1. Child Drowning Prevention in Bangladesh Dr. Aminur Rahman aminur@ciprb.org

2. Bangladesh Health and Injury Survey, 2005 12 districts randomly selected 171,000 HH (820,000 persons) Urban and rural areas All causes of morbidity and mortality were included

3. Leading killers of children 1-17 18,000 children drown every year i.e. 50 each day 0 5 10 15 20 25 30 Drowning Pneumonia Malnutrition Diarrhoea Meningitis Transport Injuries Diarr + Pneu Suicide Animal bite Chicken pox Septicemia Rate per 100,000

4. Child drowning mortality rate by age

5. But, Challenges are:  Lack of easy solution for country like Bangladesh  Interventions from developed countries are not transferable  Needs large population based research It is clear that child health programs can no longer be considered complete without injury prevention efforts at the core

6. “PRECISE” – Prevention of Child Injuries through Social Intervention and Education An operation research -to develop and implement various injury intervention packages and -to evaluate efficacy of the packages and the effectiveness of its implementation approaches for scaling-up. The largest community trial on childhood drowning prevention in developing countries

7. Factors associated with childhood drowning Widespread Exposure of water bodies 80% drowning occurred in pond, ditch and bucket 80% drowning happened within 20 meters of house Lack of awareness and supervision 60% drowning happened during 9am-1pm Children of large families are 2 times vulnerable to drowning than small families Lack of skills Swimming Skill Rescue Skill First Aid Skill Management

8. <4 = supervision> 4 = swimming Fundamental strategies for drowning prevention

9. Prevention Strategies Strategies are keyed to child’s ages which include: Improving supervision of the young children (under 5 years) Equipping older children (4 – 10 years) with the life saving swimming skills Raising awareness of children of all ages (under 18) and parents on water hazards and prevention of drowning Modifying environmental water hazards through community participation

10. PROGRAMME COMPONENTS Injury Surveillance PRECISE Safe Community Safe School Safe Home

11. Anchal  Institutional supervision  Most vulnerable time for injury including drowning  Most vulnerable age groups  Trained care-giver  Supervision  ECD Safe Community 640 Anchals - 16,500 children

12. SwimSafe Survival Swimming + rescue Community Swimming Centre Training of CSIs

13. Children learning to swimChildren learning rescue technique Over 350,000 children learnt swimming during 2006-2013 SwimSafe

14. Evaluation Effectiveness of Anchal NumberDrowning death rate per 100,000 person yr Relative Risk Anchal Participants 20,32910.90 0.20 At 95%CI 0.037 – 0.071 Non Anchal Participants 43,43954.44

15. NumberDrowning death rate per 100,000 person yr Relative Risk SwimSafe Participants 54,8341.06 0.046 At 95%CI 0.037 – 0.071 Non SwimSafe Participants 54,83423.17 Evaluation Effectiveness of SwimSafe Programme

16. IDRC-B Research Activities

17. Anchal 2.0 Appropriate timing of Anchal –50 Anchals : 9 am to 1 pm –50 Anchals : 10 am to 2 pm –50 Anchals : 10 am to 12 noon 9 am to 1 pm –Most effective –Most preferred by mothers

18. Children rescuing other children drowning in rural Bangladesh Children rescue other children. No adult assistance All the child rescuers were an average of 6 years older than the victims Most rescues took place – in ponds or ditches and within 10 metres of the bank – while the victim was bathing. Most rescues were in water contact recues.

19. Feasibility of First Responder Programme in Rural Bangladesh

20. Distribution of participants by category, sex and assessment result

21. Bangladesh Anchal and SwimSafe (BASS) Project

22. Anchal 3.0 in BASS An evolution of Anchal from 1.0 (PRECISE) and 2.0 (AusAID-IDRCB) Anchal 3.0 adds –Anthropometry for physical development –Measurement of mental and social development –Playpens for safety and supervision –Mainstreaming for special needs children

23. Anthropometry Anchal ma measures height and weight of children Maintains growth chart on child Determines if child is progressing normally or is falling behind in weight and height growth Categorizes children as increased risk (1- 2SDs below median) and high risk (2 or more SDs below median)

24. Screening of special needs children Anchal ma also screens for congenital or acquired physical disabilities such as –Cleft palate –Club foot –Cross eyes –Blindness –Deafness –Missing or paralyzed limb Categorizes child as special need on this basis

25. Development monitoring Anchal ma uses validated screening tools at 12, 15, 18, 24, 30, 36, 48 and 60 months Monitors development of –Hearing, speech and language skills –Gross and fine motor skills –Cognitive, social, emotional and self help skills Charts skills progress of each child Categorizes children as normal, increased and high risk children on the basis of screening

26. Playpens Reduce the supervisory burden on Anchal ma Increases safety for infants Allows for direct observation to learn what is the appropriate age range and if current design is optimal for use, durability and safety

27. Mainstreaming special needs children Ensures they are known to the appropriate government institutions Ensures access to all services possible Allows socialization with Anchal peers

28. SwimSafe 3.0 An evolution of SwimSafe from 1.0 (PRECISE) and 2.0 (AusAID-IDRCB) SwimSafe 3.0 adds –Lower age of entry (3 years) –Safer in-water rescue –CPR/first response for children 7,8 and 9 years –Risk management protocols for children at increased risk of injury while learning to swim

29. Lower age of entry Peak age of drowning is 27 months Adding children 3 years of age provides protection from drowning in this high risk group

30. Safer in-water rescue Research shows most rescues are in- water rescues instead of land-based rescues Adding training for safer ways to conduct in-water rescues will reduce the risk of this necessary practice

31. CPR – First response Research from IDRC-B shows that most rescues of young children are done by children 8-12 years old The same research shows many rescues are on drowning children who have stopped breathing Research from IDRCB shows children 10 years old can learn CPR and first response Adding CPR skills to older children will allow them to resuscitate rescued children who have stopped breathing

32. Risk management protocols As many as one in three children in rural Bangladesh are at increased risk of injury when learning to swim Malnutrition, epilepsy and other seizure disorders, asthma and other respiratory disorders and physical disability are the main causes Providing safe training allows these children to be protected from drowning

33. Thank You