Developing the use of quality indicators in sterilization practices

Health-care-associated infections are a major threat to the safety of patient care. Control of such problem is a major criterion for hospital accreditation. This study was aimed to determine the developing use of chemical [class 6 products] and biological indicators in Tabriz district hospitals since 1997 to 2011. We conducted this time-trend interventional study with all of the public and private hospitals, which counted to 21 in Tabriz district as a sample. The situations of indicator use were presented for each time in the base of indicator groups. Furthermore, the results were showed in the base of hospital groups. All of district hospital [n=21] with 74 autoclave machine and 22 central sterilization room were studied. The result of second time study in 2008 showed a markedly improvement in the control of sterilization processes. Furthermore, we continued our intervention results 6 month later in 2009 and 2 years later in 2011. The most striking result were use of chemical indicator in 100% of hospitals. However, there are defects in the use of biological indicators [63.65%]. The most obvious finding was significant improvement in sterilization control especially in development the use of chemical indicators. The finding of this study has a number of important implications for hospital managers and infection control practitioners such as continuous practical training of CSSD personnel in hospitals and mandating of indicator using in all sterilization process with controlling of this subject in evaluation and accreditation of hospital programs

[Symptomatic meckel's diverticulum after appendectomy]

Background: Meckel's diverticulum is the most common anomaly of the intestine. It is usually asymptomatic but could also be symptomatic with complications such as bleeding, intestinal obstruction, and inflammation

Case Report: Two weeks after gangrenous appendectomy of a 44 years old man in Shahid Beheshti Hospital in Kashan city, Iran, he complained of abdominal pain, nausea, bilious vomiting and constipation. Considering him as a suspicious case of intestinal obstruction, we performed laparatomy in which torsion of 10 cm. length of Meckel's diverticulum was confirmed

Conclusion: Since the complications of Meckel's diverticulum are rane in adults, this diagnosis is supposed to be considered as one of the probable reasons of acute abdomen surgery. Although, the common place of Meckel's diverticulum is at 40-60 cm away from ileal operculum, it is recommended to assess ileum at a 100 cm distance from it

Epidemiological pattern of non-fatal injuries in Iran

To present the incidence rate and distribution of non-fatal injuries in Iran. A one- year study was carried out in all 28 provinces of Iran in 2002-3. Overall, 53,6624 individuals [1,11626 households] from all provinces of the country were randomly selected for the study. In each province about 2000 households in urban and 2000 families in rural areas were included in the study. The guardians or heads of the households were interviewed by using a questionnaire that included information about any accidental injuries taken medical cares within the year prior to the date of data collection and some other demographic information. It is estimated that more than 9.2 million injuries with about 8286 deaths and 74379 hospitalizations occurred in Iran each year. The incidence rate of all types of non-fatal injuries was [444.3 per 100,000]. The top three causes of non-fatal injuries were transport accidents [237 per 100,000], falls [106.2 per 100,000] and struck by thrown, projected of falling object [69.8 per 100,000]. The non-fatal injuries were more common among males than females [8039.6 vs. 2021.7 per 100,000] and nearly equivalent among residence of urban areas compared to those from rural areas [5024.1 vs. 5075.5 per 100,000]. In Iran injuries are one of the main leading causes of diseases and hospital admissions in both rural and urban areas, and this figure for transport accidents is quite high in the world

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

Caesarean section in the Islamic Republic of Iran: prevalence and some sociodemographic correlates

The aim of this study was to investigate the prevalence of caesarean section in the Islamic Republic of Iran in different provinces and to compare the sociodemographic characteristics of married women with and without caesarean section. Data were analysed from the Iranian Demographic and Health Survey of a representative sample of married women [n = 17 991] who delivered a baby between September 1998 and October 2000. Overall, 35.0% of deliveries were by caesarean section. Women having a caesarean section were older, better educated, married at a later age and with lower parity than those who delivered normally. Provincial variations in rates were significantly correlated with indices of socioeconomic development

Urologic diseases in the Islamic Republic of Iran: what are the public health priorities?

