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Bardestani F, Marandi SA, Malekzadeh R, Nadim A, Malekafzali H, Bagheri Lankarani K, Bavandi M, Mesdaghinia A, Gouya MM, Sadrizadeh R, Mostafavi E. In Commemoration of Dr. Bijan Sadrizadeh, a Prominent Physician and Expert in the Field of Public Health in Iran and Around the World. ARCHIVES OF IRANIAN MEDICINE 2023; 26:54-59. [PMID: 37543923 PMCID: PMC10685805 DOI: 10.34172/aim.2023.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 10/19/2022] [Indexed: 08/08/2023]
Abstract
In line with the commemoration of the scientists who played a significant role in advancing knowledge and providing services to the country, it is imperative to publish their biographies so that their lives and achievements are recorded in the history of the country and serve as an example for future generations. Dr. Bijan Sadrizadeh, a physician and a public health specialist, undertook many valuable activities, particularly in the field of public health in Iran and the world during more than 60 years of great services, including the promotion of public health in the Islamic Republic of Iran, the development of I.R. Iran's international collaborations in the field of public health, and the development of research programs in the field of neglected tropical diseases and the eradication of polio in the world. He served the country in many high-level executive capacities, including three periods as deputy Minister of Health. In addition to several years of full-time employment in the World Health Organization (WHO), Dr. Sadrizadeh also served on the WHO Executive Board and was a member of numerous scientific and advisory committees. In reviewing his life, great determination, devotion, believing in primary health care and universal health coverage and a deep sense of responsibility are visible and can be an inspiration and a model for all.
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Affiliation(s)
- Fatemeh Bardestani
- Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Tehran, Iran
| | | | - Reza Malekzadeh
- Academy of Medical Sciences, Tehran, Iran
- Digestive Disease Research Center, Shahriari Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Abolhassan Nadim
- Academy of Medical Sciences, Tehran, Iran
- School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Malekafzali
- Academy of Medical Sciences, Tehran, Iran
- School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Kamran Bagheri Lankarani
- Academy of Medical Sciences, Tehran, Iran
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Alireza Mesdaghinia
- Academy of Medical Sciences, Tehran, Iran
- School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mehdi Gouya
- Academy of Medical Sciences, Tehran, Iran
- School of Medicine, Iran University of Medical Sciences, Teheran, Iran
| | | | - Ehsan Mostafavi
- Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Tehran, Iran
- Academy of Medical Sciences, Tehran, Iran
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Health system performance in Iran: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2022; 399:1625-1645. [PMID: 35397236 PMCID: PMC9023870 DOI: 10.1016/s0140-6736(21)02751-3] [Citation(s) in RCA: 78] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 11/22/2021] [Accepted: 11/24/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Better evaluation of existing health programmes, appropriate policy making against emerging health threats, and reducing inequalities in Iran rely on a comprehensive national and subnational breakdown of the burden of diseases, injuries, and risk factors. METHODS In this systematic analysis, we present the national and subnational estimates of the burden of disease in Iran using the Global Burden of Disease Study 2019. We report trends in demographics, all-cause and cause-specific mortality, as well as years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) caused by major diseases and risk factors. A multi-intervention segmented-regression model was used to explore the overall impact of health sector changes and sanctions. For this analysis, we used a variety of sources and reports, including vital registration, census, and survey data to provide estimates of mortality and morbidity at the national and subnational level in Iran. FINDINGS Iran, which had 84·3 million inhabitants in 2019, had a life expectancy of 79·6 years (95% uncertainty interval 79·2-79·9) in female individuals and 76·1 (75·6-76·5) in male individuals, an increase compared with 1990. The number of DALYs remained stable and reached 19·8 million (17·3-22·6) in 2019, of which 78·1% were caused by non-communicable diseases (NCDs) compared with 43·0% in 1990. During the study period, age-standardised DALY rates and YLL rates decreased considerably; however, YLDs remained nearly constant. The share of age-standardised YLDs contributing to the DALY rate steadily increased to 44·5% by 2019. With regard to the DALY rates of different provinces, inequalities were decreasing. From 1990 to 2019, although the number of DALYs attributed to all risk factors decreased by 16·8%, deaths attributable to all risk factors substantially grew by 43·8%. The regression results revealed a significant negative association between sanctions and health status. INTERPRETATION The Iranian health-care system is encountering NCDs as its new challenge, which necessitates a coordinated multisectoral approach. Although the Iranian health-care system has been successful to some extent in controlling mortality, it has overlooked the burden of morbidity and need for rehabilitation. We did not capture alleviation of the burden of diseases in Iran following the 2004 and 2014 health sector reforms; however, the sanctions were associated with deaths of Iranians caused by NCDs. FUNDING Bill & Melinda Gates Foundation.
