Award Title: Drowning Prevention for newly mobile infants under 2 years in Bangladesh
Funder: Department of Health and Social Care

Abstract: Research question  How can the risk of drowning be reduced in newly mobile children under 2 years in Bangladesh?  Background  In Bangladesh, drowning is the leading cause of death in children over 1 year, with the highest rates of drowning deaths found in 1-4-year olds. Newly mobile children are at particularly high risk. Unfortunately, existing interventions to prevent drowning have been shown to be unsuitable for children under 2 years. Barriers to prevent children accessing water have design and uptake challenges, and daycare models to provide increased supervision have poor attendance/adherence within this age range.   Aims and Objectives  Our aim is to develop a sustainable and scalable intervention to reduce the burden of drowning for newly mobile children under 2 years in Bangladesh. To achieve this, the study will generate qualitative and quantitative data to explore, formulate, design and test solutions that remove or mitigate the challenges faced by caregivers to protect and supervise their youngest children from drowning.   Methods  This multi-phase community-based study will be conducted across two sub-districts of Bangladesh; Kalapara in the south, and Sherpur Sadar in north.    The study will follow the six sequential steps to intervention development, outlined by the Quality Intervention Development (6SQuID) framework. We will use Human Centred Design (HCD) processes to engage with key stakeholders, to inform our understanding of the problem and co-design suitable interventions with communities.   This four-year study comprises six phases:      Planning and capacity building (3 months) - to develop the capacity of study collaborators in HCD processes.      Explorative social science and context analysis (12 months) - We will take a mixed methods approach, utilising qualitative data methods including focus group discussion, key informant interviews, risk mapping and observational studies. We will also technically assess existing interventions against ISO standards, and engage with end-users to understand design and implementation challenges.      Identifying and prioritising possible solutions (3 months) - Communities will be involved in the development of design concepts which will be prioritised based on expected feasibility, effectiveness, cost and acceptability.      Prototype development (9 months) - An iterative approach will be taken to design the final intervention for piloting, by building, testing, and re-designing prototypes based on experiential learning.       Piloting and evaluation (15 months) - We will evaluate the acceptability, fidelity and sustainability of the interventions using the RE-AIM framework.       Dissemination and ensuring sustainability (6 months) - Findings will be shared with communities, national stakeholders and international communities of practice, and used to inform national drowning prevention policy and programmes.     Anticipated Impact  We anticipate that interventions developed in this study will reduce drowning risk for children under 2 years in rural Bangladesh. Findings will inform the ongoing development of a national drowning prevention programme coordinated by the Ministry of Women and Children's Affairs (MoWCA), and the national drowning prevention strategy. Findings will also be fed into global and regional best practice, through the World Health Organization drowning prevention guideline development group. Project partners are already actively involved in these fora.

Lay Abstract: Globally, drowning is a major cause of injury and death and Bangladesh has one of the highest rates of drowning in the world, especially among children. Drowning is the leading cause of child deaths for 1-17 year olds. Over the past 15 years, CIPRB has researched and implemented several effective drowning prevention solutions focussed on children.  Daily exposure to water represents a real drowning risk in Bangladesh, especially for rural preschool children. The risk of drowning in rural areas is twice that of cities due to high levels of poverty and easy access to water bodies. Our intervention areas have significant numbers of ponds and ditches - natural drowning hazards for children aged 1-5 years - that drive drowning rates even higher. One project area (Kalapara) has one of the country s highest rates of drowning. Caregivers have the constant challenge of providing supervision to small children whilst also working, preparing food, or undertaking household chores. This means that toddlers are often cared for by other young siblings. CIPRB has developed a successful community daycare model that reduces drowning rates in preschool aged children. However, our analysis shows that families are reluctant to allow children under 2 years (=highest risk group) to attend daycare.  We have planned an interdisciplinary project with six key phases to identify and test better ways to prevent newly mobile infants under 2 years old from drowning. We will work with communities in the north and south of Bangladesh to (1) build the skills needed by communities and our research partners to carry southout this research in rural Bangladesh; (2) understand the challenges of keeping under 2s safe from drowning; (3) identify and prioritise possible solutions; (4) prototype solutions with designers and community members; (5) trial the best solutions in communities and evaluate them on use and maintenance, effectiveness, and ability to roll out the interventions across Bangladesh; and (6) share the findings and make sure that the value of the solutions is not lost when the research project ends.   By working with communities in two distinct areas of in the north and south of Bangladesh, we will better understand how to roll out successful interventions for different circumstances and environments. Using an inclusive, human-centred design approach, we aim to identify the solutions that are most acceptable to communities, whose input will be central to the whole process. We anticipate the findings from this research will inform a national drowning prevention programme run by Bangladesh s Ministry of Women & Children s Affairs, and other non-governmental policy and programme areas. In addition, findings will be relevant to preventing child drowning in other South-East Asian countries, where over 30% of global drowning deaths occur.

Research Activity Codes: 7.1 INDIVIDUAL CARE NEEDS
Health Categories: INJURIES AND ACCIDENTS