Child Drowning

3. EVIDENCE FOR PREVENTION
It is often stated that the principles of prevention are the same among all population groups, whether in
LMICs or HICs, and that it is only a matter of adapting what works in HICs to the context of LMICs.
However, adaptation must be both thoughtful and extensive given the different societal contexts and
norms. Given the many significant differences, it may not be possible. Examples of these differences are
as follows:
In LMICs, interventions that seek to reduce the scale of water hazard exposure by changing
the external environment are likely to be unsuccessful. Because social and behavioural
norms have evolved over time, water bodies are not viewed as hazards. They are seen as
necessary and convenient water sources for daily activities such as bathing, drinking and
cooking. The changes required both in terms of raising awareness of risk and in
implementing drowning prevention measures such as teaching survival swimming 38 and
safe rescue skills, will need to be on a societal scale, but the necessary human and financial
resources are lacking.
For the most part, LMICS do not have strong civil governance structures. Interventions that
are dependent on these structures, which include laws, regulations and enforcement, will
be unsuccessful. Examples of successful interventions in HICs are zoning residential areas to
restrict access to water hazards; and removal of water hazards through declarations of
public nuisance/hazard.
Interventions that depend on emergency medical response to the drowning child are not
possible as such systems do not exist in the rural areas where the vast majority of child
drowning occurs. An adapted response could possibly entail providing emergency medical
services outreach from hospitals, or other first response systems tied to health facilities in
some middle income countries. However, the vast majority of the rural population lives far
from available facilities. The need for very rapid responses to drowning means these
adaptations will not provide significant coverage to the populations at risk of drowning.
Rural communities lack sufficient capacity to provide resuscitation such as bystanderprovided
CPR for drowning children. In low income countries, illiteracy is common and low
educational attainment among the majority of the population presents major barriers to
developing CPR skills. Additionally there are fundamental differences in the contexts of
child drowning. Children are most often alone or with a peer who also lacks survival
swimming and safe rescue skills. This differs markedly from HICs, where peers and
bystanders are often trained in rescue and resuscitation of drowning victims.
Much of the progress in reduction of drowning rates in HICs has resulted from a multisectoral approach
that depends on established human and institutional capacity. This is not present in LMICs. The question
then becomes whether drowning interventions that are effective in HICs can be adapted to be effective,
low cost and sustainable while providing population coverage in LMICs and is addressed in the next
section.
38 Survival swimming as used in this paper means a minimum level of swimming ability, i.e. the ability to move through the water unassisted for a
distance of 25 metres, float for 30 seconds.
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