Cost-effectiveness of an injury and drowning prevention program in Bangladesh.

Journal Article (Journal Article)


Interventions that mitigate drowning risk in developing countries are needed. This study presents the cost-effectiveness of a low-cost, scalable injury and drowning prevention program called Prevention of Child Injuries through Social-Intervention and Education (PRECISE) in Bangladesh.


Between 2006 and 2010, the 2 components of PRECISE (Anchal, which sequestered children in crèches [n = 18 596 participants], and SwimSafe, which taught children how to swim [n = 79421 participants]) were implemented in rural Bangladesh. Mortality rates for participants were compared against a matched sample of nonparticipants in a retrospective cohort analysis. Effectiveness was calculated via Cox proportional hazard analysis. Cost-effectiveness was estimated according to World Health Organization-CHOosing Interventions that are Cost Effective guidelines.


Anchal costs between $50.74 and $60.50 per child per year. SwimSafe costs $13.46 per child. For Anchal participants, the relative risk of a drowning death was 0.181 (P = .004). The relative risk of all-cause mortality was 0.56 (P = .001). For SwimSafe, the relative risk of a drowning death was 0.072 (P < .0001). The relative risk of all-cause mortality was 0.750 (P = .024). For Anchal, the cost per disability-adjusted life-year (DALY) averted is $812 (95% confidence interval: $589\x{2013}$1777). For SwimSafe, the cost per DALY averted is $85 ($51\x{2013}$561). Combined, the cost per DALY averted is $362 ($232\x{2013}$1364).


Based on World Health Organization criteria, PRECISE is very cost-effective and should be considered for implementation in other areas where drowning is a significant problem.

Full Text

Duke Authors

Cited Authors

  • Rahman, F; Bose, S; Linnan, M; Rahman, A; Mashreky, S; Haaland, B; Finkelstein, E

Published Date

  • December 2012

Published In

Volume / Issue

  • 130 / 6

Start / End Page

  • e1621 - e1628

PubMed ID

  • 23147971

Electronic International Standard Serial Number (EISSN)

  • 1098-4275

International Standard Serial Number (ISSN)

  • 0031-4005

Digital Object Identifier (DOI)

  • 10.1542/peds.2012-0757


  • eng