Table 5

Final list of the most effective river drowning prevention strategies, country context, levels of evidence and level on the hierarchy of control (n=13)

StrategyAverage score (%)Effective in both HICs and LMICs (%)% Aware of evidence supporting strategyHierarchy of control level
Barriers between child play areas and rivers75.071.471.4Engineering
River safety education including recognition and awareness of hazards69.792.932.1Education
Raise awareness of the risks of drowning from alcohol61.967.950.0Low-order
Prohibiting/Restricting alcohol use53.650.032.1Elimination
Close flooded roads and/or use physical barriers (such as booms)
Swim/recreate/wash/bathe only in designated safe places40.675.039.3Low-order
Build safe and accessible infrastructure such as bridges40.578.650.0Engineering
Do not engage in water recreation alone38.882.132.1Elimination/Administrative
Wear a life jacket38.857.182.1PPE
Learn to swim with a focus on survival swimming skills35.385.778.6Low-order
Community-wide rescue and resuscitation skills24.682.132.1Low-order
Caregivers maintaining active supervision22.082.182.1Administrative
Designing the urban landscape to improve safety19.260.739.3Engineering
  • HICs, high-income countries; LMICs, low-income and middle-income countries; PPE, personal protective equipment.