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Research keeps children above water

An abundance of waterways and weak swimming skills make drowning the leading cause of death among children in Bangladesh. Research from Karolinska Institutet is now being used to reduce the number of lives lost.

Tears come to Zaeda Khatun's eyes as she relives that fateful day a year ago when her two-year-old son lost his life.

"I had just prepared our meal to break the fast and was waiting to hear the call to prayer when I looked around for Shahidul. Suddenly he was gone."

Just as in the rest of Bangladesh, the countryside where Zaeda lives is made up of a web of waterways. Zaeda found her son head-down in the water-filled ditch behind her house.

"I ran there, screaming, and many neighbours came. I don't remember anything else after that."

Shahidul's fate is one met by large numbers of Bangladeshi children every year. The extent, however, was unknown until 2004, when the Bangladesh Health Injury Survey, BHIS - the world's largest study of accidents in developing countries - showed that drowning is the leading cause of death for Bangladeshi children.

Researcher Fazlur Rahman's doctoral thesis from Karolinska Institutet in 2000 was behind the study's methods. His colleague Aminur Rahman, who at the time was in the middle of his thesis at Karolinska Institutet, focused on how Bangladesh could use the results of the study to deal with the problem. Since 2007, they have both worked on translating Aminur Rahman's theory into practice.

"It took me longer to present my thesis than for many others because I was combining my research with my work on the BHIS," says Aminur Rahman when I meet him at his office in Dhaka.

"But the advantage was that I could collect a large amount of data. Many theses were based on around a hundred cases - I had a total of 600 000." In his research, Aminur Rahman found that virtually all the cases of drowning in Bangladesh occurred during the day when the children's mothers were busy doing housework. He also found that the parents were unaware that the highest risk was found among children under five and that their notions of first aid could often be directly harmful, such as holding the children upside down and shaking them or massaging their tummies.

Aminur Rahman developed a couple of robust, local methods to address the risk of drowning, implemented them in a village and then compared the results with a control group in another village. Among other things, he employed a number of women to set up simple day-care in their homes, parents were taught the importance of putting up barriers so their toddlers would not easily be able to slip outside, and some in the village were selected for first aid training.

After two years, drowning accidents in the community where the methods had been applied had decreased by 55 per cent, whereas in the other community they had increased by 44 per cent.

After Aminur Rahman completed his doctoral thesis, he and Fazlur founded the organisation CIPRB, Centre for Injury Prevention and Research, Bangladesh. With support from sources such as UNICEF and AusAID, they have launched several projects using Aminur Rahman's methods and have developed a swimming school for children aged five or older - SwimSafe. The swimming instructors have been taught by Australian trainers in Dhaka. In six years, they have taught more than 260 000 children to swim in simple bamboo platforms, which are built locally and lowered into the ponds where people wash clothes and cattle.

"The platforms don't last that long, but they are cheap," says Aminur Rahman. Teaching a child to swim in this way costs about fifty Swedish kronor.

After long having a primary focus on infant health, the Government of Bangladesh has become increasingly alert to the drowning risk. Aminur Rahman has also travelled to nearby& countries, such as Cambodia and Thailand, to be an advisor in similar projects. After her son died, Zaeda Khatun moved from her house and got rid of all of the things that reminded her of little Shahidul. But both of her surviving children are now in the village's small day-care group set up by CIPRB. Eventually, they will also be receiving swimming lessons in the pond about half an hour's walk away. And it even looks like Aminur Rahman himself will learn to swim.

"I've done research on it, started swimming schools and even helped write primary school books about how to swim, but I don't yet know how to do it myself," he laughs.

Facts: Drownings in Bangladesh

  • Number of drownings per year: 17 000 (86 times higher than in Sweden)
  • 80 per cent of drownings occur within twenty metres of the home
  • 26 per cent of all deaths between 1 and 17 years in Bangladesh are drownings.

Text & photo: Per Liljas. First published in Medicinsk Vetenskap no 1/2013