Child Drowning Prevention Final Report (slightly updated)

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Child Drowning Prevention Program
Research for Save the Children
Thailand
By Angus Calder
September,2015

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Table of Contents
Executive Summary:..................................................................................................................3
Introduction:..............................................................................................................................6
Purpose of report:....................................................................................................................6
Global statistics:.......................................................................................................................6
Introduction to the situation in Thailand...................................................................................6
Epidemiology:............................................................................................................................7
Thai National Injury Survey (TNIS):............................................................................................7
Ministry of Health Data:...........................................................................................................7
Data Tables:.............................................................................................................................8
More recent data: ............................................................................................................... 18
Assessment of the main interventions...................................................................................19
Installing barriers controlling access to water:......................................................................... 19
Provide safe places(for example crèche) ................................................................................ 20
Teach school-aged children basic swimming, water-safety, and safe rescue skills..................... 21
Strengthen public awareness of drowning .............................................................................. 24
Local authorities, government and community partnerships ................................................... 27
The provinces in which Save the Children Thailand programs overlap with drowning rates...... 27
Convincing policy-makers/ local authorities / donorsfor the need for a national program....... 28
How to create a community ledintervention:....................................................................... 28
Merit Making program......................................................................................................... 29
Assessment of possible partner agencies: .............................................................................29
Ministry of Public Health:....................................................................................................... 29
Ministry of Education:............................................................................................................ 30
Thai Life Saving Society:.......................................................................................................... 31
UNICEF Thailand:.................................................................................................................... 32
Child Safety Promotion and Injury Prevention Research Center............................................... 32
ASEAN Institute of Health Development, Mahidol University: ................................................. 32
College of Public Health, Chulalongkorn University................................................................. 32
National Scout Organization of Thailand:................................................................................ 33
Recommended Options: .........................................................................................................33
Other possible ideas to be developed: .................................................................................... 37
Funding Possibilities............................................................................................................... 38
Works Cited:............................................................................................................................40
Appendix:.................................................................................................................................44
Contact List:........................................................................................................................... 44

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Executive Summary:
Purpose of this report:
The main questionof thisreportis “howcan Save the Childrenhelpreduce childdrowningdeathsin
Thailand?”Itwas developedforthe purpose of doingresearchintothe situationof childdrowningin
Thailand,interventionsthat have workedelsewhere andwhatinterventionshave beenappliedand
wouldbe applicable toThailand.Throughthe researchsome recommendationsare outlinedfora
Save the Childrenchilddrowningpreventionprogram.
Situationanalysis:
 Drowningclaimsthe livesof 372 000 people ayearworldwide of whichare 135,585 children
agedunder15
 Two sourcesof informationfordrowning statisticsare the National InjurySurveywhich
involvedhouseholdverbalautopsiesin100,000 householdsandthe Ministryof Public
Healthdata whichinvolvesusingdeathcertificatesandmedical facilityreporteddrowning
events.
 Drowningkills2650 childreninThailandeveryyear.The age groupat the highestriskof
drowningisthe 1-4 age group(accordingto the most reliable sources).However,less
reliable sourcespropose thatrecentlythe 5-9age group has become more atrisk of
drowning.Boysare twice as likelyasgirlstodrown.
 Drowningseemstooccur more frequentlyduringschool holidays,weekendsandafter-
school.
 Drowningoccursmore frequentlyinrural areas,mostlyinnatural watersources.For
youngerchildren(1-4) these natural watersourcesare nearbythe home within100m, and
furtherawayfor olderchildren(5-9).
Interventions:
Installingbarriers controllingaccess to water:
 Where feasibletoplace a barrieraroundthe watersource,it has beenshowntoreduce
drowningratesby 75%.
 Thisinterventionislessapplicabletothe Thai settingbecause mostdrowningoccursinlarge
natural watersourcesthat are not feasibletoplace abarrieraround.
 However,coveringcisternsandwellswouldbe effective andusingplay-pensandbaby-gates
couldbe optionsto explore.
Provide safe places (for example crèche) away from the water for pre-school children,with
capable childcare:
 Shownto reduce drowningratesby82% in the low andmiddle income setting.
 While more than84% of Thai childrenattendorganizeddaycare,holidayperiods,afterday-care,
and duringweekendsare timeswhensupervisionislacking.Furthermore the 15% or more of
childrennotattendingshouldbe targeted.
 Using the pre-school systemtodisseminate drowningmessageswouldbe effective indrowning
prevention.

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Teach school-agedchildrenbasic swimming,water-safety,andsafe rescue skills:
 Thishas beenproventoreduce drowningratesby88% in the low and middle income setting.It
isa sustainable andcross-generationalsolutiontodrowningaswell asafactor of survival during
natural disasters.
 34% of Thai childrenneverlearntoswimandthereforethisinterventionneeds widespread
implementation.However, careful attentiontoriskmanagementneedstobe made forthis
intervention.
 There are numerouspreviousandcurrentsurvival swimprogramsbutthe scope of these
programsis limitedandnotnationwide astheydependonthe willingness of local authorities.
 A swimmingcurriculumcouldbe integratedintothe school physical educationsystembutthis
needshighlymotivatedauthoritiesbothlocal andnational specificallyfromthe Ministryof
Education.
Strengthenpublicawareness ofdrowning and highlightthe vulnerabilityofchildren/focus on
behaviorchange:
 Thishas beena methodof drowningpreventionusedworldwide,butadirectlinkbetween
lowerdrowningratesandpublicawarenesshasn’tbeenidentifiedasthisinterventionis seenas
co-dependentonotherinterventions.
 There have beennumerous policiesunderthe NationalDrowningPreventionProgramtoensure
publicawarenessbuttheireffectivenesshasn’tbeenstudied. A studyonawarenessactivities
needstobe developedwithaparticularfocusontargetingbehaviorchange for children(andnot
justparents).
Local authorities, government and community partnerships
 Save the ChildrenThailandshould workoff pre-existingprograms,partnershipsandconnections
withKanchanaburi,Bahngkok,SuratThani, PhangNga,SongKlabeingparticularprovinceswhich
have higherdrowningrates(andwhere Save the Childrenworks)
Partners:
Ministryof PublicHealth has beenmotivatedoverthe long-termtocombatchilddrowningdeaths.
Theyare interestedinhelpingwithmonitoringandevaluation,developingthe use of play-pens, and
interactive media.
Ministryof Education wouldbe an importantpartnerin incorporatingwatersafetyandsurvival
swimmingcurriculumsintoschools.Tieswiththe ministrythroughthe 7% andSafe School programs
couldbe utilized.
UNICEFThailand as theyare workingonthe earlystagesof a drowningpreventionprogramand
Save the ChildrenhasworkedwiththemonDRR programs;a partnershipwithUNICEFishighly
recommended.
Thai Life Saving Society wouldbe animportantpartnerfor capacitybuildingtoteachsurvival
swimming.Itisa highlyresourceful andmotivatedsmall organization.

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ChildSafety Promotionand Injury PreventionResearchCentre is a partnershipwe alreadyhave
throughthe 7% program,theyare verywillingtopartnerwithuson thisissue forimplementation
and research.
The College ofPublicHealth,ChulalongkornUniversity and the ASEAN Institute of Health
Developmentcouldbe partnersforresearch.
National Scout Organizationof Thailand couldbe approachedforcreatinga watersafety‘badge’as
the organizationisthe keyorganizationof ascoutingmovementinThailandwith1,300,000
membersandcouldeasilyreachmanychildren.
Recommendations:
Monitoringand evaluation to prove that drowning isbeingpreventedin provinceswhere
programs have already beenimplementedisanimportantstepforadvocacy,havingbeen
requestedbyagenciescurrentlyworking the drowningpreventionitwouldbe usefulforensuring
effectivenessof theirprograms.
Comprehensive drowningpreventionproject (pilot) thiswouldbe animportanttrial fordeveloping
our expertiseand capacityondrowningprevention.Giventhe intensive managementneededfor
this,the scale shouldbe modest.
Conduct a thorough evaluationof the current drowning preventionawarenesscampaign and ways
in which to developit,with a specificfocus on developingawarenessmessagesforyoungtoddlers
thisshouldbe done toevaluate whetherSave the Childrenshouldimplementthe previous
recommendationorimplementonlyanawarenesscampaignwhichcouldbe easieronalarge scale.
Thisrecommendationasksthe question: doawarenesscampaigns reallyhave aneffectondrowning
preventionrates?
Other Possible Options:
 Researchintoincreasingthe motivationof teachers toincorporate drowning preventioninto
theirschool schedule
 Survival swimmingcurriculumintegrationintoCubScouts
 After-school/holidaycampsurvival swimwatersafetycourse
 Development/researchintothe feasibilityof usingplay-pens
 Developmentof interactive mediato incorporate drowningpreventionintothe ‘one-tablet-per-
child’initiative
 Ensuringwatersafetyandsurvival swimmingcoursesare mandatoryinPhysical Education
coursesand collegesforschool PEteachersorevenan expansiontoall teachers
 A repeatof the Thai National InjurySurvey,givingmore recentinformationondrowning.
Possible Sources of funding:
FoundationPrincesse Charlene de Monaco,Thai HealthPromotionFoundation,Bloomberg
Foundation,Global DrowningFund,EvianNatural SpringWater,NanthipBottledWater,Yum
RestaurantsInternational,SheratonHotel Group,Apartment/condominiumblocks

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Introduction:
Purpose of report:
The purpose of thisreport isto answerthe question“How can Save the Childrenhelpreduce child
drowningdeathsin Thailand?”
Secondaryandprimarydata was gathered inorderto carry out a situationanalysisof drowning
preventioninThailand.Throughthe situationanalysis adraftconceptof a drowningprevention
program isoutlined.
As perthe termsof reference of the researchof report,the followingdeliverables are included:
 Researchpaperon 1) keystosuccessfor drowningpreventionprogramsand2) ways to
change parentsand children’sbehaviorregardingwatersafety
 Catalogingof currentprogramsand agenciesworkingonthisissue,bothgloballyandwithin
Thailand
 Recommendedprogramdesignframework
 Prioritizedlistof businessestoapproachto supportthisprogram
Global statistics:
These statisticsshowthe scope andimportance of addressingthe issue of drowningandinparticular
childdrowning:
 Drowningclaimsthe livesof 372 000 people ayearworldwide of which are 135,585 children
agedunder15.
 More than 90% of these deathsoccurin low- andmiddle-income countries.
 There are approximately42drowningdeaths,everyhour everyday.
 Thisdeathtoll isalmosttwo thirds of those deathsfrom malnutritionandwelloverhalf that
of malaria.
 Malesare twice as likelytodrownasfemales.
 Globally,overhalf of all drowningdeathsare amongthose agedunder25 years.
 The economiccost of liveslostisalsohigh,andwhile difficulttoquantifyglobally,national-
level estimatesforAustralia,Canadaandthe UnitedStatesof America(USA) range from
US$ 85 milliontoUS$ 4.1 billionperyear (Meddings, 2014).
While the drowningdeathtoll amountstotwothirdsof that of malnutritionandoverhalf thatof
malariathe lack of resourcesandlack of focuson drowninglargelyshowsittobe,incomparison,an
unrecognizedandmarginalizedissue.
Introduction to the situation in Thailand
Drowningisdefinedas“the processof experiencingrespiratory impairmentfrom
submersion/immersioninliquid”(Beeck,2005).
In Thailand, whichhas risenfroma lowto middle incomecountry,the mortalityratesfrom
communicable diseases have decreased;howeverthe proportionof deathsthatare non-
communicable andinjuryrelated have increasedsignificantly (trendswhichhave alsobeenseenin
otherrapidlydevelopingnations).The decreases incommunicable diseasemortalityrateshave

