Child Drowning

facilities. The vast majority of drowning patients who are seen in facilities are seen at the
lowest level clinics and health centres which lack staff with the training to code properly.
The system works best in tandem with coronial systems and health information systems.
These either do not exist or are severely constrained in LMICs.
The lack of appropriate reporting categories that fit the environment of LMICs results in
little perceived utility, which creates a major disincentive for reporting.
The systemic factors noted above result in poor performance of the reporting system. Cultural factors
such as the reluctance of parents to bring drowned children to hospitals and the significant proportion
of drowning that is seen by informal providers (traditional healers, etc) who do not report, all combine
with the systemic factors. The end result is poor quality in the available drowning data at national level.
The issues noted relate to systemic factors such as the lack of resources and the practicalities of LMICs.
There is also a structural issue that causes the ICD system to underestimate drowning incidence.
Whether a drowning incident is classified as ‘drowning’ in the ICD system depends on where the
drowning incident occurs. If it occurs as a result of a transport incident (e.g. car crashing into a pond,
ship sinking), a flood or natural disaster, or from an assault or suicide, it is not classified as ‘drowning’,
but as a sub-classification of transport, disaster or violence. This conflicts with the definition of
drowning used by the global specialized drowning prevention and research community.
Representatives of the International Life Saving Federation and other lead drowning researchers led a
global process in 2002 that created a standard definition of drowning. Drowning was defined as “death
due to respiratory impairment resulting from immersion in a liquid”. 9 This applies to drowning in any
environment and from any predisposing factor. However, ICD-10 excludes deaths as drowning if their
occurrence stems from transport (ICD-10 codes V90, 92; ship sinking, boating accidents, etc.);
environmental forces of nature (X-36-X-39, floods, hurricanes, typhoons, tsunamis, etc.); intentional
self-harm (X-71, from suicide by drowning, etc.); and assault (X-92, assault by drowning and
submersion). These excluded causes have been found to be responsible for a large proportion of total
drowning in some HIC countries; 39 per cent in one study 10 and between 40 to 50 per cent in another. 11
The impact of these biases results in large underestimates of child drowning. This has implications far
beyond the specialized drowning research and prevention community. Drowning makes up a large
proportion of total child deaths in LMICs in Asia. In the surveys it accounted for half of all child deaths
from injury. Because drowning is largely under-reported, it also results in the lack of awareness that
injury is a leading cause of child mortality in LMICs in Asia.
1.5 INCOMPLETE AND POOR QUALITY DATA REPORTED TO THE WORLD HEALTH ORGANIZATION
National reports are aggregated at the global level in the WHO Mortality Database. In 2005, an
assessment was done of coverage and quality of the data reported to WHO. Of 192 WHO member
countries, 114 had no data available or no data more recent than 1990. In the South East Asia region,
none of the 11 countries assessed – including Bangladesh – had any data reported, or none reported
after 1990. Fourteen of 27 countries assessed in the Western Pacific – including Cambodia and Viet Nam
9 International Life Saving Federation Position Statement: Swimming and Water Safety Education, available at:
www.ilsf.org/index.php?q=en/about/statements_05.htm accessed 12 October 2011.
10 Passmore, J.W., J O. Smith and A. Clapperton (March 2007). ‘True burden of drowning: Compiling data to meet a new definition’. International
Journal of Injury Control and Safety Promotion, 14(1):1-3.
11 Lunetta, P. et al. (October 2004).‘Unintentional drowning in Finland 1970–2000: A population-based study’. International Journal of
Epidemiology, 33(5):1053-1063.
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