Outcomes of pediatric drowning in the Middle Eastern and North African population: a systematic review and meta-analysis

Drowning is a major global public health concern and one of the leading causes of unintentional injury-related mortality among infants, children, and adolescents. According to the World Health Organization, over 90% of unintentional drowning deaths occur in low- and middle-income countries, with young children bearing a disproportionate burden of both fatal and non-fatal submersion events. The Middle East and North Africa (MENA) region represents a unique socio-cultural, economic, and geographical landscape characterized by vast disparities in country-level income, rapid urban development, extensive coastlines, and distinct water exposure risks such as residential pools, open agricultural reservoirs, wells, and coastal tourism sites. Despite this, existing evidence on pediatric drowning in the MENA region remains fragmented across sub-national registries, hospital-based studies, and regional reports. A rigorous synthesis of pooled empirical evidence is prudent to quantify the epidemiological burden, identify key risk and prognostic factors, and inform context-specific prevention strategies. The primary purpose of this project is to conduct a systematic review and meta-analysis to synthesize the existing literature on pediatric drowning across countries in the MENA region. Specifically, this study aims to estimate pooled mortality and incidence rates, examine demographic distributions across age subgroups and sex, and synthesize environmental, socio-demographic, and clinical predictors of pediatric drowning outcomes. Key variables of interest include submersion duration, location of incident, presence of adult supervision, pre-hospital resuscitation, and intensive care admission. Furthermore, the review will quantify clinical outcomes including the proportions of fatal versus non-fatal drownings, emergency department presentations, pediatric intensive care unit (PICU) admissions, and neurological morbidities among survivors. This project adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The targeted population encompasses pediatric populations aged 0 to 19 years in MENA countries. Exposure is defined as involuntary immersion or submersion in liquid resulting in fatal or non-fatal drowning, excluding intentional self-harm or homicide. Included study designs cover observational studies, surveillance reports, national registry analyses, and emergency department or PICU case series. Literature searches will span major databases including PubMed/MEDLINE, Scopus, and Web of Science. Where statistical heterogeneity permits, random-effects meta-analyses will be conducted to pool prevalence and incidence rates, alongside subgroup analyses based on age, gender, geographic region, and World Bank income classification. Expected outcomes of this study include establishing a unified, quantitative evidence base of pediatric drowning epidemiology across the MENA region to replace scattered regional estimates with robust pooled effect sizes. The study will provide clear identification of vulnerable age brackets, environmental hazards, and seasonal trends specific to MENA countries. Ultimately, these findings will offer evidence-based insights to support regional policymakers, public health authorities, and trauma registries in designing targeted drowning prevention frameworks, while establishing a strategic research roadmap to guide future epidemiological studies in the region.