Integration and evaluation of cutaneous leishmaniasis laboratory diagnosis in the primary health care laboratory network

Background

The lack of an integrated national system prevents the Islamic Republic of Iran from registering and reporting all cases of cutaneous leishmaniasis.

Aim

To establish a laboratory network for the improvement of diagnosis and surveillance of cutaneous leishmaniasis in endemic areas of the Islamic Republic of Iran using parasitological and molecular methods.

Methods

This descriptive, cross-sectional, pilot study examined 49 laboratories in the 2 endemic areas for cutaneous leishmaniasis in the Islamic Republic of Iran. Samples were taken for identification of the dominant Leishmania species from individuals with cutaneous leishmaniasis referred to the laboratories and had not travelled to other endemic regions. Statistical analysis was conducted using SPSS version 25.0. Using the primary healthcare laboratory network, we established a 3-level surveillance system. We compared misdiagnosis, new cases, clinical relapses, treatment resistance, and treatment failure before and after establishment of the network.

Results

Network implementation reduced relapse of cutaneous leishmaniasis. After the laboratory training, the average misdiagnosis rate decreased from 49.3% to 4.2% for positive microscopic slides and from 31.6% to 12% for negative slides. Correct diagnosis was significantly higher in the study areas after the intervention.

Conclusion

Implementation of a cutaneous leishmaniasis laboratory network can enhance diagnosis, unify diagnostic methods and improve patient care.

Road traffic injuries and associated mortality in the Islamic Republic of Iran

Background

Road traffic accidents are a major public health problem globally, causing millions of injuries, deaths and disabilities, and a huge loss of financial resources, especially in low- and middle-income countries.

Aim

To determine the incidence of road traffic injuries and associated mortality from 1997 to 2020 in the Islamic Republic of Iran.

Methods

This retrospective study used data from the Legal Medicine Organization of the Islamic Republic of Iran to estimate the annual rates of road traffic injuries and associated mortality from 21 March 1997 to 20 March 2020. The data were analysed using STATA version 14 and the annual rates are reported per 100 000 population.

Results

During the study period, 5 760 835 road traffic injuries and 472 193 deaths were recorded in the Islamic Republic of Iran. The mortality rate increased from 22.4 per 100 000 in 1997 to 40 per 100 000 in 2005 and decreased to 18.4 per 100 000 in 2020. The injury rate increased from 111.1 per 100 000 in 1997 to 394.9 per 100 000 in 2005. It decreased in 2006 and 2007 and increased from then until 2010, finally reaching 331.8 per 100 000 in 2020. The male to female ratio for road traffic mortality was 3.9 in 1997 and 4.6 in 2020. The case fatality rate was highest (20.1%) in 1997 and decreased to 5.6% in 2020.

Conclusion

Continuous interventions are needed to reduce the burden of road traffic injuries and associated mortality in the Islamic Republic of Iran.

Fear of the unknown, anxiety, and social isolation in Iranian patients with Covid-19, the grounded theory

BACKGROUND

Coronavirus 2019 (COVID-19) pandemic has incurred a health challenge. Patients suffer from many physical and mental disorders. To accurately identify the experience of patients with Covid-19 in the Iranian society.

MATERIALS AND METHODS

This qualitative research was conducted using the grounded theory. The data of this grounded theory study were collected using 32 semi-structured interviews with participants and field notes including the patients with Covid-19, nurses, physicians, and the patients' families. Data analysis was performed using Corbin and Strauss (2008) approach for concepts, context, process, and categories' integration.

RESULTS

Qualitative analysis of data led to the extraction of 54 sub-categories and 7 final categories. "Isolation, fear of death, and fear of infection of relatives and family members" were identified as the main issue. The context to this concern was the "unfamiliarity with the virus due to its ambiguous nature that was obtained with a wide range of symptoms." Facing this issue, the patients used the strategy of "adherence to health protocol in the coronavirus infection process" that was recognized as the central variable.

CONCLUSION

The ambiguous and complex nature of the emerging virus, the appearance of different symptoms in different people, and the fear of infecting others, death and anxiety due to unknown complications of the disease make patients go through the most difficult experience of their lives. That requires ongoing training on up-to-date prevention and treatment protocols, along with the emergence of mutated viruses and new symptoms.

Relevance of the COVID-19 rapid response system to public health policymaking in Islamic Republic of Iran

BACKGROUND

The COVID-19 pandemic has increased awareness of the need for high-quality and timely evidence to support policy- and decision-making in emergency situations.

AIMS

To describe the experiences of the National Institute of Health Research (NIHR), Islamic Republic of Iran, in adopting evidence-informed policymaking during the COVID-19 pandemic.

METHODS

During the COVID-19 pandemic, NIHR institutionalized a rapid response system that was backed up by evidence-informed policy- and decision-making. Activities included establishment of a preparedness and response management committee, gathering and providing timely pandemic information to policymakers, establishing a timeline of actions and activities, and a feedback system for policy responses and queries.

RESULTS

The COVID-19 rapid response committee addressed the questions of 40 policymakers by synthesizing and analysing evidence and making it available to relevant stakeholders. It developed and disseminated knowledge products to provide relevant information. We identified the need for more timely data and more reliable research evidence for pandemic management.

CONCLUSION

National institutions responding to health emergencies need to take responsibility for establishing and managing a robust rapid response systems that can provide valid and timely evidence to policymakers. Over time, their capacity should be monitored, evaluated and strengthened to adapt and respond appropriately to pandemics, outbreaks and epidemics.

Systematic review and meta-analysis of maternal mortality ratio and related factors in the Islamic Republic of Iran

Background

Maternal mortality is an indication of the health status of women in the society.

Aims

To investigate the maternal mortality ratio, causes of maternal mortality, and related risk factors among Iranian women.

Methods

Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist and the Peer Review of Electronic Search Strategies (PRESS) guideline, we systematically searched electronic databases, and the grey literature, for publications in Farsi and English from 1970 to January 2022 for studies that reported the number of maternal deaths and/or maternal mortality ratio and their related factors. Data analysis was conducted using Stata 16 and 2-sided P ≤ 0.05 was considered statistically significant, if not otherwise specified.

Results

A subgroup meta-analysis of studies conducted since 2000 estimated the maternal mortality ratio as 45.03 per 100 000 births during 2000-2004, 36.05 during 2005-2009, and 23.71 after 2010. The most frequent risk factors for maternal mortality were caesarean section, poor antenatal and delivery care, unskilled birth attendance, age, low maternal education level, lower human development index, and residence in rural or remote areas.

Conclusion

There has been a significant decrease in maternal mortality in the Islamic Republic of Iran during the last few decades. Mothers in the country need to be monitored more carefully by trained healthcare workers during the pregnancy, delivery and postpartum periods so they can effectively handle postpartum complications, such as haemorrhage and infection, thereby further reducing maternal mortality.

