ethnicity, with a higher rate among iTaukei males at 10.5 (9.1 to 12.0) compared with male Fijians of Indian descent at 5.9 (4.4 to 7.4); and among iTaukei females at 3.2 (2.4 to 4.0) compared with female Fijians of Indian descent at 0.6 (0.2 to 1.3). Data collection systems in Fiji need improvement as prior to data cleaning, all accidental drowning records were coded to 'unspecified accidental drowning and submersion', which provides limited insight into causal factors and hinders the design of targeted prevention interventions. Conclusion: Ethnic differences in drowning risk profile must be measured and monitored in Fiji, with further research needed to determine how water exposure and usage patterns differ by ethnic group. Furthermore, data improvements are vital in Fiji to ensure all drowning deaths are identified and coded correctly.