SITUATION ANALYSIS - thaincd.comthaincd.com/document/file/download/knowledge/Situation_Analysis_of... · Acknowledgements This report, entitled “Situation Analysis of Child Drowning

SITUATION ANALYSIS

OF CHILD DROWNING SURVEILLANCE

IN THAILAND

Research Team Members:

Mrs. Suchada Gerdmongkolgan

Ms. Som Ekchaloemkiet

Mrs. Auraphin Sublon

Mrs. Roongjit Termtor

Mrs. Kanjanee Dumnakkaew

Bureau of Non-Communicable Diseases

Department of Disease Control

Ministry of Public Health, Thailand

www.thaincd.com

Supported by

World Health Organization

SITUATION ANALYSIS

OF CHILD DROWNING SURVEILLANCE

IN THAILAND

First printing: November 2009

Number of copies: …………. (English version)

Number of pages: 101

Printer: Printing Press, War Veterans Organization of Thailand

ISBN 978-616-11-0662-1

Advisors:

Dr. Prapon Tangsrikertikul

Dr. Panuwat Pankret

Dr. Tairjing Siriphanich

Research team members:

Mrs. Suchada Gerdmongkolgan

Ms. Som Ekchaloemkiet

Mrs. Auraphin Sublon

Mrs. Roongjit Termtor

Mrs. Kanjanee Dumnakkaew

Cover design:

Ms.Thitima Khuntasin

Preparared by:

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

Tiwanon Road, Mueang District, Nonthaburi Province 11000, Thailand

Tel: 0-2951-0402 Fax: 0-2590-3968

www.thaincd.com

Supported by:

World Health Organization (WHO)

Bureau of Non-Communicable Diseases, DDC, MOPH

http://www.thaincd.com/�

Acknowledgements

This report, entitled “Situation Analysis of Child Drowning Surveillance in Thailand”,

has been completed by the research team in cooperation with a number of other agencies and

officials. First, we would like to express our sincere gratitude to Dr. Taejing Siripanich, who is

the main driving force behind the preparation of this report. Our profound thankfulness also

goes to the Bureau of Policy and Strategy and the Bureau of Epidemiology for their assistance

in providing the data on overall child drowning used in the analysis.

In addition, we would like to extend our grateful thanks to Dr. Panuwat Panketu,

Director of the Bureau of Non-communicable Diseases, for his continued advice and support.

Last but not least, our profound thanks go to the World Health Organization (WHO)

for financial support.

The Research Team

October 2009

Preface

Drowning is a major cause of child fatality in countries all over the world. On average,

approximately 135,585 children die from drowning each year, or about 372 children per day.

Children under five years of age constitute the age group with the highest risk. More than 98%

of child drowning deaths occur in a country with a low or moderate national income.

In Thailand, drowning is the number one cause of fatality among children under

15 years of age, and the fatality rate is much higher than those for other causes including

infectious and non-infectious diseases. Each year, nearly 1,500 children in Thailand die because

of drowning, or about 4 children per day on average, which is a much higher rate compared to

those in developed countries such as Australia or the United States.

Successful prevention of child drowning depends on a comprehensive and systematic

compilation of data in all aspects of drowning to be utilized in devising operational plans and

preventive measures. At present, there are three major databases of individual drownings in Thailand:

the database for death certificates, the database for individual inpatients, and the Injury Surveillance

System (IS). However, these databases have different objectives, data acquisition periods, and

limitations in data acquisition. As constructing a new database seems to put too much burden on

the operators and data users, the utilization of the data from various existing databases is considered

the best option available in outlining the proposals and devising operational plans.

Thus, the Bureau of Non-communicable Diseases, Department of Disease Control,

whose main responsibility is prevention and control of injuries, has conducted the situation

analysis of child drowning surveillance in Thailand with the objectives of investigating the

scope and severity of child drowning, exploring risk factors for child drowning, and proposing

recommendations for the prevention of drowning so as to further develop and improve the child

drowning surveillance system in Thailand.

Dr. Panuwat Panket

Director, Bureau of Non-Communicable Diseases

October 2009

Table of Contents

Page

Executive summary 1

Chapter 1: Introduction 5

Objectives 9

Scope of the study 9

Definition of terms 10

Methodology 12

Chapter 2: Findings of Situation Analysis of Child Drowning in Thailand 15

Mortality 15

- Trends in mortality 19

- Regions 20

- Provinces 21

- Gender 23

- Age 25

Morbidity 30

Case-fatality rate 33

Time of drowning 35

- Month 35

- Day of incident 40

- Time of incident 42

Location of drowning injuries 44

- Water sources 44

- Sites of drowning injuries 45

Risks of alcohol consumption 46

Treatment 48

Accessibility to medical care 49

Table of Contents (Cont.)

Page

Chapter 3: Conclusions and Discussions 53

Drowning-related mortality 53

Morbidity caused by accidental drowning 57

Case-fatality rate 57

Time 57

Locaion of drowning 58

Risks of alcohol consumption 58

Treatment 59

Accessibility to treatment 59

Chapter 4: Key Findings and Recommendations 61

References 67

Appendixes 71

Appendix A: Drowning statistics 72

Appendix B: WHO regions and Member countries 96

Appendix C: Index 100

Appendix D: Report Preparation Team 100

List of Tables

Page

Table 1: Leading causes of death in children, both sexes, World, 2004 5

Table 2: Estimated numbers of drowning deaths by age group, WHO region and

country income level, 2004

8

Table 3: Numbers, percentage, and rates of child deaths (per 100,000 children

<15 years) due to the five leading causes of death in Thailand, 1999–2008

16

Table 4: Numbers and rates of child drowning deaths (per 100,000 children

<15 years) in Thailand, 1999–2008

19


<15 years) in Thailand by region, 2004–2008

20

Table 6: Top ten provinces in Thailand with the highest rates of child drowning

deaths (per 100,000 children <15 years), 2004–2008

21

Table 7: Top ten provinces in Thailand with the highest numbers of drowning

deaths in children <15 years, 2004–2008

22


<15 years) in Thailand by gender, 1999–2008 23


<15 years) in Thailand by region and gender, 2008 24

Table 10: Numbers and rates of drowning deaths in children under 15 years

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

age group, 1999–2008

25


<15 years) in Thailand by region and age group, 2008

29

Table 12: Percentage of severe injuries* among children <15 years due to

the five leading causes of injuries in Thailand, 1998–2007

30

Table 13: Numbers and rates of child drowning injuries (per 100,000 children


31

Table 14: Numbers and rates of child drowning injuries (per 100,000 children

<15 years) in Thailand by age group, 2005–2007

31

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

in Thailand, 1998–2007

33

List of Tables (Cont.)

Page

Table 16: Numbers and percentage of drowning deaths in children <15 years

in Thailand by month, 1999–2008

36

Table 17: Numbers and percentage of drowning injuries in children <15 years

admitted to hospital in Thailand by month, 2005–2007

38

Table 18: Percentage of severe drowning injuries* in children <15 years by day

of the week, 1998–2007

40

Table 19: Percentage of severe drowning injuries* in children <15 years by time

period of the day, 1998–2007

42

Table 20: Percentage of severe drowning injuries* in children <15 years by type

of water source, 1998–2007 (10-year average)

44

Table 21: Percentage of severe drowning injuries* in children <15 years by type

of incident site, 1998–2007

45

Table 22: Percentage of severe alcohol-related drowning injuries* in children

<15 years by age group, 1998–2007 (10-year average)

46

Table 23: Costs of medical care for children <15 years with drowning injuries

admitted to hospital in Thailand, 2005–2007

49

Table 24: Length of hospital stay for children <15 years with drowning injuries

admitted to hospital in Thailand, 2005–2007

49

Table 25: Numbers and percentage of severe drowning injuries in children <15 years

in Thailand by type of transport to hospital for treatment, 1998–2007

50

Table 26: Numbers and percentage of severe drowning injuries in children

<15 years in Thailand by place of death, 1998–2007

52

Table A: Numbers and rates of child drowning deaths (ICD-10, W65–W74; per

100,000 children <15 years) in Thaialnd by province, 2006–2008

72

Table B: Numbers of drowning deaths (ICD-10, W65–W74) in children <15 years

in Thaialnd by province and gender, 2006

75

Table C: Numbers of drowning deaths (ICD-10, W65–W74) in children <15 years


82

Table D: Numbers of drowning deaths (ICD-10, W65–W74) in children <15 years


89

List of Figures

Page

Figure 1: Fatal injury rates per 100,000 children aged 0–17 years in five Asian

countries

6

Figure 2: Fatal drowning rates per 100,000 children <20 years by WHO region

and country income level, World, 2004

7

Figure 3: Numbers of deaths due to leading causes of death in children <15 years


15

Figure 4: Mortality rates for the five leading causes of death in children <15 years

(rate per 100,000 children <15 years) in Thailand, 1999–2008

17

Figure 5: Numbers and rates of deaths per 100,000 population due to the five

leading causes of death in Thailand by age group, 2008

18

Figure 6: Numbers and rates of child drowning deaths (per 100,000 children


19


<15 years) in Thailand by region, 2004–2008

20


<15 years) in Thailand by gender, 1999–2008

24


<15 years) in Thailand by age group, 1999–2008

26

Figure 10: Rates of drowning deaths in children <15 years and in all age groups

(per 100,000 children <15 years) in Thailand by age group, 1999–2008

26

Figure 11: Proportion of drowning deaths in Thailand by age group, 2008 27

Figure 12: Rates of child drowning deaths (per 100,000 children <15 years)

in Thailand by age group and gender, 2008

28


<15 years) in Thailand by region and age group, 2008

29

Figure 14: Rates of child drowning injuries admitted to hospital (per 100,000

children <15 years) in Thailand, 2005–2007

32

Figure 15: Case-fatality rates for severe drowning injuries* in children <15 years


34

List of Figures (Cont.)

Page

Figure 16: Numbers of drowning deaths in children <15 years in Thailand

by month, 1999–2008 (10-year average)

37

Figure 17: Numbers of drowning injuries in children <15 years in Thailand by

month, 2005–2007 (3-year average)

39

Figure 18: Percentage of severe drowning injuries* in children <15 years by day

of the week, 1998–2007 (10-year average)

41

Figure 19: Percentage of severe drowning injuries* in children <15 years by time

period of the day, 1998–2007 (10-year average)

43

Figure 20: Percentage of severe alcohol-related drowning injuries* in children

<15 years by age group, 1998–2007 (10-year average)

47

Figure 21: Percentage of severe alcohol-related drowning injuries* in children

<15 years by age group and gender, 1998–2007

48

Figure 22: Percentage of severe drowning injuries in children <15 years in

Thailand by type of transport to hospital for treatment, 1998–2007

51

Figure 23: Percentage of severe drowning injuries in children <15 years in

Thailand by place of

53

Situation Analysis of Child Drowning Surveillance in Thailand

1

Executive Summary

This report on the situation analysis of child drowning surveillance in Thailand aims

to investigate the scope and severity of child drowning, explore risk factors for child drowning,

and propose recommendations for the prevention of child drowning and the development of

a surveillance system for child drowning. A systematic analysis was conducted utilizing three

databases which had systematically compiled data on individual reports by age as well as ongoing

reports. The three databases include: (1) the mortality database on death certificates, (2) the database

of individual inpatients, and (3) the Injury Surveillance System (IS). The first two databases are

operated by the Bureau of Policy and Strategy, Ministry of Public Health (MOPH), while the

third one is handled by the Bureau of Epidemiology, Department of Disease Control (DDC),

MOPH. Each database has its own objectives, data acquisition periods, and data acquisition

limitations. The three databases were used in the analysis to ensure that the data were as up to date

as possible. It is noteworthy that due to the aforementioned limitations, in the present study the

data regarding drowning in children under 15 years of age only with variations in terms of

duration were used. This is not different from other studies carried out abroad which also have

limitations when reporting on drowning of individuals with different age groups and durations.

The findings of the present analysis can be summarized as follows:

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.

The number of Thai children under 15 years of age dying from drowning is 2 times

higher than that from traffic accidents and 24 times higher than that due to vector-borne viral

diseases including dengue hemorrhagic fever.

In Thailand, 1,420 children under 15 years of age die from drowning each year,

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


2

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

between 1999 and 2008 ranged from 7.7 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.

Chachoengsao province is one of the top ten provinces with the highest rates of

child drownings in Thailand for 5 consecutive years (between 2004 and 2008).

Nakhon Ratchasima, Bangkok, Buri Ram, Ubon Ratchathani, Surin, Si Sa Ket,

Udon Thani, and Khon Kaen have the highest rates of drowning deaths (5-year average: 2004 to

2008).

Nakhon Ratchasima province had the highest number of drowning deaths in the

four-year period between 2005 and 2008, ranging from 59 to 82.

The top ten provinces with the highest rates of drowning deaths (between 2004

and 2008) are Surin, Si Sa Ket, Buri Ram, Phitsanulok, Ratchaburi, Phetchabun, and Nakhon

Pathom.

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

30.2% of drowning deaths in all age groups.

The 0–4 age group has the highest drowning injury rate, 2 times higher than that

for the 5–9 age group and 5 times higher than that for the 10–14 age group.

The case-fatality rate of drownings in children under 15 years of age (10-year

average: 1998 to 2007) is as high as 41.0%.

April is the month with the highest number of drowning deaths of 178 (10-year

average: 1999 to 2008), followed by May and March at 150 cases and October at 140 cases. All

these months are during school breaks.

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

injuries, accounting for 38.8% of all drowning fatalities (10-year average: 1998 to 2007).

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

is between 12:00 noon and 17:59 hrs, accounting for 64.2% of all drowning fatalities (10-year

average: 1998 to 2007).


3

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

accounting for 49.9% of all drownings, followed by swimming pools and bathtubs at 5.4% and

2.5%, respectively (10-year average: 1998 to 2007).

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

1.2% had alcohol consumption behavior.

The youngest children who were found to suffer drowning injuries and had drunk

alcohol were seven years old.

The average cost of medical care for children with drowning injuries admitted to

hospital is 12,125 baht per child per year (3-year average: 2005 to 2007).

Most (81.8%) of the children with severe drowning injuries admitted to hospital

were rescued and taken to hospital by their relatives or bystanders (10-year average: 1998 to 2007).

Recommendations 1. Efforts should be made for drowning prevention to be regarded as a national

policy as drowning is the number one cause of fatalities among Thai children.

2. Information on drowning should be publicized more widely through different media.

3. Drowning prevention campaigns should be continuously and consistently carried out

all year round, especially during school breaks when drowning incidents are highest.

4. Surveys should be undertaken on water sources that pose a risk of drowning in

the households, neighborhoods, and communities.

5. Knowledge of drowning prevention should be disseminated and awareness of

this matter should be raised among the core target groups in the following aspects:

Parents and caregivers: making them aware of the necessity to give close and

constant care to small children as they are at high risk of drowning.

Children: training them in the survival swimming curriculum.

Parents and caregivers: educating them about correct methods for rescuing

drowning children.

6. Preventive measures against child drowning should be rigorously carried out in

high-risk provinces such as Chachoengsao, Surin, Si Sa Ket, Buri Ram, Phitsanulok, Ratchaburi,

Phetchabun, Nakhon Pathom, Nakhon Ratchasima, Bangkok, Ubon Ratchathani, Udon Thani,

and Khon Kaen.

7. Concrete measures should be devised for the management of natural bodies of water

which pose a high risk for drowning.


4

8. Research should be conducted to shed more lights on major issues such as the causes

of high drowning incidents in the northeastern region, the relationship between drowning and

alcohol consumption, and the decline in drowning incidents among older children.

