Key Findings and Recommendations 61 References 67
List of Tables
Page
Table 1: Leading causes of death in children, both sexes, World, 2004 5
Table 2: Estimated numbers of drowning deaths by age group, WHO region and country income level, 2004
8
Table 3: Numbers, percentage, and rates of child deaths per 100,000 children 15 years due to the five leading causes of death in Thailand, 1999–2008
16
Table 4: Numbers and rates of child drowning deaths per 100,000 children 15 years in Thailand, 1999–2008
19
Table 5: Numbers and rates of child drowning deaths per 100,000 children 15 years in Thailand by region, 2004–2008
20
Table 6: Top ten provinces in Thailand with the highest rates of child drowning deaths per 100,000 children 15 years, 2004–2008
21
Table 7: Top ten provinces in Thailand with the highest numbers of drowning deaths in children 15 years, 2004–2008
22
Table 8: Numbers and rates of child drowning deaths per 100,000 children 15 years in Thailand by gender, 1999–2008
23
Table 9: Numbers and rates of child drowning deaths per 100,000 children 15 years in Thailand by region and gender, 2008
24
Table 10: Numbers and rates of drowning deaths in children under 15 years and all age groups per 100,000 children 15 years in Thailand by
age group, 1999–2008 25
Table 11: Numbers and rates of child drowning deaths per 100,000 children 15 years in Thailand by region and age group, 2008
29
Table 12: Percentage of severe injuries among children 15 years due to
the five leading causes of injuries in Thailand, 1998–2007
30
Table 13: Numbers and rates of child drowning injuries per 100,000 children 15 years in Thailand, 2005–2007
31
Table 14: Numbers and rates of child drowning injuries per 100,000 children 15 years in Thailand by age group, 2005–2007
31
Table 15: Case-fatality rates for severe drowning injuries in children 15 years in Thailand, 1998–2007
33
List of Tables Cont.
Page
Table 16: Numbers and percentage of drowning deaths in children 15 years in Thailand by month, 1999–2008
36
Table 17: Numbers and percentage of drowning injuries in children 15 years admitted to hospital in Thailand by month, 2005–2007
38
Table 18: Percentage of severe drowning injuries in children 15 years by day of the week, 1998–2007
40
Table 19: Percentage of severe drowning injuries in children 15 years by time period of the day, 1998–2007
42
Table 20: Percentage of severe drowning injuries in children 15 years by type of water source, 1998–2007 10-year average
44
Table 21: Percentage of severe drowning injuries in children 15 years by type of incident site, 1998–2007
45
Table 22: Percentage of severe alcohol-related drowning injuries in children 15 years by age group, 1998–2007 10-year average
46
Table 23: Costs of medical care for children 15 years with drowning injuries admitted to hospital in Thailand, 2005–2007
49
Table 24: Length of hospital stay for children 15 years with drowning injuries admitted to hospital in Thailand, 2005–2007
49
Table 25: Numbers and percentage of severe drowning injuries in children 15 years in Thailand by type of transport to hospital for treatment, 1998–2007
50
Table 26: Numbers and percentage of severe drowning injuries in children 15 years in Thailand by place of death, 1998–2007
52
Table A: Numbers and rates of child drowning deaths ICD-10, W65–W74; per
100,000 children 15 years in Thaialnd by province, 2006–2008
72
Table B: Numbers of drowning deaths ICD-10, W65–W74 in children 15 years
in Thaialnd by province and gender, 2006
75
Table C: Numbers of drowning deaths ICD-10, W65–W74 in children 15 years
in Thaialnd by province and gender, 2007
82
Table D: Numbers of drowning deaths ICD-10, W65–W74 in children 15 years
in Thaialnd by province and gender, 2008
89
List of Figures
Page
Figure 1: Fatal injury rates per 100,000 children aged 0–17 years in five Asian countries
6
Figure 2: Fatal drowning rates per 100,000 children 20 years by WHO region and country income level, World, 2004
7
Figure 3: Numbers of deaths due to leading causes of death in children 15 years in Thailand, 2004–2007
15
Figure 4: Mortality rates for the five leading causes of death in children 15 years rate per 100,000 children 15 years in Thailand, 1999–2008
17
Figure 5: Numbers and rates of deaths per 100,000 population due to the five leading causes of death in Thailand by age group, 2008
18
Figure 6: Numbers and rates of child drowning deaths per 100,000 children 15 years in Thailand, 1999–2008
19
Figure 7: Numbers and rates of child drowning deaths per 100,000 children 15 years in Thailand by region, 2004–2008
20
Figure 8: Numbers and rates of child drowning deaths per 100,000 children 15 years in Thailand by gender, 1999–2008
24
Figure 9: Numbers and rates of child drowning deaths per 100,000 children 15 years in Thailand by age group, 1999–2008
26
Figure 10: Rates of drowning deaths in children 15 years and in all age groups per 100,000 children 15 years in Thailand by age group, 1999–2008
26
Figure 11: Proportion of drowning deaths in Thailand by age group, 2008 27
Figure 12: Rates of child drowning deaths per 100,000 children 15 years in Thailand by age group and gender, 2008
28
Figure 13: Numbers and rates of child drowning deaths per 100,000 children 15 years in Thailand by region and age group, 2008
29
Figure 14: Rates of child drowning injuries admitted to hospital per 100,000 children 15 years in Thailand, 2005–2007
32
Figure 15: Case-fatality rates for severe drowning injuries in children 15 years in Thailand, 1998–2007
34
List of Figures Cont.
