Child Drowning

aware of the drowning lack the specialized training to report the death using the complex codes
required. The few staff that have the necessary training and certification are only available at top-level
referral hospitals, but do not receive reports from the community-level facilities where the drowning
occurs.
The ICD structure also requires that drowning be reported in relation to place and circumstances of
occurrence, rather than in one single category named ‘drowning’. There are separate categories for
drowning that occurs, for example as a result of transport (boat/ship sinking); forces of nature (floods,
typhoons) and intentional injury (suicide/homicide). These categories are not counted as drowning in
the WHO global statistics. Excluding these drowning cases from the WHO Mortality Database and the
Global Burden of Disease (GBD) analysis has resulted in further underestimations of the true scale of
the problem.
Drowning – Not newly occurring, just newly recognized
Given the lack of recognition of drowning, it would be easy (but incorrect) to assume that it is a new
issue that has emerged due to gains in other areas of public health in Asian LMICs, such as increasing
control of respiratory infections and diarrhoeal diseases. Drowning has always occurred at high levels
even as these other causes of mortality have been reduced through large-scale interventions. In
Bangladesh, for example, data collected in ongoing research over the past three decades through the
Matlab Demographic Surveillance System show the presence of drowning at rates similar to those
reported in household surveys. However an intense focus on communicable diseases has led to
drowning being largely overlooked.
Communicable disease deaths that occur over a period of days are better reported and are much easier
to convey to the general public and potential donors than drowning deaths, which occur in minutes and
are infrequently reported. Public awareness campaigns for communicable disease have been
extraordinarily effective at mobilizing resources, in part because of the immediate and visible link
between illness and prevention or treatment options. In contrast, drowning seems to provoke a sense
of powerlessness and fatalism that may be in part responsible for the lack of awareness-raising
campaigns.
The nature of drowning has thus ensured that despite being an ongoing public health issue, it has not
received the same attention as other leading killers of children. As a result of this neglect, while the
overall rate of drowning has remained stable, the rapid decrease in communicable disease deaths has
resulted in drowning now becoming a large proportion of all causes of child death. In the Matlab
research area in Bangladesh over the past twenty-five years, drowning has gone from being responsible
for less than 10 per cent to over 50 per cent of all child deaths among children aged 1-4, making it a
leading cause of death in early childhood. Without intervention strategies being scaled up, LMICs in
Asia that are not on track to achieve MDG 4 (a two-third reduction in the under-five mortality rate) may
struggle to achieve it.
One conclusion is that in Asian LMICs – the region contains two-thirds of the world’s children −
drowning is an urgent health policy priority. Addressing it will facilitate achievement of the MDG on
reducing child mortality.
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