Recommendations for development of surveillance systems Community-based surveillance systems should be developed to enable the communities

to utilize data to prevent and control child drowning in their localities. Village health volunteers

(VHVs) may be asked to take responsibility for compiling data to be sent to the public health

network for subsequent utilization by relevant communities and agencies to solve problems at

the local level. This is because the existing surveillance system aims to facilitate the utilization

of data on a large scale and it takes time to present the data compiled in each system as the

comprehensiveness and completeness of data need to be ensured; therefore, it is not timely

to solve local problems. Thus, there are certain limitations when such data are utilized at the district

or provincial level. In brief, if the communities are able to develop a community-based

surveillance system, it will considerably benefit the operations at the national level.


5

Chapter 1

Introduction

Drowning is a major cause of fatalities in children all over the world. There are

480 children younger than 20 years of age who die from drowning every day. Each year, about

2–3 million children and adolescents are near-drowning victims. Children under five years of age

all over the world constitute the most important high-risk group because infants (<1 year of age)

can drown even in shallow water. At present, more than 98% of the children who drowned lived

in a country with a low or moderate national income and with open bodies of water such as

lakes and streams. As for countries with a high national income, drowning is more likely to

occur at swimming pools. (1)

According to the 2004 WHO Global Burden of Disease,(2) drowning is one of the

10 leading causes of death in children, especially those aged 5–9 and 10–14 years (see Table 1).

Table 1: Leading causes of death in children, both sexes, World, 2004


6

According to a survey of injuries in children aged 0–17 years conducted by UNICEF

in five countries in the Asia (Bangladesh, China, the Philippines, Vietnam, and Thailand),

drowning is the number one cause of fatalities in children, followed by road traffic injuries (3)

(see Figure 1).

Figure 1: Fatal injury rates per 100,000 children aged 0–17 years in fivea Asian countries

Source: World Report on Child Injury Prevention. WHO, 2009.


7

According to the data of WHO in 2004, when cconsidering the drowning death rates

in children under 20 years of age per 100,000 children of the same age group by WHO region

and Member country, it was found that the countries with a low and middle income in

the Western Pacific Region had the highest rate, at 13.9, followed by the African Region,

the Eastern Mediterranean Region, and the South-East Asia Region, respectively.(2) In Thailand,

the rate is 8.2, which is higher than the average for the South-East Asia Region of 6.2 (4)

(see Figure 2).

Figure 2: Fatal drowning rates per 100,000 children* by WHO region and country income level,

World, 2004

* These data refer to those under 20 years of age.

HIC = High income countries; LMIC = Low and middle income countries

Source: WHO (2008). Global Burden of Disease, 2004 update.


8

All over the world, the rate of fatal drownings in children under 15 years of age is

135,585 per year, or 372 per day on average. In the South-East Asia Region, the rate of fatal

drownings is 32,744 per year, or 90 per day on average (3) (see Table 2).

Table 2: Estimated numbers of drowning deaths by age group, WHO region and country income

level, 2004

WHO region Income

level

Age range (years)

<1 1–4 5–9 10–14 15–19 <20

World All 10,200 48,267 39,010 38,107 39,708 175,293

High 168 958 500 393 956 2,974

Low 9,916 47,263 38,467 37,680 38,699 172,025

African Region Low 4,445 10,178 4,060 4,618 5,452 28,752

Region of the Americas All 272 2,487 1,395 1,654 2,785 8,592

High 68 445 146 155 333 1,148

Low 203 2,042 1,248 1,499 2,452 7,444

South-East Asia Region Low 2,850 9,362 11,662 8,870 11,027 43,771

European Region All 133 2,334 1,251 1,181 1,051 5,950

High 21 189 86 53 166 515

Low 112 2,145 1,165 1,128 885 5,435

Eastern Mediterranean Region All 1,021 4,605 3,711 3,253 4,342 16,932

High 51 217 117 92 302 779

Low 970 4,388 3,595 3,161 4,040 16,153

Western Pacific Region All 1,363 19,255 16,889 18,497 14,998 71,002

High 27 107 151 93 155 532

Low 1,336 19,148 16,738 18,404 14,843 70,469

Source: World Report on Child Injury Prevention. WHO, 2008.


9

Objectives 1. To investigate the scope and severity of problems and risk factors for drownings

among children in Thailand.

2. To derive at a proposal on prevention of child drowning in Thailand as well as

on development/improvement of the existing child drowning surveillance system in Thailand.

Scope of study The present study analyzed the data elicited from existing databases which have

a systematic data storage system and reports on drownings on an individual basis. The data,

which are continuously compiled and reported, can be categorized according to the age groups

of children. The data can be used to analyze the situations of drowning including trends and risk

factors of drowning among children in Thailand, to further develop or improve the child drowning

surveillance system to ensure comprehensiveness and completeness, and to devise a plan or

measure to prevent drowning among children in Thailand. The data used in the present analysis

were retrieved from three databases, namely the database of death certificates (compiled by the

Bureau of Policy and Strategy, MOPH),(5) the database of individual inpatients (also compiled

by the Bureau of Policy and Strategy),(6) and the Injury Surveillance System (IS; operated by

the Bureau of Epidemiology, DDC, MOPH).(7) The research team of the present analysis hoped

to obtain the data which were as up to date as possible. However, as each database has its own

objectives, data acquisition periods, and constraints in data acquisition, the data presented in the

present analysis varied in a number of issues. The first important issue was the durations presented

in each of the databases. The data retrieved from the death certificates were presented in a period of

10 years (from 1999 to 2008), while the data retrieved from the individual inpatients database

were presented in a period of 3 years (from 2005 to 2007). This was because the Bureau of Policy

and Strategy began its coordinated efforts with the National Health Security Office, the Comptroller

General’s Department of the Ministry of Finance (reimbursements of medical expenses of

government officials and family members) and the Social Security Office in 2005. Therefore,

the data on individual inpatients compiled before that time were not complete or comprehensive.

In addition, the data retrieved from the Injury Surveillance System (IS) were presented in a

period of 10 years (from 1998 to 2007). The second important issue was the age group. In this

study, only data on drownings in children under 15 years of age were analyzed and presented.

That was because even though the data collected in the aforementioned databases were individual

data, the data in each database were analyzed with a programme which categorized individuals

into the following age groups: under 1 year, 1–4 years, 5–9 years, 10–14 years, and 15–19 years.


10

Due to such limitations, in the present study only the data regarding drowning in

children aged under 15 years are presented with differences in durations. Such presentation

is not different from other reports on child drowning surveillance conducted in other countries

where similar limitations could be found.

Definition of terms “Child” refers to an individual who is under 15 years of age.

“Injury” refers to damage of the body which results from sudden exposure to heat energy,

mechanical energy, electricity, or chemicals. It also refers to lack of necessities such as heat or oxygen,

which can be either intentional or accidental. At present, the term “injury” has been used to replace

the term “accident” as the latter may be misleading, making individuals misunderstand that it is

unpredictable or unforeseeable. (5, 6)

“Drowning” refers to a process in which an individual loses his/her breathing or the breathing

becomes weakened because all body parts, including the respiratory system, are completely

immersed in water, or at least the face or the respiratory system is submerged in water or

another fluid, and the outcome is death or body’s abnormality or non-abnormality. (10) According to

the International Standard Classification of Disease and Related Health Problem (ICD-10),

the disease codes for morbidity and mortality from drowning are W65–W74.

“ICD-10”(8) refers to the international standard diagnostic classification of diseases and health

problems that are the causes of morbidity and mortality.

W65 refers to drowning and submersion while in a bathtub.

W66 refers to drowning and submersion following fall into a bathtub.

W67 refers to drowning and submersion while in a swimming pool.

W68 refers to drowning and submersion following fall into a swimming pool.

W69 refers to drowning and submersion while in natural water.

W70 refers to drowning and submersion following fall into natural water.

W73 refers to other specified drowning and submersion.

W74 refers to unspecified drowning and submersion.

“Severe injury” (12) refers to an injured individual who has been dead before arrival (DBA)

at hospital, an injured individual who died in an emergency department/room, and an injured

individual who is observed in or admitted to hospital.


11

“Admitted patient or admission” (13) refers to the admission of an injured individual as inpatient

with an admission number.

“Case” (13) refers a visit or admission as inpatient at hospital.

“Alcohol consumption” (14) refers to the fact that an injured individual has drunk alcohol,

as stated by the injured individual; as observed from his/her gait, speech, or body odor; or

as observed from breathing and blood examination (as mg%), signifying the level of blood alcohol

content as determined by an alcohol breath tester or analyzer or with the laboratory results of blood

or urine examination.

“Average cost of medical care” (13) refer to the average cost of medical services an inpatient

has to pay each time he/she seeks medical care or treatment at hospital.

“Mean length of hospital stay” (13) refers to the number of days an inpatient spends at hospital

from admission to discharge, as calculated by dividing the total number of days of hospital stay

of all discharged patients by the total number of patients discharged during the same period.

“Location of drowning” (14) refers to the place where the drowning injury has occurred.

House and compound of the house refers to place of living of an individual which is not

a temporary living place.

Dormitory, prison, nursery, or military base refers to a place of living of a group of

individuals who share certain similar characteristics, which is not a house or residence of a

family or an individual.

Hospital, school or temple refers to a building (and its compound) which is used by a

group of individuals or the public for various purposes such as an auditorium (except a building

under construction, a residence or a sports/athletic field).

Public sports arena refers to a venue where the general public exercise, play sports, or

participate in a sports/athletic event.

Street or highway refers to a route of public transportation that an individual uses to

travel from one place to another including the components of such a route.

Place for trading goods and services refers to a place that is meant for selling and buying

goods and services such as a bank or a market.

Construction site or factory refers to a building (and its compound) that is used for

manufacturing a large quantity of products or goods, either small or large in size, including any

building and site under construction.

Paddy field, farm or garden refers to an area that is used for agricultural and livestock raising

purposes, including a construction used for such purposes such as a temporary shelter on the farm.


12

Methodology 1. Secondary data were retrieved from the following three databases:

1) Data from death certificates (15)

Death certificate data were compiled from 1999 to 2008 by the Bureau of Policy

and Strategy, MOPH, which elicited the civil registration data from the Bureau of

Registration Administration, Department of Provincial Administration, Ministry of Interior,

and then coded the causes of death on an individual basis based on ICD-10.

Limitations of the database

The causes of death were not complete, and the “unknown” causes of death

accounted for more than 30% of the total causes. Even in the cases where the causes of

death were specified, some items were ambiguous and possibly inaccurate because the

“mode of death” was specified instead of the “cause of death”, resulting in erroneous or

incomplete causes of death. In particular, if the person who specified the causes of death

was not a physician, it was even more likely that the causes of death specified in the

death certificates would be inaccurate.

Management and examination of accuracy of data

1) The data were examined record by record on a periodical basis.

2) The causes of death were coded on an individual basis based on ICD-10.

2) Data on individual inpatients (13)

Data retrieved from the individual inpatients database were compiled from 2005

to 2007 by the Bureau of Policy and Strategy after it began to coordinate with the

National Health Security Office, the Comptroller General’s Department (reimbursement

of medical expenses of government officials and family members) and the Social Security

Office in 2005. Therefore, the data on individual inpatients were the data that the hospitals

directly sent to the funds which covered all health-care settings with more details on gender,

age group, disease/syndrome, and the level of health-care settings, etc.

Limitations of the database

The data did not comprehensively cover all inpatients who were admitted to hospital

because they were data of only the inpatients who had the rights to reimbursements for

medical expenses.


13


1) The data were examined record by record on a periodical basis. Important

disease codes, feasibility of data, gender, age, and coding were also examined, particularly

the accuracy of the disease codes of serious diseases that required close monitoring and

surveillance such as smallpox and plague. Attention was paid to external causes of injuries

as well.

2) Erroneous data regarding the coding of important communicable diseases

and specification of external causes of injuries were referred back to the related agencies

for examination and verification.

3) The National Injury Surveillance System (IS)

The data retrieved from the Injury Surveillance System (IS) were compiled between

1998 and 2007. Established in 1994, the database is run by the Bureau of Epidemiology,

Department of Disease Control, with an objective of utilizing the database to develop

health services delivery systems and referral systems at the provincial level. The data

is expected to be utilized as baseline data to devise a plan to prevent and solve problems

of injuries and accidents at both provincial and national levels. The data compiled at this

database are those on injured or deceased individuals with all external causes (ICD-10,

Chapter 20: External causes of morbidity and mortality, Codes V01–Y36), which take

place within seven days and which make the individuals seek medical services at the

emergency department/room of a large hospital in Bangkok or other provinces across

the country. This is considered a provincial surveillance network that has been continuously

expanded. At present, there are 29 hospitals in the injury surveillance network, so-called

sentinel sites, namely Maharaj Nakhon Ratchasima Hospital, Maharaj Nakhon Si Thammarat

Hospital, Lampang Hospital, Ratchaburi Hospital, Chon Buri Hospital, Yala Hospital,

Sawanpracharak Hospital (Nakohn Sawan), Lerdsin Hospital, Nopparat Ratchathani

Hospital, Saraburi Hospital, Khon Kaen Hospital, Songkhla Hospital, Prapokklao Hospital

(Chanthaburi), Chiang Rai Prachanukhro Hospital, Sappasitthiprasong Hospital (Ubon

Ratchathani), Phra Nakhon Si Ayutthaya Hospital, Chaopraya Yommaraj Hospital

(Suphan Buri), Udon Thani Hospital, Surat Thani Hospital, Trang Hospital, Rayong

Hospital, Nakhon Pathom Hospital, Buddhachinaraj Hospital (Phitsanulok), Chao Phraya

Abhaibhubejhr Hospital (Prachin Buri), Uttaradit Hospital, Buri Ram Hospital, Surin

Hospital, Pra Nangklao Hospital (Nonthaburi), and Chachoengsao Hospital. Since 2001,

the format of injury surveillance has been improved, and the hospitals that are the sentinel sites

are required to document only severe injury cases – injured individuals who are dead


14

before arrival (DBA), injured individuals who are pronounced dead at the emergency

room, and injured individuals who are observed at, or admitted to, hospital. They are

also required to submit the records to the Bureau of Epidemiology for subsequent

compilation in the database and the national surveillance reports.


1) The data were examined to ensure their completeness and accuracy by examining

the printouts and the electronic files sent by the hospitals that are the sentinel sites using

the injury surveillance analysis program. If any errors or discrepancies were found,

the responsible hospitals in the network would be informed for revision and resubmission

to the Bureau of Epidemiology.

2) Data regarding injury surveillance were compiled, organized, and recorded

using the IS on Windows program (revised version 2007) to document data regarding

severe injuries caused by 19 different causes including traffic accidents.

3) The surveillance data were analyzed using the IS program in terms of descriptive

statistics to determine the number, percentage, proportion, ratio, rate of admissions,

case-fatality rate, etc.

2. Data were analyzed by means of descriptive statistics.

3. The findings were summarized and the recommendations were proposed.


15

Chapter 2

Findings of Situation Analysis of Child Drowning Surveillance

in Thailand

Mortality

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

Policy and Strategy between 2004 and 2007, 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 (see Figure 3). When considering the five leading causes of injury-

related mortality between 1999 and 2008, it was found that drowning was the number one cause

of mortality, followed by road traffic injuries; accidental threats to breathing; exposure to

electric current, radiation, and temperature; and physical assaults. Drowning accounted for

as high as 33.9%–46.5% of the total injuries. The rate of drowning deaths ranged from 7.7 to 11.5

per 100,000 children under 15 years of age, and the total number of drowning deaths was

1,420 cases per year or 4 cases per day on average (see Table 3 and Figure 4).

Figure 3: Numbers of deaths due to leading causes of death in children <15 years in Thailand,

2004–2007

1297

1482

1471

0 300 600 900 1200 1500

2004

2005

2006

2007

Accidental drowning and submersion AssaultPneumonia Vector borne diseases and dengue hRoad traffic injuries

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

Public Health.

