Background Drowning is a major public health concern in low- and middle-income countries. In South Africa there is sound information and an emerging knowledge base for drowning prevention. However, there remains a scarcity of analyses of drowning in the country.

Methods The purpose of this analysis was to quantify the magnitude and describe occurrence of unintentional drowning deaths in five major South African cities, recorded between 2001 and 2005 by the National Injury Mortality Surveillance System.

Results Drowning in South African cities occurred at rates of between 1.4 and 2.7/100 000 population. The majority of drowning occurred amongst males, while the highest rates were observed among 0–4-year-olds. Most drowning deaths occurred during recreational periods, over weekends and in the afternoon. 41.5% of adult drowning victims were alcohol positive at the time of death.

Conclusions This study is based on one of only two known systematic sources of drowning mortality in Africa. It provides an indication of drowning rates in South African cities with young children and males at considerably more risk. The most likely locations for drowning varied from city to city. Amongst adult victims, especially men, alcohol is an important risk factor.