**3. Results**

This section outlines data trends in child drowning in the Philippines while also exploring the multisector action plan relevant to child drowning reduction and the determinants of health.

### *3.1. Child Drowning Deaths in the Philippines*

In total, 27,928 (95% Uncertainty Interval [UI]: 22,794–33,828) children aged 0–14 years died from drowning in the Philippines between 2008 and 2017 (Table 1). Fatal drowning among 5–14 year old children accounted for 52.7% of all deaths among the 0–14 years age group.


**Table 1.** Number of drowning deaths by year and age group, children 0–14 years, Philippines, 2008–2017.

Rates of child drowning for both age groups declined over the study period, with drowning among 0–4 year olds declining at a faster pace (y = −0.3368x + 13.035; R<sup>2</sup> = 0.9588) than 0–14 year olds (y = −0.0634x + 7.3047; R<sup>2</sup> = 0.5252) (Figure 4). Among 0–4 year olds, rates varied from a high of 12.67 per 100,000 children to a current low of 9.30 per 100,000 population in 2017; whereas rates for 5–14 year olds varied from a high of 7.15 per 100,000 population to a low of 6.29.

**Figure 4.** Trends over time in rate of fatal drowning per 100,000 population, 0–4 years and 5–14 years age groups, Philippines, 2008–2017.

When examined by sex, males aged both 0–4 years old and 5–14 years old recorded higher rates of drowning when compared to females. Male drowning rates among 0–4 year olds varied from a high of 15.09 per 100,000 population in 2008 to a low of 11.20 in 2017, compared to a rate of 9.88 in 2008 and 7.26 in 2017 for females. For 5–14 year olds, drowning rates for males varied from a high of 8.94 in 2015 to a current low of 7.86 in 2017, whereas female drowning rates varied from a high of 5.32 in 2011 to a current low of 4.62 per 100,000 in 2017. Male drowning rates among the 0–4 years and 5–14 years age groups declined at a faster pace than females (0–4 years: males y = −0.4018x + 15.726; R<sup>2</sup> = 0.9453; females y = −0.2679x + 10.157; R<sup>2</sup> = 0.9752; 5–14 years: males y = −0.0626x + 9.0073; R<sup>2</sup> = 0.3567; females y = −0.0659x + 5.5033; R<sup>2</sup> = 0.7285). (Figure 5).

**Figure 5.** Fatal unintentional drowning rates per 100,000 population and sex, Philippines, 2008–2017: (**a**) 0–4 year olds, males' and females' rate and linear trend; (**b**) 5–14 year olds, males' and females' rate and linear trend.

When examining data on non-fatal child drowning in the Philippines, a total of 2267.7 YLDs were recorded for children 0–14 years in the Philippines across the study period. Children aged 5–14 years accounted for 83.7% (*n* = 1898.9) of the child drowning total burden (Figure 6).

**Figure 6.** Years of Life Lost to Disability due to drowning by age group, Philippines 2008–2017.

For the total burden of drowning among children aged 0–14 years in the Philippines, there were a total of 2,292,471.0 DALYs recorded across the study period. The DALYs burden is evenly split between the age groups, with 5–14 year olds accounting for 50.6% of the total burden. When examining trends over time, the unintentional drowning-related DALY burden declined for both age groups, with a more significant decline over the study period in the 0–4 years age group (y = −2776.3x + 128512; R<sup>2</sup> = 0.8754) (Figure 7).

**Figure 7.** Number of Disability Adjusted Life Years (DALYs) for unintentional drowning and linear trend by age group, children 0–14 years, Philippines, 2008–2017.

### *3.2. Multisector Action Plan on Drowning Prevention*

The multisector action plan on drowning prevention has two guiding principles, namely: Health IN ALL (i.e., Health in All Policies) and Health BY ALL (i.e., Whole of Government and Whole of Society). These principles underpin an overall goal of reducing the drowning mortality rate in the Philippines by 50% by the year 2026. The multisector action plan on drowning prevention outlines five objectives, underpinned by 16 strategies and 53 activities, to achieve its goal. There are a range of objectives that include activities specifically targeting child drowning prevention. There were 12 activities identified by the authors as being child-specific and 20 activities where determinants of health will need to be considered when undertaking the activities. (Table 2)

> **Table 2.** Activities of the Multisector Action Plan on Drowning Prevention in the Philippines 2016–2026, relevance to children and consideration of determinants of health (DoH).


### **Table 2.** *Cont.*


> **Table 2.** *Cont.*


Notes: DoH = Social Determinants of Health.
