Situation Analysis of Child Drowning in Thailand Eng Version

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OF CHILD DROWNING SURVEILLANCE

IN THAILAND

Research Team Members:

Mrs. Suchada Gerdmongkolgan

Ms. Som Ekchaloemkiet

Mrs. Auraphin Sublon

Mrs. Roongjit Termtor

Mrs. Kanjanee Dumnakkaew

Bureau of Non-Communicable Diseases

Department of Disease Control

Ministry of Public Health, Thailand

www.thaincd.com

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OF

CHILD DROWNING SURVEILLANCE

IN THAILAND

First printing: November 2009

Number of copies: …………. (English version)

Number of pages: 101

Printer: Printing Press, War Veterans Organization of Thailand ISBN 978-616-11-0662-1

Advisors:

Dr. Prapon Tangsrikertikul Dr. Panuwat Pankret Dr. Tairjing Siriphanich

Research team members:

Mrs. Suchada Gerdmongkolgan Ms. Som Ekchaloemkiet

Mrs. Auraphin Sublon Mrs. Roongjit Termtor Mrs. Kanjanee Dumnakkaew

Cover design:

Ms.Thitima Khuntasin

Preparared by:

Bureau of Non-Communicable Diseases, Department of Disease Control, Ministry of Public Health Tiwanon Road, Mueang District, Nonthaburi Province 11000, Thailand

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This report, entitled “Situation Analysis of Child Drowning Surveillance in Thailand”, has been completed by the research team in cooperation with a number of other agencies and officials. First, we would like to express our sincere gratitude to Dr. Taejing Siripanich, who is the main driving force behind the preparation of this report. Our profound thankfulness also goes to the Bureau of Policy and Strategy and the Bureau of Epidemiology for their assistance in providing the data on overall child drowning used in the analysis.

In addition, we would like to extend our grateful thanks to Dr. Panuwat Panketu, Director of the Bureau of Non-communicable Diseases, for his continued advice and support.

Last but not least, our profound thanks go to the World Health Organization (WHO) for financial support.

The Research Team October 2009

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Drowning is a major cause of child fatality in countries all over the world. On average, approximately 135,585 children die from drowning each year, or about 372 children per day. Children under five years of age constitute the age group with the highest risk. More than 98% of child drowning deaths occur in a country with a low or moderate national income.

In Thailand, drowning is the number one cause of fatality among children under 15 years of age, and the fatality rate is much higher than those for other causes including infectious and non-infectious diseases. Each year, nearly 1,500 children in Thailand die because of drowning, or about 4 children per day on average, which is a much higher rate compared to those in developed countries such as Australia or the United States.

Successful prevention of child drowning depends on a comprehensive and systematic compilation of data in all aspects of drowning to be utilized in devising operational plans and preventive measures. At present, there are three major databases of individual drownings in Thailand: the database for death certificates, the database for individual inpatients, and the Injury Surveillance System (IS). However, these databases have different objectives, data acquisition periods, and limitations in data acquisition. As constructing a new database seems to put too much burden on the operators and data users, the utilization of the data from various existing databases is considered the best option available in outlining the proposals and devising operational plans.

Thus, the Bureau of Non-communicable Diseases, Department of Disease Control, whose main responsibility is prevention and control of injuries, has conducted the situation analysis of child drowning surveillance in Thailand with the objectives of investigating the scope and severity of child drowning, exploring risk factors for child drowning, and proposing recommendations for the prevention of drowning so as to further develop and improve the child drowning surveillance system in Thailand.

Dr. Panuwat Panket

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Page

Executive summary 1

Chapter 1: Introduction 5

Objectives 9

Scope of the study 9

Definition of terms 10

Methodology 12

Chapter 2: Findings of Situation Analysis of Child Drowning in Thailand 15

Mortality 15

- Trends in mortality 19

- Regions 20

- Provinces 21

- Gender 23

- Age 25

Morbidity 30

Case-fatality rate 33

Time of drowning 35

- Month 35

- Day of incident 40

- Time of incident 42

Location of drowning injuries 44

- Water sources 44

- Sites of drowning injuries 45

Risks of alcohol consumption 46

Treatment 48

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Chapter 3: Conclusions and Discussions 53

Drowning-related mortality 53

Morbidity caused by accidental drowning 57

Case-fatality rate 57

Time 57

Locaion of drowning 58

Risks of alcohol consumption 58

Treatment 59

Accessibility to treatment 59

Chapter 4: Key Findings and Recommendations 61

References 67

Appendixes 71

Appendix A: Drowning statistics 72

Appendix B: WHO regions and Member countries 96

Appendix C: Index 100

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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

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

Table 4: Numbers and rates of child drowning deaths (per 100,000 children <15 years) in Thailand, 1999–2008

Table 5: Numbers and rates of child drowning deaths (per 100,000 children <15 years) in Thailand by region, 2004–2008

Table 6: Top ten provinces in Thailand with the highest rates of child drowning deaths (per 100,000 children <15 years), 2004–2008

Table 7: Top ten provinces in Thailand with the highest numbers of drowning deaths in children <15 years, 2004–2008

Table 8: Numbers and rates of child drowning deaths (per 100,000 children <15 years) in Thailand by gender, 1999–2008

Table 9: Numbers and rates of child drowning deaths (per 100,000 children <15 years) in Thailand by region and gender, 2008

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

Table 11: Numbers and rates of child drowning deaths (per 100,000 children <15 years) in Thailand by region and age group, 2008

Table 12: Percentage of severe injuries* among children <15 years due to the five leading causes of injuries in Thailand, 1998–2007

Table 13: Numbers and rates of child drowning injuries (per 100,000 children <15 years) in Thailand, 2005–2007

Table 14: Numbers and rates of child drowning injuries (per 100,000 children <15 years) in Thailand by age group, 2005–2007

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Table 16: Numbers and percentage of drowning deaths in children <15 years in Thailand by month, 1999–2008

Table 17: Numbers and percentage of drowning injuries in children <15 years admitted to hospital in Thailand by month, 2005–2007

Table 18: Percentage of severe drowning injuries* in children <15 years by day of the week, 1998–2007

Table 19: Percentage of severe drowning injuries* in children <15 years by time period of the day, 1998–2007

Table 20: Percentage of severe drowning injuries* in children <15 years by type of water source, 1998–2007 (10-year average)

Table 21: Percentage of severe drowning injuries* in children <15 years by type of incident site, 1998–2007

Table 22: Percentage of severe alcohol-related drowning injuries* in children <15 years by age group, 1998–2007 (10-year average)

Table 23: Costs of medical care for children <15 years with drowning injuries admitted to hospital in Thailand, 2005–2007

Table 24: Length of hospital stay for children <15 years with drowning injuries admitted to hospital in Thailand, 2005–2007

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

Table 26: Numbers and percentage of severe drowning injuries in children <15 years in Thailand by place of death, 1998–2007

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

Table B: Numbers of drowning deaths (ICD-10, W65–W74) in children <15 years in Thaialnd by province and gender, 2006

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Figure 1: Fatal injury rates per 100,000 children aged 0–17 years in five Asian countries

Figure 2: Fatal drowning rates per 100,000 children <20 years by WHO region and country income level, World, 2004

Figure 3: Numbers of deaths due to leading causes of death in children <15 years in Thailand, 2004–2007

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

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

Figure 6: Numbers and rates of child drowning deaths (per 100,000 children <15 years) in Thailand, 1999–2008

Figure 7: Numbers and rates of child drowning deaths (per 100,000 children <15 years) in Thailand by region, 2004–2008

Figure 8: Numbers and rates of child drowning deaths (per 100,000 children <15 years) in Thailand by gender, 1999–2008

Figure 9: Numbers and rates of child drowning deaths (per 100,000 children <15 years) in Thailand by age group, 1999–2008

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

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

Figure 13: Numbers and rates of child drowning deaths (per 100,000 children <15 years) in Thailand by region and age group, 2008

Figure 14: Rates of child drowning injuries admitted to hospital (per 100,000 children <15 years) in Thailand, 2005–2007

Figure 15: Case-fatality rates for severe drowning injuries* in children <15 years in Thailand, 1998–2007

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Figure 16: Numbers of drowning deaths in children <15 years in Thailand by month, 1999–2008 (10-year average)

Figure 17: Numbers of drowning injuries in children <15 years in Thailand by month, 2005–2007 (3-year average)

Figure 18: Percentage of severe drowning injuries* in children <15 years by day of the week, 1998–2007 (10-year average)

Figure 19: Percentage of severe drowning injuries* in children <15 years by time period of the day, 1998–2007 (10-year average)

Figure 20: Percentage of severe alcohol-related drowning injuries* in children <15 years by age group, 1998–2007 (10-year average)

Figure 21: Percentage of severe alcohol-related drowning injuries* in children <15 years by age group and gender, 1998–2007

Figure 22: Percentage of severe drowning injuries in children <15 years in Thailand by type of transport to hospital for treatment, 1998–2007

Figure 23: Percentage of severe drowning injuries in children <15 years in Thailand by place of

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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.