The Effect of Sexual Counseling Based on EX‑PLISSIT Model on Improving the Sexual Function of Married Women with Systemic Lupus Erythematosus: A Randomized Controlled Trial

Systemic Lupus erythematosus (SLE) is a multisystem autoimmune disease. This disease triggers sexual dysfunction due to physiological, cognitive and mental effects. Since sexual function is often ignored in these patients, this study aimed to investigate the effect of sexual counseling based on EX‑PLISSIT model on improving the sexual function of married women with SLE. This clinical trial was conducted on 101 married women suffering from SLE (18-49 years) residing in Tehran. Randomization was performed by random block allocation with six blocks in a rheumatology clinic. A demographic questionnaire, the Depression, Anxiety, Stress Scales-21 Items (DASS-21), and the female sexual function index were used to collect the data. The intervention group received counselling sessions every week while the control group (n = 55) received routine care for the disease. Eight and twelve weeks after completion of counselling sessions, outcomes compared between the intervention and control groups, using independent ttest, paired t-test, repeated measures and Chi-squared test. The scores of sexual function in both groups did not differ significantly before the intervention (p > 0.05). At the first follow-up session, the score of all sexual function domains except sexual pain increased significantly in the intervention group while a significant reduction was observed in all domains of sexual function in the control group (p < 0.05). In the second follow-up, sexual function significantly increased in the intervention group whereas it significantly decreased in the control group (p < 0.05). According to the findings of this study, counseling based on EX-PLISSIT model positively affected the sexual function of women with SLE. Therefore, this model can be used as a cost-effective and simple counseling method to improve the sexual functions.

Comparison of the capture-recapture method and seroprevalence survey for estimation of COVID-19 prevalence in the Islamic Republic of Iran

Background

Reliable estimation of prevalence is important for monitoring and evaluation of COVID-19 prevention programmes among at-risk populations.

Aims

We compared the capture-recapture method with a seroprevalence survey for accurate estimation of the prevalence of COVID-19 during a 1-year period in Guilan Province, northern Islamic Republic of Iran.

Methods

We used the capture-recapture method to estimate the prevalence of COVID-19. Records from the primary care registry system and the Medical Care Monitoring Center were compared, using 4 matching approaches based on combinations of the following variables: name, age, gender, date of death, positive or negative cases, and alive or dead cases.

Results

The estimated prevalence of COVID-19 in the study population from the beginning of the pandemic in February 2020 until the end of January 2021 was 16.2-19.8%, depending on the matching approach used, which was lower than in previous studies.

Conclusion

The capture-recapture method may provide better accuracy than seroprevalence surveys in measuring the prevalence of COVID-19. This method may also reduce the bias in the estimation of prevalence and correct the misconception of policymakers about seroprevalence survey results.

A population-based study of obesity and its complications in southern Islamic Republic of Iran

Background

General and central obesity are important risk factors for chronic diseases and health-related outcomes.

Aims

We determined the prevalence of obesity and related complications among individuals aged 40-70 years in Kherameh, southern Islamic Republic of Iran.

Methods

This cross-sectional study included 10 663 people aged 40-70 years who participated in the first phase of the Kherameh cohort study. Data were collected on demographic characteristics, history of chronic diseases, family history of diseases, and various clinical measures. We used multiple logistic regression analysis to establish the relationships between general and central obesity, and related complications.

Results

Of the 10 663 participants, 17.9% had general obesity and 73.5% had central obesity. In people with general obesity, the odds of having the non-alcoholic fatty liver disease and cardiovascular disease were 3.10 times and 1.27 times higher than in individuals with normal weight, respectively. People with central obesity had higher odds of having other components of metabolic syndrome such as hypertension (OR: 2.87; 95% CI: 2.53-3.26), high triglyceride levels (OR: 1.71; 95% CI: 1.54-1.89), and low high-density lipoprotein cholesterol levels (OR: 1.53; 95% CI: 1.37-1.71) than those without central obesity.

Conclusions

The study showed a high prevalence of general and central obesity and health-related effects, and its association with several comorbidities. Given the level of obesity-related complications found, primary and secondary prevention interventions are needed. The results may help health policymakers establish effective interventions to control obesity and related complications.

Home health care of Iranian elderly with dementia: Study protocol for guideline adaptation

BACKGROUND

Advanced stages of dementia interfere with elderly self-care. Consequently, they need caregivers who take responsibility for their care in the long-term. Restrictions to the caregiver's access to information, resources, and organizational support have created problems in their caregiver role, which is why the World Health Organization (WHO) emphasizes caring for caregivers by providing evidence-based information and training programs. As there is no clinical practice guideline for home care in the Islamic Republic of Iran, this study aims to develop a home health care guideline for the elderly with dementia.

MATERIALS AND METHODS

The ADAPTE process provided by the Guidelines International Network was considered as the basis. In order to identify the care needs of Iranian patients with dementia, semi-structured interviews were added to this guideline.

DISCUSSION

The identification and implementation of the perspectives of patients and caregivers during the process of guidelines adaptation increase the applicability of the guidelines. Improved quality of life for the patients in their place of residence is one of the expected consequences of this guideline's implementation. The developed guidelines will be used at home health care centers, and dementia and Alzheimer's associations in Iran.

Changes in lifestyle behaviour and dietary patterns among Iranian medical students during COVID-19 lockdown

Background

The COVID-19 pandemic has affected many aspects of human life, including physical and mental health. The public health measures to prevent COVID-19 transmission led to social isolation, physical inactivity, anxiety, depression, sleep disorders, obesity, and consumption of unhealthy food.

Aims

To evaluate changes in lifestyle behaviour during the fifth wave of COVID-19 in Iranian medical students.

Methods

This was a cross-sectional descriptive study. In September 2021, an online questionnaire containing 32 questions was administered to 1143 medical students in Teheran universities. Some 286 completed copies of the questionnaire were excluded because of incomplete answers. Descriptive statistics of central tendency measures and dispersion were used and independent t-test and a Chi-square test between two variables were conducted. Statistical analysis was performed using SPSS version 24.

Results

A total of 462 (53.9%) students had COVID-19 during the fifth wave of the disease, 657 (76.7%) were deprived of social and sports activities, and 278 (32.4%) had difficulty completing their academic studies. Students who took vitamin supplements experienced lower levels of stress and 711 (83.0%) reported bodyweight change. There were significant relationships between bodyweight change, stress level and hospitalization due to COVID-19. There was a significant relationship between smoking, bodyweight change and hospitalization rate. A total of 426 (50.3%) students did not have a regular sleep-wake pattern, 701 (81.8%) spent more time using social media, 197 (23.0%) consumed more fast food, and 674 (78.6%) experienced stress or anxiety.

Conclusion

There was an increased tendency towards unhealthy lifestyle among medical students in Tehran during COVID-19 lockdown. These findings can be useful in assessing lifestyle behaviours among students and in planning for improvements.