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Perveen S, Lassi ZS, Mahmood MA, Perry HB, Laurence C. Application of primary healthcare principles in national community health worker programmes in low-income and middle-income countries: a scoping review. BMJ Open 2022; 12:e051940. [PMID: 35110314 PMCID: PMC8811559 DOI: 10.1136/bmjopen-2021-051940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To identify which primary healthcare (PHC) principles are reflected in the implementation of national community health worker (CHW) programmes and how they may contribute to the outcomes of these programmes in the context of low-income and middle-income countries (LMICs). DESIGN Scoping review. DATA SOURCES A systematic search was conducted through PubMed, CINAHL, EMBASE and Scopus databases. ELIGIBILITY CRITERIA The review considered published primary studies on national programmes, projects or initiatives using the services of CHWs in LMICs focused on maternal and child health. We included only English language studies. Excluded were programmes operated by non-government organisations, study protocols, reviews, commentaries, opinion papers, editorials and conference proceedings. DATA EXTRACTION AND SYNTHESIS We reviewed the application of four PHC principles (universal health coverage, community participation, intersectoral coordination and appropriateness) in the CHW programme's objectives, implementation and stated outcomes. Data extraction was undertaken systematically in an excel spreadsheet while the findings were synthesised in a narrative manner. The quality appraisal of the selected studies was not performed in this scoping review. RESULTS From 1280 papers published between 1983 and 2019, 26 met the inclusion criteria. These 26 papers included 14 CHW programmes from 13 LMICs. Universal health coverage and community participation were the two commonly reported PHC principles, while intersectoral coordination was generally missing. Similarly, the cultural acceptability aspect of the principle of appropriateness was present in all programmes as these programmes select CHWs from within the communities. Other aspects, particularly effectiveness, were not evident. CONCLUSION The implementation of PHC principles across national CHW programmes in LMICs is patchy. For comprehensiveness and improved health outcomes, programmes need to incorporate all attributes of PHC principles. Future research may focus on how to incorporate more attributes of PHC principles while implementing national CHW programmes in LMICs. Better documentation and publications of CHW programme implementation are also needed.
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Affiliation(s)
- Shagufta Perveen
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Zohra S Lassi
- Robinson Research Institute, Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Mohammad Afzal Mahmood
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Henry B Perry
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Caroline Laurence
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
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Doshmangir L, Moshiri E, Farzadfar F. Seven Decades of Primary Healthcare during Various Development Plans in Iran: A Historical Review. ARCHIVES OF IRANIAN MEDICINE 2020; 23:338-352. [PMID: 32383619 DOI: 10.34172/aim.2020.24] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 01/26/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To explore historically primary healthcare (PHC) development in Iran in the light of development plans before and after the Islamic Revolution. The results of this study can be used to outline the future of PHC in the Iranian health system. METHODS We conducted a retrospective analysis of the PHC development in the Iranian health system using data from relevant published and unpublished policy documents. The literature was retrieved and reviewed on the basis of predetermined inclusion criteria with no language or date restriction. The data were integrated and analyzed using content analysis. RESULTS During various upstream development plans, the attitude of the policy makers to PHC has been very different, resulting in fundamental differences in addressing such an important issue and the consequent outcomes. In the aftermath of Iran's revolution, due to more understanding of PHC services importance and the principal slogans of the revolution to pay attention to villagers and vulnerable people, health policymakers paid more attention to PHC, which was not evident in previous periods. CONCLUSION Despite considerable achievements in PHC, the history of PHC in Iran indicates frequent changes in planning and health provision structure. This suggests that the challenges facing the health sector today, the evolving needs and demands of the people, and population changes necessitate reinforcement and reform in the structure of the current PHC network as the main mission of Iran's Ministry of Health.
