Article Text
Abstract
Background We report on incidence of drowning deaths and related contextual factors in children from a population-based study in the Indian state of Bihar which estimated the causes of death using verbal autopsy (VA).
Methods Interviews were conducted for deaths in 1–14 years population that occurred from January 2012 to March 2014 in 109 689 households (87.1% participation) in 1017 clusters representative of the state. The Population Health Metrics Research Consortium shortened VA questionnaire was used for interview and cause of death was assigned using the SmartVA automated algorithm. The annualised unintentional drowning death incidence, activity prior to drowning, the body of water where drowning death had occurred and contextual information are reported.
Findings The survey covered 224 077 children aged 1–14 years. Drowning deaths accounted for 7.2%, 12.5% and 5.8% of all deaths in 1–4, 5–9 and 10–14 years age groups, respectively. The adjusted incidence of drowning deaths was 14.3 (95% CI 14.0 to 14.7) per 100 000 children, with it being higher in urban (16.1, 95% CI 14.8 to 17.3) areas. Nearly half of the children drowned in a river (5.9, 95% CI 5.6 to 6.1) followed by in a pond (2.8, 95% CI 2.6 to 2.9). Drowning death incidence was the highest while playing (5.1, 95% CI 4.9 to 5.4) and bathing (4.0, 95% CI 3.8 to 4.2) with the former accounting for more deaths in 1–4 years age group. Sixty per cent of children were already dead when found. None of these deaths were reported to the civil registration system to obtain death certificate.
Interpretation The findings from this large representative sample of children document the magnitude of and variations in unintentional drowning deaths in Bihar. Urgent targeted drowning interventions are needed to address the risk in children. Gross under-reporting of drowning deaths in children in India needs attention.
- children
- deaths
- drowning
- India
- mortality
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Footnotes
Contributors RD and GAK had full access to all the data in the study and take full responsibility for the integrity of data and accuracy of the data analysis. RD, GAK and LD conceptualised the study, guided data analysis and interpretation. RD drafted the manuscript. SG and AK contributed to data analysis and drafting of the manuscript. All authors approved the final manuscript.
Funding Bill and Melinda Gates Foundation.
Disclaimer The funder of the study had no role in study design, data collection, data analysis, data interpretation or writing of the report. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.
Competing interests None declared.
Patient consent Not required.
Ethics approval Institutional Ethics Committee of the Public Health Foundation of India.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement All relevant data are presented in the manuscript.