Epidemiology of adulthood drowning deaths in Bangladesh: Findings from a nationwide health and injury survey

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Life in Bangladesh exposes adults and children to may water bodies for daily household needs, and as a result drowning is common. In Bangladesh, due to lack of systemic data collection, drowning among adults is unknown; most research is focused on childhood drowning. The aim of the present study was to explore the epidemiology of adulthood drowning deaths in Bangladesh. Methodology: A nationwide cross-sectional survey was conducted from January to December in 2003 among 171,366 rural and urban households, with a sample of 819,429 individuals to determine the epidemiology of adulthood drowning in Bangladesh. Results: Annual fatal drowning incidence among adults was 5.85/100,000 individuals. Of these, 71.4% were male and 28.6% were female (RR 2.39). In total, 90% of the fatalities were from rural areas. Rural populations were also found to have a 8.58 times higher risk of drowning than those in urban areas. About 95% of drowning occurred in natural water bodies. About 61.6% of the deaths occurred at the scene followed by 33.5% at the home. Of the drowning fatalities, 67% took place in water bodies within 100 meters of the household. Among the drowning fatalities 78.4% occurred in daylight between 7.00 and 18.00. Over 97% of the victims were from poor socio economic conditions with a monthly income tk. 6,000 ($94) or less. Only 25.5% of incidences were reported to the police station. Conclusions: Every year a significant number of adults die due to drowning in Bangladesh. Populations living in rural areas, especially men, were the main victims of drowning. This survey finding might help policy makers and scientists to understand the drowning scenario among adults in Bangladesh." } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/6-589", "name": "Epidemiology of adulthood drowning deaths in Bangladesh: Findings..." } } ] } Home Browse Epidemiology of adulthood drowning deaths in Bangladesh: Findings... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Hossain MJ, Biswas A, Mashreky SR et al. Epidemiology of adulthood drowning deaths in Bangladesh: Findings from a nationwide health and injury survey [version 1; peer review: 3 approved, 2 approved with reservations] . F1000Research 2017, 6 :589 ( https://doi.org/10.12688/f1000research.10980.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article Epidemiology of adulthood drowning deaths in Bangladesh: Findings from a nationwide health and injury survey [version 1; peer review: 3 approved, 2 approved with reservations] Mohammad Jahangir Hossain https://orcid.org/0000-0002-6220-5808 1 , Animesh Biswas 1 , Saidur Rahman Mashreky https://orcid.org/0000-0001-7892-798X 1,2 , Fazlur Rahman 1,2 , Aminur Rahman 1 Mohammad Jahangir Hossain https://orcid.org/0000-0002-6220-5808 1 , Animesh Biswas 1 , [...] Saidur Rahman Mashreky https://orcid.org/0000-0001-7892-798X 1,2 , Fazlur Rahman 1,2 , Aminur Rahman 1 PUBLISHED 27 Apr 2017 Author details Author details 1 Centre for Injury Prevention and Research, Dhaka, Bangladesh 2 Department of Epidemiology, Bangladesh University of Health Sciences, Dhaka, Bangladesh OPEN PEER REVIEW DETAILS REVIEWER STATUS Abstract Background: Annual global death due to drowning accounts for 372,000 lives, 90% of which occur in low and middle income countries. Life in Bangladesh exposes adults and children to may water bodies for daily household needs, and as a result drowning is common. In Bangladesh, due to lack of systemic data collection, drowning among adults is unknown; most research is focused on childhood drowning. The aim of the present study was to explore the epidemiology of adulthood drowning deaths in Bangladesh. Methodology: A nationwide cross-sectional survey was conducted from January to December in 2003 among 171,366 rural and urban households, with a sample of 819,429 individuals to determine the epidemiology of adulthood drowning in Bangladesh. Results: Annual fatal drowning incidence among adults was 5.85/100,000 individuals. Of these, 71.4% were male and 28.6% were female (RR 2.39). In total, 90% of the fatalities were from rural areas. Rural populations were also found to have a 8.58 times higher risk of drowning than those in urban areas. About 95% of drowning occurred in natural water bodies. About 61.6% of the deaths occurred at the scene followed by 33.5% at the home. Of the drowning fatalities, 67% took place in water bodies within 100 meters of the household. Among the drowning fatalities 78.4% occurred in daylight between 7.00 and 18.00. Over 97% of the victims were from poor socio economic conditions with a monthly income tk. 6,000 ($94) or less. Only 25.5% of incidences were reported to the police station. Conclusions: Every year a significant number of adults die due to drowning in Bangladesh. Populations living in rural areas, especially men, were the main victims of drowning. This survey finding might help policy makers and scientists to understand the drowning scenario among adults in Bangladesh. READ ALL READ LESS Keywords fatal, drowning, adult, Bangladesh. Corresponding Author(s) Mohammad Jahangir Hossain ( [email protected] ) Close Corresponding author: Mohammad Jahangir Hossain Competing interests: No competing interests were disclosed. Grant information: BHIS was financially supported by UNICEF, Bangladesh. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Copyright: © 2017 Hossain MJ et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The author(s) is/are employees of the US Government and therefore domestic copyright protection in USA does not apply to this work. The work may be protected under the copyright laws of other jurisdictions when used in those jurisdictions. Data associated with the article are available under the terms of the Creative Commons Zero "No rights reserved" data waiver (CC0 1.0 Public domain dedication). How to cite: Hossain MJ, Biswas A, Mashreky SR et al. Epidemiology of adulthood drowning deaths in Bangladesh: Findings from a nationwide health and injury survey [version 1; peer review: 3 approved, 2 approved with reservations] . F1000Research 2017, 6 :589 ( https://doi.org/10.12688/f1000research.10980.1 ) First published: 27 Apr 2017, 6 :589 ( https://doi.org/10.12688/f1000research.10980.1 ) Latest published: 27 Apr 2017, 6 :589 ( https://doi.org/10.12688/f1000research.10980.1 ) Introduction Drowning is the process of experiencing respiratory impairment from submersion or immersion in liquid, and the outcomes are classified as death, morbidity and no morbidity 1 . Drowning is an important but neglected public health issue that affects children and youths in many societies worldwide 2 , 3 . Following road traffic and injury sustained from falls, drowning is the 3 rd leading cause of injury death in the world, claiming 42 lives every hour and 372,000 lives a year, which is almost two thirds attributed to malnutrition and over half of malaria 2 . Of all drowning deaths more than 90% occur in low and middle income countries where individuals are exposed to water during daily life 3 – 5 . According to the WHO (2014), drowning contributes to 7% of all injury-related annual deaths worldwide 6 . South-East Asian countries are considered the most affected region with 2.49 million disability adjusted life years as a result of death and disability from drowning 7 . Bangladesh is a low-lying, riverine country located in the subtropical region of South Asia and bordering with the Bay of Bengal. Its tropical monsoon climate is characterized by heavy rainfall and melting snow in the Himalayan territory, leading to large rivers, such as the Ganga, Brahmaputra and Meghna. The country has a landmass of 147,570 square kilometers and is one of the most densely inhabited countries in the world with a population of 160 million. Daily life in Bangladesh exposes people to water bodies, such as ponds, ditches, rivers, canals and the ocean, which are used for daily household needs, including agriculture, fishing and transportation. As a result, drowning effects all ages of the Bangladeshi population. Most research on drowning conducted in Bangladesh has focused on childhood drowning 8 – 10 . In Bangladesh, there is no established routine mortality registration system 11 , which, combined with inadequacy of research 12 , results in unknown drowning deaths among the adult population. To design an appropriate preventive measure for reducing adult drowning, it is important to determine the nationwide burden of drowning. Drowning mostly occurs among the rural populations 8 , so community-based