Child Drowning

Table 9: Number of children needed to achieve 50 per cent coverage of children at risk of drowning
5-17
population
50% SS coverage
over 5 years
No. of training deaths per year @
1:100,000 1:500,000 1:1,000,000
Bangladesh 41,231,000 4,123,100/year 41 8 4
Cambodia 4,068,000 406,800/year 4 1 -
China 240,567,000 24,057,000/year 240 48 24
Thailand 12,964,000 1,296,400/year 12 2 1
Viet Nam 18,795,000 1,879,500/year 18 4 2
Total 317,625,000 31,762,500/year 317 63 31
Source: Population numbers for children aged 5-17 from The State of the World’s Children 2012, UNICEF, February 2012, p.
108, table 6. Note: SS refers to the SwimSafe programme.
It is clear that at high training volumes, even very low adverse event rates result in substantial numbers
of children fatally injured. This mandates a process of evidence-based risk estimation followed by riskreduction
approaches to all aspects of swim teaching. The operational experience gained in SwimSafe
may provide such evidence for risk management. 54
3. Are the rescue skills taught effective and are they safe when used?
The safety and effectiveness of the rescue skills provided to the children was a key concern. Evidence
from drowning investigations in the surveys showed that traditional methods for rescue were
potentially harmful for the rescuer and that traditional methods of resuscitation were ineffective and
potentially harmful for the person resuscitated. The SwimSafe curriculum incorporates training in skills
necessary for safe rescue and also teaches children not to use harmful resuscitation practices.
A separate cohort study, the Risk and Rescue Study, has been underway. In July 2010 and April 2011,
monitoring cohorts made up of SwimSafe graduates of varying ages and both sexes were examined for
use of the rescue skills taught in the programme. They were asked for details of rescue activities done
after they graduated. For the July 2010 cohort, children taught safe rescue techniques reported having
used them at high rates. The rates were 6 per cent of children having engaged in a rescue since
graduation from SwimSafe, an average length of 1.7 years. This rate is substantially higher than children
graduating from swimming and water safety courses in HICs. 55 The majority of the rescues were inwater
rescues because the graduate was already in the water with the person in distress when the
rescue was conducted. Based on the evidence from this cohort, it appears that children in an LMIC who
are trained in rescue make use of the skills at significant rates and are able to conduct successful
rescues. 56
4. Does the completion of SwimSafe training lead to increased risk-taking in the water?
The protection of the programme from moral hazard was a key issue. In terms of drowning prevention,
moral hazard occurs if children who have learned survival swimming think they are completely
protected from drowning and consequently engage in high-risk behaviours that actually increase their
54 Rahman, A et al. ‘SwimSafe teaching tools: guidance for survival swimming to children in low and middle income countries’. In: Scarr et al (eds)
World Conference on Drowning Prevention, Danang, Vietnam, 2011. International Life Saving Federation, Leuven, p. 76 accessed at:
www.worldconferenceondrowningprevention2011.org.
55 Personal communication, Drowning Commissioner, International Lifesaving Federation.
56 Rahman, A. et al. ‘Rescue Rates following SwimSafe Training’. In: Scarr et al (eds) World Conference on Drowning Prevention, Danang, Vietnam,
2011. International Life Saving Federation, Leuven, p. 75 accessed at: www.worldconferenceondrowningprevention2011.org.
61