Table 2.

Drowning risks and recommendations to avoid them for travelers from high-income countries going to low- and middle-income countries.

Risk	Recommendations to avoid risk
Lack of personal flotation devices (PFDs) or PFDs that meet safety standards and fit properly	▪Bring appropriate PFD when planning water activities ▪ PFDs should be worn by: ○ All children under 13 years; ○ Anyone who cannot swim; ○ By those participating in towed activities (e.g. water skiing) ○ Operators and riders of personal watercraft; ○ Sail or kite boarders; ○ Those on a vessel that is less than 26 feet in length, including under paddle-power; and ○ Other situations.38
▪Pool safety is not prioritized ▪Pool depths and markings may be absent ▪Potentially missing drain covers	▪Feet first entry for every body of water ▪Inspect pools and spas prior to relaxing
▪Lack of lifeguards ▪Ability for children to access bodies of water unattended	▪All children should be supervised by an adult who has not consumed alcohol at all times ▪Delegate adult child supervision prior to water activities ▪Prefer to stay in accommodations that have lifeguards, as well as a climb-resistant fence with a self-closing and self-locking gate if a pool is present ▪Ensure that staff do not permit children to bodies of water
Unfamiliarity with local water conditions, poor swimming ability, absence of lifeguards, and presence of rip currents make open water swimming particularly high-risk	▪Discuss conditions with local swimmers ▪Use the buddy system
Alcohol use significantly increases drowning risk	Do not operate or ride in a watercraft, swim or supervise children after consuming alcohol
Scuba diving is often unregulated and occasionally does not require certification to participate	▪Scuba dive only if certified by an accepted international organization ▪Ensure good health prior to diving ▪Check and be familiar with the dive center's gear ▪Use a diver-down flag ▪Use the buddy system
Operating or riding in a watercraft that is unfamiliar	▪Avoid potentially dangerous watercraft (e.g. overcrowded boats, undersized for conditions) ▪Identify locations of PFDs and fire extinguishers prior to departing ▪Do not underestimate the importance of boat safety courses, navigation rules, and the potential for dangerous weather or water conditions
Lack of emergency care	▪Travelers should be competent in CPR (cardiopulmonary resuscitation) ▪Know the emergency access telephone number for the area(s) being traveled ▪Have a means of communication should injury occur ▪Have an emergency plan