Socio-economic, demographic, and environmental characteristics of child drowning on Sandwip Island, Bangladesh.

Objective: This study aims to identify the perceived risk factors associated with child drowning deaths on Sandwip Island⎯ a region of high drowning deaths over generations. Methods: This study was conducted using a purposive sampling survey to identify fatal and nonfatal child (1-17 years of age) drowning among a total of 13,857 households in two unions, namely Sarikait and Maitbanga in Sandwip Island, Bangladesh from 2018-2023. Face-to-face interviews were conducted among the households who experienced drowning on the Island. We used a combination of methods for data collection, incorporating both quantitative analyses to assess socio-economic, demographic, and environmental factors, and qualitative analysis to investigate situational factors related to drownings in the region. The annual incidence rate of fatal drowning was estimated by determining the number of events occurring per 100,000 persons. Results: By visiting 13,857 households, a total of 205 households were identified that faced drowning incidents between 2018 and 2023. Out of 205 child drowning incidents in the 2 unions studied, 117 (57.07%) were fatal and 88 (42.93%) were non-fatal. In 2023, the number of drowning incidents was 23. Annual fatal drowning rate on the Island was 20.85/100,000 in 2023. Out of 117 fatal drowning deaths, 69.2% occurred in children between the ages of 1-4 years old. Prior to drowning incidents, approximately 88% of children were without active adult supervision. The average age for 117 drowning deaths is 3.2 years. Of the child drowning deaths, 62 (53%) were male and 55 (47%) were female. The gender proportion of 88 non-fatal drownings were 60% male and 40% female. Regarding seasonality of incidences, the occurrence in summer (March to May), monsoon (June to October) and winter (November to February) were 31.69, 39.04 and 29.27%, respectively. Of drowning deaths, 96.58% occurred in ponds, 2.56% occurred in ditches and 0.85% occurred in cow's fodder bucket. From these 117 fatal drownings, approximately 98% of children did not know how to swim prior to the incident. The average age at which children first learned to swim was 7 years. Conclusion: The findings indicate that inadequate active adult supervision at the time of the incident, the high density of ponds, and locational factors-particularly the proximity of household compounds to nearby water bodies-collectively contribute to elevated drowning risk. Identifying socio-demographic and reported contributing risk factors associated with child drowning can inform the development of targeted prevention strategies, including interventions that promote earlier acquisition of swimming skills to reduce incidence among younger age groups.