Alonge Olakunle, Bishai David, Wadhwaniya Shirin, Agrawal Priyanka, Rahman Aminur, Dewan Hoque Emdad Md, Baset Kamran Ul, Salam Shumona Sharmin, Bhuiyan Al-Amin, Islam Md Irteja, Talab Abu, Rahman Qazi Sadeq-Ur, Rahman Fazlur, El-Arifeen Shams, Hyder Adnan A
Johns Hopkins International Injury Research Unit, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
Department of Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
Inj Epidemiol. 2020 May 11;7(1):17. doi: 10.1186/s40621-020-00245-2.
This paper estimates the impact on childhood drowning rates of community-based introduction of crèches or playpens or both in rural Bangladesh for children aged 0-47 months.
A baseline census of the whole population of 270,387 households in 51 unions, 451 villages from 7 rural sub-districts in Bangladesh was conducted in 2013. The baseline census determined retrospective, age-specific, and cumulative drowning incidence rates (IR) experienced in the target households in the 12 months prior to the intervention. Beginning in late 2013, creches for drowning prevention were established across the study area. Acceptance into creches was provided and written assent to attend a creche was obtained for all children aged 9-47 months in all participating unions. Playpens were provided to 45,460 of these children, of which 5981 children received only the playpens. All children were followed-up until their 48-month birthday or administrative censoring (fixed timepoint to stop observing the drowning deaths), after a two-year implementation period (2014-2016). Drowning IR were estimated for children and compared to corresponding baseline rates from 2012. Age-specific drowning IR under different "as treated" categories (playpen-only, creche-only, and playpen-plus-creche) were compared to the baseline rates experienced by the categorized households prior to intervention.
A total of 3205 creches (average of 7 creches per village) were established, and 116,054 children aged 9-47 months were exposed to the intervention packages. Aggregated drowning IRs between age 0 and 47 were estimated per 100,000 population per year at 86.73 (95% CI: 69.67-107.97) and 43.03 (95% CI: 35.55-52.10) in the baseline and post implementation period, respectively. Risk ratios were 0.40 (95% CI: 0.28-0.57) overall, and 0.34 (95% CI: 0.13-0.90), 0.09 (95% CI: 0.02-0.36), and 0.04 (95% CI: 0.002-0.60) in children under the creche-only, aged, 1, 2, and 3 years old respectively. Inexplicably, drowning rates were statistically significantly higher post-intervention in children 0-11 months. There was no mortality reduction with playpen use (alone or in combination), and this group may actually have had a higher risk of drowning.
Creches are effective for preventing childhood drowning in rural Bangladesh for children above age 1-year, and should be considered for further scale-up.
本文评估了在孟加拉国农村地区为0至47个月大的儿童引入社区日托中心或婴儿围栏或两者兼有的措施对儿童溺水率的影响。
2013年对孟加拉国7个农村地区的51个联盟、451个村庄的270387户家庭进行了全人口基线普查。基线普查确定了干预前12个月目标家庭中回顾性的、特定年龄的和累积的溺水发病率（IR）。从2013年末开始，在整个研究区域建立了预防溺水的日托中心。所有参与联盟中9至47个月大的儿童均可进入日托中心，并获得了参加日托中心的书面同意。为其中45460名儿童提供了婴儿围栏，其中5981名儿童仅获得了婴儿围栏。在为期两年的实施期（2014 - 2016年）后，对所有儿童进行随访，直至其48个月生日或行政审查（停止观察溺水死亡的固定时间点）。估计了儿童的溺水发病率，并与2012年的相应基线率进行比较。将不同“实际治疗”类别（仅婴儿围栏、仅日托中心、婴儿围栏加日托中心）下的特定年龄溺水发病率与干预前分类家庭经历的基线率进行比较。
共建立了3205个日托中心（平均每个村庄7个日托中心），116054名9至47个月大的儿童接受了干预措施。0至47岁年龄组的汇总溺水发病率估计在基线期和实施期后分别为每10万人口每年86.73（95%置信区间：69.67 - 107.97）和43.03（95%置信区间：35.55 - 52.10）。总体风险比为0.40（95%置信区间：0.28 - 0.57），仅日托中心组中1岁、2岁和3岁儿童的风险比分别为0.34（95%置信区间：0.13 - 0.90）、0.09（95%置信区间：0.02 - 0.36）和0.04（95%置信区间：0.002 - 0.60）。令人费解的是，干预后0至11个月大儿童的溺水率在统计学上显著更高。使用婴儿围栏（单独或联合使用）并没有降低死亡率，而且这组儿童实际上可能有更高的溺水风险。
日托中心对预防孟加拉国农村地区1岁以上儿童溺水有效，应考虑进一步扩大规模。
