Objective: To determine the epidemiology of child drowning in order to propose possible interventions for Bangladesh and other similar low-income countries. Design: Population-based cross-sectional study. Setting: Rural and urban communities in Bangladesh. Subjects: About 352,000 children 0-17 years were selected from over 171,000 households, using multistage cluster sampling. Main outcome measures: Incidence of fatal drowning. Results: Drowning was the leading cause of death (28.6 per 100,000 child-years) in children aged 1-17 years. The highest incidence (86.3 per 100,000 child-years) was in children aged 1-4 years. More than two-thirds of drownings occurred in ponds and ditches. Most drownings (85%) happened in daylight. In more than one-third of cases of drowning, the child was alone. In the two-thirds of cases in which the child was accompanied, almost half were with children who were 10 years or below. Only 7% of drowned children over 4 years of age knew how to swim. Conclusions: Drowning is a major cause of childhood mortality in Bangladesh. Creating drowning-safe homes, improving supervision of children, modifying the environment, and developing water safety skills for children and the community may be effective interventions for drowning prevention.