World Drowning Prevention Day: Anyone can drown, no one should

Today, July 25, 2021, is not just an ordinary day. It is a new United Nations international day. It is a day of aspiration to prevent drowning, which claims hundreds of thousands of lives every year globally. As the slogan of the day says, "Anyone can drown, no one should". In the past decade, over 2.5 million people have died due to drowning, the majority of which could have been prevented.

On the April 28, 2021, the United Nations General Assembly adopted a historic Resolution on drowning prevention, acknowledging the issue for the first time in its 75-year history, and proclaimed July 25 as World Drowning Prevention Day. The new Resolution was initiated by the Ambassador and Permanent Representative of Bangladesh to the UN, H.E. Rabab Fatima, in partnership with the Government of Ireland and co-sponsored by 79 Member States. In presenting the draft Resolution to the UN General Assembly, Ambassador Fatima said, "Every drowning death is preventable, through tested, low-cost solutions. And action on drowning presents us all with an opportunity. An opportunity to advance several of the UN sustainable development goals."

The WHO estimates that drowning is the cause of 236,000 deaths every year, excluding the drowning deaths caused by flood-related events and water transport incidents. This results in the under-representation of the true mortality by up to 50 percent in some countries. Over 90 percent of drowning deaths occur in low- and middle-income countries, with Africa recording the world's highest drowning rates and Asia carrying the highest burden of drowning deaths by number. Drowning is a social equity issue that disproportionately affects children and adolescents in rural areas. Globally drowning is among the 10 leading causes of death in children. In most of the low- and middle-income countries, including Bangladesh, children aged 1-4 years are the worst affected followed by children aged 5-9 years.

The groundbreaking Bangladesh Health and Injury Survey (BHIS) 2005 and its follow-up survey in 2016, revealed a staggering figure of drowning mortality. The surveys were conducted by Centre for Injury Prevention and Research, Bangladesh (CIPRB) with the support of the Directorate General of Health Services and Unicef-Bangladesh. BHIS 2016 estimated that about 19,000 people of all ages die due to drowning each year. Over three quarters of these deaths, approximately 14,500, occur in children under 18. In other words, each day about 40 children die from drowning in Bangladesh. When children under 5 years are considered, this number is 30 a day, about 10,000 per year. The survey also identified wide exposure to water bodies, lack of awareness, lack of supervision of young children, lack of swimming skills of children and first response skills of communities were the major risk factors of children drowning in rural Bangladesh. Bangladesh Bureau of Statistics (BBS) in their Report on Bangladesh Sample Vital Statistics 2020 also found that drowning is the second leading killer of under 5 children after pneumonia.

Bangladesh does not have the luxury to implement the interventions which are found to be effective in high-income countries. Moreover, those interventions may not be appropriate for the Bangladesh context. The country needs context specific interventions which are culturally acceptable. The CIPRB with the support of the government, development partners and donors including DGHS, Unicef-Bangladesh, UKAid, AusAid, Grand Challenges Canada, Bloomberg Philanthropies and the Royal National Lifeboat institution, UK has been conducting various community-based research activities since 2005 to identify country- and context-specific effective interventions to prevent children from drowning. Two major innovations of low-cost solutions have been identified - community daycare (Anchal) for under 5 children, and SwimSafe, a survival swimming programme for children 6-10 year olds. An Anchal provides institutional supervision of 20-25 children aged 1-5 years by two caregivers during parents' busy hours, 9 am to 1 pm, when majority of the drowning incidents occur. It also takes the opportunity to provide early childhood development (ECD) stimulations, which are very important for children's development, during their four hours stay in the centre. Through SwimSafe activities, children 6-10 years old learn survival swimming skills from a locally trained community swimming instructor in a local pond, modified by a bamboo structure to ensure safety. Through half an hour lesson a day for two weeks, on average, a child can learn to swim 25 metres and float for 30 seconds, which are the criteria to become a survival swimmer.

Research carried out by CIPRB identified that Anchals are over 80 percent protective, that is, if a child participates in an Anchal for the full duration of four hours a day, there is 80 percent less chance of that child drowning than those who do not participate. Similarly, SwimSafe was found to be over 90 percent protective. Another study explored that there was 88 percent reduction of drowning in children 1-4 years old in the rural communities where Anchals were in place and children were participating for at least one year. Another notable study was equipping community volunteers with the skills of first response including cardio-pulmonary resuscitation (CPR). The study showed that over 80 percent of the community volunteers could learn the required skills and also apply them during emergencies.

The WHO in its Global Report on Drowning: preventing a leading killer incorporated these three interventions and suggested the LMICs to adapt and implement those according to their settings to prevent child deaths from drowning. These interventions have potentials for scale-up not only in Bangladesh but also in other similar settings. Considering the benefits, the Vietnam government utilised these evidence-based Bangladeshi, child drowning prevention measures with some adaptation in their country.

The Bangladesh government recognises that child drowning is one of the major child health and protection challenges the country now faces. To achieve the SDGs, particularly Goal 3—good health and wellbeing—child drowning needs to be addressed. The Directorate General of Health Services of the Ministry of Health and Family Welfare has taken some awareness raising initiatives and the Ministry of Women and Children Affairs is in the process of establishing 8,000 community day-care centres to provide supervision of 200,000 under 5 children and to teach swimming to 6-10 year old children through primary schools. However, these interventions are yet to scale-up throughout the country.

The Ambassador and Permanent Representative of Bangladesh to the UN in partnership with the government of Ireland took a time honoured initiative to secure a first-ever Resolution on global drowning prevention, supported by WHO, Unicef and RNLI

The Resolution encourages the Member States to consider certain drowning prevention interventions in accordance with national circumstances. All actions are very relevant for Bangladesh, however, the first and the foremost thing is that the country should develop its national drowning prevention plan with a special focus on children to prevent unnecessary deaths. Bangladesh could rephrase the slogan for World Drowning Prevention Day to be: Any child can drown, no child should.

Dr Aminur Rahman, Deputy Executive Director & Director Drowning Prevention, Centre for Injury Prevention and Research, Bangladesh (CIPRB).