The Bangladesh Experience


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The Bangladesh Experience: A developing country's perspective on child drowning prevention

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The Bangladesh Experience

  1. 1. The Bangladesh Experience: a child drowning prevention program suitable for developing countries Aminur Rahman Centre for Injury Prevention and Research, Bangladesh (CIPRB)
  2. 2. Land of Rivers The Ganges The Brahmaputra The Meghna
  3. 3. Daily exposure to water bodies
  4. 4. Leading killers of children 1-17 17,000 children drown every year i.e. 46 each day 0 5 10 15 20 25 30 Drowning Pneumonia Malnutrition Diarrhoea Meningitis Transport Injuries Diarr + Pneu Suicide Animal bite Chicken pox Septicemia Rate per 100,000
  5. 5. Leading killers of children 1-4
  6. 7. Place of drowning
  7. 8. Distance to water bodies
  8. 9. <ul><li>Drowning risk is higher when </li></ul><ul><ul><li>the accompanying person is not the mother/caregiver </li></ul></ul><ul><ul><li>the child can not swim </li></ul></ul><ul><ul><li>number of children is 5 or more </li></ul></ul><ul><ul><li>the mother is illiterate </li></ul></ul>Risk factors associated with drownings
  9. 10. Fundamental strategies of drowning prevention
  10. 11. How to do those? High Children Population Poor SES Risky Environment Lack of physical structure Lack of trained personnel Financial constrains ? Lack of awareness
  11. 12. Prevention of Child Injuries through Social-intervention and Education - PRECISE
  12. 13. Objectives <ul><li>To develop an </li></ul><ul><li>- effective </li></ul><ul><li>- sustainable intervention program - using locally available resources and </li></ul><ul><li>- suitable for developing countries </li></ul>
  13. 14. Guiding principles <ul><ul><li>use of local resources </li></ul></ul><ul><ul><li>reliance on local community participation </li></ul></ul><ul><ul><li>the creation of a heightened culture of injury prevention including water safety </li></ul></ul>
  14. 15. <ul><li>Program areas </li></ul><ul><li>Intervention areas </li></ul><ul><li>Rural </li></ul><ul><li>Raiganj </li></ul><ul><li>Sherpur Sadar </li></ul><ul><li>Manohardi </li></ul><ul><li>Urban </li></ul><ul><li>Dhaka Metropolitan city </li></ul><ul><li>Households - 250,000 </li></ul><ul><li>Population – More than 1 million </li></ul><ul><li>Children <18 yrs – 500,000 </li></ul><ul><li>Children <5 yrs - 120,000 </li></ul>
  15. 16. Safe Home Safe school Safe Community Injury Surveillance PRECISE
  16. 17. Water Safety Program <ul><li>Strategies are keyed to child’s ages which include: </li></ul><ul><li>Improving supervision of the young children (under 5 years) </li></ul><ul><li>Equipping older children (4 – 10 years) with the life saving swimming skills </li></ul><ul><li>Raising awareness of children of all ages (under 18) and parents on water hazards and prevention of drowning </li></ul><ul><li>Modifying environmental water hazards through community participation </li></ul>
  17. 18. Intervention for under 5 children <ul><li>Improved supervision of children 0-4 </li></ul><ul><ul><li>Home safety counseling </li></ul></ul><ul><ul><li>Establishment of crèches </li></ul></ul>
  18. 19. <ul><li>Home safety counseling </li></ul>HCPs/CIPP (volunteer) / 400 households - Identify risks/hazards - Counsel accordingly
  19. 22. Community Crèche <ul><li>Objectives </li></ul><ul><ul><li>to keep children under direct supervision </li></ul></ul><ul><ul><li>to provide Early Childhood Development (ECD) </li></ul></ul>
  20. 23. Community Crèche - Infrastructure - Supervisor (Crèche mother ) - 20-25 Children 1-5 years - 9 a.m. to 1 p.m. (4 hours/day)
  21. 25. Intervention for children 4-10 years <ul><li>Teaching life saving swimming skills “ Swim for Life” </li></ul><ul><li>The strategies include </li></ul><ul><li>Establishing collaboration </li></ul><ul><li>Swim teaching with the help of a tested curriculum </li></ul><ul><li>Developing community swimming centers </li></ul><ul><li>Involving local people as Community Swimming Instructors (CSIs) </li></ul><ul><li>Involving community leaders to support the program </li></ul>
