Drowning Deaths in India : Need for prevention Policies and Programs. Dr. G Gururaj

Transcription

1 Drowning Deaths in India : Need for prevention Policies and Programs Dr. G Gururaj Professor & Head Department of Epidemiology WHO Collaborating Centre for Injury Prevention and Safety promotion Centre for Public Health National Institute of Mental Health & Neuro Sciences Bangalore , India Phone: /5245; Fax: / guru@nimhans.kar.nic.in / epiguru@yahoo.com

2 Purpose To identify the problem and epidemiological characteristics To delineate risk factors To identify strategies for developing policies and programmes for prevention

3 Different perspectives. Social - recreational Economic - Occupational Cultural - religious Developmental - new growth avenues Societal fatalistic People s issue variety of reasons

4 Different mindsets. Police problem Transport problem Individual problem- Not for me Behavioral problem Negligent people Media problem Developmental problem Is it a health problem and a larger public health problem? - Face and family behind numbers

5 Features of developed vs. developing countries Developing Developed Birthrate High Low Income Low Moderate high Literacy Mid level High Safety priority Low Medium - High Political stability Low High Diversity (cultural) Wide mixed Narrow Diversity (social) Wide Integrated

6 Total Area 3,287,240 Sq km No of States 28 U/T 7 Total Population 1,210,193,422 Males 623,724,248 Females 586,469,174 Density of Population India Profile 325 Per Square Km Sex Ratio 933 Per 1000 Literacy Rate 64.8 % (Rural 58.7 % Urban 79.9%) Birth Rate Per 1000 Death Rate 7.4 Per 1000 Infant Mortality Per 1000 No of Towns 7742 No of Villages

7 Fatal drowning rates per children by WHO region and country income level, World, 2004 Data refer to those under 20 years of age. HIC = High-income countries; LMIC = low-income and middle-income countries. Source: WHO (2008), Global Burden of Disease: 2004 update.

8 Rank Under 1 year 1 4 years 5 9 years years years Under 20 Lower respiratory Lower respiratory Lower respiratory 1 Perinatal causes Road traffic injuries Perinatal causes infections infections infections Lower respiratory 2 Diarrhoeal diseases Diarrhoeal diseases Road traffic injuries Road traffic injuries Self-inflicted injuries 3 Leading causes of death in children, both sexes, World, 2004 Lower respiratory infections Measles Malaria Drowning Violence 4 Malaria Malaria Diarrhoeal diseases Malaria Lower respiratory infections infections Diarrhoeal diseases Malaria 5 Congential anomalies HIV / AIDS Meningitis Meningitis Drowning Measles 6 Pertussis 7 HIV / AIDS Congenital anomalies Drowning HIV / AIDS Tuberculosis Protein-energy Protein-energy malnutrition malnutrition Congential anomalies Tuberculosis Fire-related burns HIV / AIDS 8 Tetanus Drowning Measles Diarrhoeal diseases HIV / AIDS Road traffic injuries 9 Meningitis Road traffic injuries Tuberculosis Protein-energy malnutrition Leukaemia Pertussis 10 Measles Meningitis HIV / AIDS Self-inflicted injuries Meningitis Meningitis 11 Protein-energy malnutrition Fire-related burns Fire-related burns Leukaemia Maternal haemorrhage Drowning 12 Syphilis Pertussis Falls Fire-related burns Falls 13 Endocrine disorders Tuberculosis 14 Tuberculosis Upper respiratory infections Congenital anomalies Protein-energy malnutrition War Poisoning Tetanus Epilepsy Violence Abortion Tuberculosis Upper respiratory 15 Syphilis Leukaemia Trypanosomiasis Epilepsy Fire-related burns infections Source: WHO (2008), Global Burden of Disease: 2004 update.

9 Distribution of global child injury deaths by cause, 0-17 years, World, 2004 Other intentional injuries; 31,1% Road traffic injuries; 22,3% War; 2,3% Drowning; 16,8% Self-inflicted injuries; 4,4% Homicide; 5,8% Poisoning; 3,9% Falls; 4,2% Fire-related burns; 9,1%

10 Fatal injury rates per children aged 0 17 years in five Asian countries Source: WHO (2008), Global Burden of Disease: 2004 update.

11 Fatal drowning rates per children by age and country income level, World, 2004 HIC = High-income countries; LMIC = low-income and middle-income countries. Source: WHO (2008), Global Burden of Disease: 2004 update.

