Drowning, although a relatively neglected cause of death, is a major global killer, particularly among children and young adults. According to the World Health Organization (WHO) in 2017, annually, over 360,000 people die from drowning, 90% of them occurring in low and middle income countries. Alarmingly, it is the third major cause of death worldwide for children of ages 5-14, even higher deaths than from congenital anomalies, leukemia, lower respiratory infections, epilepsy, dengue and meningitis.
Globally, the highest drowning rates are among children aged 1-4 years, followed by children aged 5-9 years. WHO (2014) revealed that, worldwide, males are twice as likely to drown as females. Drowning deaths are preventable by undertaking programs and policies that address known risk factors. However, this is still nascent in many developing countries including Bangladesh.
According to Bangladesh's first Health and Injury Survey (BHIS) 2003, drowning was identified as the highest cause of deaths in children aged 1–17 years, higher than victims from pneumonia, malnutrition and diarrhea combined. The second BHIS survey, conducted in 2016, suggested that every year approximately 14,438 children (0-17 years) died from drowning, causing 43 per day. For young children all water sources, whether in a bucket, bathtub, pond, or pool, contain potential for drowning.
A study led by Hossain et al (2022) suggested that 80% of drowning among children below five years occurred in ponds within 20m of the family home, followed by ditches and water containers, in Bangladesh. A tragic aspect of a drowning tragedy was a child attempting to rescue another in an incident resulting in both children losing their lives.
This event indicates that children are not effectively taught water safety, discernment and rescue skills. Global summary report by WHO (2017) includes six major reasons for drowning deaths: (1) Lack of physical barriers between people and water, particularly close to home; (2) lack of (or inadequate)supervision of young children; (3) uncovered or unprotected water supplies and lack of safe water crossings; (4) lack of water safety awareness and risky behaviour around water, such as swimming alone; (5) travelling on water, especially on overcrowded or poorly maintained vessels; (6) flood disasters, whether from extreme rainfall, storm surges, tsunamis, or cyclones.
Childcare centre
Playpen
Community awareness
CPR training
There is often much difference between what individuals and communities believe about their child protection. Below are a list of myths and facts to that end:
Myth: “It can't happen to me. I'm a good parent”
Fact: All parents whose children have drowned felt this way. No one believes a drowning could happen to their child or the children under their care. Without layers of protection, no child is safe from the tragedy of drowning
Myth: “Elder siblings are taking care of my child. Many people are there around me”
Fact: Many children died whilst being taken care of by their older siblings. Children died in rural Bangladesh even living with many houses and people together. You are the main responsible person for your child
Myth: “My child is safe because he's had swimming lessons”
Fact: When a child falls into water bodies alone, he may not behave the same way he does in a swimming lesson because no one is there to cue him to swim or behave in a certain manner
Myth: “My child is safe because he's inside the house with me”
Fact: Don't assume your child is safe because you last saw him napping or playing. Toddlers move fast. Unless the child is within your direct sight, there is the possibility that he is in the water
Myth: “I'll hear my child if he's in trouble”
Fact: Drowning is a silent event. Drowning children don't splash, cry, or call out for help. Kids drown without a sound
he WHO (2017) outlined six interventions to prevent child drownings which might traditionally have already been taken by individual, family, community, local and national governments: (1) Providing safe places away from water for pre-school children; (2) installing barriers controlling access to water; (3) child swimming and water safety skills; (4) building resilience and manage flood risks and other hazards; (5) train bystanders in safe rescue and resuscitation; and (6) setting and enforcing safe boating, shipping, and ferry regulations.
To be successful in implementing these interventions, WHO promulgates four strategies for drowning prevention that include: (1) Promoting multi-sectoral collaboration; (2) strengthening public awareness of drowning through strategic communications; (3) establishing a national water safety plan; (4) advancing drowning prevention through data collection and well-designed studies.
From these interventions and strategies, community-based items include: (1) Strengthening public awareness of drowning and highlighting the vulnerability of children, (2) teaching school-age children basic swimming skills, water safety, and rescue skills, and (3) training bystanders in safe rescue and resuscitation. WHO (2017) emphasized on social marketing and media training for journalists on the public health aspects of drowning greatly increase the reach and effectiveness of public awareness efforts.
The WHO (2023) has also stated that the human, social, and economic toll of drowning deaths is extremely high, but these are completely preventable. The organization adopted its first ever resolution on drowning prevention in the 76th World Health Assembly in 2023, and will act as a focal point within the UN system on drowning prevention and facilitate the observance of World Drowning Prevention Day on July 25 each year.
An injury and drowning prevention program was implemented between 2006 and 2010 in three rural sub-districts -- namely Raigangj, Sherpur, and Manohordi -- which found that Anchal (a community day care centre, or creche) and SwimSafe (a surviving swimming teaching to children) were very cost effective. It was noted that Anchal and SwimSafe, together with community awareness activities, proved effective in reducing deaths from drowning. To identify the effectiveness and the most suitable childhood drowning prevention interventions, a project “Saving of Lives from Drowning” (SoLiD) was implemented between 2013 and 2015 in 51 union parishads of seven rural sub-districts of Bangladesh.
The package comprises largely of three components: A creche-only, a playpen-only, and a creche plus playpen component; each combined with the establishment of injury prevention committees to provide community education on injury prevention. Studies led by Rahman et al (2017) suggest that community led crèche implementation is effective to reduce child mortality whilst playpen-only intervention did not bring effective results. The findings from several other pilot interventions implemented consistently evidenced playpens and community crèches are effective in preventing drowning mortality in children under five years of age.
The government has undertaken drowning prevention pilot actions manifested in its recent child protection strategies. Full scale activities for childhood drowning prevention by the government are nascent. Due to funding constraints, lack of logistics and other socio-cultural factors, it will require a longer time plan to implement the aforementioned six intervention and four drowning prevention strategies in the entire country at a time. To this end, the Disaster and Development Organization (DADO) emphasizes cost effective and voluntary commitment and activities which may play a significant role in childhood drowning prevention.
As members of the community, we all can play a role in child drowning prevention by doing a range of activities:
Charity begins at home -- start by sharing knowledge gain with your family members;
Check if children are safe from drownings at your home;
Share knowledge and experience with families, friends, neighbours and relatives;
Raise the issue when you gossip with friends
Visit your next door for awareness generation
Conduct yard meetings in your neighbourhood
Develop barrier to water bodies
Conduct as much as social media campaign and encourage others to do the same
Provide playpen for poor families
Provide swimming skills (Child can start swimming from the age of 3-4 years)
Get CPR (cardiopulmonary resuscitation) training from YouTube and certified providers
Form youth campaign committee at your village; (13) be part of the nationwide awareness and training campaigns
Check the possibility of establishing child care centres in high poverty prone rural areas.
The effective drowning prevention activities need to be scale-up in partnership with local residents and other organizations including the government, NGOs, CBOs, and the private sector.
Dr Edris Alam is an associate professor at Rabdan Academy, Abu Dhabi, United Arab Emirates (UAE).