Analyzed by: Suchada Gerdmongkolgan and Som Ekchaloemkiet, Injury Prevention Group, Bureau of Non-

Communicable Diseases, Department of Disease Control, Ministry of Public Health, Thailand.


16

Table 3: Numbers, percentage and rates of child deaths (per 100,000 children <15 years) due to

the five leading causes of death in Thailand, 1999–2008

Cause of death Year

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

1. Accidental drowning and submersion (W65–W74)

Number 1,249 1,412 1,444 1,588 1,472 1,471 1,549 1,482 1,297 1,229

Rate 7.7 8.9 9.1 11.2 10.5 10.7 11.5 11.1 9.8 9.4

Percentage 39.4 40.0 33.9 43.3 42.5 39.2 46.5 35.5 40.6 41.3

2. Road traffic injuries (V01–V89)

Number 700 864 773 829 723 762 649 659 594 636

Rate 4.3 5.4 4.9 5.9 5.2 5.5 4.8 4.9 4.5 4.9

Percentage 22.1 24.5 18.1 22.6 20.9 20.3 19.5 15.8 18.6 21.4

3. Other accidental threats to breathing (W75–W84)

Number 29 44 65 72 95 71 96 75 85 77

Rate 0.2 0.3 0.4 0.5 0.7 0.5 0.7 0.6 0.6 0.6

Percentage 0.9 1.2 1.5 2.0 2.7 1.9 2.9 1.8 2.7 2.6

4. Exposure to electric current, radiation and extreme ambient air temperature and pressure

(W85–W99)

Number 78 98 89 96 82 99 93 119 91 71

Rate 0.5 0.6 0.6 0.7 0.6 0.7 0.7 0.9 0.7 0.5

Percentage 2.5 2.8 2.1 2.6 2.4 2.6 2.8 2.9 2.9 2.4

5. Assaults (X85–Y09)

Number 159 182 93 100 86 48 67 69 87 52

Rate 1.0 1.1 0.6 0.7 0.6 0.3 0.5 0.5 0.7 0.4

Percentage 5.0 5.2 2.2 2.7 2.5 1.3 2.0 1.7 2.7 1.7


Public Health.




17

Figure 4: Mortality rates for the five leading causes of death in children <15 years (per

100,000 children <15 years) in Thailand, 1999–2008

0

2

4

6

8

10

12

14

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Accidental drowning and submersionRoad traffic injuriesAccidental threats to breathingExposure to electric current, radiation, and extreme ambient air temperature and pressureAssaults


Public Health.




18

When categorizing the causes of injury-related mortality by age group in 2008,

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

accidental threats to breathing (4.9 per 100,000 population). However, the number one cause of

mortality in the 1–4 and 5–9 age groups was drowning (13.8 and 12.0 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 (15.3 per 100,000), followed by drowning (6.4 per 100,000)

(see Figure 5).

Figure 5: Numbers and rates of deaths per 100,000 population due to the five leading causes of

death in Thailand by age group, 2008


Public Health.




19

Trends in mortality

During the 10-year period from 1999 to 2008, 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 4 and Figure 6).

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

1999–2008

Year Child drowning deaths

Number Rate

1999 1,249 7.7

2000 1,412 8.9

2001 1,444 9.1

2002 1,588 11.2

2003 1,472 10.5

2004 1,471 10.7

2005 1,549 11.5

2006 1,482 11.1

2007 1,297 9.8

2008 1,229 9.3


Public Health

Analyzed by: Som Ekchaloemkiet and Suchada Gerdmongkolgan, Injury Prevention Group, Bureau of Non-


Figure 6: Numbers and rates of child drowning deaths (per 100,000 children <15 years) in Thailand,

1999–2008

0

200

400

600

800

1,000

1,200

1,400

1,600

1,800

1999 2000 2001 2002 2003 2004 2005 2006 2007 20080

2

4

6

8

10

12

14number rate

Num

ber

Rate per 100,000 children


20

Regions

The findings revealed that the northeastern region had the highest rate of drowning

deaths in children under 15 years of age, followed by the central region, the northern region, and

the southern region; the rates per 100,000 children under 15 years in 2008 were 11.6, 9.1, 7.9,

and 6.8, respectively (see Table 5 and Figure 7).

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

Thailand by region, 2004–2008

Region

Year

2004 2005 2006 2007 2008 Number Rate Number Rate Number Rate Number Rate Number Rate

Northern 201 8.3 214 9.1 257 11.1 183 8.0 177 7.9

Northeastern 621 12.7 654 13.7 616 13.1 503 10.9 528 11.6

Central 469 10.8 493 11.5 442 10.4 459 10.8 383 9.1

Southern 180 8.4 188 8.9 167 8.0 152 7.3 141 6.8

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

of Public Health

Analyed by: Som Ekchaloemkiet and Suchada Gerdmongkolgan, Injury Prevention Group, Bureau of Non-


Figure 7: Numbers and rates of child drowning deaths (per 100,000 children <15 years) in

Thailand by region, 2004–2008

0 2 4 6 8 10 12 14 16

2004

2005

2006

2007

2008

Northern Northeastern Central Southern


Public Health.




21

Provinces

The top ten provinces which had the highest rates of drowning deaths (per 100,000

children under 15 years) in children under 15 years of age for at least three consecutive years

between 2004 nad 2008 were Chachoengsao, Rayong, Nakhon Nayok, Prachin Buri, and

Nakhon Phanom (see Table 6). However, when considering specifically only the numbers of

drowning deaths, it could be seen that Nakhon Ratchasima, Bangkok, Buri Ram, Ubon

Ratchathani, Surin, Si Sa Ket, Udon Thani, and Khon Kaen had the highest numbers of deaths

per year at 70, 62, 51, 50, 48, 47, 45, and 44, respectively on average (see Table 7).

Table 6: Top ten provinces in Thailand with the highest rates of child drowning deaths

(per 100,000 children <15 years), 2004–2008

Rank Province (rate, number)

2004 2005 2006 2007 2008

1 Rayong

(20.6, 26)

Trat

(40.1, 19)

Rayong

(21.1, 27)

Nakhon Nayok

(26.9, 13)

Prachin Buri

(21.1, 20)

2 Saraburi

(20.3, 27)

Nakhon Nayok

(24.1, 12)

Sing Buri

(20.8, 8)

Sing Buri

(21.1, 8)

Surin

(18.7, 57)

3 Petchaburi

(19.3, 18)

Pichit

(22.4, 25)

Prachin Buri

(20.7, 20)

Ratchaburi

(19.8, 33)

Nakhon Pathom

(16.8, 28)

4 Chachoengsao

(18.2, 26)

Rayong

(22.2, 28)

Phitsanulok

(19.6, 32)

Trat

(19.4, 9)

Nakhon Nayok

(16.7, 8)

5 Prachin Buri

(18.2, 18)

Pang-nga

(19.7, 11)

Uttaradit

(18.1, 16)

Ang Thong

(17.0, 9)

Nakhon Panom

(16.6, 26)

6 Buri Ram

(17.9, 66)

Chachoengsao

(19.3, 27)

Phatthalung

(17.6, 19)

Chachoengsao

(16.7, 23)

Chachoengsao

(16.1, 22)

7 Chumphon

(17.9, 19)

Chanthaburi

(18.9, 20)

Nakhon Panom

(17.4, 28)

Samut Sakhon

(16.7, 17)

Sa Kaeo

(15.8, 19)

8 Nakhon Nayok

(17.7, 9)

Sa Kaeo

(17.7, 22)

Mukdahan

(17.1, 13)

Rayong

(16.1, 21)

Uttaradit

(15.3, 13)

9 Surin

(15.8, 52)

Si Sa Ket

(17.6, 58)

Chachoengsao

(16.6, 23)

Ranong

(16.1, 7)

Chanthaburi

(14.7, 15)

10 Phetchabun

(15.8, 34)

Kanchanaburi

(17.3, 31)

Saraburi

(16.3, 21)

Nakhon Panom

(15.8, 25)

Si Sa Ket

(14.3, 45)


Public Health.




22

Table 7: Top ten provinces in Thailand with the highest numbers of drowning deaths among

children <15 years, 2004–2008

Rank Province (number)

2004 2005 2006 2007 2008

1 Bangkok

(68)

Nakhon Ratchasima

(74)

Nakhon Ratchasima

(82)

Nakhon Ratchasima

(75)

Nakhon Ratchasima

(62)

2 Buri Ram

(66)

Bangkok

(61)

Bangkok

(65)

Bangkok

(67)

Surin

(57)

3 Ubon Ratchathani

(60)

Si Sa Ket

(58)

Khon Kaen

(56)

Buri Ram

(45)

Bangkok

(51)

4 Nakhon Ratchasima

(59) Buri Ram

(53)

Ubon Ratchathani

(55)

Surin

(45)

Si Sa Ket

(45)

5 Surin

(52)

Udon Thani

(53)

Buri Ram

(48)

Udon Thani

(45)

Buri Ram

(43)

6 Udon Thani

(50)

Ubon Ratchathani

(52)

Si Sa Ket

(48)

Ubon Ratchathani

(39)

Ubon Ratchathani

(43)

7 Si Sa Ket

(46)

Surin

(44)

Udon Thani

(45)

Si Sa Ket

(38)

Khon Kaen

(41)

8 Khon Kaen

(46)

Sakon Nakhon

(43)

Surin

(41)

Ratchaburi

(33)

Chaiyaphum

(30)

9 Songkhla

(40)

Khon Kaen

(42)

Roi Et

(38)

Khon Kaen

(33)

Udon Thani

(30)

10 Chon Buri

(35)

Roi Et

(38)

Phitsanulok

(32)

Phetchabun

(29)

Nakhon Pathom

(28)


Public Health.




23

Gender

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

Strategy, between 1999 and 2008, 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 8

and Figure 8). The rate for males in the southern region was approximately 2.5 times higher than

that for females in the same region (see Table 9).


Thailand by gender, 1999–2008

Gender Year

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Male

Number 821 933 917 1,032 952 935 983 985 843 821

Rate 10.1 11.6 11.5 14.2 13.2 13.2 14.1 14.3 12.4 12.2

Female

Number 428 479 527 556 520 536 566 497 454 406

Rate 5.3 6.1 6.7 8.1 7.7 8.0 8.6 7.7 7.1 6.4

Total

Number 1,249 1,412 1,444 1,588 1,472 1,471 1,549 1,482 1,297 1,229

Rate 7.7 8.9 9.1 11.2 10.5 10.7 11.5 11.1 9.8 9.4


Public Health.




24


Thailand by gender, 1999–2008

0

2

4

6

8

10

12

14

16

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Male Female


Public Health.




Thailand by region and gender, 2008

Region

Gender

Male Female

Number Rate Number Rate

Northern 108 9.4 69 6.4

Northeastern 344 14.7 184 8.4

Central 268 12.3 115 5.6

South 103 9.6 38 3.8

Total 823 12.2 406 6.4


Public Health.



Rat

e pe

r 100

,000

chi

ldre

n


25

Age

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

Strategy, between 1998 and 2009, the mean rate of fatal drownings in children aged 0–4 years

was slightly higher than that for the 5–9 age group. However, between 2005 and 2009, the rate

for the 5–9 age group was higher than that for the 0–4 age group.

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 (7.7–11.5 per

100,000 children under 15 years) were higher than those for all age groups (5.0 –7.5 per 100,000)

(see Table 10 and Figure 10).

Table 10: 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, 1999–2008

Year

Age group (years)

0–4 5–9 10–14 <15 All

Number Rate Number Rate Number Rate Number Rate Number Rate

1999 531 10.1 501 9.3 217 4.0 1,249 7.7 3,015 5.0

2000 587 11.3 582 10.9 243 4.5 1,412 8.9 3,859 6.3

2001 591 11.5 571 10.8 282 5.3 1,444 9.1 3,811 6.2

2002 601 14.0 673 13.4 314 6.5 1,588 11.2 4,218 6.7

2003 590 14.3 608 12.2 274 5.6 1,472 10.5 4,134 6.6

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


Public Health.




26


Thailand by age group, 1999–2008

0

2

4

6

8

10

12

14

16

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

0-4 Years 5-9 Years 10-14 Years


Public Health.



Figure 10: Rates of drowning deaths in children <15 years and all age groups (per 100,000

children <15 years) in Thailand by age group, 1999–2008

0

2

4

6

8

10

12

14

16

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

0-14 Years All


Public Health.



Rat

e pe

r 100

,000

chi

ldre

n R

ate

per 1

00,0

00 p

opul

atio

n


27

In 2008, when considering the proportion of drowning deaths in children under

15 years of age, it was found that the 5–9 age group had the highest proportion (40.9%),

followed by the 0–4 age group (37.8%), and the 10–14 age group (21.2%). Compared to other

age groups, the proportion for the under-15 age group (30.2%) was higher than those for other

age groups (see Figure 11).

Figure 11: Proportion (percentage) of drowning deaths in Thailand by age group, 2008

Children younger than 15 years All age groups

40.9

21.2

37.8


22.0

18.9

14.0

14.8

30.2

0-14 Years 15-29 Years 30-44 Years45-59 Years 60+ Years


Public Health.




28

When considering the rates of drowning deaths in children under 15 years by age group

and gender in 2008, it was found that the rates for boys were 2 times higher than for girls in the

0–4 and 5–9 age groups. In the children aged 10–14, however, the rates for boys and girls were

rather similar as the rates for boys remarkably decreased, while the rates for girls only slightly

decreased (see Figure 12).

Figure 12: Rates of child drowning deaths (per 100,000 children <15 years) in Thailand

by age group and gender, 2008

0

2

4

6

8

10

12

14

16

18


Male Female


Public Health.



Rat

e pe

r 100

,000

chi

ldre

n


29

When categorizing drowning deaths in children under 15 years of age by region and

age group, it was found that the 0–4 age group in the central region had the highest rate (14.7

per 100,000 children under 15 years), while the 5–9 age group in the northeastern region had

the highest rate (17.5 per 100,000 children under 15 years) (see Table 11 and Figure 13).


Thailand by region and age group, 2008

Region Age group (years)

0-4 5-9 10-14 <15 Number Rate Number Rate Number Rate Number Rate

Northern 66 9.8 66 9.4 45 5.2 177 7.9

Northeastern 156 11.5 256 17.5 116 6.8 528 11.6

Central 190 14.7 127 9.5 66 4.2 383 9.1

Southern 53 7.9 54 8.0 34 4.6 141 6.8


Public Health.




Thailand by region and age group, 2008

0

2

4

6

8

10

1214

16

18

20

0-4 Years 5-9 Years 10-14 Years <15 Years

Northern Northeastern Central Southern


Public Health.



Rat

e pe

r 100

,000

chi

ldre

n


30

Morbidity According to the analysis of data regarding severe injuries (injured individuals who

had been dead before arrival (DBA) at hospital, injured individuals who died in an emergency

room, and injured individuals who were observed at or admitted to hospital) retrieved from the

Injury Surveillance S ystem (IS) of the Bureau of Epidemiology, Department of Disease Control,

Ministry of Public Health, the five leading causes of injury-related mortality in Thai children

under 15 years of age between 1998 and 2007 were road traffic injuries (34.9% to 41.1%), fall

accidents (26.8% to 27.7%), exposure to inanimate mechanical forces (16.3% to 18.2%),

exposure to animate mechanical forces (2.6% to 9.2%), and exposure to poisonous animals or

plants (2.4% to 3.9%) (see Table 12).

Table 12: Percentage of severe injuries* among children <15 years due to the five leading

causes of injuries in Thailand, 1998–2007

Cause of injury Year**

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

1. Road traffic injuries

(V01–V89)

41.1 38.7 39.2 39.7 40.7 38.3 38.2 34.9 37.4 37.1

2. Falls

(W00–W19)

27.4 27.7 27.4 27.5 26.8 27.7 27.5 26.9 27.5 26.9

3. Exposure to inanimate

mechanical forces

(W20–W49)

17.1 17.6 17.1 16.7 16.4 16.5 16.3 17.1 17.9 18.2

4. Exposure to animate

mechanical forces

(W50–W64)

2.6 3.2 3.5 3.3 3.3 3.5 3.5 9.2 3.5 3.4

5. Contact with venomous

animals and plants

(X20–X29)

2.4 2.7 2.6 3.2 3.5 3.2 3.2 2.9 3.9 3.8

* 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.

