RESUMEN
In Iran, diarrheal disease is the fourth cause of under five year mortality. Proper care seeking behavior and system based disease management in the national field will have a great effect in reducing morbidity and mortality. This nationwide study was performed on a target population of rural and urban communities; in all 31 provinces of the Islamic Republic of Iran. One lakh three thousand three hundred and thirty one [103331] families were sampled by multi stage stratified random sampling and were interviewed with a standard data collection form. The collected data was entered into the Stata 8.0 software and analyzed by the survey analysis method. Of the 14625 [10.1%] children who were reported to have diarrheal diseases two weeks prior to the interview, 8.8% were cured and 1.5% were not. About 70% of them had at least one visit for health seeking the most of patients were seen by a rural health worker [Behvarz] in the rural and by a general pediatrician in the urban areas. About 62% of the patients in urban and 57% in the rural areas had been treated with antibiotics and these rates for ORS were 51% and 65%, respectively. The factors most related to a care seeking pattern were the level of routine preventive well child care, number of siblings, child age, and living area. According to this national survey, our health system needs to integrate all the levels of prevention, especially the Integrated Management of Child Illnesses [IMCI] programs with a family physician project. Futher more, there is a great need for empowering the referral system and gate keeping in all referral levels, to make efficient national integrated programs
RESUMEN
It is propounded that febrile neonates with low risk criteria [LRC] can be carefully observed without parenteral antimicrobial therapy; but yet, reliability of LRC to exclude serious bacterial infection [SBI] is uncertain. The records of all febrile term neonates, seen in the emergency room and admitted in neonatal ward of 17 Shahrivar children's hospital of Rasht, Iran from January 2004 to January 2009 were reviewed. All of them underwent full sepsis workup. The prevalence of SBI in total population and LRC positive and negative neonates were calculated A total of 202 records of previously healthy febrile neonates were evaluated. SBI was shown in 38 [18.8%]. The most common type of SBI was urinary tract infection [UTI]. Sixty-two [31%] neonates had LRC, and only one [1.6%] had SBI [UTI with E. coli]. SBI was significantly more common in neonates without LRC [26.6% versus 1.6%, P<0.001]. The negative predictive value [NPV] of LRC to exclude SBI was 98.4% [95% confidence interval: 96.7% to 100%]. These findings suggest that LRC may be relied upon to exclude SBI in febrile neonates. We propose that all febrile neonates be admitted, ill or LRC negative neonates should undergo a full sepsis work up and be administered systemic antibiotics immediately. LRC positive neonates should be under close observation