Introduction of a pyramidal model based on primary health care: a paradigm for management of 2009 H1N1 Flu pandemic

Primary health care [PHC] as the first level of contact of all individuals, the family and the community with the national health system has a prominent role in response to different health events such as H1N1 pandemic. Regarding the great potentials of PHC and several experiences achieved in previous natural disasters and epidemics in Iran, in this study there is an attempt to propose a pyramidal model to combat against H1N1 pandemic. Pyramidal model puts all key components such as community, NGOs, PHC, hospitals, policy makers together to confront concurrent H1N1 pandemic and other health issues by a comprehensive, integrated and organized approach. This model should be regarded as a continuous, flexible and dynamic solution to pandemics. H1N1 pandemic, as a multi-wave and unpredictable event of the 21st century that involved most countries, threatens communities and confronts hospitals with growing demands of patients for health services. By defining the role of PHC and other important parts of pyramidal models such as community, we can fight against H1N1 pandemic appropriately with the least human and financial resources

Influenza A [H1N1] virus pandemic in Fars Province: a report from southern Iran, July-December 2009

Influenza type A [H1N1] virus is considered as a major concern for health care system all over the world and imposes a considerable burden on the community. The aim of this study was to evaluate the pattern of the disease in order to help health administrators in making decision for preventive measures. 297 definite cases of influenza A [H1N1] diagnosed from 15 July to 3 December 2009 in Fars province, south of Iran, were included in this study. Diagnosis was confirmed performing Real time-PCR. The patients' information including age, gender, occupation, nationality, education, residency area and history of overseas or domestic travel, history of contact with other influenza patients, and symptoms were collected and analyzed. The mean age at the time of diagnosis was 24.4 +/- 15.8 years. 76 [25.6%] patients were admitted in the hospitals, of whom, 11 cases died due to related influenza complications with Case Fatality Ratio [CFR] of 4.4%. The most common reported symptoms were fever, cough and sore throat. There were two waves in the disease incidence, one about 1 month after emergence of the disease and another around 1 month after school openings. The first peak was observed mainly among adults with a history of foreign travel while the second peak was mainly observed among school students. The magnitude of the epidemic was much higher when the disease was transmitted between students at the beginning of the school year. Considering the high incidence of H1N1 flu among the students [41%], vaccination programs and preventive measures should target this age group

Vulnerable household women's health assessment [VH-WHAT]: protocol design and implementation

The gender-based approach can identify women's health problems on the basis of biological differences and their social, familial and individual roles. Unequal power relationship between men and women, fewer chances of education and employment, repeated pregnancies, longer life-spans, a greater proportion of the world's poor, inappropriate familiarity with their health risks increase their need to better benefit from primary healthcare. As determinants of health, poverty and social class indicate that women and especially deprived women require a greater focus on their health. This study attempts to identify modifiable health risk factors of these individuals. The women-headed households under cover in 11 provincial centers were included in the study. Medical consultation, general physical examination, fasting blood sugar level, blood cell count, lipid profile and systematic examinations, specific examinations of breast, pelvis, mammography and Pap Smear were performed according to the protocol. As a pilot study, 2730 individuals were assessed and their demographic features were obtained. The mean age of participants in the pilot study was 47.6 +/- 10.2 years ranging from 22 to 88 years of age. We expect that the study's findings would provide the opportunity to compare the differences of the special subgroups of vulnerable women with the data available in the country, and if necessary implement changes suitable with the vulnerable groups' health status