Abstract / Summary
Abstract Background Drowning is a leading cause of death for children in Vietnam and other low- and middle-income countries (LMICs). While survival swimming interventions have demonstrated efficacy, systematic evaluations addressing scalability and sustainability remain scarce. This study applies the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework to evaluate a large-scale national drowning prevention program in Vietnam across its pilot and expansion phases (2018–2022). Methods A mixed-methods design was employed across 11 provinces in Vietnam. Data were triangulated from three primary sources: (1) secondary analysis of commune-level mortality registers (Form A6) for drowning deaths in 29 intervention districts (115 communes) and 15 matched control districts (56 communes); (2) longitudinal program monitoring logs tracking enrollment, attendance, and instructor certification; and (3) a cross-sectional household survey of 2,225 parents conducted at baseline (2017) and follow-up (2022). RE-AIM indicators were calculated to assess program scalability and sustainability. Linear regression and Spearman's rank correlation were used to quantify temporal trends in drowning mortality. Results The program reached 373,400 children (3.9% of the target population aged 0–15 years), with 78.1% of households in intervention areas reporting program awareness. Cumulative drowning incidence was significantly lower in intervention areas (67.02 per 100,000) compared to controls (98.64 per 100,000), corresponding to an estimated 31.62 deaths averted per 100,000 children. Intervention areas showed a robust downward mortality trend (R² = 0.78, p = 0.019; Spearman ρ = −0.94, p = 0.005), while control areas exhibited no significant trend. The program expanded to 11 provinces via a Training of Trainers model certifying 841 instructors, with high fidelity (2:1 student-to-instructor ratio) and zero safety incidents. Following a 94% enrollment decline during COVID-19 restrictions (2021), the program rebounded to peak enrollment in 2022. At follow-up in 2022, 24.1% of parents were willing to pay more than 750,000 VND (~ USD 30) for future courses, supporting a public-private co-funding model. Conclusions This intervention demonstrates that high-intensity drowning prevention can be scaled effectively in an LMIC context using lay providers and decentralized delivery. Future efforts must address equity gaps in reach for younger children (aged 6–8) and formalize co-funding mechanisms to transition from donor dependency to sustainable local ownership.