This study was designed to estimate the burden of urologic diseases in the Islamic Republic of Iran as a practical method for defining public health priorities. Using World Health Organization guidelines for national burden of disease studies, 6 steps were performed: selecting diseases to include; dynamic modelling of diseases; gathering data about urologic diseases; computing the local disability weights of urologic diseases; data analysis with DisMod II; and computing the disability-adjusted life years for each disease. Renal calculus, acute cystitis, chronic prostatitis, benign prostate hyperplasia, male infertility and adult polycystic kidney disease comprised the greatest burden

[Marked reduction in goiter prevalence and eventual normalization of urinary iodine concentrations in Iranian schoolchildren, 10 years after universal salt iodination [third national survey of iodine deficiency disorders 2000]]

Two years after legislation of salt iodization of 40 parts per million [ppm] in 1994, goiter was still endemic and urinary iodine concentration [UIC] remained elevated in many provinces of Iran. Goiter prevalence and UIC were compared two and seven years after sustained consumption of uniformly iodized salt by Iranian households. From December 2000 to June 2001, schoolchildren [7-10 yr] of all provinces were randomly selected by cluster sampling; their goiter rate, UIC, and household salt iodine levels were compared to similar data collected in 1996. Factory salt iodine produced in 2001 was also compared to that of 1996. Ultrasonographically determined thyroid volumes of 7-10 yr old children were compared in 2001 to those of 1999. Total, grade 1, and grade 2 goiters were 13.9 vs. 53.8%, 11.0% vs. 44.8%, and 2.9% vs. 9.0%, in 2001 [n=33600] vs. 1996 [n=36178], respectively [p<0.0001]. Median [range] UIC in 2001 [n=3329] was 165 [18-410] micro g/L and in 1996 [n=2917] was 205 [10-2300] micro g/L [P<0.0001]. Means for iodine salt content were 32.7 +/- 10.1 and 33.0 +/- 10.2 [P=0.79] in households and 33.2 +/- 13.4 and 33.8 +/- 13.2 [P=0.67] in factories, in 2001 and 1996, respectively. Only 7-yr-old children in 2001 [the only group with probably no history of iodine deficiency] showed significantly smaller thyroid volumes compared to those in 1999. After seven years of optimized iodized-salt supplementation in Iran, adequate UIC values and marked reduction in goiter rate have been achieved

[ 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

[Current status and the 10 years trend in the malnutrition indexes of children under 5 years in Iran]

Malnutrition is one of the main nutritional problems among children under 5 years especially in developing countries. The effects of malnutrition in this range of age group includes; disorder of mental and physical growth and development, increase in the morbidity and mortality, decrease of the learning capacity. A detailed epidemiological picture of the prevalent malnutrition status among children under 5 years in different regions of Iran enables health policy makers to identify priorities, establish political commitment and design appropriate interventional programs to prevent and control malnutrition and improve nutritional status of children. To determine the prevalence rate of malnutrition among children under 5 years. Demographic data, weight and height of 34200 Iranian children between 0-72 months old in 28 provinces of the country in 2005 year based on a cluster sampling were gathered. The subjects' weight and height were measured by trained staff. Prevalence of underweight, stunting, and wasting indicators was determined by measuring the weight and height of subjects in urban and rural areas. EPI6 statistical software, version b6/04, was used for all statistical analyses. 4.7% of the children aged less than five years suffered from stunting [95% CI: 4.5- 4.9%] the prevalence of this type of malnutrition among urban children is significantly less than rural children [95% CI: 3.1- 3.5% and 6.5-7.1% respectively]. Meanwhile the prevalence of underweight was 5.2% in the country [95% CI: 5.1-5.4%] while the prevalence of this type of malnutrition was significantly less among urban children than those in rural ones. Moreover, the prevalence of wasting was 3.7% [95%CI: 3.5-3.9%] and there was a significant difference in this regard between the urban and rural children. Thus this indicator was significantly higher among urban children than those in rural areas [95%CI: 3.8-4.3% and 3.0-3.5% respectively]. The results of the study show that the prevalence of protein-energy malnutrition was low among Iranian children under five years old. In comparison with previous studies, it is felt that there has been a prudent decrease in all malnutrition in all levels. However, there were significant differences in the prevalence of malnutrition in different provinces, which has resulted in the differences in their developmental stages as well. It appears that subjective strategies are required to improve the nutritional and health status among children under five in all provinces

