Keeping afloat: a case study tracing the emergence of drowning prevention as a health issue in Bangladesh 1999-2017.

BACKGROUND: Drowning is a leading cause of child death in Bangladesh. The present study investigated the emergence of drowning reduction as a priority within Bangladesh and the position it currently holds on the national policy agenda. METHODS: This case study documents the evolution of policy responses to drowning, reporting on data from semistructured interviews and a document analysis. To identify key factors that have facilitated the prioritisation of drowning prevention, data were synthesised using Shiffman and Smith's 2007 Policy Prioritisation Framework. Furthermore, an inductive approach was used to identify key themes unique to drowning prevention that were not embedded in the framework. RESULTS: Four key phases of policy development for drowning prevention were distinguishable: (1) identification of issue and the emergence of actor support; (2) enhanced leadership and the accumulation of issue characteristics; (3) the formation of an internal frame and its impact on global support; and (4) enhanced national recognition and supportive global normative factors. Four additional themes unique to the case of drowning were also identified: competing health priorities, limited issue awareness, shift of disease burden to non-communicable diseases and the multisectoral nature of drowning. CONCLUSION: This study demonstrates that the level of political prioritisation given to drowning prevention has evolved over the last decade and a half. A comprehensive understanding of factors that have elevated the issue onto the policy agenda will ensure future stakeholder engagement activities can be designed to foster deeper and more sustained commitment by key actors and organisations.

Exploring the impact, response and preparedness to water-related natural disasters in the Barisal division of Bangladesh: a mixed methods study.

OBJECTIVES: To investigate the impact of natural disasters on communities in the Barisal division of Bangladesh, exploring community approaches to disaster preparedness and mitigation. SETTING: Communities in all districts of the Barisal division of Bangladesh. PARTICIPANTS: Quantitative data were collected through a cross-sectional household survey (n=9263 households; n=38 981 individuals). Qualitative data were collected through in-depth interviews (n=7) and focus group discussions (n=23) with key informants. OUTCOME MEASURES: Quantitative research recorded features of natural disaster events from the previous 5 years, documenting risk factors that increase vulnerability to disaster, use of disaster warning systems and evacuation processes. Qualitative research investigated disaster risk perceptions, experiences during and following disaster, and disaster preparedness practices. RESULTS: The survey response rate was 94.7%. Exposure to disaster in the last 5 years was high (82%) with flooding and cyclones considered the greatest threats. Awareness of evacuation processes was low; and only 19% of respondents evacuated their homes at the time of disaster. Drowning during disaster was the primary concern (87%), followed by debt, livestock and crop loss (78%). The qualitative findings indicated prevailing fatalistic perceptions towards natural disasters among community. The consequences of disasters included significant loss of livelihoods and exposure to infections due to poor sanitation. There was also insufficient support for the most vulnerable, particularly women, children and the elderly. Although several community preparedness and practices existed, there was a lack of response to early warning systems. Barriers to disaster response and resilience included financial insecurities, loss of livelihoods and cultural concerns regarding women's privacy. CONCLUSIONS: Critical to achieving disaster resilience is increased government investment in infrastructure and systems-level responses that empower communities. Further research can support this by addressing community challenges to promoting disaster resilience and how to leverage existing community strengths to implement locally owned solutions.