Child Drowning Research Articles

Effectiveness of "Be SAFE Drowning Prevention and Water Safety Booklet" Intervention for Parents and Guardians.

Background:We aimed to assess the effectiveness of the health educational booklet intervention in improving parents/guardian’s knowledge on prevention of child drowning and, the perception of drowning risk and water safety practice.Methods:A quasi-experimental study was conducted in year 2017 in Selangor, Malaysia among 719 parents/guardians of primary school children. The parent/guardians were randomly assigned as the intervention groups and were given a health educational Be-SAFE booklet on drowning prevention and water safety. The pretest was conducted before the intervention and posttest was done one month of intervention. The data collection tool was using a validated questionnaire on knowledge, attitude and practice for drowning prevention and water safety.Results:There were 719 respondents (response rate of 89.9%) participated at baseline and 53.7% at end line (after the intervention). Significant differences found in knowledge, attitudes and practice on drowning prevention and water safety for the intervention and control groups after the intervention (P<0.001). There was a significant difference in mean scores for knowledge and attitude before and after the intervention, whereas no significant findings noted for practices (P<0.001).Conclusion:Be SAFE booklet contributed to the increase in parents/guardian’s knowledge and attitudes towards drowning prevention and water safety to prevent the risk of child drowning.

SMS Text Messages for Parents for the Prevention of Child Drowning in Bangladesh: Acceptability Study.

BackgroundIn many cases, greater use is being made of mobile phone text messages as a means of communication between patients and health care providers in countries around the world.ObjectiveWe studied the use of mobile phones and the factors related to the acceptability of text messages for parents for the prevention of child drowning in Bangladesh.MethodsFrom a randomized controlled trial involving 800 parents, 10% (80/800) were selected, and socioeconomic status, mobile phone use, and acceptability of SMS text messages for drowning prevention were measured. Participants with at least one child under 5 years of age were selected from rural areas in Rajshahi District in Bangladesh. Mobile phone–based SMS text messages were sent to the participants. Multivariate regression was used to determine the factors related to the acceptability of text messages for the prevention of child drowning in Bangladesh.ResultsThe acceptability of SMS text messages for the prevention of child drowning in Bangladesh was significantly lower among women (odds ratio [OR] 0.50, 95% CI 0.12-1.96, P=.02) than among men, lower for parents older than 30 years (OR 0.17, 95% CI 0.14-1.70, P=.01) compared to parents younger than 30 years, higher among parents who had an education (OR 1.63, 95% CI 1.11-5.80, P=.04) than among illiterate parents, and higher among parents with a monthly household income over 7000 Bangladeshi Taka (approximately US $82.54; OR 1.27, 95% CI 1.06-1.96, P=.05) than among parents whose monthly income was less than 7000 Bangladeshi Taka.ConclusionsThe high percentage of mobile phone use and the acceptability of SMS text messages for parents for the prevention of child drowning are encouraging, in terms of identifying the best strategy for using such technologies, and deserve further evaluation.

Afogamento infantil: uma abordagem do Enfermeiro frente à acidentes domésticos

A precaução dos acidentes que acontecem em domicílio em foco ao afogamento infantil é um recurso em que depende de conhecimentos profissionais para que tais sejam evitados, com orientações de um enfermeiro frente a medidas indispensáveis para estes eventos. Sendo necessária aplicação de medidas preventivas eficientes em todos os graus de cuidados, em prudência primarias com o intuito de reduzir esses acidentes, encontrando-se ações educacionais sobre estes inesperáveis acontecimentos, sendo de grande importância a ampliação destes cuidados, tendo o objetivo de avaliar também as ações elaboradas e os resultados alcançados. Objeto de estudo tem como finalidade atuação do Enfermeiro Frente às Necessidades de Cuidados Domiciliares como afogamento infantil. Objetivo analisar as condutas do enfermeiro na assistência com cuidados domésticos frente ao afogamento infantil. Este estudo se justifica, mediante as causas e consequências destes eventos, observei o quanto é essencial medida relacionada a ações de prevenções para tal ocorrido.

