Vulnerability to fatal drowning among the population in Southern Bangladesh: findings from a cross-sectional household survey

Objectives This study aimed to determine the fatal drowning burden and associated risk factors in Southern Bangladesh. Settings The survey was conducted in 39 subdistricts of all 6 districts of the Barisal division, Southern Bangladesh. Participants All residents (for a minimum 6 months prior to survey) of the Barisal division, Southern Bangladesh. Intervention/methods A cross-sectional, divisionally representative household survey was conducted in all six districts of the Barisal division between September 2016 and February 2017, covering a population of 386016. Data were collected by face-to-face interview with adult respondents using handheld electronic tablets. International Classification of Diseases (ICD)-v. 10 (ICD-10) Chapter XX: External causes of morbidity and mortality codes for drowning, W65-W74, X36-X39, V90, V92, X71 or X92, were used as the operational definition of a drowning event. Results The overall fatal drowning rate in Barisal was 37.9/100000 population per year (95%CI 31.8 to 43.9). The highest fatal drowning rate was observed among children aged 1-4 years (262.2/100000/year). Mortality rates among males (48.2/100000/year) exceeded that for females (27.9/100000/year). A higher rate of fatal drowning was found in rural (38.9/100000/year) compared with urban areas (29.3/100000/year). The results of the multivariable logistic regression identified that the factors significantly associated with fatal drowning were being male (OR 1.7, 95%CI 1.2 to 2.3), aged 1-4 years (OR 3.0, 95%CI 1.4 to 6.4) and residing in a household with four or more children (four or more children OR 1.8, 95%CI 1.1 to 2.9; and five or more children OR 2.1, 95%CI 1.2 to 3.7). Conclusion Drowning is a public health problem, especially for children, in the Barisal division of Southern Bangladesh. Male gender, children 1-4 years of age and residing in a household with four or more children were associated with increased risk of fatal drowning events. The Barisal division demands urgent interventions targeted at high-risk groups identified in the survey.