Situation of Child Drowning in Thailand, 1.39Mb

(1)

(2)

SITUATION OF CHILD DROWNING IN THAILAND

First printing:

October 2014

Number of pages:

18

Advisor:

Dr. Panuwat Panket

Editors:

Mrs. Suchada Gerdmongkolgan

Ms. Som Ekchaloemkiet

Cover design:

Ms.Thitima Khuntasin

Copyright:

Bureau of Non-Communicable Diseases, Department of Disease Control, Ministry of Public

Health, Thailand

(3)

List of Tables

Page

Table 1: Numbers and rates of child drowning deaths (per 100,000 children

<15 years) in Thailand, 2004–2013

5

Table 2: Numbers and rates of child drowning deaths (per 100,000 children

<15 years) in Thailand by gender, 2004–2013

7

Table 3: Numbers and rates of drowning deaths in children <15 years and

all age groups (per 100,000 children <15 years) in Thailand

by age group, 2004–2013

8

Table 4: Case-fatality rates for severe drowning injuries* in children

<15 years in Thailand, 2004–2013

10

Table 5: Numbers of drowning deaths in children <15 years in Thailand

by month, 2004–2013

11

Table 6: Percentage of severe drowning injuries* in children <15 years

by day of the week, 2004–2013

12

by time period of the day, 2004–2013

13

by type of water source, 2013

14

by type of incident site, 2013

15

Table 10: Percentage of severe alcohol-related drowning injuries*

in children <15 years by age group, 2013

16

Table 11: Numbers and percentage of severe drowning injuries* in children

<15 years in Thailand by type of transport to hospital for treatment,

2013

17

Table 12: Numbers and percentage of severe drowning injuries in children

<15 years in Thailand by place of death, 2013

(5)

List of Figures

Page

Figure 1: Numbers and rates of deaths per 100,000 population due to

the five leading causes of death in Thailand by age group, 2013

4

Figure 2: Numbers and rates of child drowning deaths (per 100,000 children

<15 years) in Thailand, 2004–2013

5

Figure 3: Child drowning deaths (<15 years) in Thailand by risk areas, 2013 6

<15 years) in Thailand by gender, 2004–2013

8

<15 years) in Thailand by age group, 2004–2013

9

Figure 6: Rates of drowning deaths in children <15 years and all age groups

(per 100,000 children <15 years) in Thailand by age group,

2004–2013

(6)

Summary

Summary of major points

There are 135,585 children under 15 years of age who die from drowning all over

the world each year, or about 372 children per day on average.

In the WHO South-East Asia Region, there are 32,744 drowning deaths each year

or 90 deaths per day on average.

In Thailand, the rate of child drowning deaths is 5 to 15 times higher than those

for developed countries.

Drowning is the number one cause of death among Thai children under 15 years

of age compared to fatalities due to all other causes including infectious and non-infectious diseases.

In Thailand, 1,243 children under 15 years of age die from drowning each year,

or about 4 children per day on average (10-year average).

The child drowning death rates per 100,000 children under 15 years of age between

1999 and 2008 ranged from 7.6 to 11.5.

Child drowning deaths had a steadily rising trend between 1999 and 2006 with

a downward trend afterwards.

The northeastern region has the highest rate of child drownings, followed by

the central, northern, and southern regions, respectively.

The rate of child drowning deaths for males is approximately 2 times higher than

that for females.

On average, children in the 0–4 age group ranked first for drowning deaths between

1999 and 2008, followed by the 5–9 age group; but since 2005, the 5–9 age group has ranked first.

The proportion of drowning deaths in children under 15 years of age is as high as

24.8% of drowning deaths in all age groups (2013).

The case-fatality rate for child drownings ranged from 31.2 to 47.7% (between

2004 and 2013)

April is the month with the highest number of drowning deaths, followed by

March, May and October. All these months are during school breaks.

Weekends (Saturdays and Sundays) have the highest incidents of severe drowning

injuries.

The time period of the day with the highest incidents of severe drowning injuries

(7)

As regards water sources where drownings occur, natural bodies of water rank first,

accounting for 49.4% of all drownings, followed by swimming pools and bathtubs at 6.9% and 4.6%,

respectively (2013).

Of the children under 15 years of age who suffered severe drowning injuries,

3.0% had alcohol consumption behavior.

