Identifying Gaps in Drowning Data Collection in Low-and Middle-Income Countries and the Actors Addressing Them

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Full Title: Identifying Gaps in Drowning Data Collection in Low-and Middle-Income Countries and the Actors Addressing Them

Short Title: Drowning Data Collection Project

Duration: August 2023 to May 2024

Funder: Royal National Lifeboat Institution (RNLI)

Core Team: Dr. Nibedita Ray-Bennett (PI) from the University of Leicester; Dr. Winifred Ekezie from the University of Leicester and Aston University; and Mr. Tom Mecrow and Dr. Rebecca Sindall from the Royal National Lifeboat Institution (RNLI).

Support Members: Mr. Lasith Dissanayake (Research Assistant) from the University of South Wales and Ms. Lauren MacLeod (Research Administrator) from the Avoidable Deaths Network.

Collaborators: Dr. Colleen Saunders from the University of Cape Town; Dr. Aminur Rahman from the Centre for Injury Prevention Research, Bangladesh (CIPRB); and Dr. Frederick Oporia from the Department of Trauma, Injury and Disability (Epidemiology & Prevention), Makerere University.

Volunteers: Master Arkoneil Ghosh, Dr. Azukaego Nnaji, Mr. Biswajit Paul, Dr. Madhulika Sahoo, Dr. Nimra Choudhary, Ms. Srashta Choudhary and Ms. Racheal Nantume.

Context

Drowning is serious and neglected public health threat which is estimated to result in 236,000 unintentional deaths annually worldwide according to the World Health Organisation (WHO). This estimate does not include deaths due to transport incidents, flooding and other disaster events, or intentional injury. Low-and middle-income countries (LMICs) account for over 90% of the global drowning burden amongst the high-risk groups. According to WHO’s ‘Global Report on Drowning’ (2014) high-risk groups include children under 5 years; males under 25 years of age; the poorest and the least educated people who live in rural settings (especially around water) and communities with the least resources to safely adapt to the risks around them; and communities living near water, travelling on water, working on or around water.

Drowning deaths in LMICs are under-reported as bodies may not be located quickly or even in the same area, police may regard drowning deaths as suspicious, there is little incentive to seeking medical care for a person who is clearly dead, and often a cost associated with reporting a death. As such, while the circumstances that lead to drowning make the cause of death relatively easy to determine, the drowning burden is frequently difficult to measure.

There is a clear desire and need for improving local-level data collection that can provide more accurate data on drowning burden but also on the context of drowning to inform the design of suitable interventions. A verbal autopsy (VA) has become a commonly used tool for determining the cause of death in LMICs, either as part of large-scale household surveys or within geographically specific health and demographic surveillance systems.

Whilst the primary goal of a verbal autopsy is establishing a cause of death, there is increasing interest in using the tool to identify risk factors for injury deaths, including drowning. Nevertheless, the ease of identifying injury deaths means that there are no specific questions in the verbal autopsy questionnaire that interrogate the context of the death, except for establishing the role of the deceased in road traffic accidents. As such, context can only be ascertained in the open narrative part of the questionnaire. A lack of guidance for data collectors means that this opportunity to determine useful contextual factors that could inform intervention design is lost.

Research Questions

Based on the above challenges, this collaborative project across six institutions will study:

1. How drowning data has been collected in LMIC settings identifying the challenges and opportunities of the processes employed?
2. Which organisations or individuals’ work has identified challenges and opportunities in using verbal autopsy to collect context-specific and modifiable risk factors for injury deaths in LMIC settings?

To answer these research questions, we will conduct a scoping literature review to identify and synthesise existing information on how drowning data is collected in LMIC settings in general and Bangladesh, South Africa, and Uganda in particular.

Our approach will be underpinned by WHO’s ‘Global Report on Drowning’ risk framework, which focuses on the following: what are the risks?; who is at risk?; where are the risks? The literature review will concentrate on these three main components of the risk framework related to the identified high-risk group (mentioned above).

Through the scoping literature review as well as through the ADN and RNLI’s existing networks, we will also identify organisations or individuals whose work has identified challenges and opportunities in verbal autopsy and invite these experts to attend a workshop.

At the workshop, we will explore, how drowning data is captured, and gather suggestions for a minimum dataset and guidelines needed to identify modifiable risk factors among small-scale fishers – who are drowning high-risk groups in Uganda and South Africa.  At the workshop, we will also solicit best practices for drowning data collection and partners for collaboration towards supporting the development of a full project proposal on establishing a minimum dataset for identifying modifiable risk factors for drowning for high-risk groups, as identified in the WHO Drowning Report.

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UPDATES

8 May 2024: Consultations with technical experts on verbal autopsy tools are ongoing.

6 May 2024: Core Team members Dr. Nibedita Ray-Bennett (PI) and Dr. Winifred Ekezie ran the QI Quiz on Avoidable Disaster Deaths side event at the HNPW Conference in Geneva with 44 participants. The questions have been informed by the findings of this project.

1 May 2024: Scoping Literature Review has been completed and is being reviewed by collaborators.

22 February 2024: The abstract ‘How drowning data is collected in Low- and Middle-Income Countries (LMICs): A Scoping Review’ for the 15^th World Conference on Injury Prevention and Safety Promotion (Safety 2024) has been accepted.

The poster entitled ‘How drowning data is collected in Low- and Middle-Income Countries (LMICs): A Scoping Review‘ will be displayed at the International Awareness Day for Avoidable Deaths (IAD4AD) India 2024: Symposium on Reducing Avoidable Deaths.

Scoping review data analysis is ongoing.

29 January 2024: A review of organisations or individuals whose work has identified challenges and opportunities in using verbal autopsy is being conducted.

25 January 2024: The collaborators conducted their sixth meeting, discussing the project’s implementation update, activities and deliverables. The collaborators will reconvene on Wednesday 28 February.

23 January 2024: The primary scoping literature review has been completed and analysis is ongoing.

5 January 2023: An abstract was submitted to the 15th World Conference on Injury Prevention and Safety Promotion (Safety 2024).

12 December 2023: The collaborators conducted their fifth meeting, discussing the project’s implementation update, activities and deliverables. The collaborators will reconvene on Thursday 25 January.

7 December 2023: Ethics approval has been provided by the University of Leicester.