Problems of providing services to people affected by HIV/AIDS: service providers and recipients perspectives

This qualitative study aimed to identify the health-care problems of people living with HIV [PLHIV] in 2 large cities: Tehran and Kermanshah. Two main groups of stakeholders - service providers [policy-makers, managers, physicians and counsellors] and service recipients [PLHIV and their relatives] - participated in focus group discussions and in-depth interviews. We identified 24 themes covering the major health problems of PLHIV, including: incomplete and inadequate coverage of health-care services; patients' substance abuse; patients' fear of stigma; occupational burnout of certain service providers; patients' dissatisfaction with some of the services provided by counselling centres/clinics; medical staff's failure to observe confidentiality; and patients' lack of access to required specialized services. The problems and needs identified can inform the design and implementation of health programmes in our country and elsewhere in the Eastern Mediterranean Region

Factors influencing women's willingness to volunteer in the healthcare system: evidence from the Islamic Republic of Iran

This case-control study evaluated the factors influencing volunteering in the Islamic Republic of Iran's Women's Health Volunteer [WHV] programme/which is implemented in 150 centres in Khorasan-e-Razavi Province. We recruited 145 cases [volunteers] and 146 controls [non-volunteers] from the centres. Data were collected by questionnaire. Sociodemographic variables included were: length of residence in neighbourhood, number of siblings, husband's age and education and job, family size, quality of life, self-rated health status, neighbourhood intimacy, child under 2 years, house ownership, wealth index. Social network variables included were: ego network size, type of acquaintance, intimacy with others, relationship communication, relationship duration, emotional support, advisory support, monetary support, physical support, time support. There were significant associations [P < 0.05] between women's propensity to volunteer and family size, presence of a child under 2 years in the family, neighbourhood Intimacy, social network composition, and emotional and advisory support

Intersectoral collaboration to develop health equity indicators in Iran

Health equity is considered as one of the main objectives of health care systems. This study was carried out with the aim of determining health equity indicators in Iran. Through consideration of these indicators, differences in health status of different social groups and different geographical areas can be shown in different periods and based on that, effective interventions can be designed. This study is carried out through a main workshop and expert panels and final consensus on selected indicators. The first draft of indicators and inequity stratifying variables were prepared and then revised by working groups consisting of experts inside and outside Health system. Finally ideas were accepted or rejected after presenting enough reasons and deep examination through the Consensus-Oriented Decision-Making [COMD] model. Fifty two indicators have been determined as health equity indicators in five areas including health, social and human development, economic development, physical environment and infrastructure and governance. Furthermore, for each indicator the proper and practical stratifying variables of inequity were identified. By calculating such indicators, it becomes possible to determine differences in health status of different social groups and different geographical areas

Trend of knowledge production of research centers in the field of medical sciences in Iran

Establishment of medical research centers at universities and health-related organizations and annually evaluation of their research activities was one of the strategic policies which followed by governmental organization in last decade in order to strengthening the connections between health research system and health system. The aim of this study is to scrutinize the role of medical research centers in medical science production in Iran. This study is a cross sectional which has been performed based on existing reports on national scientometrics and evaluation results of research performance of medical research centers between years 2001 to 2010. During last decade number of medical research centers increased from 53 in 2001 to 359 in 2010. Simultaneous scientific output of medical research centers has been increased especially articles indexed in ISI [web of science]. Proper policy implementation in the field of health research system during last decades led to improving capacity building and growth knowledge production of medical science in recent years in Iran. The process embedding research into the health systems requires planning up until research products improves health outcomes and health equity in country

analysis of health research system evaluation in medical sciences universities

Based on Iran by 2025 defined vision, we must to receive the first grade of science position in south western Asian region. Thus we need to have a comprehensive evaluation program. A comprehensive WHO Health Research System Analysis [HRSA]- based evaluation system was developed to evaluate the HRS in Iran. This article has explored the results of the five-year evaluation [2003-2008] and aims to introduce this method to other developing countries. Here we explore the results of research performance evaluation from 2002 to 2010 and by comparing the results with previous available information, we reveal the probable role of this method in research promotion and proposed approach to facilitate and expedite achieving the prospects for goals of health research based on the visions of Iran by 2025. All of the indicators of stewardship and capacity building axes are received to their predefined levels. Moreover all of the medical science university research policies are based on their strategic plannings which are extracted from national visions of Iran by 2025. Most of the predefined goals in knowledge production domain had a significant grow trend but for more growth for commitments they should be closely follow. We developed an HRS-based comprehensive evaluation program to our national vision as well as our regional and international research competition

