Child drowning in northern Bangladesh: barriers, local initiatives, and opportunities for prevention.

Background: Although Bangladesh has achieved substantial progress in reducing mortality from infectious diseases, child drowning, particularly in the northern regions, remains a neglected public health concern and constitutes the leading cause of death among children aged 1-17 years in rural areas. Approximately 18,268 children (aged 0-17 years) die from drowning annually, equivalent to an average of 50 deaths per day. Objective: This study aims to identify the socio-demographic characteristics of caregivers, the types of child supervision and reasons for its absence, water safety skills, traditional rescue practices, and the community's preferences for child drowning prevention interventions in northern Bangladesh. Methods: We conducted face-to-face in-depth interviews and case-story analysis with 117 households that experienced drowning in two selected unions in northern Bangladesh. We employed quantitative analysis to examine the socio-demographic characteristics of the parents and carers, along with a mixed-methods approach for data collection on the reasons for a lack of adult supervision, water safety and rescue knowledge, the community's role in preventing child drowning, and the assistance required from public and private institutions to prevent child drowning in the region. Results: After visiting a total of 18,004 households, we identified 117 drowning incidents, including 85 fatal and 32 non-fatal drownings in the last 6 years. The households that experienced drowning had an average monthly income of BDT 7,610, a lower level of education, and were primarily involved in farming and daily wage earnings. The study found that low understanding of child drowning risk, unawareness, and a lack of active adult supervision of children were associated with drowning deaths. Multivariable logistic regression identified greater distance from the drowning site, caregiver age, and household size as significant factors associated with fatal drowning, while each additional metre of distance from the drowning site increased the odds of fatal drowning. We also found limited knowledge about water safety and a lack of swimming and rescue skills as major factors in child drowning deaths. At the community level, participants preferred installing fencing along pond walkways and other reservoirs. Conclusion: In the absence of nationwide community-based drowning prevention programmes, this study recommends active community engagement to raise awareness, enhance understanding of child drowning risks, strengthen water safety, swimming, rescue, and cardiopulmonary resuscitation (CPR) skills, and reduce harmful post-rescue practices. Given the prevalence of low-income households, communities often lack the financial capacity to fence or fill unnecessary water reservoirs. Consequently, effective prevention of child drowning in northern Bangladesh will require coordinated efforts among individuals, households, communities, local councils, and civil administrations.