The SwimSafe program arose out of a four part series of research and program development activities undertaken over the last six years.
Process One: Critical examination of child drowning in low and middle income countries (LMICs) to learn how child drowning differed from recreational settings in high income countries (HIC). Also included in this process was the determination that there exists a natural method of swimming that confers protection from drowning in LMICs.
Process Two: Careful characterization of the natural swimming method and the development of a structured training process to allow its safe training and acquisition. This process defined the SwimSafe survival swimming technique and the training methodology.
Process Three: A rigorous, controlled trial of the safety of SwimSafe survival swimming training and the effectiveness of SwimSafe in protection against drowning
Process Four: Developing SwimSafe as a public health intervention that could provide protection from drowning in large populations of children in LMICs
These processes are summarised below.
The first step was to characterise child drowning in LMICs which was completed as part of The Alliance for Safe Children’s (TASC) six national and provincial surveys on injury conducted in Bangladesh, Thailand, Vietnam, the Philippines, Cambodia and in Beijing Municipality and Jiangxi Province, China.
The surveys were undertaken at the community level in a representative sample population that totaled 750,000 households with over two million respondents. All incidents of fatal and nonfatal drowning in the three years prior to the survey were identified and the “who, why, how and where” for each drowning was captured.
The results showed that child drowning in LMICs was fundamentally different from those in children in HICs. LMIC drowning resulted from multiple daily exposures to the many water hazards children were exposed to as part of their daily lives and rarely from recreational water exposure. It occurred entirely in ditches, ponds, rivers and other water bodies present at or near the child’s home and varied in frequency with the seasonal rains that increased the water bodies in the environment.
Each of these community-based surveys also examined whether there was a natural swimming technique that effectively prevented drowning. In order to achieve this, a structured process was implemented that determined parental knowledge of children’s swimming ability and then tested whether those children identified by their parents as natural swimmers were protected against drowning.
The operational definition of swimming ability used to define natural swimming ability was a positive response from a parent to the question of whether a child who fell into a pond that was 25 metres across and deeper than the child’s height, would be able to move through the water to the other side and climb out. No specific stroke or other movement technique was mentioned, in order to capture the broadest range of potentially effective swimming methods.
A case-control study, nested in each of the larger national and provincial injury surveys, then tested the effectiveness of the natural swimming ability identified by the parent. The cases were children found to have drowned in the three year period preceding the survey. The controls were age- and sex- matched children who had not drowned and were alive at the time of the survey.
The case-control studies showed in each survey that there was a positive association with swimming ability as defined by parents as being able to swim and a reduction of drowning mortality in the children who were reported by their parent to have that ability.
NOTE – All national injury surveys were completed by TASC and collaborating country organisations. The national injury reports for Thailand and Bangladesh can be found at the TASC website.
Qualitative and quantitative anthropologic research was undertaken in rural Bangladesh. It defined the process of learning natural swimming by children and described the techniques used for natural swimming as well as the techniques used to teach it.
Following completion of the anthropologic research, the Royal Life Saving Society – Australia (RLSSA) worked with the Centre for Injury Prevention and Research, Bangladesh (CIPRB) to describe the various strokes and movements and develop a training process that most effectively and safely these skills within a structured curriculum.
After this, a training program that utilised existing water bodies in villages (ponds) was developed and a cohort of community swimming instructors were trained in the process by CIPRB, RLSSA, TASC and the Bangladesh Swimming Federation. This marked the formal beginnings of the SwimSafe survival swimming program.
TASC and RLSSA worked with CIPRB and UNICEF Bangladesh to incorporate the SwimSafe program into a broader child injury prevention project called PRECISE. The intervention project had a population of over 800,000 persons with over 350,000 children. This provided a large enough number of children in a real world setting in rural Bangladesh to allow a randomised, controlled trial of the effectiveness and safety of the SwimSafe survival swimming program.
Over the course of three years between 2006 and 2009; 28,000 children were trained in SwimSafe survival swimming with no deaths or serious injuries, providing needed evidence of the safety of the training program based on the SwimSafe curriculum.
The effectiveness in drowning prevention was documented by a comparison of drowning rates among three groups that were matched for age, sex and village of residence: 1) those trained in SwimSafe; 2) those untrained in SwimSafe but learned natural swimming; and 3) those untrained in SwimSafe and who had not learned natural swimming. The analysis provided statistically significant results that SwimSafe was both safer and more effective.
NOTE – This information is based on the ‘PRECISE End of Project Technical Report’ which will be in print early October 2009.
During the third year of the Bangladesh trial, the SwimSafe curricula was adapted for use in water bodies in northern Thailand and tested in a reservoir setting in rural Chiang Rai with the College of Public Health, Chulalongkorn University. Additional adaptations for a standardized methodology that provided high training throughputs were provided by the Thai Life Saving Society.
More recently, in June 2009, the adaptation and use of the curricula in portable pools and beaches has been implemented with operational research in Danang Vietnam, with TASC, RLSSA, the Hanoi School of Public Health and the Safe Danang Project Office. The portable pool model has also been introduced in Thailand, with SwimSafe classes commencing in urban Samut Prakan province and rural Chiang Rai in November 2009.
Over this period, RLSSA and TASC have worked together to organize the curricula (both Basic and Advanced) into a standardised academic format, using the RLSSA Swim and Survive materials as a template for the instructional materials.
This series of sequential research endeavours undertaken over the last six years culminated in the completion of the SwimSafe curriculum, which is based on the results of the research and has been tested and shown to be both safe and effective in the prevention of drowning in children in Asia.
In the coming years the SwimSafe program will use this curriculum to teach the children of LMICs countries the water safety and survival swimming skills that will help reduce the incidence of drowning; the single leading cause of child (age 1-17) death in Asia.