  22. 26. Collaboration Royal Life Saving Society Australia Standard water safety program Bangladesh Swimming Federation Training of Community Swimming Instructors (CSIs)
  23. 27. <ul><li>Workshops for </li></ul><ul><li>Strategies and </li></ul><ul><li>training curriculum development </li></ul>Strategies Using local ponds and low cost, locally-available resources International criteria of life-saving swimming skills Training curriculum All major steps BSF RLSSA
  24. 28. Platform Perimeter fence Deep water Shallow water Diagram: Typical instructional pond
  25. 29. Community Swimming Center
  26. 30. Community Swimming Instructor (CSI) <ul><li>Respective village </li></ul><ul><li>Selected by VIPC </li></ul><ul><li>18 years+ </li></ul><ul><li>Good swimmer </li></ul><ul><li>Secondary level education </li></ul><ul><li>Volunteer </li></ul><ul><li>Acceptable by the community </li></ul>
  27. 31. Training of CSIs BSF trained CSIs – 5 days in swimming pool – 2 days in modified ponds
  28. 32. Training of CSIs <ul><li>knowledge and practical skills </li></ul><ul><li>pond management </li></ul><ul><li>promotion of drowning prevention across the community </li></ul><ul><li>first aid including CPR </li></ul>
  29. 33. TOT of the CSIs <ul><li>RLSSA </li></ul><ul><li>RLSSI </li></ul>
  30. 34. Swim Centers Graduation 25m swim 90 sec treading 12 sessions needed
  31. 36. Awareness building activities
  32. 37. Communication materials Posters Video Docu-drama Booklet Flip-chart/flash card
  33. 38. School Safety Programme Teachers’ training Students learning
  34. 39. Community Participation <ul><li>Community Injury Prevention Committees </li></ul><ul><li>Responsibilities </li></ul><ul><li>supervise activities </li></ul><ul><li>support and promote programs </li></ul><ul><li>motivate people </li></ul><ul><li>finding means to do by themselves in future. </li></ul><ul><li>Each month the committee holds a meeting. </li></ul>
  35. 40. PROJECT ACCOMPLISHMENT <ul><li>Swim centers – 150 </li></ul><ul><li>Sep 2005 to Dec 2006 in 75 centers about 6,000 children graduated </li></ul><ul><li>Cost of teaching US $ 2.50 per child </li></ul>
  36. 41. <ul><li>Community Crèche – 203 </li></ul><ul><li>Children enrolled – about 4,000 </li></ul><ul><li>Establishment cost – USD 150 </li></ul><ul><li>Operational cost – less than 3 US cent per day per child </li></ul>PROJECT ACCOMPLISHMENT
  37. 42. IMPACT ON CHILD DROWNING DEATHS Swim for Life (Children 4-10 yrs) 109 among 106,563 102.3/100,000 children 4-10 0 among 5,938 graduates 7 expected at baseline drowning rates Non-participant drowning rate Swim For Life graduates
  38. 43. PRECISE impact <ul><li>Statistically significant reductions in all intervention areas </li></ul><ul><li>Reduction by about half in both age groups of children </li></ul>PRECISE impact on young child drownings by area
  39. 44. Community crèche <ul><li>4,000 children in 203 crèches </li></ul><ul><li>Only 2,000 that had completed one year’s participation </li></ul><ul><li>No fatal or non-fatal drownings in crèche participants while in the crèches </li></ul>
  40. 45. Conclusion <ul><li>Rich countries have wealth and technology </li></ul><ul><li>Scarcity of resources in low-income countries </li></ul><ul><li>Efficient use of available resources is paramount </li></ul><ul><li>Research to develop an evidence-base to allocate effort and resources </li></ul>
  41. 46. <ul><li>Child drownings are preventable at </li></ul><ul><ul><li>low cost </li></ul></ul><ul><ul><li>locally-developed set of interventions </li></ul></ul><ul><ul><li>using existing human resources and infrastructure </li></ul></ul><ul><li>Likely be applicable to other developing countries </li></ul><ul><li>Need for expansion of this work – support from GO, NGOs, Donors, Development partners and philanthropists </li></ul>Conclusion
  42. 47. Thank You