The World Health Organization (WHO) has released a new Guideline on the prevention of drowning. The Guideline, released a few days ahead of the first World Drowning Prevention Day on 25 July 2021, addresses provision of day-care for children under the age of 6 years and provision of basic swimming skills and water safety training to children aged 6 years and older.
Drowning is the process of experiencing respiratory impairment from submersion or immersion in liquid, with outcomes classified as death, morbidity and no morbidity.
Drowning is the 3rd leading cause of unintentional injury death worldwide, accounting for 7% of all injury-related deaths.
More than 90% of drowning deaths occur in rivers, lakes, wells and domestic water storage vessels in low- and middle-income countries.
Half of all drowning deaths are in the Western Pacific and South-East Asia regions. However, rates of drowning deaths per 100 000 population are highest in the Western Pacific region followed by the African region.
There are an estimated 236 000 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 accounts for 75% of deaths in flood disasters.
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.
Drowning is one of the 10 leading causes of death for people aged 1–24 years in
every region of the world.
In many countries in the Western Pacific and South-East Asia regions, drowning is the leading cause of death for children aged 1–4 years, and in a considerable number of countries it is the leading cause of death among children aged 1–14 years.
Well over 90% of drowning mortality occurs in low- and middle-income countries.
Globally, the highest drowning rates occur among children aged 1–4 years, followed by children aged 5–9 years.
WHO recommends basic swim skills and water training programmes for children aged 6 years or older in high-, low- and middle-income countries.
Basic swim skills training
A basic swim skills educational programme may reduce drowning-related mortality in 1-4-year-olds compared to no basic swim skills educational programme, but the effect on drowning related mortality in 5–14-year-old children is uncertain.
Water safety training (out-of-water)
The evidence suggests that water safety training reduces drowning-related mortality (low-certainty evidence).
Combined water safety training (out-of-water) and basic swim skills training (in-water)
A large observational study of an educational programme combining water safety training and basic swim skill training found a large effect size in terms of reduction of risk of death from drowning compared to no training (moderate-certainty evidence).
WHO recommends day-care for children under 6 years of age as a drowning prevention strategy in countries with a high burden of drowning.
It was shown that formal day-care resulted in a statistically significant decrease of the risk of death from drowning, the risk of death from injuries, and the risk of overall deaths (adjusted for gender, location and birth cohort), compared to not being
enrolled in a crèche programme. A statistically significant decreased risk of death from other causes than injuries could not be demonstrated (moderate-certainty evidence).
Precautions and Challenges
Both interventions considered in this guideline are implemented within, by, and for communities and their involvement in all stages of implementation is critical. This
includes community involvement in conducting background epidemiological surveys on drowning risk; use of methods such as social autopsy to collectively identify risk factors for drowning deaths; discussion of traditional responses to drowning victims; attitudes towards organized child care and supervision; and attitudes towards provision of basic swim skills and water safety training.
Sociocultural factors may hinder implementation of either of these interventions and it is therefore imperative that implementation is preceded by efforts to ensure that programmes are both feasible to implement and acceptable for the target population.
Link to the related WHO news release:
Link to the WHO Guideline document:
Link to WHO fact sheet on drowning: