Child Drowning

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Figure 8: Mortality among children 0-17 years old, by cause and age group 100% 80% 60% 40% 20% 0% 0-1 1-4 5-9 10-14 15-17 0-17 1-17 Unable to determine Noncommunicable disease Communicable disease Other Injury Suffocation Burns Assault Animals Fall Suicide Electrocution Road traffic Drowning Source: Data from the countries included in surveys: Bangladesh Health and Injury Survey 2002, Cambodia Accident and Injury Survey 2006, Jiangxi China Injury Survey 2005, Thailand National Injury Survey 2003; population weighted for composite. Figure 8 combines data from the surveys and shows the prominence of drowning as it relates to overall child mortality in the countries surveyed. However, there are a number of caveats related to this composite: Sample surveys were used and sampling introduces uncertainty in the results. There is increased uncertainty in the results obtained for each cause of mortality because the pooling techniques used introduce additional uncertainty when combining the individual surveys. The composite is more representative of East Asia than South Asia due to the countries surveyed. For China and India, the two largest countries in Asia, only China (one province) is included in the composite. Jiangxi Province, a middle tier province in China, was selected to be representative of the country over all. Jiangxi, with a population of 44 million people, makes up only 4 per cent of the country’s population. India, which has an under-18 population of 447 million, 24 is not included and makes up a large proportion of the child population of the Asian region. However, the patterns and levels of drowning mortality for the composite closely match what is seen in China’s Disease Surveillance Points (DSP) system and India’s Million Death Study (MDS). Both of these use representative population-based national samples. One conclusion is that in Asian LMICs, which contain almost two-thirds of the world’s children, drowning needs to be an urgent health policy priority. It would help achieve progress in reducing mortality among children under five, and accelerate progress in improving mortality for children of all ages. 24 United Nations Children’s Fund (2012). The State of the World’s Children 2012. New York: UNICEF, table 6, p. 109. 32
A second conclusion is that the current system for determining and reporting drowning does not work well. The need to count deaths with reasonable precision and accuracy is a fundamental requirement for properly informing health policy and resource-allocation decisions. The available evidence shows large differences in results according to how a drowning is counted. Some differences are related to the place of detection and report, whether in the community or through a facility-based system. Some are due to the ICD classification system used, which performs best in HICs and is unsuited to LMICs. Both of these result in the need to correct the data reported to fill in the many large gaps, impute data that are not available and adjust the results. The complexity involved and the multiple non-linear sources of bias make this a difficult task with large potential for error. The sum of all the biases and uncertainties have masked a fundamentally important factor in child health: drowning is a leading cause of child death in LMICs in Asia. Any cause of mortality of this magnitude requires attention and intervention. 33
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 and 16: (iii) Methodology: Most surveys ha
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: Figure 7: Mortality among children
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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