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16 17 drown during religious festival in India. Friday, 20 September 2013, 14:30

17 Natural disasters Recent Uttarakand tragedy that resulted in death of more than 25,000 people

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19 Percentage Share of Various Causes of Accidental Deaths during 2012 (Natural and Un-Natural Causes) By Electrocution; 2,2 By Other Un-Natural Causes; 10,5 By Falls; 3,1 By Causes Not Known; 5,5 By Natural Causes; 5,8 By Road Accident; 35,2 By Sudden Deaths; 7,3 By Fire; 5,9 By Drowning; 7,0 By Poisoning; 7,8 By Rail-Road & Other Railway Accident; 7,4

20 Injury deaths in India Homicides, 32369, 7% Causes Not Known, 17534, 4% Other Causes, 43464, 9% Dowry deaths, 8383, 2% Suicides, , 27% Drowning, 25911, 5% Electrocution, 8539, 2% Fall, 10622, 2% Fire, 23268, 5% Poisoning, 26634, 6% Traffic Accidents, , 31%

21 Distribution of Drowning deaths by Un-natural Causes 10 States (All India)

22 Distribution of Drowning deaths by Un-natural Causes 10 Cities -2012

23 Drowning deaths by Un-natural Causes (All India)

24 Fatal injuries among children less than 14 years in India, 2010 (% ) 5,0 4,0 4,0 4,0 3,0 2,0 31,0 Road accidents Drowning Suicides Other causes Burns. 9,0 Snake bite / Animal bite Causes not known Fall Poisoning 10,0 Other traffic accidents Collapse of structure 12,0 17,0

25 Age and Sex wise distribution of Drowning deaths by Un-natural Causes-2012 (All India) Male Female

26 Million Death study More in rural areas and among males 73,000 deaths 11 % of total deaths Third leading cause among unintentional injuries National Mortality rate 6.4 / 1,00,000 popn Male : female 2 : 1 Significant regional variations

27 Fatal injuries among children < 18 years of age 11% Urban 4% 36% 8% 9% 11% 11% 19% Rural 17% 24% 8% 9% 27% 13% 1% 9% RTIs Burns Hanging Fall Poisoning Drowning Others

28 Young age as a risk factor In India, nearly 19% of child (<14 y) injury deaths are due to drowning (NCRB, 2012) Drowning accounted for nearly 25,000 deaths in <5 y olds in 2005 (Jagnoor et al) Jagnoor J, Bassani DG, Keay L, et al; Million Death Study Collaborators. Unintentional injury deaths among children younger than 5 years of age in India: a nationally representative study. Inj Prev. 2011;17:151 5.

29 Gender as a risk factor In India, male to female ratio of drowning is 2.3:1 (NCRB, 2012) Drowning more common among boys (Jagnoor et al) Jagnoor J, Bassani DG, Keay L, et al; Million Death Study Collaborators. Unintentional injury deaths among children younger than 5 years of age in India: a nationally representative study. Inj Prev. 2011;17:151 5.

30 Place and drowning estimates from India Drowning, leading cause of death in rural areas (27%) for children <18 y (BRISPP) Drowning 3 times higher in rural areas (110 /1,00,000 live births), frequent in north eastern parts and during April September Gururaj G, Bangalore Injury surveillance collaborators group. Bangalore road safety and injury prevention program: Results and learning, National Institute of Mental Health and Neuro Sciences, Publication No. 81, Bangalore, India; Jagnoor J, Bassani DG, Keay L, et al; Million Death Study Collaborators. Unintentional injury deaths among children younger than 5 years of age in India: a nationally representative study. Inj Prev. 2011;17:151 5.

31 Risk factors for drowning Increased access to water Unprotected watery bodies Individuals with occupations such as fishing or transport Children living near open water sources -ditches, ponds, irrigation channels, or pools Economic factors Tourism / Natural disasters cyclones and floods Unsupervised children Recreational activities Medical co morbid conditions ( epilepsy) Consumption of alcohol and drugs Absence of safety skills

32 Impact of drowning Health impact Social impact Psychological Economic direct, indirect Legal Health sector bears the brunt of drowning to the maximum Unmeasured pain and suffering

33 Drowning deaths can be reduced A rapid and significant reduction in drowning deaths and injuries can be achieved with political will and commitment. Requires a scientific approach: the provision, careful analysis and interpretation of good data; the setting-up of targets and plans; the creation of national and regional research capacity; institutional cooperation across sectors.

34 Some ongoing initiatives Water transport policy Disaster preparedness First responder care in some places Small initiatives in cities for teaching children to swim Information in recreational places Preparedness during festival times Problem is huge and efforts are little

35 The public health approach to injury prevention 1. Surveillance What is the problem? 2. Risk factor Identification What are the causes? 4. Implementation How is it done? 3. Development and evaluation of interventions What works? Source: WHO (2008), Global Burden of Disease: 2004 update.

36 Effective Promising Insufficient evidence Ineffective Potentially harmful Evidence for key strategies to prevent drowning among children Strategy Removing (or covering) water hazards Requiring isolation fencing (4-sided) around swimming pools Wearing personal flotation devices Ensuring immediate resuscitation Ensuring the presence of lifeguards at swimming areas Conducting targeted awareness-raising on drowning Teaching children older than 5 years to swim Introducing laws on pool fencing Introducing a law on the use of personal flotation devices Promoting drowning prevention through doctors Restricting access to areas unsafe for swimming Teaching children younger than 5 years to swim Introducing laws on blood alcohol content for swimmers Conducting prevention campaigns, such as on advertising drowning hoardings, for Promoting solar pool covers Using baby bath seats

37 For India.. Limiting access to open watery bodies Increased supervision of young children Safer transportation methods Fencing pools and covering wells Teaching swimming skills from young age Increasing public awareness Better disaster management mechanisms Timely care Strengthening research