New Cochrane review informing WHO drowning prevention guideline

In 2019, Cochrane First Aid and its initiator the Centre for Evidence-Based Practice of the Belgian Red Cross were approached by the World Health Organization to develop 2 systematic reviews to support the development of their new guideline on drowning prevention.
The first review, with Cochrane First Aid Director Emmy De Buck as the first author, has now been published in The Cochrane Library. It focuses on the effectiveness of organized day care on reducing drowning accident rates in children under 6 years of age in low- and middle-income countries.

The systematic review team searched multiple databases, trial registries and websites for randomized, quasi-randomized and non-randomized controlled studies investigating the effectiveness of formal day care programs. Two studies performed in rural Bangladesh involving 252 631 children were identified.
The review found that a day care program for children under 6 years of age, combined with parent education, playpens provided to parents and community-based education, probably reduces the risk of death by drowning, compared with no day care program (moderate-certainty evidence). Providing a day care program and the additional activities was cheaper than the cost of every year lost to illness, disability, or early death by drowning. The evidence is uncertain about the effects of a day care program when compared with playpens provided to parents, and about the effects of a day care program combined with playpens for parents when compared with playpens alone (very low-certainty evidence). Neither study reported results on non‐fatal drowning accidents, unsafe water exposure, the safety of the program, or other accidental injuries.

The focus of the second review was the impact of swimming skills training and water safety education programs on drowning incidents, and publication will follow soon.
The findings of these systematic reviews were used to inform a WHO Guideline Development Group meeting in May 2020, where the GRADE Evidence-to-Decision framework was used to balance desirable and undesirable effects of the day care programs. The final WHO drowning prevention guideline will soon be available.