Background Most deaths by drowning worldwide have occurred in low and middle-income countries (LMICs) (91%), particularly in Southeast Asia (35%) and Africa (20%). Poor data collection in LMICs hinders the planning, implementation, and evaluation of prevention strategies.

Objective To review the rates and risk factors of unintentional drowning in LMICs, and to identify its prevention strategies within a socio-ecological health promotion framework.

Methods A systematic search, guided by PRISMA, was conducted on Ovid MEDLINE, CINAHL, Informit health, PsycINFO (ProQuest), Scopus, SafetyLit, Google Scholar, and BioMed Central databases for all relevant studies published between 2012 and 2017. McMaster appraisal guideline was used for critical review.

Results The disparity of drowning data availability was observed across countries investigated. The highest rates were identified in lower-middle income South-east Asian countries. The socio-economic background of the family, overcrowding, and living close to water bodies were important predictors for paediatric drowning in LMICs, while the presence of mother as caregiver was identified as a protective factor. The over-reliance on individual-focused, behaviour-based preventive measures was identified.

Conclusion Further research focusing on developing relevant upstream, population-focused, socio-ecological approaches of drowning prevention and water safety promotion is needed to ensure the sustainability of drowning prevention in LMICs.