Child drownings in Bangladesh: need for action

Drowning is one of the major public health concerns, and children are the most vulnerable victims of drowning death in Bangladesh, which has been a paramount threat to child survival. Based on available data, we intend to underline the prevalence and associated risk factors for child drowning deaths in Bangladesh. According to the Center for Injury Prevention and Research, Bangladesh, about 19 000 people of all ages drown per year across the country, where approximately 77% are children (<18 years), which means that over 40 Bangladeshi children drown per day. A recent survey reported that as of data collected from January 2020 to June 2021, 83% of drowning victims were children. Insufficient parental supervision, mother’s illiteracy, lack of swimming ability, male gender, children under 5 years, geographical and environmental conditions, seasonality, and disasters significantly contribute to child drowning deaths in Bangladesh. We urge the governments and local administrations to address the current crisis by coordinating and integrating several effective efforts to prevent child drowning deaths.


Dear authors,
Thank you for the opportunity to review this original research letter. I commend you for raising awareness of the drowning burdenparticularly in a setting with such a high drowning burden. I have the following comments regarding this submission.
Article format: According to the journal's guidelines for authors, Original Research Letters should present studies that present original research but address a single research question. In my opinion the current submission does not meet this description. The current submission more closely resembles an editorial or letter to the editor that synthesises evidence from several sources and presents these as a narrative review. It does not present original research.
Study title: The title specifically speaks to non-fatal drowning. However the manuscript itself speaks only to the fatal drowning burden in Bangladesh and makes no specific reference to risk factors and interventions related to non-fatal drowning. The title does not, therefore, accurately reflect the contents of the manuscript.
Language editing: I appreciate that you may not be writing in your first language and commend you for this. However, there are a number of instances in which the grammar and sentence structure is incorrect and changes the meaning of the statement. For exampleline 80 -"riskier" versus more at risk; line 67 -"nice" versus nine. I think the manuscript would be strengthened by having a colleague who is fluent in English provide a brief language editing review.
- Figure 1: Please be cautious of confusing "death rate" with prevalence or "Proportion of all deaths". These are quite different measures and death rate would require a clear indication of the denominator.
I wish you well as you take this manuscript forward, and look forward to reading further contributions.

REVIEWER
Reviewer

GENERAL COMMENTS
Thank you for the opportunity to review manuscript ID bmjpo--2022-001464 which is an original research letter entitled "Non-fatal child drowning death and its associated risk factors in Bangladesh: Urgent call for actionable measures" which was submitted for consideration for publication in BMJ Paediatrics Open. This research letter details the important issue of child drowning in Bangladesh and makes a call for action to reduce the risk. I offer the following feedback in the hope the letter can be further strengthened. Feedback Page 2, Line 23: I'm not sure child abuse is the most appropriate keyword for this work, I'd encourage authors to revise this. However, I also note, keywords on the first page are different to others listed elsewhere. Suggest the authors clarify and make consistent but avoid use of child abuse. Page 3 Line 29, Page 3 Line 15: The title and use of the phrase nonfatal drowning death is confusing and misleading. Suggest the authors revise -if this letter wants to convey overall drowning risk among children then suggest Child drowning and its associated risk factors…. If the specific focus is on death or non-fatal suggest using only one phrase in the title and throughout the letter, including the abstract. Page 3, Line 17 -unsure what raising concerns means in this context -suggest clarifying Page 3, Line 25 -how can a death rate be a % -suggest clarifyingdo you mean between Jan 2020 and June 2021, child drowning comprises 83% of all deaths? Page 3 Line 29 and throughout paper: suggest rephrasing natural calamities to disasters Page 3, Lines 45-47: Suggest low and middle income and high income countries instead of developing and developed countries Page 3, Line 49 -not third leading cause of death, third leading cause of injury-related death Page 3 line 52 -occur not occurs Page 4 line 3 -words missing here -suggest two-fifths (42%) of a deaths… Page 4, Line 5 and throughout paper -crossreference the specific panel of the figure when you mention Figure 1 ie Figure 1, Panel A Page 4 line 21 -two-third should be two-thirds -nice should also be nine? I think you mean below 10 years if the age range is 5-9 years inclusive Page 4 line 24 -more victims doesn't make sense, suggest boys are more at risk when compared to girls Page 4 -line 39 -are happened to suggest replace with occur Page 4 line 43 -define large households -how many children is considered a large household as per the research? Page 5 -line 55 -suggest pilot actions not pilot basis actions Page 5 line 5 -focused off -not clear expression -do you mean unfocused or not given enough priority? Page 5 line 10 -a pilot based study or pilot based studies

VERSION 1 -AUTHOR RESPONSE
Editor in Chief Comments to Author: Title amend to "Child drownings in Bangladesh: Need for action" Authors responses: Dear Respected Editor-in-Chief, we would like to thank you and your assigned reviewers for reviewing the manuscript and providing your expert opinions for the improvement of the manuscript. The title of the study has been changed as follows according to your suggestions. Child drownings in Bangladesh: Need for action Avoid the term "Non-fatal child drowning death" throughout the paper as it is incorrect. Authors responses: Thank you very much for the suggestion. We have removed the term "non-fatal" from the manuscript.
Use numbers not % in the text and Figures. It will make your paper easier to read Avoid misuse of prevalence rates and death rates Authors responses: Thank you very much for your kind suggestions. We have revised and modified the Figure  The English needs improving. Sorry Authors responses: Thank you very much for the suggestions. We have carefully revised the whole manuscript and eradicated any unintentional grammar and typos errors. Besides, an English language expert has revised the manuscript for its language improvement.
Reviewer: 1 Dr. Amy E. Peden, University of New South Wales Sydney

