Child Drowning
Child Drowning Child Drowning
The surveys were reported in detail in the previous set of working papers entitled Child Mortality and Injury in Asia, published by the UNICEF Innocenti Research Centre (IRC) in 2007. 4 The surveys assessed the adequacy of reporting at local and national levels. They counted child drowning directly at the household level in the communities where it occurred and compared it to what was seen or directly reported to nearby health facilities. Examples follow, but the reader is directed to the previous working paper series for further details. 1.3 FACILITY-BASED REPORTING IN LMICS RESULTS IN MOST CASES OF DROWNING BEING MISSED In the surveys, for each case of child drowning in the community, the outcome was categorized as: ‘died immediately’; ‘initially survived but later died’; ‘survived with permanent disability’; or ‘survived with no permanent disability’. The actions taken on discovery of the child were classified according to whether a rescue was attempted and if so, how it was performed; whether resuscitation was attempted and if so how it was performed, and what the outcome was. Follow-up actions related to care-seeking were determined, such as if the child was taken to a health-care provider, and if so, what was the type of provider. If the child was not taken to a health-care provider, it was determined if the drowning was reported to a health clinic, hospital or other government facility. The figures that follow show that most cases of child drowning discovered in the community were not reported to, known about, or treated by the facilities that make up the national health-care system. Consequently, most cases of child drowning were not reflected in the national mortality and morbidity statistics, leading to incomplete and poor quality data reported to WHO. 4 See Special Series on Child Injury: Linnan, M. et al. (2007). ‘Child Mortality and Injury in Asia:An overview’, Innocenti Working Paper, No. 2007-04. Florence: UNICEF Innocenti Research Centre; Linnan, M. et al. (2007). ‘Child Mortality and Injury in Asia: Survey methods’, Innocenti Working Paper, No. 2007-05, Florence: UNICEF Innocenti Research Centre; Linnan, M. et al. (2007). ‘Child Mortality and Injury in Asia: Survey results and evidence’, Innocenti Working Paper, No. 2007-06, Florence: UNICEF Innocenti Research Centre; Linnan, M. et al. (2007). ‘Child Mortality and Injury in Asia: Policy and programme implications’, Innocenti Working Paper, No. 2007-07, Florence: UNICEF Innocenti Research Centre. 16
Proportion of drowning Figure 1: Drowning in Thailand among children 0- 17 years old, by cases seen or reported to a healthcare facility, 2003 100% 80% 14.3% 60% 40% 20% 100% 85.7% Not seen or reported to a health care facility Seen or reported to health care facility 0% 0.0% Immediately fatal Subsequently fatal Source: Survey data from the Thailand National Injury Survey 2003. Figure 1 shows reporting of the drowning events in the Thai survey. The survey had a nationally representative sample of 100,000 households; the field work was done from 2002−2003. Of 65 child drowning events identified at the community level, only 14 (21.5 per cent) were seen by or reported to a health-care facility (fatal and non-fatal drowning combined). None of the immediately fatal drowning events were seen by or reported to a health-care facility. Overall, the survey found that drowning caused about half of all injury deaths among children. Thus, missing most fatal drowning meant a marked under-reporting of fatal injury as well as fatal drowning. Figure 2 illustrates a similar situation in Bangladesh. Figure 2: Drowning in Bangladesh among children 0-17 years old, by place of report and/or receipt of care, 2002 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 64% 65% 22% 24% 7% 6% 7% 6% Immediately fatal Subsequently fatal No report/treatment Hospital/clinic Traditional healer Informal doctor Source: Survey data from the Bangladesh Health and Injury Survey 2002. Note totals exceed 100% due to rounding. The Bangladesh Health and Injury Survey (BHIS) had a nationally representative sample that included 174,000 households. Field work for the survey was completed in 2003. Figure 2 shows 12 per cent to 14 per cent of fatal drowning events were taken to traditional healers or informal doctors. These are not part of the health reporting system so that drowning was unreported in national health data. Regarding hospitals and health facilities, about two thirds (64 to 65 per cent) of fatal drowning cases (both immediately and subsequently fatal) were not taken for care or reported. Less than a quarter (22 to 24 per cent) of drowning victims were taken for care or reported to a hospital or clinic. Therefore, almost 8 17
- 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 and 14: INTRODUCTION Children living in dev
- Page 15: (iii) Methodology: Most surveys ha
- 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
The surveys were reported in detail in the previous set of working papers entitled <strong>Child</strong> Mortality and<br />
Injury in Asia, published by the UNICEF Innocenti Research Centre (IRC) in 2007. 4<br />
The surveys assessed the adequacy of reporting at local and national levels. They counted child<br />
drowning directly at the household level in the communities where it occurred and compared it to what<br />
was seen or directly reported to nearby health facilities. Examples follow, but the reader is directed to<br />
the previous working paper series for further details.<br />
1.3 FACILITY-BASED REPORTING IN LMICS RESULTS IN MOST CASES OF DROWNING BEING MISSED<br />
In the surveys, for each case of child drowning in the community, the outcome was categorized as: ‘died<br />
immediately’; ‘initially survived but later died’; ‘survived with permanent disability’; or ‘survived with no<br />
permanent disability’.<br />
The actions taken on discovery of the child were classified according to whether a rescue<br />
was attempted and if so, how it was performed; whether resuscitation was attempted and<br />
if so how it was performed, and what the outcome was.<br />
Follow-up actions related to care-seeking were determined, such as if the child was taken<br />
to a health-care provider, and if so, what was the type of provider.<br />
If the child was not taken to a health-care provider, it was determined if the drowning was<br />
reported to a health clinic, hospital or other government facility.<br />
The figures that follow show that most cases of child drowning discovered in the community were not<br />
reported to, known about, or treated by the facilities that make up the national health-care system.<br />
Consequently, most cases of child drowning were not reflected in the national mortality and morbidity<br />
statistics, leading to incomplete and poor quality data reported to WHO.<br />
4 See Special Series on <strong>Child</strong> Injury: Linnan, M. et al. (2007). ‘<strong>Child</strong> Mortality and Injury in Asia:An overview’, Innocenti Working<br />
Paper, No. 2007-04. Florence: UNICEF Innocenti Research Centre; Linnan, M. et al. (2007). ‘<strong>Child</strong> Mortality and Injury in Asia:<br />
Survey methods’, Innocenti Working Paper, No. 2007-05, Florence: UNICEF Innocenti Research Centre; Linnan, M. et al. (2007).<br />
‘<strong>Child</strong> Mortality and Injury in Asia: Survey results and evidence’, Innocenti Working Paper, No. 2007-06, Florence: UNICEF<br />
Innocenti Research Centre; Linnan, M. et al. (2007). ‘<strong>Child</strong> Mortality and Injury in Asia: Policy and programme implications’,<br />
Innocenti Working Paper, No. 2007-07, Florence: UNICEF Innocenti Research Centre.<br />
16
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