DROWNING is the third leading cause of accidental deaths across the world. The World Health Organisation states that drowning claims around 360,000 lives a year. Its statistics also show that about 1,000 cases of fatal drowning take place every day — 41 deaths an hour and two deaths about every three minutes. It is also evident that drowning causes death of at least 12,000 children a year, which is equivalent to 43 per cent of all child deaths and higher than the death rates from maternal mortality and malnutrition.
Drowning mortality is the highest among children aged 1–4 years while more than 50 per cent of drowning deaths occur before the third birthday globally. Low- and middle-income countries are the most affected compared with high-income countries — the drowning rate in low- and middle-income countries is three times higher than that in high-income counties.
The drowning mortality rate of 11.7 per 100,000 people a year, as the Bangladesh Health and Injury Survey 2016 estimates, corresponds to a total of 19,247 deaths a year, two-thirds of whom are children. Another study by the Centre for Injury Prevention and Research, Bangladesh shows that 68 per cent of drowning takes place between 9:00 am and 1:00pm and the majority of incidents take place in ponds (66 per cent) and ditches (16 per cent) located around 40 steps of households. This has been accelerated by the reality that both parents in poorer households most often have to work in distant places leaving children unattended.
Despite such facts, in the legislative history of Bangladesh, drowning has not yet been mentioned in any of the laws enacted since independence. But the Multi-Sector Action Plan for Prevention and Control of Non-Communicable Disease 2018–2025 adopted by the Directorate General of Health Services includes the development of daycare facilities aimed at improving child supervision to reduce exposer to water bodies. The strategy mandates the ministry of health and family welfare should ensure the setting up of daycare centres in partnership with the ministry of women and children affairs and the ministry of local government, rural development and cooperatives, non-governmental organisations and the private sector. But there is a lack of leadership and coordination mechanism among the ministries concerned, which has further been complicated by the diverse terms of reference, roles, and responsibilities for making multiple interventions into drowning prevention.
Globally, drowning has been considered under the non-communicable disease control segment of WHO. But if the drowning prevention interventions are thoroughly examined, it would be evident that most of the interventions do not fall under the jurisdiction or scope of the ministry/directorates of health, which creates the problem at the operational level and in designing the delivery portfolio. For example in Bangladesh, developing the daycare centres, teaching swimming skills, conduction of water safety sessions at schools do not fall under the jurisdiction of the ministry of health. Thus, through the adoption of the National Strategy on Drowning Prevention, multiple actors at the national level should be brought under a common accountability and monitoring framework for delivering the interventions to tackling the adversity of drowning.
Study and research from home and abroad identified multiple factors triggering drowning deaths such as insufficient or lack of physical barriers between people and water, particularly close to home; lack of (or inadequate) supervision of young children; uncovered or unprotected water supplies and lack of safe water crossings; lack of water safety awareness and risky behaviour around water, such as swimming alone; travelling on water, especially in overcrowded or poorly maintained substandard ferries; flood disasters, whether from extreme rainfall, storm surges, tsunamis or cyclones. But evidences show that communities, governments and non-government actors at large are not aware of the harshness of drowning while just building awareness among a critical mass is essential but not sufficient.
Bangladesh has been on track towards achieving the targets of the global goals but with a few exceptions. Although major advancements have been made so far especially in the health sector, drowning has been found as the dominating factor affecting the mortality rate of children aged below five years. The Global Goals set by the United Nations has targeted to reduce all preventable deaths by 2030 but drowning has not been mentioned, whereas without addressing the epidemic of drowning such target is just impossible to achieve. The World Conference on Drowning Prevention 2019 held at Durban, South Africa during October 8–10 where around 540 delegates from 65 countries covering all the continents gathered and raised their voices in favour of developing multi-stakeholder coordination mechanism in the light of the Sustainable Development Goals framework.
The Centre for Injury Prevention and Research, Bangladesh has innovated solutions such as strategic use of barriers to control access to water, the creation of safe places such as day-care centres for pre-school children, and teaching school-age children basic swimming skills. The organisation has developed community crèche named Anchal — the community-based institutional supervision of children during the hours when they are mostly exposed to the risk of drowning. Socially and culturally accepted, Anchal has now been found as a cost-effective useful intervention to protect children aged 1–4 years from drowning. Anchal, designed and adapted to function in the realities of rural Bangladesh, has been broadly steered by the community-based approaches in which parents play the key role while the community as supportive or facilitator.
Bamboo structure innovated by CIPRB, which can be fixed in every corner of Bangladesh where children aged 5–11 years can be trained on swimming techniques following a systematic curriculum having proper safety measures. Studies show that teaching children basic swimming skills, water safety with safe rescue skills help reduce the rate of drowning. The bamboo platform in rural settings and portable plastic pool in the urban areas have been found effective and cost-effective for training the children where the swimming instructors facilitate sessions of swimming training. Such low-cost installations providing safe areas where children can actively be supervised during sessions can be replicated in other low and middle-income countries. More importantly, both the interventions have created scope for women’s social and economic empowerment through their engagement in running the day-care facilities, transferring lifesaving skills of swimming.
There are issues of greater concern in the scaling up of the tested interventions of drowning prevention in the national context, despite being cost-effective — wide-scale implementation of community crèche seems to end when external singular donor funding runs out. The integration of drowning prevention interventions with the SDG framework including other national priorities relating to the well-being of children might be an effective way. Now, it is evident that to achieve many global goals it is imperative to scale up the drowning prevention interventions. But there is no such strategic planning regarding raising awareness among critical mass on the adversity of drowning or any national exposer for learning swimming for a mass of children. This requires policy attention having specific commitments for allocation of resources and providing strategic guidance to the national authority like Swimming federations and education directorates, be it primary or secondary level. The National Drowning Prevention (Draft) Strategy, which has already been vetted by all the ministries concerned, is now waiting for the approval of the ministry of health and family welfare. This strategy should be approved at the earliest with the necessary allocation of funds well distributed among the partner agencies for its effective enforcement.
To scale up the innovations nationally where resource mobilisation has been the dire consideration, it is urgent to bring those under revenue scheme with proper legislative and policy guidance. Most importantly, the government should facilitate a multi-stakeholder coordination mechanism to reduce deaths from drowning having special focused on: approval of the proposed National Strategy on Drowning Prevention; allocating resources to scale up the day-care model adopted by government policy strategies; enhancing awareness among critical mass on the adversity of drowning; incorporating drowning prevention and rescue module in the national curriculum of primary and secondary education; engaging the countrywide network of Ansar and Village Defence Party to provide first responder services; and widening the scope of swimming federation to unfold swimming from sports to a lifesaving skill.
Sadrul Hasan Mazumder is a policy activist.
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