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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.

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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.

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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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Chapter 1 Introduction

Drowning is a major cause of fatalities in children all over the world. There are 480 children younger than 20 years of age who die from drowning every day. Each year, about 2–3 million children and adolescents are near-drowning victims. Children under five years of age all over the world constitute the most important high-risk group because infants (<1 year of age) can drown even in shallow water. At present, more than 98% of the children who drowned lived in a country with a low or moderate national income and with open bodies of water such as lakes and streams. As for countries with a high national income, drowning is more likely to occur at swimming pools. (1)

According to the 2004 WHO Global Burden of Disease,(2) drowning is one of the 10 leading causes of death in children, especially those aged 5–9 and 10–14 years (see Table 1).

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According to a survey of injuries in children aged 0–17 years conducted by UNICEF in five countries in the Asia (Bangladesh, China, the Philippines, Vietnam, and Thailand), drowning is the number one cause of fatalities in children, followed by road traffic injuries (3) (see Figure 1).

Figure 1: Fatal injury rates per 100,000 children aged 0–17 years in fivea Asian countries

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According to the data of WHO in 2004, when cconsidering the drowning death rates in children under 20 years of age per 100,000 children of the same age group by WHO region and Member country, it was found that the countries with a low and middle income in the Western Pacific Region had the highest rate, at 13.9, followed by the African Region, the Eastern Mediterranean Region, and the South-East Asia Region, respectively.(2) In Thailand, the rate is 8.2, which is higher than the average for the South-East Asia Region of 6.2 (4) (see Figure 2).

Figure 2: Fatal drowning rates per 100,000 children* by WHO region and country income level,

World, 2004

* These data refer to those under 20 years of age.

HIC = High income countries; LMIC = Low and middle income countries Source: WHO (2008). Global Burden of Disease, 2004 update.

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All over the world, the rate of fatal drownings in children under 15 years of age is 135,585 per year, or 372 per day on average. In the South-East Asia Region, the rate of fatal drownings is 32,744 per year, or 90 per day on average (3) (see Table 2).

Table 2: Estimated numbers of drowning deaths by age group, WHO region and country income

level, 2004

WHO region Income

level

Age range (years)

<1 1–4 5–9 10–14 15–19 <20

World All 10,200 48,267 39,010 38,107 39,708 175,293 High 168 958 500 393 956 2,974

Low 9,916 47,263 38,467 37,680 38,699 172,025 African Region Low 4,445 10,178 4,060 4,618 5,452 28,752 Region of the Americas All 272 2,487 1,395 1,654 2,785 8,592 High 68 445 146 155 333 1,148 Low 203 2,042 1,248 1,499 2,452 7,444 South-East Asia Region Low 2,850 9,362 11,662 8,870 11,027 43,771 European Region All 133 2,334 1,251 1,181 1,051 5,950 High 21 189 86 53 166 515 Low 112 2,145 1,165 1,128 885 5,435 Eastern Mediterranean Region All 1,021 4,605 3,711 3,253 4,342 16,932 High 51 217 117 92 302 779 Low 970 4,388 3,595 3,161 4,040 16,153 Western Pacific Region All 1,363 19,255 16,889 18,497 14,998 71,002 High 27 107 151 93 155 532 Low 1,336 19,148 16,738 18,404 14,843 70,469

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Objectives

1. To investigate the scope and severity of problems and risk factors for drownings among children in Thailand.

2. To derive at a proposal on prevention of child drowning in Thailand as well as on development/improvement of the existing child drowning surveillance system in Thailand.

Scope of study

The present study analyzed the data elicited from existing databases which have a systematic data storage system and reports on drownings on an individual basis. The data, which are continuously compiled and reported, can be categorized according to the age groups of children. The data can be used to analyze the situations of drowning including trends and risk factors of drowning among children in Thailand, to further develop or improve the child drowning surveillance system to ensure comprehensiveness and completeness, and to devise a plan or measure to prevent drowning among children in Thailand. The data used in the present analysis were retrieved from three databases, namely the database of death certificates (compiled by the Bureau of Policy and Strategy, MOPH),(5) the database of individual inpatients (also compiled by the Bureau of Policy and Strategy),(6) and the Injury Surveillance System (IS; operated by the Bureau of Epidemiology, DDC, MOPH).(7) The research team of the present analysis hoped to obtain the data which were as up to date as possible. However, as each database has its own objectives, data acquisition periods, and constraints in data acquisition, the data presented in the present analysis varied in a number of issues. The first important issue was the durations presented in each of the databases. The data retrieved from the death certificates were presented in a period of 10 years (from 1999 to 2008), while the data retrieved from the individual inpatients database were presented in a period of 3 years (from 2005 to 2007). This was because the Bureau of Policy and Strategy began its coordinated efforts with the National Health Security Office, the Comptroller General’s Department of the Ministry of Finance (reimbursements of medical expenses of government officials and family members) and the Social Security Office in 2005. Therefore, the data on individual inpatients compiled before that time were not complete or comprehensive. In addition, the data retrieved from the Injury Surveillance System (IS) were presented in a period of 10 years (from 1998 to 2007). The second important issue was the age group. In this study, only data on drownings in children under 15 years of age were analyzed and presented. That was because even though the data collected in the aforementioned databases were individual

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Due to such limitations, in the present study only the data regarding drowning in children aged under 15 years are presented with differences in durations. Such presentation is not different from other reports on child drowning surveillance conducted in other countries where similar limitations could be found.

Definition of terms

“Child” refers to an individual who is under 15 years of age.

“Injury” refers to damage of the body which results from sudden exposure to heat energy,

mechanical energy, electricity, or chemicals. It also refers to lack of necessities such as heat or oxygen, which can be either intentional or accidental. At present, the term “injury” has been used to replace the term “accident” as the latter may be misleading, making individuals misunderstand that it is unpredictable or unforeseeable. (5, 6)

“Drowning” refers to a process in which an individual loses his/her breathing or the breathing

becomes weakened because all body parts, including the respiratory system, are completely immersed in water, or at least the face or the respiratory system is submerged in water or another fluid, and the outcome is death or body’s abnormality or non-abnormality. (10) According to the International Standard Classification of Disease and Related Health Problem (ICD-10), the disease codes for morbidity and mortality from drowning are W65–W74.

“ICD-10”(8) refers to the international standard diagnostic classification of diseases and health problems that are the causes of morbidity and mortality.

W65 refers to drowning and submersion while in a bathtub.

W66 refers to drowning and submersion following fall into a bathtub. W67 refers to drowning and submersion while in a swimming pool.

W68 refers to drowning and submersion following fall into a swimming pool. W69 refers to drowning and submersion while in natural water.

W70 refers to drowning and submersion following fall into natural water. W73 refers to other specified drowning and submersion.

W74 refers to unspecified drowning and submersion.

“Severe injury” (12) refers to an injured individual who has been dead before arrival (DBA) at hospital, an injured individual who died in an emergency department/room, and an injured

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“Admitted patient or admission” (13) refers to the admission of an injured individual as inpatient with an admission number.

“Case”(13) refers a visit or admission as inpatient at hospital.

“Alcohol consumption”(14) refers to the fact that an injured individual has drunk alcohol, as stated by the injured individual; as observed from his/her gait, speech, or body odor; or as observed from breathing and blood examination (as mg%), signifying the level of blood alcohol content as determined by an alcohol breath tester or analyzer or with the laboratory results of blood or urine examination.

“Average cost of medical care”(13) refer to the average cost of medical services an inpatient has to pay each time he/she seeks medical care or treatment at hospital.

“Mean length of hospital stay”(13) refers to the number of days an inpatient spends at hospital from admission to discharge, as calculated by dividing the total number of days of hospital stay of all discharged patients by the total number of patients discharged during the same period.

“Location of drowning”(14) refers to the place where the drowning injury has occurred.

House and compound of the house refers to place of living of an individual which is not a temporary living place.

