Child Drowning

3.1 ADAPTING PROVEN HIC INTERVENTIONS TO LMIC SETTINGS
The 2008 WHO/UNICEF World Report on Child Injury Prevention identified four interventions that were
deemed to have sufficient evidence for effectiveness, or were judged to be promising in the context of
HICs. The four key strategies that were listed as effective were: 39
Removing (or covering) water hazards.
Requiring isolation fencing (4-sided) around swimming pools.
Wearing personal flotation devices.
Ensuring immediate resuscitation.
Only the first, removing or covering water hazards, is potentially feasible in the setting of an LMIC. The
experience gained from intervention research carried out so far in Bangladesh, Thailand and Viet Nam
predicts that such steps will only be feasible in urban areas and that they will not work in rural areas
where ponds are ubiquitous and in frequent daily use. The second strategy of installing fences is not
viewed as a viable solution in LMICs. Fences are expensive, subject to theft, require maintenance and
create inconvenience. They require opening gates or relocating access paths, thus impeding convenient
access to water sources. Many bodies of water are too large to fence, and others such as rivers cannot
be surrounded by a fence.
The other three strategies are unlikely to be feasible or sustainable in the low-resource settings of the
countries surveyed.
Four-sided fencing of swimming pools: For the most part swimming pools do not exist in
LMICs outside the capital city and in private settings. The equivalent recreational venue in
LMICs would be a pond, lake or river, where fencing is impractical and has several negative
associations that reduce their use and level of effectiveness.
Personal flotation devices: These are rarely available as they are viewed as inconvenient,
costly and are likely to be stolen.
Ensuring immediate resuscitation: The surveys document that effective bystander CPR skills
are essentially non-existent in LMICs, and that there are significant barriers to training and
use, especially in low-literacy environments.
Two additional interventions were deemed to be promising in the World Report on the basis of
evidence available:
1. Ensuring the presence of lifeguards at swimming areas.
2. Conducting targeted awareness-raising on drowning.
In the countries surveyed, due to both the number and type of water bodies used for swimming
(thousands of ponds in close proximity to rural homes) the use of lifeguards is not feasible. Also lacking
are water safety professionals to train the lifeguards, and funds to pay them even if such training were
possible.
Only the second strategy, targeted awareness-raising on drowning, may be appropriate for use in
LMICs. However in order to be implemented, the health community first needs to recognize that child
39 Peden, M. et al. eds. (2008). World Report on Child Injury Prevention. Geneva: World Health Organization, p. 73, table 3.4.
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