Child Drowning
Child Drowning Child Drowning
5. BUILDING A GLOBAL PLATFORM FOR DROWNING PREVENTION Drowning is a significant, preventable cause of death among children in LMICs. The challenge is to transform this previously unidentified public health issue from a neglected issue to one addressed by national, regional or global level programmes. The challenges include: Scaling-up a package of effective drowning interventions into national, regional and global programmes. Building drowning prevention capacity at all levels of the development continuum. Stimulating and sustaining investment in drowning prevention interventions and activities. Managing the shift from a scarcity of funds to a programme of well-targeted and coordinated investments. Incorporating research into programme design and implementation. The process must recognize the considerable differences between implementing drowning prevention strategies in LMICs as compared to HICs. In the latter group of countries, lifesaving agencies, drowning prevention councils and governments provide a strong platform for drowning prevention. This capacity is lacking in LMICs and requires that drowning prevention efforts focus for the time being on the community, home, family and individual, while the necessary social, governmental and governance structures are developed. 5.1 SCALING-UP DROWNING INTERVENTIONS INTO NATIONAL, REGIONAL AND GLOBAL PROGRAMMES Reduction of each major cause of early child mortality required effective interventions delivered on a large, population-based scale in rural LMICs. Earlier interventions such as immunizations, breastfeeding and oral rehydration therapy were developed and shown to be effective at low cost. Sustained use of these interventions then led to the decline in early child mortality in LMICs. A reduction in drowning in LMICs should be no different. Research from PRECISE demonstrates the efficacy and cost-effectiveness of a number of key drowning interventions. While each intervention has individual promise and application, it is important to note that they were designed and delivered as part of an integrated package of drowning interventions within a community. In terms of cost-effectiveness and the number of child deaths prevented, this package compared favourably to other child survival interventions. Adopting an integrated approach has helped address many of the challenges for implementing drowning interventions at a community level. When viewed as an integrated package of drowning interventions, several factors should guide future programme expansion. These factors include the role of the community in identifying drowning risk and selecting or initiating interventions, the need to respond to drowning risk across age groups with a range of interventions rather than any single measure, and the need for the types of supporting community-based systems often found in larger scale community development interventions. Such an integrated package is reliant on both the strength of the individual interventions and the degree to which community acceptance and support for implementation has been achieved. Not visible, but equally important, are the supporting mechanisms, 68
systems and standards, and management and community development approaches that are responsible for the successful implementation of the package. The PRECISE programme involved a large number of participants in the implementation component of the field study. These participants were grouped into three areas: Those responsible for delivering the interventions (i.e. the SwimSafe instructors and Anchal crèche workers); Those responsible for management and implementation of the programme (i.e. the managers and field staff); and The community level partners (i.e. local government authorities, community health clinics, NGOs, schools and landowners). Recognition of the role of the latter two groups in the integrated community drowning prevention package helps inform ways of moving forward with national drowning prevention programmes. The coexistence between the integrated package of drowning interventions and community-level strategies adopted in the child survival revolution (i.e. those strategies used for other child health interventions) is not only feasible but necessary. Both sets of interventions require significant investment in community development infrastructure and a workforce attuned to the needs of the community and experienced in working with parents, children and community leaders. At the national or sub-national level, there is an overlap between the sort of infrastructure, systems and approaches used by existing development sectors, and that required to implement effective and sustainable drowning prevention programmes. Incorporation of the integrated package of drowning interventions with other development programmes provides benefits for national expansion, including: Reducing intervention costs and increasing efficiencies by using existing infrastructure (implementation, management and surveillance) at community, sub-national and national levels. Increasing the rapid scale-up of programmes through use of existing community partnerships. Strengthening other interventions by providing a vehicle for delivery of a range of health interventions is both effective and sustainable, as shown by the evidence on the village crèche model. The health sector is just one development sector where investments in drowning prevention may coexist. Opportunities in other sectors, including disaster risk reduction, water and sanitation and rural development, warrant further exploration. Anecdotally, there is some recognition of the severity and importance of addressing drowning by programme experts in these sectors. For example, some disaster risk reduction programmes, particularly those focused on community-based disaster risk reduction, have implemented survival swimming, rescue and resuscitation programmes. Rural development programmes in the Mekong Region of Viet Nam, for example, have supported local swimming education for children. The challenge for drowning prevention is to provide a platform where such approaches are strengthened, monitored for safety and linked to national drowning prevention programmes. 69
- Page 17 and 18: Proportion of drowning Figure 1: Dr
- Page 19 and 20: In high-income countries (HICs), be
- Page 21 and 22: Table 2: ICD-10 drowning (1997) W65
- Page 23 and 24: - had no data reported, or none rep
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- Page 27 and 28: A combination of these approaches i
- Page 29 and 30: Mortality rate/1,000 Drownng propor
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- Page 35 and 36: Cumulative proportion Drowning rate
- Page 37 and 38: Table 6 shows the severity of the n
- Page 39 and 40: Bangladesh Jiangxi China Cambodia B
- Page 41 and 42: 1. Drowning risks are higher when c
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- Page 49 and 50: esult, children fall in and drown,
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- Page 57 and 58: Mortality Rate (per 1,000) Figure 2
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systems and standards, and management and community development approaches that are<br />
responsible for the successful implementation of the package.<br />
The PRECISE programme involved a large number of participants in the implementation component of<br />
the field study. These participants were grouped into three areas:<br />
Those responsible for delivering the interventions (i.e. the SwimSafe instructors and Anchal<br />
crèche workers);<br />
Those responsible for management and implementation of the programme (i.e. the<br />
managers and field staff); and<br />
The community level partners (i.e. local government authorities, community health clinics,<br />
NGOs, schools and landowners).<br />
Recognition of the role of the latter two groups in the integrated community drowning prevention<br />
package helps inform ways of moving forward with national drowning prevention programmes.<br />
The coexistence between the integrated package of drowning interventions and community-level<br />
strategies adopted in the child survival revolution (i.e. those strategies used for other child health<br />
interventions) is not only feasible but necessary. Both sets of interventions require significant<br />
investment in community development infrastructure and a workforce attuned to the needs of the<br />
community and experienced in working with parents, children and community leaders. At the national<br />
or sub-national level, there is an overlap between the sort of infrastructure, systems and approaches<br />
used by existing development sectors, and that required to implement effective and sustainable<br />
drowning prevention programmes.<br />
Incorporation of the integrated package of drowning interventions with other development<br />
programmes provides benefits for national expansion, including:<br />
Reducing intervention costs and increasing efficiencies by using existing infrastructure<br />
(implementation, management and surveillance) at community, sub-national and national<br />
levels.<br />
Increasing the rapid scale-up of programmes through use of existing community<br />
partnerships.<br />
Strengthening other interventions by providing a vehicle for delivery of a range of health interventions<br />
is both effective and sustainable, as shown by the evidence on the village crèche model. The health<br />
sector is just one development sector where investments in drowning prevention may coexist.<br />
Opportunities in other sectors, including disaster risk reduction, water and sanitation and rural<br />
development, warrant further exploration. Anecdotally, there is some recognition of the severity and<br />
importance of addressing drowning by programme experts in these sectors. For example, some disaster<br />
risk reduction programmes, particularly those focused on community-based disaster risk reduction,<br />
have implemented survival swimming, rescue and resuscitation programmes. Rural development<br />
programmes in the Mekong Region of Viet Nam, for example, have supported local swimming education<br />
for children. The challenge for drowning prevention is to provide a platform where such approaches are<br />
strengthened, monitored for safety and linked to national drowning prevention programmes.<br />
69
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