58.2% of the children with severe drowning injuries admitted to hospital were rescued

and taken to hospital by their relatives or bystanders, followed by officials of emergency medical

(8)

Situation of Child Drowning in Thailand

Mortality

According to the analysis of death certificates collected at the MOPH’s Bureau of Policy

and Strategy between 2004 and 2013, drowning was the number one cause of death in Thai children

under 15 years of age, compared to other causes of mortality including infectious and non-infectious

diseases. The rate of drowning deaths ranged from 7.6 to 11.5 per 100,000 children under 15 years

of age, and the total number of drowning deaths was 1,243 cases per year or 4 cases per day

on average.

When categorizing the causes of injury-related mortality by age group in 2013,

it was found that the numer one cause of mortality in children under one year of age was accidental

threats to breathing (6.5 per 100,000 population). However, the number one cause of mortality

in the 1–4 and 5–9 age groups was drowning (10.1 and 9.30 per 100,000, respectively). As for

the children aged 10 years and older, the number one cause of mortality was road traffic injuries.

When considering the rates of deaths in all age groups, it was discovered that road traffic injuries

ranked first (22.9 per 100,000), followed by Intentional self-harm (6.1 per 100,000) and drowning

(5.7 per 100,000) (see Figure 1).

Trends in mortality

During the 10-year period from 2004 to 2013, drowning rates in children aged under

15 years steadily increased between 1999 and 2006, ranging from 7.7 to 11.5 per 100,000 children

under 15 years, before it began to decrease afterwards (see Table 1 and Figure 2).

Provinces

In 2013, the thirty-seven provinces had the highest rates of drowning deaths (7.5 per

100,000 children under 15 years) in children under 15 years of age. Follow by forty provinces

had rates of drowning deaths in children under 15 years less than 7.5 per 100,000 children under

(9)

Figure 1: Numbers and rates of deaths per 100,000 population due to the five leading causes

of death in Thailand by age group, 2013

Age Groups

Assault Intentional _self-harm Intentional _self-harm Intentional _self-harm Intentional _self-harm Falls Intentional _self-harm

(V01 - V89) (V01 - V89) (V01 - V89) (W65 - W74) (X85 - Y09) (X60 - X84) (X60 - X84) (X60 - X84) (X60 - X84) (W00 -

Assault Intentional

self-harm Assault Assault

Accidental

Assault Falls Intentional _self-harm Assault

(W00 -

Assault Intentional _self-harm

Exposure to

Note: 1)Causes of Injury Death Classified by ICD Mortality Tabulation List 1, 10 th Revision

2) Data Represent the Number and Rate per 100,000 Population.

Data source: Death certificates. Bureau of Policy and Strategy, Office of the Permanent Secretary, Ministry

of Public Health. Thailand.

Analyzed by: Injury Prevention Group, Bureau of Non-Communicable Diseases, Department of Disease Control,

(10)

Table 1: Numbers and rates of child drowning deaths (per 100,000 children <15 years) in Thailand,

2004–2013

Year Child drowning deaths

Number Rate

2004 1,471 10.7

2005 1,549 11.5

2006 1,482 11.1

2007 1,297 9.8

2008 1,229 9.4

2009 1,207 9.4

2010 1,138 8.8

2011 1,086 8.7

2012 1,049 8.4

2013 920 7.6

Ministry of Public Health, Thailand.

Figure 2: Numbers and rates of child drowning deaths (per 100,000 children <15 years) in Thailand,

2004–2013

0 200 400 600 800 1,000 1,200 1,400 1,600 1,800

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 0 2 4 6 8 10 12 14 number rate

Number

Rate

per

10

0,

0

00

(11)

Figure 3: Child drowning deaths (<15 years) in Thailand by risk areas, 2013

Note: The province is high risk areas: The rate of death from drowning of a child under 15 years in province is equal to or

more than 7.5 per 100,000 children under 15 years or the number of children died more than 20 people.

The province is moderate risk areas: The rate of death from drowning of a child under 15 years in province is 5-7.4 per 100,000 children under 15 years.

The province is less risk areas: The rate of death from drowning of a child under 15 years in province is less than 5 per 100,000 children under 15 years.

