Post on 11-Jan-2017
Drowning – a neglected but preventable public health issue
Aminur Rahmanaminur@ciprb.org
Centre for Injury Prevention and Research, Bangladesh
Objectives of the presentation
• Burden of drowning in HICs and LMICs• Reasons for high drowning in LMICs• Long term reduction of drowning in HICs• Status of drowning prevention in LMICs• Success and challenges in child drowning prevention
in Bangladesh – an example• Conclusion
Proportion of fatal-drowning by WHO region and income level
WHO estimates -Global annual drowning deaths: 372,000 90% in LMICs
Africa Americas EM Europe SEA WPHICs LMICs regions
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
9.3
20.3
4.77.9
3.0
34.9
19.7
Perc
ent
WHO, 2014
Africa Americas EM Europe SEA WPHICs LMICs regions
0
2
4
6
8
10
12
3.8
10.8
5.1
6.4 6.6
9.8
5.6
Estimated fatal drowning rate by WHO region and income level
Rate
/100
000
pop
ulati
on
Estimated fatal drowning rate by WHO region and income level
WHO, 2014
Drowning rates in LMICs is 3 times higher than HICs
Vulnerable age for drowning
HICs Africa Americas EM Europe SEA WP0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
1.8
12.0
4.1
13.7
7.8
13.2
9.1
Estimated fatal drowning rate by WHO region, income level and age
1-59m 5-9yrs 10-14yrs 15-24yrs 25-44yrs 45yrs+
Rate
/100
,000
WHO, 2014
Globally, >50% drowning death among under 25 yearsDrowning mortality is highest in children 1-4 yrs
Why drowning is high in LMICs?
• Limited or no access to piped water• Use natural open water bodies for daily household
chores• Lack of barriers or signs around water hazards• Travelling and working on or near water• Water related disaster • Limited assistance for rescue and resuscitation
Long term reduction of drowning in HICs
Why reduction?-Reduced exposure to open water-Safety standards-Legislations-Policies
Status of drowning prevention in LMICs
• HICs prevention measures not appropriate for LMICs• Needs context specific measures• Lack of data• Limited research on prevention • Not in the national priority agenda • Lack of or poor enforcement of legislation• Lack of national drowning prevention plan
Recent developments in drowning prevention in LMICs
• Changes are observed• Context specific interventions identified• Proven effective• Potential for scale-up nationally and in similar
settings• Bangladesh is an example
Land of Rivers
The Ganges
The Brahmaputra
The Meghna
Wide exposure to water bodies
Leading killers of Bangladeshi U 18 children
05
101520
2530
Drowning
Pneumonia
Malnutrition
Diarrhoea
Meningitis
Transport Injuries
Diarr + Pneu
Suicide
Animal bite
Chicken pox
Septicemia
Rate
per
100
,000
18,000 children under 18 die annually (BHIS, 2005)
0102030405060708090
100
Infant 1-4 5-9 10 – 14 15 – 17 1 - 17
Rate
per
100
,000
0
20
40
60
80
100
120
140
160
180
200
Infant 1 yr 2 yrs 3 yrs 4 yrs 5 yrs 6 yrs 7 yrs 8 yrs 9 yrs 10 yrs 11 yrs 12 yrs 13 yrs 14 yrs 15 yrs 16 yrs
Dro
wni
ng ra
te p
er 1
00,0
00
0
10
20
30
40
50
60
70
80
90
100
Perc
ent a
ble
to s
wim
Drowning death rates Swimming ability
> 5 = teach to swim
Swimming
abilit
y
< 5 = supervise
0
20
40
60
80
100
120
140
160
180
200
Infant 1 yr 2 yrs 3 yrs 4 yrs 5 yrs 6 yrs 7 yrs 8 yrs 9 yrs 10 yrs 11 yrs 12 yrs 13 yrs 14 yrs 15 yrs 16 yrs
Dro
wni
ng ra
te p
er 1
00,0
00
0
10
20
30
40
50
60
70
80
90
100
Perc
ent a
ble
to s
wim
Drowning death rates Swimming ability
> 5 = teach to swim
Swimming
abilit
y
< 5 = supervise<5 = supervision > 4 = swimming
Fundamental strategies for drowning prevention
PRECISE: Prevention of Child Injuries through Social-intervention and Education (2006-10)
Effective and cost-effective interventions
Anchal (Community Crèche)>80% protective
SwimSafe>90% protective
Rahman F, Bose S, Linnan M, Rahman A, Mashreky S, Haaland B, Finkelstein E. (2012) Cost-Effectiveness of an Injury and Drowning Prevention Program in Bangladesh. Pediatrics. 130: i1621-i1628
Why: Institutional supervision When: Vulnerable time Whom: Vulnerable age group Where: care-giver’s house Who: Trained care-giver & her
assistant Supervision ECD stimulation
Cost
Anchal: Community crèche
PRECISE: 640 Anchals 16,500 children supervised
Implementation research: Saving of Lives from Drowning (SoLiD) in Bangladesh
Anchal 3000 Anchals; 65,500 Children
Bangladesh Anchal and SwimSafe (BASS) : Making Anchals more cost-efficient
Assessing physical development
• Supervision and ECD• Physical development• Mental and social development• Disability screening• Health issues
SwimSafeBasic Swimming + Rescue
Community Swimming Centre
Training of CSIs
Children learning to swim Children learning rescue technique
500,000 children learnt swimming during 2006-2015
SwimSafe
Feasibility of First Responder Programme in Rural Bangladesh
Adolescents and adults
50556065707580859095
100
Mal
e
Fem
ale*
Mal
e
Fem
ale*
Mal
e
Fem
ale*
Mal
e
Fem
ale
Mal
e
Fem
ale
Adolescent school
attendees
Adolescent non-school attendees
Community leaders
Community volunteers
All participants
Prec
ent p
ass
Participants
Drop-out
Fail
Pass
Distribution of participants by category, sex and assessment result
Rahman A, et al. Feasibility of a first responder programme in rural Bangladesh. Resuscitation (2014), http://dx.doi.org/10.1016/j.resuscitation.2014.04.022
Teaching CPR to Children 7-9 yrs
Feasibility of First Responder Programme for younger children in Rural Bangladesh
Distribution of 7-9 yr CPR participants by category, sex and assessment result
Boys Girls Boys Girls Boys Girls Boys Girls7 years 8 years 9 years All ages
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
87.6 84.1 82.4 82.1 83.675.7
84.4 80.5
Pass Fail Drop out
Age of children
Perc
ent
Success in child drowning prevention in Bangladesh
• The research identified cost-effective interventions• Bangladesh government recognized child drowning is a
major child health issue• Drowning data collection has been incorporated into
national Management Information System (MIS)• The government has established a target of
eliminating child drowning as a leading cause of death by 2035
• Bangladesh government has started drafting a national drowning prevention plan
Challenges in child drowning prevention in Bangladesh
• National plan not yet developed• Identifying lead agency• Coordinating multiple sectors• Funding
Conclusion
– Drowning is preventable in LMICs – Proven interventions could be implemented in
LMICs considering the country context– Research should continue– System should be introduced to collect national
drowning data– National Drowning Prevention Plan for all
countries – RNLI assisting – Global partnership should be strengthened
THANK YOU