household survey data is important. The objective of this study was to estimate fatal adult drowning in Bangladesh and its variation by sex, place of residence, and seasonality using a nationally representative survey. Methods Data for this study was extracted from Bangladesh Health and Injury Survey (BHIS), which was conducted during January and December 2003. The following methodology details how the survey data were collected. Study design This was a nationwide community based cross-sectional study. Study population The study population were from 12 randomly selected districts, namely Thakurgaon, Serajgonj, Sherpur, Narsinghdi, Hobigonj, Comilla, Shariatpur, Jessore, Khulna, Pirojpur, Chittagong and Rangamati. The study also covered Dhaka Metropolitan City of Bangladesh. In total, 819,429 individuals were covered in this nationwide study. By using multi-stage cluster sampling technique, a total of 171,366 households were selected; 88,380 form rural areas, 45,183 from district towns and 37,803 from Dhaka Metropolitan city. There are several upazilas (sub districts) in each district. Populations covered in the upazila level was considered as rural population. From each district one upazila was randomly selected. An upazila comprises a number of unions, which is the lowest administrative unit of an upazila, comprising about 20,000 population. From each upazila, two unions were selected randomly and each union was considered as a cluster of this survey. All households in the selected unions were included in the survey. All 12 selected district headquarters and Dhaka Metropolitan City were considered as urban area. In the urban areas, mohalla served as cluster. Mohalla is the lowest part of the city corporation. Each mohalla constituted about 400–500 households. Systematic sampling method was applied to achieve the required number of households. Case ascertainment Individuals 18 years and above who drowned resulting in a fatality were included as a case. Data collection and interview Forty-eight full time data collectors were selected for the data collection and six supervisors were employed for the supervision and monitoring of the data collection process. All data was collected through face-to-face interviews. All selected data collectors and supervisors were trained in collecting data from individuals. Due to the availability at the household level, mothers were preferred as primary respondent in this survey. However, if the mother was not available, the most knowledgeable members of the household were considered as respondents. Where possible, the head of household and as many members of the household as possible, were present to corroborate or add detail to the respondent’s interview answers. For the identification of any mortality or morbidity cases in the household, screening forms were used. A household member was defined as someone living in the same house, including domestic helpers or long-term guests who shared daily meals and participated in regular activities within the household. For mortality information, respondents were asked about any deaths over the period of last two years, and for morbidity information, respondents were asked about any illness had occurred over the period of last 6 months. If any illnesses/deaths were identified, the interviewer proceeded with further clarification regarding the injuries. Structured questionnaires were used to identify drowning death, and drowning related data was extracted for further analysis. Distance between household of living and drowning site was determined by asking to the respondent, if the site is near to the household then data collector measured it visually. Repeat visits were made to the households where respondents were unavailable during the first visit. In spite of repeated attempts, 2.7% of households could not be interviewed. A total of 166,766 households completed participation in the study. Statistical analysis Data related to drowning death were extracted from the main data set. As the recall period was over the last two years, only data from the last year was taken for analysis. Standard descriptive statistics were used to analyze the characteristics of adulthood drowning. Mean, standard deviation (SD), and proportion were used where appropriate. Drowning deaths were presented by gender, age, seasonality and place of residence. Age was categorized into seven groups ( Figure 1 ). Rates were calculated with 95% confidence intervals (CI). Relative risk (RR) was calculated to compare the drowning risks in different age groups, place of residence, and gender using open EPI-Info software ( http://www.openepi.com/Menu/OE_Menu.htm ). The methodology has been described elsewhere 13 – 15 . Figure 1. Age wise annual incidence of fatal adult drowning in Bangladesh. Results Incidence of drowning in Bangladesh In this nationwide cross sectional survey, the annual incidence of drowning fatalities was found to be 5.85/100,000 (95% CI 4.14-8.14) in individuals aged 18 and over. Among the drowning fatalities, 71.40% were male and 28.60% were female. Males were found to be 2.39 times higher at risk than females (RR 2.399; 95% CI 1.04-5.49). Among the victims, 90% were from rural areas and 10% from urban areas. In addition, rural populations were found to have be at an 8.58 times higher risk of drowning than individuals living in the urban areas (RR 8.58; 95% CI 2.47-29.80). The mean age was 46.70 years (SD ± 21.90) ranging from 18 to 95 years. Populations aged over 60 years were found to be 3.60 times higher at risk of drowning compared with the combined populations with ages ranging from 18 to 60 years (RR 3.6; 95% CI 1.14 to 9.15) ( Figure 1 and Table 1 ). Table 1. Risk factors of fatal drowning among adults in Bangladesh. Category Frequency Rate per 100,000 individuals/year RR (95% CI) P value Sex Male 20 8.19 2.39 (1.04-5.49) 0.01 Female 8 3.41 1 Place Rural 25 10.31 8.52 (2.46-29.48) 0.000004 Urban 3 1.2 1 Age 60 + years 6 18.12 3.6 (1.14-9.15) 0.005 18–60 years 22 4.94 1 Place of drowning Around 95% of the drowning occurred in natural water bodies, whereas only 5% of fatalities occurred in a place other than a natural water source. About 61.6% of the deaths occurred at the scene followed by 33.5% at the home and 5% in hospital following rescue from water. Distance of the drowning site Of the drowning fatalities, 67% of the incidences took place in water bodies within 100 meters of the household and about 33% of the drowning incidence occurred in water bodies that were over 100 meters of distance from the household. Time of drowning Among the drowning fatalities, 78.4% occurred among in daylight between 07:00 and 18:00, and 21.5% of drowning occurred between 18:00 and 06:00 ( Table 2 ). Table 2. Details of fatal drowning among adults in Bangladesh (n=28). Occupation Frequencies (n) Percentages (%) Student 1 2.0 Farmer 5 18.9 Service (working on regular salary) 5 16.5 Daily laborer 5 17.7 Business 1 5.0 Unemployed 9 30.7 House wife 1 4.2 Other 1 5.0 Place of residence Urban 3 10.0 Rural 25 90.0 Activities prior drowning Bathing 12 44.1 Working (washing clothes) 4 8.9 Travelling (passenger) 2 7.0 Other 4 14.0 Unknown 7 26.0 Time of drowning Midnight to 6 am 2 6.2 6 am to 12 noon 11 40.2 Noon to 6 pm 11 38.4 6 pm to midnight 4 15.3 Distance of place of drowning from home 1 – 5 meters 4 13.9 6 – 10 meters 5 16.5 11 – 20 meters 2 8.9 21 – 50 meters 3 11.2 51 – 100 meters 5 16.5 100+ meters 8 28.4 Unknown 1 4.6 Swimming ability Yes 18 62.8 No 7 26.5 Unknown 3 10.7 Place of death On spot 17 61.5 Home 10 33.5 Hospital 1 5.0 Reported to the police station Yes 7 25.5 No 21 74.5 Swimming ability Among the causalities, 62.8% could swim ( Table 2 ). Swimming ability was defined by reference to ‘‘survival swimming’’ skills (ability to swim 25m) 16 . Seasonality of drowning The study findings revealed that drowning incidences were relatively low during the winter season (November to February). The incidence increased during March and September, which are considered as summer and monsoon season. The incidence peaked during March and April ( Figure 2 ). Figure 2. Seasonality of fatal drowning among adults in Bangladesh. Others factors Over 97% of the victims were from poor socio economic conditions with a monthly income of tk. 6,000 ($94) or less. Only 25.5% of the incidences were reported to the police station. Among the drowning fatalities, pre-diagnosed individuals with epilepsy and those that were mentally ill totaled 9.6% and 9.9%, respectively. Discussion In Bangladesh, natural and man-made water sources are commonly located in close proximity of households, especially in rural areas. People use these water sources for daily