Dormitory, prison, nursery, or military base refers to a place of living of a group of individuals who share certain similar characteristics, which is not a house or residence of a family or an individual.

Hospital, school or temple refers to a building (and its compound) which is used by a group of individuals or the public for various purposes such as an auditorium (except a building under construction, a residence or a sports/athletic field).

Public sports arena refers to a venue where the general public exercise, play sports, or participate in a sports/athletic event.

Street or highway refers to a route of public transportation that an individual uses to travel from one place to another including the components of such a route.

Place for trading goods and services refers to a place that is meant for selling and buying goods and services such as a bank or a market.

Construction site or factory refers to a building (and its compound) that is used for manufacturing a large quantity of products or goods, either small or large in size, including any building and site under construction.

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Methodology

1. Secondary data were retrieved from the following three databases: 1) Data from death certificates(15)

Death certificate data were compiled from 1999 to 2008 by the Bureau of Policy and Strategy, MOPH, which elicited the civil registration data from the Bureau of Registration Administration, Department of Provincial Administration, Ministry of Interior, and then coded the causes of death on an individual basis based on ICD-10.

Limitations of the database

The causes of death were not complete, and the “unknown” causes of death accounted for more than 30% of the total causes. Even in the cases where the causes of death were specified, some items were ambiguous and possibly inaccurate because the “mode of death” was specified instead of the “cause of death”, resulting in erroneous or incomplete causes of death. In particular, if the person who specified the causes of death was not a physician, it was even more likely that the causes of death specified in the death certificates would be inaccurate.

Management and examination of accuracy of data

1) The data were examined record by record on a periodical basis.

2) The causes of death were coded on an individual basis based on ICD-10.

2) Data on individual inpatients(13)

Data retrieved from the individual inpatients database were compiled from 2005 to 2007 by the Bureau of Policy and Strategy after it began to coordinate with the National Health Security Office, the Comptroller General’s Department (reimbursement of medical expenses of government officials and family members) and the Social Security Office in 2005. Therefore, the data on individual inpatients were the data that the hospitals directly sent to the funds which covered all health-care settings with more details on gender, age group, disease/syndrome, and the level of health-care settings, etc.

Limitations of the database

The data did not comprehensively cover all inpatients who were admitted to hospital

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Management and examination of accuracy of data

1) The data were examined record by record on a periodical basis. Important disease codes, feasibility of data, gender, age, and coding were also examined, particularly the accuracy of the disease codes of serious diseases that required close monitoring and surveillance such as smallpox and plague. Attention was paid to external causes of injuries as well.

2) Erroneous data regarding the coding of important communicable diseases and specification of external causes of injuries were referred back to the related agencies for examination and verification.

3) The National Injury Surveillance System (IS)

The data retrieved from the Injury Surveillance System (IS) were compiled between 1998 and 2007. Established in 1994, the database is run by the Bureau of Epidemiology, Department of Disease Control, with an objective of utilizing the database to develop health services delivery systems and referral systems at the provincial level. The data is expected to be utilized as baseline data to devise a plan to prevent and solve problems of injuries and accidents at both provincial and national levels. The data compiled at this database are those on injured or deceased individuals with all external causes (ICD-10, Chapter 20: External causes of morbidity and mortality, Codes V01–Y36), which take place within seven days and which make the individuals seek medical services at the emergency department/room of a large hospital in Bangkok or other provinces across the country. This is considered a provincial surveillance network that has been continuously expanded. At present, there are 29 hospitals in the injury surveillance network, so-called sentinel sites, namely Maharaj Nakhon Ratchasima Hospital, Maharaj Nakhon Si Thammarat Hospital, Lampang Hospital, Ratchaburi Hospital, Chon Buri Hospital, Yala Hospital, Sawanpracharak Hospital (Nakohn Sawan), Lerdsin Hospital, Nopparat Ratchathani Hospital, Saraburi Hospital, Khon Kaen Hospital, Songkhla Hospital, Prapokklao Hospital (Chanthaburi), Chiang Rai Prachanukhro Hospital, Sappasitthiprasong Hospital (Ubon Ratchathani), Phra Nakhon Si Ayutthaya Hospital, Chaopraya Yommaraj Hospital (Suphan Buri), Udon Thani Hospital, Surat Thani Hospital, Trang Hospital, Rayong Hospital, Nakhon Pathom Hospital, Buddhachinaraj Hospital (Phitsanulok), Chao Phraya Abhaibhubejhr Hospital (Prachin Buri), Uttaradit Hospital, Buri Ram Hospital, Surin Hospital, Pra Nangklao Hospital (Nonthaburi), and Chachoengsao Hospital. Since 2001,

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before arrival (DBA), injured individuals who are pronounced dead at the emergency room, and injured individuals who are observed at, or admitted to, hospital. They are also required to submit the records to the Bureau of Epidemiology for subsequent compilation in the database and the national surveillance reports.

Management and examination of accuracy of data

1) The data were examined to ensure their completeness and accuracy by examining the printouts and the electronic files sent by the hospitals that are the sentinel sites using the injury surveillance analysis program. If any errors or discrepancies were found, the responsible hospitals in the network would be informed for revision and resubmission to the Bureau of Epidemiology.

2) Data regarding injury surveillance were compiled, organized, and recorded using the IS on Windows program (revised version 2007) to document data regarding severe injuries caused by 19 different causes including traffic accidents.

3) The surveillance data were analyzed using the IS program in terms of descriptive statistics to determine the number, percentage, proportion, ratio, rate of admissions, case-fatality rate, etc.

2. Data were analyzed by means of descriptive statistics.

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Chapter 2 Findings of Situation Analysis of Child Drowning Surveillance

in Thailand

Mortality

According to the analysis of death certificates collected at the MOPH’s Bureau of Policy and Strategy between 2004 and 2007, drowning was the number one cause of death in Thai children under 15 years of age, compared to other causes of mortality including infectious and non-infectious diseases (see Figure 3). When considering the five leading causes of injury-related mortality between 1999 and 2008, it was found that drowning was the number one cause of mortality, followed by road traffic injuries; accidental threats to breathing; exposure to electric current, radiation, and temperature; and physical assaults. Drowning accounted for as high as 33.9%–46.5% of the total injuries. The rate of drowning deaths ranged from 7.7 to 11.5 per 100,000 children under 15 years of age, and the total number of drowning deaths was 1,420 cases per year or 4 cases per day on average (see Table 3 and Figure 4).

Figure 3: Numbers of deaths due to leading causes of death in children <15 years in Thailand,

2004–2007

1297

1482

1471

0 300 600 900 1200 1500

2004 2005 2006 2007

Accidental drowning and submersion Assault

Pneumonia Vector borne diseases and dengue h Road traffic injuries

Data source: Death certificates. Bureau of Policy and Strategy, Office of the Permanent Secretary, Ministry of Public Health.

Analyzed by: Suchada Gerdmongkolgan and Som Ekchaloemkiet, Injury Prevention Group, Bureau of Non-Communicable Diseases, Department of Disease Control, Ministry of Public Health, Thailand.

(27)

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

Cause of death Year

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

1. Accidental drowning and submersion(W65–W74)

Number 1,249 1,412 1,444 1,588 1,472 1,471 1,549 1,482 1,297 1,229 Rate 7.7 8.9 9.1 11.2 10.5 10.7 11.5 11.1 9.8 9.4 Percentage 39.4 40.0 33.9 43.3 42.5 39.2 46.5 35.5 40.6 41.3

2. Road traffic injuries (V01–V89)

Number 700 864 773 829 723 762 649 659 594 636 Rate 4.3 5.4 4.9 5.9 5.2 5.5 4.8 4.9 4.5 4.9 Percentage 22.1 24.5 18.1 22.6 20.9 20.3 19.5 15.8 18.6 21.4

3. Other accidental threats to breathing (W75–W84)

Number 29 44 65 72 95 71 96 75 85 77 Rate 0.2 0.3 0.4 0.5 0.7 0.5 0.7 0.6 0.6 0.6

Percentage 0.9 1.2 1.5 2.0 2.7 1.9 2.9 1.8 2.7 2.6

4. Exposure to electric current, radiation and extreme ambient air temperature and pressure (W85–W99)

Number 78 98 89 96 82 99 93 119 91 71 Rate 0.5 0.6 0.6 0.7 0.6 0.7 0.7 0.9 0.7 0.5

Percentage 2.5 2.8 2.1 2.6 2.4 2.6 2.8 2.9 2.9 2.4

5.Assaults(X85–Y09)

Number 159 182 93 100 86 48 67 69 87 52 Rate 1.0 1.1 0.6 0.7 0.6 0.3 0.5 0.5 0.7 0.4

Percentage 5.0 5.2 2.2 2.7 2.5 1.3 2.0 1.7 2.7 1.7

Data source: Death certificates. Bureau of Policy and Strategy, Office of the Permanent Secretary, Ministry of Public Health.

