Challenges in Documenting Non-Fatal Drowning Disability in Bangladesh: A Community-Based Survey.

Limited access to health care and the lack of robust data systems means non-fatal drownings are largely missed in low-and middle-income countries. We report morbidity among individuals who experienced non-fatal drowning in the Barishal Division, Bangladesh. A representative household survey was conducted in the Barishal Division in southern Bangladesh between September 2016 and February 2017, covering a population of 386,016. The burden of non-fatal drowning was assessed using the WHODAS 2.0 disability assessment tool, a generic assessment instrument for health and disability. A total of 5164 non-fatal drowning events occurred in the one year preceding the survey. Among these 18% were multiple events. From these, 4235 people were administered the WHODAS 2.0 questionnaire. Non-fatal drowning incidence rates were highest in children aged 1-4 years at 5810 per 100,000 population, and among males. Non-fatal drowning was associated with lower socio-economic status and larger family sizes. Few respondents (6.5%; 95% CI: 4.5-8.4%) reported some level of disability (WHODAS-12 score > 8). Incidence of non-fatal drowning is high in the population, however limited impact on morbidity was found. There is a need to develop tools and methodologies for reliable and comparable data for non-fatal drowning, especially to capture post-event disability in children

Vulnerability to fatal drowning among the population in Southern Bangladesh: Findings from a cross-sectional household survey

© 2019 Author(s). Objectives This study aimed to determine the fatal drowning burden and associated risk factors in Southern Bangladesh. Settings The survey was conducted in 39 subdistricts of all 6 districts of the Barisal division, Southern Bangladesh. Participants All residents (for a minimum 6 months prior to survey) of the Barisal division, Southern Bangladesh. Intervention/methods A cross-sectional, divisionally representative household survey was conducted in all six districts of the Barisal division between September 2016 and February 2017, covering a population of 386 016. Data were collected by face-to-face interview with adult respondents using handheld electronic tablets. International Classification of Diseases (ICD)-v. 10 (ICD-10) Chapter XX: External causes of morbidity and mortality codes for drowning, W65-W74, X36-X39, V90, V92, X71 or X92, were used as the operational definition of a drowning event. Results The overall fatal drowning rate in Barisal was 37.9/100 000 population per year (95% CI 31.8 to 43.9). The highest fatal drowning rate was observed among children aged 1-4 years (262.2/100 000/year). Mortality rates among males (48.2/100 000/year) exceeded that for females (27.9/100 000/year). A higher rate of fatal drowning was found in rural (38.9/100 000/year) compared with urban areas (29.3/100 000/year). The results of the multivariable logistic regression identified that the factors significantly associated with fatal drowning were being male (OR 1.7, 95% CI 1.2 to 2.3), aged 1-4 years (OR 3.0, 95% CI 1.4 to 6.4) and residing in a household with four or more children (four or more children OR 1.8, 95% CI 1.1 to 2.9; and five or more children OR 2.1, 95% CI 1.2 to 3.7). Conclusion Drowning is a public health problem, especially for children, in the Barisal division of Southern Bangladesh. Male gender, children 1-4 years of age and residing in a household with four or more children were associated with increased risk of fatal drowning events. The Barisal division demands urgent interventions targeted at high-risk groups identified in the survey

Context of water transport related drownings in Bangladesh: A qualitative study

Background: Bangladesh has one of the highest drowning mortality rates in the world. The use of unregulated water transportation may contribute to this burden, with 38% of all passenger traffic occurring by water. The present study aims to identify provider and end user perception on water transport related drowning risk, and barriers and facilitators for improving water safety practices. Methods: A qualitative study was conducted in a riverine area of Bangladesh, the Barishal division. Data was collected through 18 in-depth interviews, two small group discussions and six observations in February-March 2016. Content analysis was conducted, guided by domains of Haddon's matrix for injury prevention. Results: A range of unsafe behaviours, practices and conditions were identified at pre event, event and post event stages of water transport related drownings. It was also recognised it is not only the regulation of water transport but other factors such as occupational insecurities, poor access to rescue services and healthcare, migration and capacity for skill development among providers that contribute to unsafe water transport practices and drowning risk. Conclusion: There are some immediate measures that can be implemented, with some monitoring and accountability processes for water transport safety. However, there is need for robust data to quantify transport related drowning, making a case for prioritization and action by relevant stakeholder such as government and transport providers

Exploring the impact, response and preparedness to water-related natural disasters in the Barisal division of Bangladesh: A mixed methods study

Objectives To investigate the impact of natural disasters on communities in the Barisal division of Bangladesh, exploring community approaches to disaster preparedness and mitigation. Setting Communities in all districts of the Barisal division of Bangladesh. Participants Quantitative data were collected through a cross-sectional household survey (n=9263 households; n=38 981 individuals). Qualitative data were collected through in-depth interviews (n=7) and focus group discussions (n=23) with key informants. Outcome measures Quantitative research recorded features of natural disaster events from the previous 5 years, documenting risk factors that increase vulnerability to disaster, use of disaster warning systems and evacuation processes. Qualitative research investigated disaster risk perceptions, experiences during and following disaster, and disaster preparedness practices. Results The survey response rate was 94.7%. Exposure to disaster in the last 5 years was high (82%) with flooding and cyclones considered the greatest threats. Awareness of evacuation processes was low; and only 19% of respondents evacuated their homes at the time of disaster. Drowning during disaster was the primary concern (87%), followed by debt, livestock and crop loss (78%). The qualitative findings indicated prevailing fatalistic perceptions towards natural disasters among community. The consequences of disasters included significant loss of livelihoods and exposure to infections due to poor sanitation. There was also insufficient support for the most vulnerable, particularly women, children and the elderly. Although several community preparedness and practices existed, there was a lack of response to early warning systems. Barriers to disaster response and resilience included financial insecurities, loss of livelihoods and cultural concerns regarding women's privacy. Conclusions Critical to achieving disaster resilience is increased government investment in infrastructure and systems-level responses that empower communities. Further research can support this by addressing community challenges to promoting disaster resilience and how to leverage existing community strengths to implement locally owned solutions