Main actors in the new population policy with a growing trend in Iran: a stakeholder analysis

The total fertility rate in Iran has declined to below replacement level recently, and a new approach has been taken to tackle this issue. Thus, this study aimed to identify the involved stakeholders and their characteristics in the new population policy change in Iran. We employed a qualitative approach using the purposive sampling of key informants and the identification of relevant documents. The main stakeholders were divided into seven key groups: religious, political, governmental, professional, international sectors, media, and nongovernmental organizations. In addition, there was no centralized, clear, and comprehensive mechanism to guide the activities of stakeholders to coordinate and bring the total fertility rate to the replacement level in Iran. Despite the importance of the new population policy in Iran, in recent years, we still experience dispersion and inconsistency among various actors in this area. It is imperative to go through a consensus and coalition at macro-level authorities alongside evidenced-based population policymaking.

People's Voice and Civil Society Participation as a Core Element of Universal Health Coverage Reforms: Review of Experiences in Iran

Health governance challenges can make or break universal health coverage (UHC) reforms. One of the biggest health governance challenges is ensuring meaningful participation and adequately reflecting people's voice in health policies and implementation. Recognizing this, Iran's Health Transformation Plan (HTP) lays out the country's blueprint for UHC with an explicit emphasis on the 'socialization of health.' 'Socialization' is seen as a key means to contribute to HTP objectives, meaning the systematic and targeted engagement of the population, communities, and civil society in health sector activities. Given its specific cultural and historical context, we sought to discern what notions such as 'civil society,' 'non-governmental organization,' etc mean in practice in Iran, with the aim of offering policy options for strengthening and institutionalizing public participation in health within the context of the HTP. For this, we reviewed the literature and analysed primary qualitative data. We found that it may be more useful to understand Iranian civil society through its actions, ie, defined by its motivation and activities rather than the prevailing international development understanding of civil society as a structure which is completely independent of the state. We highlight the blurry boundaries between the different types of civil society organizations (CSOs) and government institutions and initiatives, as well as high levels of overlaps and fragmentation. Reducing fragmentation as a policy goal could help channel resources more efficiently towards common HTP objectives. The National Health Assembly (NHA) model which was first launched in 2017 offers a unique platform for this coordination role, and could be leveraged accordingly.

Bio-psychosocial factor of vaginismus in Iranian women

Background and aim

Various physical, psychological, social and cultural factors contribute to vaginismus. Therefore, given the multidimensionality of this disorder and the need to pay more attention to all biological, psychological and social dimensions in its treatment, the present study was conducted to investigate the bio-psychological factors contributing to vaginismus.

Methods

This descriptive cross-sectional study was conducted on 180 Iranian women with vaginismus who had been referred to sexual health clinics of Tehran province in 2020. Multistage random sampling method was used in this study, and vaginismus was diagnosed in women by a specialist through using a questionnaire. Data collection tools included demographic and obstetric information form, valid and reliable Sexual Function Questionnaire, Depression Anxiety Stress Scales (DASS), Sex Fear Questionnaire, Vaginal Penetration Cognition Questionnaire, Sexual Self-Efficacy Scale, Sexual Knowledge and Attitude Scale, Sexual Quality of Life-Female, Inventory of Sexual Satisfaction, ENRICH Marital Satisfaction Scale, Sexual Intimacy Scale and Questionnaire for Diagnosis of Vaginismus. In order to determine the factors related to vaginismus, multiple linear regression model was used through SPSS software version 25 (SPSS Inc., Chicago, IL).

Results

Based on the results of the present study, the mean age of women and the mean duration of their marriage were 27.77 ± 5.36 and 4.07 ± 3.87 years respectively. As the results of multiple linear regression revealed, the variables of fear of sex (B = 0.141, P = 0.036), positive cognition (B = 0.197, P = 0.046), self-image (B = 0.651, P = 0.001), sexual intimacy (B = -0.116, P = 0.021), quality of sexual life (B = 0.115, P = 0.002) and education (B = 2.129, P = 0.024) from the bio-psychosocial model were the final predictors of vaginismus diagnosis score in women with this disorder. According to the results of multiple linear regression, 45.5% of the variance of vaginismus diagnosis total score was explained by these variables (R = 0.706, R2 = 0.498 and ADJ.R2 = 0.455).

Conclusion

The results of the present study showed that the variables of fear of sex, positive cognition and negative self-image, sexual intimacy, quality of sexual life and education were the final predictors of vaginismus diagnosis score. This disorder is, thus, considered to be multidimensional.

As a sexual dysfunction, Vaginismus prevents sexual penetration through involuntary and frequent spasms of the muscles in the one-third of vagina's outer part. Factors such as negative beliefs about sex, cultural factors, fear of pain, injury, bleeding and so forth play significant roles in the prediction of vaginismus. Therefore, given the multidimensionality of vaginismus and the need to pay attention to all biological, psychological and social dimensions in treating it, and since the bio-psychosocial model is a strong framework for the factors contributing to sexual problems whose recognition will lead to the design of multidimensional treatments, the present study was conducted on 180 Iranian women with vaginismus to investigate the bio-psychological factors associated with vaginismus. The present study showed that the fear of sex, positive cognition and negative self-image, sexual intimacy, quality of sexual life and education from the bio-psychosocial model were the final predictors of vaginismus diagnosis score. Therefore, this model can be used in designing interventions for the treatment of vaginismus, especially in the psychological and interpersonal domains.

Systematic review and meta-analysis of the most common processed foods consumed by Iranian children

Background

The trend of increasing overweight and obesity among children is a huge burden on health systems. In this regard, the growing availability of processed foods, often energy dense and nutrient poor, has become a major concern. Changing this trend will require evidence-based policies.

Aims

This systematic review aimed to identify the most common processed/ultraprocessed foods consumed by 4-12-year-old Iranian children.

Methods

We searched PubMed, Scopus and Web of science, as well as Persian scientific search engines, including Iran Research Information System, Scientific Information Database and Mag-Iran. We also assessed grey literature, that is, national studies and papers presented at relevant Iranian congresses. All data collected from studies were converted to daily servings (S/D). Mean and standard deviations of the included results were combined by performing meta-analysis with a random effects model. The I² test was used to compute heterogeneity. Egger's test was used to assess publication bias.

Results

Ten studies with 67 093 children were included in this review. The meta-analysis demonstrated that the highest consumption of processed foods belonged to the sugars and sweets group with 8.01 S/D, followed by oils, and biscuits and cakes with 5.58 S/D and 3.33 S/D, respectively.

Conclusion

Given the high consumption of less healthy processed foods, robust policies to support healthy eating and help improve Iranian children's food environment are recommended.

Evaluation of smoking status: comparison of self-reports with exhaled carbon monoxide analysis in university students in the Islamic Republic of Iran

Background

Smoking is considered the leading risk factor for many chronic diseases and deaths worldwide. Thus, it is important to determine the number of smokers before implementing tobacco control initiatives. Due to stigma and deterrent measures, it is impossible to access smokers through a self-report questionnaire.