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causeddrowningtobecome the leadingkillerof childrenunder15(Sitthi-amorn,2006). A national
drowningpreventionprogramis thereforeessential toreduce childmortality..
Drowningisknownas a “silentkiller”whichowestobothitbeingalargelyunrecognizedissue
globally,aswell asthe quietnature inwhichmanyof the drowningdeathsoccur,where youngsters
quietlyslipbeneaththe wateranddrown.The majorityof drowningdeathsdo nothappenby large
scale events,suchasthe sinkingof aferryin South Koreain2014; rather mostdrowningsoccur
duringseparate,small scale events onaone byone basis (Cox,2013).
Epidemiology:
There are twomainsourcesfor drowningstatisticsinThailand:
1) Thai National Injury Survey
2) Ministry ofPublic Health
Thai National Injury Survey (TNIS):
The Thai National Injury SurveywasconductedbyChulalongkornUniversity,partneredwithThe
Alliance forSafe Children(TASC), the Ministryof PublicHealthandUNICEF.The surveyhad a
nationallyrepresentative sampleof 100,000 households;the fieldwork wasconducted from
2002−2003 usingthe verbal autopsymethod.By carryingout a householdsurvey aboutchildinjury
incidents,researcherswere abletodoa verbal autopsywhen there was a situation reported in
whicha drowningoccurred (Meddings,2014).It mustbe noted thisdatawas takenduring2002-
2003 and isperhapsoutdated(dependingonwhetherthe situationhasinfactchangedsince then).
Of 65 child drowningeventsidentifiedatthe communitylevel,only14(21.5 per cent) were seenby
or reportedtoa health-care facility(fatalandnon-fatal drowningcombined).None of the immediate
fatal drowningswere seenbyorreportedtoa health-care facility (Linnan, 2012).
Ministry of Health Data:
Ministryof Health (MoH) data wassourcedprimarilyfromthe Situation Analysis of ChildDrowning
Surveillance Thailand reportpublishedandcompliedinOctober2009. For the report,a systematic
analysiswas conductedutilizingthree databaseswhichhadsystematicallycompileddataon
individualreportsby age as well asongoing reports(Gerdmongkolgan,2009).
Most of the data (deathcertificates,medical facility) isobtainedthroughthe ICD-10classification
system.The ICD-10 referstothe international standarddiagnosticclassificationof diseasesand
healthproblems thatare the causes of morbidityandmortality.Morbidity andmortalityby
drowningare placedintothe database as codesW65-W-74 (Gerdmongkolgan 2009).Whenhealth
care codersclassifydeathsunderICD-10the categoriesof drowningdeathsthatare missedinclude
transportrelateddrownings(boat/shipsinking),forcesof nature suchas floods andtyphoons, and
intentionalinjury(suicide/homicide) which affectsthe accuracyof Thailand’sdrowningstatistics
(Linnan, 2012). The three databaseswhichare usedtocompile drowningstatisticsare:
(1) The mortality databases on death certificates

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“DeathCertificate dataiscompiledbythe Bureauof PolicyandStrategy,MOPH, whichelicitedthe
civil registrationdatafromthe Bureauof RegistrationAdministration,Departmentof Provincial
Administration,Ministryof Interior,andthencodedthe causesof deathonan individual basisbased
on ICD-10. Deathcertificate completenesshasbeenstudiedtobe at 95.2% of deaths
(Gerdmongkolgan,2009).
Limitationsof this:
While completenessof deathcertificationseemshigh,the portionof causesof deathinThailand
whichare classifiedas“ill-definedandunknowncausesof mortality”isashighas 20-39% which
couldskewthe data (“Rapid Assessmentof NationalCivilRegistration,”2012).
(2) The database of individual inpatients
“Data retrievedfromthe individualinpatientsdatabase wascompiledfrom2005 to 2007 bythe
Bureauof PolicyandStrategyafteritbeganto coordinate withthe National HealthSecurityOffice,
and the Social Securityoffice 2004” (Gerdmongkolgan,2009). Thisinformationcomesthrough
medical facilities.
Limitationsof this:
The data did notcomprehensivelycoverall inpatientswhowereadmittedtohospital because itwas
onlyinpatientswhohad the rightstoreimbursementsformedical expenses.Also,the dataexcludes
all the drowningdeathswhere the childdrownedbutwasnotadmittedorregisteredata medical
facility.
(3) The Injury Surveillance System.The first two databases are operatedby the Bureau of
Epidemiology,DepartmentofDisease Control (DDC),MOPH
The data was compiledperiodicallybythe Bureauof Epidemiologyandthe Departmentof Disease
Control through29 large hospitalsinBangkokandotherprovincesacrossthe country.
Limitationsof this:
Thisdata is compiledonlyat29 large hospitalsandnotsmall medical centres,whichmeansareas
and communitieswouldnotbe represented.
Data Tables:
Categories
of Statistics
Thai National Injury Survey
(TNIS)
Ministryof PublicHealth Discussion
General
Trends
 Drowningisthe leadingcause
of deathinchildrenagedone
yearand overin Thailand,
causingnearly2,650 deaths
everyyear.
 On topof these figures,some
3,000 childrennearlydrown
everyyear
 In Thailand,the rate of
childdrowningdeathsis5
to 15 timeshigherthan
those fordeveloped
countries.
 Drowningisthe leading
cause of deathinchildren
agedunder15 yearsof age,
notably,higherthanroad
trafficaccidents,and
While the reportedaverage
numberof deathsperyear is
significantlymore inthe Thai
National InjurySurvey(which
couldbe due to inaccuraciesin
the collectionsystemof the
Ministryof Health) bothsets
of data neverthelessrecognize
that drowningisthe leading
cause of deathforchildren

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Categories
of Statistics
(TNIS)
infectiousdiseases
 In Thailand1,243 children
under15 yearsof age die
each yearfromdrowning
(10 yearaverage)
under15.
Age  Drowningcausedalmosthalf
(46 percent) of all child
deathsinthe 1-4 age group.
These childrenare tooyoung
to learnto swimso
preventionrequiresincreased
supervision,especiallyas
infantsdevelopintotoddlers
and outstripa busymother’s
abilitytocloselysupervise
them(see figure 1).
 On average,childreninthe
0-4 age group rankedfirst
for drowningdeaths
between1999 and 2008,
followedbythe 5-9 age
group;but since 2005, the
5-9 age group has ranked
first.
 The proportionof drowning
deathsinchildrenunder15
yearsof age as highas
30.2% of drowningdeaths
inall age groups.
 On average,the 0-4 age
grouphas the highest
drowninginjuryrate,two
timeshigherthanthatfor
the 5-9 age group and 5
timeshigherthanthatfor
the 10-14 age group.

The age group of childrenwho
drownwhichhas the highest
incidence of drowninghas
beenshownonaverage tobe
1-4 forboth sourcesof data.
Although,more recent datain
boththe SituationAnalysisof
ChildDrowningSurveillance
(2009) and Situationof Child
Drowning(2014) both show
the 5-9 age group having
higherincidence of child
drowning(whichisdiscussed
below thistable).
Figure 1. Drowning rate by age group (from TNIS)
^(Linnan,2014)
Categories
of Statistics
(TNIS)
0
10
20
30
40
50
60
0-1 1-4 5-9 10-14 15-17 1-17
Reateper100,000

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Categories
of Statistics
(TNIS)
Gender  Malesin the 1-4 age group
are more than twice aslikely
to drownas females(see
figure 2).
 However,femalesaged10to
14 have higherratesof
drowningthanmalestheir
age (see figure 2).
 The rate of childdrowning
deathsformalesis
approximately2times
higherthanthat for
females.
Thisis a trendseenworldwide
(ChildDrowning2012).
Presumedtobe as a resultof
supervisiondisparities,gender
roles,andhigherrisk-taking
behaviourinboys.
The femalesaged10 to 14
have higherratesof drowning
than malesisperhapsbecause
swimmingabilitiesinboysof
that age are higherthanthat
of girls.
Figure 2. Drowning rate by age and sex (fromTNIS)
^(Linnan,2014)
Categories
of Statistics
(TNIS)
Time ofDay  Drowningisessentiallya
daylightphenomenon.The
vast majorityof children
(96%) are firstnoticed
missingduringdaylighthours
(between6amand 6pm) (See
figure 3).
 47% of childrenwhodrowned
were determinedmissing
between12:00-17:59, while
49% were determined
missingbetween6:00- 11:59
(see figure 3).
 The time periodof the day
withthe highestincidentsof
severe drowninginjuriesis
between12:00 noonand
17:58 hrs, accountingfor
64% of all drowning
fatalities(12:00-14:59 with
27% and15:00-17:59 with
37%).
There isa difference between
the two sourcesof data. The
disparitymaybe to do with
PublicHealthdatabeing
swayedbythe time the
drowningeventisreported,
rather thanactuallyoccurring
(forexample achilddrownsin
the morning,andthe incident
isreportedinthe afternoon).
If the PublicHealthdatais
validitshowswhenchildren
leave school at3pm and are
0
10
20
30
40
50
60
70
80
1-4 5-9 10-14 1-17
Rateper100,000
Male Female

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no longersupervisedtheyare
more likelytodrown.
Figure 3. Known time of day drowned childis determinedtobe missing (fromTNIS)
^(Sitthi-amorn,2006)
Categories
of Statistics
(TNIS)
Months of
the year
 January,April,
September,and
Decemberare the four
monthswiththe most
deaths(see figure 4).
 April isthe monthwiththe
highestnumberof deathsby
drowning,followedbyMay,
March, Octoberand
November.
The monthsthat have a high
drowningincidence are
aroundschool holidays.
SongkraninApril witha large
amountof interactionwith
waterdrowningratesare high.
Figure 4. Childhooddrowningby months (fromTNIS)

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^(Sitthi-amorn,2006)
Categories
of Statistics
(TNIS)
Days ofthe
week
 Weekends(Saturdaysand
Sundays) have the highest
incidentsof severe drowning
injuries(seefigure5).
Weekendsare dayswhen
childrenare notsupervisedin
day-caresor at school and are
therefore more atrisk.
Figure 5. Percentage ofsevere drowninginjuriesin children<15 by day ofthe weekaverage 1998-
2007 (From Ministryof PublicHealth)
^ (Gerdmongkolgan,2009)
Categories
of Statistics
(TNIS)
National
spatial
trends
 Overall,rural children
aged1 to 17 are almost5
timesmore likelyto
drownthan theirurban
counterparts(see figure
6).
 The Northeasternregionhas
the highestrate of child
drowning,followedbythe
central,northern,andsouthern
regions,respectively.
 NakonRatchasima,Bangkok,
Buri Ram, Ubon Ratchathani,
Surin,Si Sa Ket,Ubon Thani,
and KhonKaenhave the
highestratesof deathsby
drowning(5-yearaverage 2004
to 2008).
 NakhonRaatchismaprovince
had the highestnumberof
deathsbydrowninginthe four-
yearperiodbetween2005 and
2008.
The Northeastregionisknown
to consistentlyhave higher
drowningrates.Thiscoincides
withthe Northeastalsohaving
the highestpercentage of
childrenleftininadequate
care at 2.4% (inadequatecare
was alsohighestamongthe
poorestwealthindexquintile
whichislinkedwiththis,given
northeastbeingapoorer
region).However,the
Northeastregionwasthe
secondhighestregioninterms
of percentage of childrenaged
36-59 monthswhoare
attendinganorganizedearly

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childhoodeducation
programme (“Thailand:
Monitoring theSituation of
Women and Children,”2013).
Figure 6. Drowning rate by age and place of residence (fromTNIS)
^(Linnan,2014)
Categories
of Statistics
(TNIS)
Location of
drowning
 Riversare the leadingcause
inthe 5-9 age group (72%)
and inchildren 1-17 yearsold
generally(1to17, 35%). No
childrendrownedindoors
(see figure 7).
 76% of drowningsoccurin
natural watersources (ponds,
ditches,lakes,riversorthe
sea) (see figure 7).
 More than a quarter(28%) of
toddlers,1to 4, and15 per
centof all childrenaged1 to
17 drownin wells(seefigure
7).
 More than half (56 per cent)
of all drowningdeathsoccur
within100 metresof the
child’shome.Fortoddlers,
thisproximityisevenmore
strikingwhere almostthree
quartersof drownings(74 per
cent) occur within100m of
the home (see figure 8).
 Withregard to differentkinds
of watersourceswhere
drowningoccurs,natural
sourcesof water rank first,
accountingfor49.9% of all
drownings,followedby
swimmingpoolsat5.4% and
bathtubsat 2.5%.
There are twotypesof
drowningincidents.Type Iis
generallyinthe 1-4age group
where small toddlersdrown
nearthe home whichinvolves
brief lapsesof supervisionand
access to water,including
domesticwatercontainers
and pondsaroundor near the
house.Type IIreferstothe
drowningincidentswhere
childreninthe 5-9 age group
are inneighbourhoodareas
furtherawayfrom home and
fall intoponds,canals,dams,
and othernatural water
sources (Plitponkarnpim,
2014).
0
10
20
30
40
50
60
70
80
1-4 5-9 10-14 1-17
Rateper100,000
Urban Rural

