{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T17:01:46Z","timestamp":1779210106067,"version":"3.51.4"},"reference-count":24,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2025,8,24]],"date-time":"2025-08-24T00:00:00Z","timestamp":1755993600000},"content-version":"unspecified","delay-in-days":23,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001411","name":"Indian Council of Medical Research","doi-asserted-by":"publisher","award":["Extramural Grant"],"award-info":[{"award-number":["Extramural Grant"]}],"id":[{"id":"10.13039\/501100001411","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["Emerging Leadership Level 2 (EL2) Fellowship"],"award-info":[{"award-number":["Emerging Leadership Level 2 (EL2) Fellowship"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,8,7]]},"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Immediate 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>The 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Using 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Postdrowning 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We found evidence for \u2018delay zero\u2019 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The 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\u2019s geographical reach.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-103099","type":"journal-article","created":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T01:45:42Z","timestamp":1756086342000},"page":"e103099","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Drowning in delays: a patient journey mapping analysis of child drowning care in rural India"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5276-9095","authenticated-orcid":false,"given":"Jagnoor","family":"Jagnoor","sequence":"first","affiliation":[{"name":"Injury Division, The George Institute for Global Health, New Delhi, India"},{"name":"Injury Division, The George Institute for Global Health, Sydney, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6558-8373","authenticated-orcid":false,"given":"Medhavi","family":"Gupta","sequence":"additional","affiliation":[{"name":"Injury Division, The George Institute for Global Health, New Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,8,24]]},"reference":[{"key":"2025123106475458000_15.8.e103099.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.resuscitation.2016.04.006"},{"key":"2025123106475458000_15.8.e103099.2","unstructured":"World Health Organization . Global report on drowning: preventing a leading killer. Spain, 2014."},{"key":"2025123106475458000_15.8.e103099.3","unstructured":"World Health Organization . Preventing drowning: practical guidance for the provision of day-care, basic swimming and water safety skills, and safe rescue and resuscitation training. 2022."},{"key":"2025123106475458000_15.8.e103099.4","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1016\/j.paed.2017.05.008","article-title":"Management of drowning in children","volume":"27","author":"Macintosh","year":"2017","journal-title":"Paediatr Child Health (Oxford)"},{"key":"2025123106475458000_15.8.e103099.5","doi-asserted-by":"publisher","DOI":"10.1136\/injuryprev-2020-043911"},{"key":"2025123106475458000_15.8.e103099.6","doi-asserted-by":"crossref","first-page":"11120","DOI":"10.1007\/s10668-020-01085-2","article-title":"An assessment of socio-economic vulnerability at the household level: a study on villages of the Indian Sundarbans","volume":"23","author":"Biswas","year":"2021","journal-title":"Environ Dev Sustain"},{"key":"2025123106475458000_15.8.e103099.7","doi-asserted-by":"crossref","first-page":"172","DOI":"10.4103\/jets.jets_9_24","article-title":"Factors Influencing Treatment Delays in Trauma Patients: A Three-delay Model Approach","volume":"17","author":"Badkur","year":"2024","journal-title":"J Emerg Trauma Shock"},{"key":"2025123106475458000_15.8.e103099.8","doi-asserted-by":"publisher","DOI":"10.1016\/S0277-9536(97)10018-1"},{"key":"2025123106475458000_15.8.e103099.9","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2020-042690","article-title":"Applying the Three Delays Model to understand emergency care seeking and delivery in rural Bangladesh: a qualitative study","volume":"10","author":"Shah","year":"2020","journal-title":"BMJ Open"},{"key":"2025123106475458000_15.8.e103099.10","doi-asserted-by":"crossref","DOI":"10.1186\/s12884-017-1406-5","article-title":"Factors associated with maternal mortality in Malawi: application of the three delays model","volume":"17","author":"Mgawadere","year":"2017","journal-title":"BMC Pregnancy Childbirth"},{"key":"2025123106475458000_15.8.e103099.11","article-title":"Interventions for Child Drowning Reduction in the Indian Sundarbans: Perspectives from the Ground","volume":"7","author":"Gupta","year":"2020","journal-title":"Children (Basel)"},{"key":"2025123106475458000_15.8.e103099.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2009.01.020"},{"key":"2025123106475458000_15.8.e103099.13","doi-asserted-by":"publisher","DOI":"10.1111\/jan.15479"},{"key":"2025123106475458000_15.8.e103099.14","unstructured":"Government of India . West bengal population census 2011. Ministry of Home Affairs; 2011."},{"key":"2025123106475458000_15.8.e103099.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.resuscitation.2014.02.024"},{"key":"2025123106475458000_15.8.e103099.16","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2012-0757"},{"key":"2025123106475458000_15.8.e103099.17","doi-asserted-by":"crossref","unstructured":"Rahman A , Peden AE , Ashraf L , et al . Global Burden, Risk Factors, and Prevention Strategies. 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