Page
Figure 16: Numbers of drowning deaths in children 15 years in Thailand by month, 1999–2008 10-year average
37
Figure 17: Numbers of drowning injuries in children 15 years in Thailand by month, 2005–2007 3-year average
39
Figure 18: Percentage of severe drowning injuries in children 15 years by day of the week, 1998–2007 10-year average
41
Figure 19: Percentage of severe drowning injuries in children 15 years by time period of the day, 1998–2007 10-year average
43
Figure 20: Percentage of severe alcohol-related drowning injuries in children 15 years by age group, 1998–2007 10-year average
47
Figure 21: Percentage of severe alcohol-related drowning injuries in children 15 years by age group and gender, 1998–2007
48
Figure 22: Percentage of severe drowning injuries in children 15 years in Thailand by type of transport to hospital for treatment, 1998–2007
51
Figure 23: Percentage of severe drowning injuries in children 15 years in
Thailand by place of
53
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Executive Summary
This report on the situation analysis of child drowning surveillance in Thailand aims to investigate the scope and severity of child drowning, explore risk factors for child drowning,
and propose recommendations for the prevention of child drowning and the development of a surveillance system for child drowning. A systematic analysis was conducted utilizing three
databases which had systematically compiled data on individual reports by age as well as ongoing reports. The three databases include: 1 the mortality database on death certificates, 2 the database
of individual inpatients, and 3 the Injury Surveillance System IS. The first two databases are operated by the Bureau of Policy and Strategy, Ministry of Public Health MOPH, while the
third one is handled by the Bureau of Epidemiology, Department of Disease Control DDC, MOPH. Each database has its own objectives, data acquisition periods, and data acquisition
limitations. The three databases were used in the analysis to ensure that the data were as up to date as possible. It is noteworthy that due to the aforementioned limitations, in the present study the
data regarding drowning in children under 15 years of age only with variations in terms of duration were used. This is not different from other studies carried out abroad which also have
limitations when reporting on drowning of individuals with different age groups and durations. The findings of the present analysis can be summarized as follows:
Summary of major points
There are 135,585 children under 15 years of age who die from drowning all over
the world each year, or about 372 children per day on average.
In the WHO South-East Asia Region, there are 32,744 drowning deaths each year or 90 deaths per day on average.
In Thailand, the rate of child drowning deaths is 5 to 15 times higher than those
for developed countries.
Drowning is the number one cause of death among Thai children under 15 years of age compared to fatalities due to all other causes including infectious and non-infectious diseases.
The number of Thai children under 15 years of age dying from drowning is 2 times
higher than that from traffic accidents and 24 times higher than that due to vector-borne viral diseases including dengue hemorrhagic fever.
In Thailand, 1,420 children under 15 years of age die from drowning each year,
or about 4 children per day on average 10-year average.
2
The child drowning death rates per 100,000 children under 15 years of age
between 1999 and 2008 ranged from 7.7 to 11.5.
Child drowning deaths had a steadily rising trend between 1999 and 2006 with a downward trend afterwards.
The northeastern region has the highest rate of child drownings, followed by
the central, northern, and southern regions, respectively.
Chachoengsao province is one of the top ten provinces with the highest rates of child drownings in Thailand for 5 consecutive years between 2004 and 2008.