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Figure 7. Place of drowning of children (fromTNIS)
^ (Sitthi-amorn,2006)
Figure 8. Distance to water body where drowning took place (from TNIS)
Categoriesof
Statistics
Thai National Injury Survey(TNIS) Ministryof PublicHealth Discussion
Use of water
sources where
drowning
occurred
 Most Thai drowningsoccurin
sources of water notconnected
withthe household.Water
sources usedfor
“bathing/washing”,“storage”
Water sourcesare a large part
of rural life whetherforthe
householdorpartof
agriculture andraisingfish,
the nearbyaccess and

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Categoriesof
Statistics
and “cooking/drinking”
combinedmake upjust16 per
centof the drowninglocations.
The single largestcategoryis
“raisingfish”,whichaccountsfor
31 per centof the sources of
water.“No regularhousehold
use”,“agriculture”and“other”
are the nexthighestcategories
(see figure 9).
proximityof watersources
makesdrowningmore likely.
Figure 9. Use of water source where drowningoccurred (from TNIS)
Categories
of Statistics
(TNIS)
Supervision
factors
 At the time of drowning
mothersare usuallydoing
houseworkorbusywith
otherchores
 Acrossall age groups,only17
percent of drownedchildren
were accompaniedbytheir
mother,father,orother
primarycaretakerat the time
theydrowned.Almostone
Adequate supervisioniskey
for childrenparticularlyinthe
1-4 age group whenchildren
shouldbe watchedclosely.

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Categories
of Statistics
(TNIS)
third(29%) of all drownings
occur whenthe childisalone.
In 1 to 4 year olds,half the
time (52%) whena toddler
drownsa familymember
otherthan theirparentsis
accompanyingthe child,most
oftenan oldersiblingacting
as the supervisorforthe child
in
absence of the mother(see
figure 10).
Figure 10. Known person* accompanying childprior to drowning (from TNIS)
Categories
of Statistics
Swimming
ability  Onlyaboutone third(34 per
cent) of Thai childreneverlearn
to swim(see figure 11).
 Only15% of childrenwho drown
couldswim(theirlevel of
swimmingskill mayvary.
Swimmingabilityhasbeen
proventopreventdrowning,
the fewerchildrenwhoknow
how to swim, the more
childrenata greaterrisk of
drowning.

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Figure 11. Swimmingability by age (fromTNIS)
^(Linnan,2014)
Categories
of Statistics
Known
activity of
childwhen
drowning
occurred
 Priorto drowning52% of
childrenwere knowntobe
playinginwaterand45% were
workingorplayingnearwater,
withthe other3% actually
swimming/bathinginthe
water(see figure 12).
Whenplayinginthe water
onlya few furtherstepsaway
fromthe side of the water
source and the watercouldbe
too deeptostandand the
childcouldeasilydrown.
Figure 12. Known activity* of childrenprior to drowning(from TNIS)
^ (Sitthi-amorn, 2006)
2.4%
4.9%
7.8%
11.6%
16.1%
20.5%
23.4%
27.8% 29.9% 31.9% 33.3% 34.3% 34.5%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
5 6 7 8 9 10 11 12 13 14 15 16 17
Percentcanswim
Age in years

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Categories
of Statistics
(TNIS)
Case-
fatality
rate
 Mean case-fatalityrate is
41.0%
While drowningkillsmore
childrenthanroadaccidents,
the numberof cases of road
accidentinjuriesissignificantly
higherthoughwitha much
lowercase-fatalityrate.Local
and national policymakers
observe thatroad accidents
casesare more than drowning
casesand believeitisa much
greaterproblem, whilefailing
to realize thatthe mortality
ratesare higherbecause of
the highcase-fatalityrate of
drowning(Dr.Adisak
Interview).
Morerecentdata:
More recentMinistryof Healthdata was compiledina reportinOctober2014 namedSituationof
ChildDrowninginThailand.The datafromthisreporthas beencalledintoquestionbythe child
drowningexpertDr.Michael Linnanwhoobservesthat“whenone takesintoaccountthe confidence
limitsthatare inherentinthe systems (the systemsthatgenerate the data),itisdifficulttosee the
differences (inrecentdataresults) asbeingstatisticallysignificant”(MichaelLinnan Interview).
The recentresultsshowa reductioninthe ratesof childdrowningdeaths(per100,000 children<15
years) inThailandfroma highof 11.5 in2005 to 7.6 in 2013 (See figure 13, Gerdmongkolgan,2014).
While Dr.Michel Linnanrecognizes thatthere hasbeenanexpansioninthe earlychildhood
developmentprograminThailandwherebyattendance indaycare centreshasexpanded,thus
increasingsupervisionof children,overall thisisunlikelytohave contributedsuchalarge reduction
indrowningrates (MichealLinnan Interview).
Figure 13. Numberand rates of childdrowning deaths(per,100,000 <15 years,2004-2013)
^(Gerdmongkolgan, 2014)

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The recentreport alsopointstofurtherdecreasesinthe ratesof childrendrowninginthe 1-4age
group,whichrendersthe 5-9 age groupfirmlyasthe highestage groupfordrowningincidence.
Again,thismightowe tothe expansionof the earlychildhooddevelopmentprograminThailandthat
will be elaboratedonlaterinthe report.Furthermore,the ChildSafetyPromotionandInjury
PreventionResearchCenter(CSIP) noted adecrease of 400 since 2005 fromtheirreported600
children peryearinthe 1-4 age groupwhodrown. While atthe same time theysaw an insignificant
decrease inthe 5-9 age groupin whichtheyreport500-550 childrendrowneveryyearstill (CISP
Interview).Again,thisdataisnot accurate enoughto confirm these decreasingdrowningtrends
(MichaelLinnan Interview).
Assessment ofthe main interventions mentionedin the WHOGlobal
Report on Drowning
Installing barriers controlling access to water:
A peerreviewedstudybyDiane CThompsonandFredRiveraconcludedthatfencingwhich
completelyseparatesthe pool fromthe house andthe yardsignificantlyreducesthe riskof
drowningby75% (Thompson,1998).The studywasa review of otherstudiesall conductedinhigh-
income countries.
The distinctdifference betweenhighincomecountriesandThailandisthatdrowninginswimming
poolsare a muchlarger portionof the drowningcasesincomparisontothe mere 5.4% of total
drowningdeathsinThailand (Gerdmongkolgan,2009).In Thailand 50-76% of drowningcasesoccur
innatural watersources suchas ponds,ditches,lakes,riversorthe sea,giventhe prevalenceand
size of natural watersources placingfencingaroundthemisunfeasible.Fencingwouldbe unfeasible
inlowand middle-income countriesbecause itisexpensive,subjecttotheft,requiresmaintenance
and createsinconvenience,giventhatwatersourcesare necessaryfordailyactivitiesand
communityresidents.Theyare notviewedaswaterhazardsandtherefore communityresidentsdo
not wantto isolate thembehindbarriers (Linnan,2014).
However,more thana quarter(28%) of toddlers1 to 4 and15 percentof all childrenaged1 to 17
drowninwells.Wellsare the leadingcause of drowningdeathsintoddlers.Wellscanbe easily
coveredusinginexpensive materialsandshouldtherefore be prioritizedtorestrict accessto them.
(Gerdmongkolgan,2009).
Barriersaroundthe house (baby-gates) andplaypenscouldbe amore feasible optionthanfences
aroundwatersourcesgiventhe significantlylessamountof materialsneededtobuildthem.A study
of parentsperceptions,social andbehaviournorms(ASEAN Instituteof Health Development noted
that thismightface cultural resistance) aswell asthe ease andcost of obtainingorbuildingthem
(usinglocal materials) couldbe done todevelopthisfurtherasithas not beenstudiedorusedby
any authorityworkingondrowningsofar.It shouldbe notedthatbarriersaroundthe house and
playpensare only feasible foryoungertoddlers(aroundthe age of 3) and nearly 2,000 children goto
emergencyroomseachyearinthe USA from baby-gate relatedinjurieswhichmeansrisk
management(forexample ensuringtheyare disassembledwhenchildrenare able tostart climbing
them) shouldbe takenintoaccount (Cheng,2014)

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Provide safe places (for example crèche) away from the water for
pre-school children, with capable child care
Lack of supervisionhasbeenconsistentlylinkedwith drowningrates. “Ina 10-year studyof
childhoodsubmersionsinKingCounty,Washington USA itwas foundthatinadequate supervision
was the mostcommonfactor associatedwithsubmersions.Inmostcases,the adultreportsleaving
the childfor a shorttime to answerthe phone or attendto householdchores” (Brenner,2003).
While thisisstudyfroma highincome country it isgenerallyapplicableglobally.
Programshave beenimplementedinBangladesh,CambodiaandSouthernIndiaaimedtowards
improvingsupervisioninorderreducingdrowningrates. The daycare program inSouthernIndia was
developedfollowingastudy where the communityidentifiedthe needforalargerdaycare program
(Isaac,2007). The programin Bangladeshobservedthatdrowningdeathratesinchildrenaged1-5
attendingvillagecrècheswere 82%lowerthanamongchildrenwhodidnotattend. The program
deemedtobe cost-effective withaCostof Creche perdisabilityadjustedlife year(DALY) avertedof
$812, because thisislessthan$1486 (whichisthe GDP per capitaof Bangladesh) itisconsidered
highlycosteffective.The addedbenefitsof the programincludedincorporatingthe teachingof
hygiene andsanitationtochildrenaswell asempoweringmotherstowork (Rahman,2012).
Although,the implementationof the programinBangladeshinvolvedahighdegree of risk-
managementwherebythere wastrainingforinjuryriskreductionandfirstaid (mandatoryprovision
of firstaidkits),settingclasssize limits aswell asensuringhygiene and sanitationatthe crèchesand
managingthe locationof the crèche away fromriskareas (Meddings2014).
“Acrossall age groups,only17 percent of drownedchildrenwere accompaniedbytheirmother,
father,or otherprimarycaretakerat the time theydrowned.Almostone third(29%) of all drownings
occur whenthe childisalone.In1 to 4 yearolds,half the time (52%) whena toddlerdrownsafamily
memberotherthantheirparentsisaccompanyingthe child,mostoftenanoldersiblingactingasthe
supervisorforthe childinabsence of the mother”(Sitthi-amorn,2006). Thisshowshow children
drownsignificantlymore whennotunderadequatesupervision.
Accordingto lateststatistics84.7%of childrenaged36-59 monthsare attendinganorganizedearly
childhoodprogram. Only 21.3% of childrenaged3 attendbefore asharp increase inattendance to
88.8% at age 4 (“Thailand:Early Childhood Careand Education Programmes,”2006).
Figure 12: Structure of ChildCare/ DevelopmentAgencies

