The burden of drowning in Asia: prevalence and risk factors in children

TitleThe burden of drowning in Asia: prevalence and risk factors in children
Publication TypeConference Paper
Year of Publication2007
AuthorsDr. Linnan, M, Anh, LV, Kosen, S, Sitti-amorn, C, Dr. Rahman, F, Lim-Quezon, MC, Zeng, G
Conference NameWorld Conference on Drowning Prevention
Date Published09/2007
PublisherInternational Life Saving Federation
Conference LocationPorto, Portugal
Other Numbers02-43

Context: Current information at the regional level for Asia available from WHO indicates infectious diseases and nutritional causes are the leading child killers. However, these data are derived from national ministries of health that mainly report hospital and other facility-based mortality statistics since vital registries in these countries are incomplete and/or unreliable. Community-level research in Vietnam in 1998/99 indicated drowning and other forms of injury to be more prevalent causes of child mortality after infancy. Because of this discrepancy, TASC conducted large household surveys in 5 countries representative of the Asian region. The surveys examined drowning and near drowning, economic and social costs incurred for victims and their families, and risk factors associated with these drownings. The results confirm that hospital- and facility-based reporting systems present an inaccurate picture of mortality. The true pattern is only visible when measured where the mortality occurs, in homes and communities.

Methods: Six large, community-based surveys in five countries in Asia: Bangladesh, China, Philippines, Thailand and Vietnam were completed between 2000 and 2005. The surveys use representative samples selected by probability-proportional-to-size sampling of populations (all ages, both sexes, urban and rural), include over 516,000 households, with over 2,157,000 population including 788,000 children and examine all causes of mortality and injury morbidity. The information presented is the drowning and near drowning data from these surveys.

Results: The age- sex- and urban:rural- drowning rates all show that drowning is the leading killer of children after infancy in all countries and by extension, Asia. The fatal drowning rate for children (0-17 years) in the composite of surveys was 30.1/100,000, ranging from 16.1/100,000 in Thailand to 42.7/100,000 in Vietnam. The near-drowning rate for children (0-17 years) in the composite survey was 63.6/100,000, ranging from 1.6/100,000 in Thailand to 113.4 in Bangladesh.

Discussion/Implications: The surveys show that drowning is the leading killer of children (1-17 years) after infancy and a significant killer of adults as well in the countries surveyed. They also show that this is only visible when measuring drowning deaths in the community as the current facility-based reporting systems in these countries does not capture drownings. These data imply that significant child mortality reductions in these countries will not be possible without developing drowning prevention programs as a major component of water safety programs that are national in scale.

Learning Outcomes
  1. Drowning is the leading killer of children after infancy in several countries in Asia
  2. The current WHO statistics derived from national reporting systems grossly under-estimate the true incidence, seen only through household survey ascertainment.
  3. As the leading child killer in Asia, water safety and drowning prevention programs are urgently needed on a national and regional basis in order to decrease the high rates of child mortality and serious morbidity due to drowning and near-drowning.