Rate >7.5 or number >20 Rate 5-7.4

(12)

Gender

According to the analysis of death certificates collected at the Bureau of Policy and

Strategy, between 2004 and 2013, the rate of fatal drownings for males was approximately 2 times

higher than that for females. The rate steadily increased from 1999 to 2006 before beginning to

decline in 2007, similar to the overall picture of drowning situations (see Table 2 and Figure 4).

Age

According to the analysis of death certificates collected at the Bureau of Policy and

Strategy, between 2005 and 2013, the mean rate of fatal drownings in children aged 5–9 years

was slightly higher than that for the 0–4 age group (see Table 3 and Figure 5).

When comparing the rates of drowning deaths in children under 15 years of age

to those in all age groups, it was found that the rates in children under 15 years (7.6–11.5 per

100,000 children under 15 years) were higher than those for all age groups (5.7 –7.5 per 100,000)

(see Figure 6).

Table 2: Numbers and rates of child drowning deaths (per 100,000 children <15 years) in Thailand

by gender, 2004–2013

Gender Year

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Male

Number 935 983 985 843 821 799 788 753 745 636

Rate 13.2 14.1 14.3 12.4 12.2 12.0 12.1 11.7 11.8 10.2

Female

Number 536 566 497 454 406 408 350 333 306 284

Rate 8.0 8.6 7.7 7.1 6.4 6.5 5.7 5.5 5.2 4.9

Total

Number 1,471 1,549 1,482 1,297 1,229 1,207 1,183 1,086 1,051 920

Rate 10.7 11.5 11.1 9.8 9.4 9.4 8.8 8.7 8.4 7.6

(13)

Figure 4: Numbers and rates of child drowning deaths (per 100,000 children <15 years) in Thailand

by gender, 2004–2013

0 2 4 6 8 10 12 14 16

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Mal e Fem ale

Table 3: Numbers and rates of drowning deaths in children <15 years and all age groups

(per 100,000 children <15 years) in Thailand by age group, 2004–2013

Year

Age group (years)

0–4 5–9 10–14 <15 All

Number Rate Number Rate Number Rate Number Rate Number Rate

2004 548 13.6 637 13.2 286 5.8 1,471 10.7 4,202 6.7

2005 528 13.2 704 15.1 317 6.5 1,549 11.5 4,458 7.2

2006 521 13.1 641 14.3 320 6.5 1,482 11.1 4,666 7.5

2007 473 11.9 512 11.9 312 6.3 1,297 9.8 4,098 6.5

2008 465 11.6 503 12.0 261 5.3 1,229 9.4 4,065 6.4

2009 407 10.2 499 12.2 301 6.3 1,207 9.4 4,093 6.4

2010 398 10.0 487 11.9 253 5.3 1,183 8.8 3,984 6.3

2011 367 9.4 483 11.9 236 5.2 1,086 8.7 4,220 6.6

2012 374 9.5 422 10.4 255 5.6 1,051 8.4 4,017 6.3

2013 324 8.4 376 9.3 220 5.3 920 7.6 3,712 5.7

Rate

per

10

0,

0

00

childre

n

(14)

Figure 5: Numbers and rates of child drowning deaths (per 100,000 children <15 years) in Thailand

by age group, 2004–2013

0 2 4 6 8 10 12 14 16

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 0-4 Years 5-9 Years 10-14 Years

Figure 6: Rates of drowning deaths in children <15 years and all age groups (per 100,000 children

<15 years) in Thailand by age group, 2004–2013

0 2 4 6 8 10 12 14 16

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 0-14 Years All

Rate

per

10

0,

0

childre

n

Rate

per

10

0,

0

00

pop

u

lation

(15)

Case-fatality rate

According to the data regarding severe injuries collected at the Injury Surveillance

System (IS), Bureau of Epidemiology, Department of Disease Control, between 2004 and 2013,

the case-fatality rate for child drownings ranged from 31.2 to 47.7% (see Table 4).

Table 4: Case-fatality rates for severe drowning injuries* in children <15 years in Thailand,

2004–2013

Year Case-fatality rate (%)

2004 47.7

2005 42.4

2006 32.5

2007 40.6

2008 34.5

2009 36.8

2010 40.3

2011 35.8

2012 31.2

2013 37.2

* Severe injuries refer to injured individuals who die before arriving at hospital, injury patients who die in an emergency room, and injury patients who are admitted for observation and treatment at hospital.

