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Child Drowning

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implemented across collaborating institutions. There have been no injuries to date. 51 The PRECISE<br />

intervention development illustrates a number of these issues in relation to the safety of large-scale<br />

drowning prevention programmes, as discussed below.<br />

Placing large numbers of young children in the water when they cannot swim places them in jeopardy.<br />

Evidence-based methods allowed calculation of actual risks per child. An example is the method of<br />

setting the age of entry to SwimSafe. Growth and development curves for rural children were used to<br />

assess height and motor skills development by year of age. As a group, four-year-old children had<br />

achieved sufficient height to be able to stand and have their heads above the platform depth for the<br />

training ponds. Three-year-old children were not uniformly able to do so. Significant numbers were well<br />

below growth curve medians for both sexes and stunting was an issue regarding the standard platform<br />

height for the ponds. That resulted in the age cut-off for entry at 4 years. 52 Other evidence-based<br />

processes were used to estimate risk from other known conditions (such as epilepsy or congenital heart<br />

disorders) that lead to increased risk of drowning that were related to the children themselves.<br />

Principles of risk management set the training standards and certification for swimming teachers and<br />

teaching assistants, the maximum class size for children and minimum health standards for children at<br />

entry (e.g. no previous history of seizures or epilepsy). Best practices appropriate for rural Bangladesh<br />

set water quality standards and the length of training sessions. Supervisors for swimming trainers<br />

received specific training for effective supervision. Monitoring visits were recorded and reports<br />

reviewed periodically.<br />

The risk management approach recognized the potential for unintended adverse consequences due to<br />

the volume of children that would participate. While PRECISE was an operational research programme,<br />

it was structured to provide information on safety and hazard at high training volumes. Table 9 shows<br />

the number of children needed to be enrolled in SwimSafe over five years to achieve 50 per cent<br />

coverage of at-risk children in the countries surveyed. 53 It also shows the estimated number of deaths<br />

that would occur at different fatal adverse event rates.<br />

51 Rahman A et al Survival swimming – Effectiveness of SwimSafe in preventing drowning in mid and late childhood. In: Scarr et al<br />

(eds) World Conference on <strong>Drowning</strong> Prevention, Danang, Vietnam, 2011. International Life Saving Federation, Leuven, p 49<br />

accessed at: www.worldconferenceondrowningprevention2011.com; Rubin, T. et al. ‘SwimSafe – A survival swimming curricula’.<br />

In: Scarr et al (eds) World Conference on <strong>Drowning</strong> Prevention, Danang, Vietnam, 2011. International Life Saving Federation,<br />

Leuven, p 86 accessed at: www.worldconferenceondrowningprevention2011.org<br />

52 Biswas, A. et al. ‘Optimal Age to Learn Survival Swimming in Bangladesh’. In: Scarr et al (eds) World Conference on <strong>Drowning</strong><br />

Prevention, Danang, Vietnam, 2011. International Life Saving Federation, Leuven, p 50 accessed at:<br />

www.worldconferenceondrowningprevention2011.org<br />

53 The 50 per cent coverage level is the current estimate of the coverage levels needed for rapid and sustained reduction in<br />

drowning rates in children. It was arrived at by modeling the effects on country-specific drowning rates for the protection<br />

conferred by swimming to the child, the protection conferred on peers through the ability of the child to provide rescue (similar<br />

to the herd effect in immunizations) and the impact of parental knowledge from SwimSafe orientations and the social autopsy<br />

process for drowning deaths in older children.<br />

60

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