Posted by: tommecrow | August 25, 2016

Why girls and women should wear what they want to the beach

In a world where over 372,000 people drown each year, it seems strange some areas in France have banned the burkini from beaches. Denim jeans and a woolly jumper, comparatively unsafe swimwear, have not been banned.

In areas where Muslim women and girls have traditionally faced cultural and social obstacles to learning life saving swimming skills, the burkini, along with new swimming teaching programmes, have provided safer opportunities to learn such skills.


Girls in Zanzibar learning to swim with the Aquatic Survival Programme (RNLI/Panje) 

Learning to swim is an important life skill and being able to enjoy the water and natural environment is not a pleasure that should be restricted to a select few, wearing the clothing which a culture or country deems ‘appropriate’.

The burkini has been banned for being an item associated with ‘terror’, but it was designed to be “worn by all women no matter what race, religion, shape, colour and for what ever reason” – Aheda Zanetti, designer of the burkini.

Women and girls should be able to learn to swim, and go to the beach, and wear what they want in the water, burkini, bikini, or no bikini.


Written by Tom Mecrow and Hannah Marsden

Posted by: tommecrow | August 11, 2016

Entrepreneurs for children


Making an impact in the lives of children – that is the passion that drives Felix Uzor and Serwaa Quainoo.

Felix Uzor runs the Felix Fitness Center, a sports company. The proceeds of his business go into his foundation, the Felix Foundation which undertakes school water safety educational programs, especially in flood prone areas.

“Drowning is the third leading cause of accidental deaths around the world. The situation in Ghana is under-reported, thus the need to set up this foundation to take children through anti-drowning and safety measures”, Felix told Daryl Kwawu.

On the other hand, Serwaa Quainoo or Aunty Serwaa as she is popularly called has devoted her life to caring for children with autism. Her business started from what appeared at first a misfortune- a son with autism. Today she runs the Autism Awareness, Care and Training Center which provides training and educational services to children with autism…

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A study describing the causes of death from a Health and Demographic Surveillance site in Dande, Angola has just been published. The data – collected using verbal autopsy – suggests that drowning is the 3rd leading cause of death in children aged 5-14, above malnutrition, and the 6th leading cause of death in children aged 1-4.

Although not nationally representative, the study provides a rare glimpse into the burden of drowning in rural areas of Africa. The WHO estimates that Africa is the continent with the highest rate of drowning, yet data on drowning in Africa is limited. Poor vital registration systems mean most drowning deaths go unrecorded. This study uses verbal autopsy to identify drowning deaths, a research method that helps determine probable causes of death in cases where there was no medical record or formal medical attention given.

Read the full article:

Rosário, Edite Vila Nova, et al. “Main causes of death in Dande, Angola: results from Verbal Autopsies of deaths occurring during 2009–2012.” BMC Public Health 16.1 (2016): 1.

New figures released today (July 29) reveal that 321 people lost their lives in accidental drownings in the UK in 2015. The figures, published by the National Water Safety Forum (NWSF), also show that the majority of those who died did not intend to be in the water, with 82 people having drowned while walking […]

via Figures reveal 321 people died in accidental drownings in 2015 — National Water Safety

Posted by: tommecrow | October 15, 2015

Would you be willing to give mouth-to-mouth ventilations?

Due to the likelihood of a drowning victim being submerged under water for a significant period of time, resuscitation protocol for drowning victims emphasises the importance of ventilating a casualty (providing ‘air’) alongside chest compressions. In non-submersion related instances of cardiac arrest research suggests that in many cases oxygen levels in the body will still be high enough for compression only CPR to be effective.

In most circumstances drowning events are attended by by-standers unequipped with medical equipment. In low-income countries – where professional first response systems are almost non-existent – there is virtually no opportunity for professional medical assistance during an emergency.

Therefore ventilations for drowning victims will nearly always have to be done using mouth-to-mouth techniques that result in physical contact between the lips of one person and another.

Students in Raigonj, Bangladesh learn CPR on the First Responder program

Students in Raigonj, Bangladesh learn CPR on the First Responder program

There has been a fair amount of research on the willingness of people to do mouth-to-mouth ventilations, yet almost all of the existing literature is based on data from high-income countries where drowning rates are relatively low and first responder services generally arrive within minutes.

In Bangladesh drowning is the leading cause of childhood death. At the IDRC-B we have previously published a paper exploring the feasibility of implementing a large scale CPR programme for drowning prevention in a rural district of Bangladesh. The study examined the learning process and retention of knowledge among course participants. Our findings suggest that implementation may be feasible within certain sub-groups of the population.

But even if implementation were feasible, and course participants could retain their skills, the biggest question remains.. in a conservative society, would people put their lips on someone else’s to give ventilations?

To explore the issue in more detail we conducted a study that described hypothetical scenarios to course participants involving situations where they would have to give ventilations to family members, friends and strangers; and measured their ‘willingness’ to do so.

721 people took part in the study. The results were fascinating. We found that willingness to deliver mouth-to-mouth ventilation was heavily influenced by the sex of a potential recipient and their relationship to the trainee. Although ‘willingness’ was highest if the hypothesised victim was an immediate family member (as you would expected), we found significant differences in a persons willingness to give ventilations to a person of the opposite sex (whether close family or not).