Analyzed by: Suchada Gerdmongkolgan and Som Ekchaloemkiet, Injury Prevention Group, Bureau of Non-Communicable Diseases, Department of Disease Control, Ministry of Public Health, Thailand.

(28)

Figure 4: Mortality rates for the five leading causes of death in children <15 years (per

100,000 children <15 years) in Thailand, 1999–2008

0 2 4 6 8 10 12 14

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Accidental drowning and submersion Road traffic injuries

Accidental threats to breathing

Exposure to electric current, radiation, and extreme ambient air temperature and pressure Assaults

Data source: Death certificates. Bureau of Policy and Strategy, Office of the Permanent Secretary, Ministry of Public Health.

Analyzed by: Suchada Gerdmongkolgan and Som Ekchaloemkiet, Injury Prevention Group, Bureau of Non-Communicable Diseases, Department of Disease Control, Ministry of Public Health, Thailand.

(29)

When categorizing the causes of injury-related mortality by age group in 2008, it was found that the numer one cause of mortality in children under one year of age was accidental threats to breathing (4.9 per 100,000 population). However, the number one cause of mortality in the 1–4 and 5–9 age groups was drowning (13.8 and 12.0 per 100,000, respectively). As for the children aged 10 years and older, the number one cause of mortality was road traffic injuries. When considering the rates of deaths in all age groups, it was discovered that road traffic injuries ranked first (15.3 per 100,000), followed by drowning (6.4 per 100,000) (see Figure 5).

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

Data source: Death certificates. Bureau of Policy and Strategy, Office of the Permanent Secretary, Ministry of Public Health.

Analyzed by: Suchada Gerdmongkolgan and Som Ekchaloemkiet, Injury Prevention Group, Bureau of Non-Communicable Diseases, Department of Disease Control, Ministry of Public Health, Thailand.

(30)

Trends in mortality

During the 10-year period from 1999 to 2008, drowning rates in children aged under 15 years steadily increased between 1999 and 2006, ranging from 7.7 to 11.5 per 100,000 children under 15 years, before it began to decrease afterwards (see Table 4 and Figure 6).

Table 4: Numbers and rates of child drowning deaths (per 100,000 children <15 years) in Thailand, 1999–2008

Year Child drowning deaths

Number Rate

1999 1,249 7.7

2000 1,412 8.9

2001 1,444 9.1

2002 1,588 11.2

2003 1,472 10.5

2004 1,471 10.7

2005 1,549 11.5

2006 1,482 11.1

2007 1,297 9.8

2008 1,229 9.3

Data source: Death certificates. Bureau of Policy and Strategy, Office of the Permanent Secretary, Ministry of Public Health

Analyzed by: Som Ekchaloemkiet and Suchada Gerdmongkolgan, Injury Prevention Group, Bureau of Non-Communicable Diseases, Department of Disease Control, Ministry of Public Health, Thailand.

Figure 6: Numbers and rates of child drowning deaths (per 100,000 children <15 years) in Thailand,

1999–2008 200 400 600 800 1,000 1,200 1,400 1,600 1,800 2 4 6 8 10 12 14 number rate Nu mbe r Rate p er 10 0,00 0 ch ildr en

(31)

Regions

The findings revealed that the northeastern region had the highest rate of drowning deaths in childrenunder 15 years of age, followed by the central region, the northern region, and the southern region; the rates per 100,000 children under 15 years in 2008 were 11.6, 9.1, 7.9, and 6.8, respectively (see Table 5 and Figure 7).

Table 5:Numbers and rates of child drowning deaths (per 100,000 children <15 years) in Thailand by region, 2004–2008

Region

Year

2004 2005 2006 2007 2008

Number Rate Number Rate Number Rate Number Rate Number Rate

Northern 201 8.3 214 9.1 257 11.1 183 8.0 177 7.9 Northeastern 621 12.7 654 13.7 616 13.1 503 10.9 528 11.6 Central 469 10.8 493 11.5 442 10.4 459 10.8 383 9.1 Southern 180 8.4 188 8.9 167 8.0 152 7.3 141 6.8

Data source: Death certificates. Bureau of Policy and Strategy, Office of the Permanent Secretary of the Ministry of Public Health

Analyed by: Som Ekchaloemkiet and Suchada Gerdmongkolgan, Injury Prevention Group, Bureau of Non-Communicable Diseases, Department of Disease Control, Ministry of Public Health, Thailand.

Figure 7: Numbers and rates of child drowning deaths (per 100,000 children <15 years) in

Thailand by region, 2004–2008

0 2 4 6 8 10 12 14 16

2004 2005 2006 2007 2008

Northern Northeastern Central Southern

(32)

Provinces

The top ten provinces which had the highest rates of drowning deaths (per 100,000 children under 15 years) in children under 15 years of age for at least three consecutive years between 2004 nad 2008 were Chachoengsao, Rayong, Nakhon Nayok, Prachin Buri, and Nakhon Phanom (see Table 6). However, when considering specifically only the numbers of drowning deaths, it could be seen that Nakhon Ratchasima, Bangkok, Buri Ram, Ubon Ratchathani, Surin, Si Sa Ket, Udon Thani, and Khon Kaen had the highest numbers of deaths per year at 70, 62, 51, 50, 48, 47, 45, and 44, respectively on average (see Table 7).

Table 6:Top ten provinces in Thailand with the highest rates of child drowning deaths (per 100,000 children <15 years), 2004–2008

Rank Province (rate, number)

2004 2005 2006 2007 2008

1 Rayong (20.6, 26) Trat (40.1, 19) Rayong (21.1, 27) Nakhon Nayok (26.9, 13) Prachin Buri (21.1, 20) 2 Saraburi (20.3, 27) Nakhon Nayok (24.1, 12) Sing Buri (20.8, 8) Sing Buri (21.1, 8) Surin (18.7, 57) 3 Petchaburi (19.3, 18) Pichit (22.4, 25) Prachin Buri (20.7, 20) Ratchaburi (19.8, 33) Nakhon Pathom (16.8, 28) 4 Chachoengsao

(18.2, 26) Rayong (22.2, 28) Phitsanulok (19.6, 32) Trat (19.4, 9) Nakhon Nayok (16.7, 8) 5 Prachin Buri

(18.2, 18) Pang-nga (19.7, 11) Uttaradit (18.1, 16) Ang Thong (17.0, 9) Nakhon Panom (16.6, 26) 6 Buri Ram

(17.9, 66) Chachoengsao (19.3, 27) Phatthalung (17.6, 19) Chachoengsao (16.7, 23) Chachoengsao (16.1, 22) 7 Chumphon (17.9, 19) Chanthaburi (18.9, 20) Nakhon Panom (17.4, 28) Samut Sakhon (16.7, 17) Sa Kaeo (15.8, 19) 8 Nakhon Nayok

(17.7, 9) Sa Kaeo (17.7, 22) Mukdahan (17.1, 13) Rayong (16.1, 21) Uttaradit (15.3, 13) 9 Surin (15.8, 52)

Si Sa Ket (17.6, 58) Chachoengsao (16.6, 23) Ranong (16.1, 7) Chanthaburi (14.7, 15) 10 Phetchabun (15.8, 34) Kanchanaburi (17.3, 31) Saraburi (16.3, 21) Nakhon Panom (15.8, 25)

Si Sa Ket (14.3, 45)

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Table 7: Top ten provinces in Thailand with the highest numbers of drowning deaths among children <15 years, 2004–2008

Rank Province (number)

2004 2005 2006 2007 2008

1 Bangkok (68) Nakhon Ratchasima (74) Nakhon Ratchasima (82) Nakhon Ratchasima (75) Nakhon Ratchasima (62)

2 Buri Ram (66) Bangkok (61) Bangkok (65) Bangkok (67) Surin (57) 3 Ubon Ratchathani

(60)

Si Sa Ket (58) Khon Kaen (56) Buri Ram (45) Bangkok (51)

4 Nakhon Ratchasima

(59) Buri Ram (53) Ubon Ratchathani (55) Surin (45)

Si Sa Ket (45)

5 Surin (52) Udon Thani (53) Buri Ram (48) Udon Thani (45) Buri Ram (43)

6 Udon Thani

(50)

Ubon Ratchathani (52)

Si Sa Ket (48)

Ubon Ratchathani (39)

Ubon Ratchathani (43)

7 Si Sa Ket

(46)

Surin (44)

Udon Thani (45)

Si Sa Ket (38)

Khon Kaen (41) 8 Khon Kaen

(46) Sakon Nakhon (43) Surin (41) Ratchaburi (33) Chaiyaphum (30) 9 Songkhla (40) Khon Kaen (42) Roi Et (38) Khon Kaen (33) Udon Thani (30)

10 Chon Buri (35) Roi Et (38) Phitsanulok (32) Phetchabun (29) Nakhon Pathom (28)

Data source: Death certificates. Bureau of Policy and Strategy, Office of the Permanent Secretary, Ministry of Public Health.