Health research evaluation and its role on knowledge production

Knowledge production and evaluation are two important functions of health research system [HRS]. In this article, we aimed to reveal the correlation between evaluation of health research organizations and health knowledge production promotion. A comprehensive evaluation system was developed to evaluate the academic performance of national medical science universities on an annual basis. It assess following domains; stewardship, capacity building and knowledge production. Measurable indicators for each domain were assigned, a 'research profile' for each department was provided. In this study, we compared the results of annually national Health Research System evaluation findings during 2005-2008. The number of scientific articles has been increased from 4672 to 8816 during 2005 to 2008. It is mentionable that, the number of articles which has been published in indexed data bases has risen too. This fact could be related to directed policy for more international publication of scientific articles from Iran. The proportion of total articles to the number of academic members was 1.14 in 2008, comparing to 0.84 in 2005. It means that this proportion have increased about twice [0.7 Vs 0.45] during mentioned time. Moreover, other scientific products such as authored books based on domestic researches and cited articles in textbooks have increased according to special attention to knowledge production by policy makers. We conclude that Health System Research evaluation could be used as a mean for implementing policies and promoting knowledge production

Malaria status in economic cooperation countries; achievement and gaps toward United Nations Millennium Development Goals

Evaluating the malaria status of the Economic Cooperation Organization [ECO] member countries relation to goal 6 of 3rd Millennium Development Goals [MDGs] which includes have halted by 2015 and begun to reverse the incidence of malaria. By 2009, we reviewed the MDGs reports, extracted the data from surveillance system, published, and unpublished data. The main stakeholders, from both governmental and international organizations in the country have been visited and interviewed by the research team as part of the data validation process. The malaria incidence is very heterogeneous among ECO countries, which differ less than 200 cases in total country in Kazakhstan, Kyrgyzstan, Turkey, Turkmenistan, Uzbekistan, and Azerbaijan to 82,564 cases [2,428/100,000] in Afghanistan and 59,284 cases [881/100,000] in Pakistan and about 18/100,000 in Iran in 2008. Malaria has been a major public health problem in Pakistan and Afghanistan and will continue to pose serious threat to millions of people due to poor environmental and socioeconomic conditions conducive to the spread of disease. The main malaria endemic areas of Iran are in southeastern part of the country; consist of less developed provinces that are bordered in the east by Afghanistan and Pakistan. There are little valid information about proportion of population in malaria-risk areas using effective malaria prevention and treatment measures indicators. All ECO countries could achieve MDGs malaria indicators by 2015 except Pakistan and Afghanistan, unless preparing urgent intervention programs to fulfill the goals

[Establishment and integration of a visceral leishmaniasis surveillance system in the primary health care system and its evaluation, Meshkin-Shahr District, Iran]

Visceral leishmaniasis is a systemic parasitic disease with a high fatality rate in under-5-year-old children. The disease is endemic in some parts of Iran, particularly in the north-west region. In 2001 a visceral leishmaniasis [VL] surveillance system was established for children aged>/=12 years in the primary health system in Meshkin-Shahr District, Ardebil Province, situated in the north-west of Islamic Republic of Iran. All cases with clinical signs and symptoms of VL and confirmed positive by the direct agglutination test [DAT] were referred for physical examination and treatment. The mean annual incidence of VL decreased significantly from 1.88 per 1000 children before [1985-2000], to 0.77 per 1000 child population after [2001-07], the intervention. In the control area with no surveillance, it increased from 0.11 to 0.23 per 1000. Early detection of VL using serological tests and timely treatment of cases can decrease the mortality and morbidity rates of VL in endemic areas

experience of peer education model among medical science university students in Iran