[ prevalence of goiter and urinary iodine exertion in 7 - 10 year old school children of Qom 2001 - 2002]

Iodine deficiency was a public health problem in Iran before the start of iodine supplementation program in 1989. This study has been conducted in the framework of the national monitoring survey in 2001 to find the prevalence of goiter and urinary iodine levels in order to evaluate the effect of national supplementation program on the iodine status of school-aged children in the city of Qom. In a descriptive, cross-sectional study, 1200 schoolchildren, aged 7-10 years, were selected randomly from all regions of Qom, and the grade of goiter was determined in 600 boys and 600 girls according to WHO classification. Urinary iodine content was estimated using the digestion method in one tenth of the schoolchildren. Goiter was observed in 26% of children [24.3% of girls and 27.7% of boys]. The average urinary iodine level was 15.2 micro g/dl. Urinary iodine levels higher than 10 micro g/dl was measured in 71.7% and less than 5 micro g/dl in 8.1% of children. Urinary iodine levels less than 2 micro g/dl has not been observed in any of the cases. No significant difference was observed in prevalence of goiter and the urinary iodine level between males and females, and students in living in urban or rural areas. Comparison of these results with those of the year 1996 shows that prevalence of goiter has significantly decreased in these students. Also, it shows that in the city of Qom, the urinary iodine levels of schoolchildren fall in the standard range determined by WHO. This indicates that the iodine intake is adequate in the province of Qom. Therefore, this province can be considered as an "iodine deficiency-free" zone

Direct estimation of life expectancy for population of Iran in year 2003

Life expectancy is one of the summary measures of population health, whose values and trend of changes over time show the main outcome of health system performance. Estimation of life expectancy is performed with direct or model-based methods. In this study direct estimation of life expectancy for Iran's population in year 2003 is performed. In an ecologic study, for calculation of abridged period life table for 23 out of 28 provinces of Iran in year 2003, numbers of registered deaths for age and sex specific groups in these 23 provinces by death registration system of Ministry of Health [MOH] were used. Undernumeration of over-four year's deaths was estimated and corrected with Brass Growth-Balance method. For mortality rates of under-one and 1-4 years, similar rates from Demographic and Health Survey [DHS] 2000 with live births denominators were substituted. For total number of population of 23 provinces, information from MOH was used. Distribution of population by age and sex was taken similar to that from DHS 2003 results, and also taken as result of graduation of whole country population from 1375 census. Population of these 23 provinces was equal to 73% of total population of country in year 2003. Life expectancy was estimated by age and sex with the obtained population and death numbers. It was assumed that distributions of population and death in 23 provinces were similar to those for the whole 28 provinces of Iran in year 2003 and hence, the estimated life expectancy for 23 provinces is equal to that for all 28 provinces in 2003. Sensitivity of the results to assumptions was analyzed. Confidence intervals were calculated with Monte Carlo method. Life expectancy at birth was estimated as 71.56 years for total population [95% CI: 71.52 - 71.62], 70.09 years for males [70.02 - 70.16], and 73.17 [73.10 - 73.24] for females of Iran in year 2003. Sensitivity of results to assumptions was less than 0.5%. Values of life expectancy estimates for year 2003 with direct method are higher than those based on statistical modeling approaches performed by Statistical Center of Iran and by different United Nations agencies, due to difference in estimation methods for age and sex specific mortality rates

[Goiter survey and urinary iodine concentration in 7-10-year-old children, Tehran province, 2001]

