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