** Numbers of injuries: 14 in 1998, 19 in 1999, 21 between 2000 and 2001, 23 in 2002, 28 in 2003, 29 between 2004 and

2006, and 28 in 2007.

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

Disease Control, Ministry of Public Health.

Analyzed by: Kanjanee Dumnakkaew, Bureau of Epidemiology, Department of Disease Control, Ministry of

Public Health, Thailand.


31

According to the individual inpatients database at the Bureau of Policy and Strategy,

Ministry of Public Health, the morbidity rate in children under 15 years of age who were admitted

to hospital due to drowning between 2005 and 2007 ranged from 7.5 to 8.7 per 100,000 children

under 15 years (see Table 13). When categorizing the children into different age groups, it was

found that the 0–4 age group had the highest rate of morbidity, followed by the 5–9 and 10–14

age groups, respectively. The morbidity rate for children aged 0–4 was five times higher than

that for those aged 10–14 and two times higher than that for those aged 5–9 (see Table 14 and

Figure 14).

Table 13: Numbers and rates of child drowning injuries (per 100,000 children <15 years) in

Thailand, 2005–2007

Year Morbidity

Number Rate

2005 1,007 7.5

2006 1,147 8.6

2007 1,150 8.7

Data source: Individual inpatients database. Bureau of Policy and Strategy, Office of the Permanent Secretary,

Ministry of Public Health.



Table 14: Numbers and rates of child drowning injuries (per 100,000 children <15 years) in

Thailand by age group, 2005–2007

Year

Age group (years)

0–4 5–9 10–14 <15 All age groups

Number Rate Number Rate Number Rate Number Rate Number Rate

2005 563 14.1 314 6.8 130 2.7 1007 7.5 1,460 2.3

2006 640 16.1 348 7.8 159 3.2 1147 8.6 1,636 2.6

2007 688 17.2 289 6.7 173 3.5 1150 8.7 1,572 2.5






32

Figure 14: Rates of child drowning injuries admitted to hospital (per 100,000 children <15 years)


0

2

4

6

8

10

12

14

16

18

20

2005 2006 2007

0-4 years 5-9 years 10-14 years





Rat

e pe

r 100

,000

chi

ldre

n


33

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 1998 and 2007,

the case-fatality rate for child drownings ranged from 32.5% to 48.2%, with the mean for the

10-year period of 41.0% (see Table 15 and Figure 15).

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

1998–2007

Year** Case-fatality rate (%)

1998 36.8

1999 39.9

2000 40.2

2001 40.1

2002 48.2

2003 39.7

2004 47.7

2005 42.4

2006 32.5

2007 40.6




2006, and 28 in 2007.

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


Compiled by: Kanjanee Dumnakkaew, Bureau of Epidemiology, Department of Disease Control, Ministry of





34

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

1998–2007

0

10

20

30

40

50

60

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007




2006, and 28 in 2007.







Perc

ent


35

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 1999 and 2008, April had the highest number

of drowning deaths, followed by May, March, October, and November, respectively. The means

for May and March were rather similar. During the 10-year period, on average there were 178

child drowning deaths in April, 150 in March and May, 140 in October, and 124 in November


According to the individual inpatients database at the Bureau of Policy and Strategy,

Ministry of Public Health, when categorizing the drowning deaths in children under 15 years

of age by month of incident, it was found that, between 1999 and 2008, April had the highest

number of deaths, followed by May, March, October, and November, respectively. During the

10-year period, on average there were 127 childh drowning deaths in April, 121 in May, 114

in March, 103 in October, and 97 in November (see Table 17 and Figure 17).


36

Table 16: Numbers and percentage of drowning deaths in children <15 years in Thailand

by month, 1999–2008

Month Year

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

January 98 94 121 87 82 83 72 111 88 86

7.8 6.7 8.4 5.5 5.6 5.6 4.6 7.5 6.8 7.0

February 100 79 98 109 110 104 112 135 77 71

8.0 5.6 6.8 6.9 7.5 7.1 7.2 9.1 5.9 5.8

March 155 118 133 147 162 193 161 140 135 151

12.4 8.4 9.2 9.3 11.0 13.1 10.4 9.4 10.4 12.3

April 162 165 206 184 196 210 210 158 136 157

13.0 11.7 14.3 11.6 13.3 14.3 13.6 10.7 10.5 12.8

May 155 150 125 139 176 156 175 142 132 148

12.4 10.6 8.7 8.8 12.0 10.6 11.3 9.6 10.2 12.0

June 83 111 109 127 105 125 116 101 87 95

6.6 7.9 7.5 8.0 7.1 8.5 7.5 6.8 6.7 7.7

July 86 102 94 112 97 105 106 89 72 83

6.9 7.2 6.5 7.1 6.6 7.1 6.8 6.0 5.6 6.8

August 72 112 133 112 109 111 73 107 91 80

5.8 7.9 9.2 7.1 7.4 7.5 4.7 7.2 7.0 6.5

September 57 110 98 135 103 97 110 109 121 84

4.6 7.8 6.8 8.5 7.0 6.6 7.1 7.4 9.3 6.8

October 123 152 139 160 126 121 154 173 144 105

9.8 10.8 9.6 10.1 8.6 8.2 9.9 11.7 11.1 8.5

November 92 132 97 152 134 115 150 138 108 117

7.4 9.3 6.7 9.6 9.1 7.8 9.7 9.3 8.3 9.5

December 66 87 91 124 72 51 110 79 106 52

5.3 6.2 6.3 7.8 4.9 3.5 7.1 5.3 8.2 4.2

Total 1249 1412 1444 1588 1472 1471 1549 1482 1297 1229

100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0


Public Health.




37

Figure 16: Numbers of drowning deaths in children <15 years in Thailand by month, 1999–2008

(10-year average)

020406080

100120140160180200

Janua

ry

Februa

ryMarc

hApri

lMay

June

July

August

Septem

ber

Octobe

r

Novem

ber

Decembe

r


Public Health.



Num

ber


38

Table 17: Numbers and percentage of drowning injuries in children <15 years admitted to hospital

in Thailand by month, 2005–2007

Month Year

2005 2006 2007

January 42 75 80

4.2 6.5 7.0

February 65 98 82

6.5 8.5 7.1

March 100 113 130

9.9 9.9 11.3

April 140 120 121

13.9 10.5 10.5

May 113 130 119

11.2 11.3 10.3

June 75 88 96

7.4 7.7 8.3

July 63 73 76

6.3 6.4 6.6

August 52 78 95

5.2 6.8 8.3

September 56 70 93

5.6 6.1 8.1

October 100 122 87

9.9 10.6 7.6

November 104 94 94

10.3 8.2 8.2

December 97 86 77

9.6 7.5 6.7

Total 1,007 1,147 1,150

100.0 100.0 100.0






39

Figure 17: Numbers of drowning injuries in children <15 years in Thailand by month, 2005–2007

(3-year average)

0

20

40

60

80

100

120

140

January

Februa

ryMarc

hApril

May June July

August

Septem

ber

October

November

December





Num

ber


40

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

1998 and 2007, the day of the week with the largest number of drowning injuries was Saturday,

followed by Sunday (see Table 18 and Figure 18).

Table 18: Percentage of severe drowning injuries* in children <15 years by day of the week,

1998–2007

Day Year**

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Sunday 18.2 21.3 17.2 21.5 19.6 16.3 18.9 19.1 18.2 20.6

Monday 10.2 10.3 12.3 14.0 12.2 8.3 9.9 9.7 12.2 15.1

Tuesday 13.6 9.2 13.0 11.4 11.9 11.5 10.9 11.5 13.6 9.7

Wednesday 14.8 13.8 10.4 12.7 11.4 11.5 13.2 11.3 11.4 11.4

Thursday 8.5 9.9 11.4 11.4 9.3 17.8 13.3 12.4 8.9 13.2

Friday 14.2 13.5 14.9 13.7 17.0 14.0 14.9 16.4 13.4 11.4

Saturday 20.5 22.0 20.8 15.3 18.6 20.6 18.9 19.6 22.3 18.6

Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0




2006, and 28 in 2007.



Compiled and Analyzed by: Kanjanee Dumnakkaew, Bureau of Epidemiology, Department of Disease Control,

Ministry of Public Health, Thailand.


41

Figure 18: Percentage of severe drowning injuries* in children <15 years by day of the week,

1998–2007 (10-year average)

0

5

10

15

20

25

Sunday Monday Tuesday Wednesday Thursday Friday Saturday







Perc

ent


42

Time of incident

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


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 19 and Figure 19).

Table 19: Percentage of severe drowning injuries* in children <15 years by time period of the day,

1998–2007

Time period Year**

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

00:00–02:59 3.0 3.0 3.7 2.4 3.6 5.6 2.5 1.1 2.3 3.5

03:00–05:59 0.0 0.8 0.3 1.0 0.3 0.0 0.0 0.0 0.3 0.0

06:00–08:59 2.3 6.0 7.1 4.7 5.1 3.8 3.9 5.0 4.4 2.7

09:00–11:59 10.7 16.2 15.9 17.2 14.8 15.5 17.6 18.9 16.8 21.8

12:00–14:59 30.8 24.2 26.0 24.6 24.4 27.6 28.8 25.1 30.2 27.4

15:00–17:59 39.6 39.6 33.8 36.0 34.5 39.3 36.3 41.2 38.2 34.5

18:00–20:59 13.0 7.2 11.8 11.4 12.9 7.9 10.3 8.4 7.5 9.2

21:00–23:59 0.6 3.0 1.4 2.7 4.4 0.3 0.6 0.3 0.3 0.9

Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0




2006, and 28 in 2007.






43

Figure 19: Percentage of severe drowning injuries* in children <15 years by time period of the day,


0

5

10

15

20

25

30

35

40

00:00

- 02

:59

03:00

- 05

:59

06:00

- 08

:59

09:00

- 11:5

9

12:00

- 14:5

9

15:00

- 17:5

9

18:00

- 20:5

9

21:00

- 23:5

9







Perc

ent


44

Location of drowning injuries Water sources



1998 and 2007, the sites where drowning deaths most frequently occurred were natural bodies of

water, accounting for 49.9% of all drownings, followed by swimming pools and bathtubs at

5.4% and 2.5%, respectively. In addition, the sites of drowning injuiries most frequently occurred

were natural bodies of water (48.2%), followed by swimming pools (6.0%), and bathtubs (3.8%)

(see Table 20).

Table 20: Percentage of severe drowning injuries* in children <15 years by type of water source,


Water source

(categorized according to ICD-10)**

Mortality Morbidity

Percent Percent

Accidental drowning and submersion while in a bathtub (W65) 1.5 2.5

Accidental drowning and submersion following fall into a bathtub (W66) 1.0 1.3

Accidental drowning and submersion while in a swimming pool (W67) 4.9 5.0

Accidental drowning and submersion following fall into a swimming pool (W68) 0.5 1.0

Accidental drowning and submersion while in natural water (W69) 42.9 39.9

Accidental drowning and submersion following fall into natural water (W70) 7.0 8.3

Other specified drowning and submersion (W73) 5.8 8.4

Unspecified drowning and submersion (W74) 36.4 33.6

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.






45

Site of drowning injuries



1998 and 2007, the sites where drowning injuries most frequently occurred were the houses or

the compounds of the house (33.4%), followed by paddy fields, farms, or gardens (15.9%)

(see Table 21).

Table 21: Percentage of severe drowning injuries* in children <15 years by type of incident site,

1998–2007

Site of incident 1998-2007

Percent

Houses and compounds of the houses 33.4

Paddy fields, farms, gardens 15.9

Schools or hospitals 2.5

Public sports arenas 1.6

Places of trade and services 0.9

Construction sites or factories 0.7

Roads or highways 0.5

Dormitories, prisons, nurseries, or military barracks 0.4

Others 40.3

Unspecified 3.8

Total 100.0








46

Risks of alcohol consumption According to the data regarding severe injuries collected at the Injury Surveillance


1.2% of children under 15 years of age who suffered drowning injuries had alcohol consumption

behavior; and 12.6% 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 6.6% were in the 5–9 age group and 0.6% in the 10–14 age group.

The youngest children who had drunk alcohol and drowned were only seven years old


Table 22: Percentage of severe alcohol-related drowning injuries* in children <15 years

by age group, 1998–2007 (10-year average)

Age group (years) Percentage of alcohol-related drownings

(1998–2007)

0–4 0.0

5–9 6.6

10–14 0.6

0–14 1.2

All age groups 12.6








47

Figure 20: Percentage of severe alcohol-related drowning injuries* in children <15 years by

age group, 1998–2007 (10-year average)

0

1

2

3

4

5

6

7

0-4 5-9 10-14

* Severe injuries refer to patients who died before arriving at the hospital, patients who died at the Emergency Room, and

patients who are admitted for observation and treatment at the hospital







Figure 21: Percentage of severe alcohol-related drowning injuries* in children <15 years and

all age groups by age group and gender, 1998–2007

0

2

4

6

8

10

12

14

16

18

0-14 all age groups

Male Female Total



Perc

ent

Perc

ent


48

Treatment According to the individual inpatients database of the Bureau of Policy and Strategy,

Ministry of Public Health, between 1999 and 2008 the average cost of medical care for drowning

injuries among children under 15 years of age admitted to hospital was 12,125 baht per person

(see Table 23).

When considering the lengths of hospital stay of the hospitalized children, it was

discovered that the mean length of stay was 4 days and the longest hospital stay was 201 days

(see Table 24).

Table 23: Medical care costs for children <15 years with drowning injuries admitted to hospital


Year Number of cases Total cost (Baht)

2005 1,007 14,815,104

2006 1,147 14,122,868

2007 1,150 11,122,555

Total (2005–2007) 3,304 40,060,527

Average cost/person/year 12,124.90

Data source: Individual inpatients database, Bureau of Policy and Strategy, Office of the Permanent Secretary,


Analyzed by: Bureau of Policy and Strategy, Office of the Permanent Secretary of the Ministry of Public Health.,


Table 24: Length of hospital stay for children <15 years with drowning injuries admitted to hospital


Year Average number

of days

Maximum number

of days

Standard deviation (SD)

2005 4.5 420 16.8

2006 3.5 92 7.1

2007 3.3 91 6.7

Average/child 3.8 201 10.2

Data source: Individual inpatients database, Bureau of Policy and Strategy, Office of the Permanent Secretary,


Analyzed by: Bureau of Policy and Strategy, Office of the Permanent Secretary of the Ministry of Public Health.,



49

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

Strategy between 1999 and 2008, for the drowning children under 15 years of age, most of them

(81.8%) were were rescued and taken to hospitals by their relatives/bystanders, followed by

officials of charity foundations (11.3%), officials of emergency medical service (EMS) units

(4.7%), and police officers (1.3%) (see Table 25 and Figure 22).

Table 25: Numbers and percentage of severe drowning injuries* in children <15 years in Thailand

by type of transport to hospital for treatment, 1998–2007

Persons who took injured children

to hospital

1998–2007

Number Percent

No one 14 0.9

Officials of EMS units 78 4.7

Officials of charity foundations 186 11.3

Police officers 22 1.3

Others such as relatives/bystanders, etc. 1,346 81.8

Total 1,646 100.0








50

Figure 22: Percentage of severe drowning injuries in children <15 years in Thailand by type of

transport to hospital for treatment, 1998–2007

11.3

1.3

4.7

81.8

0.9

No one Officials of EMS units

Officials of charity foundations Police officers

Others such as relatives/bystanders, etc.