household needs, such as irrigation, fish farming, bathing, swimming, animal feeding and washing clothes. In addition to this, a large number of the population use water transport for regular travelling and goods carrying. As a result, regular exposure to water bodies is very high. Bangladeshi population are experiencing massive destructive natural disasters, such as floods and cyclones, frequently, which often cause a high number of unexpected drowning deaths ( https://en.wikipedia.org/wiki/List_of_Bangladesh_tropical_cyclones ). In this study, the main three causes of death due to drowning were bathing, working and travelling. The survey findings revealed that the annual drowning fatality among adults aged 18 years and above is 5.85/100,000 individuals, which means annually about 8,195 fatal drownings take place among the adult population of Bangladesh. Of these 5,851 are male and 2,344 are female. Adult males were found to be 2.39 times higher at risk of drowning than females in this study. Our findings of higher risk among the male population are similar to other studies on drowning from other countries 3 , 17 , 18 . Individuals aged over 60 years were found to be 3.5 times at a higher risk than those aged between 18 and 60 years. The reasons behind that could be due to lack of a water supply in rural areas; therefore, people use natural water bodies as a source of water for daily regular activities and older populations are not under supervision. Similar findings were also observed in a study conducted among US populations between 1999 and 2010 19 . Drowning is always sudden, unexpected and often fatalities occur at the scene of the water bodies. As a result, drowned individuals need emergency medical support on the site immediately when rescued from the water. Like most developing countries, emergency medical help is absent, particularly in rural areas, of Bangladesh 20 , 21 . In this study, 61.5% of the drowning incidents ended with fatality at the scene of drowning. Findings in Finland suggested that around 24% causalities ended with fatality at the scene 22 . In addition, of those who were rescued alive (38.5%) from water bodies only 20% sought medical care from the hospital. This suggested that rural populations do not consider receiving medical care following drowning. The study findings show that among the drowning fatalities 56.1% took place in water bodies that were over 20 meters far the household, whereas the same survey finding shows that about 80% of child fatalities due to drowning took place within 20 meters of the household 23 . In rural Bangladesh, households are located near water bodies so that getting water is easy for daily household needs. As a result exposure to water is very high for both adults and children. As in most developing countries, injury incidences are poorly reported to the police station by the relatives of the victims 24 . The survey findings identified that only 25% of cases were reported to the police station following drowning fatalities. Drowning is not a new event concerning injury, like road traffic or machine injury, instead it is an issue that has occurred for thousands of years among populations living near water sources. Rural populations consider drowning as a part of a natural death and pre-decided ‘God’s will 25 ; as a result relatives of the drowning victims start the burial process immediately after fatal drowning occurs. Unless the drowning incident was intentional, relatives of the victim do not report the death to the police station or any other agencies to avoid further investigation about the death. Many high income countries reduced drowning rates by introducing effective interventions 1 . This paper describes the epidemiological situation of adulthood drowning in Bangladesh so as to explore people’s perceptions on drowning and to design effective interventions for the adult population further research is needed. In addition, this paper might draw the attention to the policy makers to design possible preventive measures. Conclusions Adult drowning is an important, but neglected, public health issue in Bangladesh, especially in populations living in the rural areas. Every year a significant number of unwanted and preventable adult drowning fatalities occur in Bangladesh. The current survey findings might help policy makers and scientists to understand the epidemiology and the risk factors leading to adult drowning in Bangladesh. Data availability BHIS data is stored at the Department of Public Health Science and Injury Prevention of CIPRB. Due to sensitivity of the data (contains identifying information), permission is required from the ethical committee for sharing data with a third party. Data can be requested from the Department of Public Health Science and Injury Prevention of CIPRB, who will contact the ethical review committee to gain approval to share the data. The conditions for gaining data access are a formal request with a clear objective and formal permission from the ethical committee. Please contact Dr Saidur Rahman Mashreky ( [email protected] ) in order to request the data. Ethics and consent Ethical approval for the collection of the BHIS data was obtained from the Ethical Committee of the Institute of Child and Mother Health, Dhaka (ref: ICMH/ECR/2002/009). During conduction of the survey all participants were informed about the objectives and benefits of the study. As the sample was over 800,000 individuals, only oral consent was obtained from each of the household head before proceeding the interview. Author contributions Authors FR and AR designed this nationwide study. Authors MJH, AB, SRM and AR reviewed literatures, analyzed surveyed data and prepared the manuscript. Competing interests No competing interests were disclosed. Grant information BHIS was financially supported by UNICEF, Bangladesh. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Acknowledgements We are gratefully acknowledge the contribution of UNICEF, TASC, ICMH and DGHS for this study. Special thanks to Tom Mecrow for reviewing and editing the manuscript. Faculty Opinions recommended References 1. van Beeck EF, Branche CM, Szpilman D, et al. : A new definition of drowning: towards documentation and prevention of a global public health problem. Bull World Health Organ. 2005; 83 (11): 853–6. PubMed Abstract | Free Full Text 2. Rahman A, Giashuddin SM, Svanström L, et al. : Drowning--a major but neglected child health problem in rural Bangladesh: implications for low income countries. Int J Inj Contr Saf Promot. 2006; 13 (2): 101–5. PubMed Abstract | Publisher Full Text 3. World Health Organization: Global report on drowning preventing a leading killer. 2014. Reference Source 4. World Health Organization: Drowning Prevention in the South-East Asia Region–2014. 2014. Reference Source 5. Fact sheet about drowning. 2000. Reference Source 6. World Health Organization: Drowning, Fact sheet no. 347. Geneva; 2014. Reference Source 7. World Health Organization: The Global Burden of Disease: 2004 update. 2008; 2010 . Reference Source 8. Rahman A, Mashreky SR, Chowdhury SM, et al. : Analysis of the childhood fatal drowning situation in Bangladesh: exploring prevention measures for low-income countries. Inj Prev. 2009; 15 (2): 75–9. PubMed Abstract | Publisher Full Text 9. Ahmed MK, Rahman M, van Ginneken J: Epidemiology of child deaths due to drowning in Matlab, Bangladesh. Int J Epidemiol. 1999; 28 : 306–11. PubMed Abstract | Publisher Full Text 10. Iqbal A, Shirin T, Ahmed T, et al. : Childhood mortality due to drowning in rural Matlab of Bangladesh: magnitude of the problem and proposed solutions. J Health Popul Nutr. 2007; 25 (3): 370–6. PubMed Abstract | Free Full Text 11. Baqui AH, Black RE, Arifeen SE, et al. : Causes of childhood deaths in Bangladesh: results of a nationwide verbal autopsy study. Bull World Health Organ. 1998; 76 (2): 161–71. PubMed Abstract | Free Full Text 12. Sethi D, Zwi A: Challenge of drowning prevention in low and middle income countries. Inj Prev. 1998; 4 (2): 162. PubMed Abstract | Publisher Full Text | Free Full Text 13. Mashreky SR, Hossain MJ, Rahman A, et al. : Epidemiology of electrical injury: findings from a community based national survey in Bangladesh. Injury. 2012; 43 (1): 113–6. PubMed Abstract | Publisher Full Text 14. Hossain J, Biswas A, Rahman F, et al. : Snakebite Epidemiology in Bangladesh — A National Community Based Health and Injury Survey. Health. 