Gupta Medhavi, Rahman Aminur, Dutta Notan C, Saha Ashim K, Zwi Anthony, Ivers Rebecca Q, Jagnoor Jagnoor
The George Institute for Global Health, Newtown, New South Wales, Australia.
Centre for Injury Prevention and Research Bangladesh, Dhaka, Bangladesh.
Inj Prev. 2022 Feb;28(1):23-31. doi: 10.1136/injuryprev-2020-044066. Epub 2021 Feb 26.
Living and environmental conditions in rural Bangladesh expose children to drowning. The Anchal programme protects children through crèche-based supervision in an enclosed space run by locally recruited carers. It is unclear under what conditions the programme best operates to maximise protection. We conducted a process evaluation of Anchal to determine enabling factors and challenges to implementation.
Quantitative programme data were analysed to calculate metrics including child participation and fidelity of implementation to defined processes. Qualitative data collection with programme participants and implementers provided insights into barriers and enablers of implementation. Analysis was guided by the UK Medical Research Council's process evaluation framework.
Anchal operated 400 centres with an average of 22.2 children enrolled, as per target. However, daily attendance averaged lower than the 80% target. Children aged 1-2 years old, who are most at risk of drowning, were least likely to enrol and attend regularly due to low engagement with activities and parental concerns for safety. Greater distances and lower educational attainment in some regions reduced attendance and increased carer attrition.
The Anchal programme met most programme delivery targets. However, programme success could be improved through increasing supervision, providing communication training for implementing staff, designing programmes for children aged 1-2 years old, encouraging community ownership and providing child pick-up services. These contextual solutions can be adapted to similar programmes operating through grassroots-level engagement and recruitment of community health workers, to maximise their effectiveness and sustainability.
孟加拉国农村的生活和环境条件使儿童面临溺水风险。安查尔项目通过在由当地招募的护理人员管理的封闭空间内基于日托中心的监督来保护儿童。目前尚不清楚该项目在何种条件下能最佳运作以实现最大程度的保护。我们对安查尔项目进行了过程评估，以确定其实施的促成因素和挑战。
对项目定量数据进行分析，以计算包括儿童参与度和对既定流程的实施保真度等指标。对项目参与者和实施者进行定性数据收集，以深入了解实施的障碍和促成因素。分析以英国医学研究理事会的过程评估框架为指导。
安查尔项目运营了400个中心，平均每个中心招收22.2名儿童，达到了目标。然而，日均出勤率平均低于80%的目标。1至2岁的儿童溺水风险最高，但由于对活动参与度低以及家长对安全的担忧，他们入学和定期出勤的可能性最小。一些地区距离较远且教育程度较低，这降低了出勤率并增加了护理人员的流失率。
安查尔项目达到了大多数项目交付目标。然而，通过加强监督、为实施人员提供沟通培训、为1至2岁儿童设计项目、鼓励社区自主以及提供儿童接送服务，可以提高项目的成功率。这些因地制宜的解决方案可适用于通过基层参与和招募社区卫生工作者开展的类似项目，以最大限度地提高其有效性和可持续性。
