Willingness to administer mouth-to-mouth ventilation in a first response program in rural Bangladesh.

BACKGROUND: Timely mouth-to-mouth ventilation is critical to resuscitate drowning victims. While drowning is frequent, there are no lay persons trained in cardio-pulmonary resuscitation (CPR) in rural Bangladesh. As part of a feasibility study to create a first response system in a conservative Islamic village environment, a pilot was undertaken to examine willingness to provide mouth-to-mouth ventilation for drowning resuscitation. METHODS: A questionnaire was administered to 721 participants at the beginning of a village-based CPR training course. Trainees were asked regarding willingness to administer mouth-to-mouth ventilation on a variety of hypothetical victims. Responses were tabulated according to the age, sex and relationship of the trainee to the postulated victim. RESULTS: Willingness to deliver mouth-to-mouth ventilation was influenced by sex of a potential recipient and relationship to the trainee. Adolescent participants were significantly more willing to perform mouth-to-mouth ventilation on someone of the same sex. Willingness increased for both sexes when the postulated victim was an immediate family member. Willingness was lower with extended family members and lowest with strangers. Adult trainees were more likely to perform mouth-to-mouth ventilation than adolescent trainees in any scenario. CONCLUSION: Adults express more willingness to resuscitate a broader range of drowning victims than adolescents. However in rural Bangladesh, adolescents are more likely to be in close proximity to a drowning in progress. Further efforts are needed to increase willingness of adolescents to provide resuscitation to drowning victims. However, despite potential cultural limitations, trained responders appear to be willing to give mouth-to-mouth ventilation to various recipients. Final determination will require evidence on response outcomes which is being collected.

Does teaching children to swim increase exposure to water or risk-taking when in the water? Emerging evidence from Bangladesh.

BACKGROUND: SwimSafe, a basic swimming and safe rescue curriculum, has been taught to large numbers of children in Bangladesh. Teaching swimming potentially increases risk if it increases water exposure or high-risk practices in water. This study compares water exposure and risk practices for SwimSafe graduates (SS) with children who learned swimming naturally. METHODS: Interviewers obtained detailed water exposure histories for the preceding 48 h from 3936 SS aged 6-14 and 3952 age-matched and sex-matched children who had learned swimming naturally. Frequencies of water exposure and water entries for swimming or playing were compared. RESULTS: There were 9741 entries into water among the 7046 participants in the 48 h prior to interview. About one-third (31.2%) had no water entries, one-tenth (10.5%) entered once, half (49.2%) entered twice and a tenth (9.1%) entered three or more times. Proportions of children in each group were similar. About 99.5% of both groups only entered the water for bathing. For those entering to swim or play, the mean number of entries was similar (SS 1.63, natural swimmer (NS) 1.36, p=0.40). Swimming or playing alone in the water was rare (1 SS, 0 NS). CONCLUSIONS: Most water exposure for children is for bathing. Less than 1% swam or played in the water during the 48 h recall period (0.6% SS, 0.4% NS). Learning swimming in SwimSafe did not increase water exposure nor did it increase water entry for playing or swimming compared with children who learned to swim naturally.

Children reporting rescuing other children drowning in rural Bangladesh: a descriptive study.

BACKGROUND: SwimSafe, a basic swimming and safer rescue curriculum, has been taught to large numbers of Bangladeshi children since 2006. This study examines the frequency and characteristics of rescues reported by children who graduated from SwimSafe and compares them with age-matched and sex-matched children who did not participate in SwimSafe. METHODS: Interviews were conducted during the swimming season in Raiganj, Bangladesh. Data were collected from 3890 SwimSafe graduates aged 6-14. Two age-matched and sex-matched controls were selected; one who had learned to swim naturally, the other who had not learned to swim. RESULTS: 188 rescues were reported by the three groups. The 12-14-year age groups reported the highest monthly rate of rescues (SwimSafe 10.5/100 000 (95% CI 3.4 to 24.5), natural swimmers 8.5/100 000 (95% CI 2.2 to 21.2)) and annual rate of rescue reported (SwimSafe 25.4/100 000 (95% CI 13.2 to 43.9), natural swimmers 35.4/100 000 (20.8 to 56.2)). Reported rescue numbers among both swimming groups was similar. Mean victim age was 4.1 years and 92.5% were under 7 years. All victims were younger than their rescuer (mean 5.9 years less). Most rescues (73.7%) took place in ponds or ditches with most (86.6%) within 10 m of the bank. Most victims had entered the water to bathe (53.8%). A large majority of reported rescues (90.9%) were conducted with the rescuer in the water, half requiring the rescuer to swim. CONCLUSIONS: Children report frequent drowning rescues of younger children in rural Bangladesh. Most reported are contact rescues with the rescuer in the water. Formal training for in-water rescue techniques may be needed to reduce the risk to the child rescuer.

Feasibility of a first responder programme in rural Bangladesh.

OBJECTIVES: To develop and implement a first responder training programme, assess the feasibility of training lay persons with low literacy in rural Bangladesh and determine the acceptability of the programme in the community. METHODS: A first responder training programme including cardiopulmonary resuscitation (CPR) was developed covering 20 villages in a rural sub-district in north-central Bangladesh. 2398 participants received training and 2120 graduated over a 14-month period. Responders were a mix of adolescents, community volunteers and community elders. The programme was evaluated through post-training assessment of knowledge and skills of participants and performance evaluation of trainers. A focus group discussion was used to assess the response of community leaders to usefulness and community acceptance of the programme. RESULTS: Materials developed for training include a low-literacy training manual, posters and a training video. Almost 90 per cent (88.4) of participants qualified in post training assessment. Adolescents and community volunteers had higher pass rates than community elders. In all, CPR skills showed a significant decline over 9 months of assessment, while first aid knowledge appeared stable over the same period. Community leaders considered the programme useful for the community and expressed their support for the programme. CONCLUSION: Developing a first responder training programme that includes CPR in a rural Bangladesh community is feasible if participants have secondary school attainment. Adolescents and young adults are suitable candidates. Evaluation is ongoing to see whether the programme graduates were able to reduce morbidity and mortality through effective first response efforts.