2016; 8 : 479–86. Publisher Full Text 15. Biswas A, Dalal K, Hossain J, et al. : Lightning Injury is a disaster in Bangladesh? - Exploring its magnitude and public health needs [version 1; referees: 3 approved, 1 approved with reservations]. F1000Res. 2016; 5 : 2931. PubMed Abstract | Publisher Full Text | Free Full Text 16. The Royal Life Saving Society Australia: Swimming & lifesaving: water safety for all Australians. Sydney: Elsevier Mosby; 2004. Reference Source 17. Donson H, Van Niekerk A: Unintentional drowning in urban South Africa: a retrospective investigation, 2001–2005. Int J Inj Contr Saf Promot. 2013; 20 (3): 218–26. PubMed Abstract | Publisher Full Text 18. Meel BL: Drowning deaths in Mthatha area of South Africa. Med Sci Law. 2008; 48 (4): 329–32. PubMed Abstract | Publisher Full Text 19. Xu J: Unintentional drowning deaths in the United States, 1999–2010. NCHS Data Brief. 2014; (149): 1–8. PubMed Abstract 20. Razzak Ja, Kellermann AL: Emergency medical care in developing countries: is it worthwhile? Bull World Health Organ. 2002; 80 (11): 900–5. PubMed Abstract | Free Full Text 21. Hossain M, Rahman A, Dalal K, et al. : Effects of Emergency Injury Care (EIC) Training for the Community Volunteers in the Rural Community of Bangladesh. Int J Trop Dis Heal. 2016; 19 (1): 1–7. Publisher Full Text 22. Vähätalo R, Lunetta P, Olkkola KT, et al. : Drowning in children: Utstein style reporting and outcome. Acta Anaesthesiol Scand. 2014; 58 (5): 604–10. PubMed Abstract | Publisher Full Text 23. Rahman A, Mashreky SR, Chowdhury SM, et al. : Analysis of the childhood fatal drowning situation in Bangladesh: exploring prevention measures for low-income countries. Inj Prev. 2009. 15 (2): 75–9. PubMed Abstract | Publisher Full Text 24. Dandona R, Kumar GA, Ameer MA, et al. : Under-reporting of road traffic injuries to the police: results from two data sources in urban India. Inj Prev. 2008; 14 (6): 360–5. PubMed Abstract | Publisher Full Text | Free Full Text 25. Rahman A, Shafinaz S, Linnan M, et al. : Community perception of childhood drowning and its prevention measures in rural Bangladesh: A qualitative study. Aust J Rural Health. 2008; 16 (3): 176–80. PubMed Abstract | Publisher Full Text Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 27 Apr 2017 ADD YOUR COMMENT Comment Author details Author details 1 Centre for Injury Prevention and Research, Dhaka, Bangladesh 2 Department of Epidemiology, Bangladesh University of Health Sciences, Dhaka, Bangladesh Competing interests No competing interests were disclosed. Grant information BHIS was financially supported by UNICEF, Bangladesh. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Article Versions (1) version 1 Published: 27 Apr 2017, 6:589 https://doi.org/10.12688/f1000research.10980.1 Copyright © 2017 Hossain MJ et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The author(s) is/are employees of the US Government and therefore domestic copyright protection in USA does not apply to this work. The work may be protected under the copyright laws of other jurisdictions when used in those jurisdictions. Data associated with the article are available under the terms of the Creative Commons Zero "No rights reserved" data waiver (CC0 1.0 Public domain dedication). Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Hossain MJ, Biswas A, Mashreky SR et al. Epidemiology of adulthood drowning deaths in Bangladesh: Findings from a nationwide health and injury survey [version 1; peer review: 3 approved, 2 approved with reservations] . F1000Research 2017, 6 :589 ( https://doi.org/10.12688/f1000research.10980.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 27 Apr 2017 Views 0 Cite How to cite this report: Keshtkar AA. Reviewer Report For: Epidemiology of adulthood drowning deaths in Bangladesh: Findings from a nationwide health and injury survey [version 1; peer review: 3 approved, 2 approved with reservations] . F1000Research 2017, 6 :589 ( https://doi.org/10.5256/f1000research.11838.r22570 ) The direct URL for this report is: https://f1000research.com/articles/6-589/v1#referee-response-22570 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 18 May 2017 Abbas Ali Keshtkar , Endocrinology and Metabolism Research Institute, Department of Health Sciences, Tehran University of Medical Sciences, Tehran, Iran Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.11838.r22570 INTRODUCTION: If we accept the mentioned issues that presented in the last paragraph of INTRODUCTION (line 1: In Bangladesh, there is no established routine mortality registration system ....), then the line 4 issue ( Drowning mostly occurs among the rural populations) is ... Continue reading READ ALL INTRODUCTION: If we accept the mentioned issues that presented in the last paragraph of INTRODUCTION (line 1: In Bangladesh, there is no established routine mortality registration system ....), then the line 4 issue ( Drowning mostly occurs among the rural populations) is in opposite / contrast with the paragraph starting issue. 1. Please delete the sentence of line 4 of last paragraph ( Drowning mostly occurs among the rural populations). METHODS: Study Population: If the population size of each UNION was 20,000 persons and the study sample was all of the eligible persons of the selected UNION, then almost 88,000 persons were included from 4-5 UNIONs. 2. Please clearly describe the sampling method and specify the numbers of Upzila and UNION (in total population) and the number of selected Upzila and UNION. 3. Please specify the sampling frame or list for including the selected households and selected eligible persons. Data collection and interview: The time-frame of this survey is unknown. 4. Please report the study (data collection) time-frame (from data collection starting point to the ending) 5. Why the investigators use 6-months period for assessing the drawing occurrence? As you know, we need the 12-months period for assessing the seasonality pattern. Statistical analysis: The investigators used Mixed sampling method (combining Cluster, Systematic and Simple random sampling methods) and this situation causes the estimator variance inflation (increasing) and the widening the 95% CIs for the prevalence, incidence, mean and relative risk indicators. It should be noted that cluster sampling method mainly leads to the phenomenon. In other hand, the common event in community survey is the different distribution of main demographic variables such as gender and age groups. The "Survey Data Analysis" (SDA) or "Complex Sampling Analysis" method was developed for correcting or adjusting the two essential pitfalls as well as the finite population problem and the stratified random sampling consideration. Unfortunately, if the investigator(s) don't perform SDA in the mixed sampling methods (similar to the above paper), the point and interval estimation (95% CIs) of incidence or prevalence measures are not valid and also the effect size measures (Risk Ratio, Rate Ratio, ...) may be inaccurate an imprecise. 6. I suggest that the authors/ investigators indicate to Survey Data Analysis (SDA) method as the statistical method for estimating the valid and reliable INCIDENCE data (point and 95% interval estimation). Please specify the important components of SDA method (PSU or Primary Sampling Units, Stratum/ strata, Sampling weights, ....). 7. It is obvious the investigators should be carried out the data re-analysis using SDA method (based on previous item) by the relevant statistical package such as STATA. RESULTS: 8. As I mentioned, all of the study findings should be corrected based on the above suggestions (items no 6 and 7). 9. In reference to the item no 5 (Major limitation for assessing the incidence seasonality), please delete to the seasonality pattern. Of course, the investigators could report the time fluctuation of the incidence data based on the collected data and indicate to this limitation in DISCUSSION part. DISCUSSION: 10. Unfortunately, the study limitations were not indicated. Please specify the study limitations. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? No If applicable, is the statistical analysis and its interpretation appropriate? No Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: Methodology of Observational and Interventional studies. Systematic review and meta-analysis in biomedical research I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Keshtkar AA. Reviewer Report For: Epidemiology of adulthood drowning deaths in Bangladesh: Findings from a nationwide health and injury survey [version 1; peer review: 3 approved, 2 approved with reservations] . F1000Research 2017, 6 :589 ( https://doi.org/10.5256/f1000research.11838.r22570 ) The direct URL for this report is: https://f1000research.com/articles/6-589/v1#referee-response-22570 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Rahman M and Yunus FM. Reviewer Report For: Epidemiology of adulthood drowning deaths in Bangladesh: Findings from a nationwide health and injury survey [version 1; peer review: 3 approved, 2 approved with reservations] . F1000Research 2017, 6 :589 ( https://doi.org/10.5256/f1000research.11838.r22872 ) The direct URL for this report is: https://f1000research.com/articles/6-589/v1#referee-response-22872 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 18 May 2017 Mahfuzar Rahman , Research and Evaluation Division, Building Resources Across Communities (BRAC), Dhaka, Bangladesh Fakir Md Yunus , University of Saskatchewan, Saskatoon, SK, Canada Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.11838.r22872 In the Methods section: the author may consider providing reference of BHIS data from any previous published article. If no article published using this dataset, then the authors should be explaining the entire dataset in separate heading ... Continue reading READ ALL In the Methods section: the author may consider providing reference of BHIS data from any previous published article. If no article published using this dataset, then the authors should be explaining the entire dataset in separate heading under the Methods section. It would be good and understandable if authors consider providing a flow chart of their population selection by strata. In the data collection and interview section: The authors mentioned that “Structured questionnaires were used to identify drowning death, and drowning related data was extracted for further analysis.” It is not clear how the authors confirmed that the reason of the death was due to drowning. However, it is possible that the primary respondents could confirm the death but it does not make a strong conclusion of the reason behind the death. Potential question could raise “how the primary respondents know that it was not suicide?”. Another clarification is required that in Bangladesh mostly the rural people - adults knows how to swim, particularly those live near the river bank. And also, those have ponds and/or shared ponds, they take baths and use for daily primary source of water for their household use. The author should mention if they use verbal autopsy in this case. If not, please mention it in the limitation. In the swimming ability skill - how did the authors collected that information. Is that the primary respondents responded on the died person? It's hard to believe that the person who knows how to swim died due to drowning? Please clarify in the discussion part. And also, it creates more confusion when the death occurs in the natural water bodies. What does the authors mean by natural water bodies? It would be also useful if the authors consider providing a brief context of Bangladeshi population using water bodies for their daily HH work. Map of Bangladesh water bodies would help other nationals to understand the context of natural water distribution of Bangladesh. It could make more sense. The authors failed to mention their limitation and strength of the study. I believe there are good number of limitation which authors skipped. Furthermore, discussion part was poorly written and the authors failed to discuss their finding elaborately in this part Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. We confirm that we have read this submission and believe that we have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however we have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Rahman M and Yunus FM. Reviewer Report For: Epidemiology of adulthood drowning deaths in Bangladesh: Findings from a nationwide health and injury survey [version 1; peer review: 3 approved, 2 approved with reservations] . F1000Research 2017, 6 :589 ( https://doi.org/10.5256/f1000research.11838.r22872 ) The direct URL for this report is: https://f1000research.com/articles/6-589/v1#referee-response-22872 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Pant PR. Reviewer Report For: Epidemiology of adulthood drowning deaths in Bangladesh: Findings from a nationwide health and injury survey [version 1; peer review: 3 approved, 2 approved with reservations] . F1000Research 2017, 6 :589 ( https://doi.org/10.5256/f1000research.11838.r22706 ) The direct URL for this report is: https://f1000research.com/articles/6-589/v1#referee-response-22706 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 15 May 2017 Puspa Raj Pant , Centre for Child and Adolescent Health, University of the West of England, Bristol, UK Approved VIEWS 0 https://doi.org/10.5256/f1000research.11838.r22706 Very well composed article, very timely and it must appeal the decision makers and donors. The authors' contribution must be appreciated. As stated by the authors, this paper might draw the attention to the policy makers to design possible preventive measures. ... Continue reading READ ALL Very well composed article, very timely and it must appeal the decision makers and donors. The authors' contribution must be appreciated. As stated by the authors, this paper might draw the attention to the policy makers to design possible preventive measures. Therefore I would like to recommend for its publication. I would like to recommend the authors to look into following minor comments. Introduction, second paragraph: it would be better to add - what proportion of the total area of the country is water i.e. roughly 7% of it is covered with water. Introduction, third paragraph: Would it be possible to highlight the neglected importance of drowning research that the data collected in 2003 that hasn't yet been utilised to uncover the problem of drowning among adult population. Keeping in mind, children related findings were already published with the support of Unicef and other children's agencies. Methods: In the first paragraph, you can also refer previously published Methodological details. Case ascertainment: Please make it clear that the "individuals 18 years and above who drowned resulting in a fatality were included as a case" is for this paper. However, BHIS might have collected much more. Although case identification has been clearly described under "Data collection and interview", the 'mother' is the primary source of information. Therefore there are chances that this study under-reports the adult drowning rates (as compared to GBD estimates are nearly 4 times higher for the year 2003). This can be something that should be considered for adult injuries in future. Discussion: the term 'Regular Travelling' should be replaced by 'Commuting' in the sentence - "a large number of the population use water transport for regular travelling" Discussion: As indicated in #5 above, it is suspected that this study under-reports adult drowning mortality. But the estimates for children are closer to GBD estimates. Is it due to the fact - "In this study, the main three causes of death due to drowning were bathing, working and travelling." or the authors' intention was to say the disaster related drownings for adults were not included. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Pant PR. Reviewer Report For: Epidemiology of adulthood drowning deaths in Bangladesh: Findings from a nationwide health and injury survey [version 1; peer review: 3 approved, 2 approved with reservations] . F1000Research 2017, 6 :589 ( https://doi.org/10.5256/f1000research.11838.r22706 ) The direct URL for this report is: https://f1000research.com/articles/6-589/v1#referee-response-22706 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Anwar KS. Reviewer Report For: Epidemiology of adulthood drowning deaths in Bangladesh: Findings from a nationwide health and injury survey [version 1; peer review: 3 approved, 2 approved with reservations] . F1000Research 2017, 6 :589 ( https://doi.org/10.5256/f1000research.11838.r22378 ) The direct URL for this report is: https://f1000research.com/articles/6-589/v1#referee-response-22378 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 10 May 2017 Kazi Selim Anwar , Ex: Microbiology Unit, Faculty of Medicine, AIMST (Asian Institute of Medical, Science and Technology) University, Bedong, Bangladesh; Institute of Epidemiology, Disease Control and Research (IEDCR), Mohakhali, Dhaka, Bangladesh Approved VIEWS 0 https://doi.org/10.5256/f1000research.11838.r22378 The topic of the article: This is a well written epidemiologically sound and statistically valid original research article on an important topic of public health, titled ‘ Epidemiology of adulthood drowning deaths in Bangladesh: Findings from a nationwide health and ... Continue reading READ ALL The topic of the article: This is a well written epidemiologically sound and statistically valid original research article on an important topic of public health, titled ‘ Epidemiology of adulthood drowning deaths in Bangladesh: Findings from a nationwide health and injury survey’ highlighting several crucial issues pertaining to drowning epidemiology in the country. The quality & merit of this paper: This research paper is based on the analysis of a nationwide cross-sectional survey conducted in Bangladesh in 2003. Data analysis that this study attempted highlights several scientific potentials, public health implications and policy issues. These important findings add values in the current knowledge-base on fatal adult drowning not only in Bangladesh but also in global science - which has the potentiality of being replicated by other researchers/scientists from other countries. Overall comment on this manuscript reviewed I recommend this paper for publication in F1000Research but it would definitely carry more value if the authors consider in bringing certain minor changes, as I suggested below: The title: It would have sound better as ‘Epidemiology of fatal adult drowning in Bangladesh: Findings from a nationwide health and injury survey’ – it the authors consider only as fine. The Methodology part in abstract (on page 1 of 7): Right on the first line of the methodology section, it would have been more rationale to add… ’This updated paper based on a ..’ so as to read the first line of methodology as ‘This updated paper based on a nationwide cross-sectional survey was conducted… again only if the authors consider it as fine (Thus to make relevant corrections in methodology section on page 3, too) The Introduction: (on page 3 of 7) Even there is no big mistake or major flaw in the introduction section it might have sound more logical & lucid if the authors consider the 2 nd and 3 rd paragraph of ‘Introduction’ section to be framed (re-written) as shown below (first paragraph of introduction looks fine) : Bangladesh is a low-lying, riverine country located in the subtropical region of South Asia and bordering with the Bay of Bengal. The country has a landmass of 147,570 square kilometers being world’s 8 th -most densely populated countries in the world with a population of 160 million people. Having a tropical monsoon climate it is characterized by heavy rainfall and melted-snow from the Himalayan territory, leading to three large rivers: the Ganges, the Brahmaputra and the Meghna. Daily life in Bangladesh exposes people to water bodies, such as ponds, ditches, rivers, canals and the ocean- which serve the daily household needs, particularly in rural areas including agriculture, fishing and transportation. In adjunct to country’s geographic & climatic phenomena drowning plausibly effects all ages of the Bangladeshi population compounded by round-the-year prevailing natural disasters like cyclone, flood, hurricane, tidal bore, etc. Most of the research conducted in Bangladesh on drowning remains focused on childhood drowning 8–10. In Bangladesh, there is no established routine mortality registration system 11, that also may have contributed in the inadequacy of research 12, resulting in ‘unknown adult drowning deaths’ often among the adult population. To design an appropriate preventive measure in reducing adult drowning, it is imperative to determine the nationwide burden of drowning. Further, drowning mostly occurs among rural populations in Bangladesh 8, so robust data from community-based household survey remains crucial. Based on the aforementioned facts & figures, this study was conducted with the objective of estimating gender-specific fatal adult drowning in Bangladesh including seasons and place of residence using the data of a nationally representative survey. Data availability: (on page 6 of 7) It is very well referenced, adequately explained and logically utilized (Available data). Only that this section may be taken to methodology section to insert right between 'Statistical analysis' and ‘Results’ sections (on page on page 4 of 7) Final comment on the quality of this manuscript reviewed to be published: I strongly recommend that this original article written well scientifically being very sound epidemiologically, pertinent methodologically and valid statistically to be published in F1000Research. This will add values in pertinent topic not only in national (Bangladesh) but also in global data-archiving system towards enhancing the current knowledge base on fatal adult drowning issues. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Anwar KS. Reviewer Report For: Epidemiology of adulthood drowning deaths in Bangladesh: Findings from a nationwide health and injury survey [version 1; peer review: 3 approved, 2 approved with reservations] . F1000Research 2017, 6 :589 ( https://doi.org/10.5256/f1000research.11838.r22378 ) The direct URL for this report is: https://f1000research.com/articles/6-589/v1#referee-response-22378 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Ramos WD. Reviewer Report For: Epidemiology of adulthood drowning deaths in Bangladesh: Findings from a nationwide health and injury survey [version 1; peer review: 3 approved, 2 approved with reservations] . F1000Research 2017, 6 :589 ( https://doi.org/10.5256/f1000research.11838.r22377 ) The direct URL for this report is: https://f1000research.com/articles/6-589/v1#referee-response-22377 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 09 May 2017 William D. Ramos , Department of Recreation, Park, and Tourism Studies, IU School of Public Health-Bloomington, Indiana University Bloomington, Bloomington, IN, USA Approved VIEWS 0 https://doi.org/10.5256/f1000research.11838.r22377 The article is timely and relevant. The authors are correct in stating that there is little attention given to adult drowning across the world. This type of epidemiological study is crucial as a first step to developing effective strategies for ... Continue reading READ ALL The article is timely and relevant. The authors are correct in stating that there is little attention given to adult drowning across the world. This type of epidemiological study is crucial as a first step to developing effective strategies for intervention. I would like to see more explanation on how rural versus urban settings were determined as well. In regards to distance of incident to homes, it should be stated that since it was measured visually by data collectors there may be some issues with accuracy. More clarification on self-reported swimming ability would also be helpful to better understand the validity of that variable. I’m cautious about the use of the Wikipedia source cited in the discussion. Overall the article is well developed and methodologically sound. Conclusion drawn appropriately from the data. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Ramos WD. Reviewer Report For: Epidemiology of adulthood drowning deaths in Bangladesh: Findings from a nationwide health and injury survey [version 1; peer review: 3 approved, 2 approved with reservations] . F1000Research 2017, 6 :589 ( https://doi.org/10.5256/f1000research.11838.r22377 ) The direct URL for this report is: https://f1000research.com/articles/6-589/v1#referee-response-22377 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 27 Apr 2017 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 3 4 5 Version 1 27 Apr 17 read read read read read William D. Ramos , Indiana University Bloomington, Bloomington, USA Kazi Selim Anwar , AIMST (Asian Institute of Medical, Science and Technology) University, Bedong, Bangladesh; Institute of Epidemiology, Disease Control and Research (IEDCR), Mohakhali, Bangladesh Puspa Raj Pant , University of the West of England, Bristol, UK Mahfuzar Rahman , Building Resources Across Communities (BRAC), Dhaka, Bangladesh Fakir Md Yunus , University of Saskatchewan, Saskatoon, Canada Abbas Ali Keshtkar , Tehran University of Medical Sciences, Tehran, Iran Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2017 Keshtkar A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 18 May 2017 | for Version 1 Abbas Ali Keshtkar , Endocrinology and Metabolism Research Institute, Department of Health Sciences, Tehran University of Medical Sciences, Tehran, Iran 0 Views copyright © 2017 Keshtkar A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions INTRODUCTION: If we accept the mentioned issues that presented in the last paragraph of INTRODUCTION (line 1: In Bangladesh, there is no established routine mortality registration system ....), then the line 4 issue ( Drowning mostly occurs among the rural populations) is in opposite / contrast with the paragraph starting issue. 