Drowning Prevention for newly mobile infants under 2 years in Bangladesh

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.