Day care as a strategy for drowning prevention in children under 6 years of age in low‐ and middle‐income countries

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[Below is the Plain language summary]

Key message

A day care program with extra features such as community‐based education, parent education, and playpens provided to parents outside the day care facility probably reduces the risk of death by drowning for children under 6 years living in areas where large numbers of children drown each year.

Why did we do this Cochrane Review?

Children living in rural areas near open water are at risk of drowning, particularly if they are not attending school or are left unsupervised. Child supervision is recommended to prevent drowning accidents, and organized day care at a center outside the home could help.

We wanted to know if a day care program for children under 6 years of age in low‐ to middle‐income countries might help to reduce the number of drowning accidents (fatal and non‐fatal).

What did we do?

We searched for studies that looked at the effects of a day care program on drowning accidents in children under 6 years of age. The day care program could include features such as educational activities aimed at preventing injuries or drowning and early childhood development activities.

How up‐to‐date is this review?

We included evidence published up to August 18, 2020.

What did we find?

We found 2 studies that involved 252,631 children and took place in rural Bangladesh.

One study lasted 4 years and 8 months. It assessed the effects of a day care program that combined parent education, playpens provided to parents, and community education as compared to the effects of no day care program.

The other study lasted 3 years and 4 months. The effects of a day care program alone and the effects of a combined program of day care with playpens provided to parents were each compared with the effects of only playpens provided to parents.

What are the main results of our review?

Compared with no day care program, a day care program for children under 6 years of age, combined with parent education, playpens for parents, and community education, probably reduces the risk of death from drowning (evidence from 1 study in 136,577 children). For every 100,000 children under 6 years of age who were not in the day care program, 77 children might die from drowning, compared with 14 children included in the day care program.

Providing this day care program with additional activities was cheaper than the cost of every year lost to illness, disability, or early death by drowning (evidence from 1 study in 136,577 children).

We are uncertain about the effects of a day care program when compared with playpens provided to parents, and we are uncertain about the effects of a day care program combined with playpens for parents when compared with playpens alone.

Neither study reported results on non‐fatal drowning accidents, unsafe water exposure, the safety of the program, or other accidental injuries.

Limitations of the evidence

The results were from two observational studies in which researchers observed the effects of a factor (such as a day care program) without trying to change who did, or did not, experience it. Evidence from observational studies is not as reliable as evidence from randomized controlled studies, in which the programs people receive are decided at random.

We are moderately confident about the effects of a day care program (with extra features) on the risk of death by drowning in children under 6 years of age. Further research is likely to increase our confidence in these results.