Child Drowning

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Acknowledgements: The authors gratefully acknowledge the partnership of the UNICEF Office of Research, and have a special debt of gratitude to those who endeavoured to make this series a reality, in particular, Gordon Alexander (Director), Morten Giersing (consultant) and David Parker (former Deputy Director). The paper results from the work of a large number of technical contributors who are listed in the annex. The authors are grateful for financial contributions from the UNICEF Bangladesh Country Office for the PRECISE project, and for assistance from Australian Agency for International Development (AusAID) for providing support in editing and statistical analysis for this paper. The authors are also grateful to Steve Beerman of the International Life Saving Federation (Belgium), William Bertrand and Joy Jones at The Payson Center for International Development, Tulane University (United States), Ross Cox at The Alliance for Safe Children, Danang (Viet Nam), Julie Gilchrist at the Centers for Disease Control and Prevention (United States), Joan Ozanne-Smith at Monash University (Australia) and Curtiss Swezy of George Mason University (United States) who reviewed the manuscript at various stages of completion and whose comments and suggestions greatly improved the content. Keywords: Asia, Bangladesh, Cambodia, cause of death, child injury, child deaths, child mortality, children, China, community survey, demographic change, drowning, drowning injury, drowning interventions, drowning prevention, epidemiological transition, fatal drowning, injury, injury survey, low and middle-income countries (LMICs), mortality estimates, non-communicable disease, Thailand, tsunami, Viet Nam. 4
TABLE OF CONTENTS Executive Summary 7 Introduction 13 1. Scope of the Problem 14 1.1 An invisible issue 14 1.2 Lack of national scale, community-based surveys to provide population-based estimates of the burden of drowning 14 1.3 Facility-based reporting in LMICs results in most cases of drowning being missed 16 1.4 A classification system unsuitable for LMICs 19 1.5 Incomplete and poor quality data reported to the World Health Organization 22 1.6 Adjusting incomplete national data for global estimates 23 1.7 A new issue or simply an unrecognized issue? 27 1.8 Impact on early child mortality in the Asian region 30 2. How and Why Children Drown in LMICs in Asia 34 2.1 How children drown in LMICs in Asia and implications for prevention 34 2.2 Disasters make headlines, but are not the cause 40 2.3 Notable issues from the country data 40 2.4 Child drowning in Asian LMICs compared to drowning in HICs 48 2.5 Prevention challenges in LMICs 50 2.6 Levels of exposure to hazards are much higher in LMICs than HICs 51 3. Evidence for Prevention 53 3.1 Adapting proven HIC interventions to LMIC settings 54 3.2 Evidence for prevention in the surveys and subsequent research 55 3.3 New evidence on the costs and cost-effectiveness of preventing child drowning 57 3.4 Key related evidence for public health interventions 58 3.5 Taking interventions to scale 62 3.6 Issues regarding resuscitation 64 4. The Basis for Intervention 66 4.1 Drowning deaths in LMICs are preventable 66 4.2 If drowning is not counted, it does not count 66 4.3 Lack of capacity in the international health and development community 67 5. Building a Global Platform for Drowning Prevention 68 5.1 Scaling-up drowning interventions into national, regional and global programmes 68 5.2 Building drowning prevention capacity at all levels 70 5.3 Stimulating and sustaining investment in drowning prevention 71 5.4 Managing the shift from scarce funds to well-targeted, coordinated investments 71 5.5 The time to act is now 72 Acronyms 74 Annex – List of contributors 75 5
Page 1 and 2: UNICEF Office of Research Child Dro
Page 3: THE UNICEF OFFICE OF RESEARCH In 19
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 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
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drowning is a leading but preventab
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Mortality Rate (per 1,000) Figure 2
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The analysis allowed examination of
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Table 9: Number of children needed
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The intervention developed a formal
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immediate resuscitation is discusse
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2011) has 107 indicators, but does
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systems and standards, and manageme
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5.3 STIMULATING AND SUSTAINING INVE
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effective against ‘other diseases
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ANNEX: LIST OF CONTRIBUTORS This pa
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STAFF AND VOLUNTEERS OF THE ROYAL L
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