Child Drowning Prevention in Bangladesh Dr Aminur Rahman

Child Drowning Prevention in Bangladesh Dr. Aminur Rahman aminur@ciprb. org

Bangladesh Health and Injury Survey, 2005 • 12 districts randomly selected • 171, 000 HH (820, 000 persons) • Urban and rural areas • All causes of morbidity and mortality were included

25 20 15 10 5 Rate per 100, 000 Leading killers of children 1 -17 30 0 em ia x po te bi en ic pt Se ck hi C eu ur nj t. I or Pn e al m ni A + id ic Su rr ia D tis gi sp an Tr ea on iti ia on tr ho in en M rr ia D nu al M ng ni m eu Pn w ro D s ie 18, 000 children drown every year i. e. 50 each day

Child drowning mortality rate by age

It is clear that child health programs can no longer be considered complete without injury prevention efforts at the core But, Challenges are: § Lack of easy solution for country like Bangladesh § Interventions from developed countries are not transferable § Needs large population based research

“PRECISE” – Prevention of Child Injuries through Social Intervention and Education An operation research -to develop and implement various injury intervention packages and -to evaluate efficacy of the packages and the effectiveness of its implementation approaches for scaling-up. The largest community trial on childhood drowning prevention in developing countries

Widespread Exposure of water bodies Lack of awareness and supervision Lack of skills 80% drowning occurred in pond, ditch and bucket 60% drowning happened during Swimming Skill 80% drowning happened within 20 meters of house 9 am-1 pm Children of large families are 2 times vulnerable to drowning than small families Rescue Skill First Aid Skill Management Factors associated with childhood drowning

Fundamental strategies for drowning prevention <4 = supervision > 4 = swimming

Prevention Strategies are keyed to child’s ages which include: • Improving supervision of the young children (under 5 years) • Equipping older children (4 – 10 years) with the life saving swimming skills • Raising awareness of children of all ages (under 18) and parents on water hazards and prevention of drowning • Modifying environmental water hazards through community participation

PROGRAMME COMPONENTS Injury Surveillance PRECISE Safe Home Safe School Safe Community

Safe Community Anchal § Institutional supervision § Most vulnerable time for injury including drowning § Most vulnerable age groups § Trained care-giver § Supervision § ECD 640 Anchals - 16, 500 children

Swim. Safe Survival Swimming + rescue Community Swimming Centre Training of CSIs

Swim. Safe Children learning to swim Children learning rescue technique Over 350, 000 children learnt swimming during 2006 -2013

Evaluation Effectiveness of Anchal Participants Non Anchal Participants Number Drowning death rate per 100, 000 person yr 20, 329 10. 90 43, 439 54. 44 Relative Risk 0. 20 At 95%CI 0. 037 – 0. 071

Evaluation Effectiveness of Swim. Safe Programme Swim. Safe Participants Non Swim. Safe Participants Number Drowning death rate per 100, 000 person yr 54, 834 1. 06 54, 834 23. 17 Relative Risk 0. 046 At 95%CI 0. 037 – 0. 071

IDRC-B Research Activities

Anchal 2. 0 Appropriate timing of Anchal – 50 Anchals : 9 am to 1 pm – 50 Anchals : 10 am to 2 pm – 50 Anchals : 10 am to 12 noon 9 am to 1 pm – Most effective – Most preferred by mothers

Children rescuing other children drowning in rural Bangladesh • Children rescue other children. • No adult assistance • All the child rescuers were an average of 6 years older than the victims • Most rescues took place – in ponds or ditches and within 10 metres of the bank – while the victim was bathing. • Most rescues were in water contact recues.

Feasibility of First Responder Programme in Rural Bangladesh

Distribution of participants by category, sex and assessment result

Bangladesh Anchal and Swim. Safe (BASS) Project

Anchal 3. 0 in BASS • An evolution of Anchal from 1. 0 (PRECISE) and 2. 0 (Aus. AID-IDRCB) • Anchal 3. 0 adds – Anthropometry for physical development – Measurement of mental and social development – Playpens for safety and supervision – Mainstreaming for special needs children

Anthropometry • Anchal ma measures height and weight of children • Maintains growth chart on child • Determines if child is progressing normally or is falling behind in weight and height growth • Categorizes children as increased risk (12 SDs below median) and high risk (2 or more SDs below median)

Screening of special needs children • Anchal ma also screens for congenital or acquired physical disabilities such as – Cleft palate – Club foot – Cross eyes – Blindness – Deafness – Missing or paralyzed limb • Categorizes child as special need on this basis

Development monitoring • Anchal ma uses validated screening tools at 12, 15, 18, 24, 30, 36, 48 and 60 months • Monitors development of – Hearing, speech and language skills – Gross and fine motor skills – Cognitive, social, emotional and self help skills • Charts skills progress of each child • Categorizes children as normal, increased and high risk children on the basis of screening

Playpens • Reduce the supervisory burden on Anchal ma • Increases safety for infants • Allows for direct observation to learn what is the appropriate age range and if current design is optimal for use, durability and safety

Mainstreaming special needs children • Ensures they are known to the appropriate government institutions • Ensures access to all services possible • Allows socialization with Anchal peers

Swim. Safe 3. 0 • An evolution of Swim. Safe from 1. 0 (PRECISE) and 2. 0 (Aus. AID-IDRCB) • Swim. Safe 3. 0 adds – Lower age of entry (3 years) – Safer in-water rescue – CPR/first response for children 7, 8 and 9 years – Risk management protocols for children at increased risk of injury while learning to swim

Lower age of entry • Peak age of drowning is 27 months • Adding children 3 years of age provides protection from drowning in this high risk group

Safer in-water rescue • Research shows most rescues are inwater rescues instead of land-based rescues • Adding training for safer ways to conduct in-water rescues will reduce the risk of this necessary practice

CPR – First response • Research from IDRC-B shows that most rescues of young children are done by children 8 -12 years old • The same research shows many rescues are on drowning children who have stopped breathing • Research from IDRCB shows children 10 years old can learn CPR and first response • Adding CPR skills to older children will allow them to resuscitate rescued children who have stopped breathing

Risk management protocols • As many as one in three children in rural Bangladesh are at increased risk of injury when learning to swim • Malnutrition, epilepsy and other seizure disorders, asthma and other respiratory disorders and physical disability are the main causes • Providing safe training allows these children to be protected from drowning

Thank You