Child Drowning

data from multiple sources including national death registries, coronial investigations and other national
mortality reporting systems. The differences between GBD figures and the member reported figures
range from +50 per cent (Australia) to +300 per cent (United Kingdom). 17
The GBD estimates have many uncertainties built into them. Normally, estimates with such an amount
of uncertainty are stated with confidence intervals (e.g. 95% confidence intervals) or a range of
likelihood scenarios (e.g. low, medium and high ranges). Listing a single, precise number can suggest
precision in an estimate that is not there, especially to non-technically trained policy-makers.
Table 4 below shows for children aged 0-14, direct comparisons for the GBD 2004 estimates of fatal
child drowning with the estimated numbers of drowning deaths in three countries surveyed.
Table 4: WHO Global Burden of Disease estimates and survey estimates of fatal drowning among
children 0-14 years old
Country
GBD 2004 estimated
drowning deaths
Drowning deaths
estimated in the
country survey
Year of
survey
Percentage
difference
Bangladesh 3,828 16,452 2002 +330%
Thailand 1,322 2,093 2003 +58%
Cambodia 1,074 1,871 2006 +74%
Source: Data from countries included in surveys (Bangladesh Health and Injury Survey, Cambodia Accident and Injury Survey, Thailand National
Injury Survey) and World Health Organization Global Burden of Disease website. The comparison is between children aged 0–14, as GBD does
not include a category for children aged 0- 17 years.
There is a substantial difference between the numbers of fatal child drowning deaths estimated by the
GBD 2004 and by the surveys done in the three countries. Apart from regular seasonal flooding, there
were no aquatic disasters or other factors that would increase the rate of child drowning in the three
countries during the period. National records do not show any significant differences in annual
reporting during the same period. The most likely explanation for the large difference is the virtual
impossibility of adjusting for all the errors, biases, undercounts, and incompleteness in the raw data
used in the estimation process. Many of the factors involved are simply unknowable. There are no
means of validating the results against reliable drowning data from other LMICs as such reliable data
does not exist. Hence the estimates, even when adjusted for the known factor of not counting drowning
from transport, natural cataclysms and intentional injury, may have substantial inaccuracies built in.
The GBD 2008 update reported even lower drowning numbers in Bangladesh (-32.8%), Cambodia
(25.9%), and an increase in Thailand (+21.3%) resulting in a net reduction in drowning deaths compared
to 2004. The increase in Thailand is not related to the Indian Ocean tsunami (Dec 26, 2004). It was
during the 2004 GBD time frame and this was a cataclysm of nature; thus these drowning deaths are
excluded from GBD estimates. There were no other changes in environmental conditions or risk factors
for drowning in the three countries between 2005 and 2008, further increasing the disparity between
the GBD estimates and the country surveys.
Other corroborating evidence of the potential for large undercounts is available from India. The GBD
2004 estimate for India was 21,785 drowning deaths in children 0-14 years of age. The Million Death
Study (MDS), a nationally representative verbal autopsy study in India, covered more than 1.1 million
17 Franklin R.C. and J. Scarr (2011). ‘ILS Drowning Data and Research Survey’, International Life Saving Federation, Leuven; in
press.
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