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Affiliation(s)
- Leila Doshmangir
- Social Determinants of Health Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran.,Tabriz Health Services Management Research Center, Iranian Center of Excellence in Health Management, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Esmaeil Moshiri
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Doshmangir L, Moshiri E, Mostafavi H, Sakha MA, Assan A. Policy analysis of the Iranian Health Transformation Plan in primary healthcare. BMC Health Serv Res 2019; 19:670. [PMID: 31533710 PMCID: PMC6751681 DOI: 10.1186/s12913-019-4505-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 08/30/2019] [Indexed: 11/10/2022] Open
Abstract
Background Health systems reform is inevitable due to the never-ending changing nature of societal health needs and policy dynamism. Today, the Health Transformation Plan (HTP) remains the major tool to facilitate the achievements of universal health coverage (UHC) in Iran. It was initially implemented in hospital-based setting and later expanded to primary health care (PHC). This study aimed to analyze the HTP at the PHC level in Iran. Methods Qualitative data were collected through document analysis, round-table discussion, and semi-structured interviews with stakeholders at the micro, meso and macro levels of the health system. A tailored version of Walt & Gilson’s policy triangle model incorporating the stages heuristic model was used to guide data analysis. Results The HTP emerged through a political process. Although the initiative aimed to facilitate the achievements of UHC by improving the entire health system of Iran, little attention was given to PHC especially during the first phases of policy development – a gap that occurred because politicians were in a great haste to fulfil a campaign promise. Conclusions Health reforms targeting UHC and the health-related Sustainable Development Goals require the political will to improve PHC through engagements of all stakeholders of the health system, plus improved fiscal capacity of the country and financial commitments to implement evidence-informed initiatives. Electronic supplementary material The online version of this article (10.1186/s12913-019-4505-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Leila Doshmangir
- Social Determinants of Health Research Center, Iranian Center of Excellence in Health Management, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran. .,Department of Health Services Management, Tabriz Health Services Management Research Centre, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Daneshgah St, Tabriz, 5165665811, Iran.
| | - Esmaeil Moshiri
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Hakimeh Mostafavi
- Health Economy, Standard and Health Technology Office, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Minoo Alipouri Sakha
- Department of Global Health and Public Policy, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Abraham Assan
- Global Policy and Advocacy Network (GLOOPLAN), Accra, Ghana.,Ghana College of Nurses and Midwives (GCNM), Accra, Ghana
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Danaei G, Farzadfar F, Kelishadi R, Rashidian A, Rouhani OM, Ahmadnia S, Ahmadvand A, Arabi M, Ardalan A, Arhami M, Azizi MH, Bahadori M, Baumgartner J, Beheshtian A, Djalalinia S, Doshmangir L, Haghdoost AA, Haghshenas R, Hosseinpoor AR, Islami F, Kamangar F, Khalili D, Madani K, Masoumi-Asl H, Mazyaki A, Mirchi A, Moradi E, Nayernouri T, Niemeier D, Omidvari AH, Peykari N, Pishgar F, Qorbani M, Rahimi K, Rahimi-Movaghar A, Tehrani FR, Rezaei N, Shahraz S, Takian A, Tootee A, Ezzati M, Jamshidi HR, Larijani B, Majdzadeh R, Malekzadeh R. Iran in transition. Lancet 2019; 393:1984-2005. [PMID: 31043324 DOI: 10.1016/s0140-6736(18)33197-0] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 11/20/2018] [Accepted: 12/06/2018] [Indexed: 01/19/2023]
Abstract
Being the second-largest country in the Middle East, Iran has a long history of civilisation during which several dynasties have been overthrown and established and health-related structures have been reorganised. Iran has had the replacement of traditional practices with modern medical treatments, emergence of multiple pioneer scientists and physicians with great contributions to the advancement of science, environmental and ecological changes in addition to large-scale natural disasters, epidemics of multiple communicable diseases, and the shift towards non-communicable diseases in recent decades. Given the lessons learnt from political instabilities in the past centuries and the approaches undertaken to overcome health challenges at the time, Iran has emerged as it is today. Iran is now a country with a population exceeding 80 million, mainly inhabiting urban regions, and has an increasing burden of non-communicable diseases, including cardiovascular diseases, hypertension, diabetes, malignancies, mental disorders, substance abuse, and road injuries.
