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

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.