Further qualitative research is needed to explain why willingness to give mouth-to-mouth ventilations varies so significantly. Studies from high-income countries suggest that fear of infection is most likely to put people off, yet in Bangladesh our participants noted cultural values (particularly the notion of ‘respect’ to the elderly) as being key drivers.

The results suggest that significant cultural barriers need to be overcome in order to for a community first responder programme for drowning to be feasible in rural Bangladesh. Community education and sensitisation programmes should be developed to highlight the importance of ventilations for drowning victims and normalise the concept of giving mouth-to-mouth ventilations to someone of the opposite sex.

You can read the full article for free in the journal BMC International Health and Human Rights:

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.

Posted by: tommecrow | November 24, 2014

Is teaching CPR appropriate in a low-resource environment?

Our article entitled ‘Feasibility of a CPR programme in Rural Bangladesh’ was recently published in the journal ‘Resuscitation’.

The publication was a result of a large research project in Bangladesh by the International Drowning Research Centre (IDRC-B) to investigate the feasibility of implementing a CPR training programme at the community level, with the aim of reducing deaths due to drowning – the leading cause of childhood death in Bangladesh. The World Health Organisation Drowning Report recently recommended lay people be trained in CPR as a drowning prevention intervention.

Key questions included:

  • Are currently available training materials suitable for the low-resource context?
  • For how long will participants retain their knowledge? Is retraining in this time-scale feasible given the rural nature of the programme?
Students in Raigonj, Bangladesh learn CPR on the First Responder program

Students in Raigonj, Bangladesh learn CPR on the First Responder program

The programme provided CPR and basic First Aid training to 2,398 participants over a 14 month period, in the rural community of Raigonj.  Participants came from a wide range of backgrounds including students, community leaders and local businessmen. Very few had any previous first aid experience, and non had any previous experience in CPR.

Programme material was developed following wide ranging review of training literature developed almost exclusively for use in high-income and high-resource areas. Of key concern were:

  • The lack of recommendations for when to stop delivering CPR: Vigilante attacks in Bangladesh are common, and there is a lack of ‘good Samaritan’ laws commonly found in high income countries. There was a worry that responders might be put at risk after delivering CPR, particularly if the casualty died. A high level group of cardiac experts from Bangladesh were consulted, and consensus was agreed that a 30 minute ‘cut off’ would be appropriate for responders to cease delivery of CPR.
  • The lack of low literacy materials: Nearly all materials reviewed were targeted towards people with high literacy. Training materials including posters, videos and a picture based manual were developed in Bangla and tested for contextual relevance.


Almost 90 per cent (88.4) of participants qualified in post training assessment. Adolescents and community volunteers had higher pass rates than community elders. In all, CPR skills showed a significant decline over 9 months of assessment, while first aid knowledge appeared stable over the same period. Community leaders considered the programme useful for the community and expressed their support for the programme.


Our research suggested that CPR training is feasible in the rural Bangladesh context, if participants have secondary school attainment. Further research is needed to see if the training results in a reduction in drowning deaths, however early reports from the ongoing monitoring system suggests that a number of lives have already been saved due to the intervention.

Get the full article here:

A new report published this week by the US Centre for Disease Control (CDC) highlights the disparity in rates of drowning between racial/ethnic groups in the USA.

The report highlights that rates of drowning are highest in American Indians/Alaskan Natives, who are twice as likely to drown as their white peers.

Astonishingly the report also highlights that blacks aged 5-19 years are 5.5 times more likely to drown in a swimming pool than their white peers.

The report concludes that these rates may be much higher, as exposure to water was not measured as part of the study.


The figure shows rates of fatal unintentional drowning among persons aged ≤29 years, by year of age and selected race/ethnicities in the United States during 1999-2010. Racial/ethnic differences in overall drowning rates varied by each year of age.

FIGURE 1. Rates of fatal unintentional drowning among persons aged ≤29 years, by age and race/ethnicity* — United States, 1999–2010. Source: Morbidity and Mortality Weekly Report, CDC, May 16, 2014 / 63(19);421-426

Causation for the disparity were not measured as part of the study, however previous studies have suggested opportunities to learn swimming skills may be differ between racial/ethnic groups.

The authors recommend teaching survival swimming skills as a drowning prevention strategy.

Posted by: tommecrow | May 15, 2014

Report on drowning deaths in Fiji

Nice report on drowning in Fiji.

Looking at statistics it’s easy to forget the impact that a preventable death has on a family and community.

Posted by: tommecrow | May 15, 2014

WHO: Drowning a leading cause of adolescent death

WHO: Drowning a leading cause of adolescent death

The World Health Organisation have today published a new report on the state of adolescent health.

The report highlights drowning as a leading cause of adolescent death:

“Drowning is also a major cause of mortality. It is among the top five causes in all regions except the African Region, although, again, the actual mortality rates from drowning in the African Region are higher than in all other regions”

Drowning is often left out of the public health agenda as mortality statistics for children usually include neonatal conditions which account for a significant proportion of deaths in children under 1 year of age, and skew the data for the age group as a whole.

The World Health Organisation have previously recognised that their drowning figures do not include drowning due to ‘cataclysmic events’ such flooding, or suicide. Therefore the total number of drowning deaths are likely to be much greater.

The WHO Global Burden of Disease suggested that over 97% of drowning deaths take place in low and middle income countries. This new report provides additional evidence that a global push to promote drowning prevention interventions is desperately needed.





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