Posted by: tommecrow | February 5, 2015

Does teaching children to swim increase exposure to water or risk-taking when in the water? Emerging evidence from Bangladesh

Teaching swimming potentially increases risk if it increases water exposure or high-risk practices in water. Our study at the International Drowning Research Centre – Bangladesh compared water exposure and risk practices for SwimSafe graduates (SS) with children who learned swimming naturally.

Bangladesh is a country inundated with ponds, bisected by rivers and has one of the longest stretches of coastal beach in the world. Piped household water is generally confined to the cities, and because of this rural households are located close to easily accessible open water sources that can be used for everyday activities (such as bathing, cooking and cleaning). Perhaps unsurprisingly, childhood drowning is commonplace. However despite the dramatic progress made in tackling communicable disease in Bangladesh over the past 20 years, rates of drowning have continued to stay steady. Perhaps surprisingly, drowning is currently the leading cause of childhood death in Bangladesh.

Following a large scale study a high proportion of drowning deaths were shown to be in children who were unable to swim. However, there was previously no conclusive evidence to show teaching a population to swim would decrease their risk of drowning. Counter intuitively, some public health researchers worried that teaching swimming could increase a populations’ risk of drowning as more people entered the water and took greater risks, or drowned whilst learning to swim.

Children in Bangladesh learning how to swim using the SwimSafe programme.

Children in Bangladesh learning how to swim using the SwimSafe programme.

In an attempt to draw conclusions, a study was undertaken. The SwimSafe programme – which consists of swimming and safe rescue curriculum – was developed (by CIPRB, RLSSA and TASC) and taught to thousands of children in an injury surveillance area set up by CIPRB in Bangladesh. The study showed that teaching children how to swim reduced their relative risk of drowning by 92%. An amazing find, considering that drowning is the leading cause of childhood death in Bangladesh.

However, there was still an issue. Naturally acquired swimming ability (learning from friends, family etc) is high in Bangladesh, and even a targeted large scale swim programme would no doubt include those who could already swim. What if children who already knew how to swim undertook the SwimSafe programme? Could their risk be increased? Would they be more likely to enter the water for recreational activities, in addition to the day-to-day essential activities already undertaken?

To better understand the issue the International Drowning Research Centre Bangladesh (IDRCB) conducted a study of nearly 4000 children who had previously undertaken the SwimSafe programme, and matched them by age and sex to children who had acquired swimming skills naturally. We looked at the number of times the children entered the water in the 48 hours prior to survey completion, why they entered the water, and who they entered the water with.

Our results – recently published in Injury Prevention – showed there were 9741 entries into water among the 7046 participants in the 48 hours prior to interview. About one-third had no water entries, one-tenth entered once, and a tenth entered three or more times. Proportions of children in each group were similar. About 99.5% of both groups only entered the water for bathing. For those entering to swim or play, the mean number of entries was similar (SS 1.63, natural swimmer (NS) 1.36, p=0.40). Swimming or playing alone in the water was rare (1 SS, 0 NS).

What did the results tell us? Well, firstly they highlight the necessity of entry into open water for children in rural Bangladesh. In both groups nearly all entries into water were for bathing. Contrast this to open water use in high-income countries (HICs) where open water is largely used for recreational purposes and you can start to understand how the epidemiology of drowning in LMICs varies significantly from HICs, and how public health interventions to reduce rates of drowning are likely to be quite different.

Secondly, the data suggests that attending the SwimSafe programme does not increase exposure to water for children who have already learned to swim naturally. Although further research is always needed, the results provide evidence to suggest that expansion of the SwimSafe programme does not impede on the ‘do no harm’ principle enshrined within development and public health programming.

 

Download the full article from Injury Prevention: Tom Mecrow, Michael Linnan, Aminur Rahman, Justin Scarr, Saidur Rahman Mashreky, Abu Talib, AKM Fazlur Rahman, Does teaching children to swim increase exposure to water or risk-taking when in the water? Emerging evidence from Bangladesh, Inj Prev 2015 Jan 7. Epub 2015 Jan 7. 

Note: This post does not necessarily reflect views of co-authors. Please read the full article for methodology and a comprehensive discussion of the data.


Responses

  1. It is true that thousands of children in our country are drowning in every year but it is bad luck that our govt don’t care about that. Although it is a revering country.Only IDRCB take and attention about that. Thanks to IDRCB.


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