Large-scale evaluation of interventions designed to reduce childhood Drownings in rural Bangladesh: a before and after cohort study

BackgroundThis paper estimates the impact on childhood drowning rates of community-based introduction of crèches or playpens or both in rural Bangladesh for children aged 0–47 months.MethodsA baseline census of the whole population of 270,387 households in 51 unions, 451 villages from 7 rural sub-districts in Bangladesh was conducted in 2013. The baseline census determined retrospective, age-specific, and cumulative drowning incidence rates (IR) experienced in the target households in the 12 months prior to the intervention. Beginning in late 2013, creches for drowning prevention were established across the study area. Acceptance into creches was provided and written assent to attend a creche was obtained for all children aged 9–47 months in all participating unions. Playpens were provided to 45,460 of these children, of which 5981 children received only the playpens. All children were followed-up until their 48-month birthday or administrative censoring (fixed timepoint to stop observing the drowning deaths), after a two-year implementation period (2014–2016). Drowning IR were estimated for children and compared to corresponding baseline rates from 2012. Age-specific drowning IR under different “as treated” categories (playpen-only, creche-only, and playpen-plus-creche) were compared to the baseline rates experienced by the categorized households prior to intervention.ResultsA total of 3205 creches (average of 7 creches per village) were established, and 116,054 children aged 9–47 months were exposed to the intervention packages. Aggregated drowning IRs between age 0 and 47 were estimated per 100,000 population per year at 86.73 (95% CI: 69.67–107.97) and 43.03 (95% CI: 35.55–52.10) in the baseline and post implementation period, respectively. Risk ratios were 0.40 (95% CI: 0.28–0.57) overall, and 0.34 (95% CI: 0.13–0.90), 0.09 (95% CI: 0.02–0.36), and 0.04 (95% CI: 0.002–0.60) in children under the creche-only, aged, 1, 2, and 3 years old respectively. Inexplicably, drowning rates were statistically significantly higher post-intervention in children 0-11 months. There was no mortality reduction with playpen use (alone or in combination), and this group may actually have had a higher risk of drowning.ConclusionsCreches are effective for preventing childhood drowning in rural Bangladesh for children above age 1-year, and should be considered for further scale-up.

Autism spectrum disorder and unintentional fatal drowning of children and adolescents in Australia: an epidemiological analysis

ObjectivesThis study explored unintentional fatal drowning among children and adolescents (0–19 years) diagnosed with autism spectrum disorder (ASD) in Australia.DesignThis total population, cross-sectional audit used data from the Royal Life...

Causes of distraction leading to supervision lapses in cases of fatal drowning of children 0–4 years in Australia: A 15‐year review

Supervision is a strategy for preventing drowning among children. However, supervision lapses continue to be a contributory factor in child drowning. This study aims to identify, describe and analyse the causes of distraction leading to lapses in supervision in child drowning. A total population survey of all fatal unintentional drownings among children aged 0-4 years between 1 July 2002 and 30 June 2017 was undertaken using data from the Australian National Coronial Information System. Among closed coronial cases, causes of distraction leading to lapses in supervision were collected as free text from closed case documentation and subsequently thematically grouped into categories. Univariate and χ2 analysis was undertaken (P < 0.01). A total of 447 children drowned during the study period (62.0% male; 66.9% aged 1-2 years; 53.3% swimming pools; 79.4% falls into water). Of the 426 (95.3%) closed cases, common supervision lapses were due to indoor household duties (27.6%), outdoor household duties (12.6%) and talking/socialising (11.9%). This study has identified common scenarios for distractions leading to supervision lapses including the link between indoor household duties and bathtub drowning deaths and talking/socialising for deaths in swimming pools and at rivers. Challenges include medical issues impacting sole carers. The 7% of cases where a supervision lapse occurred due to miscommunication are opportunities to further reinforce the need for a designated supervisor, particularly with two or more adults present. Study findings on distraction causes, and strategies to minimise them, should be incorporated into national public awareness campaigns aimed at parents and care givers of this at-risk group.

