Reviewed September 2016
- Drowning is the 3rd leading cause of unintentional injury death worldwide, accounting for 7% of all injury-related deaths.
- There are an estimated 372 000 annual drowning deaths worldwide.
- Global estimates may significantly underestimate the actual public health problem related to drowning.
- Children, males and individuals with increased access to water are most at risk of drowning.
Drowning is the process of experiencing respiratory impairment from submersion/immersion in liquid; outcomes are classified as death, morbidity and no morbidity.
Scope of the problem
In 2012, an estimated 372 000 people died from drowning, making drowning a major public health problem worldwide. Injuries account for over 9% of total global mortality. Drowning is the 3rd leading cause of unintentional injury death, accounting for 7% of all injury-related deaths.
The global burden and death from drowning is found in all economies and regions, however:
- low- and middle-income countries account for 91% of unintentional drowning deaths;
- over half of the world's drowning occurs in the WHO Western Pacific Region and WHO South-East Asia Region;
- drowning death rates are highest in the WHO African Region, and are 10-13 times higher than those seen in the United Kingdom or Germany respectively.
Despite limited data, several studies reveal information on the cost impact of drowning. In the United States of America, 45% of drowning deaths are among the most economically active segment of the population. Coastal drowning in the United States alone accounts for US$ 273 million each year in direct and indirect costs. In Australia and Canada, the total annual cost of drowning injury is US$ 85.5 million and US$ 173 million respectively.
There is a wide range of uncertainty around the estimate of global drowning deaths. Official data categorization methods for drowning exclude intentional drowning deaths (suicide or homicide) and drowning deaths caused by flood disasters and water transport incidents.
Data from high-income countries suggest these categorization methods result in significant underrepresentation of the full drowning toll by up to 50% in some high-income countries. Non-fatal drowning statistics in many countries are not readily available or are unreliable.
Age is one of the major risk factors for drowning. This relationship is often associated with a lapse in supervision. Globally, the highest drowning rates are among children 1-4 years, followed by children 5-9 years. In the WHO Western Pacific Region children aged 5-14 years die more frequently from drowning than any other cause.
Child drowning statistics from a number of countries are particularly revealing:
- Drowning is one of the top 5 causes of death for people aged 1-14 years for 48 of 85 countries with data meeting inclusion criteria1.
- Australia: drowning is the leading cause of unintentional injury death in children aged 1-3 years.
- Bangladesh: drowning accounts for 43% of all deaths in children aged 1-4 years.
- China: drowning is the leading cause of injury death in children aged 1-14 years.
- United States: drowning is the second leading cause of unintentional injury death in children aged 1-14 years.
Males are especially at risk of drowning, with twice the overall mortality rate of females. They are more likely to be hospitalized than females for non-fatal drowning. Studies suggest that the higher drowning rates among males are due to increased exposure to water and riskier behaviour such as swimming alone, drinking alcohol before swimming alone and boating.
Access to water
Increased access to water is another risk factor for drowning. Individuals with occupations such as commercial fishing or fishing for subsistence, using small boats in low-income countries are more prone to drowning. Children who live near open water sources, such as ditches, ponds, irrigation channels, or pools are especially at risk.
Drowning accounts for 75% of deaths in flood disasters. Flood disasters are becoming more frequent and this trend is expected to continue. Drowning risks increase with floods particularly in low- and middle-income countries where people live in flood prone areas and the ability to warn, evacuate, or protect communities from floods is weak or only just developing.
Travelling on water
Daily commuting and journeys made by migrants or asylum seekers often take place on overcrowded, unsafe vessels lacking safety equipment or are operated by personnel untrained in dealing with transport incidents or navigation. Personnel under the influence of alcohol or drugs are also a risk.
Other risk factors
There are other factors that are associated with an increased risk of drowning, such as:
- lower socioeconomic status, being a member of an ethnic minority, lack of higher education, and rural populations all tend to be associated, although this association can vary across countries;
- infants left unsupervised or alone with another child around water;
- alcohol use, near or in the water;
- medical conditions, such as epilepsy;
- tourists unfamiliar with local water risks and features;
There are many actions to prevent drowning. Installing barriers (e.g. covering wells, using doorway barriers and playpens, fencing swimming pools etc.) to control access to water hazards, or removing water hazards entirely greatly reduces water hazard exposure and risk.
Community-based, supervised child care for pre-school children can reduce drowning risk and has other proven health benefits. Teaching school-age children basic swimming, water safety and safe rescue skills is another approach. But these efforts must be undertaken with an emphasis on safety, and an overall risk management that includes a safety-tested curricula, a safe training area, screening and student selection, and student-instructor ratios established for safety.
