Child Drowning

attended the village crèche were 82 per cent lower than death rates in an age-, sex- and locationmatched
control group of children who did not. Drowning death rates among children who participated
in SwimSafe were 93 per cent lower than in an age-, sex- and location-matched control group of
children who did not. Both were large and statistically significant reductions.
Cost-effectiveness was estimated using the WHO CHOICES (World Health Organization - CHOosing
Interventions that are Cost Effective) methodology by determining the numbers of deaths averted, the
number of disability-adjusted life years averted (DALY) and the cost associated with preventing the
deaths. Implementing both the community crèche and SwimSafe programmes together in rural
Bangladesh would result in over 196,000 child deaths prevented at a cost of $12,596 per death
prevented and $362 per DALY averted. These costs compare very favourably with the cost of preventing
other causes of child mortality in the same region, such as diarrhoeal and respiratory deaths.
Conclusions
Having established that drowning is a significant and preventable cause of death in children in LMICs in
Asia, we need to focus on how this previously unidentified public health issue is transformed from a
neglected matter into a one that is addressed by national, regional or global level programmes.
To produce a significant reduction in the burden of drowning in LMICs, substantial investment in
building capacity at all levels of the development continuum will be needed. At national level, there
needs to be a recognition that drowning prevention requires multisectoral collaboration. Fundamental
to this is ensuring that the limited resources and energies of key groups and government agencies align
in a manner that increases the overall capacity of the system to reduce drowning.
Building the capacity to implement, manage and monitor drowning prevention programmes is
essential, but focus must also be given to the issue of elevating drowning prevention into the national
priorities of governments, increasing the availability of funds and devising systems and plans to prevent
and reduce drowning at a national level.
The development community is now at the same place with drowning as it was with communicable
diseases such as measles in the 1970s and 1980s. In the region of the world that holds the largest
number of children at risk of drowning, LMIC Asia, we know drowning is a leading killer of children after
infancy. We also know that there are cost-effective interventions against this leading killer − and that
for the children who are taught to swim, the evidence suggests that they are protected for life (or at
least through childhood) and they also provide ‘herd immunity’ for their peers through their ability to
rescue them when they are drowning.
There is much to be done to address the pressing needs for more evidence, expertise, recognition and
intervention; but the evidence now in front of us is more than enough to act on. Simply put, child
drowning is a leading cause of death in children in LMICs in Asia. This region contains two thirds of the
children in the world, thus making it a problem of global proportions. Now that we know it is as
preventable as other leading causes of child death in these countries, it is time to act.
It really is that simple.
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