Posted by: tommecrow | August 20, 2011

Drowning in Bangladesh

So after being here for a year, and with only a few months left in Bangladesh, I thought it would be a good idea to tell people what I do here (because some people still don’t have a clue).

Drowning is the leading cause of childhood death in Bangladesh (between the ages of 1-17). My Dhaka friends are a bit sick of me telling them this, but it’s still a hugely under-recognised problem.

So we (my organisation, the Centre for Injury Prevention and Research Bangladesh) are looking at interventions to reduce the high rate of fatal drowning (death rate currently approximately 85/100,000 in children aged 1-4).

In children over the age of 5 we’re looking at teaching survival swimming skills as an intervention.  Prior to the studies done in Bangladesh there had been no studies conducted looking at the association between swimming and drowning. In fact, it was suggested that teaching someone how to swim might actually increase their risk of drowning due to ‘moral hazard’; they might be more inclined to undertake risky swimming behaviour  due to increased confidence in the water. In some states in the US the moral hazard worry actually led to the suspension of a state wide swimming program because public health experts in the government were so worried they might inadvertently increase drowning rates.

In most high-income countries it would be impossible to study the association between swimming ability and drowning because there are so few drownings that take place. In Bangladesh over 18,000 children drown each year, and there are many children who are unable to swim. The Centre for Injury Prevention and Research Bangladesh (CIPRB) have trained over 100,000 children how to swim since 2005. They have been following all the children they have trained and have been monitoring their rate of drowning. For each child that can swim they have control children matched by age and sex.

Results have shown that rates of drowning in SwimSafe swimmers are 95% lower than in the control groups.  This is the first ever research to draw causation between swimming ability and drowning.

One of the research projects I’m doing at the moment is a follow up from this study. We now know that children who can swim are less likely to drown than children who can’t swim. But what about those children who can already swim? A large proportion of children in Bangladesh learn swimming ‘naturally’ from their peers. By giving them extra swimming skills could inadvertently we be putting them at extra risk? It’s the whole Moral Hazard question all over again. If they are put at extra risk (even if this risk is small) then this could have a huge impact on the numbers of children drowning if swimming lessons were to be rolled out nationally.

I’ve been involved in running and analysing data from a study of  over 25,000 children in Bangladesh, looking at their swimming ability and their number of entries into water over the previous 48 hours. I’ve just finished the analysis and it looks like there is no difference in risk taking behaviours between children who have learnt how to swim in the SwimSafe program and those who have learnt naturally from their peers. We’ll be publishing the results soon, but in our small drowning community this is big stuff. It shows that by rolling out a national swimming program to all children over the age of 4 we could reduce drowning rates in this age group by 95%. This would have a huge impact on Bangladesh reaching it’s millennium development goals in reducing childhood mortality.

In children under the age of 5 we have shown that by introducing a simple day-care scheme between the peak drowning hours of 9am-1pm (when mothers are cleaning and preparing food for the day) rates of drowning can be reduced by 85%. Not only this, but it also has a significant effect on all other types of injury, and even seems to have an effect on reducing communicable disease!

Both interventions have had an independent cost effectiveness analysis done on them. Both are considered to be ‘very cost effective’ by WHO guidelines.

I’m also working on the rollout of a community based First Responder program. There has been no evidence of the effectiveness of CPR in developing countries, or even the feasibility of introducing community based responder schemes. We’re training 2,400 people in CPR and First Aid.

One of the biggest problems we’re finding is the cultural acceptance of CPR. In a conservative Muslim country like Bangladesh it’s difficult to convince someone to do ‘mouth to mouth’ on someone, particularly if they are of the opposite sex. We’ve been asking questions on peoples perception of CPR, their willingness to perform it, and the retention period of their skills. We’re about 1/2 way through the program now, and are currently entering the data for the past 6 months into a database for analysis.

I’m also doing some other stuff with portable swimming pools. I’ll tell you about that next time because my fingers hurt.


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