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^(“Thailand:Early Childhood Careand Education Programmes”,2006).
Figure 12 showsthe variousECD programsimplementedinThailand.The timingof the ECD
programsis relativelysimilartoprimaryandsecondaryschool timings.
The gaps in supervisioncanbe foundafterday-care/school,duringweekendsandholidays,which
can be seeninthe spikesindrowningratesduringtheseperiods.A programtargetingthe effects of
lesssupervisionshouldfocusspecificallyonthe timeswhenchildrenare notat school or day-care as
well aspromotingECD centres toincrease enrolmentto100% for childrenagedabove 36 months
until primaryschool.
Furthermore,incorporatingwatersafetymessagesintoECDprogramsthroughthe mainagencies
responsible suchasthe Office of BasicEducation Commission (OBEC),Departmentof Local
Administrationaswell asthe Office of Private EducationCommission (OPEC)couldbe developed.
Thisshouldinvolve behavioural change researchtargetedatchildrenandresearchintothe most
effectivemethodsof disseminatinginformationtochildren.
Teach school-aged children basic swimming, water-safety, and safe rescue
skills
A studyof 14,299 persons acrossage groups observedthatof those whowere “inundatedand
completelysubmergedby the tsunami,mortality ratesinthose able toswimwere half those found
insame-age respondentswhowere unabletoswim”asseeninfigure 12 (Linnan,2012). Thisshows
that not only doesswimmingabilityimprove watersurvival butalsoshowshow survival swimming
lessonscouldcontribute towardsdisasterpreparedness.
Figure 12: Mortality rates by age group and swimming ability in the 2004 tsunami, Aceh, Indonesia:
^(Kosen,2011)
SwimSafe isaregional survival swiminitiative forchildrenagedfouryearsandolder toteach survival
swimming,safe rescue andwatersafetyskills setupby a collaborationof The Alliance forSafe
Children(TASC), Royal LifeSavingSocietyAssociation(RLSSA) andlocal partnersinBangladesh
(where more than200,000 childrenwere participants),Thailandand Vietnam(“SwimSafeHistory”).
A cohort studyof 79,421 participantchildrenand matchedcontrol groups showeda93% reduction

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infatal drowningparticipantscomparedtothose innon-attendingcontrol groups (Rahman,2012).
Otherstudiessuchas one invariousUS states showedthatparticipationinformal swimminglessons
was associatedwithan88% reduction inthe riskof drowningin 1- to 4-year-oldchildren (Brenner,
2009) alsoadd to SwimSafe’sresults.
Survival swimminglessonsisacross-generational andsustainablesolution because the swimming
skills,safe rescue andwatersafetyskillscanbe passedtothe nextgeneration fromparenttochild.
The cost of SwimSafe inBangladeshperchild,peryearis$13.46, and cost perDALY advertedis$85,
significantlylessthanthe GDPpercapita of $1486, entailingahighdegree of cost-effectiveness
(Rahman,2012).
A detailedriskmanagementplanneedstobe implemented, includingage cut-off forentryintothe
program,ensuringthe skillsbeingtaughtare bestpractice,certificationof teachers andteaching
assistants(andrecertification),maximumclasssize forchildren(andmodificationof thisfordisabled
children), minimumhealthstandardsatentry(e.gnoprevioushistoryof seizure orepilepsy),water
qualitystandards,andlengthof trainingsessions.InBangladeshsupervisors forswimmingtraining
receivedspecifictrainingforeffectivesupervision.Monitoringvisitswererecordedandreports
reviewedperiodically (Rahman,2012).
Figure 14: Number of children needed to achieve 50 per cent coverage of children at risk of drowning
^(Linnan,2012)
From figure 14 it can be seenthatoperatinga program ona large scale,whichinvolveshundredsof
thousandsormillionsof children,couldentailacertainamountof trainingdeaths,evenif the risks
are significantlylow. Therefore whendevelopingaprogram careful attentionshouldbe made by
diligence inplanning,recognitionof the lackof capacityand experience andpartneringtoattainit
(Michel Linnan Interview).
Furthermore,attentionneedstobe paidto Thai childrenwhoare at an increasedriskinaswim
learningprogram:
 “ThailandMISC 2012 documentedstuntingandwastingprevalence inchildrenunder5years
oldrangingfrom 10-27% nationally.Delayeddevelopmentwithshortstature and/orwasting
placeschildrenata significantriskwhenplacedinwatertolearnhow toswim.”

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 "In Thailand,the prevalence ratesof seizuredisorders,asthma,heartrhythmandother
conditionsthatincrease riskapproach10-15%. These conditionsmayleadtolossof
consciousness,respiratorydistressandseizures.These place childrenatveryhighriskof
injury,includingdeathwhenplacedinthe waterandlearningtoswim.”
(Linnan,2014)
In Thailandonly34.5% of children everlearnhow toswim(Sitthi-amorn,2006) whichclearlyshows
the necessityforsuchprograms. SwimSafe inThailandfocusedondevelopingthe use of portable
poolswith 3 of themboughtfromChinaand setup inSamut Prakhan,Ayutthaya, andChangRai.The
program (whichwasa partnershipbetweenTASC,RLSSA,Thai Life SavingSociety(TLSS) and
ChulalongkornUniversityCollege of PublicHealth) showedthatsurvival-swimmingcoursesinthe
formof SwimSafe was cost-effective and suitableforThailand. The portable poolsproveduseful
because of theirtransportabilitysothattheyreach a maximumnumberof students. Although
specificriskmanagementwithportable pools needstobe ensured, suchascontrollingaccessto
themoutside of lessons,providingadequateshadingoverthem, ensuringthere isasite manger
properlytrainedinstructural maintenanceaswell aswaterquality maintenance (Rubin,2011). This
specificprogramrunby TASC(the associationforSafe Children) isnolongerinoperationbutthe
three portable swimmingpoolsare nowrunandmaintainedbythe Thai Life SavingSociety(TLSS).
The Ministryof PublicHealthallocated100,000 baht for eachof the 220 EducationService Office
Areas(ESAO),withthe intentionof training200 studentsperESAOwith 500baht allocatedforeach
studenttogo towardssurvival swimming andwatersafetylessonsfor teachers(usingthe curriculum
developedincooperationwithTLSSandCSIP withadaptationof SwimSafe curriculum toashortened
version). The programinvolved FiveWaterSafetyLearningObjectives,whichincluded“the
identificationof high-riskwaterlocations,floatingfor3 minutes,swimmingfor15 meters,andskills
to helpothers,suchas,shouting,andthrowingandhandingacrossa life jacket” (Plitponkarnpim,
2014). The programwhichcoincidedwiththe establishmentof 65 out of 77 provinceshaving
established survival swimmingtrainingcentreswassaidtobe largelyineffective asitwas
unsustainable.The moneywaswastedonteachingteachersandnotstudentsinsome instances and
some ESAOsonlytaughtswimskillsandnotwatersafetyandrescue accordingto the 5 watersafety
objectives.Howeverthe mainissue wasthatthe moneywasnotcontinuedthe nextyearandlocal
authoritiesdidnottake ownershiptocontinue the programandtrainingcentres(CISP Interview and
Ministry of Health interview).
To developscale andintegrate a survival-swimmingcurriculumintothe school curriculum (Mackay,
2010) itwouldrequire greaterwillingnessandcooperationfromthe Ministryof Education andin
particularthe Office of BasicEducationCouncil.Furthermore,itwouldalsorequire supportfrom
otheragencies todevelopcapacityforswimtrainingatthe school level aswell asthe allocationof
sufficientfundsfordevelopingthe numbersof swimming poolsneeded(ascurrentlythere isonly40
in-ground poolsunderthe Ministryof Educationsjurisdiction) (Ministryof HealthInterview).At
more specificlevel schoolteachers alsoneedtobe motivated,encouragedandengagedin learning
and teachingsurvival swimming whichwasone of the issues highlighted inthe SwimSafe program,
as well asby the MoH. In addition, behavioural change actionresearchcouldbe aimedathelping
and encouragingteacherstomake survival swimmingan additiontothe teaching curriculum
includingtimetablingthe regularityof swimclassesandincorporatingthemintothe school routine
(Rubin,2011). The currentprogram underMinistryof Healthwouldalsobe more effective if it

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targetedyoungerchildren,asthe curriculumcurrentlyrecommends only childrenof the age of 7 to
commence trainingbutthisismuchlaterthan childrenage of 4 and uptargetedinBangladesh.CISP
and TLSS note that the reasonfor thisisbecause age 7 coincideswiththe firstyearof primary
school, butperhapsthe program couldincorporate the survival swimprogramthrough Officeof
Basic EducationCommission (OBEC),andEducationService Office Areas(ESAO) earlychildhood
developmenteducationprograms (CISPand TLSSInterviews).
Currentlythe developmentof survivalswimmingcurriculumhasamore bottom-upstructure
wherebythe local authoritiesthatare mostwillingandmotivatedtowardsimplementingasurvival
swimcurriculumare askingforcapacity buildingfromagenciessuchasTLSS to teachswimmingand
allocatingsufficientfundstodoso.For example,in adistrictinSurinprovince 40-50 portable
swimmingpoolswerebought,with500 trainersbeingtrainedby TLSS(InterviewswithCISPand
TLSS).OrganizationssuchasTLSS are usingthe earlyversionsof the SwimSafe curriculumthatneed
to be updatedto the thirdand mostrecentversiontoensure greaterriskmanagement(Interview
withMichael Linnan).
Strengthen public awareness of drowning and highlight the vulnerability of
children/ focus on behavior change
An international surveyquestionnaire wasdistributedduring2013 viae-mail andelectronicsocial
networkingtoover20,000 people fromdifferentregionsand backgrounds.The surveyshowed five
differentdrowningpreventioneducational videosinthe beginning.62% of participants expressed
afterwatchingthe videothattheirattitude towards drowninghadchanged.The type of videothat
had the greatestimpacton the participant’swatersafety awarenesswasthe real testimonybya
relative of someonewhodrowned.The mostcommonsuggestionforhow toincrease people’s
awarenesswastoensure the videoswere aspersonal aspossibleinordertomake people feel how
theytoo couldeasilybe at riskof drowning (Szpillman,2013).
While the fear-based,more personalorientateddrowningpreventionawarenessmessagesshould
be aimedat parents, there needstobe a differentapproachtochildrenthemselves.Fear-based
messageswouldworklesseffectively onchildren giventhatthey are lessattunedtoassessingrisks..
Othertargetedwatersafetyinitiativeswere aimedatolder,child-agedchildren,andnotpre-school
1-4 age group children. Jabariof theWateris an initiative totargetyoungtoddlersbyusingneutral,
recognizable charactersof familiarpersonalitiesthroughpositive stories.Itisbasedonacademic
theoryof appealingmosteffectivelytochildren (Robinson,2012).
A projectsimilarto Jabariof the Water is“the Water Giants childdrowningpreventionprogram –a
social mediaandweb-basedchilddrowningpreventionprogramcurrentlybeingdevelopedbyJWT
(previouslyJWalterThompson World-Wide Media) inpartnershipwithTASC.JWTThailandhas
developedananimatedcharacterthatisappealingtoThai childrenandwill be developingepisodes
usingthischaracter that aimto target Thai childrenandcommunicate aspectsof watersafetyand
howto protectthemselvesandtheirfriendsfromdrowning.” Giventhatthisprogramhasalready
beenadaptedforthe Thai contextismightbe more useful than Jabariof theWater, buttheyboth
followthe same academicunderstandings (Linnan,2014).
Anotherapproachto behavioural change andwatersafetyawarenesswasorientatedaround trying
to ensure thatthe messageswere disseminatedinawaythat wasappropriate for“rural village and