The prevention of child drowning: the causal factors and social determinants impacting fatalities in portable pools

There is a scarcity of research into portable pool drowning and its prevention. This total population study examines fatal drowning among children under five in portable pools in Australia. All child drowning deaths in portable pools for the period 1 July 2002 to 30 June 2018 were identified. A portable pool was defined as any structure used for swimming and wading which, when emptied, can be moved. Twenty-three children (aged 0-17years) drowned in portable pools. The drowning rate for children less than 5years of age was 0.09 per 100000 population. The peak age of death was 12-23months (RR=2.99; CI: 1.09-8.23), with the majority (n=20 deaths) aged 16-31months. Ninety per cent followed a fall into water. None were supervised. Children commonly resided in areas classified as socially and economically disadvantaged (85%; n=17). Drowning rates in very remote areas were 15 times greater (RR=15.41; CI: 0.03-7579.65) than city children. Eleven (55%) drowning deaths occurred in pools with a depth >300mm, of which 10 (91%) were known to be unfenced. Social determinants impact child drowning in portables pools, which can occur quickly and in just 150mm of water. Active supervision and a regulation-compliant barrier are effective prevention stratagems, factors which were absent from the deaths in this study. SO WHAT?: Portable pool drowning disproportionately impacts those aged 16-31months who reside in very remote areas and areas classified as having high socio-economic disadvantage. Education for these groups on fencing and supervision of children must be provided.

Epidemiological characteristics and influencing factors of fatal drowning in children under 5\u2009years old in Hunan Province, China: case-control study

BackgroundDrowning is still the primary cause of death in children under 5 years old, however, little is known about the drowning of Hunan province children. This study identifies the previously unpublished incidence and characteristics of fatal drowning in children of Hunan Province, and provide a basis for formulating strategies for children’s survival, development and protection.MethodsData were collected through sampling with the multistage stratified cluster. The case group included all fatal frowning children under 5 years old in 13 districts between October 2015 and September 2016. The control group was matched 1:1.The epidemic features and influencing factors of fatal drowning were analyzed retrospectively according to descriptive analysis, conditional univariate and multivariate logistic regression analysis.ResultsFor children aged 0–4 years, the fatal drowning was 16.1/100000 in Hunan Province. Drowning rates were higher for boys than girls. The proportion of rural areas is much higher than that of urban areas. The 1–2 years age-group was the highest of all age groups. Fatal drowning mainly occurred in summer. The three leading drowning locations were pond, ditch and well. Playing close to the water were the leading activities that preceded fatal drowning. Multivariate logistic regression analysis showed that: children with primary caregiver education in high school and above (OR = 0.05) have a lower risk of fatal drowning; children with full-time care (OR = 0.17) have a lower risk; children who received unintentional drowning safety education (OR = 0.23) have a lower risk of fatal drowning. Children who were always swimming or playing near the water in the past 6 months (OR = 3.13) have a higher risk of fatal drowning.ConclusionThe fatal drowning among children under 5 years is the result of the interaction of multiple factors. A significant number of child deaths could have been prevented if parents and other close relatives had been more concerned about the safety of their children. We should develop health education plans for villagers to warn them of the dangers of drowning and preventive measures.

Seasonal variation in childhood mortality

Aim: This ecological study was carried out to determine the cyclic trends in the rate of perinatal and infant mortality and among children aged under 15 years who died in traffic accidents or from drowning, respiratory disease or cancer.Methods: Monthly data on the numbers of live births, perinatal and infant deaths, and deaths from respiratory disease, cancer, traffic accidents, accidental drowning, and submersion in children aged under 15 years were obtained from the Hungarian nationwide population register. The data were aggregated over the study period and cyclic trends were investigated using the Walter–Elwood and negative binomial regression methods.Results: Significant double-peak (May and November) trends were found in mortality rates for perinatal and infant deaths, respectively. Additionally, significant (p-value < .001) seasonal variation in monthly mortality rates for deaths from respiratory diseases was observed with a peak in February, and a significant single peak was observed in mortality rates in July in both deaths from traffic accidents and drowning among children aged 0–14 years. However, there was no seasonal variation in monthly mortality rates for deaths from childhood cancer.Conclusions: Since cyclic trends in mortality suggest some effect of environmental factors in etiology, we might speculate that perinatal mortality may have been related to respiratory infections. A significant single peak was observed in mortality rates in July in both deaths from traffic accidents and drowning among children aged 0–14 years which could be related to environmental factors, such as temperature, air masses, and fronts. However, there was no seasonal variation in monthly mortality rates for deaths from childhood cancer. All of these novel findings could prove useful in preventive strategies, but further cohort studies are needed to investigate this hypothesis.What is knownSeasonality in infant mortality is known.What is newA significant cyclic trend was found in infants’ mortality, with a peak in deaths in winter during the post-perinatal period and double peaks in May and November during the perinatal period, which might be associated with respiratory syncytial virus infections.Winter-peak cyclic trends were observed in both preterm and low birthweight mortality.A significant cyclic trend was observed in mortality, with a peak in deaths from traffic accidents and drowning in July for children aged 0–14 years, but seasonal variation was not found in monthly deaths from childhood cancer.