Analyzed by:Som Ekchaloemkiet and Suchada Gerdmongkolgan, Injury Prevention Group, Bureau of Non-Communicable Diseases, Department of Disease Control, Ministry of Public Health, Thailand.

(34)

Gender

According to the analysis of death certificates collected at the Bureau of Policy and Strategy, between 1999 and 2008, the rate of fatal drownings for males was approximately 2 times higher than that for females. The rate steadily increased from 1999 to 2006 before beginning to decline in 2007, similar to the overall picture of drowning situations (see Table 8 and Figure 8). The rate for males in the southern region was approximately 2.5 times higher than that for females in the same region (see Table 9).

Table 8: Numbers and rates of child drowning deaths (per 100,000 children <15 years) in Thailand by gender, 1999–2008

Gender Year

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Male

Number 821 933 917 1,032 952 935 983 985 843 821 Rate 10.1 11.6 11.5 14.2 13.2 13.2 14.1 14.3 12.4 12.2

Female

Number 428 479 527 556 520 536 566 497 454 406 Rate 5.3 6.1 6.7 8.1 7.7 8.0 8.6 7.7 7.1 6.4

Total

Number 1,249 1,412 1,444 1,588 1,472 1,471 1,549 1,482 1,297 1,229

Rate 7.7 8.9 9.1 11.2 10.5 10.7 11.5 11.1 9.8 9.4

Data source: Death certificates. Bureau of Policy and Strategy, Office of the Permanent Secretary, Ministry of Public Health.

Analyzed by: Som Ekchaloemkiet and Suchada Gerdmongkolgan, Injury Prevention Group, Bureau of Non-Communicable Diseases, Department of Disease Control, Ministry of Public Health, Thailand.

(35)

Figure 8: Numbers and rates of child drowning deaths (per 100,000 children <15 years) in Thailand by gender, 1999–2008

0 2 4 6 8 10 12 14 16

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Male Female

Data source: Death certificates. Bureau of Policy and Strategy, Office of the Permanent Secretary, Ministry of Public Health.

Analyzed by: Som Ekchaloemkiet and Suchada Gerdmongkolgan, Injury Prevention Group, Bureau of Non-Communicable Diseases, Department of Disease Control, Ministry of Public Health, Thailand.

Table 9: Numbers and rates of child drowning deaths (per 100,000 children <15 years) in Thailand by region and gender, 2008

Region

Gender

Male Female

Number Rate Number Rate

Northern 108 9.4 69 6.4

Northeastern 344 14.7 184 8.4

Central 268 12.3 115 5.6

South 103 9.6 38 3.8

Total 823 12.2 406 6.4

Data source: Death certificates. Bureau of Policy and Strategy, Office of the Permanent Secretary, Ministry of Public Health.

Analyzed by: Som Ekchaloemkiet and Suchada Gerdmongkolgan, Injury Prevention Group, Bureau of Non-Communicable Diseases, Department of Disease Control, Ministry of Public Health, Thailand.

Rate p

0,00

0 ch

ildr

(36)

Age

According to the analysis of death certificates collected at the Bureau of Policy and Strategy, between 1998 and 2009, the mean rate of fatal drownings in children aged 0–4 years was slightly higher than that for the 5–9 age group. However, between 2005 and 2009, the rate for the 5–9 age group was higher than that for the 0–4 age group.

When comparing the rates of drowning deaths in children under 15 years of age to those in all age groups, it was found that the rates in children under 15 years (7.7–11.5 per 100,000 children under 15 years) were higher than those for all age groups (5.0 –7.5 per 100,000) (see Table 10 and Figure 10).

Table 10:Numbers and rates of drowning deaths in children <15 years and all age groups (per 100,000 children <15 years) in Thailand by age group, 1999–2008

Year

Age group (years)

0–4 5–9 10–14 <15 All

Number Rate Number Rate Number Rate Number Rate Number Rate

1999 531 10.1 501 9.3 217 4.0 1,249 7.7 3,015 5.0 2000 587 11.3 582 10.9 243 4.5 1,412 8.9 3,859 6.3 2001 591 11.5 571 10.8 282 5.3 1,444 9.1 3,811 6.2 2002 601 14.0 673 13.4 314 6.5 1,588 11.2 4,218 6.7 2003 590 14.3 608 12.2 274 5.6 1,472 10.5 4,134 6.6 2004 548 13.6 637 13.2 286 5.8 1,471 10.7 4,202 6.7 2005 528 13.2 704 15.1 317 6.5 1,549 11.5 4,458 7.2 2006 521 13.1 641 14.3 320 6.5 1,482 11.1 4,666 7.5 2007 473 11.9 512 11.9 312 6.3 1,297 9.8 4,098 6.5 2008 465 11.6 503 12.0 261 5.3 1,229 9.4 4,065 6.4

Data source: Death certificates. Bureau of Policy and Strategy, Office of the Permanent Secretary, Ministry of Public Health.

Analyzed by: Som Ekchaloemkiet and Suchada Gerdmongkolgan, Injury Prevention Group, Bureau of Non-Communicable Diseases, Department of Disease Control, Ministry of Public Health, Thailand.

(37)

Figure 9: Numbers and rates of child drowning deaths (per 100,000 children <15 years) in

Thailand by age group, 1999–2008

0 2 4 6 8 10 12 14 16

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

0-4 Years 5-9 Years 10-14 Years

Data source: Death certificates. Bureau of Policy and Strategy, Office of the Permanent Secretary, Ministry of Public Health.

Analyzed by: Som Ekchaloemkiet and Suchada Gerdmongkolgan, Injury Prevention Group, Bureau of Non-Communicable Diseases, Department of Disease Control, Ministry of Public Health, Thailand.

Figure 10: Rates of drowning deaths in children <15 years and all age groups (per 100,000

children <15 years) in Thailand by age group, 1999–2008

0 2 4 6 8 10 12 14 16

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

0-14 Years All

Data source: Death certificates. Bureau of Policy and Strategy, Office of the Permanent Secretary, Ministry of Public Health.

Analyzed by: Som Ekchaloemkiet and Suchada Gerdmongkolgan, Injury Prevention Group, Bureau of

Non-Rate p er 10 0,00 0 ch ildr en Rate p er 10 0,00 0 pop u lation

(38)

In 2008, when considering the proportion of drowning deaths in children under 15 years of age, it was found that the 5–9 age group had the highest proportion (40.9%), followed by the 0–4 age group (37.8%), and the 10–14 age group (21.2%). Compared to other age groups, the proportion for the under-15 age group (30.2%) was higher than those for other age groups (see Figure 11).

Figure 11: Proportion (percentage) of drowning deaths in Thailand by age group, 2008

Children younger than 15 years All age groups

40.9 21.2

37.8

0-4 Years 5-9 Years 10-14 Years

22.0 18.9

14.0 14.8

30.2

0-14 Years 15-29 Years 30-44 Years

45-59 Years 60+ Years

Data source: Death certificates. Bureau of Policy and Strategy, Office of the Permanent Secretary, Ministry of Public Health.

Analyzed by:Suchada Gerdmongkolgan and Som Ekchaloemkiet, Injury Prevention Group, Bureau of Non-Communicable Diseases, Department of Disease Control, Ministry of Public Health, Thailand.

(39)

When considering the rates of drowning deaths in children under 15 years by age group and gender in 2008, it was found that the rates for boys were 2 times higher than for girls in the 0–4 and 5–9 age groups. In the children aged 10–14, however, the rates for boys and girls were rather similar as the rates for boys remarkably decreased, while the rates for girls only slightly decreased (see Figure 12).

