Effectiveness of mobile short messaging services to improve parents’ knowledge, attitude and practices on drowning prevention in Charghat Upazila, Bangladesh

Introduction: Drowning contributes to injury and early death in many countries. Over 50% of global drowning deaths occur among children aged under 15 years old with children aged between 1 and 4 years of age being most at risk. Drowning is the third leading cause of death for children aged 0–4 years in many Asian countries, and is a serious but neglected health problem in low and middle-income countries (LMICs) like Bangladesh. In Bangladesh, drowning rates are 10 to 20 times more than those in other developed countries. The aim of the qualitative part of this study was to develop a mobile SMS (short messaging services) intervention to prevent children from drowning, while the quantitative part was to test the effectiveness of a mobile SMS intervention to improve the knowledge, attitude, and practices of parents of children aged under five concerning the prevention of drowning. Method: A mixed method was used. Qualitative part: Design: focus group discussions (FGDs) were conducted. Setting: a rural community in Bangladesh. Participants: Four FGDs were conducted with mothers and fathers of children aged under five years, and two group local community leaders. One FGD was conducted for each group. Out of 45 participants, 13 were women. Three in-depth interviews (IDIs) were conducted with parents who had children who had drowned, of which two were female. Quantitative part: Design: a cluster randomized community trial with 788 parents of children aged under five in a rural community of Bangladesh. Intervention: Mobile SMS intervention for parents of children under five years concerning the prevention of drowning. Outcome: differences in knowledge, attitude and practices of parents concerning the prevention of drowning between the baseline and immediate follow-up after the intervention, and after three months. Results: A total of 45 respondents participated in the qualitative part of this study, of which 32 (71.1%) were male, and 13 (28.8%) were female. The risk factors for drowning included the time (11:00am-2:00pm), gender, especially male, lack of swimming ability, parents who were not aware about childhood drowning, unwanted ditches that were not filled in, lack of medical facilities, and lack of information through mass media for the prevention of childhood drowning. There was a significant improvement in knowledge in the intervention group compared to the control group at different time points [baseline: F(1, 787) = 0.33, ρ-value = 0.56; immediately after intervention: F(1, 772) = 2989.25, ρ-value = 0.001; 3-months after intervention F(1, 761) = 4591.33, ρ-value = 0.001]. Similarly, there was an improvement in the positive attitude and good practices of parents on prevention of drowning. There were significant main effect for group [F(1, 379) = 5084.81, ρ-value = 0.001], time [F(1, 379) = 5786.11, ρ-value = 0.001], and group and time interaction [F(1, 331) = 2425.33, ρ-value = 0.001] in terms of the drowning prevention knowledge of parents. Similarly, the main effects for group, time, and group and time interaction for drowning prevention attitude and drowning prevention practices of parents were also significant. Conclusion: The mobile based SMS intervention developed was effective in improving the knowledge, attitude, and practices of parents of children aged under five concerning drowning prevention in a rural community of Bangladesh.

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