The impact and understanding of childhood drowning by a community in West Bengal, India, and the suggested preventive measures.

Our aim was to improve our understanding of the contextual factors contributing to child drowning in rural West Bengal, India. This 2017 study used interviews, focus groups and observations and the participants included community leaders, household heads, parents and children aged 7-17years from three remote villages. They included adults and children who had been directly affected by the loss of family members or friends. We conducted 19 in-depth interviews, six focus groups and three informal observations in public locations where people were exposed to water. The area contained a high number of natural open areas of water, which increased the drowning risk. Participants reported that children frequently played unsupervised near potentially hazardous water, as their parents worked long hours and there was a lack of safe recreational spaces. Suggested approaches to reducing the drowning risk included parental education to improve child supervision and establishing village committees to effectively communicate the drowning risks to local government. Low-cost, community-based approaches to improving child water safety need to be developed. Drowning was clearly a complex issue in rural West Bengal, with a significant impact on children and their families. Community-based approaches are clearly needed.

Surviving the swim: Psychosocial influences on pool owners’ safety compliance and child supervision behaviours

In Queensland, Australia drowning deaths of children under the age of 5 have increased over the last 3 years, with home swimming pools being the most common site of this tragedy. Restriction of access to pools and supervision of children using the pool are two behaviours that can prevent drowning. Pool owners who were parents or guardians of children aged under 5 years (N = 242) completed a survey regarding these behaviours. We examined the impact of owners’ risk perceptions and feelings of anticipated regret on the pool safety intention and behaviours of (1) restriction of child access and (2) supervision of children, after taking into account established psychosocial determinants of decision making conceptualised by the theory of planned behaviour (attitude, subjective norm, perceived behavioural control). In addition, underlying beliefs (attitudinal, normative, control) were examined. While anticipated regret significantly predicted intentions for both behaviours, risk perception was not a significant predictor of intention to perform either behaviour. The established decision-making constructs of attitudes, norms, and control factors influenced intention, with intention and control factors predicting behaviour. Furthermore, the critical beliefs identified in this study, in particular the approval from close others and experts in the swimming domain, provides for a better understanding of pool safety behaviour. The findings based on psychological variables and critical beliefs can be applied to future intervention strategies aimed at decreasing the incidence of childhood drowning.

Childhood Drowning: Review of Patients Presenting to the Emergency Departments of 2 Large Tertiary Care Pediatric Hospitals Near and Distant From the Sea Coast.

Drowning is a leading cause of death among infants and toddlers. Unique physiological and behavioral factors contribute to high mortality rates. Drowning incidents predominantly occur during warmer months and holidays. The aim of this study was to describe the characteristics of pediatric drowning victims who attended 2 different emergency departments (EDs), 1 near and 1 distant from the sea coast, to recognize risk factors, complications, causes of death, and the educational needs of families and caregivers. Retrospective cohort analysis of incident history, clinical presentation, treatments, and outcomes of drowning victims was performed. Data were analyzed both by age group and proximity of institution to the sea coast. From 2005 to 2015, 70 drowning patients presented to the 2 institutions; there was no difference in incident history or outcomes based on proximity to the sea coast. Fifty-six percent of patients were younger than 6 years, the majority drowning in pools. More of the older children drowned in the sea (48% vs 23%). Half of all patients were treated and followed in the ED or ward, and the other half were treated in the pediatric intensive care unit; 12 suffered severe complications, including 5 diagnosed with brain death. Cardiopulmonary resuscitation was performed in 80% of the fatal group and 23% of the nonfatal group (P = 0.006). Seven children who experienced a cardiac arrest with hypothermia were treated before arrival in the ED, and 5 had ongoing cardiac arrest upon arrival in the ED (these were the 5 suffering brain death). Most of patients younger than 6 years drowned in swimming pools, suggesting that parents are perhaps less vigilant in these circumstances, even though they may remain in close proximity. Active adult supervision entails attention, proximity, and continuity. Educational efforts should be aimed at reminding parents of this, especially in the summer months.

