https://imcjms.com Ibrahim Medical College Journal of Medical Science https://imcjms.com/registration/journal_full_text/75 Tue, 02 Aug 2016 12:17:45 +0000 Drowning has been identified as a major cause of death in children in both developed and developing countries. Non-fatal drowning is several times higher than the fatal drowning. To describe the socio-demographic and environmental attributes of non-fatal drowning in rural children this community based descriptive study was conducted on 122 children having non-fatal drowning events within one year of study period. This study was undertaken in Raigonj sub-district of Sirajgonj district in Bangladesh. Mothers of those children were interviewed using a structured questionnaire. Out of all participants 56.6% children were 2-4 years of age and male-female ratio was almost equal. Of the total respondent mothers 55% were illiterate and 41.8% were below the age of 25 years. Seasonal variation was observed in non-fatal drowning. Rainy season (50.8%) appeared as the most risky period followed by summer (29.5%). Higher incidence occurred (53.3%) between 10 am to 2 pm of the day. Although most of the drowning occurred outside the home, 9% drowning occurred in water container (like drum, tub) within the home. Pond (50.5%) was found as the most common place among open water source. During the occurrence, 23% child was not accompanied by parents or any caregivers. At the time of drowning, 47.5% mothers were engaged with usual household work and were not present at the place of occurrence whereas 13% mothers were present around the place of occurance. Before drowning, 45.1% victim was either playing, bathing or swimming in the water. Only 10.7% needed resuscitation, 25% were taken to health centre and reached the health centre within an hour, about a fifth (22.6%) of them were admitted. Restriction in dangerous water activities, strengthening supervision of children might decrease the incidence of drowning while quick and effective medical response might prevent its fatal consequences. Ibrahim Med. Coll. J. 2015; 9(2): 37-41     Drowning is the process of experiencing respiratory impairment from submersion/immersion in liquid. Its outcomes are death, morbidity, and no morbidity.1,2 Non-fatal drowning is the unintentional submersion in open water reservoir and household water containers with or without morbidity and no fatal consequence within 24 hours.3 Drowning has been identified as a major killer of children in both developed and developing countries. Children younger than 5 years old account for nearly 40% of all drowning fatalities.4-7 In 1–4 year old children, drowning is the second leading cause of injury death in the United States and Africa and the leading cause in Australia.8 There are an estimated 500,000 significant submersions in the United States each year; 50,000 of these require medical intervention. As many as 50% of all submersion victims are declared dead at the scene and never referred to medical facilities for care.8,9 For every death in child drowning, four cases are hospitalized and 16 receive emergency care for non-fatal drowning at the point of occurance.10 Although, in addition to mortality due to drowning, it is a major cause of morbidity for children while non-fatal drowning yet remains poorly understood. Most previous studies on drowning focused on description of drowning mortality and trends.11-13 There are few international studies done on non-fatal drowning in China14-16 USA17-19 and Australia.20-22 This exploratory study was an attempt to find out the issues and factors associated with non-fatal drowning cases in a rural area of Bangladesh. Methodology Mothers of index children were interviewed using a pretested semi-structured questionnaire in Bengali. The questionnaire was pretested and finalized after necessary modifications. A check list was prepared to observe certain environmental variables. Data were collected on variables related to socio-economic status and occurrence of non-fatal drowning. Statistical Package for Social Sciences (SPSS) version 17.0 was used to analyse the data. The study was approved by the Ethical Committee of National Institute of Preventive and Social Medicine (NIPSOM), Bangladesh. Informed consent was obtained from mothers after explaining the purposes of the research. Sex distribution of 122 non-fatal drowning cases was almost equal between boys (62) and girls (60). Mean age of the children was 43.8 months and 56.6%of children was between 2-4 years of age while 27% was more than 4 years of age.   Table 1 Parental Socio-demographic and economic characteristics of the parents of enrolled participants (n=122)                                                                                            Table 2 Distribution of non-fatal drowning events (n=122)         Table 3 Events while drowning took place         Table 4 Measures taken after non-fatal drowning event       Discussion In this study 91% non-fatal drowning incidents occured in natural bodies of water outside the home premises. The finding is similar with fatal drowning data in China.8 But it, is different from non-fatal drowning data of USA where 75% of non-fatal drowning occurred in swimming pools.18 This indicates that the locations of non-fatal drowning are likely to be different between and within countries due to geographical and economic differences. Seasonal variations in child drowning also observed in this study. About half of the drowining events occurred in rainy season. Bangladesh is a tropical country and during monsoon heavy rainfall floods and fills up the rivers, canals, ponds and ditches. For this, children have more chance to be exposed to wider area for risk of drowning. Hot summer season is also appeared as vulnerable (29%) as hot and humid temperature allure kids to more water fun which may end up in drowning in many cases. This trend has been observed in other studies in both developing and developed countries.8,16,18 Total 53.3% incidents occurred between 10 am to 2 pm followed by morning. During these time periods parents in rural area usually remain busy with livelihood or household works, elder siblings stay in school resulting in unattended kids. Early rescue and management, either on spot or in health centre, play vital role in preventing fatal outcome of drowning. In this study 10.7% cases received immediate resuscitation and 31 cases were taken to health centre and mostly reached the health facility within an hour. Minimum time loss before resuscitation is one of the key factors to save the life of drowning victim.18 These findings are supported by studies in China and Australia.8,21   1.    Krug E. Injury: A leading cause of the global burden of disease. Geneva: Department of Injuries and Violence Prevention, Non-communicable Diseases and Mental Health Cluster, World Health Organization 2002; 50. 3.    Wen JM, Shao PN et al. An analysis of risk factors of non-fatal drowning among children in rural areas of Guangdong Province, China: A case-control study. BMC Public Health 2010; 10: 156. 5.    Peden M, McGee K, Sharma G: The injury chart book: A graphical overview of the global burden of injuries. Geneva: World Health Organization 2002. 7.    Barss P. Drowning and other Water-related injuries in Canada. 1991-2000, Module 1: overview. The Canadian Red Cross Society 2006. 9.    Wintemute G, Kraus J, Teret S, Wright M. Drowning in childhood and adolescence: a population-based study. American Journal of Public Health 1987; 77: 830-832. 11.  Rahman A, Mashreky SR, Chowdhury SM, Giashuddin MS, Uhaa IJ, Shafinaz S et al. Analysis of the childhood fatal drowning situation in Bangladesh: exploring prevention measures for low income countries. Injury Prevention 2009; 15: 75-79. 13.  Rahman A, Rahman F, Shafinaz S, Linnan M. Bangladesh Health and Injury Survey: Report on children 2005; (5): 49–56. available at: http://www. unicef.org/bangladesh/Bangladesh_Health_and_Injury_ Survey-Report_on_Children.pdf 15.  Ma WJ, Xu YJ, Zhang YR. The study on death pattern and burden of disease in Guangdong province, China. Guangzhou: The economic press of Guangdong province 2008. 17.  Wintemute GJ. Childhood drowning and near-drowning in the United States. Am J Dis Child 1990; 144: 663–9. 19.  Calder RA, Clay CY. Drowning in Florida 1977–1986. J Flo Med Assoc 1990; 77: 679–82. 21.  Pitt WR, Balanda KP. Childhood drowning and near drowning in Brisbane: The contribution of domestic pools. Med J Aust 1991; 154: 661–5. 23.  Ahmed MK, Rahman M, Ginneken JV. Epidemiology of child death due to drowning in Matlab, Bangladesh. International Journal of Epidemiology 1999; 28: 306-311 2026 Ibrahim Medical College. All rights reserved.