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Child Drowning Prevention in Bangladesh. Dr. Aminur Rahman aminur@ciprb.org. 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. 30. 25. 20. 15.
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Child Drowning Prevention in Bangladesh Dr. Aminur Rahman aminur@ciprb.org
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
30 25 20 15 Rate per 100,000 10 5 0 Suicide Drowning Diarrhoea Meningitis Pneumonia Animal bite Septicemia Malnutrition Diarr + Pneu Chicken pox Transport Injuries Leading killers of children 1-17 18,000 children drown every year i.e. 50 each day
It is clear that child health programs can no longer be considered complete without injury prevention efforts at the core • But, Challenges are: • Lack of easy solution for country like Bangladesh • Interventions from developed countries are • not transferable • Needs large population based research
“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
Lack of awareness and supervision 60% drowning happened during 9am-1pm Children of large families are 2 times vulnerable to drowning than small families Widespread Exposure of water bodies 80% drowning occurred in pond, ditch and bucket 80% drowning happened within 20 meters of house Lack of skills Swimming Skill Rescue Skill First Aid Skill Management Factors associated with childhood drowning
Fundamental strategies for drowning prevention <4 = supervision > 4 = swimming
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
Injury Surveillance Safe Home Safe Community Safe School PROGRAMME COMPONENTS PRECISE
Anchal Safe Community • Institutional supervision • Most vulnerable time for injury including drowning • Most vulnerable age groups • Trained care-giver • Supervision • ECD 640 Anchals - 16,500 children
SwimSafe Survival Swimming + rescue Community Swimming Centre Training of CSIs
SwimSafe Children learning toswim Children learning rescue technique Over 350,000 children learnt swimming during 2006-2013
Evaluation Effectiveness of Anchal
Evaluation Effectiveness of SwimSafe Programme
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
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.
Feasibility of First Responder Programme in Rural Bangladesh
Distribution of participants by category, sex and assessment result
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
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)
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
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
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
Mainstreaming special needs children • Ensures they are known to the appropriate government institutions • Ensures access to all services possible • Allows socialization with Anchal peers
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
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
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
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
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