The purpose of this study was to evaluate the effectiveness of peer education among university students for reproductive health promotion based on researchers' experiences. This interventional study was conducted in Qazvin University of Medical Science during 2002 to 2004 through stakeholders' partnership and selection of 24 volunteer students according to their knowledge, interest, communication skills. Capacity building was performed through holding an interactive reproductive health coarse contained marital health, illegal abortion, family planning, STI/AIDS, communication and counseling skills. Trained peer educators have introduced to other student and present education and counseling formally and informally. A post interventional study was conducted after 9 months in order to find its effectiveness. In our experience Stakeholders' partnership in community interventional programs led to the best expected availability of better health through ownership and adopting policies. In present study, the proper determined criteria for selection of peer educators and clear understood expectations of the peer educators' role were very important in health promotional program. Although peer education was acceptable program for university students, more support and supervising for peer groups are needed. The students believed that the power point of peer education and counseling related to same age groups sympathy, confident, well behaved, cheerful, and kind-hearted and peer educators awareness. Universities are appropriate real world for experience a friendly youth program and then disseminate it to other young communities. There seems peer education is effective strategy for reproductive health promotion and reinforce positive behaviors in youth

explanatory model of depression among female patients in Fars, Kurds, Turks ethnic groups of Iran

Depressive disorder is globally estimated to be as many as one in five visits to primary health care. Approximately more than 50% of depressed women in primary care are not diagnosed. As a part of a major investigation into perceptions of women's depression, this study explored how female patients and their relatives conceptualize patients' conditions in three ethnic groups in Iran [Fars, Kurds and Turks]. Qualitative methods were used for data collection. Depressed women and their relatives were purposively selected from the public psychiatric clinics affiliated to university of medical sciences in the three study cities. Twenty-five depressed women and 14 relatives were interviewed in three ethnic groups. One theme "illness meaning", including three categories: perceived symptoms, label of the illness, and effects of the illness was found through the content analysis. The participants perceived symptoms of illness as somatic and psychological depending on the participant's assumed reason for the onset of the illness. There were most similarities in term used for of the illness in the three ethnic groups. Most of the study participants described the illness in terms of nerve problems/illness, and depression "afsordehgi". The most important effects that depressed women had experienced because of their illness were marital conflict or a guilt feeling originating from their inability to support family. These findings suggest the need to recognize and choose appropriate diagnostic approach for depressed women in the context of Iran

Integrated visceral leishmaniasis surveillance system in primary care for children in Meshkin-Shahr district, north-western Islamic Republic of Iran

In 2001 a visceral leishmaniasis [VL] surveillance system was set up for children aged

effectiveness of educational intervention in the health promotion in elderly people

More than 8% of Iran's populations are elderly. The greatest challenge in this generation is improvement of health and quality of life. So we decided to perform an interventional study with the aim of promoting the health of the elderly. This study was a community interventional in Ekbatan Complex. Subjects were elderly. At first, need assessment was done with the participation of 200 elderly by questionnaire. Based on the need assessment, we designed the educational interventions in different fields such as nutrition, mental health, and exercise and then, we compared the results. One hundred elderly participated as interventional group. There were 86% women and 24% of men. Almost 59% were in the 60-69 age group. More than 1/4 of the subjects were university graduates. Pre and post interventional groups were matched in age, education and gender. Regarding nutrition, second priority food in women aged 60-69 was rice and after the intervention, it was changed to vegetables [P=0.05] but in other age groups and in the men's groups no difference were noted. Aerobic exercises in women has increased after the intervention [P=0.01]. With regards to mental health, life satisfaction among women under study has increased from 68% to 90% after the intervention [P=0.01]. Feeling happy most of the time has increased from 53% to 83% in women aged 60-69 [P=0.01] and in men from 64% to 83% [P=0.05] respectively. Policymakers should design long-term educational programs to promote the elderly lifestyles

Coronary heart disease and associated risk factors in Qazvin: a population-based study

In a cross-sectional study in Qazvin, Islamic Republic of Iran, 846 residents [425 men and 421 women] aged >/= 25 years were assessed for coronary heart disease and its associated risk factors comparing ischaemic and non-ischaemic groups. The age-adjusted prevalence of possible myocardial infarction, ischaemic ECG changes and angina pectoris were 4.2%, 36.8% and 2.2% respectively. There was no difference in the mean systolic and diastolic blood pressure and body mass index between ischaemic and non-ischaemic groups. There was a significant association between possible myocardial infarction and hypertension, type 2 diabetes, and smoking in women. There was also a significant association between ischaemic ECG changes and waist'hip ratio in women and between ischaemic ECG changes and hypertension in men

relationship between ischemic heart disease and coronary risk factors in population aged over 25 in Qazvin: a population-based study

Coronary heart disease [CHD] is the first and the most common cause of death in all age groups and both sexes in Iran. To determine the CHD prevalence among the population of Qazvin. In this cross sectional study, 501 males and 499 females aged 25 or more [mean 47.1 +/- 11.9 yr] were assessed for the presence of CHD. Twelve lead ECG was obtained for each participant over 30 years old. The CHD risk factors were compared between normal and ischemic groups. The Minnesota code was used for ECG coding. Age adjusted prevalence of possible MI, ischemic ECG and angina pectoris were 2.5%, 18.9%, and 1.1%, respectively. There was no significant difference between mean values of systolic/diastolic blood pressure among ischemic ECG and possible MI groups when compared with normal group. Also, the comparison of mean values for BMI in ischemic ECG and possible MI groups with normal group shown to be insignificant, statistically. There was a significant association between possible MI and hypertension, type II diabetes, and smoking in females. The data were also indicative of a significant relationship between the ischemic ECG and WHR in females and hypertension in males. Meanwhile, the possible MI was more frequent in smokers than non smokers. Based on results obtained in our study, CHD was directly associated with age and smoking in all sex and age groups and also with hypertension and diabetes in females. So, regarding the high prevalence of asymptomatic CHD, the screening and preventive measures for CHD risk factors seem to be necessary

Community-based nutritional intervention for reducing malnutrition among children under 5 years of age in the Islamic Republic of Iran

A project was conducted in a rural area in September 1994 with the aim of decreasing the incidence of protein-energy malnutrition among children under 5 years, by nutritional intervention through the primary health care system. An initial situation analysis revealed the region's resources and causes of malnutrition. Practical instruction on feeding methods, deworming, environmental sanitation, the promotion of home-grown vegetables and reinforcement of the growth monitoring programme were chosen as the routes for intervention. All indices were reassessed in the region after 1 year. Results showed that nutritional awareness had grown among mothers, and that the incidence of malnutrition had dropped from 6.5% to 1.8%, as measured against the weight-for-height index

survey on breast feeding in the Islamic Republic of Iran

In this paper breastfeeding was studied among 10240 urban and 10794 rural mothers, whose children were 18 to 23 months of age. The sample size for rural and urban areas was equal, but in each province the cluster sampling method was used proportional to the population of each district. The results of the study show that between 17% to 28% of urban mothers in the provinces have deprived their children from the minimum period of breastfeeding namely 4 months. The results also show that between 51% to 68% of mothers have breastfed their children for at least one year. The percentage of mothers who have breastfed their children for at least 1.5 years was in the range of 36% to 50%. On the other hand, 11% to 22% of mothers residing in rural areas have never breastfed their children or if so, the period has been less than 4 months. The percentage of mothers who have breastfed their children for at least one year is in the range of 61 to 79 percent. The percentage for mothers who have breastfed their children for 1.5 years is between 47 to 66 percent. The overall conclusion is that: - Rural mothers have more willingness to breastfeed their children than urban mothers. - In all urban areas and in some rural areas, illiterate mothers have a higher percentage of breastfeeding. - In some rural areas, literate mothers breastfed their sons more than their daughters