Childhood drowning in Matlab, Bangladesh: An in-depth exploration of community perceptions and practices Lauren S. Blum a, * , Rasheda Khan a , Adnan A. Hyder b , Sabina Shahanaj a , Shams El Arifeen a , Abdullah Baqui b a International Center for Diarrheal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh b Johns Hopkins Bloomberg School of Public Health, Baltimore, MD article info Article history: Available online xxx Keywords: Drowning prevention Explanatory models Child health Bangladesh abstract While reductions in infectious disease have resulted in impressive declines in child mortality in Bangladesh, drowning is becoming proportionately more important as a major cause of death, accounting for at least 19% of deaths of children between 1 and 4 years of age in trend analysis since 2000. Little is known about indigenous beliefs and behaviors associated with drowning, which may be critical to pre- venting child-related drowning deaths. Qualitative research was carried out over 13 months in Matlab, Bangladesh to describe the indigenous explanatory model of drowning and to identify behavioral factors increasing the risk for drowning deaths. Methods included cognitive mapping procedures as well as open- ended interviews with families who had lost a child or experienced a near-death due to drowning and families with at least one child under 5 years living near a body of water. Along with diarrhea, fever, and pneumonia, drowning is perceived as a leading cause of child death. Causal explanations are primarily associated with ‘‘evil spirits’’ believed to entice young children to water or bewitch mothers so that they forget about the child. Another primary interpretation relates to a water goddess known to prey on small children. When a young child is discovered in water, parents refrain from rescuing the child due to a belief that if a parent touches a drowning child, the child will die. After the child is removed from the water, traditional practices that have no known benefit are employed. The research identified locally constructed beliefs and practices such as refraining from touching the child that may increase the incidence of drowning deaths. Future efforts are required to address these beliefs and assess the feasibility, cultural acceptability and effectiveness of strategies designed to prevent drowning. Ó 2009 Elsevier Ltd. All rights reserved. Introduction The Global Burden of Disease study provided information for the first time about the impact of drowning worldwide (Murray & Lopez, 1997). In the 0–4 age group, drowning was the 11th leading cause of mortality resulting in more than 125 thousand deaths annually and the 13th leading cause of burden of disease in terms of disability adjusted life years (DALY) lost. Global data for 2000–2001 indicate that approximately half a million people drown worldwide with more than 97% of such deaths occurring in low- and middle- income countries (Peden & McGee, 2003). This accounts for nearly 10% of deaths, making drowning the third leading cause of mortality for ages 5–14 years. Drowning has been reported as a major health problem in southeast Asian countries including Thailand, Vietnam, the Philippines, Malaysia and China (Arokiasamy & Krishnan, 1994; Consunji & Hyder, 2004; Faridah & Khairani, 2003; Huong, Minh, & Byass, 2003; Kozik et al., 1999; WHO, 2006). In Bangladesh, where reductions in deaths from infectious disease have led to impressive declines in mortality rates of children under five years of age, injuries, particularly drowning, have become proportionately greater (NIPORT, Mitra and Associates, & ORC Macro, 2005). A national survey showed that drowning is responsible for 20% of deaths in children 1–4 years between 1992 and 1996 (Baqui et al., 2001). More recent national level data suggest that drowning accounts for between 19% and 26% of mortality among children 1–4 years of age (NIPORT, Mitra and Associates, & ORC Macro, 2005; Rahman, Rahman, Shafinaz, & Linnan, 2005). Drowning was almost exclusively a problem in rural areas where the majority of the population lives. The Matlab Health and Demographic Surveillance System maintained by the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) has provided information on trends in drowning deaths for over 40 years (see Fig. 1). Though population-based mortality rates due to drowning have remained * Corresponding author. E-mail address: laurensblum@yahoo.com (L.S. Blum). Contents lists available at ScienceDirect Social Science & Medicine journal homepage: www.elsevier.com/locate/socscimed ARTICLE IN PRESS 0277-9536/$ – see front matter Ó 2009 Elsevier Ltd. All rights reserved. doi:10.1016/j.socscimed.2009.01.020 Social Science & Medicine xxx (2009) 1–8 Please cite this article in press as: Blum, L.S., et al., Childhood drowning in Matlab, Bangladesh: An in-depth exploration of community perceptions and practices, Social Science & Medicine (2009), doi:10.1016/j.socscimed.2009.01.020