Data source: Sentinel sites. National Injury Surveillance System, Bureau of Epidemiology, Department of Disease Control,

Ministry of Public Health.

Compiled and Analyzed by: Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health,

(16)

Time of drownings

Months

According to the data from the death certificates collected at the Bureau of Policy and

Strategy, when categorizing the drowning deaths among children under 15 years of age by month

of incident, it was found that, between 2004 and 2013, April had the highest number of drowning

deaths, followed by March, May, and October, respectively. (see Table 5).

Table 5: Numbers of drowning deaths in children <15 years in Thailand by month, 2004–2013

Month Year

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

January 83 72 111 88 86 62 65 62 76 62

February 104 112 135 77 71 114 100 84 91 60

March 193 161 140 135 151 134 124 115 116 99

April 210 210 158 136 157 175 184 128 130 108

May 156 175 142 132 148 100 112 160 114 87

June 125 116 101 87 95 103 79 89 89 81

July 105 106 89 72 83 79 63 73 58 53

August 111 73 107 91 80 63 74 67 52 63

September 97 110 109 121 84 95 65 69 79 89

October 121 154 173 144 105 133 105 89 99 112

November 115 150 138 108 117 88 101 102 76 65

December 51 110 79 106 52 61 66 48 71 41

Total 1,471 1,549 1,482 1,297 1,229 1,207 1,138 1,086 1,051 920

(17)

Day of incident

According to the data regarding severe drowning injuries collected at the Injury

Surveillance System (IS), Bureau of Epidemiology, Department of Disease Control, between

2004 and 2013, the day of the week with the largest number of drowning injuries was Saturday,

followed by Sunday (see Table 6).

Table 6: Percentage of severe drowning injuries* in children <15 years by day of the week,

2004–2013

Day Year

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Sunday 18.9 19.1 18.2 20.6 12.6 13.6 11.6 8.2 9.8 12.8

Monday 9.9 9.7 12.2 15.1 12.3 13.0 13.9 11.7 12.8 15.0

Tuesday 10.9 11.5 13.6 9.7 9.6 14.5 11.3 12.5 13.3 12.0

Wednesday 13.2 11.3 11.4 11.4 14.8 12.1 16.8 13.2 13.7 8.6

Thursday 13.3 12.4 8.9 13.2 10.7 13.3 12.9 15.6 19.2 12.0

Friday 14.9 16.4 13.4 11.4 18.4 14.8 13.9 18.3 14.5 22.7

Saturday 18.9 19.6 22.3 18.6 21.6 19.0 19.7 20.6 16.7 17.1

Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

(18)

Time of incident

System (IS), Bureau of Epidemiology, Department of Disease Control, between 2004 and 2013,

the time of the day with the largest number drowning injuries was between 15:00 and 17:59 hrs,

followed the period of time between 12:00 noon and 14:59 hrs (see Table 7).

Table 7: Percentage of severe drowning injuries* in children <15 years by time period of the day,

2004–2013

Time period Year

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

00:00–02:59 2.5 1.1 2.3 3.5 3.7 0.6 0.7 0.4 2.2 0.0

03:00–05:59 0.0 0.0 0.3 0.0 0.0 0.0 0.0 0.4 0.0 0.4

06:00–08:59 3.9 5.0 4.4 2.7 6.7 4.6 3.7 5.2 3.9 3.9

09:00–11:59 17.6 18.9 16.8 21.8 18.5 23.1 17.6 17.5 16.9 21.2

12:00–14:59 28.8 25.1 30.2 27.4 25.0 25.9 25.9 23.5 26.4 24.8

15:00–17:59 36.3 41.2 38.2 34.5 36.2 38.2 39.5 45.0 40.7 38.3

18:00–20:59 10.3 8.4 7.5 9.2 8.4 7.1 12.0 7.6 9.5 11.2

21:00–23:59 0.6 0.3 0.3 0.9 1.4 0.6 0.7 0.4 0.4 0.4

Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

(19)

Location of drowning injuries

Water sources

Surveillance System (IS), Bureau of Epidemiology, Department of Disease Control, 2013, the sites

where drowning deaths most frequently occurred were natural bodies of water, accounting for

49.4% of all drownings, followed by swimming pools and bathtubs at 6.9% and 4.6%, respectively.