Nakhon Ratchasima, Bangkok, Buri Ram, Ubon Ratchathani, Surin, Si Sa Ket,
Udon Thani, and Khon Kaen have the highest rates of drowning deaths 5-year average: 2004 to 2008.
Nakhon Ratchasima province had the highest number of drowning deaths in the
four-year period between 2005 and 2008, ranging from 59 to 82.
The top ten provinces with the highest rates of drowning deaths between 2004 and 2008 are Surin, Si Sa Ket, Buri Ram, Phitsanulok, Ratchaburi, Phetchabun, and Nakhon
Pathom.
The rate of child drowning deaths for males is approximately 2 times higher than that for females.
On average, children in the 0–4 age group ranked first for drowning deaths
between 1999 and 2008, followed by the 5–9 age group; but since 2005, the 5–9 age group has ranked first.
The proportion of drowning deaths in children under 15 years of age is as high as
30.2 of drowning deaths in all age groups.
The 0–4 age group has the highest drowning injury rate, 2 times higher than that for the 5–9 age group and 5 times higher than that for the 10–14 age group.
The case-fatality rate of drownings in children under 15 years of age 10-year
average: 1998 to 2007 is as high as 41.0.
April is the month with the highest number of drowning deaths of 178 10-year average: 1999 to 2008, followed by May and March at 150 cases and October at 140 cases. All
these months are during school breaks.
Weekends Saturdays and Sundays have the highest incidents of severe drowning injuries, accounting for 38.8 of all drowning fatalities 10-year average: 1998 to 2007.
The time period of the day with the highest incidents of severe drowning injuries
is between 12:00 noon and 17:59 hrs, accounting for 64.2 of all drowning fatalities 10-year average: 1998 to 2007.
3
As regards water sources where drownings occur, natural bodies of water rank first,
accounting for 49.9 of all drownings, followed by swimming pools and bathtubs at 5.4 and 2.5, respectively 10-year average: 1998 to 2007.
Of the children under 15 years of age who suffered severe drowning injuries,
1.2 had alcohol consumption behavior.
The youngest children who were found to suffer drowning injuries and had drunk alcohol were seven years old.
The average cost of medical care for children with drowning injuries admitted to
hospital is 12,125 baht per child per year 3-year average: 2005 to 2007.
Most 81.8 of the children with severe drowning injuries admitted to hospital were rescued and taken to hospital by their relatives or bystanders 10-year average: 1998 to 2007.
Recommendations
1. Efforts should be made for drowning prevention to be regarded as a national policy as drowning is the number one cause of fatalities among Thai children.
2. Information on drowning should be publicized more widely through different media. 3. Drowning prevention campaigns should be continuously and consistently carried out
all year round, especially during school breaks when drowning incidents are highest. 4. Surveys should be undertaken on water sources that pose a risk of drowning in
the households, neighborhoods, and communities. 5. Knowledge of drowning prevention should be disseminated and awareness of
this matter should be raised among the core target groups in the following aspects:
Parents and caregivers: making them aware of the necessity to give close and constant care to small children as they are at high risk of drowning.
Children: training them in the survival swimming curriculum.
Parents and caregivers: educating them about correct methods for rescuing
drowning children. 6. Preventive measures against child drowning should be rigorously carried out in
high-risk provinces such as Chachoengsao, Surin, Si Sa Ket, Buri Ram, Phitsanulok, Ratchaburi, Phetchabun, Nakhon Pathom, Nakhon Ratchasima, Bangkok, Ubon Ratchathani, Udon Thani,
and Khon Kaen. 7. Concrete measures should be devised for the management of natural bodies of water
which pose a high risk for drowning.
4
8. Research should be conducted to shed more lights on major issues such as the causes of high drowning incidents in the northeastern region, the relationship between drowning and
alcohol consumption, and the decline in drowning incidents among older children.
Recommendations for development of surveillance systems
Community-based surveillance systems should be developed to enable the communities to utilize data to prevent and control child drowning in their localities. Village health volunteers
VHVs may be asked to take responsibility for compiling data to be sent to the public health network for subsequent utilization by relevant communities and agencies to solve problems at
the local level. This is because the existing surveillance system aims to facilitate the utilization of data on a large scale and it takes time to present the data compiled in each system as the
comprehensiveness and completeness of data need to be ensured; therefore, it is not timely to solve local problems. Thus, there are certain limitations when such data are utilized at the district
or provincial level. In brief, if the communities are able to develop a community-based surveillance system, it will considerably benefit the operations at the national level.
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