Child Drowning

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1. SCOPE OF THE PROBLEM 1.1 AN INVISIBLE ISSUE The magnitude of child drowning in LMICs in Asia has been invisible for many reasons. Among them are the following: Lack of national-scale, community-based surveys to provide population-based estimates of the burden of drowning Reliance on facility-based reporting that fails to capture most cases of drowning Use of a classification system unsuitable for LMICs Incomplete, poor quality LMIC data reported to the World Health Organization (WHO) Reliance on models and expert opinion to adjust incomplete drowning data, which results in underestimates. As a consequence, the actual number of children in LMICs in Asia who drown each year has not been recognized until recently. New surveys jointly conducted by UNICEF and The Alliance for Safe <strong>Child</strong>ren (TASC) show that the numbers estimated in the WHO Global Burden of Disease process for child drowning in the countries surveyed are substantial underestimates. 1.2 LACK OF NATIONAL SCALE, COMMUNITY-BASED SURVEYS TO PROVIDE POPULATION-BASED ESTIMATES OF THE BURDEN OF DROWNING Information has been available from previous population-based studies on child drowning in various LMICs in Asia. However, the survey data are of limited quality and largely incomplete. Given these constraints, it has not been possible to detect the actual number of children who drown in the communities surveyed. The limitations include the following: (i) Scope: None of the community-based surveys used a large representative population that included both urban and rural areas to cover an entire country. Most of the surveys had small sample sizes, often only 500-2,500 children and lacked statistical power. The small sample sizes limited the findings to small groups of children (e.g. urban primary schoolchildren). (ii) Not representative: Most surveys lacked well-defined populations. Often they used numerators and denominators drawn from hospitals or schools (e.g. per 1,000 admissions; per 1,000 students). It was not possible to calculate comparable drowning rates that showed the difference in rates and patterns of drowning among children of varying ages. Many of the surveys were conducted over a short period, and thus failed to capture the seasonal pattern of drowning (i.e. the number of child fatalities in the dry season vs. rainy season, during monsoon, floods, etc.). 14
(iii) Methodology: Most surveys had differing recall periods, resulting in a difference in calculated rates. The recall periods ranged from a few weeks to several months to a year. For surveys with recall periods of less than a year, different methods were used to convert the periods to annual rates, resulting in incomparable rates. Most surveys used different definitions of fatal drowning, such as immediately fatal; fatal within 24 hours; drowning in water only; drowning in any liquid. The dissimilar outcomes measured could not be compared. Most surveys used different definitions of severity in non-fatal drowning, such as hospitalization; missing school for a half day; missing school for one day; or seeking any medical care. Non-fatal outcomes therefore could not be compared. (iv) Information for prevention: Almost none of the surveys collected information on antecedent events or risk factors other than age and sex. The drowning rates cannot be understood without taking into consideration the context of occurrence, predisposing factors, occupational connections, or linkage to aquatic transport. The lack of adequate survey data has led to drowning being counted mainly at hospitals and clinics. However, fatally drowned children are rarely brought to a health facility so the estimates are unreliable. Few hospitals can provide reliable information on rapid causes of death, especially when the deaths occur in communities that are distant from the hospital. This is the case with drowning, which means that the majority of drowning cases go unrecorded. Over the past decade a series of national and sub-national surveys have been conducted by TASC in collaboration with UNICEF country offices in Bangladesh, Cambodia, China, Thailand and Viet Nam. The surveys were conducted with the technical capacity in epidemiology, demography and statistics developed at the national and local levels in most countries in Asia over the past 20 years. They have shown the overall scale of child drowning and its scope at the different stages of childhood and have highlighted the need to undertake intervention research on drowning in children as an urgent priority. In each country the survey counted deaths in the community and classified them by cause, including infectious (communicable) diseases, non-communicable diseases, injury and a category called ‘unable to determine’. The surveys also counted serious and disabling injury events. The surveys had very large sample sizes, on the order of 100,000 households, and were able to examine causes of death in the different age groups of childhood and adulthood. The survey instruments were standardized, with common definitions of age groups, recall periods, risk factors, behavioural factors, circumstances and outcomes facilitating comparison across countries. The countries surveyed span the gamut of development. They include countries classified as low income as well as middle income, countries with low and high child mortality rates, and countries in East and South Asia with the differing socio-cultural characteristics of each sub-region. 15
Page 1 and 2: UNICEF Office of Research Child Dro
Page 3 and 4: THE UNICEF OFFICE OF RESEARCH In 19
Page 5 and 6: TABLE OF CONTENTS Executive Summary
Page 7 and 8: EXECUTIVE SUMMARY Childhood drownin
Page 9 and 10: Household survey findings Drowning
Page 11 and 12: Loss of health and social investmen
Page 13: INTRODUCTION Children living in dev
Page 17 and 18: Proportion of drowning Figure 1: Dr
Page 19 and 20: In high-income countries (HICs), be
Page 21 and 22: Table 2: ICD-10 drowning (1997) W65
Page 23 and 24: - had no data reported, or none rep
Page 25 and 26: data from multiple sources includin
Page 27 and 28: A combination of these approaches i
Page 29 and 30: Mortality rate/1,000 Drownng propor
Page 31 and 32: Figure 7: Mortality among children
Page 33 and 34: A second conclusion is that the cur
Page 35 and 36: Cumulative proportion Drowning rate
Page 37 and 38: Table 6 shows the severity of the n
Page 39 and 40: Bangladesh Jiangxi China Cambodia B
Page 41 and 42: 1. Drowning risks are higher when c
Page 43 and 44: Rate per 100,000 Figure 17: Cause o
Page 45 and 46: Figure 19: Resuscitation received b
Page 47 and 48: drowning. It states: “Unprecedent
Page 49 and 50: esult, children fall in and drown,
Page 51 and 52: Drowning rate per 100,000 2.6 LEVEL
Page 53 and 54: 3. EVIDENCE FOR PREVENTION It is of
Page 55 and 56: drowning is a leading but preventab
Page 57 and 58: Mortality Rate (per 1,000) Figure 2
Page 59 and 60: The analysis allowed examination of
Page 61 and 62: Table 9: Number of children needed
Page 63 and 64: The intervention developed a formal
Page 65 and 66:
immediate resuscitation is discusse
Page 67 and 68:
2011) has 107 indicators, but does
Page 69 and 70:
systems and standards, and manageme
Page 71 and 72:
5.3 STIMULATING AND SUSTAINING INVE
Page 73 and 74:
effective against ‘other diseases
Page 75 and 76:
ANNEX: LIST OF CONTRIBUTORS This pa
Page 77 and 78:
STAFF AND VOLUNTEERS OF THE ROYAL L
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Child Drowning

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