Drowning in the developing world: Differences from drowning in rich countries and prevention implications

TitleDrowning in the developing world: Differences from drowning in rich countries and prevention implications
Publication TypeConference Paper
Year of Publication2007
AuthorsDr. Linnan, M, Chaipayom, O, Cuong, PV, Linnan, H, Dr. Rahman, F, Dr Rahman, A, Shafinaz, S, Wei, JR, Zeng, G
Conference NameWorld Conference on Drowning Prevention
Date Published09/2007
PublisherInternational Life Saving Federation
Conference LocationPorto, Portugal
Other Numbers02-45

Context: Drowning is a leading killer of children in wealthy countries. Knowledge of risk-factors for child drowning has allowed the development of effective intervention programs which have reduced child drownings by an order of magnitude over the last five decades. Many of the interventions have targeted various risk-factors for child drownings such as barriers to water hazards, (particularly swimming pools); providing personal flotation devices for water exposure in recreational settings and targeting alcohol exposure in the same recreational settings.

Drownings in Asia and by extension developing countries in other regions are very different, as shown by the recent surveys in five countries in Asia. Intervention programs in developing countries will need to have a different strategic approach to be effective in this different water-hazard environment

Methods: The recent surveys conducted in five countries in Asia have specifically been designed to look at risk factors for drowning. Each survey has a case-control study nested within the larger survey which examines the risk-factors associated with drowning. Additional potential protective factors such as swimming ability are measured across the entire population surveyed.

Results: Peak ages of drowning in all countries was in the second and third year of life, was independent of location (urban same as rural) and showed a close and significant association with education and relationship of primary caretaker to the drowned child. Early childhood drowning was also associated with size of family and number of siblings greater than 4.

For childhood drownings in adolescence, alcohol use was not associated as a co-factor, nor was recreational activities in the aquatic setting. For all drownings in all ages of childhood, the water exposures were almost universally associated with activities of daily life rather than recreation. Ability to swim was shown to be a protective factor and the odds of drowning after age five and before age 18 were about 1 in 100 for children unable to swim. Being able to swim effectively halved thee odds.

Discussion/Implications: The surveys conducted in five countries in Asia have identified key differences in child drowning as compared to rich countries. The primary differences that will mandate a changed approach are:

  1. the almost universal non-recreational settings the drownings occur in;
  2. the extraordinarily high exposure rates to potential drowning hazards that occur on a daily basis in almost every child’s daily activities; and
  3. the lack of prominent risk-factors such as alcohol, swimming pools, and water-based recreational activities as major social activities for children.

Despite these differences, there appears to be effective prevention mechanisms that may be effective in the settings of developing countries: among these are using the existing antenatal care and immunization programs to sensitize mothers to “drown-proof” their infants environment, and to encourage them to have their children learn survival swimming from the age of five years.

Learning Outcomes
  1. Drowning is the leading killer of children after infancy in countries in Asia.
  2. Risk factors and antecedent events are different for drowning in the countries surveyed than in wealthy countries.
  3. There appear to be effective interventions that will have the same impact on child drowning rates in these countries. They only need to be put in place on a national and regional scale.