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Affiliation(s)
- Goodarz Danaei
- Department of Global Health and Population and Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA; Scientific Association for Public Health in Iran, Boston, MA, USA
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Roya Kelishadi
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Arash Rashidian
- Endocrinology and Metabolism Clinical Sciences Institute, Department of Health Management and Economics, Tehran University of Medical Sciences, Tehran, Iran; Department of Information, Evidence and Research, Eastern Mediterranean Regional Office, World Health Organization, Cairo, Egypt
| | - Omid M Rouhani
- Department of Civil Engineering and Applied Mechanics, McGill University, Montreal, QC, Canada
| | - Shirin Ahmadnia
- Faculty of Social Sciences, Allameh Tabataba'i University, Tehran, Iran
| | - Alireza Ahmadvand
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mandana Arabi
- Scientific Association for Public Health in Iran, Boston, MA, USA; Global Alliance for Improving Nutrition, New York, NY, USA
| | - Ali Ardalan
- School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Harvard Humanitarian Initiative, Cambridge, MA, USA
| | - Mohammad Arhami
- Department of Civil Engineering, Sharif University of Technology, Tehran, Iran
| | | | - Moslem Bahadori
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Jill Baumgartner
- Institute for Health and Social Policy, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Arash Beheshtian
- Cornell Program in Infrastructure Policy, Cornell University, Ithaca, NY, USA
| | - Shirin Djalalinia
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Deputy of Research and Technology, Tehran, Iran
| | - Leila Doshmangir
- Health Services Management Research Center, Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Akbar Haghdoost
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Rosa Haghshenas
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Reza Hosseinpoor
- Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland
| | - Farhad Islami
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA
| | - Farin Kamangar
- Scientific Association for Public Health in Iran, Boston, MA, USA; Department of Biology, School of Computer, Mathematical, and Natural Sciences, Morgan State University, Baltimore, MD, USA
| | - Davood Khalili
- Scientific Association for Public Health in Iran, Boston, MA, USA; Prevention of Metabolic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kaveh Madani
- Department of Physical Geography, Stockholm University, Stockholm, Sweden; Centre for Environmental Policy, Imperial College London, London, UK
| | - Hossein Masoumi-Asl
- Center for Communicable Diseases Control, Tehran, Iran; Research Center of Pediatric Infectious Diseases, Institute of Immunology and Infectious diseases, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Mazyaki
- Department of Economics, Allameh Tabataba'i University, Tehran, Iran; Institute for Management and Planning Studies, Tehran, Iran
| | - Ali Mirchi
- Department of Biosystems and Agricultural Engineering, Oklahoma State University, Stillwater, OK, USA
| | - Ehsan Moradi
- Department of Civil Engineering and Applied Mechanics, McGill University, Montreal, QC, Canada
| | - Touraj Nayernouri
- Department of Neuroscience, School of Advanced Medical Technologies, Tehran University of Medical Sciences, Tehran, Iran
| | - Debbie Niemeier
- Department of Civil and Environmental Engineering, University of California, Berkeley, CA, USA
| | - Amir-Houshang Omidvari
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Niloofar Peykari
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Ministry of Health and Medical Education, Tehran, Iran
| | - Farhad Pishgar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Qorbani
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Kazem Rahimi
- Scientific Association for Public Health in Iran, Boston, MA, USA; The George Institute for Global Health, University of Oxford, Oxford, UK
| | - Afarin Rahimi-Movaghar
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nazila Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeid Shahraz
- Scientific Association for Public Health in Iran, Boston, MA, USA; Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Amirhossein Takian
- Department of Global Health and Public Policy, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Tootee
- Diabetes Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Majid Ezzati
- MRC-PHE Centre for Environment and Health, Imperial College London, London, UK
| | - Hamid Reza Jamshidi
- Research Institute for Endocrine Sciences, School of Medicine, Department of Pharmacology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Reza Majdzadeh
- Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran; Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran; Community Based Participatory Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Malekzadeh
- Digestive Disease Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran; Non-Communicable Disease Research Center, Shiraz University of Medical Science, Shiraz, Iran
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7
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Affiliation(s)
