Inequality in school readiness and autism among 6-year-old children across Iranian provinces: national health assessment survey results

To assess the national inequality of school readiness and autism among 6-year-old Iranian children before school entry using a national health assessment survey. In a cross-sectional nationwide survey, all Iranian children entering public and private elementary schools were asked to participate in a mandatory national screening program in Iran in 2009 in two levels of screening and diagnostic levels. The study population consisted of 955388 children [48.5% girls and 76.1% urban residents]. Of the whole children 31% of the 6 year old children had impaired vision In addition, 1.2, 1.8, 1.4, 7.6, 0.08, 10, 10.9, 56.7, 0.7, 0.8 and 0.6 percent had color blindness, hearing impaired, speech disorder, school readiness, autism, height to age retardation, body mass index extremes, decayed teeth, disease with special needs, spinal disorders, and hypertension, respectively. The distribution of these disorders was unequally distributed across provinces. Our results confirmed that there is an inequality in distribution of school readiness and autism in 6-year-old children across Iranian provinces. The observed burden of these distributions among young children needs a comprehensive national policy with evidence-based province programs to identity the reason for different inequality among provinces

Development and evaluation of a questionnaire for assessment of determinants of weight disorders among children and adolescents: the caspian-IV study

Little experience exists on valid and reliable tools for assessment of the determinants of underweight and overweight in children and adolescents living in the Middle-East and North Africa [MENA]. This study aimed to develop a valid and wide-ranging questionnaire for assessment of these parameters in a nationwide sample of Iranian children and adolescents. This national study was conducted in 31 provinces in Iran. The first phase consisted of focus group discussion with 275 children and adolescents and their parents. After a qualitative content analysis, the initial items were extracted. In the next step, the face validity was assessed by expert panelists using the quantitative method of the Impact Score. To assess the content validity, the content validity rate [CVR] and the content validity index [CVI] were determined. The internal consistency was examined by Cronbach alpha, and its test-retest reliability was determined. The socio-demographic variables, perinatal factors, lifestyle factors, family history, knowledge and attitude were assessed. Dietary intakes were assessed using a validated 168-item semi-quantitative food frequency questionnaire. A validated questionnaire for quality of life was filled in anonymously. A team of expert researchers conducted the data analysis of 576 interviews by using qualitative content analysis method. The analysis process began by determining the semantic units associated with the understanding of participants about the concepts studied. The initial questionnaire was developed in four domains by including Likert scale questions. In the face validity step, all questions of the primary questionnaire obtained a score of more than 1.5. In the phase of CVR assessment, 6 questions obtained a score of less than 0.62, and were omitted. The rest of questions were assessed for CVI, and got a score of more than 0.75. Cronbach's alpha coefficient of the whole questionnaire was 0.97, and the Pearson correlation coefficient of the test-retest phase was 0.94. The developed questionnaire is a valid and reliable tool for assessment of the determinants of weight disorders in a nationally representative sample of children and adolescents in the MENA

Methodology and early findings of the third survey of CASPIAN study: a national school-based surveillance of students' high risk behaviors

A school-based surveillance system entitled the childhood and adolescence surveillance and prevention of Adult No communicable disease [CASPIAN] Study is implemented at national level in Iran. This paper presents the methods and primary findings of the third survey of this surveillance system. This national survey was performed in 2009-2010 in 27 provinces of Iran among 5570 students and one of their parents. In addition to physical examination, fasting serum was obtained. Body mass index was categorized based on the World Health Organization growth charts. Data of 5528 students [2726 girls, 69.37% urban, mean age 14.7 +/- 2.4 years] were complete and are reported. Overall, 17.3% [17.3% of girls and 17.5% of boys] were underweight, and 17.7% [15.5% of girls and 19.9% of boys] were overweight or obese. Abdominal obesity was documented in 16.3% of students [17.8% of girls and 15% of boys]. 57.6% of families consumed breads, the staple food for Iranians, prepared with white flour. Most families [43.8% in urban areas and 58.6% in rural areas] used solid hydrogenated fats. 22.7% of students did not add salt to the table food. 14.2% of students reported to have a regular daily physical activity for at least 30 min a day. Overall, 10.4% of students [11.7% in urban areas and 7.3% in rural areas] reported that they used tobacco products, often water pipe. 32.8% of students experienced at least three times of bullying in the previous 3 months. During the year prior to the survey, 14.46% of students had an injury needing the interference by school health providers. This survey is confirmatory evidence on the importance of establishing surveillance systems for risk behaviors to implement action-oriented interventions