Academic journal article Journal of Health Population and Nutrition

A Framework for Addressing Implementation Gap in Global Drowning Prevention Interventions: Experiences from Bangladesh

Academic journal article Journal of Health Population and Nutrition

A Framework for Addressing Implementation Gap in Global Drowning Prevention Interventions: Experiences from Bangladesh

Article excerpt

INTRODUCTION

Globally, the total deaths caused by injuries increased from 4 million in 1990 to 5 million in 2011 (1). According to the World Health Organization (WHO), more than 359,000 deaths in 2011 were due to drowning (1). Thirty-six percent of these deaths occurred among individuals aged below 15 years; children aged 1-4 year(s) accounted for 18% of all drowning-related deaths (1). Drowning is the second leading cause of childhood injury-related deaths worldwide and is the commonest cause of injury-related deaths among under-five children (1,2).

The 2011 WHO estimates show that the burden of drowning is disproportionately borne by populations in low- and middle-income countries (LMICs) (1). Analyses of community-based surveillance data from Southeast Asian countries show that those aged 1-4 year(s) are at the highest risk of drowning (3). In Bangladesh, drowning accounts for 42% of all deaths in children aged 1-4 year(s) (4). These deaths occur particularly in rural areas of the country; 75% of deaths occur in natural water bodies less than 20 metres from the home (5,6). Other risk factors for childhood drowning in Bangladesh include inadequate supervision, male gender, and the monsoon/rainy season (April-September) (7,8). Indeed, lack of direct supervision often leads to childhood drowning worldwide and has been associated with 70% of drowning-related deaths among children in Bangladesh (9).

Several attempts have been made in the past to tackle the high rate of childhood drowning in Bangladesh through prevention (10,11). Two supervisory tools--door barriers and playpens--were pilot-tested in rural areas of the country to prevent childhood drowning (10). While both tools improved supervision, playpens found a greater acceptance among the caregivers (10). Another study explored the option of a creche which provides a suitable environment for primary caregivers to place children in during busy hours for the family. The study reported a drastic drop in drowning rate and risk among 1 to 5 year(s) old children who participated in the programme, with children being 72% less likely to drown, compared to those who did not participate (11). While these two interventions hold significant promise in reducing the burden of childhood drowning in Bangladesh, these have not been implemented at scale. In fact, it has been proposed that funding for a large-scale drowning prevention intervention study focusing on under-5 children in LMICs may be an appropriate research investment (5).

In a previous paper (Hyder et al. 2014), we described the protocol for a implementation study, the Saving of Children's Lives from Drowning (SoLiD) Project, to implement the playpen and creche interventions at a large-scale in Bangladesh (12). The overall goal of this paper is to present a framework for implementing drowning prevention interventions in resource-limited settings (13,14). This framework was used in developing the SoLiD Project. To provide some background on the discussion of the framework and its application to SoLiD, a brief review of selected potential intervention options for addressing the burden of drowning in LMICs is also presented. The hope is that this paper will further the dialogue on how to close the implementation gap for childhood drowning prevention interventions in LMICs and provide guidance on initial steps for implementing these interventions in resource-limited settings (12).

SELECTED INTERVENTION OPTIONS FOR CHILDHOOD DROWNING PREVENTION AND THEIR RELEVANCE IN LMICs

A review of the systematic reviews on drowning prevention interventions was conducted, and original research articles were pulled and summarized into broad prevention categories. The initial review was based on the WHO World Report on Child Injury Prevention (WRCIP) (7). The WRCIP report comprises a systematic review of interventions for major child injury-related death mechanisms, including drowning. …

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