Willingness to administer mouth-to-mouth ventilation in a first response program in rural Bangladesh
© Mecrow et al. 2016
Received: 30 August 2014
Accepted: 20 July 2015
Published: 
Willingness to administer mouth-to-mouth ventilation in a first response program in rural Bangladesh
© Mecrow et al. 2016
Received: 30 August 2014
Accepted: 20 July 2015
Published: 1 August 2015
Timely mouth-to-mouth ventilation is critical to resuscitate drowning victims. While drowning is frequent, there are no lay persons trained in cardio-pulmonary resuscitation (CPR) in rural Bangladesh. As part of a feasibility study to create a first response system in a conservative Islamic village environment, a pilot was undertaken to examine willingness to provide mouth-to-mouth ventilation for drowning resuscitation.
A questionnaire was administered to 721 participants at the beginning of a village-based CPR training course. Trainees were asked regarding willingness to administer mouth-to-mouth ventilation on a variety of hypothetical victims. Responses were tabulated according to the age, sex and relationship of the trainee to the postulated victim.
Willingness to deliver mouth-to-mouth ventilation was influenced by sex of a potential recipient and relationship to the trainee. Adolescent participants were significantly more willing to perform mouth-to-mouth ventilation on someone of the same sex. Willingness increased for both sexes when the postulated victim was an immediate family member. Willingness was lower with extended family members and lowest with strangers. Adult trainees were more likely to perform mouth-to-mouth ventilation than adolescent trainees in any scenario.
Adults express more willingness to resuscitate a broader range of drowning victims than adolescents. However in rural Bangladesh, adolescents are more likely to be in close proximity to a drowning in progress. Further efforts are needed to increase willingness of adolescents to provide resuscitation to drowning victims. However, despite potential cultural limitations, trained responders appear to be willing to give mouth-to-mouth ventilation to various recipients. Final determination will require evidence on response outcomes which is being collected.
Drowning rates in Bangladesh
Adult drowning rates
Age group (yrs)
65 & above
Child drowning rates
Age group (yrs)
The European Resuscitation Council provide specific guidelines on the resuscitation of drowning victims which include the provision of mouth-to-mouth ventilations. Therefore, the CPR taught in this first response programme incorporates mouth-to-mouth ventilation and compressions, rather than compression-only CPR.
The success of this first response programme largely depends on lay-person responders being able to learn CPR as well as their willingness to deliver it in a timely fashion. Although a programme assessment published in 2014 found that participants in Bangladesh were able to learn CPR for drowning resuscitation and other skills needed for first aid, no studies have previously been conducted in Bangladesh that look at willingness to provide mouth-to-mouth ventilations.
A key question regarding drowning response was whether willingness to administer mouth-to-mouth ventilation would be influenced by cultural values and relatively conservative religious beliefs prevalent in rural Bangladesh where approximately 90 % of the population is Muslim. A literature review found two studies that addressed willingness to administer CPR in Islamic countries. In Malaysia a study of medical and dental students showed that respondents were less likely to perform mouth-to-mouth ventilations on a member of the opposite sex, or of another race. In Saudi Arabia university students noted that the gender of the victim would be the most important factor in their willingness to perform mouth-to-mouth ventilation.
Willingness of trained responders to administer mouth-to-mouth ventilation is essential to a CPR program targeting drowning. The goal of this pilot study was to determine whether rural Bangladeshi villagers would administer mouth-to-mouth ventilation to a variety of hypothesised victims. Age, sex of the responder and sex of the victim as well as relationship with the victim were examined in relation to willingness to administer mouth-to-mouth ventilation.
Raiganj, population 3,097,450, is a landlocked rural sub-district where drowning rates are high. 721 participants were recruited to attend a First Response training course in a union (a union is a smallest administrative unit) of Raiganj between March and August 2011. Approximately 70 % of participants were adolescents aged 10-