Injury prevention and safety promotion in rural communities : Contribution of community health workers and an injury data registry system in Iran

Abstract: Injuries affecting people from the rural populations of middle-income countries are poorly documented and so are people health care seeking behaviour and their views and concern about injury prevention. The aim of this thesis, based on studies conducted in rural areas of the Twiserkan district (Iran) is to increase knowledge about injury epidemiology and the potential contribution of community health workers to the control and prevention of injuries. A retrospective interview-based study including the victims of all unintentional injuries leading to hospitalization or death that had occurred within a twelve month period was first conducted (134 injuries from 117 households). Both injury circumstances and opinions about potential means of prevention were documented. A community-based household survey was also conducted on a cluster sample of 759 households so as to assess the frequency of occurrence of injuries of various severity levels, determine people injury-related healthcare seeking behaviour, and people s views about possible prevention measures. Thereafter, all community health workers (known as Behvarzes) from the district (over 100) were enrolled in a prospective six-month injury registration project during which they conducted injury analysis, proposed preventive measures, and identified their implementation barriers. These studies showed the injury incidence rates in the rural community of Twiserkan varied and decreased with severity level. Road traffic injuries (RTIs) were the most important injury mechanism, and motorcycle, the most common mode of transportation of the victims. Most people with severe injuries and nearly half of those with moderate ones went first to the hospital; all those with minor injuries sought care initially at the local health house. Common suggestions made by injured and non-injured people for prevention were engineering changes (under the responsibility of the authorities), safety education (responsibility of the Behvarzes), and safe behaviour/practice together with better cooperation (by citizens). Behvarzes emphasized the adoption of safe behaviour/practice as an important means for RTI prevention, with a focus on motorcycle helmet use and compliance with traffic rules. They also raised the need for engineering, law enforcement, and education. They saw their own contribution as being health and safety educators and promoters. A complementary study on the injury data registry system in place as perceived by various stakeholders from the national, provincial, and district levels indicated the system is acceptable for Behvarzes to work with and a useful tool for them to use for educational purposes in the local community. The most important facilitator of the system agreed upon was the fact that Behvarzes come from the area. The Behvarzes high workload is regarded as a potential barrier for them to their commitment in the system and their health services to the people. In conclusion, injuries in general and RTIs in particular are important health problems in the rural areas. Behvarzes can play an important role in injury surveillance and in identifying context-relevant means of prevention that they or other actors may then implement.