Aims

To compare exhaled carbon monoxide levels with self-reports among university students in the Islamic Republic of Iran.

Methods

This cross-sectional study included a convenience sample of 60 university students recruited in 2016 in Tehran. There were 30 women and 30 men with an average age of 23.1 (±15.6) years. They were interviewed using an adaptation of the International Union Against Tuberculosis and Lung Diseases questionnaire and further assessed by breath analysis. Smoking status was compared and then correlated with the resultant carbon monoxide levels at a cutoff of 6 ppm.

Results

Mean cigarette consumption was 4.7 (±1.8) each day and smoking status was reported as 19 (31.7%) current smokers and 41 (68.3%) nonsmokers of tobacco. Significant correlations were obtained between the exhaled carbon monoxide levels of the smoker and nonsmoker groups (P < 0.05). Irrespective of the measures of smoking status, the frequency of detecting smokers was comparable to that of detecting nonsmokers (P = 0.756).

Conclusions

Similar to self-reports, the exhaled carbon monoxide measurement successfully distinguished smokers from nonsmokers. This allows healthcare providers and policy-makers to examine the effectiveness of tobacco cessation and prevention programmes.

Salt intake and its sources in children, adolescents and adults in the Islamic Republic of Iran

Background

There is little evidence about salt intake and its food sources in the Iranian population, especially in children and adolescents.

Aims

To investigate salt intake and dietary sources in Isfahan, Islamic Republic of Iran.

Methods

This was a cross-sectional survey conducted in 2014-2015. We randomly selected 1384 adults (50.3% female, 49.7% male) aged > 18 years [mean 37.9 (10.6) years], and 786 children and adolescents (50.9% male, 49.1% female) aged 6-18 years [mean 12.5 (3.4) years]. All participants underwent a dietary assessment for salt intake, using a validated food frequency questionnaire.

Results

The total salt intake was 10.9 (3.4) g/day in adults and 10.3 (2.9) g/day in children and adolescents. Added salt was the primary source of salt intake, followed by bread and cheese in both groups. Salt intake was related significantly to being younger, male, a smoker, less educated and physically active in the adult group. In children and adolescents, it was significantly associated with increasing age, male sex, low physical activity and parents' education level (all P < 0.05).

Conclusions

Salt intake in Isfahan was more than twice that recommended by the World Health Organization. The main source of sodium was added salt, followed bread and cheese. Future national studies are warranted to assess the dietary salt intake and its main sources in different provinces in the Islamic Republic of Iran.

Cutaneous leishmaniasis as an increasing threat for Iranian travellers attending religious ceremonies

Background

The Islamic Republic of Iran is one of the most important endemic foci of cutaneous leishmaniasis in the world. Annually, a large number of Iranian Shia pilgrims travel to Iraq from this area in order to participate in one of their most important religious ceremonies. This trip has coincided with the seasonal activity of sand flies in recent years. So, cutaneous leishmaniasis could be a serious threat for pilgrims on these trips.

Aims

To report cases of cutaneous leishmaniasis among Iranian Shia pilgrims attending a religious ceremony in Iraq during 2017.

Methods

Sixteen patients were referred to our laboratory in the Department of Parasitology and Mycology at Qazvin University of Medical Sciences. Dermal scrapings and stained slides prepared of skin lesions were used to morphological diagnosis. DNA extraction and PCR amplification were optimized to identification of Leishmania species.

Results

All of the patients were infected with cutaneous leishmaniasis in microscopic survey. L. major was detected by molecular approach. The number of lesions observed in patients were 1 (31%), 2 (25%), and ≥ 3 (44%).

Conclusions

Since a large number of Shia Muslims participate in the annual religious ceremonies, serious measures must be taken to prevent the disease.

Human resources for health density and its associations with child and maternal mortality in the Islamic Republic of Iran

BACKGROUND

The Family Physician and Social Protection Scheme for Iranian rural inhabitants was launched in June 2005 to improve physician density. To our knowledge, a comprehensive study of the impact of the Scheme on mortality-related health indicators has not been conducted.

AIMS

To investigate the effects of health workforce density on maternal, neonatal, infant and under-5 mortality rates in rural areas of the Islamic Republic of Iran between 2005 and 2011.

METHODS

We built mixed-effects Poisson regression models including mortality measures as response variables and physician and behvarz (community-based health worker) densities as independent variables, using data from the Iranian Vital Horoscope tool, annual Households Income and Expenditure Survey, and DTARH software. We also included population sizes, age of inhabitants, rate of urbanization, years of schooling, and wealth index in each district, as well as effect of time, as covariates.

RESULTS

Physician density was significantly associated with child mortality rates (1.5%, 1.1% and 63.5% decrease in neonatal, under-5 and maternal mortality with a 1-unit increase in physician density per 1000 individuals). In the model built for infant mortality rate, physician density and behvarz densities were not significantly associated with this measure.

CONCLUSIONS

Improving the distribution of family physicians was associated with lower child and maternal mortality. Improvements in behvarz densities were not associated with decrements in these rates, which probably calls for improvement in access to more professional health services and facilities.

Relative risk of injury due to alcohol consumption in car and motorcycle drivers

Background

There is strong evidence that a substantial number of fatal as well as nonfatal injuries in road traffic accidents result from alcohol consumption and abuse.

Aims

To examine the relationship between blood alcohol concentration and characteristics of injury in trauma patients admitted to a major teaching hospital.

Methods

This was a cross-sectional investigation of trauma characteristics among 38 435 car and motorcycle drivers referred to the South of Iran Trauma Center between October and March 2018. A log-binomial regression model was used to evaluate the relative risk of each covariate on the Injury Severity Score.

Results

There were 253 patients (7.78%) with alcohol consumption. Also, blood alcohol level was positive in 8.66% and 6.93% of car and motorcycle drivers, respectively. The ISS in alcohol consumers and nonconsumers was 6.34 (standard deviation; 8.73) and 4.12 (7.78), respectively, which was significantly higher in the alcohol consumers (t test = 12.96, P < 0.001). Therefore, alcohol consumption was a significant factor in increasing the relative risk of injury, which was 2.83 units more than among drivers who had not consumed alcohol.

Conclusions

Our findings show that the police and law enforcement agencies have a responsibility to enforce stricter rules to reduce drink driving and the burden of trauma on the healthcare system.

Socioeconomic inequalities in tobacco, alcohol and illicit drug use: evidence from Iranian Kurds

BACKGROUND

The associations between socioeconomic status (SES) and tobacco use, alcohol consumption and drug use are poorly understood in the Islamic Republic of Iran.

AIMS

To measure education- and wealth-related inequalities in cigarette smoking, hookah smoking, illicit drug use and alcohol consumption in Kermanshah Province, Islamic Republic of Iran.

METHODS

We used baseline data from the Ravansar Noncommunicable Disease (RaNCD) study. The study collected information on socioeconomic and demographic characteristics, cigarette and hookah smoking, alcohol consumption and illicit drug use of 10 015 adults aged ≥ 35 years between 2014 and 2016. The relative concentration index and absolute concentration index were used to measure education- and wealth-related inequalities in cigarette smoking, hookah smoking, illicit drug use and alcohol consumption.

