Child Drowning

A combination of these approaches in key countries in the regions where data was lacking would
provide validation for the modeled and adjusted estimates outputs for the countries in the region. In
the three countries mentioned above, the substantial differences between the GBD fatal drowning
estimates and the national survey estimates, as well as the large changes in sequential GBD estimations
only 4 years apart lends uncertainty to policymaking for prevention of child drowning that is based on
these numbers.
1.7. A NEW ISSUE OR SIMPLY AN UNRECOGNIZED ISSUE?
An important question to ask is whether the large number of deaths from drowning is due to drowning
replacing infectious and other causes of disease now being prevented by child survival programmes, or
whether it has always been present but simply unrecognized due to biased reporting systems. This is
important because it will drive policy choices in selecting which causes of child mortality for
interventions or for funding research necessary to develop interventions.
If drowning is replacement mortality, then it occurs after the primary causes of mortality have been
eliminated. In this case, the priorities will be to eliminate the primary causes which precede drowning. If
it is concurrent mortality that happens alongside the other causes of mortality – one that has always
been there but is only now recognized – then drowning itself is a primary cause of early child death. As a
primary cause, to rapidly decrease early child mortality, drowning interventions need to be integrated
with programmes that target other primary causes of early child death, such as respiratory infections,
diarrhoeal diseases and nutritional causes.
While the significant number of drowning cases has been invisible to most in the child and public health
community, some public health experts such as researchers at Matlab, Bangladesh, have been aware of
the problem for the past three decades. The Matlab Demographic Surveillance System (DSS) associated
with the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) has provided
precise information on the issue. ICDDR,B has published numerous reports that have specifically
commented on the significance of child drowning on early childhood mortality and noted the increasing
proportion of early child deaths due to drowning. 20
The Matlab DSS shows that drowning has been an ever-present and significant child-killer over the past
three decades. It has not become a new cause of death as more children have survived due to
immunizations, breastfeeding or other child survival interventions. It has been concurrent primary
mortality alongside the other leading causes of child mortality such as measles. Figure 4 shows causes of
under-five mortality from 1974 to 2003.
20 Baqui, A. H. et al. (1998). ‘Causes of childhood deaths in Bangladesh: Results of a nationwide verbal autopsy study’. Bulletin of
the World Health Organization, 76(2): 161-171; Ahmed M. K., M. Rahman and J. van Ginneken (April 1999). ‘Epidemiology of child
deaths due to drowning in Matlab, Bangladesh’, International Journal of Epidemiology 28: 306-311; International Centre for
Diarrhoeal Disease Research, Bangladesh (November 2002). ‘The emergence of drowning as a principal cause of childhood death
in Bangladesh’. Health and Science Bulletin, 1(1): 10-12; Baqui, A. H. et al. (June 2001). ‘Causes of childhood deaths in
Bangladesh: An update’, Acta Paediatrica; 90(6): 682-690.
27