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low-literacyenvironments.”The followingtypesof mediainwhichtodisseminatethe information
were foundtobe successful inthe initiative inBangladesh:
 Home safetycounselling
 Courtyardmeetings
 Videodocu-dramas
 Interactive populartheatre
(Walker,2011)
Strengtheningpublicawarenessof drowningprevention isaninterventionthatshould notbe used
alone,insteaditshouldbe usedapart of broader,comprehensive drowningpreventionstrategythat
isadaptedfor differentage groups.Asthere hasbeennorigorousstudiesobservingadirectlink
betweenstrengtheningpublicawarenessandlower drowningratesthismethodof intervention
shouldbe seenasa catalyst to motivate stakeholderstouse additionalinterventionstoreducing
drowningrates(Meddings,2014).
A cross-sectional household study wasconducted inThailandin2013 by the ASEAN institute for
HealthDevelopmentobservingthe drowningriskperceptionsamong633 rural guardiansof children
whoattended12 schoolsserving48 villagesinarural community.The studyconcludedthat23% of
guardiansperceivedthattheirchildwasnotatrisk of drowningand40% were unable todetermine
that drowningwasa seriousproblem (Laosee,2013).Thiscouldpossiblyshow the shortcomingof
currentdrowningawarenesscampaignsandhow much still needstobe done toincrease awareness.
The 2006 National DrowningPreventionCampaignincluded:
 Publicawareness campaignsdirectedatthe general publicandseniorgovernment officials
duringfloods,SongkranFestival,LoyKrathongFestival,andschool breaksemphasisingthe
preventabilityof drowning.
 The ChildDrowningPreventionCampaignDayonthe firstSaturday of March each year,
whichiswidely publicized.
 Havingall health-care facilitieseducate the parentswhobringtheirchildrenfor
immunizationandcheck-upsaboutdrowningprevention andwatersafety
 Passinga lawto regulate the labellingof bath-tubsanddomesticwatercontainersabout
supervisionanddue care.
 Water safetyanddrowningawarenessinformationhasbeenincorporatedintothe Well
ChildBookwhichparentsreceive uponthe deliveryof theirchild.
CommunityHealthVolunteersare beingexpectedinthe future torecorddrowningincidentsand
conduct home visits,whereparentsare helpedatidentifyingriskareasandtimes (Plitponkarnpim,
2014).
CSIPnotedthat “parental awarenessregardingpreventative measuresforyoungchildrencould be
strengthenedbyincreasingmessages with‘case reports’ (tomake themmore personal).Theyalso
noted,asdid the ASEAN Institute forHealthDevelopmentatMahidol (ASEAN,CSIPInterviews) that
there wasa lackof awarenessregarding youngerchildrenandchildreningeneral.While the Ministry
of PublicHealthdidnote thattheyhadcreatedwatersafetyawarenessmaterials,the extentto
whichthey have beendisseminated, the qualityof the materialsandthe extenttowhichthe

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informationhasbeenadaptedforyoungtoddlers needstobe reviewed.Outof the Five Water
SafetyLearningObjectivesunderthe watersafetycurriculumdevelopedbythe Ministryof Health
and otheragencies,the three objectiveswhichcouldbe incorporatedintobehavioural change
orientatedwatersafetyawarenesscampaignsare 1) the identificationof high-riskwaterlocations,2)
skillstorescue others,suchas,shouting,andthrowing floatableobjects(whichinclude plasticwater
containers,wood,rubbershoes,coconuts), 3) the use of life jackets.
Anotherpossibleideaforpromotingwatersafetyisthe drowningof “PrincessSunandha
Kumariratana(10 November1860- 31 May 1880) who wasa daughterof KingMongkut(Rama IV).
She was one of the four queensof KingChulalongkorn(RamaV).The queenandherdaughter
drownedwhenthe royal boatcapsizedwhile onthe waytoBang-Pa-InRoyal SummerPalace.The
grief strickenChulalongkornlatererectedamemorial toherand hisunbornchildat the Bang-Pa-In
Palace.There isan opportunity todevelopdemonstrationareasfordrowningpreventionthatbuild
uponthispowerful cultural meme” (Linnan,2014).
A full evaluationof behavioural change andthe currentawarenesscampaignsneedstobe
conductedinorderto reach the capacity whereby there isfullsocialmobilization toward the
prevention of drowning (Plitponkarnpim, 2014). For a behaviourchange approachto awareness
programs and the evaluationof drowningpreventionawarenesscampaigns inThailand the ‘twin
revolutions’circle diagramsare auseful wayof understandingthe differentfactorsinvolvedin
influencingbehaviourforstakeholderssuchaschildren,teachersandparents(Eldridge).The
approach combinesthe general principlesof behaviourinthe innercircle andthe contextinwhich
these principlesinfluence behaviourare showninthe outercircle (Interview with Christopher
Eldridge).The interactionsthatinfluence behaviouroccurwithinthe outercircle contexts,withinthe
innercircle principles andacrossboththe innerandoutercirclesof influence. Thiswasanapproach
usedforthe Thai Police BIRapidResearchProjectwhichcan be emulatedif abehaviourchange
approach istakentowardsinfluencingchildren’sbehaviouraroundwaterthroughawarenessand
influencingteacher’sbehaviourtobe more engagedwithwatersafetyprograms (Interview with
ChristopherEldridge).
Figure 15: Twin Revolutions in the Practice and Scienceof BehaviourChange:

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Local authorities,government and community partnerships
Figure16: TheprovincesinwhichSavethe ChildrenThailandprogramsoverlapwith
highdrowningrates:
(SCI Thailand Brief, 2015 and Gerdmongkolgan, 2014)
Kanchanaburi- Notonlydoesthisprovince show upredon figure 16 but thisprovince alsoshowsup
in2005 as havingthe 10th
highestdrowningrate.Thisprovince isunderoureducationprogram,
whichwouldbe useful forthe drowningpreventionprogramasitwill involvepartneringwithlocal
educationauthorities.
Provincial Distribution of Child Drowning Rates per 100,000,
per year

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Bangkok- Parts of provincesthatmake up the greaterBangkokarea show up as redon figure 16. It
showsupas havingthe highestdrowningdeathsamongchildren<15 yearsin2004, and second
highestin2005, 2006 and 2007, andthird highestin2008. It shouldbe notedthatBangkokdoes not
have the highestratesof drowning(percapita) buthas one of the highesttotal drowningdeaths.
Surat Thani- This province doesnotfeature ineitherthe top10 highesttotal numbersof drowning
deathsbetween2004 and 2008 or inthe top 10 highestratesof drowningdeathsbutdoesshow up
as red on figure 16.
Phang Nga- Thisprovince showsupas havingthe fifth highestdrowningrate in2005 but doesnot
feature amongstthe top10 highestnumbersof drowningdeaths.Itisshown asredon figure 16.
Song Khla- Thisprovince showsupashavingthe 9th
highesttotal drowningdeathsin2004 butdoes
feature amongthe top 10 highestaverage drowningrates.Itis alsoshownas redon figure 16.
Convincingpolicy-makers/local authorities / donors fortheneedfora national program
o Emphasize thatdrowningisthe leadingcause of deathforchildrenunder15.Use the Thai
National InjurySurveyDataandthe Ministryof PublichealthDatabyadvocatingusing
rangesof data.For example,drowningdeaths,peryearforchildrenunder15 are between
2,650 to 1,243.
o Discussthe economiccostof drowning,bothintermsof medical facilitycostsfordrowning
injuriesandthe costto societyhavinglostsomeone whocouldhave beenpartof the
workforce.
o Emphasize the preventabilityof drowning;show evidence of the interventions,whichcan
reduce drowningeffectively.
o Compare drowningdeathratestoroad accidentdeathrates(whichare oftenseentobe
more important) inorderto highlightthatbothare veryimportant.
o Use emotive arguments,particularcase studiesfrom the specificprovince.
o The linkbetweenswimmingabilityanddisastersurvival mightbe especiallyuseful for
obtainingfunding,especiallygivenThailand’ssusceptibilitytonatural disasterssuchas
floodsandtsunamis.
o Nextyear(2016) will be the 10 year anniversaryof the beginningof the National Drowning
PreventionCampaignanddrowningpreventionawarenessandadvocacycouldbe centered
arounda renewedcommitmentfollowingthe anniversary.
Howto create a communityledintervention:
o Involve local authoritiesfromthe beginning;askforadvice onhow to effectivelyimplement
interventions.
o The AssociationforSafe Childrenplacedspecificlocal authorityofficial namesclearlyon
watersafetyanddrowningpreventionmaterialsforownershiptobe takenof the program
(generallyensure publicityforauthoritiesinvolved). The possibilityof contactingpoliticians
to getthison theirelectoral platformcould alsobe explored.
o Work throughpre-existingtiesforSave the Childrenanduse Save the ChildrenStaff thatthe
local authoritiesand governmentofficialsare familiarwith (Interview with Chulalongkorn
Ministry of Public Health).
o Buildlocal capacityto ensure the programissustainable.

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o A communityledintervention wasdeveloped inthe Phillipineswhere there wasdialogue
withlocal communityleaders(formationof avillage drowningpreventioncommittee),focus
groupdiscussions,local capacitybuildingandcommunitywalk-throughsof the drowning
preventionprogram.The programensuredthatpreventioninterventionswereadaptedfor
the specificcommunity,inthatforexample materialsusedforcoveringwells,making play-
penswere locallysourced.Methodsof effective intervention(coveringwells) were
suggestedbythe community themselves (Guevarra,2014).
o In termsof creatinga local communityinterventionthe community’sperceptionof specific
interventionsneedstobe managed.Forexample inSri Lankaa local drowningprevention
program neededtoadaptto promote the abilityforgirlstolearnhow to swim.Forthe
communitytoaccept the program swim-suitsleggingsweredistributedtothe girlslearning
to swimto preserve modestyandswimming areaswere alsowalled/fencedintoprevent
predatorymale spectatorswhohadassembled.Suchanapproach,where swimminglessons
are adapted forfemale attendees couldalso be appliedtocertaincommunitiesinThailand
(suchas Muslim communities) (Fonfe,2013).
MeritMakingprogram:
o The “meritmaking”program isa Ministryof PublicHealthinitiativetomotivate and
promote local authoritiestohave acomprehensive andeffective drowningprevention
program.
o The scheme isessentiallyagradingsystemtorate individual teamsontheirprogressfor
drowningprevention.The gradesare ‘goldlevel,’‘silverlevel’and‘bronze level.’The bronze
level involvesrecognitionforachievementsatthe local level,silverlevel involvesrecognition
for achievementsatthe provincial levelandgold levelinvolvesrecognitionatthe national
level.
o Eligibilityfor‘meritmakingstatus’involves10criteriatowardsan effective drowning
preventionprogramforpolicy(providingplans,manifestcontinuousperformance),
administration(conductedbymultipleprofessionsobtainingresources),information
(monitoringandevaluation),riskmanagementof watersources,kindergarteninterventions,
educationof the community,conductingsurvival swimlessons,providingaCardiopulmonary
resuscitationworkshop andpublicizingactivities.
o Ministryof PublicHealthhasrecommendedthatSave the Childreneitherhelptorate and
evaluate different‘meritmaking’teamsorbecome ateamourselves,theythinkthiswould
be an effective wayof becominginvolvedindrowningprevention andpartneringwiththem.
(Gerdmongkolgan, 2014 and Interviewwith Ministry of Public Health)
Assessment ofpossible partner agencies:
Ministry of Public Health:
In 2006, the Ministryof PublicHealthinitiatedthe National DrowningPreventionProgram.The
program wascoordinatedbythe National DrowningPreventionCommitteethatconsistedof 30
differentagencymembers(mostlyingovernment).
Under thisprogram,the keypolicydirectionsinclude:

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o Trainingall childrenaged6 yearsandover to be able to swimforsurvival.
o Designatingthe firstSaturdayof March each yearas the ChildDrowningPrevention
CampaignDay.
o Havingall health-care facilitieseducate the parentswhobringtheirchildrento
immunizationsandcheck-upsaboutdrowningprevention.
o Train communityleaders,teachers,parents,childrenandothersondrowning
rescue,includingCPR.
o Incorporatingchilddrowningpreventioninthe activitiesof healthpromotingschools
o Integratinganactionplanfor drowningpreventionandwaterrescue intothe
national emergencymedical service system.
o Teachinga course on drowningpreventioninnursingcolleges.
o Requiringthe Ministryof Educationtodevelopaplanforenhancingwatersafety
skillsforschool children.
o Passinga lawto regulate labelingof babybathtubs.
o Collaboratingwithlocal governmentorganizations(LGOs) in the managementof
riskywatersettings.
o The developmentof the ‘meritmaking’initiative.
The extentorscope to whichthe keypolicydirectionshave beenimplementedare largelyunclear,
there are few statisticsfornumbersof childrenreachedandwhetherthese have beenimplemented
long-term.
The main areasin whichthe Ministry assesses Save the Children couldhelpwere the MeritMaking
program (asmentionedpreviously) and monitoringandevaluationof the national program
generally.Theyalsorecommendedwe developthe use of play-pensand perhaps the use of
interactive media(suchasphone andtabletapplications)fordisseminatingwatersafetymessagesto
children(note:primaryschool childrenreceivedcomputertabletsunderaMinistryof Education
initiativenamedthe One-Tablet-PerChildpolicyand watersafetymessages couldbe incorporated).
The main recommendationwhere Ibelieve Save the Children couldassistisensuringthe materials
developedforprimaryandpre-school age childrenare distributedwidelyandare qualityand
effectivematerialsadaptedtopromote behaviorchange forchildrenof specificages.Thiscouldbe
firstpre-testedinaprovince inwhichSave the Childrenalreadyworks.
(Gerdmongkolgan,2014,and Ministry of Public Health interview)
Ministry of Education:
The Ministryof Educationare keyin ensuringaneffective childdrowningpreventionprogram.The
500 bahtdistributedforeachstudentwentthrough the 220 EducationService Office Areas (ESAOs),
but wasprimarilydrivenandfundedbythe Ministryof PublicHealth (Interview with CISP).
A partnershipordialogue betweenESAOs(the educationadministrationauthorities),Office of the
Basic EducationCommission (OBEC, whoare incharge of implementingthe basiceducation
curriculum) andthe TambonAdministrative Organizations(TAO, local authorities) couldbe
developed.Thispartnershipwouldbe toensure thatthe watersafetycurriculum(containing
informationonthe five objectives,bothsurvival swimmingandrescue aswell asbeingcareful
aroundwatergenerally) isdevelopedandimplementedasessentiallyamandatorycurriculum

