Drowning is the leading cause of death from unintended injury in children globally. Drowning is preventable, and mechanisms exist which can reduce its impact, however the peer-reviewed literature to guide public health interventions is lacking. This paper describes a protocol for a review of drowning prevention interventions for children. Electronic searching will identify relevant peer-reviewed literature describing interventions to prevent child drowning worldwide. Outcome measures will include: drowning rates, water safety behaviour change, knowledge and/or attitude change, water safety policy and legislation, changes to environment and water safety skills. Quality appraisal and data extraction will be independently completed by two researchers using standardised forms recording descriptive and outcome data for each included article. Data analysis and presentation of results will occur after data have been extracted. This review will map the types of interventions being implemented to prevent drowning amongst children and identify gaps within the literature.
Globally, the impact of drowning and non-fatal drowning is significant. Drowning continues to be a preventable cause of death worldwide and in 2011, was the greatest (over 22%) cause of death from unintended injury in children aged less than 14 years with an estimated 129,553 deaths worldwide [
High income countries (HICs) have implemented comprehensive interventions to prevent children from drowning, reducing its occurrence in this age group. However, LMIC have not seen such reductions, as reflected in the injury statistics whereby LMICs experience 96% of global unintentional drowning deaths [
Unintentional drowning deaths can be largely averted through a combination of structural, environmental, educational, behavioral and technological interventions [
Recent systematic reviews on adult public health related drowning interventions [
Currently, there is no available systematic review of child public health related drowning interventions. Further, there is insufficient information regarding evaluated and effective interventions to guide the design and delivery of future interventions. Additionally, while evidence of health promotion intervention effectiveness grows, often reviews of the literature do not include details of implementation processes to provide sound evidence for practitioners and policymakers [
Approaches to evaluation of injury prevention and other health promotion initiatives can vary widely and lack methodological rigor [
Public health plays a key role in developing, monitoring and evaluating public health-related drowning interventions. A comprehensive and systematic approach is required to improve the reporting of interventions to reduce child drowning deaths. This will ensure the use of the best practice, encompassing appropriate theories/models and the inclusion of evaluation frameworks. This study aims to assess the global scope of child drowning prevention strategies. This review will investigate the differing designs, settings and effectiveness of prevention interventions associated with drowning in children, substantially adding to the evidence base.
The review will be conducted following established criteria for the evidence-based implementation and reporting of systematic reviews using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) [
The overall aim of this review is to systematically identify, assess and report on drowning prevention interventions for children (aged 0 to 18 years) that have been published in peer-reviewed literature. This project has two additional objectives: 1) To investigate the utilisation of behaviour change theories/models and evaluation frameworks in guiding child drowning prevention interventions; and 2) To establish which child drowning prevention intervention strategies and methods demonstrate effectiveness in HICs and LMICs.
The studies included in the review will be those found in the peer reviewed literature published in English, describing drowning prevention interventions for children aged 0 - 18 years. Interventions developed at an individual, community and population level will be included. Interventions that constitute primary prevention (eliminating or reducing causes of poor health, promotion of protective factors) will be included [
The inclusion of a range of intervention study designs is important to assess the breadth of literature available. For the purposes of this review, this will include randomized and non-randomized controlled trials, cohort studies, case-control studies, cross-sectional studies, retrospective analysis, observational studies and qualitative studies.
The review will assess public health related drowning interventions on an international scope. Studies will include participants aged from birth to those aged 18. Eighteen years of age has been designated as the age at which childhood ends by the UNICEF Convention on the Rights of the Child [
Outcome measures will include drowning rates, water safety behavior change or change in behavioral intention, drowning awareness/knowledge/intention/attitude change, water safety policy and legislation, changes to environment and water safety skills.
An electronic search will be conducted through the following academic databases to identify relevant publications which describe interventions to prevent infant, child and adolescent drowning deaths worldwide: PubMed; JSTOR; CINAHL; EMBASE; ERIC; Proquest; PsycINFO; Science Direct; Scopus; Global Health; Web of Science; Current Contents; Wiley Online Library and Medline.
Databases searches will be date-limited to before May 31 2013. Searched fields will be keyword, title and abstract. Two independent researchers will complete the following key word searches in the selected databases:
1) infant OR child* OR adolescen* OR kid* OR boy* OR girl* OR young OR youth OR teen*
2) drown* OR submers* OR “water safety”
3) injur* OR mortality OR morbidity 4) interven* OR evaluat* OR “best practice” OR “good practice” OR “best practise” OR “good practise” “health promot*” OR “public health” OR polic* OR research* OR prevent*
The researchers will cross check 10 per cent of search outcomes to ensure consistency in meeting the set criteria. Researchers will review the reference lists of journals articles published in 2012 to May 31 2013 to assess whether database results are exhaustive. Additionally they will manually search records from the last two years published in the five most common journals established by the electronic searches [
Citation management software will be used to manage articles. All citations will be downloaded into Endnote X6 software. Duplicates will be removed after search results have been imported in to the software at which point screening will commence. Screening will be piloted with the research team using criteria established in previous reviews. Titles and abstracts will be screened for relevance using the inclusion criteria. Publications that do not meet the inclusion criteria will be identified by titles and abstracts, which will be checked by two reviewers. Next, the remaining publications will be screened based on their full text and assessed as to whether they meet the stated inclusion criteria and checked by the research team. Citations will be assessed and categorised into three groups: possibly relevant studies; background literature and excluded studies. The full-text of any studies deemed possibly suitable for inclusion will be retrieved. These will be then reviewed to decide eligibility against the inclusion criteria.
Quality appraisal will assess the methodological quality of included studies and then determine whether a study has addressed the likelihood of bias in its design, conduct and analysis [
Data extraction will identify and record descriptive and outcome data for each article that is included in the review. Extraction will be independently completed by two researchers using a standardised data extraction form [
Data analysis and presentation of the results will occur after data has been extracted. A descriptive evaluation of each study will occur which will be presented in a table. It is not expected that there will be any homogeneity within the data and therefore meta-analysis and synthesis will be not be undertaken. Basic reporting of “pooled” data on age, gender, and key findings will be included. SPSS software, version 19 [
Anecdotally, practitioners indicate that the peer reviewed literature lacks sufficient and robust policy-ready evidence on the effectiveness of interventions to prevent child drowning. Results of evaluation must be reported, documented and shared so that intervention effectiveness can inform best practice and prioritisation of interventions [
This review of international child drowning prevention will not only add to the small evidence base of effective implementation and evaluation of child drowning prevention interventions, but may also support the development of a best practice model. The review will function as a call to action for practitioners to systematically report on interventions that work and more importantly those that do not to create a critical mass of research and evaluation on drowning within the peer-reviewed literature. This review will provide the most recent and comprehensive available evidence to catalogue what data exist, and further, what works to reduce the burden of child drowning globally.
There is no conflict of interest of any parties contributing to this study.