- Bahram Heshmati
- HIV/AIDS Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hassan Joulaei
- HIV/AIDS Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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Al-lela OQB, Baidi Bahari M, Al-abbassi MG, Salih MRM, Basher AY. Influence of health providers on pediatrics' immunization rate. J Trop Pediatr 2012; 58:441-5. [PMID: 22538210 DOI: 10.1093/tropej/fms014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
To identify the immunization providers' characteristics associated with immunization rate in children younger than 2 years. A cohort and a cluster sampling design were implemented; 528 children between 18 and 70 months of age were sampled in five public health clinics in Mosul-Iraq. Providers' characterizations were obtained. Immunization rate for the children was assessed. Risk factors for partial immunization were explored using both bivariate analyses and multi-level logistic regression models. Less than half of the children had one or more than one missed dose, considered as partial immunization cases. The study found significant association of immunization rate with provider's type. Two factors were found that strongly impacted on immunization rate in the presence of other factors: birthplace and immunization providers' type.
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Affiliation(s)
- Omer Q B Al-lela
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Penang, Malaysia.
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9
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Abstract
Iran experienced a dramatic decline in fertility from 1984 to 2001, which was most rapid in rural areas. Although many attribute the decline to the government's active participation in providing family planning services, most services were provided after the initial fertility decline that took place after 1984. We assess the extent to which timing of exposure to basic healthcare is related to fertility outcomes. We estimate the association between a woman's age of exposure to a health house (clinic) and number of children, using the 2001 Iranian Household Expenditure and Income Survey and the 2006 Iranian Census, and the location and dates of operation for each rural health house. We also look at the probability of a woman's giving birth one year after a clinic opened in her village. We use Poisson and logistic multivariate regressions and we control for individual, household, and village characteristics. Exposure to a health house in a woman's most fertile years (20-34) is associated with an 18 percent decrease in number of children ever born relative to those exposed after age 40. This negative association gets progressively stronger as length of exposure increases. Our findings suggest that early exposure to health services in rural areas contributed to Iran's fertility decline.
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Affiliation(s)
- Sepideh Modrek
- Stanford University School of Medicine, 1070 Arastradero Road, Palo Alto, CA 94304, USA.
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10
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Kruk ME, Porignon D, Rockers PC, Van Lerberghe W. The contribution of primary care to health and health systems in low- and middle-income countries: a critical review of major primary care initiatives. Soc Sci Med 2010; 70:904-11. [PMID: 20089341 DOI: 10.1016/j.socscimed.2009.11.025] [Citation(s) in RCA: 191] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2009] [Revised: 11/20/2009] [Accepted: 11/29/2009] [Indexed: 10/19/2022]
Abstract
It has been 30 years since the Declaration of Alma Ata. During that time, primary care has been the central strategy for expanding health services in many low- and middle-income countries. The recent global calls to redouble support for primary care highlighted it as a pathway to reaching the health Millennium Development Goals. In this systematic review we described and assessed the contributions of major primary care initiatives implemented in low- and middle-income countries in the past 30 years to a broad range of health system goals. The scope of the programs reviewed was substantial, with several interventions implemented on a national scale. We found that the majority of primary care programs had multiple components from health service delivery to financing reform to building community demand for health care. Although given this integration and the variable quality of the available research it was difficult to attribute effects to the primary care component alone, we found that primary care-focused health initiatives in low- and middle-income countries have improved access to health care, including among the poor, at reasonably low cost. There is also evidence that primary care programs have reduced child mortality and, in some cases, wealth-based disparities in mortality. Lastly, primary care has proven to be an effective platform for health system strengthening in several countries. Future research should focus on understanding how to optimize the delivery of primary care to improve health and achieve other health system objectives (e.g., responsiveness, efficiency) and to what extent models of care can be exported to different settings.
