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25 June, 2019 00:00 00 AM
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Building awareness is essential for prevention of drowning

Though preventable through human intervention, evidences show that drowning is a leading cause of death worldwide, particularly in low-and-middle-income countries
Sadrul Hasan Mazumder
Building awareness is essential for 
prevention of drowning
Children at Anchal

Bangladesh has been on track towards achieving the targets of the global goals but few exceptions. Especially in the health sector though major advancements have been made so far, drowning has been found as the dominating factor affecting the mortality rate of children below five years. World Health Organisation data shows that drowning is the cause of 43% of all child deaths, which is higher than the death rates from maternal mortality and malnutrition where drowning caused the death of at least 12,000 children per year. Bangladesh Health and Injury Survey 2016, estimated that the drowning mortality rate of 11.7 per 100,000 persons per year corresponds to a total of 19,247 deaths per year, two-thirds of whom are children. Centre for Injury Prevention and Research, Bangladesh (CIPRB) study shows that 68% of drowning takes place between 9 am and 1 pm and the majority of incidents take place in ponds (66%) and ditches (16%) located around fourty 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. Albeit, drowning has yet been discussed in the policy fora and neglected in the wider discussion of allocating national budget.

WHO report spelled out the factors triggering drown 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 on overcrowded or poorly maintained mal-standard ferries; flood disasters, whether from extreme rainfall, storm surges, tsunamis or cyclones. Children in Bangladesh across societies are exposed to all such causes of drowning. But communities at large are not aware of the harshness of drowning while building awareness among critical mass is essential but not sufficient.

Though preventable through human intervention, evidences show that drowning is a leading cause of death worldwide, particularly in low-and-middle-income countries. By now, range of interventions have been evidentially found as effective to prevent drowning in Bangladesh rural context to reduce child drowning. Proven in Bangladesh context, interventions such as strategic use of barriers to control access to water, creation of safe places such as daycare centres for pre-school children, and teaching school-age children basic swimming skills have now been replicated in other parts of the globe. In addition to these three tested interventions, there must have an effective mechanism to flood risk management; strict enforcement of inland water transport legislations followed by enactment and adoption of water safety policies. To establish a preventive safety net it requires to capacitate a critical mass as the first responder and ensuring that communities as a whole reject all harmful traditional practices. These three interventions are awaiting to get global recognition as the best practice for reducing drowning deaths.

Anchal for pre-school children: In Bangladesh like other low-income countries, childhood drowning tends to occur during guardians’ busy hours, when they are doing household work or other daily tasks.

CIPRB has developed 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 played the key role while the community as supportive or facilitator. By now, CIPRB has been providing day care services to fifteen thousandchildren while it requires to reach additional fifteen million children.

Installation of barriers controlling children's access to water: Installing barriers limiting access to water hazards reduces exposure and drowning risk of children aged 1-4 years' old. Sound though simple, precaution should be taken considering the ground realities free from the risk of injury in a sustainable manner. Installation of barriers includes covering wells and cisterns; using doorway barriers and playpens; fencing swimming pools. Legislative measures having provisions for building codes might enable the sustainability of the drowning prevention interventions applicable for urban settings.

Teaching school-age children basic swimming skills: CIPRB has developed a frugal structure for teaching swimming techniques available at the rural setting where children aged 4-12 years are trained following a structured curriculum and adequate safety measures. Studies show that teaching children basic swimming, water safety, and safe rescue skills reduce drowning. In rural settings, Bamboo platform while in the urban setting portable plastic pool has been found effective and cost-effective for training the children where the community has chosen trained instructor do facilitate the sessions.

Such installations are low cost and provide safe areas where children can be actively supervised while they learn.So far, CIPRB has trained half a million children while requires to train thirty four million children.

In the context of Bangladesh, scaling up the tested innovations of drowning prevention though frugal is a great concern – in particular, implementation of the day-care programs like Anchal seems to end when external funding runs out. Integration with other established national activities – including education curricula or child welfare activities is the key to ensure the process for scalability and sustainability of day-care activities. During the upcoming budget discussion interventions of drowning prevention should be discussed in the country’s highest policy fora leading to developing a multi-stakeholder coordination mechanism to mobilise and accumulating resources. Frugal innovation as Anchal - designed to save children from drowning having unique features and opportunities for promoting stimulations for early childhood development in a rural setting should be dealt through multifaceted efforts. Such opportunities need to be linked with all concerned government agencies having a special mandate to maintain welfare and ensure education for children. More importantly, such interventions have created scope for women’s social and economic empowerment through their involvement in running the daycares facilities.

Multi-Sector Action Plan for Prevention and Control of Non-Communicable Disease, 2018-2025 adopted by Directorate General of Health Services (DGHS) though includes the provision of setting up daycare facilities aimed at improving child supervision to reduce exposer to water bodies but the progress of implementation is slower than expected. The strategy mandated the Ministry of Health and Family Welfare (MoHFW) to ensure setting up of daycare centres in partnership with the Ministry of Women and Children Affairs (MoWCA) and Ministry of Local Government, Rural Development and Cooperatives (MoLGRDC) including NGOs and private sectors. But there is no such strategic planning regarding bringing 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 the Directorate of Education be it primary or secondary level. The National Drowning Prevention (draft) Strategy, which has already been vetted by all concerned line ministries now awaiting for the approval of the Ministry of Health and Family Welfare. This strategy should be approved at the soonest with necessary allocation of funds well distributed among the partner agencies for its effective enforcement.  

To scaling up the frugal 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:

O    allocating resources to scale up the daycare model adopted by government policy strategies;

O    enhancing awareness among critical mass on the adversity of drowning;

O    incorporating drowning prevention and rescue module in the national curriculum of Primary and Secondary education;

O    incorporating drowning indicator in the existing Health Management Information System (HMIS);

O    provisioning utilisation of the installations of Directorate of Social Services to deliver swimming teaching techniques and rescue mechanism;

O    setting up swimming teaching facilities at union level;

O    engaging the countrywide network of Ansar & VDP to provide first responder services;

O    introducing swimming teaching techniques within the disaster preparedness programme;

O    widening scope of Swimming Federation to unfold swimming teaching from sports to life-saving skills;

O    integrate swimming teaching and rescue techniques into existing training module for Integrated Management of Child Illness (IMCI);

O engaging community-based cadres of Directorate of Agriculture Extension (DAE), MoLGRDC and MoWCA with the drowning prevention interventions.

The writer is s a policy activist and can be reached at m.sadrul@hotmail.com

 

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Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
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Editor : M. Shamsur Rahman
Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

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