RESULTS

Cigarette smoking was concentrated among less-educated and less-wealthy men and women. Similarly, illicit drug use was concentrated among lower-SES men. In contrast, hookah smoking and alcohol consumption were more prevalent among higher-SES men.

CONCLUSIONS

There were education- and wealth-related inequalities in tobacco, alcohol and illicit drug use in the west of the Republic of Iran. Future studies should aim to identify the main socioeconomic determinants of these inequalities in Kermanshah Province and generally in the Islamic Republic of Iran.

Biting and resting behaviour of malaria vectors in Bandar-Abbas County, Islamic Republic of Iran

Background

Blood feeding and resting behaviour of malaria vectors are the most influential factors in malaria transmission.

Aims

To measure blood feeding and resting behaviour, conventional mosquito sampling methods were performed in an area with potential for malaria transmission.

Methods

Adult mosquitoes were collected monthly from indoor/outdoor places by conventional sampling methods, and larval habitats were investigated. Enzyme-linked immunosorbent assay was used to measure the human blood index (HBI) of the mosquitoes.

Results

Anopheles stephensi, Anopheles culicifacies, Anopheles dthali and Anopheles fluviatilis, were collected. Overall, 1249 female Anopheles mosquitoes were captured on human and animal baits, but no human-vector contact occurred indoors. A. dthali, A. fluviatilis and A. culicifacies showed a greater tendency to outdoor resting places in contrast to A. stephensi, which had a propensity to indoor resting places. The seasonal biting activities of all species occurred at average temperatures between 23 and 27°C. HBI was measured as 27.2%, 20.7%, 19.1%, and 23.0% for A. fluviatilis, A. stephensi, A. culicifacies and A. dthali, respectively.

Conclusion

Vector control strategy depends upon mosquito behaviour. Therefore, using appropriate sampling methods based on mosquito behaviour is critical for malaria control planning. Exophilic/exophagic habit of mosquito vectors leads to fewer human bites, resulting in biting protection. Exophilic behaviour also requires specific larvicidal operations in order to prevent and control malaria transmission.

COVID-19 Management in Iran as One of the Most Affected Countries in the World: Advantages and Weaknesses

COVID-19 management is a hot topic due to its extensive spread across the world and the declaration of pandemic status. How a crisis is managed in each country is influenced by several factors, and various strategies are applied in accordance with these factors in order to manage the crisis. Due to the rapid spread and increasing trend of the crisis and the fact that almost more than half of the countries are engaged in this pandemic, it is impossible to apply trial-and-error based strategies. One of the best strategies is to use the experiences of other countries in dealing with COVID-19. This report explores the advantages and weaknesses of the Islamic Republic of Iran in the management of this crisis in regard with political economic and cultural issues, health service coverage, and the transparency of information that can be used as a model for other countries around the world.

Shiga toxin-producing bacteria as emerging enteric pathogens associated with outbreaks of foodborne illness in the Islamic Republic of Iran

Background

Detection of the cause of diarrhoeal diseases is important for the management of the outbreaks.

Aims

This study investigated the prevalence of Shiga toxin-producing bacteria in stool samples of patients with diarrhoea associated with outbreaks of foodborne illness in the Islamic Republic of Iran.

Methods

A total of 532 stool and rectal swab samples from 70 sporadic outbreaks during May 2014 to August 2015 were examined for infection with Shiga toxin-producing bacteria. The isolates were examined for carriage of the virulence genes stx₁ and stx₂ in all isolates and eae/ehxA in Escherichia coli.

Results

E. coli, Shigella spp., Citrobacter spp., Enterobacter spp., Klebsiella spp. and other enteric bacteria were detected in 77.7% (376/484), 5.0% (24/484), 3.9% (19/484), 0.4% (2/484), 3.7% (18/484) and 9.3% (45/484) of the samples respectively. Of the 196 sorbitol-negative E. coli strains, 3 (1.5%) carried the stx₁ gene as did 2 of the 19 (10.5%) Citrobacter strains.

Conclusion

Shiga toxin-producing Citrobacter spp. strains should be considered as a newly emerging foodborne pathogen in outbreaks.

Using a geographic information system to identify the number and location of new health centres needed in the city of Kermanshah, Islamic Republic of Iran

Background

Inappropriate distribution of health centres can increase inequities in health care. A geographic information system (GIS) is a useful tool to help plan, monitor and evaluate health systems by analysing and visualizing geospatial data.

Aims

This study aimed to propose an optimal model for establishing new health centres in the city of Kermanshah, Islamic Republic of Iran using GIS.

Methods

In this descriptive analytical study, the number and location of health centres and people's access to them across Kermanshah were evaluated using the GIS system, ArcGIS 10.3, for the years 1997, 2007 and 2012. To determine the best locations for establishing health centres, five principles were considered: access, distance, service delivery radius, proximity to areas of compatible and incompatible land-use, and population density.

Results

In spite of an increase in the number of health centres in Kermanshah between 1997 and 2012, the population without access to such centres also increased, and this varied by age group. Based on the final map of all the land in Kermanshah, 6% of the land was considered unsuitable or very unsuitable, 16% medium suitability, and 78% good or very good for the location of health centres in Kermanshah city.

Conclusion

The spatial distribution of health centres (in terms of the radius of access) and compatibility of the land-use were not properly considered over the 15-year period. To provide health coverage for the current population in the city of Kermanshah, 13 new health centres are needed in suitable locations.

Socioeconomic-related inequalities in self-rated health status in Kermanshah city, Islamic Republic of Iran: a decomposition analysis

Background

Socioeconomic-related inequalities in health are a major public health challenge in both developed and developing countries. Little evidence is available on socioeconomic-related inequalities in health in different regions of the Islamic Republic of Iran.

Aims

This study aimed to determine socioeconomic-related inequality in poor self-rated health in adults in Kermanshah city, western Islamic Republic of Iran.

Methods

This cross-sectional study with stratified sampling obtained data on socioeconomic status, demographic characteristics, behavioural risk factors and self-rated health of 2040 adults (≥ 18 years) in Kermanshah city. A self-administrated questionnaire was used to collect data from the participants. The concentration (C) index and C curve were used to determine the socioeconomic-related inequality in poor self-rated health. A decomposition analysis of the C index was done to identify the factors explaining socioeconomic-related inequality in poor self-rated health.

Results

The crude and age-adjusted prevalence of poor self-rated health was 13.8% and 18.1%, respectively. The estimated C for the whole sample was -0.295, indicating that poor SRH was concentrated in the poor. The decomposition results suggested that socioeconomic status (45.5%), having a chronic health condition (11.9%) and smoking (7.3%) were the main factors contributing to the concentration of poor self-rated health among those of lower socioeconomic status.