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nation-widenotonlyatprimaryand secondaryschoolsbutalsoat pre-schoolsorearlychildhood
developmentcentres.Whilethispartnershiphasbeendevelopedtoa certainextentincertain
provincesanddistrictsithasyet to become anation-wideandmandatoryprogram.
The reasonsfor currentfailuresonthe part of the Ministryof Educationto implementthe water
safetycurriculumasa national programare due to reluctance of teacherstotake thison as it adds
to theirworkload, the lackof swimmingpoolscurrentlyunderthe purview of the Ministryof
Education,andOBEC arguingthat the school curriculumingeneral istoolarge already.The TLSS
arguesthat the curriculumcouldsimplybe incorporatedintothe physical educationprogram.
Anotheradditiontoawater safetycurriculumcouldbe researchintochangingthe behavioursof
teachersto be more motivatedtolearnhow to teachsurvival swimandincorporate drowning
preventionintotheirschool schedule workingwiththe Ministryof Education(ESAO,OBEC) and
TambonAdministrative Organizations (TAO) toreachteachers.
Save the ChildrenThailandshouldaimtoensure the disseminationof watersafetymessages and
materialstopre-school childrenparticularly (if thisisdeterminednottohave beendone effectively
and sufficiently) andensure thatthese messagesare appropriate forthatage group. Partnerships
shouldbe developedwithESAOsinaparticularprovince tofacilitate the disseminationof these
messages(couldevenstrive toensure thisisdone nationally).
Exploitationof linksandpartnershipsdevelopedinthe “safe school”and“7% project”withlocal
authoritiessuchasBangkokMetropolitanAuthority,andthe ESAOsinthe particularprovinces
shouldbe developedfora trial periodof a survival-swimmingprogram(aswithdisseminatingwater
safetymessages) withcapacitybuildingforteachingandthe curriculumbeingdevelopedwiththe
helpof the TLSS. Followingthe trail period,Save the Childrencouldinvolve OBECtodevelopthe
program ona national scale.There isalsothe possibilityof expandingthe DRRand“safe school”
program withUNICEFto incorporate watersafetygiventhe significantlinkbetweendisastersurvival
and swimmingability.
The ministryof education shouldworktoensure thatwatersafetyandsurvival swimteachingis
mandatory/incorporatedintoPhysical EducationCollegesforlong-termcapacitybuilding.
Thai Life Saving Society:
The Thai Life SavingSocietyisasmall organizationrunbyGeneral AdisakSuvanprakornwho
collaboratedwithSwimSafe previouslybuthasnow takenoverthe portable poolspreviouslyusedby
SwimSafe.TLSSisa non-profitorganisationthataimstoeducate Thai people inwatersafety
practices.TLSS trainslocal communitymembersinwatersafetyskillsandknowledge,developingthe
capacityto teach youngchildrensurvival swimming.
TLSS currentlyworkswithlocal authorities,Ministryof PublicHealthandthe ChildSafetyPromotion
and InjuryPreventionResearchCentre atMahidol Universitymainlyindevelopingcapacitytoteach
swimming. The programthatTLSS usesisan earlyversionof SwimSafewithsome modificationsto
reduce the lengthof the course.Dr Michael Linnanhas discussedworkingwithGeneral Adisakto
revise hiscurriculumtothe thirdSwimSafe curriculum. Furthermore, TLSShastrouble withfunding,
whichithas asked for helpwith.
TLSS couldbe partneredwithtobuildcapacityand helpconducta survival swimprogramgiventheir
experience andexpertiseinwatersafety.Althoughdiscussionswouldneedtobe made withthemto

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update andevaluate theirswimcurriculum toensure complete riskmanagement,thiswouldinvolve
usingthe latestversionof SwimSafe.
(TLSSInterview)
UNICEF Thailand:
UNICEF isdevelopingadrowningpreventionprogram. InOctober2014 Dr Michael Linnan
developed aprogramconceptnote. The program is in partnership withthe Ministryof Education.
The program includes partnership withthe ThailandECD/DayCare educationsystem whichwould
be effective indisseminatingwatersafetyinformationtoyoungerchildrenand involve pre-school
childreninsurvival swimmingprograms. Save the ChildrenpartneringwithUNICEFwouldbe helpful
to obtain fundingaswell as increasingcapacitytoreach sharedgoals (Linnan,2014).
Child Safety Promotion and Injury Prevention Research Center, Ramathibodi
Hospital, Mahidol University
The CISP hasbeenworkingondrowningpreventionsincethe beginningof the National Drowning
PreventionProgram (2006),withMahippathornChinapa,astaff memberatCSIP havinga seaton
the National DrowningPreventionCommittee.
CISPhas beenintegral indevelopingandimplementingthe Survival Swimmingcurriculum, involving
communityhealthvolunteersindrowningpreventionactivities,promotingthe labellingof domestic
watercontainersandbathtubsforsafetywarnings(Plitponkarnpim,2014)
CISPis workingwithSave the ChildrenThailandonthe 7% project,Dr AdisakPiltponkarnpimis keen
to partnerSave the Children onthisissue.CISPcouldalsobe useful indevelopingconnectionswith
otheragencies.Itwaspointedoutthat the Ministerof PublicHealthcame fromMahidol University
and ismotivatedon drowningprevention;ameetingcould therefore be arrangedthroughCISPif
needed.
WorkingwithCISP would helpincrease andevaluate theirsurvival swimmingandwatersafety
course (basedonthe five objectivesforwatersafety).CSIP mayalsobe ahelpful partnerinmany
areas of a drowningpreventionprogram (Interview with CISP).
ASEAN Institute of Health Development, Mahidol University:
The ASEAN Institute of HealthDevelopmentis partof Mahidol University.The research centre has
workedondrowningprevention,andSwimSafe Thailand.The Institute couldbe useful indeveloping
any future program mainlywithassistance inmonitoring,evaluationandresearch.
College of Public Health, Chulalongkorn University
The college of PublicHealthatChulalongkornwasasignificantpartnerinSwimSafe andpartnered
withTASC,TLSS, and ALSSA toestablishSwimSafe Thailand.ChulalongkornUniversityworkedwith
TASC onthe Safe School Projectwhere the goal of the project wasto create an injuryfree
environmentata school inPhang NgaProvince,an area deeplyaffectedbythe 2004 Tsunami (“Safe
SchoolProjectin Thailand”).
The college conductedthe Thai National InjurySurvey,areportthat uncoveredthe true extentof
childdrowningasthe leadingcause of deathforchildrenunderthe age of 15. Partneringwiththe
college would be useful forconductingresearchintodrowningpreventionbutlessusefulforactual

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implementation.The college hasexpressedtheirdesire to continue workingondrowningprevention
and wouldbe willingtoworkwithSave the ChildrenThailand.
National Scout Organization of Thailand:
There iswidespreadparticipationinscoutinginThailand,withatotal numberof scoutmembersat
around1,300,000, whichisthe fifthlargestnumberof scoutspercountryin the world.Scoutingisa
keypart of the educationsysteminThailand,andthe National ScoutOrganizationof Thailand isthe
mainThai scoutingorganizationthat partnerswiththe Ministry of Educationspecificallythe Office of
the Basic EducationCommission(OBEC) and Office of the PermanentSecretary.Scoutingisopento
bothmalesand females,andincludesdifferentage groupssuchas the Cub Scouts(ages7-9), Scouts
(ages10-12), and SeniorScouts (13-15). “AlthoughScoutingispartof the school program, especially
for grades6-8, it isnot actuallymandatory.Optionsdoexistforparticipationinotheryouth
programs,such as the Thai RedCross;however,the vastmajorityof Thai youthparticipate in
Scouting.ScoutsweartheirScoutuniformstoschool once a week,thoughwhichdayof the week is
setby the local schools”(“NationalScoutOrganization of Thailand”).
A partnershipcouldbe made withthe National ScoutOrganizationof Thailand,particularlywithCub
Scoutswho number119,134 children(59,635 female and59,499 male) andare more at riskof
drowning(Grand TotalCensus).The partnershipcouldinvolve settingupaScout‘badge’whereby
attainmentof the badge involveswater safetyknowledge suchassurvival swimmingability,safe
waterrescue and CPR.There isalso membershipof the Girl GuidesinThailandbutthisismuchless
widespreadwithonly57,731.
RecommendedOptions:
Intervention What wouldit address? Whocould be partneredto achieve this?
o Monitoringand
evaluationto
prove that
drowning isbeing
preventedin
provinceswhere
programs have
already been
implemented.
o While there hasbeen quite afew drowning
preventionprogramsbeingimplemented,
very little researchhasgone intoanalysing
whetherthese programsare reducing
drowningrates.
o Provincessuchas Sukhonthai,NakonSawan,
and Surin where control groupscouldbe
comparedwiththose children whohave
been inthe prevention programs.
o Thisstudywouldprovide motivationtoother
districtsandprovincestoreplicate what
these model districts/provinceshave done.
It wouldalsohelpthese provincestowork
on anyweaknessesandadjustinterventions
for efficiency.
o Thisresearchwas requested bythe Ministry
of Health,CSIP,andASEAN Institute of
HealthDevelopment.
o Thiswouldhelpwithdevelopingtieswith
the Ministryof Health,and buildinga
relationshipforfuture projects.
o For researchthe mainpartnerscould
be the researchagenciessuchasCSIP,
ChulalongkornCollege of Public
Health, ASEAN instituteof Health
Development,aswell aspartnering
withthe Ministryof PublicHealthto
identifythe rightdistrictforthisstudy
(basedoncohort size,interventions
needingevaluated).
o The monitoringandevaluationshould
be conductedoversufficienttime and
size neededtoobserve adifference in
drowningrates.

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o Comprehensive
drowning
prevention
project
o Focuson a districtwithinaprovince with
Save the Childrenconnections.
o Thiscouldbe a pilotprojecttoevaluate best
practice,developcapacityandbuild
connectionswithpartners.
o Thiswouldinvolve differentinterventionsat
differentstagesof children’slives.
o Thispilotprojectwouldbe aninitial stage to
increase the scale of the project.
o While thisisa comprehensive plan,one or
twointerventionscouldbe effective.
o *See graphicbelow (figure 17) forfull outline
of comprehensiveapproachtoa drowning
interventionplan.
o Thiscouldbe an extensionof the DRR
projector ‘safe school’project
workingwithlinksandfunded
developedthroughthose projects.
The linkto DRR couldbe easily
established byshowingthe
associationbetweenswimmingability
and disastersurvival.
o It couldalsobe developedthrough
the 7% projectby workingwiththe
BangkokMetropolitanAuthority and
Bangkok EducationService Office
Areaswhichwe have pre-existingties
with(Bangkokisan area
recommendedabove foradrowning
preventionprogram).
o TLSS couldhelpwithbuildingcapacity
by teachingmastertrainersand
supervisingthe performance of swim
teachers. Theyshouldteachthe latest
versionof SwimSafe.
o FormerSwimSafe Thailandstaff and
Save the ChildrenVietnam couldassist
withensuringriskmanagementand
bestpractice as well asobtainingthe
latestversionof SwimSafe.
o The use of CommunityHealth
VolunteerswhichCSIPhastieswith
couldbe developedtoensure ‘home-
safety-rounds’ are done.
o Chulalongkorn College of Public
Health,CISPandASEAN Institute of
HealthDevelopmentcouldhelpwith
the monitoringandevaluationsideof
the pilotproject.