Figure 12: Rates of child drowning deaths (per 100,000 children <15 years) in Thailand

by age group and gender, 2008

0 2 4 6 8 10 12 14 16 18

0-4 Years 5-9 Years 10-14 Years

Male Female

Data source: Death certificates. Bureau of Policy and Strategy, Office of the Permanent Secretary, Ministry of Public Health.

Analyzed by: Som Ekchaloemkiet and Suchada Gerdmongkolgan, Injury Prevention Group, Bureau of Non-Communicable Diseases, Department of Disease Control, Ministry of Public Health, Thailand.

Rate p

0,00

0 ch

ildr

(40)

When categorizing drowning deaths in children under 15 years of age by region and age group, it was found that the 0–4 age group in the central region had the highest rate (14.7 per 100,000 children under 15 years), while the 5–9 age group in the northeastern region had the highest rate (17.5 per 100,000 children under 15 years) (see Table 11 and Figure 13).

Table 11: Numbers and rates of child drowning deaths (per 100,000 children <15 years) in

Thailand by region and age group, 2008

Region

Age group (years)

0-4 5-9 10-14 <15

Number Rate Number Rate Number Rate Number Rate

Northern 66 9.8 66 9.4 45 5.2 177 7.9 Northeastern 156 11.5 256 17.5 116 6.8 528 11.6 Central 190 14.7 127 9.5 66 4.2 383 9.1 Southern 53 7.9 54 8.0 34 4.6 141 6.8

Data source: Death certificates. Bureau of Policy and Strategy, Office of the Permanent Secretary, Ministry of Public Health.

Analyzed by: Som Ekchaloemkiet and Suchada Gerdmongkolgan, Injury Prevention Group, Bureau of Non-Communicable Diseases, Department of Disease Control, Ministry of Public Health, Thailand.

Figure 13: Numbers and rates of child drowning deaths (per 100,000 children <15 years) in

Thailand by region and age group, 2008

0 2 4 6 8 10 12 14 16 18 20

0-4 Years 5-9 Years 10-14 Years <15 Years

Northern Northeastern Central Southern

Data source: Death certificates. Bureau of Policy and Strategy, Office of the Permanent Secretary, Ministry of Public Health.

Analyzed by: Som Ekchaloemkiet and Suchada Gerdmongkolgan, Injury Prevention Group, Bureau of Non-Communicable Diseases, Department of Disease Control, Ministry of Public Health, Thailand.

Rate p er 10 0,00 0 ch ildr en

(41)

Morbidity

According to the analysis of data regarding severe injuries (injured individuals who had been dead before arrival (DBA) at hospital, injured individuals who died in an emergency room, and injured individuals who were observed at or admitted to hospital) retrieved from the Injury Surveillance System (IS) of the Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health, the five leading causes of injury-related mortality in Thai children under 15 years of age between 1998 and 2007 were road traffic injuries (34.9% to 41.1%), fall accidents (26.8% to 27.7%), exposure to inanimate mechanical forces (16.3% to 18.2%), exposure to animate mechanical forces (2.6% to 9.2%), and exposure to poisonous animals or plants (2.4% to 3.9%) (see Table 12).

Table 12: Percentage of severe injuries* among children <15 years due to the five leading

causes of injuries in Thailand, 1998–2007

Cause of injury Year**

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

1. Road traffic injuries (V01–V89)

41.1 38.7 39.2 39.7 40.7 38.3 38.2 34.9 37.4 37.1

2. Falls (W00–W19)

27.4 27.7 27.4 27.5 26.8 27.7 27.5 26.9 27.5 26.9

3. Exposure to inanimate mechanical forces (W20–W49)

17.1 17.6 17.1 16.7 16.4 16.5 16.3 17.1 17.9 18.2

4. Exposure to animate mechanical forces (W50–W64)

2.6 3.2 3.5 3.3 3.3 3.5 3.5 9.2 3.5 3.4

5. Contact with venomous animals and plants (X20–X29)

2.4 2.7 2.6 3.2 3.5 3.2 3.2 2.9 3.9 3.8

* Severe injuries refer to injured individuals who die before arriving at hospital, injury patients who die in an emergency room, and injury patients who are admitted for observation and treatment at hospital.

** Numbers of injuries: 14 in 1998, 19 in 1999, 21 between 2000 and 2001, 23 in 2002, 28 in 2003, 29 between 2004 and 2006, and 28 in 2007.

(42)

According to the individual inpatients database at the Bureau of Policy and Strategy, Ministry of Public Health, the morbidity rate in children under 15 years of age who were admitted to hospital due to drowning between 2005 and 2007 ranged from 7.5 to 8.7 per 100,000 children under 15 years (see Table 13). When categorizing the children into different age groups, it was found that the 0–4 age group had the highest rate of morbidity, followed by the 5–9 and 10–14 age groups, respectively. The morbidity rate for children aged 0–4 was five times higher than that for those aged 10–14 and two times higher than that for those aged 5–9 (see Table 14 and Figure 14).

Table 13: Numbers and rates of child drowning injuries (per 100,000 children <15 years) in

Thailand, 2005–2007

Year Morbidity

Number Rate

2005 1,007 7.5

2006 1,147 8.6

2007 1,150 8.7

Data source: Individual inpatients database. Bureau of Policy and Strategy, Office of the Permanent Secretary, Ministry of Public Health.

Analyzed by:Suchada Gerdmongkolgan and Som Ekchaloemkiet, Injury Prevention Group, Bureau of Non-Communicable Diseases, Department of Disease Control, Ministry of Public Health, Thailand.

Table 14: Numbers and rates of child drowning injuries (per 100,000 children <15 years) in

Thailand by age group, 2005–2007

Year

Age group (years)

0–4 5–9 10–14 <15 All age groups

Number Rate Number Rate Number Rate Number Rate Number Rate

2005 563 14.1 314 6.8 130 2.7 1007 7.5 1,460 2.3 2006 640 16.1 348 7.8 159 3.2 1147 8.6 1,636 2.6 2007 688 17.2 289 6.7 173 3.5 1150 8.7 1,572 2.5

Data source: Individual inpatients database. Bureau of Policy and Strategy, Office of the Permanent Secretary, Ministry of Public Health.

Analyzed by:Suchada Gerdmongkolgan and Som Ekchaloemkiet, Injury Prevention Group, Bureau of Non-Communicable Diseases, Department of Disease Control, Ministry of Public Health, Thailand.

(43)

Figure 14: Rates of child drowning injuries admitted to hospital (per 100,000 children <15 years)

in Thailand, 2005–2007

0 2 4 6 8 10 12 14 16 18 20

2005 2006 2007

0-4 years 5-9 years 10-14 years

Data source: Individual inpatients database. Bureau of Policy and Strategy, Office of the Permanent Secretary, Ministry of Public Health.

Analyzed by:Suchada Gerdmongkolgan and Som Ekchaloemkiet, Injury Prevention Group, Bureau of Non-Communicable Diseases, Department of Disease Control, Ministry of Public Health, Thailand.

Rate p

0,00

0 ch

ildr

(44)

Case-fatality rate

According to the data regarding severe injuries collected at the Injury Surveillance System (IS), Bureau of Epidemiology, Department of Disease Control, between 1998 and 2007, the case-fatality rate for child drownings ranged from 32.5% to 48.2%, with the mean for the 10-year period of 41.0% (see Table 15 and Figure 15).

Table 15: Case-fatality rates for severe drowning injuries* in children <15 years in Thailand,

1998–2007

Year** Case-fatality rate (%)

1998 36.8

1999 39.9

2000 40.2

2001 40.1

2002 48.2

2003 39.7

2004 47.7

2005 42.4

2006 32.5

2007 40.6

** Numbers of injuries: 14 in 1998, 19 in 1999, 21 between 2000 and 2001, 23 in 2002, 28 in 2003, 29 between 2004 and 2006, and 28 in 2007.

Data source: Sentinel sites. National Injury Surveillance System, Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health.

Compiled by: Kanjanee Dumnakkaew, Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health, Thailand.

Analyzed by: Suchada Gerdmongkolgan and Som Ekchaloemkiet, Injury Prevention Group, Bureau of Non-Communicable Diseases, Department of Disease Control, Ministry of Public Health, Thailand.

(45)

Figure 15: Case-fatality rates for severe drowning injuries* in children <15 years in Thailand,

1998–2007

0 10 20 30 40 50 60

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

** Numbers of injuries: 14 in 1998, 19 in 1999, 21 between 2000 and 2001, 23 in 2002, 28 in 2003, 29 between 2004 and 2006, and 28 in 2007.

