Article type
Year
Abstract
Background: Lack of adequate child supervision has been linked to unintentional injuries, including drowning, especially in children under five years of age in low and middle income countries (LMIC). In the context of a World Health Organization (WHO) guideline on drowning prevention, we conducted a systematic review regarding formal day care as drowning prevention. The guideline development group was also interested in other benefits and possible harms of daycare, and in evidence from high income countries (HIC). The constrained timeline of 6 months provided an added challenge.
Objectives: To provide a comprehensive synthesis, within a limited time frame, of available evidence for an Evidence-to-Decision (EtD) framework regarding formal day care as a drowning prevention intervention.
Methods: Three approaches were combined to meet the time constraints: (1) a focused systematic review (SR) to study the effectiveness of formal day care as a drowning prevention intervention in LMIC, (2) an overview of SRs to assess the additional harms and benefits of formal day care in LMIC and HIC, and (3) a tabular overview of other relevant references, which did not fulfil the selection criteria of the SR or overview (e.g. qualitative studies); this information was offered as “expert opinion” to the guideline expert panel for consideration during the EtD approach. For inclusion in the focused SR, studies had to report at least one drowning-related mortality or morbidity outcome, which was also taken into account during the development of the search strategies. All results will be presented to the guideline development group in May, where the EtD framework will be completed and recommendations will be formulated.
Results: First, a focused SR was developed. Restricting the SR at the level of the outcome led to a manageable number of records for screening (e.g. 100.000 records in PubMed alone) and for data extraction; in the end only one study was included. This was complemented with an overview of existing SRs with no restrictions on population (inclusion of HIC and LMIC) or outcome (all outcomes included), and 19 relevant reviews were found. Third, 17 additional references were summarized in a table and provided as additional information for the EtD framework. The guideline development group felt that this would adequately cover the majority of their questions. Results of the final EtD framework will be presented during the colloquium.
Conclusions: A three-pronged approach using a focused SR, an overview of reviews, and a tabular overview of other relevant information rather than one exhaustive SR allowed us to deliver the requested evidence and information for the EtD framework within the time limits set forth by the WHO.
Patient or healthcare consumer involvement: Benefits and harms of this specific intervention to the final healthcare consumers will be discussed and balanced using the EtD approach during the guideline panel meeting.
Objectives: To provide a comprehensive synthesis, within a limited time frame, of available evidence for an Evidence-to-Decision (EtD) framework regarding formal day care as a drowning prevention intervention.
Methods: Three approaches were combined to meet the time constraints: (1) a focused systematic review (SR) to study the effectiveness of formal day care as a drowning prevention intervention in LMIC, (2) an overview of SRs to assess the additional harms and benefits of formal day care in LMIC and HIC, and (3) a tabular overview of other relevant references, which did not fulfil the selection criteria of the SR or overview (e.g. qualitative studies); this information was offered as “expert opinion” to the guideline expert panel for consideration during the EtD approach. For inclusion in the focused SR, studies had to report at least one drowning-related mortality or morbidity outcome, which was also taken into account during the development of the search strategies. All results will be presented to the guideline development group in May, where the EtD framework will be completed and recommendations will be formulated.
Results: First, a focused SR was developed. Restricting the SR at the level of the outcome led to a manageable number of records for screening (e.g. 100.000 records in PubMed alone) and for data extraction; in the end only one study was included. This was complemented with an overview of existing SRs with no restrictions on population (inclusion of HIC and LMIC) or outcome (all outcomes included), and 19 relevant reviews were found. Third, 17 additional references were summarized in a table and provided as additional information for the EtD framework. The guideline development group felt that this would adequately cover the majority of their questions. Results of the final EtD framework will be presented during the colloquium.
Conclusions: A three-pronged approach using a focused SR, an overview of reviews, and a tabular overview of other relevant information rather than one exhaustive SR allowed us to deliver the requested evidence and information for the EtD framework within the time limits set forth by the WHO.
Patient or healthcare consumer involvement: Benefits and harms of this specific intervention to the final healthcare consumers will be discussed and balanced using the EtD approach during the guideline panel meeting.