It is time we paid attention to the drowning epidemic in Bangladesh
Drowning is the third leading cause of accidental deaths across the globe; the WHO states that drowning claims around 322,000 lives per year. WHO statistics also show that approximately 1,000 fatal drowning incidents take place every day, ie, 41 deaths per hour and two deaths every three seconds.
It is also evident that drowning causes the deaths of at least 12,000 children per year, which is equivalent to 43% of all child deaths and higher than the death rates from maternal mortality and malnutrition. Drowning mortality is the highest among children aged 1-4 years globally.
A recently published factsheet on drowning published by the Royal Life Saving Society (RLSS), the Commonwealth’s oldest and largest live-saving and drowning prevention organization, shows that during 2017, about 110,000 people died from drowning in Commonwealth countries, which is equivalent to 37% of global drowning deaths; the rate of fatal drowning was 4.6 per 100,000 per year.
It is evident from the RLSS report that two-thirds of drowning deaths are male. The report spelled out that 51% of deaths from drowning occurred among children and adolescents aged 0-19 years, while 25% of them drowned before their fifth birthday. The report also evidenced that India, Bangladesh, and Pakistan account for 78% of estimated drowning fatalities within the Commonwealth, where Bangladesh stands 5th highest among the commonwealth countries.
Research and study show that low and middle-income countries are the most affected compared to the high-income countries, where the drowning rate is three times higher than that of high-income counties.
A study by Centre for Injury Prevention and Research, Bangladesh (CIPRB) shows that every year in Bangladesh, more than 18,000 children aged 1-17 years drown, which means roughly 50 children die from drowning every day. Among the children of this group, those who cross their second year of birth remain at the highest risk, and CIPRB study shows that such incidences take place between 9:00am to 1:00pm when parents, particularly mothers, remain busy with household work.
Despite such cruel facts, in the history of the United Nations, drowning has not yet been mentioned in any of the 26,000 resolutions adopted so far. The Global Goals set by the UN has targeted to reduce all preventable deaths by 2030 but drowning has not been mentioned, whereas without addressing the epidemic of drowning, targets of achieving preventable deaths are just impossible.
It is worth mentioning that the Royal National Lifeboat Institution (RNLI) has been advocating with the United Nations (UN) to adopt the first-ever UN resolution on drowning prevention. Ambassador Rabab Fatima, permanent representative of Bangladesh to the UN, has been leading the process of negotiation and lobbying with the UN, along with seven other countries.
Proposed solutions and interventions
Public health scientists from different countries have already invented a wide range of solutions, which have evidently been found as effective means to prevent drowning in rural contexts and diverse geography across the globe. Proven in a Bangladeshi context, solutions such as the strategic use of barriers to control access to water, creation of safe places such as daycare centres for preschool children, and teaching school-age children basic swimming skills have been found effective in other parts of the globe and replicable in diverse contexts and geography.
In addition to these three tested interventions, there must be an effective mechanism for flood risk management -- strict enforcement of inland water transport legislations followed by enactment and adoption of water safety policies. Establishing a preventive safety net requires capacitating a critical mass as first responders and ensuring that communities as a whole reject all harmful traditional practices. These three interventions have already been recognized by global public health scientists and practitioners as the best practice for reducing drowning deaths.
Given the current scope of the WHO, drowning has been considered under the non-communicable disease control segment. But if drowning prevention interventions were thoroughly examined, it would be evident that most of the interventions do not fall under the jurisdiction or scope of the Department of Health, which creates a problem at the country level.
For example, in Bangladesh, developing daycare centres, teaching swimming skills, and conducting water safety sessions at school do not fall under the jurisdiction of the Ministry of Health. Thus, to deal with the adversity of drowning, through the adoption of a UN resolution on drowning prevention, the multiple actors at the global and state levels should be made accountable.
What Bangladesh has done
In Bangladesh, the extent of drowning was exposed for the first time through the Bangladesh Health and Injury Survey (BHIS) 2005 conducted by the CIPRB and supported by Unicef. In 1996, the same BHIS was conducted by the Directorate General of Health Services (DGHS) with technical support from CIPRB, which marked the official recognition of drowning as one of the leading causes of child death at the government level in Bangladesh.
Since then, the Bangladesh government has responded to the drowning epidemic through the adoption of the Multi-Sectoral Action Plan for Prevention and Control of Non-Communicable Diseases 2015-2018. The action plan spelled out the issues of building awareness to reduce the rate of child drowning, while elaborating on the stakeholder specific response.