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o Conduct a
thorough
evaluationof the
current drowning
prevention
awareness
campaign and
ways in which to
developit,with a
specificfocuson
developing
awareness
messagesfor
young toddlers.
o There has beennocritical evaluationof the
drowningpreventionawarenesscampaign.
o There isa large gap inthe understanding
whetherthe awarenesscampaignconducted
by the Ministryof PublicHealthand
awarenesscampaignsingeneral are
effectiveinincreasingsupervisionspecifically
and reducingdrowningingeneral.
o Thiswouldgive abetterunderstandingon
whethersurvival swimlessonsshouldbe
preferredoverawarenesscampaignsbySave
the Children.
o A focuson whetherthere hasbeensufficient
and effective targetingof childrenandyoung
children(insteadof justparents) whichhas
beenquestionedbyCSIP,andthe ASEAN
Institute of HealthDevelopment.Thisalso
shouldinvolvewhetherbest-practice for
behaviourchange of childrenspecificallyhas
beenused.
o The campaignand targetingof children
specificallyshouldbe modifiedandre-
developedif itisfoundtobe ineffective.
o Thisrecommendationasksthe question:do
awarenesscampaignsreallyhave aneffect
on drowningpreventionrates?
o Analysingalinkbetweenawarenessand
supervisionlevelswouldbe easiertodoon a
smallerscale (assupervisionlevelsincreasing
impliesareductionindrowningrates).
o Nextyear(2016) will be the 10 year
anniversaryof the beginningof the National
DrowningPreventionCampaignand
drowningpreventionawarenessand
advocacy couldbe centredarounda
renewedcommitmentfollowingthe
anniversary.
o For the researchintothe awareness
campaign,partnershipscanbe made
withCISP,ChulalongkornCollege of
PublicHealthandthe ASEAN Institute
of HealthDevelopment.
o Coordinationwiththe Ministryof
PublicHealthto monitorthe
materials,andreachof their
campaign.
o The Jabari inthe Water initiativefor
drowningawarenessisbasedonsome
promisingandwell-substantiated
academictheory,buttheirrange of
materialsneedexpanding.
o The Water Giants program(as
discussedinthe waterawareness
section) isadaptedforthe Thai setting
and isanotherpossible optionfor
partnershipwiththisprogram.

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0
1
2
3
4
5
6
7
8
9
10
0-4 5-9 10-14
Rateofdrowningdeathsper100,000
Age of child drowned
ComprehensiveDrowning Intervention Plan (figure 17)
Pre-School Age (3-7)
--> Ensure the distributionof the Well ChildBook
throughcommunicationwith Ministryof Public
Healthinthe area.
--> CommunityHealthVolunteervisitswhere risk
areas nearand inthe home are identifiedanddealt
withappropriately(coveringwellsandcisterns),
communityhealthvolunteersalsodisseminate
watersafetymessagessuchastellingparentsto
ensure supervisionof the child.
--> WaterSafetyawarenessmessagesfocusingon
supervisionandrecognitionof riskareasspread
throughlocal mediaandmediaadaptedforrural
areas (suchas interactive populartheatre,and
puppetshows).
--> Encouragementof the use of play-pensand
childsafetybarriersthroughaparental targeting
awarnesscampagin.
--> Ensure the attendence of day-
care
--> Childtargetedwatersafety
messagesdisseminatedatday-care
throughpartnershipwith Education
Service Office Areas and Tambon
Administrative Organizations(local
authorities)
--> ImplementSurvivalSwim/
SwimSafe swimminglessonsare
implmentedatdaycare through
partneringwithESOA TAOs
--> Reinforcementof messages
aboutrisk of drowningandneedfor
constantadultsupervisionathome
to parentsthroughlocal media
awarenesscampaignsandday-cares.
--> Coordinate withTAOsandESAOsto
allowandfacilitate the attendance of a
school teachingfacilityforbasic
SwimSafe/Survival Swimprogram,
includingrescue andwatersafety
advice
--> Ensure all childrenwhoattend
primaryschool alsoattendSwimSafe/
Survival Swimprogram
--> Trainingincludessafe
rescue,firstaidandCPR.

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^Linnan,2014, 2015)
Other possible ideas to be developed:
Research into increasingthe motivationof teachers to learn how to teach survival swimand
incorporate drowningpreventioninto theirschool schedule workingwith the Ministry of
Education (Education Service Office Areas,Office ofthe Basic Education Commission) andTAO:
 Thisissue wasraisedbythe Ministryof Health,CISPandSwimSafe.The problemthatthese
agencieswere facingwasthat teachersfelttheyhadtoobusyand teachingchildrenhow to
swim,andeducatingaboutwatersafetywasjustanotherunnecessaryadditiontotheir
workload. Researchintobehaviourchange andworkingwiththe Ministryof Educationto
advocate for drowning andwatersafetycurriculumaimedspecificallyatteachersmightgofar in
helpingtoensure thatwatersafetyandsurvival swimbecomesamandatorypart of the national
educationcurriculuminpre-schoolandprimaryschool agedchildrenagedfourandabove.This
wouldneedcooperationwiththe Ministryof Educationandlocal authoritieswiththe research
agencies’help.
Survival swimmingcurriculumintegration intoCub Scouts
o Scoutingisa large part of the school curriculuminThailand,withmanyschool childrenattending
a scout program,membershipisestimatedat 1,300,000 scouts.Developing apartnershipwith
the National ScoutOrganizationof Thailandtodevelopwater safetycurriculum ‘badge’ for
scoutscouldbe effective fordrowningprevention.The fundsforsucha program couldbe
sustainedbythe Scoutorganizationthemselves (“NationalScoutOrganization of Thailand,”
2014).
After-school/holidaycamp survival swim water safetycourse:
o An after-school/holidaycampsurvival swimmingwatersafetycourse couldbe incorporatedinto
the pilotprojectmentionedabove as asecondchoice to integratingitintoschool curriculum.
Couldhave the addedbenefitof ensuringsupervisionduringholidayperiodorafterschool when
drowningratesseemtobe at theirpeak.The average time ittakesto teach the survival
swimmingis15 hours;thiscouldbe spreadovera few or more daysto developanintensive
camp course (InterviewwithTLSS and CISP).The feasibility of thismayneedtobe assessed as
howmany children are availableorgo awayduringholidayperiods.
Development/researchintothe feasibilityofusingplay-pens:
o Play-penshave beenusedinBangladeshforaidingwithsupervisioninthe 1-4 age group. This
methodof interventionhasn’tbeendevelopedandimplementedinThailandfordrowning
prevention.A feasibilityandcommunityandsocial perceptionstudy couldtobe carriedout
giventhatthe ASEAN Institute forHealthDevelopmentnotedthatparentsmaybe afraidof
puttingtheirchildina small confinedspace.There alsoneedstobe monitoringandevaluation
to see if the intervention hasaneffectondrowningrates.
Developmentofinteractive mediato incorporate drowning preventionintothe ‘one-tablet-per-
child’initiative:

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o Thisintervention hasyettobe implementedinThailand.Giventhe government’s national‘one-
tablet-per-child’initiative itcouldbe feasible toincorporatingadrowningpreventionapplication
for the tabletsalreadydistributed.Itcouldalsobe developedasaphone app or general
computerapplication. Furtherresearch isrequired todevelopitsfeasibility.
Conduct another Thai National Injury Survey
o While the Thai National Injury Survey was instrumental in recognizing the issue of drowning in
Thailandandas a use of advocacy fordrowningprevention it is quite outdated as the fieldwork
was conducted in 2002-2003. Conducting another survey would provide recent data on the
epidemiologyof drowning andinjury inThailandthatcouldbe usedto compare against Ministry
of PublicHealthdataandwouldbe instrumental indrowningpreventionadvocacy.Thiscouldbe
done incoordinationwiththe researchinstitute whichworkedonthe surveypreviously(College
of PublicHealthChulalongkorn) andindividualsfromthe ASEAN Institute of HealthDevelopment
who were previous SwimSafe staff as well as other former TASC staff.
Ensuring water safety and survival swimming courses are mandatory in Physical Education courses
and colleges for school PE teachers or even an expansion to all teachers
o Work couldbe done withthe Ministryof Educationto ensure that Physical Educationcolleges
and courseshave to teachsurvival swimming.Thiswouldbe more of along-termintervention.
Thisintervention couldbe helpful forafuture watersafetysurvival swimcurriculumtobe
mandatory nationwide.
Funding Possibilities:
Fundingsource: Discussion
FoundationPrincesse Charlene de Monaco FoundationPincesse Charlnede Monacohas
beenfundingactivitiesbyTLSSand SwimSafe
Sharks(an offshootsmall swimteaching
program) (Stenning,2014).
Thai Health Promotion Foundation Thai healthpromotionfoundationworkson
manyhealthissuesinThailandincluderoad
safety.Thiscouldbe a possible route forfunding,
we have linkswiththemthroughthe 7% project.
The foundationhasa focuson water safety
issues.
BloombergFoundation BloombergPhilanthropiescurrentlyworkingon
fundingdrowningprojectsinPhilippinesand
Bangladeshwhere theyfundlarge scale
programs.Michael Bloomberghasan interestin
fundingpublichealthprogramsandhassetup a
publichealthinstitute atJohnHopkins
University. The fundingcomesthrough The Johns
HopkinsInternationalInjuryResearchUnit(JH-
IIRU).The foundationisinterestedin
implementingandmonitoringandevaluating
innovative drowningpreventionideasthat
haven’talreadybeentrailedandtested.ForSave

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Fundingsource: Discussion
the ChildrenThailandfundingaprogramwhich
observesalinkbetweenawarenessprograms
and drowningratescouldbe a possibilityasthis
hasn’tbeenresearchedthoroughly aswell as
developingthe use of scoutsforsurvival swim
programs (Scarr,2013).
Global Drowning fund Thisis an affiliatedtothe AustralianLife Saving
Societywhichhasworkedwithfundingprograms
inVietnamandBangladesh.
Evian Natural Spring Water The corporation fundsprogramsthat aim to
manage waterresourcesforlong-term
sustainabilityandfunded aprogramat Bung
KhongLong Lake in Thailand in2008. Save the
Childrencouldapproachthe corporationwitha
proposal tomanage water resourcesfor
drowningprevention("EvianNatural Spring
Water ExpandsSustainableDevelopment
Strategy,”2008).
Namthip BottledWater The bottle watercompanyis affiliatedwithCoca
Colaand has initiatedseveral CorporateSocial
Responsibilityactivitiesmanyrelatedtothe
environment(“Namthip,”2013).
Yum Restaurants International (Thailand) The company whichisthe franchise ownerof
KFC Thailandrunsportsprogram initiativesand
alsoa disasterriskrelief program.Theycouldbe
approachedto expandtheirdisasterriskrelief
program withthe angle of teachingchildrento
swim("DisasterRelief”).
Sheraton Hotel Group Thisis a nationwide hotel group.Approaching
themto use theirswimmingpoolsandforthe
opportunityof fundingwouldbe feasible
consideringanexistingconnectionwiththem.
Apartment/condominiumBlocks Apartmentblocksandcondominiums couldbe
approachedforthe use of theirswimmingpools,
withstipulationsformanagingnoise levels,and
duringhourswhenthe poolsaren’tinsignificant
use.

