Day care as a strategy for drowning prevention in children under 6 years of age in low‐ and middle‐income countries

Cochrane Public Health group published a systematic review in April 2021 where the effects of day care programs for children under 6 years of age on drowning‐related mortality or morbidity, or on total drowning accidents (fatal and non‐fatal), in LMICs, compared to no day care programs or other drowning prevention interventions were assessed.

The evidence published up to August 18, 2020 found 2 studies that involved 252,631 children and took place in rural Bangladesh.

One study lasted 4 years and 8 months. It assessed the effects of a day care program that combined parent education, playpens provided to parents, and community education as compared to the effects of no day care program.

The other study lasted 3 years and 4 months. The effects of a day care program alone and the effects of a combined program of day care with playpens provided to parents were each compared with the effects of only playpens provided to parents.

The results of the review showed that compared with no day care program, 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 (evidence from 1 study in 136,577 children). For every 100,000 children under 6 years of age who were not in the day care program, 77 children might die from drowning, compared with 14 children included in the day care program. Providing this day care program with additional activities was cheaper than the cost of every year lost to illness, disability, or early death by drowning (evidence from 1 study in 136,577 children).

The authors are uncertain about the effects of a day care program when compared with playpens provided to parents, and we are uncertain about the effects of a day care program combined with playpens for parents when compared with playpens alone. Neither study reported results on non‐fatal drowning accidents, unsafe water exposure, the safety of the program, or other accidental injuries.

This review provides evidence suggesting that a day care program with additional out‐of‐day care components such as community‐based education, parent education, and playpens provided to parents likely reduces the drowning mortality risk in regions with a high burden of drowning compared to no intervention.

The systematic review can be accessed at https://doi.org/10.1002/14651858.CD014955