Piloting pond fencing for child drowning prevention: a process evaluation in rural India

BACKGROUND: Protecting children aged 1-5 years from drowning in low-income deltaic or riverine regions like the Sundarbans, India, has proven to be challenging due to resource and access constraints. Fencing of water bodies to prevent access is one low-cost intervention proposed for resource-limited settings. We co-developed, implemented a prototype and conducted a process evaluation of a fencing intervention for the first time in a low-income region and assessed its acceptability and feasibility. METHODS: The study was conducted in the rural region of Sundarbans, India, which faces some of the highest child drowning rates globally. 100 households with children received the intervention where nearby ponds were fenced and monitored over 1 year. The process evaluation was guided by UK Medical Research Council's Guidance for Evaluating Complex Interventions. Quantitative data assessing the fence's safety and use were collected at baseline and four quarterly monitoring visits. Qualitative data was collected from participants, non-participants, self-motivated fence-builders and project team members to understand barriers and enablers to usage and maintenance. RESULTS: Results showed high levels of acceptability by community members, who showed ownership to build and maintain the fencing. However, long-term sustainability may be impacted for those unable to afford materials for maintenance. Community engagement was essential in ensuring continuous use, particularly the involvement of community leaders. Buy-in could be improved by holding engagement sessions in the evening when household decision-makers were available. CONCLUSIONS: The fencing intervention was found to be successful and may be considered for larger scale-up to assess its effectiveness against drowning.