Data source: Sentinel sites. National Injury Surveillance System, Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health.

Compiled by: Kanjanee Dumnakkaew, Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health, Thailand.

Analyzed by: Suchada Gerdmongkolgan and Som Ekchaloemkiet, Injury Prevention Group, Bureau of Non-Communicable Diseases, Department of Disease Control, Ministry of Public Health, Thailand.

Perce

(46)

Time of drownings

Months

According to the data from the death certificates collected at the Bureau of Policy and Strategy, when categorizing the drowning deaths among children under 15 years of age by month of incident, it was found that, between 1999 and 2008, April had the highest number of drowning deaths, followed by May, March, October, and November, respectively. The means for May and March were rather similar. During the 10-year period, on average there were 178 child drowning deaths in April, 150 in March and May, 140 in October, and 124 in November (see Table 16 and Figure 16).

According to the individual inpatients database at the Bureau of Policy and Strategy, Ministry of Public Health, when categorizing the drowning deaths in children under 15 years of age by month of incident, it was found that, between 1999 and 2008, April had the highest number of deaths, followed by May, March, October, and November, respectively. During the 10-year period, on average there were 127 childh drowning deaths in April, 121 in May, 114 in March, 103 in October, and 97 in November (see Table 17 and Figure 17).

(47)

Table 16: Numbers and percentage of drowning deaths in children <15 years in Thailand

by month, 1999–2008

Month Year

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 January 98 94 121 87 82 83 72 111 88 86

7.8 6.7 8.4 5.5 5.6 5.6 4.6 7.5 6.8 7.0 February 100 79 98 109 110 104 112 135 77 71 8.0 5.6 6.8 6.9 7.5 7.1 7.2 9.1 5.9 5.8 March 155 118 133 147 162 193 161 140 135 151 12.4 8.4 9.2 9.3 11.0 13.1 10.4 9.4 10.4 12.3 April 162 165 206 184 196 210 210 158 136 157 13.0 11.7 14.3 11.6 13.3 14.3 13.6 10.7 10.5 12.8 May 155 150 125 139 176 156 175 142 132 148 12.4 10.6 8.7 8.8 12.0 10.6 11.3 9.6 10.2 12.0 June 83 111 109 127 105 125 116 101 87 95

6.6 7.9 7.5 8.0 7.1 8.5 7.5 6.8 6.7 7.7 July 86 102 94 112 97 105 106 89 72 83 6.9 7.2 6.5 7.1 6.6 7.1 6.8 6.0 5.6 6.8 August 72 112 133 112 109 111 73 107 91 80 5.8 7.9 9.2 7.1 7.4 7.5 4.7 7.2 7.0 6.5 September 57 110 98 135 103 97 110 109 121 84 4.6 7.8 6.8 8.5 7.0 6.6 7.1 7.4 9.3 6.8 October 123 152 139 160 126 121 154 173 144 105 9.8 10.8 9.6 10.1 8.6 8.2 9.9 11.7 11.1 8.5 November 92 132 97 152 134 115 150 138 108 117 7.4 9.3 6.7 9.6 9.1 7.8 9.7 9.3 8.3 9.5 December 66 87 91 124 72 51 110 79 106 52 5.3 6.2 6.3 7.8 4.9 3.5 7.1 5.3 8.2 4.2

Total 1249 1412 1444 1588 1472 1471 1549 1482 1297 1229

100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Data source: Death certificates. Bureau of Policy and Strategy, Office of the Permanent Secretary, Ministry of Public Health.

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Non-Figure 16: Numbers of drowning deaths in children <15 years in Thailand by month, 1999–2008

(10-year average)

0 20 40 60 80 100 120 140 160 180 200

Jan uary

Febr uary

Ma rch

April May June Ju

Augu

st Sept

embe

Octo

ber Nov

ember

Dec emb

Data source: Death certificates. Bureau of Policy and Strategy, Office of the Permanent Secretary, Ministry of Public Health.

Analyzed by:Suchada Gerdmongkolgan and Som Ekchaloemkiet, Injury Prevention Group, Bureau of Non-Communicable Diseases, Department of Disease Control, Ministry of Public Health, Thailand.

mbe

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Table 17: Numbers and percentage of drowning injuries in children <15 years admitted to hospital

in Thailand by month, 2005–2007

Month Year

2005 2006 2007

January 42 75 80

4.2 6.5 7.0

February 65 98 82

6.5 8.5 7.1

March 100 113 130

9.9 9.9 11.3

April 140 120 121

13.9 10.5 10.5

May 113 130 119

11.2 11.3 10.3

June 75 88 96

7.4 7.7 8.3

July 63 73 76

6.3 6.4 6.6

August 52 78 95

5.2 6.8 8.3

September 56 70 93

5.6 6.1 8.1

October 100 122 87

9.9 10.6 7.6

November 104 94 94

10.3 8.2 8.2

December 97 86 77

9.6 7.5 6.7

Total 1,007 1,147 1,150

100.0 100.0 100.0

Data source: Individual inpatients database. Bureau of Policy and Strategy, Office of the Permanent Secretary, Ministry of Public Health.

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Non-Figure 17: Numbers of drowning injuries in children <15 years in Thailand by month, 2005–2007

(3-year average)

0 20 40 60 80 100 120 140

Janu ary

Febr uary

rch _April _May _June _July

Augu

st Sept

embe

Octo

ber

Nove

mbe

Decem

ber

Data source: Individual inpatients database. Bureau of Policy and Strategy, Office of the Permanent Secretary, Ministry of Public Health.

Analyzed by:Suchada Gerdmongkolgan and Som Ekchaloemkiet, Injury Prevention Group, Bureau of Non-Communicable Diseases, Department of Disease Control, Ministry of Public Health, Thailand.

mbe

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Day of incident

Table 18: Percentage of severe drowning injuries* in children <15 years by day of the week,

1998–2007

Day Year**

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 Sunday 18.2 21.3 17.2 21.5 19.6 16.3 18.9 19.1 18.2 20.6 Monday 10.2 10.3 12.3 14.0 12.2 8.3 9.9 9.7 12.2 15.1 Tuesday 13.6 9.2 13.0 11.4 11.9 11.5 10.9 11.5 13.6 9.7 Wednesday 14.8 13.8 10.4 12.7 11.4 11.5 13.2 11.3 11.4 11.4 Thursday 8.5 9.9 11.4 11.4 9.3 17.8 13.3 12.4 8.9 13.2 Friday 14.2 13.5 14.9 13.7 17.0 14.0 14.9 16.4 13.4 11.4 Saturday 20.5 22.0 20.8 15.3 18.6 20.6 18.9 19.6 22.3 18.6 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

** Numbers of injuries: 14 in 1998, 19 in 1999, 21 between 2000 and 2001, 23 in 2002, 28 in 2003, 29 between 2004 and 2006, and 28 in 2007.

Data source: Sentinel sites. National Injury Surveillance System, Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health.

Compiled and Analyzed by: Kanjanee Dumnakkaew, Bureau of Epidemiology, Department of Disease Control,

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Figure 18: Percentage of severe drowning injuries* in children <15 years by day of the week,

1998–2007 (10-year average)

0 5 10 15 20 25

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Data source: Sentinel sites. National Injury Surveillance System, Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health.

Analyzed by: Suchada Gerdmongkolgan and Som Ekchaloemkiet, Injury Prevention Group, Bureau of Non-Communicable Diseases, Department of Disease Control, Ministry of Public Health, Thailand.

Perce

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Time of incident

According to the data regarding severe injuries collected at the Injury Surveillance System (IS), Bureau of Epidemiology, Department of Disease Control, between 1998 and 2007, the time of the day with the largest number drowning injuries was between 15:00 and 17:59 hrs, followed the period of time between 12:00 noon and 14:59 hrs (see Table 19 and Figure 19).

