The International Drowning Research Centre Bangladesh (IDRC-B) has been established to conduct research to develop effective sustainable drowning interventions that are appropriate for Bangladesh and countries with similar social cultural and risk environments. It is part of the Centre for Injury Prevention and Research Bangla¬desh (CIPRB). It is an initiative of Royal Life saving Society Australia and The Alliance for safe Children.
CIPRB is a full member of the International Life Saving Federation, and is currently in the process of applying for membership to the Royal Life Saving Society Commonwealth which will lead to greater collaboration with other Commonwealth Countries. We look forward to working with colleagues around the world in developing a global drowning prevention strategy.
Feasibility and scalability of portable swimming pools for survival swim training
Studies done across Asia by TASC, UNICEF and local partners have shown drowning is the leading cause of child mortality after infancy. The Bangladesh Health and Injury Survey showed that Bangladesh has the highest child drowning rate among countries surveyed.
As a result, CIPRB worked with RLSSA, BSF and TASC to develop a survival swimming curricula called SwimSafe. SwimSafe was designed to be suitable for use in rural Bangladesh where the primary water body for swim learning was the pond.
Between 2006 and 2011, the SwimSafe program safely taught over 134,000 children survival swimming. That cohort of children has provided evidence that SwimSafe is protective against drowning in daily life.
A “back of the envelope” estimate shows that cover¬age rates of 75% for SwimSafe in children 5-17 years old would result in rapid reduction of the child drowning rate. However, in Bangladesh, this means approximately 34 million children need to be covered by SwimSafe. Scaling from 50,000 children to 34 million is an almost 700 fold expansion of the program.
The three years of experience with pond-based teaching has identified a number of issues that will pose major problems for scaling up the program using only ponds.
First, the ponds have a relatively low throughput when used to train children in survival swimming. While suit¬able for training one year’s birth cohort of children in most rural villages, extending survival swimming cover¬age to at least 75% of all children 5-17 is not achievable using the ponds for a number of reasons:
Ponds dry up in the summer, the water level fluctuates in monsoon season and the water is too cold in the winter period for children to enter, As a result, most ponds can only be used a maximum of 5 months a year.
Many villages are unable to dedicate a large pond for exclusive use in swim training. Village economics require dual use of large ponds and this usually is aquaculture, which results in fluctuating water quality. This limits use for swim teaching, due to fluctuating water quality, par¬ticularly when ponds begin to dry up.
The cheapest and most available material for the swim platform construction is bamboo, but this requires con¬stant maintenance and refurbishment, which can inter¬rupt the swim teaching schedule.Ponds are only present in rural areas and are not avail¬able in urban areas. Even in rural areas, many villages lack suitable ponds for swimming teaching.
Therefore, it is necessary to explore the use of other water bodies as solutions to these problems. SwimSafe is a regional program and is being implement¬ed in Thailand and Bangladesh. In these countries, TASC and RLSSA have been introducing portable pools to test the reliability, acceptability and utility of such a water body for survival swim training. Now in the second year of use, the portable pools in Thailand and Vietnam have already shown a number of potential benefits.
The portable pool configuration used is 12 meters long, 5 meters wide and 1 meter deep. It uses a thick, rein¬forced plastic liner that is mounted on a metal frame and holds 60 cubic meters of water. The pool uses chlorine and a san is transportable and can be installed in a permanent installation as well as trans¬ported between venues. The two year experience with the pools has shown that the advantages of a portable pool are:
•Good water quality at all times and able to be main¬tained regardless of numbers of children using the pool.
•Optimum water level all the time which can be lowered or raised depending on height of children being taught, which contributes to both safety as well as teaching efficiency.
•Are well-suited for use in urban areas. Once filled initially, the filtration system keeps the water clean without having to add additional water other than to replace evaporative losses. This is helpful from a cost basis as potable water used to fill the pools can be costly, as well as it solves potential discharge and run-off issues in urban areas.
d filtration system powered by a pump to main¬tain high water quality. The pool
• The pools are transportable and potentially can be used in a “round-robin” training fashion, rotated among sites if needed. The three year experience has shown the basic durability of the pools. While the initial cost of the pool is several thousand dollars, it is very little in comparison to actually digging and installing a perma¬nent pool. Additionally, if the pools last the expected 5 years, the costs are very low when amortized over a five year training period.
• Theoretically, using the pools provides a safer train¬ing experience, as the water is never deeper than chest high, even for very young children. Any child in trouble can simply stand up. Since the pools are only 5 meters wide, any child in trouble is within easy arm’s reach from anyone standing at the side of the pool.