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Works Cited:
Beeck, E.F Van. "A New Definition of Drowning: Towards Documentation and Prevention of a
Gobal Public Health Problem." Bullintin of the World Health Organization 83.11 (2005): n.
pag. World Health Organization. Nov. 2005. Web.
<http://www.who.int/bulletin/volumes/83/11/853.pdf>.
Brenner, R. A. "Prevention of Drowning in Infants, Children, and Adolescents." Pediatrics 112.2
(2003): 440-45. Web.
Brenner, Ruth A., Gitanjali Saluja Taneja, Denise L. Haynie, Ann C. Trumble, Cong Qian, Ron M.
Klinger, and Mark A. Klebanoff. "Association Between Swimming Lessons and Drowning in
Childhood."Arch Pediatr Adolesc Med Archives of Pediatrics & Adolescent Medicine 163.3
(2009): 203. Web.
Cheng, Yao-Wen. "Baby-Gate Related Injuries Among Children in the United States." Academic
Pediatrics, 2014. Web.
Cox, Ross. "About." Global Drowning Interventions Part 1. Royal Life Saving Society Australia,
04 Apr. 2013. Web. <http://www.royallifesaving.com.au/about/news-and-events/news-
items/global-drowning-interventions-part-1>.
"Disaster Relief." Yum! Thailand. N.p., n.d. Web. <http://www.yum.co.th/en/csr_hugeheart.php>.
Eldridge, Christopher. "ThinkFluence Conceptual Framework: Principles, Contexts and
Interactions."
"Evian Natural Spring Water Expands Sustainable Development Strategy." CRS News. Evian North
America, 23 Apr. 2008. Web. <http://www.csrwire.com/press_releases/14388-Evian-Natural-
Spring-Water-Expands-Sustainable-Development-Strategy>.
Fonfe, Christina. "Breaking Culture Barriers to Asian Women Swimming." Basic & Clinical
Pharmacology & Toxicology 109 (2011): 52. World Conference on Drowning Prevention
2013 Abstracts. 2013. Web.
<http://www.wcdp2013.org/fileadmin/Documentation/Presentations/wcdp_abstracts_web.pdf
>.

AngusCalder
09/09/2015
41
Gerdmongkolgan, Suchada, and Som Ekchaloemkiet. "Drowning Prevention in Thailand." (n.d.): n.
pag. Bureau of Non-Communicable Diseases. Ministry of Public Health, Oct. 2014. Web.
<http://thaincd.com/document/file/drowning/DrowningPreventionInThailand.pdf>.
Gerdmongkolgan, Suchada, and Som Ekchaloemkiet. SITUATION OF CHILD DROWNING IN
THAILAND (n.d.): n. pag. WHO Regional Office for South East Asia. Bureau of Non-
communicable Diseases, Ministry of Public Health Thailand, Oct. 2014. Web.
<http://www.searo.who.int/entity/disabilities_injury_rehabilitation/country_experiences/situa
tionofchilddrowning2014tha.pdf>.
Gerdmongkolgan, Suchada Team, and Som Ekchaloemkiet. "Situation Analysis of Child Drowning
Surveillance Thailand." (n.d.): n. pag. Bureau of Non-Communicable Diseases. WHO, Nov.
2009. Web.
<http://thaincd.com/document/file/download/knowledge/Situation_Analysis_of_Child_Drow
ning_in_Thailand_Eng_Version.pdf>.
Guevarra, JP. "Child Drowning Prevention in the Philippines: The Beginning of a Conversation."
International Journal of Injury Control and Safety Promotion, June 2014. Web.
<http://www.ncbi.nlm.nih.gov/pubmed/25011660>.
"Grand Total Census." (n.d.): n. pag. Scout.org. World Organization of the Scout Movement
(WOSM)., 31 Dec. 2013. Web. <http://www.scout.org/node/9767>.
Isaac, Rita, Jasmine Helan, Shantidani Minz, and Anuradha Bose. "Community Perception of Child
Drowning in South India: A Qualitative Study." Annals of Tropical Paediatrics 27.3 (2007):
225-29. Web.
KITJAKOSOL, THANAPAT. "Namthip "eco-crush" Initiative a Hit." The Nation. N.p., 02 June
2013. Web. <http://www.nationmultimedia.com/business/Namthips-eco-crush-initiative-a-
hit-30207309.html>.
Kosen, Soewarta. "Drowning Mortality in the Asian Tsunami and Correlates for Survival." (n.d.): n.
pag. World Conference on Drowning Prevention 2011. The Alliance for Safe Children, 2011.
Web.
<http://www.worldconferenceondrowningprevention2011.org/SiteMedia/w3svc1092/Upload
s/Documents/WCDP2011_Disaster_Kosen_p316_Presentation.pdf>.

AngusCalder
09/09/2015
42
Laosee, O., J. Khiewyoo, and R. Somrongthong. "Drowning Risk Perceptions among Rural
Guardians of Thailand: A Community-based Household Survey." Journal of Child Health
Care 18.2 (2013): 168-77. Web.
Linnan, Michael. "Child Drowning: Evidence for a Newly Recognized Cause of Mortality." (2012):
n. pag. UNICEF.org. UNICEF Office of Research, May 2012. Web.
<http://www.unicef.org/eapro/Child_Drowning_2012.pdf>.
Linnan, Michael, Dr. "Preventing Drowning in Thai Children: A Concept Note for UNICEF
Thailand." UNICEF Thailand, Nov. 2014. Web.
Linnan, Michael, Dr. Water Safety and Child Drowning in Vietnam. Rep. N.p.: Report for Save the
Children Vietnam, 2015. Print.
Mackay, M., J. Vincenten, O. Heller, and M. Peden. "Water Safety Education as Compulsory Part
of School Curricula in Europe: A Potential Model for Low and Middle Income
Countries?" Injury Prevention16.Supplement 1 (2010): n. pag. Web.
Meddings, David. "Global Report on Drowning." (2014): 1-61. World Health Organization.
Bloomberg Philanthropies. Web.
<http://www.who.int/violence_injury_prevention/publications/drowning_global_report/Final
_report_full_web.pdf>.
"National Scout Organization of Thailand." Wikipedia. Wikimedia Foundation, n.d. Web.
<https://en.wikipedia.org/wiki/National_Scout_Organization_of_Thailand>.
"National Scout Organization of Thailand." Scoutthailand.org. N.p., n.d. Web.
<http://www.scoutthailand.org/>.
Plitponkarnpim, Adisak, and Mahippathorn Chinapa. Mahidol University Faculty of Topical
Medicine. Child Safety Promotion and Injury Prevention Research Center, 2014. Web.
<http://www.tm.mahidol.ac.th/seameo/2014-45-1-suppl/c3-03p50-52.pdf>.
Rahman, F., S. Bose, M. Linnan, A. Rahman, S. Mashreky, B. Haaland, and E. Finkelstein. "Cost-
Effectiveness of an Injury and Drowning Prevention Program in
Bangladesh." Pediatrics 130.6 (2012): n. pag. Web.

AngusCalder
09/09/2015
43
Rapid Assessment of National Civil Registration and Vital Statistics Systems: A Case Study of
Thailand (n.d.): n. pag. Thai Health Information Standards Development Center. Health
Systems Research Institute, Nov. 2012. Web. <http://www.this.or.th/files/6.pdf>.
Robinson, Rebecca Wear. "Jabari- the Global Face of Water Safety." N.p., 09 Mar. 2012. Web.
<http://www.scribd.com/doc/84652652/Why-Jabari>.
Rubin, Tarina. "Portable Pools and the SwimSafe Thailand Experience." (n.d.): n. pag. World
Conference on Drowning Prevention 2011. SwimSafe, 3 June 2011. Web.
<(http://www.worldconferenceondrowningprevention2011.org/SiteMedia/w3svc1092/Upload
s/Documents/WCDP2011_Swim&WS_Rubin_p234_Presentation.pdf>.
"Safe School Project in Thailand." TASC : The Alliance for Safe Children. N.p., n.d. Web.
<http://www.tasc-gcipf.org/safeSchool.html>.
Scarr, Justin. "Drowning Prevention Grants Announced." International Life Saving Federation.
Bloomberg Philanthropies, 01 Nov. 2013. Web. <http://www.ilsf.org/news/drowning-
prevention-grants>.
"SCI Thailand Brief." Save the Children- Thailand Country Office, June 2015. Web.
Sitthi-amorn, Chitr. "Child Injury in Thailand: A Report on the National Injury Survey." (n.d.): n.
pag. The Alliance for Safe Children. 2006. Web. <http://www.tasc-
gcipf.org/downloads/Thai%20child%20report.pdf>.
Stenning, Andrew. "Thailand - Chanthaburi Province." Princess Charlene of Monaco Foundation,
01 Oct. 2014. Web. <http://www.fondationprincessecharlene.mc/en/learn-to-swim/thailand-
chanthaburi-province-01102014-01102015>.
"SwimSafe History." SwimSafe: Preventing Child Drowning. TASC, n.d. Web.
<http://swimsafe.org/about-swimsafe/swimsafe-history/>.
Szpillman, David. "Video Survey on People's Perceptions about the Most Impacting Messages That
Raise Awareness and Change Attitude Against Drowning." (n.d.): n. pag. Szpilman. Brazilian
Life Saving Society, 2013. Web.
<http://www.szpilman.com/new_szpilman/szpilman/ARTIGOS/Video%20Survey_Perceptio
ns_303.pdf>.

AngusCalder
09/09/2015
44
"Thailand: Early Childhood Care and Education Programmes." (n.d.): n. pag. UNESCO. UNESCO
International Bureau of Education (IBE), 2006. Web.
<http://unesdoc.unesco.org/images/0014/001472/147249e.pdf>.
"Thailand: Monitoring the Situation of Women and Children." (n.d.): n. pag. UNICEF. National
Statistical Office, Nov. 2013. Web.
Thompson, Diance C., and F. P. Rivara. "Pool Fencing for Preventing Drowning in
Children." Cochrane Database of Systematic Reviews 1 (1998). N.p., 1998. Web.
<http://www.ncbi.nlm.nih.gov/pubmed/10796742>.
Walker, Danyel. "Behavioral Change Communications for Drowning Prevention in Low Literacy
Environments." World Conference on Drowning Prevention 2011, 13 Mar. 2011. Web.
<http://www.researchgate.net/publication/273457507_behavioral_change_communications_f
or_drowning_prevention_in_low_literacy_environments>.
Appendix:
Contact List:
Agency Contact Email Phone Number Interview
Date
Bureau of Non-
communicable
Diseases,Ministryof
PublicHealth
Suchada
Gerdmongkolgan
and
Som
Ekchaloemkiet
jew_suchada@hotmail.co
m
+(66)29510402 22/08/2015
(inperson)
ASEAN Institute of
Health Development,
Mahidol University
Dr. OrapinLaosee orapin.lao@mahidol.ac.th +(66)24419040-
3 ext.43
07/08/2015
(inperson)
Institute of Health
Research,College of
PublicHealth,
Chulalongkorn
University
Dr. Ratana
Somrongthong
ratana.so@chula.ac.th 0-2218-
88226 /0-2255-
6046
25/08/2015
(inperson)
ChildSafety and
Injury Prevention
Centre (CISP),Faculty
of Medicine,
Ramathibodi
Hospital, Mahidol
University
Dr. Adisak
Plitponkarnpim
and Dr.
Mahippathorn
Chinapa
adisak.pli@mahidol.ac.th 14/08/2015
TASC/ SwimSafe
(formerly)
Dr. Michael
Linnan
mlinnan@tasc-gcipf.org 08/12/2015
(email)
Thai Life Saving General adisak_oui@yahoo.com 081 286 6864 19/08/2015

AngusCalder
09/09/2015
45
Society Adisak Suvanprak
orn
(inperson)
Save the Children
Behaviour Change
Consultant
Christopher
Eldridge
christophereldridge@yah
oo.co.uk
24/08/2015
(byphone)
Jabari of the Water
Initiative
RebeccaWear
Robinson rebeccalioness@gmail.co
m
28/08/2015
(byemail)
UNICEFThailand
Country Office
Rangsun
Wiboonuppatum
rwiboonuppatum@unicef
.org
No interview
Save the Children
Vietnam
Cay Bui Thi BuiThi.Cay@savethechildr
en.org
+84(0)983 622
147
02/09/2015
(byemail)
Sheraton Thailand
(QualityInn)
NarinNarula narin@quality.co.th No interview
National Scout
Organization of
Thailand
nsot@scoutthailand.org 02-2192731 No interview

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