Drowning in delays: a patient journey mapping analysis of child drowning care in rural India.

objectivesImmediate or urgent and appropriate postevent response to child drowning is crucial to decrease mortality and morbidity. However, these responses are often delayed, especially in low-income contexts. In this study, we use patient journey mapping to identify key delays to care occurring after child drowning incidents in a low-resource, high-risk region.

settingThe study was conducted in the Sundarbans, a rural region in India facing a high burden of child drowning due to high presence of open water and regular flooding.

participantsUsing purposive sampling, recent child drowning events in the Sundarbans were identified and in-depth interviews were conducted with adults present throughout the rescue and postevent journey to record decisions and delays.

designPostdrowning event delays identified through in-depth interviews were mapped against the three-delay framework, encompassing the delays of deciding to seek medical care, transporting the victim to medical facilities and delays in receiving appropriate care at the facility. In addition to the delays identified in the model, we hypothesised that an further delay occurred at rescue, which we called delay zero.

resultsWe found evidence for 'delay zero' at the time of rescue, which was caused by poor supervision preventing early identification of the event, and unclear water and nighttime both increasing the difficulty of searching for the child. We additionally documented major delays when deciding to attain medical care as bystanders first applied traditional resuscitation methods. Distance to formal medical facilities constituted a barrier, so local bystanders enlisted the help of untrained local doctors before attempting travel.

conclusionsThe results highlighted the critical need to improve child supervision and employ preventative programmes as once drowning events occur, appropriate care was rarely applied in this context. However, postdrowning care could be improved by training bystanders and local informal doctors in cardiopulmonary resuscitation, and by expanding the health system's geographical reach.