Drowning has been described as a major global public health problem and has recently been
acknowledged by a United Nations Declaration on Global Drowning Prevention. While
drowning impacts countries of all income levels, the burden is overwhelmingly borne by lowand middle-income countries (LMICs) who account for 90% of the global death toll. In
addition, there is scarce data collection on drowning in LMICs, so the magnitude of drowning
may be far greater than is represented. A range of factors including sex, age, education,
income, access to water, a lack of swimming skills, certain occupations like commercial
fishing, geographically isolated and flood-prone locations, preexisting medical conditions, and
unsafe water transport systems, influence the risk of drowning. Some behavioral factors, such
as alcohol or drug consumption, not wearing life jackets, and engaging in risky behaviors such
as swimming or boating alone, increase drowning risk. Geopolitical factors such as migration
and armed conflict can also impact drowning risk. There is a growing body of evidence on
drowning prevention strategies. These include pre-event interventions such as pool fencing,
enhancing community education and awareness, providing swimming lessons, use of
lifejackets, close supervision of children by adults, and boating regulations. Interventions to
reduce harm from drowning include appropriate training for recognition of a drowning event,
rescue, and resuscitation. An active and/or passive surveillance system for drowning, focusing
on individual settings and targeting populations at risk, is required.
Drowning requires coordinated multisectoral action to provide effective prevention, rescue,
and treatment. Therefore, all countries should aim to develop a national water safety plan, as
recommended in the WHO Global Report on Drowning. Further research is required on the
epidemiology and treatment of drowning in LMICs as well as non-fatal and intentional
drowning in both high-income countries (HICs) and LMICs. Effective and context-specific
implementation of drowning prevention strategies, including pilot testing, scale up and
evaluation, are likely to help reduce the burden of both fatal and non-fatal drowning in all
countries.
Keywords: drowning, injury, risk factors, prevention, epidemiology, alcohol, swimming, rescue, resuscitation, migration