Drowning

Since the mid-1980s, Bangladesh has seen an impressive decline in childhood deaths due to reductions in infectious disease mortality and as a result, other causes of childhood deaths are becoming proportionately more important. Drowning is one of these causes - now responsible for 19% of deaths among children 1 to 4 years in Bangladesh. Drowning kills more children aged 1 to 4 than any disease.
 
Geographically dominated by the fertile Ganges delta, Bangladesh has rivers, ponds, ditches, lakes, embankments, in addition to the annual monsoon floods and frequent cyclones. With the world’s highest density of rivers per unit area, 7% of the surface area of Bangladesh is covered by water and approximately two-thirds of the land frequently flooded. According to a recent ICDDR,B Health and Demographic Surveillance System mapping exercise, there are more than 6500 ponds and 4000 ditches, excluding rivers and canals, in the Matlab field site, covering 225,000 people from 143 villages.

Figure 1: Trends in drowning deaths in 1-4 year old children in   Matlab, 1983-2005

What do we know?

ICDDR,B has been conducting studies on childhood drowning in the rural area of Matlab, where drowning deaths are as high as in the other part of the country. Compared to other childhood mortality, there is no change in absolute drowning mortality in Matlab and now it is responsible for over half of deaths among 1 to 4 year old children in that area.

It’s been ten years since drowning was first detected as an increasingly important cause of death among young Bangladeshi children by ICDDR,B. Since then, ICDDR,B has learnt a lot about drowning from our population surveillance site in Matlab. We know that most deaths occur:

• in ponds or ditches
• in the monsoon season (April – September)
• in children between 1 and 2 years of age
• before midday
• when the mother is busy with household work.

An ethnographic study has been carried out over a period of 14 months in a non-intervention area of rural Matlab to describe the local explanatory model of drowning, to identify the behavioural factors that place families at risk for drowning and to guide the development of feasible and culturally appropriate interventions for preventing childhood drowning. Methods used included cognitive mapping procedures (free-listing and rating), in-depth interviews and focus group discussions.
 
Local beliefs

Findings from the formative research suggest that the most common causal explanations for the incident is linked with evil spirit (alga batash) or some supernatural forces that are believed to live in the water bodies. Most of the deaths or near-deaths occur in ponds and ditches and in low-level water, which is not considered as potentially harmful for drowning. Most of the mothers were busy with household chores during the time of the accident and therefore, children were either by themselves or with the older siblings whose age is between 4 to 10 years. Since mothers are perceived to be the primary caretakers, other adult members do not consider childcare as their primary responsibility and are therefore less vigilant.
 

Local beliefs suggest that parents touching or trying to rescue a child in water may cause the child to die. Other people are called to apply local practices to revive the child. A variety of traditional practices are applied such as:

• spinning the child
• applying pressure to the child’s stomach to extract the water
• massaging the body with mustard oil, ash or mud
• covering the child with a thick blanket to heat the body.

If these fail to revive the child, parents then seek care from the local healthcare providers, but very few seek care from the hospital.

Traditional prevention methods

A variety of traditional methods are used to protect the child from drowning including blessing the child and the spirits believed to be living in bodies of water; placing an amulet on the small child; restraining the child’s movement by keeping him/her in an adult’s lap and scaring the child about the dangers of water. When a child starts walking, other physical measures are employed. These include placing bells on the child, barricading the household door, putting a fence around the households and ponds, putting thorns on the way to water bodies and placing poles in the water to which the child can hold onto.

Exploring prevention strategies

An ICDDR,B study analyzed data to understand community acceptance to various childhood drowning prevention intervention tools tested in Matlab. Potential prevention strategies explored different approaches,  ranging from targeting the child, the mother and the community.

Using tools such as playpens or door barriers are possible tools of keeping children away from water and were found to be most acceptable to local communities. Carrying the child on the mother’s back and establishing a daycare centre were considered culturally inappropriate and less feasible. Community members greatly supported the introduction of a playpen as it would have multiple benefits, saving the child from clod and dirt. Suggestions were received for its design - collapsible, portable, lightweight and spacious.
 
Door barriers are presently already used in the community, placed horizontally across the doorway to protect children in their first year. Suggestions were made to restrict older children’s mobility by making door barriers vertical and higher.
 
The introduction of such technologies would have to be supported by well-designed educational programmes to teach families and caretakers how to use them. People also need to be taught about sources of risk, good child supervision, and child safety, devising specific messages regarding what situations are and are not appropriate to ensure that the child is safe.