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Implementing a crèche-based community drowning programme in rural Bangladesh: a process evaluation
  1. Medhavi Gupta1,
  2. Aminur Rahman2,
  3. Notan C Dutta2,
  4. Ashim K Saha2,
  5. Anthony Zwi3,
  6. Rebecca Q Ivers1,4,
  7. Jagnoor Jagnoor5
  1. 1 The George Institute for Global Health, Newtown, New South Wales, Australia
  2. 2 Centre for Injury Prevention and Research Bangladesh, Dhaka, Bangladesh
  3. 3 Health, Rights and Development (HEARD@UNSW), School of Social Sciences, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, New South Wales, Australia
  4. 4 School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
  5. 5 The George Institute for Global Health India, New Delhi, Delhi, India
  1. Correspondence to Dr Jagnoor Jagnoor, The George Institute for Global Health India, New Delhi 110025, India; jjagnoor1{at}


Background Living and environmental conditions in rural Bangladesh expose children to drowning. The Anchal programme protects children through crèche-based supervision in an enclosed space run by locally recruited carers. It is unclear under what conditions the programme best operates to maximise protection. We conducted a process evaluation of Anchal to determine enabling factors and challenges to implementation.

Methods Quantitative programme data were analysed to calculate metrics including child participation and fidelity of implementation to defined processes. Qualitative data collection with programme participants and implementers provided insights into barriers and enablers of implementation. Analysis was guided by the UK Medical Research Council’s process evaluation framework.

Results Anchal operated 400 centres with an average of 22.2 children enrolled, as per target. However, daily attendance averaged lower than the 80% target. Children aged 1–2 years old, who are most at risk of drowning, were least likely to enrol and attend regularly due to low engagement with activities and parental concerns for safety. Greater distances and lower educational attainment in some regions reduced attendance and increased carer attrition.

Conclusions The Anchal programme met most programme delivery targets. However, programme success could be improved through increasing supervision, providing communication training for implementing staff, designing programmes for children aged 1–2 years old, encouraging community ownership and providing child pick-up services. These contextual solutions can be adapted to similar programmes operating through grassroots-level engagement and recruitment of community health workers, to maximise their effectiveness and sustainability.

  • public health
  • drowning
  • mixed methods
  • program evaluation
  • process/impact evaluation
  • child

Data availability statement

Data will be shared upon reasonable request by contacting the corresponding author (

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Data availability statement

Data will be shared upon reasonable request by contacting the corresponding author (

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  • Contributors AR, JJ, RQI, AZ and MG conceptualised research questions and methods. MG and NCD developed tools with support from AR and JJ. MG and NCD led analysis of results. MG drafted and edited publication with inputs from AR, JJ, RQI, AKS, AZ and NCD.

  • Funding This project is funded by the Royal National Lifeboat Institution (RNLI) UK (no grant number). RNLI provided guidance on key research questions and data collection methods at the inception of the project.

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  • Competing interests None declared.

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