Embed Size (px)
Citation preview
1
Child drowning in Thailand
Ratana Somrongthong, PhD
College of Public Health Sciences,
Chulalongkorn University, [email protected]
Outlines
• Introduction
• Objectives
• Methodology
• Results
• Conclusions & Recommendations
2
3
•Population: 63.7 millions*
•Children Under 15 yrs
: 20 % of total population
•Children Under 18 yrs
: 25 % of total population
•Population density: 125 people per km2
•Arrangement: 77 provinces
•Religion: 95% Buddhism
•GDP per capita: 2,645 U$ (2008)
Thailand
Introduction
*MoPH ,2009
Introduction
• The Thai National Injury Survey
was the largest community-
based survey on child mortality
and morbidity ever conducted
in Thailand.
• The survey was conducted by
College of Public Health
Sciences, Chulalongkorn
University and TASC in
collaboration with UNICEF and
MoPH
3
Objectives
• to understand the burden of
injury as compared to other
causes of mortality and
morbidity
• to understand the
epidemiology and risk
factors for injury and to
enable development of interventions
Methodology
The methodology
employed in this study
is the same as the
methodology developed
by TASC for other
national surveys
undertaken by UNICEF
/TASC and local
institution partners in Asia region.
4
7
Study design: A cross-sectional in 32 provinces out of 76 provinces
Provinces• North 7 :18•Northeast 8 :19•Central 9 :24•South 7 :14•Bangkok 1
Defining sampling frame• Overall Mortality Rate of the Sample is 5.1/1000
( year 2003), therefore 60,000 households to capture 3000 deaths at 5/1000
• National Statistic Office (NSO) provided a frame which include 20 to 76 provinces, we add 12 provinces which have sentinel surveillance for injury ( total = 32 provinces)
• Health profile of 389, 531 people was assessed
(100,179 households )
• Cause of death: medical certificate or verbal autopsy.
5
Data collection
• The trained interviewers asked
primary respondents all morbidity
and mortality events that
occurred to members of the
household.
• The respondent was asked to
recall:
– all mortality events in the last 1, 2
and 3 years (verbal autopsy)
– all morbidity events in the last 1, 3,
6 and 12 months
Data collection
• The total sample size = 100,179 households (HHs)
from rural areas = 61,464 HHs
from non-slum municipal areas = 35,706 HHs
from slum areas in Bangkok = 3,009 HHs
• The survey covered 389,531 individuals within these
households including 98,904 children between the ages of
0 and 17.
• Respondent: mother/ caretaker of child
6
Results
12
Proportional mortality by age
Source: Child Injury in Thailand
7
13
Source: Child Injury in Thailand
Leading causes of deaths in children age 1 - 17
0%
10%
20%
30%
40%
50%
60%
70%
80%
- - - -
Figure 6: Proportion of all child mortality due to drowning and RTA by age group
Drowning RTA
8
Leading causes of deaths in children 1 - 4 yrs.
Leading causes of deaths in children 5-9
9
Leading causes of deaths in children 10-14
Drowning rates by age
0
51015202530354045
0-1 1-4 5-9 10-14 15-17 1-17
Rate
per
100
,00
0
10
Drowning rates by age and sex
010
2030
4050
60
1-4 5-9 10-14 1-17
Ra
te p
er
100,
000
Male Female
20
Leading causes of death in children aged 1-17 by place of residence
Source: Child Injury in ThailandUTD: Unable to determine
11
Drowning rates by age and place of resident
0
10
20
30
40
50
60
1-4 5-9 10-14 1-17
Rate
per
100
000
Urban Rural
22
Places children drown
12
23
Estimated numbers of child deaths from injury in Thailand
Fatal injury Per year Time between each death
Drowning 2,645 3.3 Hours
RTA 2,605 3.4 Hours
Suffocation 450 1.2 Days
Animal 280 1.3 Days
Homicide 160 2.3 Days
Fall 85 4.2 Days
Suicide 70 5.2 Days
Burn 45 8.5 Days
Electrocution 45 8.5 Days
13
14
15
0%
20%
40%
60%
80%
100%
- - - -
Activity of mother/caregiver at time of child drowning
Sick at home Gambling Unknown
Looking after another child Accomanying the child Working outside home
Sleeping Gossiping Household chores
16
Drowning rate versus swimming ability
0
10
20
30
40
50
60
70
80
90
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
0%
5%
10%
15%
20%
25%
30%
35%
40%
Age in years
Dro
wnin
g r
ate
per
100,0
00
Perc
enta
ge o
f child
ren w
ho c
an s
wim
Source: Sitthi-amorn et al, 2006
0
68
19
2
10
0
4
8
12
16
20
Imm. Fatal Sub. Fatal Non-fatal
Dro
wn
ing inju
ries
Figure 5.29: Drownings in the Thailand National Injury Survey; whether immediately fatal, subsequently fatal and whether they were reported to a hospital
Not treated at hospital
Treated at hospital
Drowning in the TNIS: whether immediately fatal, subsequently fatal and whether they were reported to a hospital (n= 27 )
17
Conclusions
• There is a previously unrecognized
epidemic of child injury in Thailand
• Injury is a leading killer of children after
infancy ( 1-17 )
• Drowning was the single leading cause of
death in children after infancy.
• Over 2,600 children drown in Thailand
annually.
• Most drowning occurs in rural areas ,
during the day when mother are busy
with housework/other chores
Conclusions (cont.)
• Almost three quarters (74%) occur within 100
meters of the home and almost 40% occur within
10 meters of the home.
• Most drowning occurs in bodies of water not
connected with the household.
• Wells are the leading cause of drowning deaths
in toddlers, while rivers are the leading cause in
the 5–9 age group (72%) and in children
generally (1 to 17, 35%).
• Most (85%) of children over the age of four who die from drowning do not know how to swim.
18
Recommendations
• Effective Community –Based surveillance system is
needed
• Given the majority of drowning occurs in early childhood,
interventions will need to focus on:
• increasing child supervision
• isolating very young children from water hazards.
• for the older children, interventions should focus
on providing them with swimming and water safety skills.
THANK YOU
