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Keeping afloat: a case study tracing the emergence of drowning prevention as a health issue in Bangladesh 1999–2017
  1. Madeleine Dodd1,
  2. Anthony Zwi2,
  3. Aminur Rahman3,
  4. Fazlul Kader Chowdhury4,
  5. Rebecca Q Ivers5,6,
  6. Jagnoor Jagnoor1,7
  1. 1The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
  2. 2Health, Rights and Development, School of Social Sciences, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, New South Wales, Australia
  3. 3International Drowning Research Centre-Bangladesh (IDRC-B), Dhaka, Bangladesh
  4. 4Centre for Injury Prevention and Research Bangladesh, Dhaka, Bangladesh
  5. 5School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
  6. 6Injury Division, The George Institute for Global Health, Sydney, NSW, Australia
  7. 7Injury Division, The George Institute for Global Health, New Delhi, India
  1. Correspondence to Dr Jagnoor Jagnoor, Injury Division, The George Institute for Global Health, New Delhi 110025, India; jjagnoor{at}


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.

  • policy analysis
  • drowning
  • low-middle income country
  • qualitative research

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  • Twitter @rebeccaivers, @jjagnoor80

  • Contributors MD designed the study methods, collected the qualitative data and drafted the manuscript, AZ, AR, RQI and JJ collaborated in the development of data collection tools, the development of drafts, providing review and feedback and critically revising the manuscript for intellectual content. FKC contributed to the data collection, including the selection of key informants.

  • Funding This research received funding from the Royal National Life Boat Institution under project Bhasa. Data used in this study were collected to inform stakeholder engagement activities that will take place to enhance the position drowning prevention has on the policy agenda.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Human Research Ethics Committee at The University of Sydney, the reference number for this project is 2016/606.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. This is a qualitative study. Deidentified data available on request on approval from the study steering committee.

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