51

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

Strategy between 1999 and 2008, more than half (61.0%) of the children with severe drowning

injuries died after being admitted to hospital. Furthermore, 31.5% died before arriving at hospital,

and 7.5% were pronounced dead at the emergency room (see Table 26 and Figure 23).

Table 26: Numbers and percentage of severe drowning injuries in children <15 years in

Thailand by place of death, 1998–2007

Place of death 1998–2007

Number Percent

Death before arriving at hospital 401 31.5

Death at the emergency room 95 7.5

Death after being admitted to hospital 775 61.0

Total 1,271 100.0








52

Figure 23: Percentage of severe drowning injuries in children <15 years in Thailand by place

of death, 1998–2007

61.0

7.5

31.5

Death before arriving at the hospital Death at the Emergency Room

Death after hospital admission










53

Chapter 3

Conclusions and Discussions

The data regarding drowning in Thailand that were used in the present analysis were

retrieved from three databases: the death certificates, the individual inpatients, and the Injury

Surveillance System (IS). The research team strived to retrieve the most recent data to the

extent possible. However, it is worth noting that each database has its own objectives, data

acquisition periods, and limitations in data acquisition. As a consequence, the data presented in

the present analysis vary in terms of duration of time and age groups of children. As for the

former, the data retrieved from the death certificates were presented in the time span of 10 years

(between 1999 and 2008), the data regarding individual inpatients were presented in the time

span of 3 years (between 2005 and 2007), and the data retrieved from the Injury Surveillance

System (IS) wee presented in the time span of 10 years (between 1998 and 2007). Regarding the

latter, only the data of drowned children under 15 years of age were presented because even though

the data stored in the databases were individual data, the analysis of the data in each database

was conducted using a program which categorized the children according to their age group.

Drowning-related mortality The analysis of child drowning surveillance data in Thailand has revealed that

drowning is the number one cause of fatalities in Thai children under 15 years of age, compared

to other causes of fatalities including infectious and non-infectious diseases. The number of children

who died from drowning was twice as high as the number of children who were killed in traffic

accidents and 24 times higher than the number of children who died from viral infectious diseases

including dengue hemorrhagic fever. (16, 17) Likewise, a community survey conducted by Chulalongkorn

University (18) has shown that more Thai children die from drowning than from infectious diseases

and other sicknesses. However, when considering the data from the Injury Surveillance System (IS),

it can be seen that drowning is second only to traffic accidents when it comes to child fatality.

This can be explained that the data stored in the Injury Surveillance System (IS) were the data

regarding children with serious injuries who were admitted to hospital. However, drowned

children were mostly pronounced dead at the sites of accidents and were not taken to hospital,

so they were not included in the databases.


54

Among the five leading causes of injury-related fatalities in children between 1999

and 2008, drowning ranked first, followed by road traffic injuries; accidental threats to breathing;

accidents caused by exposure to electric current, radiation, and temperature; and physical assaults.

Among children, drowning deaths accounted for 33.9%–4 6.5% of all injury deaths. The rate of fatal

child drownings was 7.7 to 11.5 per 100,000 children under 15 years, and each year the number

of child drowning deaths was 1,420, or 4 children per day (10-year average). When categorizing

data according to the cause of injury in different age groups in 2008, it was found that the

number one cause of fatalities in children under one year old was accidental threats to breathing

(4.9 per 100,000 children under 15 years), but the number one cause of fatalities in children

aged 1–4 years and 5–9 years was drowning (13.8 and 12.0 per 100,000 children under 15 years,

respectively). However, among children aged 10 years and over, the number one cause of death

was road traffic accidents. And for all age groups, the number one cause of fatalities was also

road traffic injuries (15.3 per 100,000 children under 15 years), followed by drowning (6.4 per

100,000 children under 15 years).

Trends in mortality

Over the past 10 years between 1999 and 2008, the drowning death rates per

100,000 children under 15 years in children under 15 years of age consistently increased from

7.7 and 11.5 between 1999 and 2006, before declining to 9.3 in 2008. This may have resulted

from the fact that around the end of 2006, the Ministry of Public Health began to publicize

the information on child drowning throughout the country through different media as well as

major events or festivals including flood disasters mitigation, Songkran festivals, Loy Kratong

festivals, and school breaks. Consequently, the public and private sectors have begun to realize

the significance of drowning prevention and become actively involved in the prevention of child

drowning.

Region

When considering the child drowning situation in different regions in Thailand,

it was discovered that the northeastern region had the highest rate of drowning deaths in children

under 15 years at 11.6 per 100,000 children under 15 years, followed by the central, northern,

and southern regions, at 9.1, 7.9, and 6.8 per 100,000, respectively. Furthermore, it was also found

that the trends in drowning deaths were in congruence with the trends for the whole country.

This may be explained that there are a large number of water sources in the northeastern region

of the country that are used for agricultural purposes. In addition, the children living in this region

are likely to have less access to swimming lessons, resulting in a higher child drowning incidence.


55

Provinces

The top ten provinces with the highest child drowning rates (per 100,000 children

under 15 years) in children under 15 years old that were included on the list for at least

3 consecutive years between 2004 and 2008 were Chachoengsao, Rayong, Nakhon Nayok,

Prachin Buri, and Nakhon Phanom. It is noteworthy that Chachoengsao is one of the top ten

provinces with a high child drowning rate for 5 consecutive years. In 2008, Prachin Buri had the

highest child drowning rate at 2.1.

However, when considering only the drowning fatalities that occurred between 2004

and 2008, it could be seen that Nakhon Ratchasima, Bangkok, Buri Ram, Ubon Ratchathani,

Surin, Si Sa Ket, Udon Thani, and Khon Kaen had the highest rates of child drowning deaths,

with the average rate (5-year average) of 70, 62, 51, 50, 48, 47, 45, and 44 per 100,000 children

under 15 years, respectively; and Nakhon Ratchasima had the highest child drowning rate

in 4 years (between 2005 and 2008), ranging from 59 to 82 per 100,000.

When considering the numbers together with the rates of child drowning fatalities

per 100,000 children under 15 years in 2004 to 2008, it could be seen that, among the ten provinces,

those with both highest rates and numbers were Surin, Si Sa Ket, Buri Ram, Phitsanulok,

Ratchaburi, Phetchabun, and Nakhon Pathom.

Gender

During the period of 10 years from 1999 to 2008, the rates of child drownings

(per 100,000 children under 15 years) for males were twice as high as those for females (10.1–14.3

for males and 5.3–8.6 for females). In 2008, the rate for males living in the southern region of

the country was about 2.5 times higher than that for females living in the same region.

Likewise, the findings of other studies conducted all over world have revealed that

drownings were more common in males than in females.(19) This may be because males are

more likely to be exposed to risk factors due to various reasons such as naughtiness, curiosity,

desire to swim alone, and preference for water sports, etc.(19-23)


56

Age

The average rate of drowning deaths between 1999 and 2008 in children aged 0–4 years

was slightly higher than those aged 5–9 years. Moreover, in 2005, the rate for the 5–9 age group

was higher than for the 1–4 age groupd. When considering the trends over the 10-year period,

it could be seen that the rate for the 5–9 age group remarkably increased.

When comparing the rate of accidental drowning fatalities in children under 15 years

of age with that for all age groups, it could be seen that the rate for children under 15 years

(7.7–11.5 per 100,000 children under 15 years) was higher than for all age groups (5.0–7.5

per 100,000 children under 15 years).

As regards children younger than 15 years of age, in 2008 it was found that those

aged 5–9 had the highest proportion of drowning deaths (40.9%), followed by those aged

0–4 years and 10–14 years (37.8% and 21.2%, respectively). When a comparison was made

across all age groups, it was discovered that the children under 15 years had the highest

pproportion (30.2%).

In 2008, in children under 10 years of age, the number of fatal drownings for boys

was about two times higher than that for girls. However, when the children became older

(aged 10–14 years), the number of boys who died from accidental drowning was similar to

that for girls; that means the number of fatal drownings for boys remarkably decreased, while that

for girls decreased slightly. Moreover, when analyzing the fatal drowning situation in all regions,

it was found that, for the toddler group (0–4 years), the mortality rate was highest in the central

region (14.7 per 100,000 children under 15 years). In the small children group (5–9 years),

the mortality rate was highest in the northeastern region (17.5 per 100,000 children under 15 years).

Finally, in the older group (10–14 years), there were no differences in the rates for all regions.

Mortality caused by accidental drowning among children in different age groups in

Thailand may be different from that in other countries to a certain extent. This is because in other

countries, the 0–4 age group had the highest mortality rate (19, 24, 25), followed by the 5–9 age group.

However, when considering the 10-year average, it could be seen that the drowning mortality rates

in Thai children aged 0–4 years and 5–9 years were not different. The trends were similar all over

the world. In other countries, when children became older (aged 10–14 years), the number of

accidental drowning deaths decreased, especially among boys, but the number of fatalities due to

road traffic accidents increased.


57

Morbidity caused by accidental drowning Between 2005 and 2007, the drowning morbidity rates per 100,000 children

under 15 years of age who were admitted to hospital ranged from 7.5 to 8.7. The children aged

0–4 years had the highest rates, followed by those in the 5–9 and 10–14 age groups. It is

noticeable that the morbidity rate in the 0–4 age group was two times higher than that for the

5–9 age group and five times higher than that for the 10–14 age group. The reason why the rate

was low was because the children who accidentally drowned would die within four minutes if

they were not immediately rescued (26). In addition, the 0–4 age group had a remarkably higher

morbidity rate than other age groups. This may be because accidental drowning in small

children is likely to occur at home or in the compound of the house, so it is easier for the parents

or caregivers to rescue the children and take them to hospital faster.

Case-fatality rate The case-fatality rate of child drowning between 1998 and 2007 ranged from 32.5%

to 48.2%, with the mean case-fatality rate in the 10-year span of 41.0%. This was considered

rather high compared to the case-fatality rates for other causes. However, such rate was lower

than the actual case-fatality rate as the data used in the analysis were the data regarding only

children with serious injuries who were admitted to hospital.

Time Months

Over the 10-year period between 1999 and 2008, the number of child drowning deaths

was highest in April, followed by May, March, October, and November, respectively. On average,

in the 10-year span, the number of children under 15 years of age who died from drowning

in April was 178, followed by March and May at 150, October at 140, and November at 124.

The findings also showed that the months with the highest injuries for the 10-year period were

also consistent with the months with the highest injuries from 2005 to 2007. Regarding the

3-year average, April saw the highest number of drowning injuries in children under 15 years (127),

followed by May (121), March (114), October (103), and November (97). It is noticeable that

the months with the highest incidents of child drowning are the months of school breaks,

especially summer breaks (March to May), with the total number of child drowning deaths of

almost 500.


58

Day and time

Between 1998 and 2007, the day with the highest incidents of severe child drowning

injuries was Saturday, followed by Sunday. Saturday and Sunday alone accounted for as high as

38.8% of all child drowning injuries. As regards the time of the day, the time period of the day

with the highest rate of child drowning injuries was from 15:00 to 17:59 hrs, followed by

12:00 noon to 14:59 hrs. These two periods alone, from 12:00 noon to 17:59 hrs, accounted for

as high as 64.2% of child drowning injuiries. This was in congruence with the findings reported

in other countries that child drowning injuiries occur more frequently during the summer season,

during the weekend, and in the afternoon.(21, 22, 27-30)

Location of drowning Water sources and places of drowning

During the 10-year span (between 1998 and 2007), most of the child drowning fatalities

occurred in natural bodies of water, making up 49.9%, followed by swimming pools and bathtubs

at 5.4% and 2.5%, respectively. Similarly, the places where drowning injuries occurred most

frequently were natural bodies of water (48.2%), followed by swimming pools and bathtubs

(6.0% and 3.8%, respectively).(1, 21, 31-34) The places where drownings most frequently occurred

were inside the house or in the compound of the house (33.4%), followed by rice fields, farms,

and gardens (15.9%).

Risk of alcohol consumption Between 1998 and 2007, 1.2% of the children under the age of 15 who suffered severe

drowning injuries had drunk alcohol. When considering the children younger than 15 years old

who suffered severe drowning injuries and had alcohol consumption behavior, it was found that

6.6% of them were children aged 5–9 years and 0.4% were those aged 10–14 years. The youngest

children who suffered from alcohol-related drowning injuries were only seven years old.

In the population of all age groups, 12.6% drank alcohol. When considering by gender,

it was found that more males suffered serious alcohol-related drowning injuries than females

in both the under-15 and all age groups. Such findings were consistent with those of other

alcohol-related drowning studies conducted abroad. This is because alcohol has an effect on

body balance and decision-making ability. A study carried out by Driscoll and colleagues (2004)

has indicated that individuals with a blood alcohol level of 0.10 g/100 ml have 10 times higher

risks of drowning than those who do not drink alcohol.(35-38)


59

Treatment According to the data between 2005 and 2007, the average cost of medical care for

children under 15 years old who were admitted to hospital due to drowning was 12,125 baht per

child. The mean length of hospital stay was 4 days, with the longest duration of 201 days. It is

worth noting that this is only the medical costs for hospitalization, but not including economic

losses due to other aspects.

Accessibility to treatment During the period of 10 years between 1998 and 2007, most (81.8%) of the children

under 15 years of age who drowned were rescued and taken to hospital by their relatives,

followed by officials of charity foundations (11.3%), officials of EMS units (4.7%), and police

officers (1.3%).

In addition, it was found that more than half (61.0%) of the drowning children younger

than 15 years died after they were admitted to hospital. Furthermore, 31.5% died before they

arrived at the hospital, and 7.5% were pronounced dead at the emergency room. It is noteworthy

that these data were only on children who were seriously injured and taken to hospital for

treatment, but did not include fatal drownings at the sites of accidents.


60


61

Chapter 4

Key Findings and Recommendations

This report on situation analysis of child drowning surveillance in Thailand has been

prepared based on an analysis of individual drowning data from three databases, namely

(1) the death certificates database, (2) the database for individual inpatients, and (3) the Injury

Surveillance System (IS). The first two databases are operated by the Bureau of Policy and

Strategy, Ministry of Public Health, while the third database is run by the Bureau of Epidemiology,

Department of Disease Control. Each database has its own objectives, data acquisition periods,

and limitations in data acquisition. The three databases were used in the analysis to ensure that

the data were as up to date as possible. It is noteworthy that, due to the aforementioned limitations,

this analysis was based on the data regarding drowning of only children under 15 years of age

with variations in terms of duration. This is not different from other studies carried out abroad

which also had limitations when reporting on drowning of individuals with different age groups

and durations. The findings of the present analysis can be summarized as follows:

Summary of major points Worldwide (children under 20 years of age)

According to the WHO’s Global Burden of Disease, drowning is one of the

10 leading causes of child fatalities, especially in the 5–9 and 10–14 age groups.

Each day, 480 children under 20 years of age die from drowning all over the world.

Approximately 2 to 3 million children and adolescents all over the world almost

die from drowning every year.

Infants can drown even in shallow water.

More than 98% of child drowning deaths occur in countries with a low or moderate

national income, commonly in open bodies of water such as lakes and streams. In high-income

countries, child drowning deaths most frequently occur in swimming pools.

According to WHO’s estimates of child drowning death rates (per 100,000 children

under 20 years), low- and middle-income countries in the WHO Western Pacific Region have

the highest rate (13.9), followed by the Africa Region (7.2), the Eastern Mediterranean Region (6.8),

and the South-East Asia Region (6.2). With regard to Thailand, the rate is 8.2, which is higher than

that for the South-East Asia Region.


62

A survey conducted by UNICEF on drowning mortality in children aged 0–17 years

in 5 countries in the Asia, including Bangladesh, China, the Philippines, Vietnam, and Thailand,

reveals that accidental drowning is the number one cause of mortality, followed by road traffic

injuries.

