Child Drowning

The two survival plots above from Bangladesh and Viet Nam illustrate a point of difference for
childhood drowning between South Asia and East Asia. In Bangladesh, drowning mortality (the blue line)
starts at an early age and reflects highest rates (i.e. falls most rapidly) between the ages of 2 and 7. The
median age of drowning is very early in childhood, at 2.3 years. In contrast, in Viet Nam drowning occurs
at about the same rate as other causes of death until age 5, when drowning rates begin to increase. This
results in an older median age of drowning of 3.9 years.
The difference in rates is associated with children’s external environment during early childhood. In
Bangladesh, very few children attend pre-school, while in Viet Nam most children do attend. This has a
large impact on drowning rates in early childhood as children typically drown during the same hours as
they would have attended pre-school. Since Vietnamese children are at school, they are in a safe haven
under the constant supervision of adult caretakers and protected from exposure to water hazards. In
contrast, in Bangladesh, few children attend preschool and drowning rates are high during these hours
as children are often left unattended while their caretakers do household chores.
This pattern may represent important regional differences. Countries in East Asia tend to have higher
pre-school attendance for children in early childhood than countries in South Asia, possibly due to the
high levels of development that have occurred across East Asia over the past several decades. While it
can be a useful generalization in comparing regional differences in child drowning, the pattern is not
universal. There are still East Asian countries that have lower rates of development and high rates of
early child mortality, such as Cambodia, where preschool attendance rates are low. 30
The findings indicate that the pre-school environment provides a safe haven from drowning. It also
extends a protection umbrella for other forms of injury. Accelerating efforts to introduce pre-school in
the countries where it does not yet exist can be an effective strategy to prevent early child drowning, in
addition to conferring other educational, social and cognitive benefits on young children.
In LMICs, children do not drown in swimming pools
It is notable that despite the very large survey sample sizes and the multiple years of recall, no child was
found to have drowned in a swimming pool. Pools are very rare in LMICs in Asia. They are usually
present in the capital city for use by the national swimming team, in private schools or in hotels that
cater to tourists. Given the scarcity of pools, an extremely small fraction of the child population is at risk
of drowning in a swimming pool.
Consequently, drowning prevention strategies for HICs that rely on the presence of lifeguards and pool
fencing will be ineffective in LMICs since the vast majority of child drowning occurs during nonrecreational
activity and in the normal course of their daily lives.
Traditional resuscitation practices are often harmful to children
In contrast to HICs, resuscitation skills at community level are rare in the LMICs surveyed. Figure 19
below shows the proportion of drowned children who received resuscitation.
30 Linnan, M., J. R. Wei and T. Reinten (March 2009). ‘Technical Report on Child Injury in Cambodia’, Report to UNICEF Cambodia. Bangkok: The
Alliance for Safe Children.
44