Epidemiology and prevention of home related injuries in the Islamic Republic of Iran

Abstract: Background: As elsewhere, unintentional injuries are among the leading causes of death In Iran, but non-fatal injuries due to injury events In the home environment have not been analyzed. Many injuries occur in the home environment, where nobody expects there to be a risk of injury. A survey shows that 36% of all injuries occur in the home environment in Iran. An intervention project has been designed in order to integrate an injury prevention program with a focus on home safety into the healthcare system in the country. The project has been implemented after evaluation of a pilot phase and subsequent revision of the whole project. Aim: The overall aim of the thesis Is to assess the effects of a national home safety program, including home safety visits and a surveillance system on the rate of home-related injuries during the program and the safety level in the home environment (according to a checklist). Materials and methods: Data from the pilot phase of the program and a survey after the pilot phase were employed (Study I). Also examined were the surveillance system implemented for home-related injuries as one part of the national program (studies II and III), and the checklist for home visits as the other part of the national program (Study IV). The results of the pilot phase of the home-visitation program were analyzed (Study I), and the supervisors of the pilot phase were asked to participate in a survey in the field of home-related injuries (Study I). A surveillance system for home-related injuries in selected rural and urban areas was established for the systematic collection of data; the information obtained covers emergency-department visits and health services. The incidence rate obtained from the system in the first year of the program was analyzed in the second study, and the trend in injuries during the four years of the program was discussed In the third study. Finally, in order to elucidate the effects of a home-visitation program on safety elements in home environments, the data gathered from the checklist for the program were analyzed and discussed (in the forth study). Findings: The first study shows that the pilot phase resulted in an Increase in the safety level from 10% to 20%. The survey also found that the supervisors of the program agreed to change the checklist to a comprehensive one, and also to add the surveillance system to the program. The results of the surveillance system in the first year were presented in the second study. Injury rates were highest among children aged 0-4, and lowest among the elderly (60 or over). Rates varied between the genders; among children under 15 most patients were male, but the opposite applied to all groups >15. Leading causes of death among the 628 people who died because of home-related injuries were burns, fails, and cases of poisoning. The third study shows a slight decline in the trend in injuries during the years of the program. The decline is more significant in rural areas than in urban areas. The fourth study resulted in an increase in the safety level from 7 to 14% in items of safety at home (according to the comprehensive checklist). Conclusion: The studies found that the home-visitation program, through the primary healthcare system in Iran, was effective in terms of reducing injuries and promoting safety elements at home environments. This kind of intervention can be recommended for other countries with a similar health system.