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11
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Injection drug use in Rural Iran: integrating HIV prevention into iran's rural primary health care system. AIDS Behav 2008; 12:S7-12. [PMID: 18521737 DOI: 10.1007/s10461-008-9408-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2007] [Accepted: 05/05/2008] [Indexed: 10/22/2022]
Abstract
Major opium trafficking routes traverse rural Iran, but patterns of drug use and HIV infection in these areas are unknown. In 2004, Iran's Ministry of Health integrated substance use treatment and HIV prevention into the rural primary health care system. Active opium or heroin users (N = 478) were enrolled in a rural clinic. Participants received counseling for abstinence from substances, or daily needle exchange and condoms. On enrollment, 108 (23%) reported injecting; of these, 79 (73%) reported sharing needles. Of 65 participants tested for HIV, 46 (72%) tested positive. Participants who received daily needle exchange/condoms stayed in the program longer than those who did not (AOR 2.08, 95% CI 1.1-3.88). This project demonstrates that HIV risks exist in rural Iran and suggests the innovative use of Iran's rural health care system to extend prevention and treatment services to these populations.
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Zargarzadeh AH, Emami MH, Hosseini F. Drug-related hospital admissions in a generic pharmaceutical system. Clin Exp Pharmacol Physiol 2007; 34:494-8. [PMID: 17439421 DOI: 10.1111/j.1440-1681.2007.04600.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
1. Generically based pharmaceutical systems exist in a few countries of the world, such as Iran. Most developed countries have free market pharmaceutical systems. Drug-related problems (DRP) have been reported mostly in the Western world but few data are available for generic systems. In this study, we tried to measure the prevalence of drug-related problems leading to hospital admissions in Isfahan, Iran. 2. One thousand consecutive hospital admissions in three major teaching hospitals were studied for a period of 6 months for the presence of DRP as a cause of hospital admissions. Two subcategories of DRP were considered: (i) drug therapy failure; and (ii) adverse drug reactions. Preventability and outcome measures were also assessed. Medications responsible for DRP were classified according to the Anatomic Therapeutic Chemical (ATC) classification of the World Health Organization. 3. Of the 1000 admissions studied, 115 (11.5%) were owing to DRP, 81% as a result of drug therapy failure and 19% as adverse drug reactions. A total of 106 out of the 115 DRP cases (92%) were either preventable or probably preventable, most of which had to do with either prescriber or patient error. An overview of DRP showed that 58.3% resulted in complete recovery, 33.9% in relative recovery and 7.8% in death. Close to 1% of hospital admissions resulted in DRP-related deaths. 4. The overall prevalence of hospital admissions caused by DRP is similar to that in free market pharmaceutical systems. The high preventability rate of these problems should alert clinicians and policy makers to design strategies to curtail this. Also, reasons for differences in subtypes of DRP between the results of this study and those of the literature from free market systems needs to be investigated further.
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Affiliation(s)
- A H Zargarzadeh
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Isfahan University of Medical Sciences, Isfahan, Iran.
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Asadi-Lari M, Farshad AA, Assaei SE, Vaez Mahdavi MR, Akbari ME, Ameri A, Salimi Z, Gray D. Applying a basic development needs approach for sustainable and integrated community development in less-developed areas: report of ongoing Iranian experience. Public Health 2005; 119:474-82. [PMID: 15826888 DOI: 10.1016/j.puhe.2004.08.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2004] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Despite considerable achievements in the provision of basic developmental facilities in terms of drinking water, access to primary healthcare services, high-quality and nutritious food, social services, and proper housing facilities, there are many rural and slum communities in Iran where these essential needs remain unfulfilled. Lack of equity is prominent, as large differences exist in underprivileged provinces. New policies developed in the past two decades have resulted in substantial achievements in meeting population needs and reducing the socio-economic gap; nevertheless, poverty levels, unemployment due to a large increase in the birth rate in the early 1980s, and lack of community participation are matters yet to be addressed. To overcome these deficiencies, a basic development needs approach was adopted to promote the concept of community self-help and self-reliance through intersectoral collaboration, creating an environment where people could take an active part in the development process, with the Iranian government providing the necessary support to achieve the desired level of development. DESCRIPTION OF THE PROJECT Following firm commitment from the Iranian government and technical support from the World Health Organization Regional Office, basic development needs was assigned a high priority in health and health-related sectors, reflected in the third National Masterplan (2001-2005). A comprehensive intersectoral plan was designed, and pilot projects were commenced in three villages. Each village elected a representative, and committee clusters were formed to run and monitor projects identified by a process of local needs assessment and priority assignment. In each region, a variety of needs were elicited from these assessments, which were actively supported by local authorities. LESSON LEARNED A basic development needs approach was found to be a reliable discipline to improve community participation, needs-led resource allocation and intersectoral co-operation in community development, particularly in underprivileged areas. Iran's initial experience of basic development needs has gained widespread public support but will require periodical evaluation as it is introduced into other rural and urban regions across the country.