Improving Pool Fencing Legislation in Queensland, Australia: Attitudes and Impact on Child Drowning Fatalities.

Four-sided, non-climbable pool fencing is an effective strategy for preventing children from drowning in home swimming pools. In 2009, the Queensland Government introduced legislation to improve the effectiveness of pool fencing. This study explores community attitudes towards the effectiveness of these legislative changes and examines child (<5 years) drowning deaths in pools. Data from the 2011 Queensland Computer-Assisted Telephone Interviewing (CATI) Social Survey include results from questions related to pool ownership and pool fencing legislation. Fatal child drowning cases between 1 January 2005 and 31 December 2015 were sourced from coronial data. Of the 1263 respondents, 26/100 households had a pool. A total of 58% believed tightening legislation would be effective in reducing child drowning deaths. Pool owners were more likely to doubt the effectiveness of legislation (p < 0.001) when compared to non-pool owners. Perceptions of effectiveness did not differ by presence of children under the age of five. There were 46 children who drowned in Queensland home pools (7.8/100,000 pools with children residing in the residence/annum) between 2005 and 2015. While pool owners were less likely to think that tightening the legislation would be effective, the number of children drowning in home swimming pools declined over the study period. Drowning prevention agencies have more work to do to ensure that the most vulnerable (young children in houses with swimming pools) are protected.

Epidemiology of adulthood drowning deaths in Bangladesh: Findings from a nationwide health and injury survey

Background: Annual global death due to drowning accounts for 372,000 lives, 90% of which occur in low and middle income countries. Life in Bangladesh exposes adults and children to may water bodies for daily household needs, and as a result drowning is common. In Bangladesh, due to lack of systemic data collection, drowning among adults is unknown; most research is focused on childhood drowning. The aim of the present study was to explore the epidemiology of adulthood drowning deaths in Bangladesh. Methodology: A nationwide cross-sectional survey was conducted from January to December in 2003 among 171,366 rural and urban households, with a sample of 819,429 individuals to determine the epidemiology of adulthood drowning in Bangladesh. Results: Annual fatal drowning incidence among adults was 5.85/100,000 individuals. Of these, 71.4% were male and 28.6% were female (RR 2.39). In total, 90% of the fatalities were from rural areas. Rural populations were also found to have a 8.58 times higher risk of drowning than those in urban areas. About 95% of drowning occurred in natural water bodies. About 61.6% of the deaths occurred at the scene followed by 33.5% at the home. Of the drowning fatalities, 67% took place in water bodies within 100 meters of the household. Among the drowning fatalities 78.4% occurred in daylight between 7.00 and 18.00. Over 97% of the victims were from poor socio economic conditions with a monthly income tk. 6,000 ($94) or less. Only 25.5% of incidences were reported to the police station. Conclusions: Every year a significant number of adults die due to drowning in Bangladesh. Populations living in rural areas, especially men, were the main victims of drowning. This survey finding might help policy makers and scientists to understand the drowning scenario among adults in Bangladesh.

Drowning fatalities in childhood: the role of pre-existing medical conditions

ObjectivesThis study is an analysis of the contribution of pre-existing medical conditions to unintentional fatal child (0–14 years) drowning and a of critique prevention stratagems, with an exploration of issues...

Epidemiology of adulthood drowning deaths in Bangladesh: Findings from a nationwide health and injury survey.

Background: Annual global death due to drowning accounts for 372,000 lives, 90% of which occur in low and middle income countries. Life in Bangladesh exposes adults and children to may water bodies for daily household needs, and as a result drowning is common. In Bangladesh, due to lack of systemic data collection, drowning among adults is unknown; most research is focused on childhood drowning. The aim of the present study was to explore the epidemiology of adulthood drowning deaths in Bangladesh. Methodology: A nationwide cross-sectional survey was conducted from January to December in 2003 among 171,366 rural and urban households, with a sample of 819,429 individuals to determine the epidemiology of adulthood drowning in Bangladesh. Results: Annual fatal drowning incidence among adults was 5.85/100,000 individuals. Of these, 71.4% were male and 28.6% were female (RR 2.39). In total, 90% of the fatalities were from rural areas. Rural populations were also found to have a 8.58 times higher risk of drowning than those in urban areas. About 95% of drowning occurred in natural water bodies. About 61.6% of the deaths occurred at the scene followed by 33.5% at the home. Of the drowning fatalities, 67% took place in water bodies within 100 meters of the household. Among the drowning fatalities 78.4% occurred in daylight between 7.00 and 18.00. Over 97% of the victims were from poor socio economic conditions with a monthly income tk. 6,000 ($94) or less. Only 25.5% of incidences were reported to the police station. Conclusions: Every year a significant number of adults die due to drowning in Bangladesh. Populations living in rural areas, especially men, were the main victims of drowning. This survey finding might help policy makers and scientists to understand the drowning scenario among adults in Bangladesh.