Considering the advantages IDRC-B started operational research to test the feasibility and scalability of portable swimming pools for survival swimming in Bangladesh. This study will test the reliability, acceptability and utility of the portable swimming pool as a potential solution to reduce drowning in urban and rural areas Bangladesh
Impact of SwimSafe on risk taking behaviors
IDRC-B is conducting a series of surveys in Raiganj and Dhaka to explore the risk taking behavior of SwimSafe graduates - who have learnt survival swimming and water safety skills - and comparing their water exposure with that of children who have learnt naturally from their peers or relatives.
The first survey was conducted in July –August in 2010 on children who live in the rural areas of Raiganj, Sherpur and Manohardi. The survey conducted in March-April 2011 included the children who had learnt swimming through the SwimSafe programme in Mirpur in Dhaka city. The second survey also included the parent’s percep¬tion on their children risk taking behavior which was ab¬sent in the first survey. The survey was conducted on 7500 children and their parents in Raiganj and urban Mirpur of Dhaka
Twelve data collectors and three supervisors were recruit¬ed to conduct the study in February, 2011. In preparation, a training manual was developed to provide the data col¬lectors with tools and information they needed to conduct the survey. A two-day data collector training session was also organized for the data collectors in Raiganj on 18th March and 19th March 2011 held at CIPRB’s office in Raiganj to train the data collectors on how to conduct an interview, as well as providing them with a brief overview of the research project. The researchers and Program Coordinator trained the data collector. A similar training session was also organized for the urban data collectors on March 2011.
The data collectors started collecting the data from the end of March to April. Data entry was started from the start of April and finished by the end of April in 2011. The data cleaning and initial analysis has been performed and report writing is under way.
The third and the final round of surveys will be conducted during September 2011 and will use a cohort size of 7500 children.
Effectiveness of Anchal in facilitating early childhood development
Within the PRECISE Project of CIPRB, Anchals (Integrated child survival and development centres) were initially de¬signed to protect children from injuries including drown¬ing by giving direct supervision by a trained care-taker. During implementation an early childhood development (ECD) component was also included, focusing on the so¬cial, emotional, cognitive, and physical growth of young children.
An Anchal is established within a local community, using available facilities. It uses an existing household within a cluster of 40-60 houses, preferably, centrally placed in that cluster which has suitable space for 20-25 children. The place is cleaned and decorated, with all physical haz-ards removed from the areas accessible to small children. In the PRECISE project Anchal children of 18 months to 5 years are kept under supervision for four hours (9 a.m. to 1 p.m.) a day and six days a week.
The current study is intended to ascertain the most ap¬propriate timing of Anchal to maximize the benefit of ensuring safety and to make it most cost-effective for drowning prevention. The current time of 9am-1pm has been shown to be effective and covers the period of time where almost 2/3rds of drowning normally occurs. The purpose of the research is to investigate if other anchal times were more suitable for mothers (same 4 hours but different starting times) and if this would cover a larger part of the peak drowning hours from the baseline research. Additionally, the shorter 2 hour period is being investigated to see whether a shorter period (2 hours) would be more cost-effective than the 4 hour operational period in terms of cost per child drowning prevented. Given the need to expand Anchals throughout rural Bangladesh, it is important to understand cost consid¬erations of a national scale up and investigate whether shorter duration of the anchal might be one strategy for scale-up.
Under this study 150 Anchals have been developed and monitored in three different unions of Raiganj. In each union there are 50 anchals. Different open¬ing and closing hours for the Anchals are being trialed in each union. Each anchal operates 6 days in a week except Friday. In Bromogacha union the time of operation is from 9am to 1pm (4 hours a day), in Chandaikona it is between 10am and 2pm (4 hours a day) and in Dhangora the timing is 10am to 12pm ( 2 hours a day).
IDRC-B recruited 300 Anchal Mas and Anchal As-sistants and 3 supervisors and one monitoring officer in March 2011. The Anchals include a developmen-tal programme that use a wide variety of activities designed to teach and practice developmental skills for the children. Each month a parents meeting is organized in each Anchal that gives an opportunity for the parents to discuss various issues in safety, development, and other social issues. This gives the parents an opportunity to become more knowledge-able in child injury prevention and may also increase their status in society.
Model centre development in Raiganj
IDRC-B established a model centre for the systematic study of drowning interventions in rural villages that will provide objective evidence on acceptability by the community, effectiveness in drowning prevention and sustainability over time. The centre includes a model An¬chal and two types of swimming pools - modified pond and portable pool and a training venue. The develop-ment is currently in progress. Land was leased in Raiganj of Sirajganj for developing the model centre since 1 April 2010.
The first initiative of the model centre was leasing the land and building the model Anchal in Decem¬ber 2010. The model Anchal is different from other anchals in terms of size of the house, decoration and facilities. This Anchal will act as a model training centre to support expansion of the anchals in future scale-up activities.
The model centre is a completely equipped venue for training Anchal mothers and community swimming instructors. Part of the research is to look at develop¬ing more effective ways to train them.