In addition, the sites of drowning injuiries most frequently occurred were natural bodies of water

(42.3%), followed by bathtubs (6.4%), and swimming pools (5.2%) (see Table 8).

Table 8: Percentage of severe drowning injuries* in children <15 years by type of water source,

2013

Water source

(categorized according to ICD-10)**

Mortality Morbidity

Percent Percent

Accidental drowning and submersion while in a bathtub (W65) 4.6 5.1

Accidental drowning and submersion following fall into a bathtub (W66) 0.0 1.3

Accidental drowning and submersion while in a swimming pool (W67) 4.6 3.9

Accidental drowning and submersion following fall into a swimming pool (W68) 2.3 1.3

Accidental drowning and submersion while in natural water (W69) 44.8 38.0

Accidental drowning and submersion following fall into natural water (W70) 4.6 4.3

Other specified drowning and submersion (W73) 17.2 16.7

Unspecified drowning and submersion (W74) 21.8 29.5

Total 100.0 100.0

** International Standard Classification of Disease and Related Health Problem: ICD 10 refers to the international standard diagnostic classification of diseases and health problems that are the causes of morbidity and mortality.

(20)

Site of drowning injuries

Surveillance System (IS), Bureau of Epidemiology, Department of Disease Control, 2013, the sites

where drowning injuries most frequently occurred were the houses or the compounds of the house

(38.5%), followed by paddy fields, farms, or gardens (13.3%) (see Table 9).

Table 9: Percentage of severe drowning injuries* in children <15 years by type of incident site,

2013

Site of incident 2013

Percent

Houses and compounds of the houses 38.5

Paddy fields, farms, gardens 13.3

Schools or hospitals 3.0

Public sports arenas 0.4

Places of trade and services 1.7

Construction sites or factories 1.3

Roads or highways 0.0

Dormitories, prisons, nurseries, or military barracks 0.0

Unspecified 41.9

Total 100.0

(21)

Risks of alcohol consumption

System (IS), Bureau of Epidemiology, Department of Disease Control, 2013, 0.5% of the drowning

victims in all age groups had drunk alcohol. When categorizing the children under 15 years who

drank alcohol and suffered drowning into different age groups, it was found that 3.0% were in

the 10–14 age group and 0% in other age group. (see Table 10).

Table 10: Percentage of severe alcohol-related drowning injuries* in children <15 years by

age group, 2013

Age group (years) Percentage of alcohol-related drownings

(2013)

0 - 4 0.0

5 - 9 0.0

10 - 14 3.0

All age groups 0.5

(22)

Accessibility to medical care

According to the individual inpatients database of the MOPH’s Bureau of Policy and

Strategy 2013, for the drowning children under 15 years of age, most of them (58.2%) were rescued

and taken to hospitals by their relatives/bystanders, followed by officials of emergency medical

service (EMS) units (39.3%) and officials of charity foundations (2.5%) (see Table 11).

According to the individual inpatients database of the MOPH’s Bureau of Policy and

Strategy between 2013, 58.6% of the children with severe drowning injuries died after being

admitted to hospital. Furthermore, 31.0% died before arriving at hospital, and 10.4% were pronounced

dead at the emergency room (see Table 12).

Table 11: Numbers and percentage of severe drowning injuries* in children <15 years in Thailand

by type of transport to hospital for treatment, 2013

Persons who took injured children

to hospital

2013

Number Percent

No one 0 0.00

Officials of EMS units 31 39.3

Officials of charity foundations 2 2.5

Police officers 0 0.0

Others such as relatives/bystanders, etc. 46 58.2

Total 79 100.0

(23)

Table 12: Numbers and percentage of severe drowning injuries in children <15 years in Thailand

by place of death, 2013

Place of death 2013

Number Percent

Death before arriving at hospital 27 31.0

Death at the emergency room 9 10.4

Death after being admitted to hospital 51 58.6

Total 87 100.0

Thailand.

...

Acknownledgement

Bureau of Health Policy and Strategy, Ministry of Public Health

(24)

Situation of Child Drowning in Thailand, 1.39Mb

SITUATION OF CHILD DROWNING IN THAILAND

Contents

List of Tables

List of Figures

Summary

Situation of Child Drowning in Thailand