Comments to the Author
Thank you for the opportunity to review manuscript ID bmjpo--2022-001464 which is an original research letter entitled "Non-fatal child drowning death and its associated risk factors in Bangladesh: Urgent call for actionable measures" which was submitted for consideration for publication in BMJ Paediatrics Open. This research letter details the important issue of child drowning in Bangladesh and makes a call for action to reduce the risk. I offer the following feedback in the hope the letter can be further strengthened. Authors responses: Thank you very much for reviewing the manuscript and providing your expert opinions for the improvement of the manuscript. Feedback Page 2, Line 23: I'm not sure child abuse is the most appropriate keyword for this work, I'd encourage authors to revise this. However, I also note, keywords on the first page are different to others listed elsewhere. Suggest the authors clarify and make consistent but avoid use of child abuse. Authors responses: Thank you very much for the points regarding the keywords. We did not use child abuse as keyword rather we used child drowning as a keyword.
Page 3 Line 29, Page 3 Line 15: The title and use of the phrase non-fatal drowning death is confusing and misleading. Suggest the authors revise -if this letter wants to convey overall drowning risk among children then suggest Child drowning and its associated risk factors…. If the specific focus is on death or non-fatal suggest using only one phrase in the title and throughout the letter, including the abstract. Authors responses: Thank you very much for your suggestions. We have revised the title and changed it as follows- Page 4 line 3 -words missing here -suggest two-fifths (42%) of a deaths… Authors responses: Thank you so much for the nice correction. We have revised accordingly.
Page 4, Line 5 and throughout paper -cross reference the specific panel of the figure when you mention Figure 1 ie Figure 1, Panel A Authors responses: Thank you very for the suggestion. We have corrected accordingly.
Page 4 line 21 -two-third should be two-thirds -nice should also be nine? I think you mean below 10 years if the age range is 5-9 years inclusive Authors responses: Thank you very for the points. We have corrected the typos errors. As another category indicates 9 to 14 years age group in reported study (Figure 1, Panel C), the right word is nine, and we followed the original reported report style.5 Page 4 line 24 -more victims doesn't make sense, suggest boys are more at risk when compared to girls Authors responses: Thank you very for the suggestion. We have revised the lines as follows: The study also reported that boys were significantly more at risk of being victims of drowning when compared to girls ( Article format: According to the journal's guidelines for authors, Original Research Letters should present studies that present original research but address a single research question. In my opinion the current submission does not meet this description. The current submission more closely resembles an editorial or letter to the editor that synthesises evidence from several sources and presents these as a narrative review. It does not present original research. Authors responses: Thank you very much for your observations. We have extracted data from various scholarly databases and recent data available from various media websites. We analyzed and figured the trend and prevalence of the child drownings in Bangladesh that might be considered as an explorative study based on its nature of the data. However, more countrywide epidemiological study needs to be conducted in this regard.
Study title: The title specifically speaks to non-fatal drowning. However the manuscript itself speaks only to the fatal drowning burden in Bangladesh and makes no specific reference to risk factors and interventions related to non-fatal drowning. The title does not, therefore, accurately reflect the contents of the manuscript. Authors responses: Thank you very much for concerns. We have revised the title and changed it as follows to reflect the study aims. Child drownings in Bangladesh: Need for action Language editing: I appreciate that you may not be writing in your first language and commend you for this. However, there are a number of instances in which the grammar and sentence structure is incorrect and changes the meaning of the statement. For example -line 80 -"riskier" versus more at risk; line 67 -"nice" versus nine. I think the manuscript would be strengthened by having a colleague who is fluent in English provide a brief language editing review. Authors responses: Thank you very much for your comments and suggestions. We have revised the whole manuscript and eradicated grammar errors through an English language expert. We have also corrected your suggested points.  I wish you well as you take this manuscript forward, and look forward to reading further contributions. Authors responses: Thank you very much for your kind comments.

GENERAL COMMENTS
Thank you for re-submitting this manuscript for review after engaging with the reviewers comments and suggestions. I think that you have for the most part addressed the previous comments.
The only remaining major comment is that there still remains some confusion between period prevalence or proportion of deaths (indicated with a %) versus death rates (which require a denominator value e.g. x drowning deaths per 100 000 population), in Figure 1. As it currently stands, Figure 1 A is not easy to interpret.
I also have the following specific comments: - Figure 1 A & Page 2 Line 54-56: Please differentiate between drowning death prevalence (%) and drowning death rates (which are presented as a fraction i.e. x per y). Figure 1 presents a period frequency and prevalence, not drowning rate.
-Page 4 Line 94: "children" not "kids" Line 58 Replace "Besides, the prevalence of death rate from the drowning of rural children is significantly higher than urban children in the country" with "The risk of drowning is significantly higher in rural children" Authors' responses: Thank you very much for your kind suggestions. We have replaced accordingly as follows: