Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda.
Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, Kampala, Uganda.
PLoS One. 2023 Oct 20;18(10):e0292754. doi: 10.1371/journal.pone.0292754. eCollection 2023.
The burden of drowning among occupational boaters in low and middle-income countries is highest globally. In Uganda, over 95% of people who drowned from boating-related activities were not wearing lifejackets at the time of the incident. We implemented and evaluated a peer-led training program to improve lifejacket wear among occupational boaters on Lake Albert, Uganda.
We conducted a two-arm cluster randomized controlled trial in which fourteen landing sites were randomized to the intervention and non-intervention arm with a 1:1 allocation ratio. In the intervention arm, a six-month peer-to-peer training program on lifejacket wear was implemented while the non-intervention arm continued to receive the routine Marine Police sensitizations on drowning prevention through its community policing program. The effect of the intervention was assessed on self-reported and observed lifejacket wear using a test of differences in proportions of wear following the intention to treat principle. The effect of contamination was assessed using mixed effect modified Poisson regression following the As Treated analysis principle at 95% CI. Results are reported according to the CONSORT statement-extension for cluster randomized trials.
Self-reported lifejacket wear increased markedly from 30.8% to 65.1% in the intervention arm compared to the non-intervention arm which rose from 29.9% to 43.2%. Observed wear increased from 1.0% to 26.8% in the intervention arm and from 0.6% to 8.8% in the non-intervention arm. The test of differences in proportions of self-reported lifejacket wear (65.1%- 43.2% = 21.9%, p-value <0.001) and observed wear (26.8%- 8.8% = 18%, p-value <0.001) showed statistically significant differences between the intervention and non-intervention arm. Self-reported lifejacket wear was higher among boaters who received peer training than those who did not (Adj. PR 1.78, 95% CI 1.38-2.30).
This study demonstrated that peer-led training significantly improves lifejacket wear among occupational boaters. The government of Uganda through the relevant ministries, and the Landing Site Management Committees should embrace and scale up peer-led training programs on lifejacket wear to reduce drowning deaths.
在中低收入国家，职业划船者溺水的负担是全球最高的。在乌干达，超过 95%的与划船相关的溺水事件中，溺水者当时没有穿救生衣。我们实施并评估了一项以同伴为基础的培训计划，以提高乌干达阿尔伯特湖上职业划船者穿救生衣的意识。
我们进行了一项两臂整群随机对照试验，其中 14 个登陆点随机分为干预组和非干预组，比例为 1:1。在干预组中，实施了为期六个月的同伴关于救生衣穿着的培训计划，而非干预组则继续通过其社区警务计划接受常规的海洋警察溺水预防方面的宣传。采用意向治疗原则下的差异比例检验来评估干预对自我报告和观察到的救生衣穿着的效果。采用基于治疗分析原理的混合效应修正泊松回归来评估污染的影响，置信区间为 95%。结果按照扩展后的簇随机试验 CONSORT 声明进行报告。
与非干预组从 29.9%上升到 43.2%相比，干预组的自我报告救生衣穿着率从 30.8%显著上升到 65.1%。观察到的穿着率从干预组的 1.0%上升到 26.8%，从非干预组的 0.6%上升到 8.8%。自我报告的救生衣穿着率（65.1%-43.2%=21.9%，p 值<0.001）和观察到的穿着率（26.8%-8.8%=18%，p 值<0.001）之间的差异比例检验显示，干预组和非干预组之间存在统计学显著差异。接受同伴培训的划船者比未接受培训的划船者更有可能穿戴救生衣（调整后的 PR 1.78，95%CI 1.38-2.30）。
这项研究表明，同伴主导的培训显著提高了职业划船者穿戴救生衣的意识。乌干达政府应通过相关部委和登陆点管理委员会，接受并推广以同伴为基础的救生衣穿戴培训计划，以减少溺水死亡人数。
