title: Prevention of drowning by community-based intervention: implications for low- and middle- income countries.
abstract: BACKGROUND
  Drowning is a serious but neglected health problem in low-and middle-income countries.
  
  
  OBJECTIVE
  To describe the effectiveness of drowning prevention program on the reduction of drowning mortality rates in rural settings at the north of Iran, and guide its replication elsewhere.
  
  
  METHODS
  This interventional design included pre- and post-intervention observations in the rural area of the Caspian Sea coastline without a comparison community. Cross-sectional data were collected at pre- and post-intervention phases. Outcome evaluation was based on a four-year period (March 2005-March 2009) utilizing drowning registry data for the north of Iran.
  
  
  RESULTS
  The implementation program increased the rate of membership in an organization responsible for promoting safety in high risk areas near the Caspian Sea. Compared to a WHO standardized population, drowning incidence in rural areas of the study demonstrated a continuous decrease in age-specific drowning rate among the oldest victims with a gradual decline during the implementation. In the study area, the epidemiological aspects of the study population were exposed and contributing factors were highlighted.
  
  
  CONCLUSIONS
  This study showed that the promotion of passive interventions had a greater effect on drowning rate than that of active interventions.
authors.affiliation: Trauma Research Center, Guilan University of Medical Sciences, Rasht, IR Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Davoudi-Kiakalayeh
authors.affiliation: Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Reza
authors.initials: R
authors.lastname: Mohammadi
authors.affiliation: Trauma Research Center, Guilan University of Medical Sciences, Rasht, IR Iran.
authors.forename: Shahrokh
authors.initials: S
authors.lastname: Yousefzadeh-Chabok
keywords: Community Based; Drowning; Intervention; Iran; Prevention and Control