Article Text

Download PDFPDF
Determining child drowning mortality in the Sundarbans, India: applying the community knowledge approach
  1. Medhavi Gupta1,
  2. Soumyadeep Bhaumik2,
  3. Sujoy Roy3,
  4. Ranjan Kanti Panda3,
  5. Margaret Peden4,
  6. Jagnoor Jagnoor2
  1. 1George Institute for Global Health, Newtown, New South Wales, Australia
  2. 2Injury Division, The George Institute for Global Health India, New Delhi, India
  3. 3The Child In Need Institute, Pailan, West Bengal, India
  4. 4The George Institute for Global Health UK, London, UK
  1. Correspondence to Dr Jagnoor Jagnoor, The George Institute for Global Health India, New Delhi 110025, India; jjagnoor1{at}


Background The Sundarbans in India is a rural, forested region where children are exposed to a high risk of drowning due to its waterlogged geography. Current data collection systems capture few drowning deaths in this region.

Methods A community-based survey was conducted in the Sundarbans to determine the drowning mortality rate for children aged 1 to 4 years and 5 to 9 years. A community knowledge approach was used. Meetings were held with community residents and key informants to identify drowning deaths in the population. Identified deaths were verified by the child’s household through a structured survey, inquiring on the circumstances around the drowning death.

Results The drowning mortality rate for children aged 1 to 4 years was 243.8 per 100 000 children and for 5 to 9 years was 38.8 per 100 000 children. 58.0% of deaths were among children aged 1 to 2 years. No differences in rates between boys and girls were found. Most children drowned in ponds within 50 metres of their homes. Children were usually unaccompanied with their primary caretaker engaged in household work. A minority of children were treated by formal health providers.

Conclusions Drowning is a major cause of death among children in the Sundarbans, particularly those aged 1 to 4 years. Interventions keeping children in safe spaces away from water are urgently required. The results illustrate how routine data collection systems grossly underestimate drowning deaths, emphasising the importance of community-based surveys in capturing these deaths in rural low- and middle-income country contexts. The community knowledge approach provides a low-resource, validated methodology for this purpose.

  • drowning
  • epidemiology
  • surveys
  • mortality
  • child
  • low-middle income country

Statistics from


  • Twitter @MedGupta, @margiepeden, @jjagnoor

  • Contributors MG and JJ formulated the research questions and methodology with inputs from SB. SR and RKP conducted data collection and quality maintenance activities with support from MG, SB and JJ. MG drafted the manuscript with inputs from JJ, SB, MP, SR and RKP.

  • Funding This project was supported by the University of New South Wales through the Research Training Program Scholarship (awarded to MG, no award number) and National Health and Medical Research Council (Australia) Early Career Fellowship funding (Application ID: APP1104745) (awarded to JJ).

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was granted by the University of New South Wales Human Research Ethics Committee (HC 190274) and The George Institute for Global Health India Ethical Review Committee (06/2019).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. Data will be shared upon reasonable request by contacting the Corresponding Author (

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.