Table 19: Percentage of severe drowning injuries* in children <15 years by time period of the day,

1998–2007

Time period Year**

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 00:00–02:59 3.0 3.0 3.7 2.4 3.6 5.6 2.5 1.1 2.3 3.5 03:00–05:59 0.0 0.8 0.3 1.0 0.3 0.0 0.0 0.0 0.3 0.0 06:00–08:59 2.3 6.0 7.1 4.7 5.1 3.8 3.9 5.0 4.4 2.7 09:00–11:59 10.7 16.2 15.9 17.2 14.8 15.5 17.6 18.9 16.8 21.8 12:00–14:59 30.8 24.2 26.0 24.6 24.4 27.6 28.8 25.1 30.2 27.4 15:00–17:59 39.6 39.6 33.8 36.0 34.5 39.3 36.3 41.2 38.2 34.5 18:00–20:59 13.0 7.2 11.8 11.4 12.9 7.9 10.3 8.4 7.5 9.2 21:00–23:59 0.6 3.0 1.4 2.7 4.4 0.3 0.6 0.3 0.3 0.9

Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

** Numbers of injuries: 14 in 1998, 19 in 1999, 21 between 2000 and 2001, 23 in 2002, 28 in 2003, 29 between 2004 and 2006, and 28 in 2007.

Data source: Sentinel sites. National Injury Surveillance System, Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health.

Compiled and Analyzed by: Kanjanee Dumnakkaew, Bureau of Epidemiology, Department of Disease Control,

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Figure 19: Percentage of severe drowning injuries* in children <15 years by time period of the day,

1998–2007 (10-year average)

0 5 10 15 20 25 30 35 40 00:00 - 02:

03:00 - 05:

06:00 - 08

:59 09:0

0 - 1 1:59

12:00 - 14:

15:00 - 17:

18:00 - 20:

21:0 0 - 2

3:59

Data source: Sentinel sites. National Injury Surveillance System, Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health.

Analyzed by: Suchada Gerdmongkolgan and Som Ekchaloemkiet, Injury Prevention Group, Bureau of Non-Communicable Diseases, Department of Disease Control, Ministry of Public Health, Thailand.

Perce

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Location of drowning injuries

Water sources

According to the data regarding severe drowning injuries collected at the Injury Surveillance System (IS), Bureau of Epidemiology, Department of Disease Control, between 1998 and 2007, the sites where drowning deaths most frequently occurred were natural bodies of water, accounting for 49.9% of all drownings, followed by swimming pools and bathtubs at 5.4% and 2.5%, respectively. In addition, the sites of drowning injuiries most frequently occurred were natural bodies of water (48.2%), followed by swimming pools (6.0%), and bathtubs (3.8%) (see Table 20).

Table 20: Percentage of severe drowning injuries* in children <15 years by type of water source,

1998–2007 (10-year average) Water source

(categorized according to ICD-10)**

Mortality Morbidity Percent Percent Accidental drowning and submersion while in a bathtub (W65) 1.5 2.5 Accidental drowning and submersion following fall into a bathtub (W66) 1.0 1.3 Accidental drowning and submersion while in a swimming pool (W67) 4.9 5.0 Accidental drowning and submersion following fall into a swimming pool (W68) 0.5 1.0 Accidental drowning and submersion while in natural water (W69) 42.9 39.9 Accidental drowning and submersion following fall into natural water (W70) 7.0 8.3 Other specified drowning and submersion (W73) 5.8 8.4 Unspecified drowning and submersion (W74) 36.4 33.6

Total 100.0 100.0

** International Standard Classification of Disease and Related Health Problem: ICD 10 refers to the international standard diagnostic classification of diseases and health problems that are the causes of morbidity and mortality.

Data source: Sentinel sites. National Injury Surveillance System, Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health.

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Site of drowning injuries

According to the data regarding severe drowning injuries collected at the Injury Surveillance System (IS), Bureau of Epidemiology, Department of Disease Control, between 1998 and 2007, the sites where drowning injuries most frequently occurred were the houses or the compounds of the house (33.4%), followed by paddy fields, farms, or gardens (15.9%) (see Table 21).

Table 21: Percentage of severe drowning injuries* in children <15 years by type of incident site,

1998–2007

Site of incident 1998-2007

Percent Houses and compounds of the houses 33.4 Paddy fields, farms, gardens 15.9

Schools or hospitals 2.5

Public sports arenas 1.6

Places of trade and services 0.9 Construction sites or factories 0.7

Roads or highways 0.5

Dormitories, prisons, nurseries, or military barracks 0.4

Others 40.3

Unspecified 3.8

Total 100.0

Data source: Sentinel sites. National Injury Surveillance System, Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health.

Compiled and Analyzed by: Kanjanee Dumnakkaew, Bureau of Epidemiology, Department of Disease Control,

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WHO regions and Member countries

WHO regions and Member countries (in 2004)

African Region (46 Member States)

Low-income and middle-income

Algeria Lesotho Angola Liberia Benin Madagascar Botswana Malawi

Burkina Faso Mali

Burundi Mauritania Cameroon Mauritius

Cape Verde Mozambique

Central African Republic Namibia

Chad Niger Comoros Nigeria Congo Rwanda

Cote d’lvoire Sao Tome and Principe

Democratic Republic of the Congo Senegal

Equatorial Guinea Seychelles

Eritrea Sierra Leone

Ethiopia South Africa

Gabon Swaziland Gambia Togo Ghana Uqanda

Guinea United Republic Tanzania

Guinea-Bissau Zambia Kenya Zimbabwe

(2)

WHO regions and Member countries (in 2004) – cont.

Region of the Americas (35 Member States)

High-income

Antigua and Barbuda Canada

Bahamas United States of America

Barbados

Low-income and middle-income

Argentina Haiti

Belize Honduras Bolivia Jamaica Brazil Mexico Chile Nicaragua Colombia Panama

Costa Rica Paraguay

Cuba Peru

Dominica Saint kitts and Nevis

Dominican Republic Saint Lucia

Ecuador Saint Vincent and the Grenadines

El Salvador Suriname

Grenada Trinidad and Tobago

Guatemala Uruguay Guyana Venezuela

WHO regions and Member countries (in 2004) – cont.

South-East Asia Region (11 Member States)

Low-income and middle-income

Bangladesh Myanmar Bhutan Nepal

Democratic People’s Republic of Korea Sri Lanka

India Thailand Indonesia Timor-Leste Maldives

(3)

European Region (51 Member States)

High-income

Andorra Luxembourg Austria Malta Belgium Monaco Denmark Netherlands Finland Norway France Portugal

Germany San Marino

Greece Slovenia Iceland Spain Ireland Sweden lsrael Switzerland

ltaly United Kingdom

Low-income and middle-income

Albania Moldova Armenia Poland Azerbaijan Romania

Belarus Russian Federation

Bosnia and Herzegovina Serbia and Montenegro

Bulgaria Slovakia Croatia Tajikistan

Czech Republic The former Yugoslav Republic

Estonia of Macedonia

Georgia Turkey Hungary Turkmenistan Kazakhstan Ukraine

Kyrgyzstan Uzbekistan Latvia

(4)

WHO regions and Member countries (in 2004) – cont.

Eastern Mediterranean Region (22 Member States)

High-income

Bahrain Qatar

Cyprus United Arab Emirates

Kuwait

Low-income and middle-income

Afghanistan Oman Djibouti Pakistan

Egypt Saudi Arabia

Iraq Somalia

Islamic Republic of lran Sudan

Jordan Syrian Arab Republic

Lebanon Tunisia

Libyan Arab Jamahiriya Yemen

Morocco

WHO regions and countries (in 2004)

Western Pacific Region (27 Member States)

High-income

Australia New Zealand

Brunei Darussalam Republic of Korea

Japan Singapore

Low-income and middle-income

Cambodia Niue China Palau

Cook lslands Papua New Guinea

Federated States of Micronesia Philippines

Fiji Samoa

Kiribati Solomon lslands

Lao People’s Democratic Republic Tonga

Malaysia Tuvalu

Marshall lslands Vanuatu

Mongolia Viet Nam

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Index

accessibility to treatment: 59

International Statistical Classification of Disease

admit/admitted: 11

and Related Health Problem (ICD-10): 10

age: 25, 56

Morbidity: 10, 30, 57

alcohol consumption: 3, 4, 11, 46, 58, 65

mortality: 10, 15, 53

case-fatality rate: 2, 33, 57, 63

site of drowning injuries: 45

child: 10

road traffic injuries: 6, 15, 18, 30, 54, 62

cost of medical care: 3, 11, 48, 59, 64

location of drowning: 11, 44, 58

data from death certificates: 12

sex/gender: 23, 55

data on individual inpatients: 9, 12

time: 35, 42, 57, 58

drowning: 10

water sources: 44, 58

Global Burden of Disease: 5, 61

WHO regions and countries: 7, 96

injury/severe injury: 10

Injury Surveillance System (IS): 1, 9, 13, 33,

40, 42, 44, 45, 46, 53, 61

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