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

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.

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

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).

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).

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.