Worldwide (children under 15 years of age)

Among children under 15 years of age, 135,585 die from drowning all over the

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

In the WHO South-East Asia Region, the number of child drowning deaths is

32,744 per year, or 90 per day on average.

Thailand (children under 15 years of age)

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

in developed countries.

Drowning is the number one cause of death among Thai children compared to

other causes of fatality including infectious and non-infectious diseases.

The number of Thai children who died from drowning is about 2 times higher than

that from traffic accidents and 24 times higher than that from vector-borne viral diseases

including dengue hemorrhagic fever.

The proportion of child drowning deaths is 33.9%–46.5% of all injury-related

fatalities.

Among children under 15 years of age, 1,420 die from drowning each year,

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

The child drowning death rates between 1999 and 2008 ranged from 7.7 to 11.5

per 100,000 children under 15 years.

Child drownings steadily increased between 1999 and 2006 from 7.7 to 11.5

(per 100,000 children under 15 years) before declining in 2008 to 9.3.

The highest rate of child drowning deaths was noted in the northeastern region,

followed by the central, northern, and southern regions, respectively, with the rates of 11.6, 9.1,

7.9, and 6.8 per 100,000 children under 15 years in 2008, respectively.

Chachoengsao province was one of the top ten provinces with the highest rates

of child drowning in Thailand for 5 consecutive years (between 2004 and 2008).


63

Nakhon Ratchasima, Bangkok, Buri Ram, Ubon Ratchathani, Surin, Si Sa Ket,

Udon Thani, and Khon Kaen had the highest rates of child drowning fatalities (5-year average:

2004 to 2008), totaling 70, 62, 51, 50, 48, 47, 45, and 44 per 100,000 children under 15 years,

respectively.

Nakhon Ratchasima province had the highest rate of child drownings in the 4-year

period between 2005 and 2008, ranging from 59 to 82 per 100,000 children under 15 years.

The top ten provinces with the highest rates of drowning deaths (between 2004

and 2008) were Surin, Si Sa Ket, Buri Ram, Phitsanulok, Ratchaburi, Phetchabun, and Nakhon

Pathom.

The rate of child drownings in males was approximately two times higher than

that for females (between 1999 and 2008). However, when the children became older (aged 10–

14 years), the rate for males was similar to that for females. In other words, the incidents of

drowning declined remarkably in males but did slightly in females.

On average, the 0–4 age group ranked first for child drowning (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 drownings in children under 15 years of age is as high as

30.2% of all age groups.

The rate of child drowning deaths (per 100,000 children under 15 years) in the

0–4 age group is highest (14.7) in the central region while that in the 5–9 age group is highest

(17.5) in the northeastern region.

The rate of drowning deaths in children under 15 years of age who were admitted

to hospital (between 2005 and 2007) was 7.5 to 8.7 per 100,000 children under 15 years.

The rate of child drowning deaths was highest in the 0–4 age group, 2 times

higher than in the 5–9 age group and 5 times higher than in the 10–14 age group.

The case-fatality rate of drowning in children under 15 years of age (10-year

average: 1998 to 2007) was as high as 41.0%.

April had the highest number of child drowning deaths (10-year average: 1999 to

2008) at 178, followed by May and March at 150 and October at 140. All of these months are

during school breaks.

Weekends (Saturdays and Sundays) were the days with the highest incidents of

serious drowning injuries; the number for the 2 days alone accounted for 38.8% of all drowning

fatalities (10-year average: 1998 to 2007).

The time of the day with the highest incidents of serious drowning injuries was

between 15:00 and 17:59 hrs, followed by between 12:00 noon and 14:59 hrs, both periods

accounting for as high as 64.2% of all fatal drownings (10-year average: 1998 to 2007).


64

As regards water sources where drownings took place, natural bodies of water

were noted at 49.9%, followed by swimming pools and bathtubs at 5.4% and 2.5%, respectively

(10-year average: 1998 to 2007).

The most frequently found sites of downing accidents were the compounds of

the houses (33.4%), followed by paddy fields, farms, and gardens (15.9%) (10-year average:

1998 to 2007).

Among the children under 15 years of age who suffered serious drowning

injuries, 1.2% were alcohol-related.

The youngest children who had alcohol-related severe drowning injuries were

only seven years old.

The cost of medical care for children who were seriously injured and admitted to

hospital due to drowning was 12,125 baht per person per year (3-year average: 2005 to 2007).

The average duration of hospital stay of drowning children admitted to hospital

was as long as 201 days (3-year average: 2005 to 2007).

Most (81.8%) of the children admitted to hospital with severe drowning injuries

were taken to hospital by their relatives or bystanders (10-year average: 1998 to 2007), followed by

officials of charity foundations (11.3%).

Among child drowning deaths, as many as 61% died after being admitted to

hospital, whereas 31.5% died before arriving at hospital.

Recommendations 1. Efforts should be made for drowning prevention to be regarded as a national

policy as drowning is the number one cause of fatalities among Thai children.

2. Information on drowning should be publicized more widely through different media.

3. Drowning prevention campaigns should be continuously and consistently carried

out all year round, especially during school breaks when the drowning incidents are highest.

4. Surveys should be undertaken on water sources that pose a risk of drowning

in the households, neighborhoods, and communities.

5. Knowledge of drowning prevention should be disseminated and awareness of

this matter should be raised among the core target groups in the following aspects:

Parents and caregivers: making them aware of the necessity to give close and

constant care to small children as they are at high risk of drowning.

Children: training them in the survival swimming curriculum.

Parents and caregivers: educating them about correct methods for rescuing

drowning children.


65

6. Preventive measures against child drowning should be rigorously carried out in

high-risk provinces such as Chachoengsao, Surin, Si Sa Ket, Buri Ram, Phitsanulok, Ratchaburi,

Phetchabun, Nakhon Pathom, Nakhon Ratchasima, Bangkok, Ubon Ratchathani, Udon Thani,

and Khon Kaen.

7. Concrete measures should be devised for the management of natural bodies of water

which pose a high risk for drowning.

8. Research should be conducted to shed more lights on major issues such as the

causes of high drowning incidents in the northeastern region, the relationship between drowning

and alcohol consumption, and the decline in drowning incidents among older children.

Recommendations for development of surveillance systems Community-based surveillance systems should be developed to enable the communities

to utilize data to prevent and control child drowning in their localities. Village health volunteers

(VHVs) may be asked to take responsibility for compiling data to be sent to the public health

network for subsequent utilization by relevant communities and agencies to solve problems at

the local level. This is because the existing surveillance system aims to facilitate the utilization

of data on a large scale and it takes time to present the data compiled in each system as

the comprehensiveness and completeness of data need to be ensured; therefore, it is not timely

to solve local problems. Thus, there are certain limitations when such data are utilized at

the district or provincial level. In brief, if the communities are able to develop a community-based

surveillance system, it will considerably benefit the operations at the national level.


66


67

References


68

References

1. Peden M, Oyegbite K, Smith JO, Hyden AA, Branche C, Rahman AF, et.al. World report

on child injury prevention. Geneva (Switzerland): World Health Organization; 2009.

2. World Health Organization. The global burden of disease: 2004 update. (http://www.who.int/

healthinfo/global_burden_disease/2004_report_update/en/index.html, accessed 15 Sept 2009).

3. Linnan M. et al. Child mortality and injury in Asia: survey results and evidence. Florence,

UNICEF Innocenti Research Centre, 2007.

4. Ekchaloenkiet S and Gerdmongkolga S. Numbers and rates of child drowning deaths in

Thailand, 2006–2008 [unpublished]. Bureau of Non-communicable Diseases, Department

of Disease Control, Ministry of Public Health, 2009.

5. National Committee for Injury Prevention and Control. Injury Prevention: Meeting the

Challenge. New York: Oxford University Press; 1989.

6. Robertson LS. Injury Epidemiology. Oxford University Press, New York, 1992, 241.

7. Idris AH, Berg R, Bierens J, et al. Recommended guidelines for uniform reporting of data

from drowning: The Utstein Style. Circulation 2003; 108: 2565-74.

8. World Health Organization. International Classification of Diseases (ICD). (http://www.

who. int/ classifications/icd/en, accessed 15 Sept 2009).

9. Sublon A. Number, percentage and rate of deaths due to drowning. 1999–2008 [File].

Bureau of Policy and Strategy, Ministry of Public Health, 2009.

10. Termtor R. Individual inpatients database: 12 file report, 2005–2007 [File]. Bureau of Policy

and Strategy, Ministry of Public Health, 2009.

11. Dumnakkaew K. Injury Surveillance System (IS). 1998–2007 [File]. Bureau of Epidemiology,

Department of Disease Control, Ministry of Public Health.

12. Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health.

Trends in injuries and deaths releated to transportation accidents, 1998–2007. Bangkok:

Bureau of Epidemiology; 2008.

13. Bureau of Policy and Strategy, Ministry of Public Health. Summary illness report.

Bangkok: Printing Press of the War Veterans Organization of Thailand; 2008.

14. Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health.

Manual for data collection: provincial injury surveillance. Bangkok: Bureau of Epidemiology;

2008.

http://www.who.int/ healthinfo/global_burden_disease/2004_report_update/en/index.html, accessed 15 Sept 2009�

http://www.who.int/ healthinfo/global_burden_disease/2004_report_update/en/index.html, accessed 15 Sept 2009�

http://www/�


69

15. Bureau of Policy and Strategy, Ministry of Public Health. Public Health Statistics 2007.

Bangkok: Printing Press of the War Veterans Organization of Thailand; 2008.

16. Gerdmongkolgan S. Number, percentage and rate of deaths due to injuries. 2003–2007

[unpublished]. Bureau of Non-communicable Diseases, Department of Disease Control,

Ministry of Public Health, 2008.

17. Ekchaloenkiet S. The first literature review of childhood drowning. Bangkok: Printing

Press of the War Veterans Organization of Thailand, 2007.

18. Sitthi-amorn C, Chaipayom O, Udomprasertgul V, Linnan M, Dunn T, Beck , et al. The Thai

National Injury Survey. Bangkok: Institute of Health Research, Chulalongkorn University;

2006.

19. World Health Organization (WHO). WHO drowning fact sheet (http://www.who.int/entity/

violence_injury_prevention/publications/other_injury/ en/drowning factsheet.pdf, accessed

18 October 2005).

20. Krug E (Ed). Injury: A leading cause of the global burden of disease, Injury 1999. Geneva:

WHO.

21. Children Hospital Boston. Water safety: injury statistics & incidence rates (http://www.

childrenshospital.org, accessed 21 April 2006).

22. International Life Saving Federation. Drowning facts and figures. World Water Safety;

2004 (http://www.ilsf.org/about/drowning_statistics.htm, accessed 19 July 2005).

23. World Health Organization (WHO). Water-related diseases 2004 (http://www.who.int/water_

sanitation_health/diseases/drpwning/en, accessed 19 October 2005).

24. The Royal Life Saving Society Australia. National drowning report 2005 (http://www.

royallifesaving.com.au/uploads/res/29451.pdf, accessed 11 November 2005).

25. Foundation for Aquatic Injury Prevention (FAIP). Aquatic injury facts: drowning & near-

drowning accidents (http://www.aquaticisf.org/facts.htm, accessed 21 April 2006).

26. Vichitsoonthonkul K, Plitponkarnpim A and Mekmasin A. Risk factors of death due to

drowning in children, 2003–2002. Disease Control Journal; 29: 229–36.

27. Kids & Parents Resource on Health and Safety. Learn Prevention of Accidents: Drowning

(http://www.geocities.com/sssukhmeet/ prevention_accidents.html, accessed 9 July 2004).

28. See &Save watch kids around water. Talking Points and Statistics [online]. Child care licensing,

Texas Department of Family and Protective Services (http://www.dfps.state.tx.us/seeandsave/

statistics.asp, accessed 11 October 2005).

29. Foundation for Aquatic Injury Prevention (FAIP). Drowning and aquatic injury facts

(http://www.aquaticisf.org/facts2.htm, accessed 21 October 2006).

http://www.who.int/entity/ violence_injury_prevention/publications/other_injury/ en/drowning factsheet.pdf�

http://www.who.int/entity/ violence_injury_prevention/publications/other_injury/ en/drowning factsheet.pdf�

http://www.childrenshospital.org/�

http://www.childrenshospital.org/�

http://www.ilsf.org/about/drowning_statistics.htm�

http://www.who.int/water_ sanitation_health/diseases/drpwning/en, a�

http://www.who.int/water_ sanitation_health/diseases/drpwning/en, a�

http://www.royallifesaving.com.au/uploads/res/29451.pdf�

http://www.royallifesaving.com.au/uploads/res/29451.pdf�

http://www.aquaticisf.org/facts.htm�

http://www.geocities.com/sssukhmeet/prevention_accidents.html�

http://www.geocities.com/sssukhmeet/ prevention_accidents.html�

http://www.dfps.state.tx.us/seeandsave/ statistics.asp�

http://www.dfps.state.tx.us/seeandsave/ statistics.asp�

http://www.aquaticisf.org/facts2.htm�


70

30. The Royal Life Saving Society Australia. The New South Wales Drowning Report 2004

(http://www.royallifesaving.com.au/uploads/res/3_3991.pdf, accessed 14 October 2005).

31. World Health Organization. WHO drowning fact sheet (http://www.who.int/entity/violence_

injury_prevention/publications/other_injury/en/drowningfactsheet.pdf, accessed 18 October

2005).

32. U.S. Consumer Product Safety Commission (CPSC). How to plan for the unexpected:

preventing child drowning (http://www.cpsc.gov, accessed 21 April 2006).

33. Scott I. Australian reports. Injury Prevention 1998; 4: 321–2.

34. The Australian Water Safety Council (AWSC). National water safety plan 2004–2007,

2004 (http://www.watersafety.com.au, accessed 13 October 2005).

35. Lifesaving Society. Newfound and Labrador drowning trend 2005 (http://lifesaving.nfld.net/

2005%20Drowning%20Report.pdf, accessed 12 October 2005).

36. Smith GS, Kraus JF. Alcohol and residential, recreational, and occupational injuries:

A review of the epidemiologic evidence. Annu Rev of Public Health 1988; 9: 99–121.