Iodine deficiency disorder [IDD] is a worldwide health problem. Parts of Iran, such as Tehran, had been known as endemic areas for goiter. IDD was accepted as a priority health problem in our country and a National IDD Council was formed in 1989. This study was performed to evaluate the National IDD Council program in 2001 among 7-10-year-old children in Tehran province. In this cross sectional study, 1200 children [M/F ratio=1], aged 7-10 years, were selected and grading of goiter was performed in accordance to the WHO criteria. Urinary samples were obtained from 120 children and urinary iodine was measured using digestion method. Total prevalence of goiter was 5.1% [3.5% in girls and 6.3% in boys]. The median urinary iodine was 19 microg/dl 80.8% had urinary iodine of more than 10microg/dl, while 11.2% had urinary iodine levels of <5microg/dl. None of the candidates has urinary iodine of less the 2microg/dl. there was no significant difference between sexes and urban or rural areas. Results have revealed that the total prevalence of goiter has significantly decreased among children in Tehran province, meanwhile, urinary iodine concentration of children has reached to WHO approved rate. Thus, Tehran province could be classified among [iodine-deficiency-free] areas in Iran

[Goiter survey and urinary iodine concentration in 7-10-year-old children, Mazandaran province, 2001]

Iodine deficiency disorder [IDD] is a worldwide health problem. Parts of Iran, such as Mazandaran, had been known as endemic areas for goiter. IDD was accepted as a priority health problem in our country and a National IDD Council was formed in 1989. This study was performed to evaluate the National IDD Council program in 2001 among 7-10-year-old children in Mazandaran province. In this cross sectional study, 1200 children [M/F ratio=1], aged 7-10 years, were selected and grading of goiter was performed in accordance to the WHO criteria. Urinary samples were obtained from 120 children and urinary iodine was measured using digestion method. Total prevalence of goiter was 4%. The median urinary iodine was 16.5 microg/dl.82% had urinary iodine of more than 10 microg/dl, while 3.3% had urinary iodine levels of <5 microg/dl. None of the candidates has urinary iodine of less the 2 microg/dl. There was no significant difference between sexes and urban or rural areas. Results have revealed that the total prevalence of goiter has significantly decreased among children in Mazandaran province, meanwhile, urinary iodine concentration of children has reached to WHO approved rate. Thus, Mazandaran province could be classified among [iodine-deficiency-free] areas in Iran

[Evaluation of iodine sufficiency in school children of Markazi province, 2001]

Markazi province was one of the regions with endemic goiter in Iran. Following initiation of iodine deficiency control program in 1989, production, distribution and consumption of iodized salt begun. This survey was conducted in the frame work of national monitoring survey in 2001 to find the prevalence of goiter and urinary iodine level in order to evaluate the iodie status of school age children in Markazi province. 1200 school children [600 boys and 600 girls], aged 7-10 years, were selected randomly from all regions of Markazi province. The grade of Goiter was determined according to WHO classification and urinary iodine content was estimated uing the digestion method in one tenth of the tese children. Data was analyzed using T, Chi square and Pearson tests. Total Goiter rate was 4.4% [4.4% in girls and 4.4% in boys]. Urinary iodine median was 16.7 micro g/dl. Urinary iodine was above 10 micro g/dl in 81.2% and less than 5 micro g/dl in 9.2% of samples. No one had urinary iodine below 2 micro g/dl. It is concluded that the rate of Goiter in Markazi province has decreased significantly since 1986 and urinary iodine levels in school children are indicative of adequate iodine intake. Therefore Markazi province can be considered as an ''iodine deficiency free'' zone

Transition in health status in Islamic Republic of Iran

Data on transitions in health status are among the most important types of information used for promotion of health and social development. Health transition comprises two elements: demographic and epidemiologic transition. This paper depicts the health transition in I.R. Iran over the last few decades. We used demographic data gathered over the last 45 years in order to get an idea of the demographic transition. Several other sources were used to gather data on mortality and fertility patterns, occurrence of communicable and non-communicable diseases, etc to trace epidemiologic transition. Indices relating to mortality and fertility patterns have undergone marked changes parallel with rising income levels, urbanization, industrialization, and access to health care. Also notable are decreasing under-5 and maternal mortality rates, aging of the population, and a shift from communicable to non-communicable diseases. Because of the uneven rate of social development, epidemiologic transition has followed varying patterns across different regions. It is crucial that these differences be taken account of in future health programs

