Preventing Child Drowning : The importance of an evidence based approach

by | May 28, 2020 | Blog | 0 comments

With around 2,000 fatal child drowning cases a year in Vietnam, drowning prevention activities are essential. However it’s important that interventions are evidence based and safe to ensure they are effective and do not put children at risk.

Drowning is the leading cause of death in Vietnam. Around 2,000 children drown annually in Vietnam – the highest of any South East Asian Country. Globally, drowning is described by the World Health Organisation as a ‘silent epidemic’, claiming more than 400,000 lives each year.

In 2014, the World Health Organisation released its first Global Report on Drowning. This was followed up in 2016 by an implementation guide, which recommends 6 interventions and 4 strategies for preventing drowning:

Interventions:

  • Install barriers controlling access to water
  • Provide safe places (for example a day-care centre) away from water for pre school children, with capable child care
  • Teach school-age children swimming and water safety skills
  • Train bystanders in safe rescue and resuscitation
  • Set and enforce safe boating, shipping and ferry regulations
  • Build resilience and manage flood risks and other hazards locally and nationally

Strategies:

  • Strengthen public awareness of drowning through strategic communications
  • Promote multisectoral collaboration
  • Develop a national water safety plan
  • Advance drowning prevention through data collection and well-designed studies

Why teach school-age children swimming and water safety skills?

In Vietnam, the drowning burden is the highest amongst school aged children. For this reason, many government and reputable, internationally supported drowning prevention programmes focus on the recommendation to ‘teach school-age children swimming and water safety skills’ in Vietnam. This programme follows an evidence based approach and covers the core competencies that are set out in the WHO’s Implementation Guide.

The evidence that supports this intervention largely comes from SwimSafe – a programme currently operating in Bangladesh, that has trained over 525,000 children. In this programme, children learn survival swimming skills, water safety knowledge and safe rescue techniques. An evaluation conducted in 2010 among 84,000 SwimSafe trained children, it was found that that none of the swim graduates drowned. Another cohort study conducted among 109,668 children shows that that SwimSafe is a protective measure to prevent drowning. It was revealed that SwimSafe graduates had 96% less chance of drowning than the non-SwimSafe participants (RR 0.46; 95% CI 0.037 -0.071). Importantly, a follow-up study has shown it does not lead to increased exposure or engaging in high-risk behaviours in the water.

As an example, in line with this evidence base, Hue Help’s Swimming for Safety programme teaches the same skills over an 18 lesson programme. To date, the programme has trained nearly 500 teachers and 11,000 children in Vietnam with these vital safety skills. There are several organisations now working in Vietnam to implement best practice, evidenced based survival swimming classes, which is also in support of the Vietnam Prime Ministers decision 234 of 2016 on child injury prevention.

Our caution against ‘drown proofing’ techniques

‘Drown proofing’ is a technique that was developed in the 1930s in the USA. It involves remaining in a vertical position in the water, inhaling when the head is out of the water, before sinking below the water and returning to the surface to breath periodically.

We have seen this technique taught in Vietnam in classroom environments with children practicing ‘drown proofing’ in barrels of water!

There are some points to note about the ‘drown proofing’ methodology:

  • This was developed in 1938 at the request of the US Navy. It was developed at Georgia Tech University but was removed from their curriculum in 1986.
  • There is no peer reviewed research that shows the effectiveness of this technique generally.
  • There is no peer reviewed research that shows that teaching children this technique is effective at preventing child drowning. There is no research or evidence to show that adapting this technique with a barrel of water in a classroom environment is effective.
  • This technique is not taught as part of evidence-based survival swimming programmes. Instead, children are taught to float on their back. This technique is not compatible with the evidence-based survival swimming programme skills.

While there is strong evidence that supports survival swimming programmes for school aged children, there is no such evidence or peer reviewed research to support teaching children this ‘drown proof’ methodology in barrels of water in a classroom environment. Current best practice guidance advises that children are instead taught to float on their back, so their airway is constantly out of the water and they can breath normally. The ‘drown proofing’ technique contradicts that advice and the techniques taught in programmes that have been proven to reduce child drowning significantly.

A lack of research around ‘drown proofing’ does not only mean that its effectiveness has not been properly tested, but it also means that unintended consequences have not been analyzed. We remain concerned that children who learn this technique in a barrel of water may believe they have the skills needed to survive a drowning situation – when in fact there is no evidence that they do – and this may lead to more risk taking behaviour around water.

For these reasons, this technique is not advocated by leading water safety bodies. Although the technique was originally developed in the USA, this does not form part of mainstream water safety education programmes for school aged children – including the university at which it was developed.

Children are not trainee Navy Seals. The reality of drowning situations is very different from standing in a barrel of water. We would urge anyone looking to implement child drowning activities to implement evidenced based techniques that have been proven as safe and effective at preventing child drowning.

The challenges of implementing swimming lessons

There are challenges to implementing swimming lessons in Vietnam. Resources for drowning prevention are limited, and it is not always easy to find a suitable location to run a survival swimming programme. It is also true that just simply teaching swimming is not enough. A survival swimming programme should include water safety education and safe rescue techniques as well as swimming.

For this reason, many reputable organisations have developed classroom based water safety education programme that teaches children vital water safety education skills and safe rescue skills in line with current best practice. In addition, NGO Hue Help has provided very low cost survival swimming training to approximately 10,000 children safely in open water, teaching the core competencies that have been proven to be effective in preventing child drowning – showing it is possible to safely implement survival swimming lessons in Vietnam at low cost in many parts of the country. If you have questions about prevent child drowning or survival swimming, please get in touch! VSLC are committed to preventing drowning in Vietnam through sharing best practice and the latest evidence based techniques.

Authors:
Graham Buckley
Garry Seghers

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