Keeping afloat: investigating how past and future research can facilitate the implementation and scale-up of a national drowning prevention strategy for Bangladesh.

Abstract

Over the last forty-seven years Bangladesh has made significant improvements in population health. Part of this success has been attributed to the use of evidence from pilot programs to inform policy and program scale-up. Adoption of evidence informed health policies has led to the improved treatment of diarrhoeal diseases, a reduction in newborn deaths and the elimination of many vaccine preventable diseases. These achievements have created an epidemiological shift in which injuries have emerged as the leading causes of death and disability among children.

In 1998 a community surveillance survey identified drowning as the third leading cause of child mortality for children aged 1-4 years of age, following pneumonia. This finding led to further research to determine fatal drowning rates throughout Bangladesh, as well as to identify the risk factors and effective interventions to prevent drowning. Despite the accumulation of research evidence about drowning rates and effective prevention over the ensuing years, limited government uptake of this evidence has occurred to date.

To better understand strategies that can leverage political action for drowning prevention, this thesis investigates factors that have led to the political prioritisation and implementation of health policies within Bangladesh. Furthermore, through the analysis of qualitative data this study has illustrated how drowning has emerged as a health issue within Bangladesh and identified factors that have facilitated or constrained this process. Learnings from these past experiences have been used to propose further actions that can improve knowledge translation activities employed by a current drowning reduction program.

Findings from this thesis highlight, (1) the importance of early stakeholder involvement in research programs to facilitate the uptake of evidence informed interventions as well as the formation of a cohesive network of policy actors to push the issue forward; (2) how drowning can be connected to priorities outlined by the global development agenda; and (3) the complexity of enhancing the political prioritisation of a multi-sectoral health issue. To facilitate the formation of a national drowning prevention strategy, a greater emphasis on the design, monitoring and evaluation of evidence informed stakeholder engagement strategies is required for future drowning reduction programs.