37. Grenfell RD. Beach-related injuries. Med J Aust 1996; 166: 390.

38. Driscoll TR, Harrison JE, Steenkamp M. Review of the role of alcohol in drowning

associated with recreational aquatic activity. Inj Prev 2004; 10 (2): 107–13.

http://www.royallifesaving.com.au/uploads/res/3_3991.pdf�

http://www.who.int/entity/violence_ injury_prevention/publications/other_injury/en/drowningfactsheet.pdf�

http://www.who.int/entity/violence_ injury_prevention/publications/other_injury/en/drowningfactsheet.pdf�

http://www.cpsc.gov/�

http://www.watersafety.com.au/�

http://lifesaving.nfld.net/ 2005 Drowning Report.pdf�

http://lifesaving.nfld.net/ 2005 Drowning Report.pdf�


71

Appendixes


72

Appendix A

Drowning Statistics

Table A: Numbers and rates of child drowning deaths per 100,000 children <15 years (ICD-10

W65–W74) in children <15 years of age in Thailand by province, 2006–2008

Ran

k 2006 2007 2008

Province Number Rate Province Number Rate

Province Number Rate

Total 1482 11.08 Total 1297 9.80 Total 1229 9.39

1 Rayong 27 21.05 Nakhon Nayok 13 26.89 Prachin Buri 20 21.05

2 Sing Buri 8 20.77 Sing Buri 8 21.05 Surin 57 18.66

3 Prachin Buri 20 20.72 Ratchaburi 33 19.76 Nakhon Pathom 28 16.76

4 Phitsanulok 32 19.61 Trat 9 19.41 Nakhon Nayok 8 16.73

5 Uttaradit 16 18.07 Ang Thong 9 17.04 Nakhon Phanom 26 16.59

6 Phatthalung 19 17.63 Chachoengsao 23 16.74 Chachoengsao 22 16.13

7 Nakhon Phanom 28 17.43 Samut Sakhon 17 16.73 Sa Kaeo 19 15.75

8 Mukdahan 13 17.11 Rayong 21 16.13 Uttaradit 13 15.30

9 Chachoengsao 23 16.59 Ranong 7 16.07 Chanthaburi 15 14.69

10 Saraburi 21 16.34 Nakhon Phanom 25 15.76 Si Sa Ket 45 14.30

11 Chai Nat 10 16.23 Chanthaburi 16 15.47 Suphan Buri 22 13.78

12 Phang-nga 9 16.12 Saraburi 19 14.87 Chaiyaphum 30 13.33

13 Nong Bua Lam Phu 18 15.98 Sa Kaeo 18 14.79 Kamphaeng Phet 19 12.74

14 Sukhothai 18 15.60 Phetchaburi 13 14.64 Surat Thani 27 12.40

15 Khon Kaen 56 15.44 Surin 45 14.48 Buri Ram 43 12.38

16 Nakhon Ratchasima 82 15.29 Phetchabun 29 14.47 Kalasin 24 12.17

17 Phra Nakhon Si

Ayutthaya

23 15.21 Samut

Songkhram

5 14.23 Phitsanulok 19 11.99

18 Uthai Thani 10 15.05 Nong Bua Lam Phu 75 14.18 Nong Bua Lam Phu 62 11.88

19 Ang Thong 8 14.97 Phichit 15 13.90 Saraburi 15 11.82

20 Yasothon 17 14.92 Prachin Buri 13 13.59 Khon Kaen 41 11.82

21 Si Sa Ket 48 14.77 Udon Thani 45 13.44 Samut Sakhon 12 11.82

22 Phichit 16 14.58 Buri Ram 45 12.75 Ang Thong 6 11.51

23 Kanchanaburi 26 14.51 Nakhon Pathom 21 12.50 Ratchaburi 19 11.49

24 Kamphaeng Phet 22 14.42 Sukhothai 14 12.39 Loei 14 11.34

25 Lop Buri 21 14.41 Kanchanaburi 22 12.32 Rayong 15 11.31

26 Samut Songkhram 5 14.03 Nakhon Sawan 25 12.16 Nong Bua Lam Phu 12 11.04

27 Roi Et 38 13.68 Si Sa Ket 38 11.87 Uthai Thani 7 10.81

28 Chumphon 14 13.56 Pathum Thani 22 11.78 Kanchanaburi 19 10.65

29 Buri Ram 48 13.40 Yasothon 13 11.71 Ubon Ratchathani 43 10.51

30 Udon Thani 45 13.21 Nong Khai 23 11.38 Nong Khai 21 10.51


73


W65–W74) in children <15 years of age in Thailand by province, 2006–2008 (cont.)

Ran

k 2006 2007 2008



31 Ubon Ratchathani 55 13.09 Phra Nakhon Si

Ayutthaya

17 11.27 Nakhon Sawan 21 10.36

32 Sa Kaeo 16 13.03 Phayao 9 10.78 Sakhon Nakhon 25 10.24

33 Surin 41 13.01 Uthai Thani 7 10.69 Phetchabun 20 10.12

34 Nakhon Sawan 27 12.97 Loei 13 10.39 Chai Nat 6 10.11

35 Sakhon Nakhon 31 12.35 Chai Nat 6 9.92 Nan 9 10.10

36 Phetchaburi 11 12.27 Chon Buri 26 9.88 Roi Et 26 9.89

37 Kalasin 25 12.12 Prachuap Khiri

Khan

10 9.64 Phatthalung 10 9.48

38 Nong Khai 24 11.73 Krabi 10 9.45 Yasothon 10 9.24

39 Phayao 10 11.58 Ubon Ratchathani 39 9.38 Udon Thani 30 9.12

40 Prachuap Khiri

Khan

12 11.54 Phitsanulok 15 9.34 Trat 4 8.70

41 Phetchabun 23 11.30 Khon Kaen 33 9.30 Phayao 7 8.65

42 Loei 14 11.04 Trang 13 9.12 Phra Nakhon Si

Ayutthaya

13 8.62

43 Satun 8 10.77 Lamphun 6 9.07 Mukdahan 6 8.10

44 Nakhon Pathom 17 10.10 Nong Bua Lam

Phu

10 9.03 Nakhon Si

Thammarat

26 8.02

45 Chon Buri 26 10.06 Lop Buri 13 9.01 Sing Buri 3 8.00

46 Pathum Thani 18 9.95 Chumphon 9 8.80 Songkhla 24 7.80

47 Samut Sakhon 10 9.86 Chaiyaphum 20 8.74 Prachuap Khiri

Khan

8 7.73

48 Chiang Mai 30 9.76 Roi Et 23 8.51 Lop Buri 11 7.69

49 Samut Prakan 22 9.41 Yala 11 7.99 Krabi 8 7.48

50 Lampang 12 9.05 Kamphaeng Phet 12 7.95 Chon Buri 20 7.47

51 Ratchaburi 15 8.91 Surat Thani 17 7.83 Pattani 13 6.90

52 Nakhon Si

Thammarat

29 8.74 Phrae 6 7.77 Phetchaburi 6 6.81

53 Trat 4 8.54 Nan 7 7.62 Nonthaburi 13 6.63

54 Phuket 6 8.15 Phatthalung 8 7.51 Phichit 7 6.59

55 Songkhla 25 8.12 Maha Sarakham 14 7.45 Pathum Thani 12 6.27

56 Chanthaburi 8 7.64 Kalasin 15 7.44 Chiang Mai 18 6.05

57 Phrae 6 7.51 Pattani 14 7.43 Maha Sarakham 11 6.00

58 Surat Thani 15 6.92 Sakhon Nakhon 18 7.28 Samut Prakan 14 5.96

59 Chaiyaphum 16 6.89 Nonthaburi 14 7.21 Yala 8 5.83

60 Nonthaburi 13 6.75 Phang-nga 4 7.15 Samut Songkhram 2 5.79

61 Maha Sarakham 13 6.74 Uttaradit 6 6.92 Trang 8 5.68


74


W65–W74) in children <15 years of age in Thailand by province, 2006–2008 (cont.)

Ran

k 2006 2007 2008



62 Tak 9 6.49 Satun 5 6.72 Sukhothai 6 5.42

63 Chiang Rai 15 6.33 Mukdahan 5 6.66 Phrae 4 5.35

64 Nakhon Nayok 3 6.12 Songkhla 20 6.49 Chiang Rai 12 5.28

65 Suphan Buri 10 6.08 Lampang 8 6.28 Lampang 6 4.90

66 Mae Hong Son 4 6.00 Suphan Buri 10 6.17 Bangkok 51 4.70

67 Narathiwat 12 5.90 Bangkok 67 6.07 Lamphun 3 4.68

68 Bangkok 65 5.81 Samut Prakan 14 5.96 Chumphon 4 3.94

69 Yala 8 5.80 Nakhon Si

Thammarat

19 5.80 Phuket 3 3.85

70 Pattani 10 5.31 Narathiwat 11 5.39 Tak 5 3.55

71 Amnat Charoen 4 4.82 Phuket 4 5.30 Narathiwat 7 3.42

72 Krabi 5 4.76 Amnat Charoen 4 4.94 Satun 2 2.68

73 Lamphun 3 4.40 Chiang Mai 12 3.96 Amnat Charoen 2 2.53

74 Nan 4 4.23 Tak 5 3.58 Phang-nga 1 1.79

75 Trang 6 4.18 Chiang Rai 7 3.02 Mae Hong Son 1 1.53

76 Ranong 1 2.28 Mae Hong Son 0 0.00 Ranong 0 0.00

Source: Death certificates. Bureau of Policy and Strategy, Office of the Permanent Secretary, Ministry of Public Health

Analyzed by: Som Ekchaloemkiet and Suchada Gerdmongkolgan, Bureau of Non-Communicable Diseases, Department of

Disease Control, ministry of Public Health.


75

Table B: Numbers and rates of child drowning deaths per 100,000 children <15 years (ICD-10

W65–W74) in children under 15 years by province and gender, 2006

Province Sex 0-4 years 5-9 years 10-14 years <15 years

Total All 521 641 320 1482

Male 363 447 175 985

Female 158 194 145 497

Bangkok All 30 22 13 65

Male 20 15 9 44

Female 10 7 4 21

Samut Prakan All 14 6 2 22

Male 10 4 2 16

Female 4 2 0 6

Nonthaburi All 9 4 0 13

Male 6 4 0 10

Female 3 0 0 3

Pathum Thani All 11 4 3 18

Male 4 3 2 9

Female 7 1 1 9

Phra Nakhon Si Ayutthaya All 12 7 4 23

Male 8 6 3 17

Female 4 1 1 6

Ang Thong All 2 2 4 8

Male 1 0 4 5

Female 1 2 0 3

Lop Buri All 4 13 4 21

Male 3 10 2 15

Female 1 3 2 6

Sing Buri All 2 2 4 8

Male 1 2 2 5

Female 1 0 2 3

Chai Nat All 4 3 3 10

Male 2 2 2 6

Female 2 1 1 4

Saraburi All 8 10 3 21

Male 6 8 2 16

Female 2 2 1 5


76


W65–W74) in children under 15 years by province and gender, 2006 (cont.)


Chon Buri All 10 13 3 26

Male 8 10 0 18

Female 2 3 3 8

Rayong All 5 15 7 27

Male 3 11 5 19

Female 2 4 2 8

Chanthaburi All 2 5 1 8

Male 2 5 0 7

Female 0 0 1 1

Trat All 1 3 0 4

Male 1 3 0 4

Female 0 0 0 0

Chachoengsao All 14 6 3 23

Male 11 5 1 17

Female 3 1 2 6

Prachin Buri All 3 12 5 20

Male 2 10 3 15

Female 1 2 2 5

Nakhon Nayok All 1 2 0 3

Male 1 2 0 3

Female 0 0 0 0

Sa Kaeo All 6 7 3 16

Male 5 4 1 10

Female 1 3 2 6

Nakhon Ratchasima All 21 44 17 82

Male 14 23 3 40

Female 7 21 14 42

Buri Ram All 22 15 11 48

Male 17 13 5 35

Female 5 2 6 13

Surin All 14 19 8 41

Male 11 13 1 25

Female 3 6 7 16


77




Si Sa Ket All 13 20 15 48

Male 9 15 10 34

Female 4 5 5 14

Ubon Ratchathani All 15 28 12 55

Male 11 16 5 32

Female 4 12 7 23

Yasothon All 4 6 7 17

Male 2 6 3 11

Female 2 0 4 6

Chaiyaphum All 5 6 5 16

Male 3 4 2 9

Female 2 2 3 7

Amnat Charoen All 1 2 1 4

Male 1 0 1 2

Female 0 2 0 2

Nong Bua Lam Phu All 2 11 5 18

Male 1 9 3 13

Female 1 2 2 5

Khon Kaen All 17 27 12 56

Male 14 16 5 35

Female 3 11 7 21

Udon Thani All 14 19 12 45

Male 11 12 6 29

Female 3 7 6 16

Loei All 7 6 1 14

Male 2 2 0 4

Female 5 4 1 10

Nong Khai All 6 14 4 24

Male 4 8 3 15

Female 2 6 1 9

Maha Sarakham All 3 5 5 13

Male 3 5 2 10

Female 0 0 3 3


78




Roi Et All 9 21 8 38

Male 6 17 5 28

Female 3 4 3 10

Kalasin All 9 11 5 25

Male 6 6 2 14

Female 3 5 3 11

Sakhon Nakhon All 13 13 5 31

Male 12 8 2 22

Female 1 5 3 9

Nakhon Phanom All 11 11 6 28

Male 8 9 5 22

Female 3 2 1 6

Mukdahan All 3 6 4 13

Male 3 2 2 7

Female 0 4 2 6

Chiang Mai All 9 12 9 30

Male 8 8 4 20

Female 1 4 5 10

Lamphun All 0 2 1 3

Male 0 2 0 2

Female 0 0 1 1

Lampang All 0 9 3 12

Male 0 8 2 10

Female 0 1 1 2

Uttaradit All 3 9 4 16

Male 3 6 3 12

Female 0 3 1 4

Phrae All 0 2 4 6

Male 0 2 2 4

Female 0 0 2 2

Nan All 1 2 1 4

Male 1 2 1 4

Female 0 0 0 0


79




Phayao All 4 2 4 10

Male 4 0 2 6

Female 0 2 2 4

Chiang Rai All 10 3 2 15

Male 8 1 1 10

Female 2 2 1 5

Mae Hong Son All 2 0 2 4

Male 1 0 1 2

Female 1 0 1 2

Nakhon Sawan All 7 14 6 27

Male 3 11 4 18

Female 4 3 2 9

Uthai Thani All 2 8 0 10

Male 1 8 0 9

Female 1 0 0 1

Kamphaeng Phet All 8 11 3 22

Male 5 7 2 14

Female 3 4 1 8

Tak All 3 5 1 9

Male 2 3 1 6

Female 1 2 0 3

Sukhothai All 5 9 4 18

Male 3 7 4 14

Female 2 2 0 4

Phitsanulok All 4 18 10 32

Male 2 16 5 23

Female 2 2 5 9

Phichit All 5 9 2 16

Male 3 6 1 10

Female 2 3 1 6

Phetchabun All 5 12 6 23

Male 4 7 4 15

Female 1 5 2 8


80




Ratchaburi All 7 5 3 15

Male 3 4 1 8

Female 4 1 2 7

Kanchanaburi All 10 10 6 26

Male 6 4 5 15

Female 4 6 1 11

Suphan Buri All 7 3 0 10

Male 4 1 0 5

Female 3 2 0 5

Nakhon Pathom All 11 3 3 17

Male 8 3 2 13

Female 3 0 1 4

Samut Sakhon All 6 3 1 10

Male 4 1 1 6

Female 2 2 0 4

Samut Songkhram All 4 0 1 5

Male 4 0 1 5

Female 0 0 0 0

Phetchaburi All 3 7 1 11

Male 1 5 1 7

Female 2 2 0 4

Prachuap Khiri Khan All 4 7 1 12

Male 3 5 0 8

Female 1 2 1 4

Nakhon Si Thammarat All 11 11 7 29

Male 5 9 5 19

Female 6 2 2 10

Krabi All 3 2 0 5

Male 2 2 0 4

Female 1 0 0 1

Phang-nga All 3 3 3 9

Male 3 2 1 6

Female 0 1 2 3


81




Phuket All 1 4 1 6

Male 1 2 1 4

Female 0 2 0 2

Surat Thani All 10 4 1 15

Male 7 3 1 11

Female 3 1 0 4

Ranong All 0 0 1 1

Male 0 0 1 1

Female 0 0 0 0

Chumphon All 8 3 3 14

Male 5 3 1 9

Female 3 0 2 5

Songkhla All 9 10 6 25

Male 7 7 3 17

Female 2 3 3 8

Satun All 6 2 0 8

Male 5 2 0 7

Female 1 0 0 1

Trang All 2 3 1 6

Male 2 2 1 5

Female 0 1 0 1

Phatthalung All 8 8 3 19

Male 5 5 1 11

Female 3 3 2 8

Pattani All 4 3 3 10

Male 1 3 2 6

Female 3 0 1 4

Yala All 3 3 2 8

Male 3 2 2 7

Female 0 1 0 1

Narathiwat All 6 0 6 12

Male 4 0 5 9

Female 2 0 1 3

Source: Death certificates. Bureau of Policy and Strategy, Office of the Permanent Secretary, Ministry of Public Health.

