Please cite this article in press as: Kiakalayeh, A.D., et al., Unintentional drowning in northern Iran: A population-based study. Accid. Anal. Prev.
ARTICLE IN PRESS
Accident Analysis and Prevention xxx (2008) xxx–xxx
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Accident Analysis and Prevention
journal homepage: www.elsevier.com/locate/aap
Unintentional drowning in northern Iran: A population-based study
Ali Davoudi Kiakalayeha,∗, Reza Mohammadia,1, Diana Stark Ekmana,1,
Shahrokh Yousefzade Chabokb,2, Bjarne Jansona,1
aDivision of Social Medicine, Department of Public Health Science, Krolinska Institutet, Norrbacka, SE-171 76 Stockholm, Sweden
bTrauma Research Center, Guilan University of Medical Science, Iran
a r t i c l e i n f o
Received 29 May 2008
Received in revised form 24 July 2008
Accepted 7 August 2008
Death Registry System
a b s t r a c t
The Iranian Ministry of Health documented that about 1500 people died from drowning annually in Iran
between years 2000 and 2001. This study is a descriptive, retrospective, population-based analysis of 342
unintentional drowning deaths occurring to residents and tourists in Guilan and Mazandran Provinces in
Iran over a 1-year period (2005–2006), using multiple data sources. The findings from this study demon-
strate that the drowning rate for residents of the study population, 4.24 per 100,000, is much higher than
drowning rates for populations in developed economies in Europe. Risk factors for drowning in the study
populations include male gender, young age, and swimming in unsupervised areas. Drownings occurred
most frequently in rivers, followed by canals and lakes. While much more remains to be done to investi-
gate the problems associated with drowning deaths and injuries in Iran, the information obtained from
this study can help point the way to targeted interventions.
© 2008 Elsevier Ltd. All rights reserved.
Recent data shows that in 2002, drowning was the third leading
cause of mortality from unintentional injuries after road traffic
injuries and household falls (World Health Organization, 2008).
According to the World Health Organization (WHO) (2008) 97% of
all deaths from drowning occur in low- and middle-income coun-
tries. Over half of the global drowning-related mortality occurs
among children less than 15 years of age.
Drowning is a serious public health problem in the Islamic
Republic of Iran. For the population as a whole, the primary
causes of mortality in Iran are cardiovascular disease, uninten-
tional injuries, and cancers (Naghavi, 2004). The most common
injury-related deaths in Iran are due to road traffic injury followed
by burns and falls, but in northern Iran (Guilan and Mazandran
Provinces) drowning is the second leading cause of injury-related
deaths (Naghavi, 2004). According to Ministry of Health and Med-
ical Education in Iran, in 2001 the mortality rate due to drowning
∗Corresponding author. Tel.: +46 8 7373775; fax: +46 8 30 73 51.
E-mail addresses: Ali.Davoudi.Kiakalayeh@ki.se (A.D. Kiakalayeh),
Reza.Mohammadi@ki.se (R. Mohammadi), firstname.lastname@example.org (D.S. Ekman),
Yousefzade@gums.ac.ir (S.Y. Chabok), bjarne.Janson@ki.se (B. Janson).
1Tel.: +46 8 7373775; fax: +46 8 307351.
2Tel.: +98 131 3239843; fax: +98 131 3238373.
100,000 population) with wide variations shown among Iran’s 23
provinces (Naghavi, 2002). For a 12-month period from 20 March
2001 through 20 March 2002 (based on Iran’s calendar year), the
per 100,000 residence population in Hamedan Province in central
Iran, where there is no access to the sea (Naghavi, 2004). The Ira-
nian Ministry of Health documented that about 1500 people died
from drowning annually in Iran between years 2000 and 2001. It is
important to note that of these fatalities more than 50% of victims
were less than 15 years old. Overall, the Ministry found there were
no gender differences in terms of drowning-related fatalities when
victims were under 10 years of age. However, as the victims’ ages
increase, gender differences become marked. The drowning inci-
dence rate in young men aged 10–20 was 20 times higher than the
rate for females in the same age group. Geographic differences in
drowning patterns also are marked in Iran; drowning is two times
and there are numerous ponds surrounding households.
Swimming and water-based recreation are widespread activ-
ities in northern Iran. Guilan Province and Mazandran Province
border the Caspian Sea, and both are popular tourist destinations.
There is a combined resident population of about 4.5 million peo-
year. There are some protected parts along the seaside of Caspian
Sea, which employed lifeguards and other facilities during the day-
0001-4575/$ – see front matter © 2008 Elsevier Ltd. All rights reserved.