Systematic review to support WHO drowning prevention guideline


In 2019 CEBaP and Cochrane First Aid were approached by WHO to develop two systematic reviews to support the development of their new guideline concerning drowning prevention

One of the reviews focused on the implementation of day care programs on drowning accidents in children under 6 years of age in low- and middle-income countries. Children living in rural areas near open water are at risk of drowning, particularly if they are not attending school or are left unsupervised. Child supervision is recommended to prevent drowning accidents, and organized day care at a center outside the home could help. We searched several databases, two trial registries and several websites of organizations that develop programs targeted to children, for randomized, quasi-randomized, and non-randomized controlled studies that researched the effect of formal day care programs. We found 2 studies that involved 252,631 children and took place in rural Bangladesh. It was concluded that a day care program for children under 6 years of age, combined with parent education, playpens for parents, and community education, probably reduces the risk of death from drowning, when compared with no day care program. Cost-effectiveness was reported as 812 USD per disability-adjusted life-year averted as a consequence of drowning. In addition, we are uncertain about the effects of a day care program when compared with playpens provided to parents, and about the effects of a day care program combined with playpens for parents when compared with playpens alone.

The review on day care programs is now published at The Cochrane Library.

The focus of the second review was the impact of swimming skills training and water safety education programs on drowning incidents, and publication will follow soon. 

The content of the systematic reviews was used to support a WHO Guideline Development Group meeting in May 2020, and the GRADE Evidence-to-Decision framework was used to balance desirable and undesirable effects of the intervention of interest. The final WHO drowning prevention guideline will soon be available.