Conclusion

The concentration of poor self-rated health among the poor in Kermanshah city warrants policy attention. Policies aimed at reducing inequality in wealth distribution and risky health behaviour and preventing chronic health conditions among the poor may mitigate socioeconomic-related inequalities in poor self-rated health in Kermanshah.

Developing a questionnaire to assess Iranian nurses' knowledge of and attitude to Middle East respiratory syndrome

Background

With the emergence of Middle East respiratory syndrome (MERS), health care preparedness has received increasing attention, which requires valid tools to assess the knowledge and attitude of health workers, such as nurses, with regard to this disease.

Aims

This study aimed to develop and evaluate a knowledge and attitudes questionnaire on MERS coronavirus for Iranian nurses.

Methods

A questionnaire was developed based on international and national guidelines and a literature review. Ten nurses were recruited to assess face validity and 11 experts reviewed the instrument to determine the content validity ratio and index. Exploratory factor analysis was then done with a random sample of 155 nurses in Tabriz city, Islamic Republic of Iran.

Results

Following determination of face and content validity, 78 items (61 knowledge and 17 attitude) were retained in the final version of the questionnaire. The knowledge scale had an average content validity index of 0.80 and the attitude scale a value of 0.91. In the exploratory factor analysis, five dimensions with eigenvalues > 1 and loading level ≥ 0.4 were extracted for the knowledge scale (46 items) and two for the attitude scale (16 items). The Kuder-Richardson 21 coefficient and intraclass correlation coefficient for the knowledge scale were 0.94 and 0.91 respectively. In the attitude scale, the Cronbach alpha coefficient and intraclass correlation coefficients were 0.82 and 0.89 respectively.

Conclusions

The scale developed in this study is reliable and stable and a suitable instrument for evaluating the knowledge and attitude of nurses about MERS-CoV.

Priority setting for research in the field of medical ethics in the Islamic Republic of Iran: a Delphi study

Background

Priority-setting is one way to develop research in a particular field.

Aims

We aimed to identify and prioritize the most important medical ethics issues for research in the Islamic Republic of Iran.

Methods

A 3-round Delphi survey was conducted using a questionnaire covering 77 medical ethics topics in 10 categories and subcategories (extracted from literature review); this was emailed to 40 experts in medical ethics. The participants rated categories and subcategories for importance on a 5-point Likert scale and ranked the topics based on their research priorities. The highest Likert score showed the most important issue and the lowest priority score indicated the first priority.

Results

After consensus, the panel identified 6 categories as the highest priority and most important areas: professionalism [priority score = 2.66, standard deviation (SD) 2.63, importance score = 4.45, SD 0.72], education (priority score=3.12, SD 1.89, importance score = 4.25, SD 0.84), end of life (priority score = 3.79, SD 1.91, importance score = 4.47, SD 0.66), beginning of life (priority = 4.62, SD 1.68, importance score= 4.26, SD 0.61), public health (priority score = 5.20, SD 2.39, importance score = 4.29, SD 0.75), and ethics in research (priority score = 5.33, SD 1.97, importance score = 4.34, SD 0.64).

Conclusion

The rankings for priority and importance was not the same. Our results highlight a lack of applicable knowledge in the areas of professionalism and end of life. This study could be used as a foundation for developing further investigations by ensuring the most appropriate use of limited resources.

Estimating population cause-specific mortality fractions in the Islamic Republic of Iran: validation of Murray's method

Background

Vital civil information is recorded in only 25% of middle-income countries.

Aims

To estimate the number and causes of deaths expected in the population, using hospital mortality data and comparing them with data from the Ministry of Health and Medical Education, Tehran, Islamic Republic of Iran.

Methods

Hospital mortality data for 2011-2015 were extracted and were corrected qualitatively through reference to medical records. Using Murray's proposed method, an estimate of the expected deaths was obtained according to cause of death.

Results

During 2011-2015, 12 704 deaths were recorded in the hospital and Murray's method estimated 28 768 deaths for the entire population. The most frequent cause of death was ischemic heart disease. The results were compared with data from the Ministry of Health and Medical Education, which had a relative error of 6.9% and -13.5% respectively. The mortality rates registered by the Civil Registration Office were higher than those estimated in the present study. The mortality rates registered by the Ministry of Health and Medical Education were lower than those in the present study.

Conclusions

Considering the importance of registering deaths, alternative methods, with efficiency and low cost, are needed to estimate the number and causes of death in a population.

Hypertension and associated factors in the Islamic Republic of Iran: a population-based study

Background

Hypertension is a major risk factor for cardiovascular diseases and has a high prevalence in the Eastern Mediterranean Region.

Aims

To estimate the prevalence and awareness of hypertension and its associated factors in a central province of the Islamic Republic of Iran.

Methods

This cross-sectional study was conducted among 2320 adults aged 40-80 years in Yazd, Islamic Republic of Iran, in 2010-2011. Multivariable logistic regression analysis was performed to calculate the odds ratios (ORs) for exploring the association between hypertension and associated risk factors. Of eligible subjects, 2098 participated in clinical examinations (response rate: 90.4%).

Results

The sex- and age-standardized prevalence of hypertension was 52.8% [95% confidence interval (CI): 49.6-56.1%]. Of 1170 participants with hypertension, 421 were diagnosed for the first time in this survey; therefore, the unawareness proportion was 36.0% (95% CI: 33.2-38.8%). Among known cases (749 of 1170), 68.5% (95% CI: 65.0-71.8%) had uncontrolled blood pressure. Age (OR 70-80 vs. 40-50 years=7.01, 95% CI: 4.01-12.24), obesity (OR=2.78, 95% CI: 2.06-3.75), diabetes (OR=1.46, 95% CI: 1.12-1.89), hyperlipidaemia (OR=1.60, 95% CI: 1.26-2.03) and living in a rural area (OR=1.57, 95% CI: 1.0- 2.45) were significantly associated with hypertension.

Conclusions

Although age is an inevitable risk factor for hypertension, the high unawareness proportion, uncontrolled hypertension and modifiable risk factors such as obesity, hyperlipidaemia and diabetes demand effective preventive and curative strategies.

Indirect estimation of child mortality using 2011 census data in the Islamic Republic of Iran

Background

Child mortality rates are considered to be one of the key indicators of child health.

Aims

The main objective of this research was to calculate child mortality rates (CMRs) indirectly, using census data, and to investigate using spatial pattern analysis the presence of any clustering patterns among provincial regions.

Methods

The Trussell version of the Brass method and Coale-Demeny West model were used to estimate CMRs and life expectancy (LE) at birth. The analyses were performed using the QFive program of MORTPAK 4 software. For cluster analysis, local and global Moran's I indexes were measured.

Results

Infant mortality rate, under-5 mortality rate, 1-4 mortality rate and LE at birth were estimated as 21.9, 26, 4.1 (deaths per 1000 live births) and 72.1 years, respectively. Global Moran's I index was calculated as 0.09, 0.09, 0.08 and 0.12, respectively.

