Child Drowning

EXECUTIVE SUMMARY
Childhood drowning in low- and middle-income countries (LMICs) in Asia has been greatly underreported
since the 1980s when efforts to estimate child mortality were accelerated. Beginning in 2001,
research conducted using large-scale surveys featuring direct interviews at households in the
community has demonstrated that drowning is a leading cause of death in childhood after infancy in
Bangladesh, Cambodia, China (one province and the capital, Beijing), Thailand and Viet Nam. This
finding represents a significant shift in the prevailing understanding of childhood mortality in LMICs in
Asia. It has led to trials of interventions that address the specific needs of LMICs. This research from
across the region is drawn together here for the first time.
Drowning is under-recognized
The very nature of drowning deaths has contributed to its absence from most sources of official data.
The contributing factors are mainly structural and cultural. They represent the difficulties of operating
in low-resource environments where data collection is limited due to an inability to measure mortality
that occurs outside hospitals and other health facilities. Generally, staff with the capacity to diagnose
and record the cause of death are only present in hospitals and clinics. But, a majority of drowning
deaths among children occur at home or in the community and drowned children are rarely brought to
a health facility. The traditional reliance on facility-based reporting has meant that causes of death that
result in immediate or very rapid death such as drowning are rarely seen or known about at the
hospital or facility that submits death reports. In LMICs, in addition to the evident futility of going to a
health facility because the child is already dead, societal factors ranging from financial considerations to
a fear of punitive legal implications for the persons reporting the drowning reduced the number of
incidents reported at health facilities to around 20 per cent in all countries surveyed. Factors such as
distance to health facilities and lack of transportation were also major impediments to reporting.
Without the data being captured at the local level, it is not represented in national reports. Thus, child
drowning has remained undetected as a significant health issue.
Previous surveys have had major limitations that have also served to mask the scope of the issue. These
include: small sample sizes; unrepresentative samples; poorly defined populations; short survey time
frames; definitional inconsistencies; lack of detail on antecedent events or risk factors; and different
recall periods, all of which limited researchers’ ability to establish the scale of the issue or to compare
drowning rates.
The absence of drowning as a cause of mortality and morbidity in statistics captured at local level
ensures its absence from national data. Consequently, drowning is not fully reported to the World
Health Organization (WHO) and is therefore under-represented in the global mortality database. As an
example, a 2005 assessment of the data supplied by WHO’s 192 member countries, 114 had either no
drowning data available or no data more recent than 1990 to report.
The structure of the International Classification of Diseases (ICD) reporting system also hinders capture
of drowning deaths in official statistics. While the classification is effective at recording information
relevant to high-income countries (HICs), the coding options make inclusion of relevant detail in LMICs
difficult. Many of the categories in the ICD refer specifically to recreational activities that have little or
no relevance to LMICs, such as scuba diving and water skiing. In addition, staff at the local level that are
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