Exploring the paradox between perception and actual childhood drowning risk: an evidence-based study in Bangladesh.

Childhood drowning is a major public health issue in Bangladesh, especially in rural and island regions. This cross-sectional study explored the gap between perceptions and actual drowning risks by surveying 322 respondents from the northern mainland and Sandwip Island. A purposive sampling strategy was used to identify households with child drowning experiences, and data were collected using a culturally adapted, semi-structured questionnaire. Statistical analyses, including logistic and linear regression, examined associations between perceptions, drowning mortality, and sociodemographic factors. Although 90.37% of respondents believe drowning is preventable, only 5.28% teach their children how to respond during incidents, and 84.47% lack rescue knowledge. Surprisingly, willingness to send children to childcare centers was associated with higher reported drowning deaths (aOR: 3.69). Geographic and income disparities influenced risk perception, with island residents reporting lower awareness (β = -0.04) and higher-income respondents showing greater perception. Findings highlight a critical mismatch between awareness and action, emphasizing the need for community-based prevention strategies, safety audits of childcare facilities, and targeted interventions for low-income populations.