Assessing health system responsiveness: a household survey in 17[th] district of Tehran

Responsiveness is an indicator by WHO to evaluate the performance of health systems on non-medical expectations of consumers. This study measures the health system responsiveness and the factors affecting responsiveness in Iran health system. World Health Survey [WHS] questionnaire was used to collect data on a two-stage cluster sampling in 17[th] District of Tehran in 2003. Of a sample of 773, 677 and 299 individuals who respectively had outpatient or inpatient services utilization responded to the responsiveness module of WHS questionnaire. More than 90% of respondents believed that responsiveness issues were very important. Performance of outpatient services was better than hospital services in terms of responsiveness. [Prompt attention] and [quality of basic amenities] received low score for outpatient services. Service user variables had no significant effect on responsiveness, while type of centers was significantly related to responsiveness. Principal component analysis found three factors for both outpatient and inpatient services that explained 62% and 61% of total variances respectfully. Iran health system should pay more attention to responding non-medical expectations of service users. It sounds that health system interventions are main determinant of responsiveness score compared to demographic or user variables. Training health staff, allocating more resources and reengineering some processes may play a role in improving responsiveness. Responsiveness domains seems to be tailored based on each society's cultural factors

Direct estimation of life expectancy in the Islamic Republic of Iran in 2003

We estimated the life expectancy for 2003 for 23 provinces in the Islamic Republic of Iran using population and mortality data from the Ministry of Health and Medical Education. The underreporting of deaths above 4 years was corrected using the Brass Growth Balance method. We assumed that the distributions of population, deaths, and hence life expectancy in the 23 provinces were equal to those for all 28 provinces of the country. Thus we estimated life expectancy at birth to be 71.56 years for the total population [95% uncertainty interval [UI]: 71.52-71.62]; 70.09 [95% UI: 70.02-70.16] years for males, and 73.17 [95% UI: 73.10-73.24] years for females. Our estimates were higher than the model-based estimates of the Statistical Centre of Iran, United Nations agencies and the World Bank, due to differences in the estimation methods used

[ burden of disease and injury in Iran in the year 2003]

Disability-Adjusted Life Years [DALY] summarizes the fatal and nonfatal outcomes of diseases and injuries in one number and gives a quantitative assessment of the health of a population. Estimating the burden of diseases and injuries in Iran in terms of DALY both nationwide and in 6 provinces. We used slightly modified versions of the methods developed by the World Health Organization for estimating the burden of premature mortality, disability, and the DALY. The DALY rate per 100,000 was 21572 and 62% of this was life lost due to premature mortality; the remaining 38% was due to disability from diseases and injuries. Fifty-eight percent of the total DALYs had been lost due to non-communicable diseases, 28% due to external causes [injuries], and 14% due to communicable, maternal/ perinatal and nutritional illnesses. The group of diseases and injuries with the highest burden in males was intentional and unintentional injuries [2.789 million DALYs], while in the female population this position was held by mental disorders with 1.191 million DALYs. The single most important cause of burden was traffic accidents in males and ischemic heart disease in females. Disease burden showed considerable variability between different provinces. The profile of health and disease in Iran has generally shifted from the predominance of communicable, maternal/perinatal, and nutritional illnesses towards predominance of non-communicable diseases and injuries at the national level. These figures on disease burden at population level are the most objective evidence that can be used in policy making and management of health programs, health research, and resource development within the health sector

[Knowledge, Attitude and Practice Regarding the mass Anti-Measles and Rubella Immunization Campaign [2004] in the Population Covered by Tehran University of Medical Sciences]

The campaign to eliminate measles and rubella [MR] is one of the most important current health projects in Iran. One of the basic requirements of this program is the creation of an efficient system for collecting data on MR morbidity and mortality, people's knowledge, attitude and practice [KAP] regarding MR prevention, and people's participation in the eradication drive. The present study was done to assess people's knowledge, attitude and practice in relation to the current anti-MR campaign. This cross- sectional study was carried out four months after the mass [anti-MR campaign [performed in May 2004]. The target population included at the people aged 20-25y who lived in areas covered by Tehran University of Medical Sciences and Health Services. The calculated sample size was 384, using a 2-stage sampling procedure. We used X2 tests, odds ratios and confidence intervals to detect relationships between various categorical variables. We also performed Cronbach's alpha test to assess questionnaire reliability, and principal component analysis to ensure construct validity. Data were collected on 390 individuals. The percentages of people with an acceptable level of knowledge, attitude and practice were 63.3%, 53.6% and 93.1% respectively. After controlling for confounders in a logistic regression model, it became apparent that knowledge concerning the mass immunization campaign was related to the individual's own education and that of his/her mother. Attitude was found to be affected by factors such as education, marital status and the family's main income level. The practice component, on the other hand, was not significantly related to any of the variables included in this study. The positive achievements of this program should be used in planning any future immunization campaigns. Particular attention should be paid to factors that affect overall coverage. These include human resources, equipment, vaccines and other materials, service quality, the cold chain, information provided to the public, and people's as well as providers' knowledge of the immunization program, the target diseases [s] and the vaccines

[Analysis of demographic and socioeconomic determinants of 17th zone Tehran: Tehran population lab region]

Introduction: the human being is part of its surrounding socio-economic framework. He is affected by the environment and actively affects it. Ignoring the socio-economic dimensions of health leads to the failure of health promotion programs and widens the inequity in the health status of different groups in the society. The aim of this study is to identify the socio-economic and demographic status of the inhabitants in 17th zone of Tehran

Methods: a combination of qualitative and quantitative approaches was used in this study. A crosssectional descriptive study was carried out in population research Center of Tehran University of Medical Sciences [TUMS] with a sample containing 1121 households. They were chosen by random cluster sampling. Data was gathered using the World Health Survey questionnaire of WHO. Construct validity, and test-retest reliability and internal consistency of the questionnaires were already approved. The SEAGA tools, which are classified as Rapid Appraisal [RA] methods were used to complete the community profile .Techniques such as direct observation, Semi-structured interview with key informants, field notes, social map, and trend line were devised to identify community profile. The method of triangulation was used to validate the data

Results: data analysis showed means of age was 27/9 years. The average size of the household was 4.23. 47.5% of the respondents were unmarried. The Majority of participants [30/7%] have been qualified at high school level. The dominant ethnic group was Azari [57/8%]. All of them were Moslems. The majority are self-employed [11/9%]. The qualitative studies showed that district one is the economic core of the area. Economical heterogeneity in three districts of 17th zone was evident. Social problems were reported as unemployment, drug abuse, violence and aggressive behavior and so on

Conclusion: the variety of socio-economic problems among inhabitants in 17th zone of Tehran represents this area as a problematic community. Capacity building and providing proper background for community participation in solving its own health problems can be an effective approach towards sustainable development. Total reliance on the health sector to solve the numerous problems of this area will not be successful as inter-sectoral collaboration and community participation are mandatory requirements of this process

[Evaluation of the household expenses per capita and the inequity in people's economic status and healthcare services]

Introduction: the success of a health system depends on the accessibility and the quality of health services it provides. One major indicator of service quality is peoples satisfaction from the service. In this article, healthcare availability and satisfaction of people in 17th zone of Tehran is investigated

Methods: population Research Center has performed a survey in 17th zone of Tehran to investigate people s access to health services and healthcare costs. This face- to-face survey is based on the standard questionnaire of World Health Survey. 1121 households were chosen through cluster sampling. The validity and reliability of the questionnaire are confirmed in previous studies

Results: the average size of the households is 4.23 and its ratio to the number of rooms in the households is 1.98. Expenses per capita and the insurance coverage and quality have no significant difference in large and small households. The share of health expenditures is significantly smaller in households with a female guardian than those with male guardians. People s overall satisfaction from health services is mediocre, little or very little in 62% of the cases

Conclusion: although the level of inequity in coverage and quality of health services is small over the area, the overall health care quality is not enough for customer s satisfaction. Initiatives to improve the quality of health services seem mandatory

Adherence of the private sector to national tuberculosis guidelines in the Islamic Republic of Iran, 2001-02

We determined the knowledge and practice of private sector physicians in three cites regarding management of pulmonary tuberculosis [TB] and their determinants. A random sample questionnaire survey was conducted of 732 private physicians. Stratified analysis and logistic regression were used to identify the adjusted determinants of the two outcomes. A high proportion of the doctors had correct knowledge about the major diagnostic criteria but there was a low level of knowledge and practice of TB management. Significant risk factors for poor knowledge were age > / = 36 years, being a GP rather than a specialist and no attendance in TB training courses or attendance in courses held by institutions other than the public health system. Age > / = 36 years was the only significant risk factor for poor practice