The study reveals that injuries among people in rural areas affect mainly males and also people of working age, which is in line with the injury distribution in other settings [2, 5, 9, 11, 14, 17, 30, 31]. One finding is the relative importance of injuries on the road, not only because of their severity (10 out 26 deaths), but also because of their frequency. They are indeed as numerous as injuries in the home. Similar results were obtained in earlier studies from Vietnam  and Nicaragua .
Thus, traffic injuries are not only a concern among urban people in Iran but also among rural dwellers . As motorized commuting is on the increase even in rural Iran, it is important to pay attention to road safety [4, 32]. In particular, the safety of motorcyclists must be carefully considered as motorcycles are a popular means of transport  – as is the case in many Asian countries [7, 34].
According to the opinions of the people interviewed – coming from households that have been affected by a severe RTI during the past year -, various things can be done: roads can be better designed and maintained, individual protection legislation (e.g. compulsory safety belt and helmet wearing) could be enforced, people could comply with and adopt safer behaviours, Behvahzes could educate the population and convey information of relevance for injury control and prevention upwards in the health system. Interestingly, many of those suggestions find an echo in the recommendations found in the WHO report on road traffic injuries, in particular concerning making road safety a political priority, enacting and enforcing legislation, managing infrastructure to promote safety for all, and campaigning for greater attention to road safety .
Injuries at home are also a concern in rural areas just as they are for instance in Pakistan, a neighbouring country, where they form the majority of injuries . In the district studied herein, burns may require special attention, if not because of their frequency, because of their severity (see also earlier Iranian studies [35–38]). Burns also affect children to a greater extent, which is consistent with an earlier study from Bangladesh that showed that the incidence of burns among rural children was more than four times higher than among urban children .
In the Twiserkan district – and perhaps even in Iran as a whole – gas equipment used for cooking or heating may warrant special attention. Some villages still do not have gas mains and people use gas capsules and/or other heating equipment that is poorly adapted to in-house use. At present, fire stations are far from most villages and people did mention this as a matter of concern.
For its part, the prevention of falls is undermined by the vast number of different situations leading up to them, which is a challenge for community-based education programs. Potentially more severe falls from a height, e.g. from a roof and falls from a tree may constitute important targets. The latter occur during work activities, mainly during the walnut harvest. This work is done in a traditional, non-technical manner and every year some people fall from large trees and are injured or killed. The results of one study on safety assessment of agricultural machinery in Iran showed that in 60% of cases agricultural injuries were severe . It ought to be emphasized that an important number of falls affect older people, which has been also observed in an earlier study showing that falls from standing height, falls during walking and falls on stairs were important risk factors for hip fracture for older patients . Fall-related injury prevention may require not only environmental improvements in and around the house but also, in the long run, changes in health behaviours (e.g. eating, smoking, and exercising) so as to reduce individual susceptibility to fall and also recovery after fall.
Generally, people frequently mentioned that Behvarzes could play an important role in safety education matters on the local level. Behvarzes already have face-to-face meetings with community members as part of their traditional duties. Also, in recent years, the Ministry of Health and Medical Education has introduced a number of home safety program [20, 35, 42], and provided Behvarzes with educational packages, which is consistent with international literature.
To our knowledge, there is a dearth of studies conducted thus far in Iran or in other rural settings that have collected people's opinions and suggestions about injury control and prevention. This study shows that rural people have a lot of ideas which can be considered for the conception and implementation of context-relevant measures for injury prevention in their community. In particular, people from households where injuries have occurred during the past year consider that not only a change in their own behaviour but also environmental changes and the provision of information and education are needed. We hope that the suggestions highlighted, though not fully representative of the whole rural population, will be taken into account in future developments of safety measures and programs, in both the Twiserkan district and other districts.
Because of the routines in place  and the relatively small size of the catchment areas, we have good reasons to believe that the study offers an accurate coverage of the severe injuries incurred in the population under study during the study period. It is indeed very likely that health houses do have a complete coverage of injuries leading to hospitalization and death in their community . In spite of the fact that collecting injury data was a relatively new procedure when the cases were identified, we regard the likelihood of missing cases as very unlikely given that the injuries covered are relatively severe, that the Behvarzes are well anchored in their community, and that those communities are relatively small.
Before concluding, it ought to be underlined that the study covers one district only and is limited to one year of observation. Because of this, it is not possible to extrapolate our results to any other time period or district. Yet, some results can be regarded as a matter for investigation in other districts as well (e.g., traffic related injuries or burns).