Conclusion

Special attention must be paid in provinces with high clusters regarding the evaluation of public health programmes, and the cause of failure of these programmes in reduction of childhood mortality indices.

Inter-professional ethical values in Iranian aged care: a qualitative study

Aim Ethical values are the basis of the behaviour and performance of professional care staff. This study aimed to identify inter-professional ethical values in aged care. Methods This qualitative thematic content analysis study was conducted in Khorramabad, Iran, from September 2018 to June 2109, and 36 core members of the aged care team (including 24 nurses, 5 physicians, 3 physiotherapists, and 4 social workers) were selected through the purposive sampling method and interviewed in depth. The data were analysed using the directed content analysis and the method of Zhang and Wildemuth. Results Four main themes of providing professional care, preserving the integrity of the aged, observing the dignity of the aged, establishing human relationship, along with 21 subthemes were extracted as ethical values in aged care. Conclusion The results of this study indicate that providing ethical aged care is influenced by the specific conditions of this age group. In addition to general ethical values such as providing professional care, providing ethical aged care is based on ethical values such as promoting social interaction, promoting peace and comfort, preserving and promoting independence, and autonomy in aged care. Promoting collaborative care and paying more attention to the human dimensions of communication and interaction were other emphasized values.

Prevalence, dimensions, and predictor factors of sexual dysfunction in women of Iran Multiple Sclerosis Society: a cross-sectional study

BACKGROUND

Sexual dysfunction (SD) is a stressful and common symptom in women with multiple sclerosis (MS) and affects different aspects of their life, seriously. The purpose of this study was to determine the prevalence, dimensions, and predictor factors of SD in Iranian women with MS.

METHODS

This cross-sectional study was conducted in Iran MS Society. Participants were 260 married women who had definite MS. Data were collected using self-report questionnaires, including Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19); Fatigue Severity Scale (FSS); Depression, Anxiety, and Stress Scale-21 (DASS-21); Questionnaire for Urinary Incontinence Diagnosis (QUID); ENRICH Marital Satisfaction Scale (EMS); Sexual Self-Efficacy Questionnaire; and socio-demographic and disease information questionnaire. Pearson correlation coefficients, independent sample t-test, one-way analysis of variance (ANOVA), and multiple linear regression model were used for data analysis.

RESULTS

Majority (76.2%) of the participants had SD, and according to the dimensions of SD in MS, primary SD was found in 176 (67.7%), secondary SD in 158 (60.7%), and tertiary SD in 126 (48.5%) of the participants. The most important and common problem was delayed orgasm (60%). According to the results of multiple linear regression model, the predictor factors of SD were sexual self-efficacy (B = -0.721, P < 0.001), disability status (B = 2.714, P < 0.001), urge incontinence (B = 0.367, P = 0.029), depression (B = 0.446, P = 0.007), anxiety (B = 0.332, P = 0.037), fatigue (B = 0.177, P = 0.002), duration of disease (B = -0.463, P = 0.014), and duration of DMT use (B = 0.662, P = 0.002).

CONCLUSION

According to the results of this cross-sectional study, SD was a very common and complex problem in women of Iran MS Society, and a number of physical, neurological, and psychological factors, such as sexual self-efficacy, disability status, urge incontinence, depression, anxiety, fatigue, duration of DMT use, and duration of disease, play a role in SD of these patients. So, in the treatment procedure of SD in MS women, adopting a multidisciplinary approach, as well as considering all contributory factors and their impact on sexual function, is recommended.

Intersectoral Expectations for Promoting Mental Health: A Qualitative Case Study of Islamic Republic of Iran

Background

The prevalence of mental diseases is 23.6% in Iran. Taking intersectoral measures is said to be effective in promoting mental health and reducing the burden of the diseases caused by social determinants. The aim of this study was to determine the role of national organizations in promoting mental health in Iran.

Methods

An applied descriptive qualitative method was used. The data were collected by reviewing the literature, interviewing with experts, and holding focus group discussions. To identify the roles of organization, a two-dimensional matrix was drawn.

Results

The roles of 31 national organizations in five groups were determined. Then, the intersectoral organizational expectations in two key areas were extracted. The key roles determined were mostly related to the Ministry of Education, Islamic Republic of Iran Broadcasting, Ministry of Labor and Social Welfare, and the Ministry of Sports and Youth.

Conclusions

Due to the growing burden of mental disorders in the country, informing national organizations and attracting their active participation based on intersectoral expectations and developing interaction mechanisms among them can be an effective step in promoting mental health and reducing the environmental factors threatening mental health.

Quality of life in Iranian elderly population using the SF-36 questionnaire: systematic review and meta-analysis

Background

Ageing is a major known risk factor that is a threat to human health. To date, many studies have investigated quality of life (QOL) among the elderly population in the Islamic Republic of Iran. However, their results were inconsistent.

Aims

We designed this systematic review and meta-analysis to estimate the overall mean score of QOL based on the Short Form 36 Health Survey Questionnaire (SF-36) among the Iranian elderly population.

Methods

We searched international databases (Medline, Scopus and Science Direct) and national databases (Science In-formation Database, MagIran, IranMedex and Irandoc) up to February 2015. We included all cross-sectional studies that evaluated QOL among the Iranian elderly population using SF-36.

Results

Of 2150 studies identified, 15 were included in the meta-analysis. The mean scores for QOL in the 8 scales were: 47.58, 51.75, 55.42, 55.78, 59.55, 51.54, 47.85 and 51.31 for physical-role, physical function, mental health, bodily pain, social functioning, emotional-role, general health, and vitality, respectively.

Conclusions

Our results indicated that health-related QOL decreased with increasing age. QOL was worse in women than in men, especially in physical-role and general health scales. Elderly people who lived in a nursing home had lower QOL than those who lived in their own home. So, health policy-makers should design comprehensive programmes to improve health-related QOL for the Iranian elderly population.

Study protocol for promoting physical activity among women based on the MAPP process

Background

The participation of all stakeholders is necessary when a community-based intervention is designed. For running a practical intervention, it is necessary to have a framework to design the programme while considering all stages of planning, implementation and evaluation.

Aims

To describe a study protocol based on the MAPP process (Mobilizing for Action through Planning and Partnerships) for promoting physical activity (PA).

Methods

This protocol is implemented in 6 distinct phases. The goal of the first and second phase is to organize the programme and increase participation, and to determine the vision of the programme, respectively. The third phase provides a comprehensive picture of a community. The fourth and fifth phases identify strategies for the programme. The sixth phase is about the action cycle.

Conclusion

The framework considers all factors on PA improvement and, consequently, results in a culture-based programme for women.

Repellency effect of flumethrin pour-on formulation against vectors of Crimean-Congo haemorrhagic fever

Background

Ticks are able to transmit important diseases to humans, including Rocky Mountain spotted fever, Q fever, Crimean-Congo haemorrhagic fever, summer Russian encephalitis, and relapsing fever.