Epidemiology of deaths from injuries in the Islamic Republic of Iran

A 1-year study of fatal injuries was carried out in 10 provinces of the Islamic Republic of Iran based on a population of 16 740 637 in 2000-01. All reported deaths were compared and validated with other sources of death registration. Out of 66 846 deaths, 9733 [58/100 000] resulted from injuries. Overall, 14.9% of all deaths with 26.9% of years of lost life were from injuries. Most fatal injuries were unintentional [48.0/100 000]. Deaths from traffic injuries [30.0/100 000] are the highest in the world. Of 1693 intentional fatal injuries, 61% were due to suicide, at a mean age of 29 years

Effectiveness of adolescents' immunization against hepatitis B on burden of the disease in Iran

Hepatitis B is a common problem in many countries. Due to high efficacy, safety and low cost of vaccine, mass immunization has become a favorite strategy to improve population health. In this study, we tried to estimate marginal effectiveness of adolescents' immunization program in Iran. Epidemiologic data about of hepatitis B in Iran was gathered through literature review, expert opinion, existing resources of data and synthesis by modeling of other data. In a state transition model, different stages of disease were simulated in 15 to 100 year old individuals. Comparing the results of burden of hepatitis B with and without immunization revealed an estimate of avoidable burden of disease with intervention. Monte Carlo simulation and sensitivity analyses were done for uncertainty analysis of results. Immunization of around one million 15-year, old males and females prevents 2071 of male and 581 of female premature deaths due to acute hepatitis B, cirrhosis and hepatocellular carcinoma annually. Moreover, it prevents loss of about 52 and 36 percent of YLL [years of life lost] due to hepatitis B complications in males and females respectively. On average, it avoids loss of Disability Adjusted Life Years [DALY] of 0.012 and 0.006 years, according to present value of life. Monte Carlo simulation of populations showed that effectiveness of the intervention is quite significant and about half of males and one third of females with disability, equal to at least one year of full health, will be free. With sensitivity analyses, results were standing in acceptable limit of values in both bivariate and probabilistic calculations. Our study showed that effectiveness of adolescents' immunization against hepatitis B is quite significant. Calculation using basic estimates of cost of intervention program implies that this intervention is possibly very cost effective. For final judgment, results should be combined with cost effectiveness analysis, and compared to other interventions

Knowledge and practice of Iranian women toward cervical cancer

Cervical cancer is a preventable disease, However more than 500,000 cases of invasive cervical cancers can be detected yearly. It has been proven that having information about the screening tests and regular practicing of Pap smear test decreases prevalance of malignant cervical cancer and prevents related mortality. A national cross-sectional study were desinged to assess knowledge and practice of 20-46 years old married women about cervical cancer. Using cluster sampling method 10449 married women were recuited and interviwed. The study demonstrated that 60-80% of women were informed about cervical cancer. 41.6% of women had practiced Pap smear test, at least once. However 21.1% of women claimed that they practice the test more than 2 years ago. Regression model were used to indentify knowledge and practice of women toward cervical cancer. Using this model, Factors such as: educatioanl level, age residence have significant effect on their practice. For improving knowledge and practice of women toward cervical cancer, using modern educational methods can be recommended

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

Deaths from unintentional injuries in rural areas of the Islamic Republic of Iran

Deaths from accidental injury in the rural areas of 13 provinces in the Islamic Republic of Iran from 1993 to 1994 were investigated. The crude mortality rate was 4.33 per 1000 and the number of deaths from unintentional injuries was 5213 [10.7% of all deaths]. There were more deaths among males than females [65.7 per 100,000 versus 26.1 per 100,000]. After the age of 1 year, over 65-year-olds had the highest average of deaths resulting from injuries [111.9 per 100,000]. The leading causes of death were traffic accidents [55.0%], drowning [10.1%], falls [9.5%] and burns and scalding [9.5%]. Since most injuries are preventable, their reduction should be considered a priority