‘Anchals’ save lives

Drowning is an under-recognised global public health issue causing an estimated 322,000 deaths each year, with nearly 94 percent of these deaths occurring in low- and middle-income countries.

In Bangladesh, drowning is the leading cause of death for children ages 1-4, with 10,000 children drowning every year. But there is a solution to prevent these unnecessary deaths. Bloomberg Philanthropies has been supporting anchals (community daycare centres) across the country since 2012, with 50,000 children currently enrolled. The benefits of anchals are numerous, including protection against drowning but also cognitive and social development. Our hope is the government of Bangladesh will support and scale-up this programme to other regions of the country. 

Given the large toll drowning takes on 1-4 year-olds in Bangladesh, Bloomberg Philanthropies launched a drowning prevention study in 2012 to identify cost-effective strategies to prevent drowning among this age group. Partnering with Johns Hopkins University, Bloomberg School of Public Health and local research organisations, Centre for Injury Prevention and Research, Bangladesh (CIPRB) and the International Centre for Diaorrheal Disease Research, Bangladesh (icddr,b), Bloomberg Philanthropies supported the study in seven sub-districts of Bangladesh: Raiganj, Sherpur Sadar, Manohardi, Matlab North and South, Chandpur Sadar, and Daudkandi.

The study followed 72,000 children ages 1-4 years during 2014-2016, with the goal of measuring the effectiveness of anchals to prevent drowning. In anchals, a caregiver ("anchal ma") supervises children from 9am to 1pm Monday through Saturday, the timeframe when parents are busy with household chores or other work and children are most vulnerable. It takes only moments to lose sight of a child and 80 percent of drowning among 1-4-year-olds occur 20 metres from the family's front door. The study is pending publication, but preliminary findings show that community anchals were effective in preventing drowning among 1-4 year-olds.

Since the conclusion of the study in 2016, more than 50,000 children have continued to be enrolled in Bloomberg Philanthropies-supported anchals, with village injury prevention committee providing guidance in communities where anchals exist. The demand for anchals in Bangladesh continues. When I visited one anchal in Manohardi in 2016, members of the village injury prevention committee requested similar support in the neighbouring area where two children had recently drowned. 

Anchals save lives, with numerous co-benefits for participating children. Enrolment in anchals was found to be associated with higher psychosocial scores demonstrating higher cognitive development among children in this age group. It also showed improved socialisation and problem-solving abilities. The benefits by far exceeded the annual cost of USD 25 per child, demonstrating anchals' cost-effectiveness.

One death from drowning is too many; 10,000 deaths are unimaginable, but occur every year in Bangladesh. The government of Bangladesh recognises drowning as a public health issue and we are optimistic they will fund the expansion of this effort to ensure all children aged 1-4 years have access to anchals.

Kelly Larson is the director of US-based Bloomberg Philanthropies' injury prevention portfolio, including drowning prevention and road safety. She also directs the Partnership for Healthy Cities. She has worked in public health for 30 years for local, national and international agencies.

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