Risk factors for nonfatal drowning in children in rural Bangladesh: a community-based case-control study.

INTRODUCTION Most studies of drowning in Bangladeshi populations to date have described mortality and trends. We sought to identify associations between socioeconomic status and child-care practices and nonfatal drowning in rural Bangladeshi children. MATERIALS AND METHODS This community-based case-control study was conducted in rural children aged 1-5 years in Raiganj subdistrict of Bangladesh. 122 cases and 134 age-matched controls were recruited and their mothers were interviewed by use of a structured questionnaire. Univariate analyses and logistic regression were done to analyse the data. RESULTS Child nonfatal drowning was significantly associated with mothers: With low educational status (P < 0.001), of younger age (P < 0.005), of single status (P < 0.001) and with more than three children (P < 0.001). Nonfatal drowning was 12 and five times more likely in children of illiterate mothers than in children of mothers with academic knowledge equivalent to sixth to tenth grade (OR [95% CI] 0.08 [0.02-0.26]) and above tenth grade (OR [95% CI] 0.21 [0.04-0.95]) (P < 0.001), respectively. Low socioeconomic status, indicated by lower family expenditure (P < 0.001) and no house (P < 0.05; OR [95% CI] 0.58 [0.17-0.99]), were found to be risk factors for childhood nonfatal drowning. Improved child care, as measured by a child-care index, was associated with significantly lower non-fatal drowning (P < 0.001). Child care improved with higher educational attainment of mothers (P < 0.005) and increased socioeconomic status. Nonfatal drowning was more common when the main caregiver was not the mother (P < 0.001). Forward likelihood ratio logistic regression indicated mothers' lower educational status as the best predictor of nonfatal drowning. CONCLUSION Better child care and prevention of nonfatal drowning might be ensured through increasing mothers' educational attainment and improvements in socioeconomic status.