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Affiliation(s)
- M Asadi-Lari
- Division of Cardiovascular Medicine, Queens Medical Centre, University of Nottingham, Nottingham NG7 2UH, UK.
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Asadi-Lari M, Sayyari AA, Akbari ME, Gray D. Public health improvement in Iran—lessons from the last 20 years. Public Health 2004; 118:395-402. [PMID: 15313592 DOI: 10.1016/j.puhe.2004.05.011] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2003] [Revised: 05/10/2004] [Accepted: 05/26/2004] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Health services are historically based on providers's and policy makers's understanding of population health status. This does not necessarily reflect the real needs of a population. Health needs assessment (HNA) should improve individual or population health and optimize the way that limited resources are utilized. OBJECTIVES To review health needs literature and to describe Iranian primary healthcare (PHC) achievements in developing a needs-driven health system. FINDINGS The Iranian PHC system was established to meet healthcare needs identified through population health status surveys. Since 1984, the PHC system has become highly organized and efficient, resulting in a dramatic decrease in infant, maternal and neonatal mortality rates, population growth, increasing life span and a marked shift towards non-communicable diseases. Through an organized partnership of the general population, volunteers, health workers and health professionals, a needs-oriented healthcare system became central to health policy in Iran. Several information sources were utilized to establish need. Improving death certification was an immediate and important part of this process. COMMENT Improved knowledge about personal rights, community and environmental health policies, and involvement of the media led to an increased range and depth of needs. Moving towards quality improvement and a needs-driven healthcare system requires continuous needs assessment. Novel methods of HNA, such as postal and telephone surveys, group discussions, surrogates for need such as quality-of-life measurement (commonly used in developed countries) or other locally designed methods such as the basic development needs approach, may be relevant to the Iranian PHC network.
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Affiliation(s)
- M Asadi-Lari
- Division of Cardiovascular Medicine, Queens Medical Centre, University Hospital, Nottingham NG7 2UH, UK.
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Janghorbani M, Daie Parizi MH, Ghorbani K. Measles epidemics in Kerman City, Iran. Public Health 1993; 107:79-87. [PMID: 8480016 DOI: 10.1016/s0033-3506(05)80403-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
In early 1990 an outbreak of measles occurred in Kerman City (population 257,284), Iran. Overall 745 cases were identified, four of whom died (case fatality ratio was 5.4 per thousand). Illness was limited, primarily, to children below 15 years of age: 166 (22.3%) cases were in children under five years, 573 (77%) in those aged between five and 14 years and six (0.8%) were above 15 years of age. The age of the cases ranged from 5 months to 35 years. The age-specific attack rates were 3.9, 1.8, 7.3 and 2.8 per 1,000 for children under 1, 1-4, 5-9 and 10-14 years of age respectively. Overall 14 (1.9%) children with measles were hospitalized for severe complications which consisted mainly of pneumonia, otitis and gastroenteritis. Based on 745 cases with available immunization records, vaccine efficacy was calculated at 88% indicating a slight problem with the cold chain or vaccine. The outbreak was primarily related to low immunization coverage during the last 10 years and indicates the need to improve vaccine coverage with the AIK-C existing vaccine. It also highlights the urgent need for an effective single-dose measles vaccine (Edmondson-Zagreb) for children below nine months of age.
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Affiliation(s)
- M Janghorbani
- Department of Community Medicine, Kerman University of Medical Sciences, Iran
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