Aims

To determine the repellency effect of 1% flumethrin pour-on formulation against hard ticks.

Methods

The concentration of flumethrin pour-on formulation was 1 mg/10 kg body weight and was administered on the dorsal midline from the head to the base of the tail. The livestock included cows, goats, oxen and sheep in 2 villages in Ardabil Province, Islamic Republic of Iran.

Results

We studied 200 livestock comprising 5 age groups (< 2, 3-4, 5-6, 7-8 and >8 years). The main hard ticks identified were Hyalomma species (62.5%) and Rhipicephalus bursa (37.5%). In the treatment village, the maximum number of ticks per animal was 11.6 in oxen, 9.5 in sheep, 8.9 in goats and 8.6 in cattle. The repellency effect of flumethrin remained for 2 months.

Conclusions

Flumethrin provided 2 months protection against hard ticks. Therefore, it could be used in the livestock industry. Control of ticks is important for prevention of disease transmission.

Human resources for health strategies: the way to achieve universal health coverage in the Islamic Republic of Iran

Background

It is impossible to achieve universal health coverage (UHC) without an adequate, competent and motivated workforce.

Aims

The study aimed to describe how the Iranian health sector has formulated its human resources strategies to achieve UHC.

Methods

This was a qualitative study using a conceptual framework approach to content analysis. Primary data were gathered through expert focused group discussions and document analyses. Both transcribed discussions and the selected documents were analysed using in-depth thematic analysis. A conceptual framework from the Global Health Workforce Alliance was used for content analysis and to draft and develop the strategies. The framework suggested five human resources for health (HRH) pathways to achieve UHC aspects structured according to availability, accessibility, acceptability and quality.

Results

Thirty strategies were formulated for Iranian HRH. Eleven of the developed strategies were related to the field of education and training, such as development of new required academic disciplines; balancing university admissions based on workforce requirements; and enrolling local students from deprived and underserved areas. Ten of the developed strategies were structured under the workforce accessibility dimension.

Conclusions

Strategies for HRH were formulated by adopting a comprehensive, scientific and collaborative approach to ensure alignment with the country's health system priorities and Global Strategy on Human Resources for Health to overcome health workforce challenges.

Factors influencing medical specialists' dual practice in the Islamic Republic of Iran

Background

Dual practice (DP) is performing several different jobs at the same time and has effects on healthcare services delivery.

Aims

To identify the causes of medical specialists' tendency towards DP in the Islamic Republic of Iran.

Methods

We used a qualitative approach to identify the factors affecting DP in medical specialists in 2016. We used a purposive and outlier sampling method to conduct semistructured deep interviews with 14 key informants. The data analysis was performed simultaneously with data collection using thematic content analysis by MAXQDA (version 10.0). Interviews continued up to data saturation. The quality of the study was ensured by addressing the criteria of Guba and Lincoln.

Results

The results of the interviews showed six themes and 16 subthemes for specialists' propensity to DP. Major themes included financial incentives, cultural attitudes about professional identity of physicians, experience and academic level of specialists, controlling approaches in the public sector, available infrastructure for responding to the population needs in the public sector, and regional characteristics of health service locations.

Conclusions

Medical specialists' DP is a multidimensional issue, influenced by different factors such as financial incentives, cultural attitudes and available infrastructure. Considering the capacities and conditions of each country, control and management of this phenomenon require regulatory and incentive mechanisms, which in the long term can modify private and public sector differences and increase the willingness of doctors to work in the public sector.

Systematic review of priority setting studies in health research in the Islamic Republic of Iran

Background

Several research priority-setting studies have been conducted in different countries, including the Islamic Republic of Iran.

Aims

We conducted a systematic review and evaluated the quality of the priority-setting reports about health research in the Islamic Republic of Iran.

Methods

English and Farsi databases were searched from January to July 2016 to extract reports (up to December 2015) about priority setting in health research in the Islamic Republic of Iran. We constructed a checklist to extract data from the identified studies. Articles were studied in detail and content analysis was carried out. Relevant items were scored and analysed using Microsoft Excel.

Results

We identified 36 articles. Eight articles involved all the main stakeholders. About half the articles used valid criteria for ranking. Transparency was fulfilled in 13 articles. Upstream rules and regulations were ignored in 26 articles. An implementation plan was considered in 9 articles and context analysis was demonstrated in only 3.

Conclusions

Developing standard packages for priority setting, training of researchers and improving the capacity of organizations may improve the quality of priority-setting studies in the future.

The search for underlying principles of health impact assessment: progress and prospects: Comment on "Investigating underlying principles to guide health impact assessment"

Health Impact Assessment (HIA) is a relatively young field of endeavour, and hence, future progress will depend on the planning, implementation and rigorous evaluation of additional HIAs of projects, programmes and policies the world over. In the June 2014 issue of the International Journal of Health Policy and Management, Fakhri and colleagues investigated underlying principles of HIA through a comprehensive review of the literature and expert consultation. With an emphasis on the Islamic Republic of Iran, the authors identified multiple issues that are relevant for guiding HIA practice. At the same time, the study unravelled current shortcomings in the understanding and definition of HIA principles and best practice at national, regional, and global levels. In this commentary we scrutinise the research presented, highlight strengths and limitations, and discuss the findings in the context of other recent attempts to guide HIA.

Prevalence of Iron Deficiency Anemia among Iranian Pregnant Women; a Systematic Review and Meta-analysis

INTRODUCTION

Anemia, particularly Iron Deficiency Anemia (IDA), is the most common hematological disorder during pregnancy with considerable complications in both mothers and fetuses. The estimation of anemia prevalence is an important step for health policy makers. Despite being considered a hot topic in epidemiological studies in Iran for the last twenty years, lack of a comprehensive overview on the findings encouraged the authors to carry out this study.

MATERIALS AND METHODS

All published papers in main national and international databases were systematically searched for some specific keywords to find the related studies between the years 1993 and 2007. All published studies which had reported the prevalence of anemia were included in the study except studies on refugees, patients undergoing hemodialysis, patients with thalassemia or cancer or other selective sub-populations. Two trained reviewers independently assessed the inclusion/exclusion criteria and the quality of the selected papers, summarized them and eventually analyzed the data.

RESULTS

Ten eligible papers including 11,037 participants were entered into the analysis. The maximum and minimum reported prevalence rates of anemia during pregnancy were 4.3% and 21.5%, respectively. The overall estimate of anemia prevalence in Iranian pregnant women was 13.6 (95% CI: 8.3 - 18.9). Excluding the only out-layer from the meta-analysis, the overall estimated prevalence was 12.4% (95% CI: 9.6% - 17.9%).

CONCLUSION

The prevalence of anemia in Iranian women during pregnancy is considerably lower than that of most EMRO countries or the one reported by WHO for Iran (> 40%) which had been performed on a small group 16 years ago. The lower prevalence rate of anemia in pregnant women versus the regional rates could be due to the improvements of the national health system and prenatal programs in recent years.