Verbal autopsy instruments for ‘causes and circumstances’ surrounding drowning deaths in low– and middle–income countries: a scoping review

Abstract

Background Understanding the causes and circumstances surrounding drowning events is vital to inform context-specific interventions. Verbal autopsy (VA) instruments have been used to improve the identification of drowning deaths in low-income and middle-income countries. However, the challenges and opportunities of using VA to understand the causes and circumstances surrounding fatal drowning deaths are unknown. Objective To explore the extent to which causes and circumstances surrounding fatal drowning data are captured by the studies that use VA instruments, what challenges are faced, and what opportunities lie in improving this instrument. Methods A scoping review, including publications from January 2012 to September 2023, was conducted using 14 electronic databases, 3 academic search engines and 10 grey literature sources. Data were analysed using frequency counts. Five experts were engaged to corroborate the review findings. Results 11 457 publications were identified, and 9 were included after eligibility screening. Only one study captured the causes and circumstances of fatal drowning using VA instruments. Challenges regarding the VA instruments were reporting and recall bias, misclassification of cause of death and missing records. Opportunities include: optimising the ‘open narrative’ section, creating a drowning-specific module for VA instruments and complementing the instrument with social autopsy tools and qualitative methods. Conclusions Findings indicate a severe gap in evidence, with implications for global organisations which develop VA instruments, to update their VA instruments with questions that can report the circumstances of a drowning death. It is anticipated that this could accelerate the action on global drowning prevention for sustainable development.

Publication DOI: https://doi.org/10.1136/ip-2025-045685
Divisions: College of Business and Social Sciences > School of Social Sciences & Humanities > Sociology and Policy
Funding Information: The project was funded by the Royal National Lifeboat Institution, UK.
Additional Information: Copyright © Author(s) (or their employer(s)) 2025. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: https://creativecommons.org/licenses/by-nc/4.0/.
Last Modified: 07 Aug 2025 07:53
Date Deposited: 06 Aug 2025 15:00
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Related URLs: https://injuryp ... /ip-2025-045685 (Publisher URL)
PURE Output Type: Review article
Published Date: 2025-08-05
Published Online Date: 2025-08-05
Accepted Date: 2025-06-26
Authors: Ray-Bennett, Nibedita S.
Dissanayake, Lasith
Ekezie, Winifred (ORCID Profile 0000-0001-6622-0784)
Macleod, Lauren
Mecrow, Thomas
Saunders, Colleen
Sindall, Rebecca
Oporia, Frederick
Rahman, Aminur
Choudhary, Nimra Iqbal
Nantume, Racheal Margaret
Nnaji, Azukaego Nwando
Chowdhury, Srashta
Paul, Biswajit
Buckett, Eleanor
Biswas, Isha
Hoque, Shahidul
Sahoo, Madhulika

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