Child Drowning

programme called SwimSafe, 46 which taught water safety, safe rescue and survival swimming in the
village pond, which had been converted into a safe training site.
Both programmes sharply reduced drowning deaths in each age group. Drowning death rates in children
who attended the Anchal crèche were 82 per cent lower than non-attending control children. Fatal
drowning rates in children who participated in the SwimSafe intervention were 93 per cent lower than
non-participating children in the control group, both large and statistically significant reductions. 47
Cost-effectiveness was calculated according to WHO-CHOICE guidelines (CHOosing Interventions that
are Cost Effective) by determining the numbers of deaths averted, the number of disability adjusted life
years averted (DALY) and the cost associated with preventing the deaths. Implementing both the
community crèche and SwimSafe programmes together in rural Bangladesh would result in over
196,000 deaths prevented at a cost of $12,596 per death prevented and $362 per DALY averted. These
costs compare favourably with the costs of preventing other causes of child mortality such as
respiratory infections and diarrhoeal disease in the same region. 48
3.4 KEY RELATED EVIDENCE FOR PUBLIC HEALTH INTERVENTIONS
The PRECISE cohort study of survival swimming was designed to provide evidence that equipping
children with survival swimming skills reduced drowning mortality. It was designed to provide evidence
on four key questions; one regarding effectiveness and three regarding safety. The findings below
represent preliminary answers from the ongoing research:
1. Is the protection from drowning effective across all ages and both sexes for the drowning
environment normally encountered in a rural LMIC?
The case control studies done earlier included only specific age groups and had relatively small sample
sizes. Because of the study design, the drowning cases were children with the highest likelihood of
drowning, which meant that factors that increased the risk of drowning, such as younger age, being
male and being at highest risk of water hazard exposure, would be over-emphasized. A different
research design was therefore required to provide better answers to the question.
The PRECISE cohort study in rural Bangladesh had three separate geographic sites to include the
broadest range of water hazard exposures encountered in daily life. These were similar to the rural
drowning environments in the other countries surveyed. The large size of the cohorts (66,000 children),
the long duration (four years) and the criteria for inclusion of all children in the three areas, ensured
that children of all ages, both boys and girls, and the spectrum of daily water hazard exposures were
included.
46 SwimSafe is a regional programme developed by TASC, RLSSA and local partners in Bangladesh, Thailand and Viet Nam. Details
are available at http://swimsafe.org/about-swimsafe/swimsafe-history/. SwimSafe Bangladesh was developed in 2005 by the
Centre for Injury Prevention, Bangladesh, RLSSA, and TASC with assistance from the Bangladesh Swim Federation. UNICEF
Bangladesh funded the inclusion of SwimSafe as the survival swimming component of PRECISE. Following completion of the
PRECISE project, SwimSafe Bangladesh has continued as a joint programme overseen by CIPRB with TASC and RLSSA assistance
and with UNICEF Bangladesh providing funding for continued training.
47 Linnan, M. et al. ‘Child Drowning in Asia – from evidence to action’ in: Scarr et al (eds), World Conference on Drowning
Prevention, Danang, Vietnam, 2011. International Life Saving Federation, Leuven, p 29; accessed at:
www.worldconferenceondrowningprevention2011.org.
48 Finkelstein E. et al. ‘The cost of reducing drowning in rural Bangladesh and implications for governments, policy makers and
donors’. In: Scarr et al (eds), World Conference on Drowning Prevention, Danang, Vietnam, 2011. International Life Saving
Federation, Leuven, p 30; accessed at: www.worldconferenceondrowningprevention2011.org.
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