The association between water, sanitation and hygiene (WASH) conditions and drowning in Bangladesh.

The present study investigated associations between water, sanitation and hygiene (WASH) factors and fatal and non-fatal drowning events in Bangladesh. Here, we report findings from a large household survey (89,700) conducted in Barisal Division of Bangladesh. Univariate analyses showed that the use of surface water rather than piped water was associated with an increased risk of both fatal and non-fatal drowning events. Additionally, increased risk of non-fatal drowning events was associated with shared toilet facilities, lack of toilet facilities and non-cemented flooring such as bamboo and wood. The WASH measures reduce the need to access exposure to open water, thus reducing drowning events.

Complexity in Implementing Community Drowning Reduction Programs in Southern Bangladesh: A Process Evaluation Protocol.

Living and geographical conditions in Bangladesh expose children to a high risk of drowning. Two programs operating in the Barishal Division of Bangladesh aim to reduce drowning risk through the provision of crèches (Anchal) and swim and rescue classes (SwimSafe). Anchal provides a safe environment with early childhood education to children aged 1⁻5 years old, while SwimSafe teaches children aged 6⁻10 years old basic swimming and rescue skills. Despite evidence for their effectiveness, it is unclear under which conditions these programs best operate. This protocol describes a project that seeks to conduct a process evaluation and gender analysis to identify implementation inefficiencies and contextual considerations for improved sustainability of the programs. A mixed- method approach using both qualitative and quantitative data will be used. Quantitative program data will be analysed to measure program utilisation, delivery and reach, while qualitative data will be collected via key informant in-depth interviews (IDIs), focus group discussions (FGDs) and observations. The process evaluation of the Anchal and SwimSafe programs provides an opportunity for implementers to identify practical strategies to improve program delivery and improve contextual adaptability of these programs. Furthermore, the findings may provide guidance to other implementers aiming to deliver community-based programs in rural lower-middle income contexts.

Lightning Injury is a disaster in Bangladesh? - Exploring its magnitude and public health needs.

Background: Lightning injury is a global public health issue. Low and middle-income countries in the tropical and subtropical regions of the world are most affected by lightning. Bangladesh is one of the countries at particular risk, with a high number of devastating lightning injuries in the past years, causing high mortality and morbidity. The exact magnitude of the problem is still unknown and therefore this study investigates the epidemiology of lightning injuries in Bangladesh, using a national representative sample. Methods: A mixed method was used. The study is based on results from a nationwide cross-sectional survey performed in 2003 in twelve randomly selected districts. In the survey, a total of 819,429 respondents from 171,336 households were interviewed using face-to-face interviews. In addition, qualitative information was obtained by reviewing national and international newspaper reports of lightning injuries sustained in Bangladesh between 13 and 15 May 2016. Results: The annual mortality rate was 3.661 (95% CI 0.9313-9.964) per 1,000,000 people. The overall incidence of lightning injury was 19.89/100,000 people. Among the victims, 60.12% (n=98) were males and 39.87% (n=65) were females. Males were particularly vulnerable, with a 1.46 times increased risk compared with females (RR 1.46, 95% CI 1.06-1.99). Rural populations were more vulnerable, with a 8.73 times higher risk, than urban populations (RR 8.73, 95% CI 5.13-14.86). About 43% of injuries occurred between 12 noon and 6 pm. The newspapers reported 81 deaths during 2 days of electric storms in 2016. Lightning has been declared a natural disaster in Bangladesh. Conclusions: The current study indicates that lightning injuries are a public health problem in Bangladesh. The study recommends further investigations to develop interventions to reduce lightning injuries, mortality and related burden in Bangladesh.