The plan under the section “Promote Healthy Setting” stipulated that, to improve child supervision for reducing exposure to water bodies, the Ministry of Health and Family Welfare (MoHFW) will develop community day care centres in partnership with the Ministry of Women and Children Affair (MoWCA), the Ministry of Local Government, Rural Development and Cooperatives (MoLGRDC), and NGOs and private organizations.
The MoWCA will develop Adolescent Brigades in partnership with MoHFW including NGOs and private organizations; MoHFW will promote Play Pen in partnership with MoWCA, including NGOs and private organizations.
The Operation Plan (OP) 1917-1922 of Non-Communicable Disease Control under the DGHS of the government of Bangladesh also includes drowning under the Injury, Occupational Health, and Climate Change sections. The OP also includes activities of awareness building and education in schools/madrasas, families, and communities on rescue and resuscitation under the component Injury including Poisoning and Snakebite.
The DGHS has already got an allocation of resources, though insufficient, from the MoHFW to implement the OP. End Preventable Child Deaths by 2035: Bangladesh Call for Action has targeted to reduce seven preventable deaths, including drowning, by 2035. Drowning prevention has also been included in the Integrated Management of Child Illness (IMCI).
Early childhood development is one of the priorities embedded with the drowning prevention interventions. In Bangladesh, Early Child Care and Development (ECCD) has been recognized through the ratification of the Convention of Child Rights followed by the signing of the World Declaration on Education for All in 1990 and the Dakar Framework for Action 2000, which had emphasized the importance of early childhood years as a means to achieve Education for All.
Steered from the highest policy level and orchestrated by leading NGOs, the ECCD -- albeit regarded as a new concept in its early stage of development -- opportunities for early childhood education have now flourished, although in an unstructured and informal manner.
Scaling up efforts
NGO-driven innovative initiatives promoting ECCD have been broadly steered by community-based approaches in which parents played the key role while the community was supportive or a facilitator. The government of Bangladesh has been seamlessly providing policy support, and eventually formulated the Comprehensive Early Childhood Care and Development (ECCD) Policy 2013.
The government’s firm commitment in attaining the standards of early childhood development has been echoed in the recent move of framing legislation toward the institutionalization of a day-care centre for children. Also, the government drafted the Day-Care Centre Act 2018, which is waiting to be passed by the parliament, though the Cabinet has already approved it.
After a thorough examination of the laws, policies, and strategies that relate to drowning prevention in Bangladesh, it is evident that drowning has been directly and indirectly addressed by multiple stakeholder agencies where effective coordination needed to be strengthened.
The necessity of integrating child supervision mechanisms of drowning prevention into the broader discussion of early childhood development approaches lies in the fact that such a supervision mechanism also deals with children aged 9-59 months who are the ultimate target group of every childhood development intervention.
CIPRB study evidenced that children receiving early childhood stimulation through drowning prevention interventions are better performers in primary school compared to those who did not receive similar stimulations. It’s worth mentioning that childhood supervision can reduce drowning by 80%.
Thus, it is imperative to scale up drowning prevention interventions and initialization of the supervision mechanism of drowning prevention, into a greater discourse of ECD, which has a proven track record of providing early childhood stimulations among children exposed to the risk of drowning.
The proposed Day-Care Centre Act 2018 approved by the cabinet has covered almost all the technical aspects of early childhood development that are to be addressed, which have been referred to the formulation of the rules after the enactment of the Act. If so is the case, it is imperative to further the consultations of all the stakeholders to enable a comprehensive rule for the proposed Act to ensure its effective and efficient implementation once enacted.
Given the reality of addressing the drowning epidemic through scaling up supervision mechanisms in rural contexts, the scope of the proposed Day Care Centre (draft) Act 2018 needs to be widened.
In addition to making the best usage of state resources, it is imperative to rethink policy issues such as approving the national drowning prevention strategy, setting up multi-stakeholder coordination mechanism engaging government agencies, non-government organizations, international development partners, UN agencies that include but are not limited to setting up national monitoring framework, developing stakeholder-specific indicators for tracking the progress of implementation and reforming the resource allocation mechanism.
To make the state response to drowning more effective, drowning prevention interventions should be brought under the revenue scheme with proper legislative and policy guidance without any further delay.
Sadrul Hasan Mazumder is a policy activist and can be reached at [email protected]; Twitter @policyactivist1.