Are fatal and non-fatal drownings associated with poor water, sanitation and hygiene facilities?

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Inadequate water, hygiene and sanitation (WASH) facilities, such as lack of access to toilets and piped water, have been shown to expose populations to a myriad of health risks. But what do we know about the relationship between WASH factors and drowning? Drowning kills over 300,000 people each year, and 90% of these occur in low and middle income countries. Many more people experience non-fatal drowning events, often experiencing long term disability as a result. Children aged 1-9 years old are the most affected by drowning.

Figure 1: WASH factors associated with higher rates of drowning

The Royal National Lifeboat Institution (RNLI) partnered with The Centre for Injury Prevention and Research Bangladesh (CIPRB), and The George Institute for Global Health (TGI) to run a study with 89,700 households in Bangladesh to understand how both fatal and non-fatal drowning events may be associated with factors such as lack of toilet facilities at home, the used of shared water sources and the use of surface water. As Dan Ryan, International Research Manager at RNLI, explains, “In Bangladesh, many people in rural communities have to navigate the hazards of open water sources to meet their daily needs” which may increase their risk of drowning.

This study was the first to explore how WASH factors may be associated with the risk of drowning, and found some interesting results (see Figure 1). Non-fatal drowning events were more likely in households with shared toilet facilities, lack of toilet facilities, and the use of shared and surface water sources. Fatal drowning events were also more likely in households using shared water sources for washing and bathing. These findings suggest that improving access to adequate WASH facilities may reduce exposure to drowning hazards.

According to Dr Jagnoor Jagnoor, Senior Research Fellow at TGI, understanding how WASH factors may contribute to drowning is crucial to the “joint achievement of Sustainable Development Goal (SDG) 3, which aims to reduce under-5 child mortality, and SDG 6, which aims to ensure the availability and sustainability of sanitation for all.” Meeting these goals will require multi- and inter-sectoral action that covers the economic, environmental and social pillars of global development with a strong focus on equity.” Drowning will be reduced not only through health systems solutions, but also solutions from other sectors such as community infrastructure and education.

These results will provide guidance for the implementation of WASH facility improvement programs with the aim of reducing drowning rates in high-risk regions. Dan Ryan stated the “the RNLI plans to use this evidence and the experience gained through our programmes to begin a conversation about how WASH improvements can include drowning prevention in Bangladesh and beyond.”

This study – "The association between water, sanitation and hygiene (WASH) conditions and drowning in Bangladesh" – is available fully Open Access from the Journal of Water & Health.

Download it for free here: https://doi.org/10.2166/wh.2018.243