Collected by: Suchada Gerdmongkolgan and Som Ekchaloemkiet, Bureau of Non-Communicable Diseases, Department of



82

Table C: Numbers of drowning deaths (ICD-10 W65–W74) in children under 15 years in Thailand

by province and gender, 2007


Total All 473 512 312 1297

Male 323 355 165 843

Female 150 157 147 454


Male 24 16 9 49

Female 10 5 3 18


Male 5 6 1 12

Female 1 1 0 2

Nonthaburi All 7 7 14

Male 6 0 3 9

Female 1 0 4 5


Male 8 3 3 14

Female 6 1 1 8


Male 6 3 5 14

Female 2 1 0 3


Male 3 3 1 7

Female 1 1 0 2


Male 5 4 1 10

Female 3 0 0 3

Sing Buri All 4 4 8

Male 2 0 1 3

Female 2 0 3 5


Male 0 2 1 3

Female 1 0 2 3


Male 2 7 4 13

Female 2 4 0 6


83


by province and gender, 2007 (cont.)



Male 8 7 4 19

Female 2 2 3 7

Rayong All 10 8 3 21

Male 4 5 3 12

Female 6 3 0 9


Male 3 5 1 9

Female 2 3 2 7

Trat All 3 5 1 9

Male 1 4 0 5

Female 2 1 1 4


Male 12 2 1 15

Female 3 1 4 8


Male 5 0 2 7

Female 3 2 1 6


Male 3 2 0 5

Female 2 1 5 8


Male 7 3 3 13

Female 1 3 1 5


Male 11 20 12 43

Female 6 11 15 32


Male 9 9 2 20

Female 4 9 12 25

Surin All 14 20 11 45

Male 11 12 4 27

Female 3 8 7 18


84





Male 6 18 6 30

Female 4 0 4 8


Male 10 9 4 23

Female 5 4 7 16


Male 1 5 2 8

Female 1 4 0 5


Male 5 11 0 16

Female 1 1 2 4

Amnat Charoen All 2 1 1 4

Male 2 1 0 3

Female 0 0 1 1


Male 3 1 2 6

Female 1 1 2 4


Male 10 10 5 25

Female 2 3 3 8


Male 9 16 4 29

Female 2 11 3 16

Loei All 1 8 4 13

Male 0 6 1 7

Female 1 2 3 6


Male 3 10 3 16

Female 2 4 1 7


Male 2 4 2 8

Female 3 0 3 6


85





Male 5 10 3 18

Female 3 2 0 5


Male 3 8 0 11

Female 0 3 1 4


Male 0 4 3 7

Female 1 5 5 11


Male 4 5 1 10

Female 3 5 7 15


Male 0 3 0 3

Female 0 0 2 2


Male 1 4 5 10

Female 1 0 1 2

Lamphun All 0 2 4 6

Male 0 0 1 1

Female 0 2 3 5

Lampang All 1 3 4 8

Male 0 2 3 5

Female 1 1 1 3


Male 2 3 0 5

Female 0 0 1 1

Phrae All 0 2 4 6

Male 0 2 2 4

Female 0 0 2 2

Nan All 1 3 3 7

Male 0 1 2 3

Female 1 2 1 4


86




Phayao All 3 5 1 9

Male 1 5 1 7

Female 2 0 0 2


Male 3 0 0 3

Female 1 2 1 4

Mae Hong Son All 0 0 0 0

Male 0 0 0 0

Female 0 0 0 0


Male 5 9 3 17

Female 3 3 2 8


Male 1 4 0 5

Female 0 2 0 2


Male 2 6 3 11

Female 0 1 0 1

Tak All 3 1 1 5

Male 1 1 1 3

Female 2 0 0 2

Sukhothai All 4 6 4 14

Male 2 2 3 7

Female 2 4 1 7


Male 3 4 3 10

Female 2 2 1 5

Phichit All 3 7 5 15

Male 2 6 3 11

Female 1 1 2 4


Male 7 10 2 19

Female 3 4 3 10


87





Male 12 3 3 18

Female 9 6 0 15


Male 9 6 1 16

Female 4 1 1 6


Male 5 3 1 9

Female 1 0 0 1


Male 5 4 2 11

Female 4 4 2 10


Male 8 3 0 11

Female 3 2 1 6


Male 2 1 0 3

Female 1 1 0 2


Male 4 4 2 10

Female 2 0 1 3


Male 5 1 2 8

Female 0 1 1 2


Male 10 4 2 16

Female 0 1 2 3

Krabi All 2 4 4 10

Male 2 2 2 6

Female 0 2 2 4


Male 2 1 0 3

Female 0 1 0 1


88




Phuket All 2 1 1 4

Male 2 0 1 3

Female 0 1 0 1


Male 7 3 1 11

Female 4 1 1 6

Ranong All 2 1 4 7

Male 1 0 2 3

Female 1 1 2 4


Male 3 2 3 8

Female 0 1 0 1


Male 6 5 3 14

Female 3 2 1 6

Satun All 3 1 1 5

Male 1 1 1 3

Female 2 0 0 2

Trang All 3 7 3 13

Male 1 5 1 7

Female 2 2 2 6


Male 4 3 1 8

Female 0 0 0 0


Male 2 4 3 9

Female 1 3 1 5

Yala All 4 4 3 11

Male 3 3 1 7

Female 1 1 2 4


Male 1 4 4 9

Female 1 0 1 2





89

Table D: Numbers of drowning deaths (ICD-10 W65–W74) in children under 15 years in Thailand

by province and gender, 2008


Total All 465 503 261 1229

Male 325 348 150 823

Female 140 155 111 406


Male 17 14 10 41

Female 5 3 2 10


Male 8 3 1 12

Female 1 1 0 2

Nonthaburi All 8 4 1 13

Male 5 3 1 9

Female 3 1 0 4


Male 6 1 0 7

Female 3 1 1 5


Male 4 4 1 9

Female 1 2 1 4


Male 3 1 0 4

Female 2 0 0 2


Male 2 3 4 9

Female 0 2 0 2

Sing Buri All 2 0 1 3

Male 1 0 1 2

Female 1 0 0 1


Male 2 0 0 2

Female 0 4 0 4


Male 5 5 1 11

Female 2 1 1 4


90





Male 6 4 1 11

Female 4 3 2 9

Rayong All 3 5 7 15

Male 2 5 5 12

Female 1 0 2 3


Male 2 7 1 10

Female 2 2 1 5

Trat All 2 1 1 4

Male 2 1 1 4

Female 0 0 0 0


Male 11 1 4 16

Female 2 3 1 6


Male 7 5 4 16

Female 3 1 0 4


Male 2 2 0 4

Female 3 1 0 4


Male 4 7 0 11

Female 3 3 2 8


Male 15 16 10 41

Female 7 10 4 21


Male 11 16 2 29

Female 4 8 2 14

Surin All 16 25 16 57

Male 14 12 10 36

Female 2 13 6 21


91





Male 10 13 6 29

Female 4 5 7 16


Male 3 18 5 26

Female 5 8 4 17


Male 0 2 2 4

Female 1 4 1 6


Male 3 16 3 22

Female 0 5 3 8

Amnat Charoen All 1 1 2

Male 1 1 0 2

Female 0 0 0 0


Male 1 5 1 7

Female 0 1 4 5


Male 7 11 5 23

Female 5 6 7 18


Male 9 6 3 18

Female 4 3 5 12

Loei All 4 8 2 14

Male 1 7 1 9

Female 3 1 1 5


Male 5 9 0 14

Female 4 2 1 7


Male 3 6 1 10

Female 1 0 0 1


92





Male 7 12 4 23

Female 1 1 1 3


Male 3 12 3 18

Female 2 3 1 6


Male 8 3 1 12

Female 3 5 5 13


Male 8 9 2 19

Female 0 4 3 7


Male 0 2 0 2

Female 1 1 2 4


Male 4 6 1 11

Female 5 0 2 7

Lamphun All 0 2 1 3

Male 0 1 1 2

Female 0 1 0 1

Lampang All 2 2 2 6

Male 2 2 1 5

Female 0 0 1 1


Male 2 4 2 8

Female 1 2 2 5

Phrae All 2 2 4

Male 2 2 0 4

Female 0 0 0 0

Nan All 2 4 3 9

Male 0 2 2 4

Female 2 2 1 5


93




Phayao All 3 1 3 7

Male 3 1 0 4

Female 0 0 3 3


Male 0 2 2 4

Female 2 3 3 8

Mae Hong Son All 1 1

Male 0 0 0 0

Female 1 0 0 1


Male 6 5 2 13

Female 3 3 2 8


Male 2 2 2 6

Female 0 1 0 1


Male 7 3 1 11

Female 3 3 2 8

Tak All 1 4 0 5

Male 1 3 0 4

Female 0 1 0 1

Sukhothai All 4 2 6

Male 3 0 2 5

Female 1 0 0 1


Male 4 3 3 10

Female 2 6 1 9

Phichit All 1 2 4 7

Male 1 1 3 5

Female 0 1 1 2


Male 6 3 3 12

Female 3 3 2 8


94





Male 7 4 3 14

Female 4 1 0 5


Male 5 4 1 10

Female 5 3 1 9


Male 9 5 1 15

Female 4 1 2 7


Male 15 3 1 19

Female 5 3 1 9


Male 3 3 2 8

Female 1 2 1 4


Male 2 0 0 2

Female 0 0 0 0


Male 2 2 0 4

Female 0 0 2 2


Male 2 2 2 6

Female 1 0 1 2


Male 7 7 4 18

Female 3 2 3 8

Krabi All 5 1 2 8

Male 4 1 1 6

Female 1 0 1 2


Male 1 0 0 1

Female 0 0 0 0


95




Phuket All 1 1 1 3

Male 1 1 1 3

Female 0 0 0 0


Male 11 6 1 18

Female 5 1 3 9

Ranong All 0 0 0 0

Male 0 0 0 0

Female 0 0 0 0


Male 0 2 2 4

Female 0 0 0 0


Male 7 7 5 19

Female 2 2 1 5

Satun All 1 1 0 2

Male 1 1 0 2

Female 0 0 0 0

Trang All 1 4 3 8

Male 1 4 2 7

Female 0 0 1 1


Male 3 4 0 7

Female 0 3 0 3


Male 0 5 3 8

Female 2 1 2 5

Yala All 2 3 3 8

Male 1 2 2 5

Female 1 1 1 3


Male 2 3 0 5

Female 0 1 1 2





96

Appendix B

WHO regions and Member countries

WHO regions and Member countries (in 2004) African Region (46 Member States)

Low-income and middle-income

Algeria Lesotho

Angola Liberia

Benin Madagascar

Botswana Malawi

Burkina Faso Mali

Burundi Mauritania

Cameroon Mauritius

Cape Verde Mozambique

Central African Republic Namibia

Chad Niger

Comoros Nigeria

Congo Rwanda

Cote d’lvoire Sao Tome and Principe

Democratic Republic of the Congo Senegal

Equatorial Guinea Seychelles

Eritrea Sierra Leone

Ethiopia South Africa

Gabon Swaziland

Gambia Togo

Ghana Uqanda

Guinea United Republic Tanzania

Guinea-Bissau Zambia

Kenya Zimbabwe


97

WHO regions and Member countries (in 2004) – cont. Region of the Americas (35 Member States) High-income Antigua and Barbuda Canada

Bahamas United States of America

Barbados

Low-income and middle-income Argentina Haiti

Belize Honduras

Bolivia Jamaica

Brazil Mexico

Chile Nicaragua

Colombia Panama

Costa Rica Paraguay

Cuba Peru

Dominica Saint kitts and Nevis

Dominican Republic Saint Lucia

Ecuador Saint Vincent and the Grenadines

El Salvador Suriname

Grenada Trinidad and Tobago

Guatemala Uruguay

Guyana Venezuela

WHO regions and Member countries (in 2004) – cont. South-East Asia Region (11 Member States) Low-income and middle-income Bangladesh Myanmar

Bhutan Nepal

Democratic People’s Republic of Korea Sri Lanka

India Thailand

Indonesia Timor-Leste

Maldives


98

WHO regions and Member countries (in 2004) – cont. European Region (51 Member States) High-income Andorra Luxembourg

Austria Malta

Belgium Monaco

Denmark Netherlands

Finland Norway

France Portugal

Germany San Marino

Greece Slovenia

Iceland Spain

Ireland Sweden

lsrael Switzerland

ltaly United Kingdom

Low-income and middle-income Albania Moldova

Armenia Poland

Azerbaijan Romania

Belarus Russian Federation

Bosnia and Herzegovina Serbia and Montenegro

Bulgaria Slovakia

Croatia Tajikistan

Czech Republic The former Yugoslav Republic

Estonia of Macedonia

Georgia Turkey

Hungary Turkmenistan

Kazakhstan Ukraine

Kyrgyzstan Uzbekistan

Latvia


99

WHO regions and Member countries (in 2004) – cont. Eastern Mediterranean Region (22 Member States)

High-income Bahrain Qatar

Cyprus United Arab Emirates

Kuwait

Low-income and middle-income Afghanistan Oman

Djibouti Pakistan

Egypt Saudi Arabia

Iraq Somalia

Islamic Republic of lran Sudan

Jordan Syrian Arab Republic

Lebanon Tunisia

Libyan Arab Jamahiriya Yemen

Morocco

WHO regions and countries (in 2004) Western Pacific Region (27 Member States) High-income Australia New Zealand

Brunei Darussalam Republic of Korea

Japan Singapore

Low-income and middle-income Cambodia Niue

China Palau

Cook lslands Papua New Guinea

Federated States of Micronesia Philippines

Fiji Samoa

Kiribati Solomon lslands

Lao People’s Democratic Republic Tonga

Malaysia Tuvalu

Marshall lslands Vanuatu

Mongolia Viet Nam

Nauru


100

Appendix C

Index

accessibility to treatment: 59 International Statistical Classification of Disease

admit/admitted: 11 and Related Health Problem (ICD-10): 10

age: 25, 56 Morbidity: 10, 30, 57

alcohol consumption: 3, 4, 11, 46, 58, 65 mortality: 10, 15, 53

case-fatality rate: 2, 33, 57, 63 site of drowning injuries: 45

child: 10 road traffic injuries: 6, 15, 18, 30, 54, 62

cost of medical care: 3, 11, 48, 59, 64 location of drowning: 11, 44, 58

data from death certificates: 12 sex/gender: 23, 55

data on individual inpatients: 9, 12 time: 35, 42, 57, 58

drowning: 10 water sources: 44, 58

Global Burden of Disease: 5, 61 WHO regions and countries: 7, 96

injury/severe injury: 10

Injury Surveillance System (IS): 1, 9, 13, 33,

40, 42, 44, 45, 46, 53, 61


101

Appendix D

Report Preparation Team

Advisors Dr. Prapon Tangsrikertikul Deputy Director General, Department of Disease Control

Dr. Panuwat Pankret Director, Bureau of Non-communicable Diseases,

Department of Disease Control

Dr. Tairjing Siriphanich National Human Rights Commission

Research team members Mrs. Suchada Gerdmongkolgan Bureau of Non-communicable Diseases,

Department of Disease Control, Ministry of Public Health

Ms. Som Ekchaloemkiet Bureau of Non-communicable Diseases,


Mrs. Auraphin Sublon Bureau of Health Policy and Strategy,

Ministry of Public Health

Mrs. Roongjit Termtor Bureau of Health Policy and Strategy,


Mrs. Kanjanee Dumnakkaew Bureau of Epidemiology, Department of Disease Control,


Cover design Ms. Thitima Khuntasin Bureau of Non-communicable Diseases,


Financial support World Health Organization (WHO)

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

Translator

Mr. Cha-Krit Sirohit

Documents

SITUATION ANALYSIS - thaincd.comthaincd.com/document/file/download/knowledge/Situation_Analysis_of... · Acknowledgements This report, entitled “Situation Analysis of Child Drowning