Controlled evaluation of injury in an international Safe Community: Kashmar, Iran

doi:10.1016/j.puhe.2010.02.014

Public Health

Volume 124, Issue 4, April 2010, Pages 190-197

https://doi.org/10.1016/j.puhe.2010.02.014 Get rights and content

Summary

Objectives

To determine the degree to which the Safe Community (SC) model is effective in reducing injuries. Although positive results have been reported for some communities in developed countries, there is no consistent relationship between being an international designated SC and subsequent changes in observed rate of injury, and no controlled studies have examined the effectiveness of the SC model in developing countries. The aim of this study was to evaluate and compare the injuries in the SC programme of Kashmar (population 149,358) with injuries in counties in Iran that have not applied the SC model.

Study design

Retrospective study using available data from 20 March 2005 to 19 March 2008.

Methods

Data were obtained from the Injury Prevention and Safety Promotion Department of the Disaster and Emergency Management Centre of the Ministry of Health and Medical Education of Iran. These data are collected upon presentation of injured patients to the emergency room. Different types of injuries are evaluated, including motor vehicle injuries (including pedestrians, passengers, drivers and motorcyclists), falls, blows by an object or a person, violence, burns, scorpion and snake bites, electrocution, animal attack, toxicity, suicide and other causes. A control group was selected from all counties in Iran with a population between 100,000 and 200,000. The mean injury rate of these counties was calculated, and counties which had an injury rate within one standard deviation (SD) of the mean rate for all 3 years of the study were included in the control group (n = 44 counties).

Results

The mean population of the 44 control counties was 142,123 in 2006. The numbers of injuries per 100,000 population in Kashmar were 4654.6 [95% confidence interval (CI) 4584.3–4762.6], 4570.9 (95% CI 4465.5–4678.0) and 4949.2 (95% CI 4839.7–5060.4) in 2005–2006, 2006–2007 and 2007–2008, respectively. At the same time, the mean numbers of injuries per 100,000 population in the 44 control counties were 822.7 (95% CI 815.6–829.8), 1130.0 (95% CI 1121.7–1138.3) and 1245.5 (95% CI 1236.8–1254.2). The injury-related fatality rate in the emergency room was 57.6, 52.9 and 44.2 per 100,000 population in Kashmar and 12.2, 13.0 and 11.9 per 100,000 population in the control counties in the three study years. Although a comparison of the fatality rate between the first and third years of the study shows a decrease of 13.4 per 100,000 population in Kashmar, this was not significant (P = 0.1056). In the 44 control counties, the injury-related fatality rate decreased by 0.3 per 100,000 population between the first and third years of the study. The difference between the decrease in injury-related fatality rate in Kashmar (13.4 per 100,000 population) and the 44 control counties (0.3 per 100,000 population) was significant (P < 0.0001).

Conclusion

The controlled evaluation of injury in the international SC of Kashmar showed an increase in the number and rate of injuries in Kashmar and in the 44 control counties over 3 years, but the injury-related fatality rate decreased over the same time period. A greater decrease was seen in Kashmar than in the control counties. Long-term evaluation is necessary to confirm these results.

Introduction

Injuries are a major cause of morbidity and mortality in developing and developed countries.¹ Worldwide, there were 5 million injury-related deaths in 1999,² which accounts for 10% of global mortality. The World Health Organization (WHO) predicts that the number of injuries and deaths following injury will increase in the next 20 years, and the majority of this increase will be seen in developing countries.³ According to a report from Iran in 2003, injuries have the highest burden of disease and represent the primary cause of life years lost due to premature mortality.⁴

Injuries are often ignored as a major cause of death, and innovative strategies may be required to reduce their burden. The WHO Safe Community (SC) model is recognized as a long-term approach to injury prevention at a local level, and has been applied all over the world in the past 20 years.⁵ In this active programme, which covers all ages and environments, all sectors of the community work together to develop the SC and try to sustain it.⁵ In this model, there is a shift from individual- to community-based interventions to ensure that everyone in the society is involved.⁶ To date, 177 communities have been designated as SCs⁷; however, all SCs are not active and this number is expected to increase in the following years. Involvement, commitment and understanding of the community’s specific problems, needs, advantages and capacities are important factors in recognizing and activating resources to achieve injury prevention.⁸

Kashmar County includes the city of Kashmar, the suburbs and surrounding villages in North-east Iran. It was the first nominated SC-designated by the international SC Network in 2007. The programme started in 1998, before SC designation, when co-operation was initiated among different sectors in the community. The population of Kashmar County was reported to be 149,358 by the Statistical Centre of Iran in 2006.⁹ The Kashmar SC programme covers the promotion of safety activities for different age groups and environments. Specific attention is focused on preventing injuries in four high-risk groups; motor vehicle accidents, paediatric burns, household injuries, and falls by the elderly.

In the interest of public health, it is necessary to verify the degree to which the SC model is effective in reducing injuries.¹⁰ A meta-analysis was performed analysing results from 21 communities in five countries from two geographical regions in the world: Austria, Sweden, Norway, Australia and New Zealand. Although positive results were reported for some communities, no consistent relationship was found between being an internationally designated SC and subsequent changes in observed injury rates. Additionally, to the best of the author’s knowledge, no controlled studies have been undertaken in developing countries. The aim of this study was to evaluate and compare the injuries in Kashmar with those in 44 counties in Iran that have not applied the SC model from 20 March 2005 to 19 March 2008.

Section snippets

Methods and materials

A retrospective review was performed to assess the incidence of injuries in Kashmar County and the control counties. Injury-related deaths in the emergency room were used as a secondary outcome measure. Injury and death data were collected from the Injury Prevention and Safety Promotion Department of the Disaster and Emergency Management Centre of the Ministry of Health and Medical Education of Iran. International Classification of Diseases – Version 10 is the injury classification system used

Results

The population of Kashmar was 149,358 in 2006 (Table 2). In the 44 control counties which did not use the SC model, the total population was 6,253,406 (mean 142,123) (Table 3). Table 4 shows the mean injury rates in the control counties and Kashmar for the 3 years included in the study based on different aetiologies. Table 5 shows the mean age ± SD of patients sustaining injuries in Kashmar and the control counties based on different aetiologies. Fig. 2 shows the incidence of injury in Kashmar

Discussion

This study showed no significant difference in the injury trends in Kashmar and the 44 control counties from 20 March 2005 to 19 March 2008, although there was an increase in the injury rate. The number or rate of injuries in Kashmar were not compared directly with those of the control counties; however, the higher crude number and rate of injuries in Kashmar suggests precise injury registration, and may be an important achievement of SC designation. Over the 3 years of the study, there was a

Acknowledgements

The database was provided by the Injury Prevention and Safety Promotion Department of the Disaster and Emergency Management Centre of the Ministry of Health and Medical Education of Iran. The author would like to thank Dr. Soheil Saadat for statistical analysis; Mr. Yousif Rahim, Dr. Alexander R. Vaccaro, Dr. Mashyaneh Haddadi and Ms Shadrokh Sirous for their valuable comments and editing the manuscript; and Miss Somayeh Jafari for her assistance in the project.

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Iran is one of the most active nations with regards to implementing ISC programs, and a total of 34 Iranian cities and municipal districts are designated as members of the WHO Safe Communities networks (WHO Collaborating Centre on Community Safety Promotion (WHO CCCSP), 2014). In 2007, Kashmar in the east of Iran became the first Iranian Safe Community, followed by Bardaskan and Khalilabad, which were designated as Iranian members of this international network in 2009 and 2010, respectively (Rahimi-Movaghar, 2010; Safe Community Bardaskan, 2007; Safe Community Khalilabad, 2010). Iranian Safe Communities are involved in implementing plans in different safety areas, and traffic injury prevention is considered a priority in the interventional programs based on the ISC model in Iran (Safe Community Association (S.G.A), 2014).
In Iran the prevalence of traffic injuries and death from vehicle collisions are high. Driver engagement in non-driving-related tasks has been previously identified as an important contributing factor to crashes. Therefore, the objective of the present study was to investigate the prevalence of drivers’ engagement in potentially distracting activities in Kashmar, Khalilabad and Bardaskan, which are three Iranian International Safe Communities. Observations took place at 12 randomly selected roadside locations in each city, which were comprised of six main streets and six side streets. In total 7979 drivers were observed. The prevalence rates of potentially distracting activities in Kashmar, Khalilabad and Bardaskan were 24.3%, 26% and 24.9%, respectively. In both Kashmar and Khalilabad the most frequently observed secondary tasks were drivers talking to passengers (10.6% and 11.5%, respectively) followed by mobile phone use (3.4% and 4.0%, respectively). Although in Bardaskan the most commonly observed secondary task was also talking to passengers (12.7%), the second most common was reaching for an object (3.2%). In all three cities younger drivers were significantly more likely to be observed engaged in a secondary task while driving. Furthermore, involvement in secondary tasks while driving was significantly higher amongst females and those driving on a working day. The percentage of drivers identified as potentially distracted in these three Safe Communities was worryingly high. Thus, interventions should be integrated into the WHO Safe Community network in these cities, including: education regarding the risks associated with engaging in secondary activities while driving, law enforcement, tougher legislation, periodic assessment, raising public awareness, as well as attracting political and social support.
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Original ResearchControlled evaluation of injury in an international Safe Community: Kashmar, Iran

Summary

Objectives

Study design

Methods

Results

Conclusion

Introduction

Section snippets

Methods and materials

Results

Discussion

Acknowledgements

Public Health

Accid Anal Prev

Assessing the burden of injury in six European countries

Bull World Health Organ

Injury: a leading cause of the global burden of disease

The burden of disease and injury in Iran 2003

Popul Health Metr

Injury status and perspectives on developing community safety promotion in China

Health Promot Int

Safe Communities Network members. Updated 31/08/2009

Safe community in different settings

Int J Inj Contr Saf Promot

The ‘WHO Safe Communities’ model for the prevention of injury in whole populations

Cochrane Database Syst Rev

Road traffic crashes in Iran from 1997 to 2007

Int J Inj Contr Saf Promot

Original Research
Controlled evaluation of injury in an international Safe Community: Kashmar, Iran