1. Please delete the sentence of line 4 of last paragraph ( Drowning mostly occurs among the rural populations). METHODS: Study Population: If the population size of each UNION was 20,000 persons and the study sample was all of the eligible persons of the selected UNION, then almost 88,000 persons were included from 4-5 UNIONs. 2. Please clearly describe the sampling method and specify the numbers of Upzila and UNION (in total population) and the number of selected Upzila and UNION. 3. Please specify the sampling frame or list for including the selected households and selected eligible persons. Data collection and interview: The time-frame of this survey is unknown. 4. Please report the study (data collection) time-frame (from data collection starting point to the ending) 5. Why the investigators use 6-months period for assessing the drawing occurrence? As you know, we need the 12-months period for assessing the seasonality pattern. Statistical analysis: The investigators used Mixed sampling method (combining Cluster, Systematic and Simple random sampling methods) and this situation causes the estimator variance inflation (increasing) and the widening the 95% CIs for the prevalence, incidence, mean and relative risk indicators. It should be noted that cluster sampling method mainly leads to the phenomenon. In other hand, the common event in community survey is the different distribution of main demographic variables such as gender and age groups. The "Survey Data Analysis" (SDA) or "Complex Sampling Analysis" method was developed for correcting or adjusting the two essential pitfalls as well as the finite population problem and the stratified random sampling consideration. Unfortunately, if the investigator(s) don't perform SDA in the mixed sampling methods (similar to the above paper), the point and interval estimation (95% CIs) of incidence or prevalence measures are not valid and also the effect size measures (Risk Ratio, Rate Ratio, ...) may be inaccurate an imprecise. 6. I suggest that the authors/ investigators indicate to Survey Data Analysis (SDA) method as the statistical method for estimating the valid and reliable INCIDENCE data (point and 95% interval estimation). Please specify the important components of SDA method (PSU or Primary Sampling Units, Stratum/ strata, Sampling weights, ....). 7. It is obvious the investigators should be carried out the data re-analysis using SDA method (based on previous item) by the relevant statistical package such as STATA. RESULTS: 8. As I mentioned, all of the study findings should be corrected based on the above suggestions (items no 6 and 7). 9. In reference to the item no 5 (Major limitation for assessing the incidence seasonality), please delete to the seasonality pattern. Of course, the investigators could report the time fluctuation of the incidence data based on the collected data and indicate to this limitation in DISCUSSION part. DISCUSSION: 10. Unfortunately, the study limitations were not indicated. Please specify the study limitations. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? No If applicable, is the statistical analysis and its interpretation appropriate? No Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise Methodology of Observational and Interventional studies. Systematic review and meta-analysis in biomedical research I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Keshtkar AA. Peer Review Report For: Epidemiology of adulthood drowning deaths in Bangladesh: Findings from a nationwide health and injury survey [version 1; peer review: 3 approved, 2 approved with reservations] . F1000Research 2017, 6 :589 ( https://doi.org/10.5256/f1000research.11838.r22570) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/6-589/v1#referee-response-22570 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2017 Rahman M et al. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 18 May 2017 | for Version 1 Mahfuzar Rahman , Research and Evaluation Division, Building Resources Across Communities (BRAC), Dhaka, Bangladesh Fakir Md Yunus , University of Saskatchewan, Saskatoon, SK, Canada 0 Views copyright © 2017 Rahman M et al. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions In the Methods section: the author may consider providing reference of BHIS data from any previous published article. If no article published using this dataset, then the authors should be explaining the entire dataset in separate heading under the Methods section. It would be good and understandable if authors consider providing a flow chart of their population selection by strata. In the data collection and interview section: The authors mentioned that “Structured questionnaires were used to identify drowning death, and drowning related data was extracted for further analysis.” It is not clear how the authors confirmed that the reason of the death was due to drowning. However, it is possible that the primary respondents could confirm the death but it does not make a strong conclusion of the reason behind the death. Potential question could raise “how the primary respondents know that it was not suicide?”. Another clarification is required that in Bangladesh mostly the rural people - adults knows how to swim, particularly those live near the river bank. And also, those have ponds and/or shared ponds, they take baths and use for daily primary source of water for their household use. The author should mention if they use verbal autopsy in this case. If not, please mention it in the limitation. In the swimming ability skill - how did the authors collected that information. Is that the primary respondents responded on the died person? It's hard to believe that the person who knows how to swim died due to drowning? Please clarify in the discussion part. And also, it creates more confusion when the death occurs in the natural water bodies. What does the authors mean by natural water bodies? It would be also useful if the authors consider providing a brief context of Bangladeshi population using water bodies for their daily HH work. Map of Bangladesh water bodies would help other nationals to understand the context of natural water distribution of Bangladesh. It could make more sense. The authors failed to mention their limitation and strength of the study. I believe there are good number of limitation which authors skipped. Furthermore, discussion part was poorly written and the authors failed to discuss their finding elaborately in this part Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. We confirm that we have read this submission and believe that we have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however we have significant reservations, as outlined above. reply Respond to this report Responses (0) Rahman M and Yunus FM. Peer Review Report For: Epidemiology of adulthood drowning deaths in Bangladesh: Findings from a nationwide health and injury survey [version 1; peer review: 3 approved, 2 approved with reservations] . F1000Research 2017, 6 :589 ( https://doi.org/10.5256/f1000research.11838.r22872) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/6-589/v1#referee-response-22872 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2017 Pant P. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 15 May 2017 | for Version 1 Puspa Raj Pant , Centre for Child and Adolescent Health, University of the West of England, Bristol, UK 0 Views copyright © 2017 Pant P. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Very well composed article, very timely and it must appeal the decision makers and donors. The authors' contribution must be appreciated. As stated by the authors, this paper might draw the attention to the policy makers to design possible preventive measures. Therefore I would like to recommend for its publication. I would like to recommend the authors to look into following minor comments. Introduction, second paragraph: it would be better to add - what proportion of the total area of the country is water i.e. roughly 7% of it is covered with water. Introduction, third paragraph: Would it be possible to highlight the neglected importance of drowning research that the data collected in 2003 that hasn't yet been utilised to uncover the problem of drowning among adult population. Keeping in mind, children related findings were already published with the support of Unicef and other children's agencies. Methods: In the first paragraph, you can also refer previously published Methodological details. Case ascertainment: Please make it clear that the "individuals 18 years and above who drowned resulting in a fatality were included as a case" is for this paper. However, BHIS might have collected much more. Although case identification has been clearly described under "Data collection and interview", the 'mother' is the primary source of information. Therefore there are chances that this study under-reports the adult drowning rates (as compared to GBD estimates are nearly 4 times higher for the year 2003). This can be something that should be considered for adult injuries in future. Discussion: the term 'Regular Travelling' should be replaced by 'Commuting' in the sentence - "a large number of the population use water transport for regular travelling" Discussion: As indicated in #5 above, it is suspected that this study under-reports adult drowning mortality. But the estimates for children are closer to GBD estimates. Is it due to the fact - "In this study, the main three causes of death due to drowning were bathing, working and travelling." or the authors' intention was to say the disaster related drownings for adults were not included. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Pant PR. Peer Review Report For: Epidemiology of adulthood drowning deaths in Bangladesh: Findings from a nationwide health and injury survey [version 1; peer review: 3 approved, 2 approved with reservations] . F1000Research 2017, 6 :589 ( https://doi.org/10.5256/f1000research.11838.r22706) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/6-589/v1#referee-response-22706 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2017 Anwar K. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 10 May 2017 | for Version 1 Kazi Selim Anwar , Ex: Microbiology Unit, Faculty of Medicine, AIMST (Asian Institute of Medical, Science and Technology) University, Bedong, Bangladesh; Institute of Epidemiology, Disease Control and Research (IEDCR), Mohakhali, Dhaka, Bangladesh 0 Views copyright © 2017 Anwar K. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The topic of the article: This is a well written epidemiologically sound and statistically valid original research article on an important topic of public health, titled ‘ Epidemiology of adulthood drowning deaths in Bangladesh: Findings from a nationwide health and injury survey’ highlighting several crucial issues pertaining to drowning epidemiology in the country. The quality & merit of this paper: This research paper is based on the analysis of a nationwide cross-sectional survey conducted in Bangladesh in 2003. Data analysis that this study attempted highlights several scientific potentials, public health implications and policy issues. These important findings add values in the current knowledge-base on fatal adult drowning not only in Bangladesh but also in global science - which has the potentiality of being replicated by other researchers/scientists from other countries. Overall comment on this manuscript reviewed I recommend this paper for publication in F1000Research but it would definitely carry more value if the authors consider in bringing certain minor changes, as I suggested below: The title: It would have sound better as ‘Epidemiology of fatal adult drowning in Bangladesh: Findings from a nationwide health and injury survey’ – it the authors consider only as fine. The Methodology part in abstract (on page 1 of 7): Right on the first line of the methodology section, it would have been more rationale to add… ’This updated paper based on a ..’ so as to read the first line of methodology as ‘This updated paper based on a nationwide cross-sectional survey was conducted… again only if the authors consider it as fine (Thus to make relevant corrections in methodology section on page 3, too) The Introduction: (on page 3 of 7) Even there is no big mistake or major flaw in the introduction section it might have sound more logical & lucid if the authors consider the 2 nd and 3 rd paragraph of ‘Introduction’ section to be framed (re-written) as shown below (first paragraph of introduction looks fine) : Bangladesh is a low-lying, riverine country located in the subtropical region of South Asia and bordering with the Bay of Bengal. The country has a landmass of 147,570 square kilometers being world’s 8 th -most densely populated countries in the world with a population of 160 million people. Having a tropical monsoon climate it is characterized by heavy rainfall and melted-snow from the Himalayan territory, leading to three large rivers: the Ganges, the Brahmaputra and the Meghna. Daily life in Bangladesh exposes people to water bodies, such as ponds, ditches, rivers, canals and the ocean- which serve the daily household needs, particularly in rural areas including agriculture, fishing and transportation. In adjunct to country’s geographic & climatic phenomena drowning plausibly effects all ages of the Bangladeshi population compounded by round-the-year prevailing natural disasters like cyclone, flood, hurricane, tidal bore, etc. Most of the research conducted in Bangladesh on drowning remains focused on childhood drowning 8–10. In Bangladesh, there is no established routine mortality registration system 11, that also may have contributed in the inadequacy of research 12, resulting in ‘unknown adult drowning deaths’ often among the adult population. To design an appropriate preventive measure in reducing adult drowning, it is imperative to determine the nationwide burden of drowning. Further, drowning mostly occurs among rural populations in Bangladesh 8, so robust data from community-based household survey remains crucial. Based on the aforementioned facts & figures, this study was conducted with the objective of estimating gender-specific fatal adult drowning in Bangladesh including seasons and place of residence using the data of a nationally representative survey. Data availability: (on page 6 of 7) It is very well referenced, adequately explained and logically utilized (Available data). Only that this section may be taken to methodology section to insert right between 'Statistical analysis' and ‘Results’ sections (on page on page 4 of 7) Final comment on the quality of this manuscript reviewed to be published: I strongly recommend that this original article written well scientifically being very sound epidemiologically, pertinent methodologically and valid statistically to be published in F1000Research. This will add values in pertinent topic not only in national (Bangladesh) but also in global data-archiving system towards enhancing the current knowledge base on fatal adult drowning issues. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Anwar KS. Peer Review Report For: Epidemiology of adulthood drowning deaths in Bangladesh: Findings from a nationwide health and injury survey [version 1; peer review: 3 approved, 2 approved with reservations] . F1000Research 2017, 6 :589 ( https://doi.org/10.5256/f1000research.11838.r22378) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/6-589/v1#referee-response-22378 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2017 Ramos W. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 09 May 2017 | for Version 1 William D. Ramos , Department of Recreation, Park, and Tourism Studies, IU School of Public Health-Bloomington, Indiana University Bloomington, Bloomington, IN, USA 0 Views copyright © 2017 Ramos W. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The article is timely and relevant. The authors are correct in stating that there is little attention given to adult drowning across the world. This type of epidemiological study is crucial as a first step to developing effective strategies for intervention. I would like to see more explanation on how rural versus urban settings were determined as well. In regards to distance of incident to homes, it should be stated that since it was measured visually by data collectors there may be some issues with accuracy. More clarification on self-reported swimming ability would also be helpful to better understand the validity of that variable. I’m cautious about the use of the Wikipedia source cited in the discussion. Overall the article is well developed and methodologically sound. Conclusion drawn appropriately from the data. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Ramos WD. Peer Review Report For: Epidemiology of adulthood drowning deaths in Bangladesh: Findings from a nationwide health and injury survey [version 1; peer review: 3 approved, 2 approved with reservations] . F1000Research 2017, 6 :589 ( https://doi.org/10.5256/f1000research.11838.r22377) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/6-589/v1#referee-response-22377 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions Adjust parameters to alter display View on desktop for interactive features Includes Interactive Elements View on desktop for interactive features Competing Interests Policy Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. 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