A search for a safer bucket to prevent children drowning at home.

:Background:Unintentional drowning is the leading cause of death for children younger than 5 years old. A bucket is one of the most common water container in which children can drown. The objective of this work was to evaluate the base diameter of a bucket and the necessary force to shed it.Methods:This was an experimental study. We used six galvanized buckets of different diameters. Each selected bucket was pulled using a pulley with other buckets full of water until the water spilled out. The statistical analysis was done by linear regression with p less than 0.05 as statistically significant.Results:This research shows a direct relation between the wide base diameter (in a bucket 23 cm high, 25 cm rim, with a 20 cm water depth) and the strength required to spill the liquid contents (β= 1.21; x= diameter of the base in centimeters; α= 14.59; r= 0.99 and p less than 0.001).Conclusions:We conclude that the bucket structure could determine the risk of child drowning. The risk could increase directly as its base width increases.

Understanding Contributing Factors to Child Drownings in Public Pools in Australia: a Review of National Coronial Records

Understanding Contributing Factors to Child Drownings in Public Pools in Australia: a Review of National Coronial Records

Non-fatal drowning in under-five rural children of Bangladesh

Drowning has been identified as a major cause of death in children in both developed and developing countries. Non-fatal drowning is several times higher than the fatal drowning. To describe the socio-demographic and environmental attributes of non-fatal drowning in rural children this community based descriptive study was conducted on 122 children having non-fatal drowning events within one year of study period. This study was undertaken in Raigonj sub-district of Sirajgonj district in Bangladesh. Mothers of those children were interviewed using a structured questionnaire. Out of all participants 56.6% children were 2-4 years of age and male-female ratio was almost equal. Of the total respondent mothers 55% were illiterate and 41.8% were below the age of 25 years. Seasonal variation was observed in non-fatal drowning. Rainy season (50.8%) appeared as the most risky period followed by summer (29.5%). Higher incidence occurred (53.3%) between 10 am to 2 pm of the day. Although most of the drowning occurred outside the home, 9% drowning occurred in water container (like drum, tub) within the home. Pond (50.5%) was found as the most common place among open water source. During the occurrence, 23% child was not accompanied by parents or any caregivers. At the time of drowning, 47.5% mothers were engaged with usual household work and were not present at the place of occurrence whereas 13% mothers were present around the place of occurance. Before drowning, 45.1% victim was either playing, bathing or swimming in the water. Only 10.7% needed resuscitation, 25% were taken to health centre and reached the health centre within an hour, about a fifth (22.6%) of them were admitted. Restriction in dangerous water activities, strengthening supervision of children might decrease the incidence of drowning while quick and effective medical response might prevent its fatal consequences.Ibrahim Med. Coll. J. 2015; 9(2): 37-41

The development of an intervention package to prevent children under five years old drowning in rural Bangladesh.

There are an estimated 372 000 worldwide deaths by drowning every year, and it has been described as a secret epidemic in Bangladesh. The aim of this study was to develop an intervention package to prevent children under the age of five from drowning in rural Bangladesh. This was a qualitative study using focus group discussions in three villages in rural Bangladesh. The 45 participants were mothers and fathers with children under five, the parents of children who had drowned and community leaders. The majority of the participants (71%) were male. The focus groups revealed that most drowning's occurred between 11am and 2pm and that risk factors included the following: children not being able to swim, ditches that were not filled in, lack of medical facilities, parents who were not aware of childhood drowning and lack of information through the media about how to prevent of childhood drowning. Suggestions included using a mobile-based short messaging service or voice calls to parents, especially mothers, could increase awareness and reduce the risk of childhood drowning. A safety education programme could be effective in increasing knowledge and changing attitudes, which could prevent drowning among children in Bangladesh.