Effective policies and legislation are also important for drowning prevention. Setting and enforcing safe boating, shipping and ferry regulations is an important part of improving safety on the water and preventing drowning. Building resilience to flooding and managing flood risks through better disaster preparedness planning, land use planning, and early warning systems can prevent drowning during flood disasters.
Developing a national water safety strategy can raise awareness of safety around water, build consensus around solutions, provide strategic direction and a framework to guide multisectoral action and allow for monitoring and evaluation of efforts.
WHO released the "Global report on drowning: preventing a leading killer" in November 2014. This is the first time WHO has developed a report dedicated exclusively to drowning. The report points out that drowning has been highly overlooked to date, and that a great deal more should be done by governments and the research and policy communities to prioritize drowning prevention and its integration with other public health agendas.
The "Global report on drowning" provides recommendations to governments to tailor and implement effective drowning prevention programmes to their settings, improve data about drowning, and develop national water safety plans. The report also points out the multisectoral nature of drowning and calls for greater coordination and collaboration among UN agencies, governments, key NGOs and academic institutions to prevent drowning.
At country level, WHO has worked with Ministries of Health in some low- and middle-income countries to prevent drowning through the use of barriers controlling access to water and the establishment of day care centres for pre-school children. In addition, WHO has also funded research in low-income countries exploring priority questions related to drowning prevention. At a regional level, WHO organizes training programmes and convenes workshops to draw together representatives of governments, NGOs and UN agencies working on drowning prevention.
1 Mortality data for countries were considered if they met the following criteria: estimated coverage of national deaths of 70% or more; ill-defined causes of death less than 20%; 10 or more deaths in the 1–14 year old age group; and data available from 2007 or later.
What has research found?
- Swimming skills help. Taking part in in formal swimming lessons reduces the risk of drowning among children aged 1 to 4 years.9,10 However, many people don’t have basic swimming skills. A CDC study7 about self-reported swimming ability found that:
- Younger adults reported greater swimming ability than older adults.
- Self-reported ability increased with level of education.
- Among racial groups, African Americans reported the most limited swimming ability.
- Men of all ages, races, and educational levels consistently reported greater swimming ability than women.
- Seconds count—learn CPR. CPR performed by bystanders has been shown to save lives and improve outcomes in drowning victims. The more quickly CPR is started, the better the chance of improved outcomes.19
- Life jackets can reduce risk. Potentially, half of all boating deaths might be prevented with the use of life jackets.16
Tips to help you stay safe in the water
- Supervise When in or Around Water. Designate a responsible adult to watch young children while in the bath and all children swimming or playing in or around water. Supervisors of preschool children should provide “touch supervision”, be close enough to reach the child at all times. Because drowning occurs quickly and quietly, adults should not be involved in any other distracting activity (such as reading, playing cards, talking on the phone, or mowing the lawn) while supervising children, even if lifeguards are present.
- Use the Buddy System. Always swim with a buddy. Select swimming sites that have lifeguards when possible.
- Seizure Disorder Safety. If you or a family member has a seizure disorder, provide one-on-one supervision around water, including swimming pools. Consider taking showers rather than using a bath tub for bathing. Wear life jackets when boating.
- Learn to Swim. Formal swimming lessons can protect young children from drowning. However, even when children have had formal swimming lessons, constant, careful supervision when children are in the water, and barriers, such as pool fencing to prevent unsupervised access, are still important.
- Learn Cardiopulmonary Resuscitation (CPR). In the time it takes for paramedics to arrive, your CPR skills could save someone’s life.
- Air-Filled or Foam Toys are not safety devices. Don’t use air-filled or foam toys, such as "water wings", "noodles", or inner-tubes, instead of life jackets. These toys are not life jackets and are not designed to keep swimmers safe.
- Avoid Alcohol. Avoid drinking alcohol before or during swimming, boating, or water skiing. Do not drink alcohol while supervising children.
- Don’t let swimmers hyperventilate before swimming underwater or try to hold their breath for long periods of time. This can cause them to pass out (sometimes called "hypoxic blackout” or “shallow water blackout”) and drown.
- Know how to prevent recreational water illnesses. For more information about illnesses from recreational water, see the More Information section below.
- Know the local weather conditions and forecast before swimming or boating. Strong winds and thunderstorms with lightning strikes are dangerous.
If you have a swimming pool at home:
- Install Four-Sided Fencing. Install a four-sided pool fence that completely separates the pool area from the house and yard. The fence should be at least 4 feet high. Use self-closing and self-latching gates that open outward with latches that are out of reach of children. Also, consider additional barriers such as automatic door locks and alarms to prevent access or alert you if someone enters the pool area.
- Clear the Pool and Deck of Toys. Remove floats, balls and other toys from the pool and surrounding area immediately after use so children are not tempted to enter the pool area unsupervised.
If you are in and around natural water settings:
- Use U.S. Coast Guard approved life jackets. This is important regardless of the distance to be traveled, the size of the boat, or the swimming ability of boaters; life jackets can reduce risk for weaker swimmers too.
- Know the meaning of and obey warnings represented by colored beach flags. These may vary from one beach to another.
- Watch for dangerous waves and signs of rip currents. Some examples are water that is discolored and choppy, foamy, or filled with debris and moving in a channel away from shore.
- If you are caught in a rip current, swim parallel to shore. Once free of the current, swim diagonally toward shore.
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. [cited 2012 May 3]. Available from: URL: http://www.cdc.gov/injury/wisqars.
- CDC. Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2016. Available at http://wonder.cdc.gov.
- Cummings P, Quan L. Trends in Unintentional Drowning: The Role of Alcohol and Medical Care. JAMA, 1999; 281(23):2198-2202.
- Spack L, Gedeit R, Splaingard M, Havens PL. Failure of aggressive therapy to alter outcomes in pediatric near-drowning. Pediatric Emergency Care 1997; 13(2):98-102.
- Gilchrist J, Parker EM. Racial/ethnic disparities in fatal unintentional drowning among persons aged ≤29 years—United States, 1999–2010. MMWR 2014;63:421–6.
- Branche CM, Dellinger AM, Sleet DA, Gilchrist J, Olson SJ. Unintentional injuries: the burden, risks and preventive strategies to address diversity. In: Livingston IL, editor. Praeger handbook of Black American health (2nd edition): Policies and issues behind disparities in health. Westport (CT): Praeger Publishers; 2004. p. 317-27.
- Gilchrist J, Sacks JJ, Branche CM. Self-reported swimming ability in U.S. adults, 1994. Public Health Reports 2000;115(2–3):110–1.
- Irwin CC, Irwin RL, Ryan TD. Urban minority youth swimming (in)ability in the United States and associated demographic characteristics: toward a drowning prevention plan. Injury Prevention 2009; 15: 234-239.
- Brenner RA, Taneja GS, Haynie DL, Trumble AC, Qian C, Klinger RM, Klevanoff MA. Association between swimming lessons and drowning in childhood: A case-control study. Archives of Pediatrics & Adolescent Medicine 2009;163(3):203-10.
- Yang L, Nong QQ, Li CL, Feng QM, Lo SK. Risk factors for childhood drowning in rural regions of a developing country : a case-control study. Injury Prevention, 2007; 13:178-182.
- U. S. Consumer Product Safety Commission. Safety barrier guidelines for home pools [online]. [cited 2012 May 3]. Available from URL: http://www.cpsc.gov/cpscpub/pubs/pool.pdf.
- Thompson DC, Rivara FP. Pool fencing for preventing drowning in children. Cochrane Database of Systematic Reviews 2000; 2.
- U. S. Consumer Product Safety Commission. Submersions related to non-pool and non-spa products, 2011 report.[online]. [cited 2012 May 9]. Available from URL: http://www.cpsc.gov/LIBRARY/FOIA/FOIA11/os/nonpoolsub2011.pdf.
- Pelletier AR, Gilchrist J. Fatalities in swimming pools with lifeguards: USA, 2000-2008. Injury Prevention, 2011;17:250-253.
- U.S. Coast Guard, Department of Homeland Security (US). Recreational Boating Statistics – 2010 [online]. [cited 2012 May 3]. Available from: http://www.uscgboating.org/assets/1/workflow_staging/Page/2010_Recreational_Boating_Statistics.pdf.
- Cummings P, Mueller BA, Quan L. Association between wearing a personal floatation device and death by drowning among recreational boaters: a matched cohort analysis of United States Coast Guard data. Injury Prevention 2011;17:156-159.14.
- Driscoll TR, Harrison JA, Steenkamp M. Review of the role of alcohol in drowning associated with recreational aquatic activity. Injury Prevention 2004;10:107–113.
- Lhatoo SD, Sander JWAS. Cause-specific mortality in epilepsy. Epilepsia 2005; 46(Suppl. 11):36–39.
- Kyriacou DN, Arcinue EL, Peek C, Kraus JF. Effect of Immediate Resuscitation on Children with Submersion Injury. Pediatrics, 1994; 94 (2): 137-142.