The vaccination coverage rate in under-5 children in Nasiriyah, Iraq before and during the COVID-19 pandemic / 한국역학회지

METHODS@#This cross-sectional study was conducted in the city of Nasiriyah in southeastern Iraq, with data collected from 79 primary healthcare facilities. This study evaluated the VCR in 3 periods (2018, 2019, and 2020) using multi-level random sampling. Pertinent data were extracted from the vaccination records of 598 children for Bacillus Calmette-Guérin (BCG); pentavalent 1, 2, and 3; measles; and activated oral poliovirus vaccine 1 and 2. Missing data were completed by telephone calls to participants’ parents. Logistic regression was applied to compare and estimate the odds ratios (ORs) with 95% confidence intervals (CIs) for the association between VCR and related factors. @*RESULTS@#The data showed the greatest decline in the studied vaccines in 2020. Among the vaccines studied, BCG had the highest rate in all 3 periods (100% VCR) and measles had the lowest rate (83.7%), reaching 63.6% in 2020 (p<0.001). The highest OR among all types of vaccine were found for the pentavalent-3 vaccine among city dwellers and those born in 2020 (OR, 2.67; 95% CI, 1.39 to 5.10 and OR, 2.34; 95% CI, 1.28 to 4.28, respectively). @*CONCLUSIONS@#The VCR for children decreased during the COVID-19 pandemic in Iraq, and new health policies are needed to increase the coverage rate. Improving the knowledge and attitudes of parents, as well as removing barriers or risk factors, can also be effective in improving the VCR.

Evaluating maternal and child health indicators for the Sustainable Development Goals in 2018: what is Iran's position? / 한국역학회지

OBJECTIVES: Since many Millennium Development Goals (MDGs) were not achieved, countries including Iran—despite achieving some of the MDGs—need regular planning to achieve the Sustainable Development Goals (SDGs) by 2030. This article examines maternal and child health indicators in the early years of the SDGs in Iran relative to several other countries.METHODS: This study was carried out through a secondary analysis of maternal and child health indicators in Iran. The results were compared with data from other countries divided into three groups: countries with upper-middle income levels, countries in the Eastern Mediterranean region, and the countries covered by the Outlook Document 1,404 (a regional classification). Then, the relationship between these indicators and the Human Development Index was investigated.RESULTS: Iran has attained better results than other countries with respect to maternal mortality, family planning, skilled birth attendance, under-5 deaths, incidence of hepatitis B, diphtheria-tetanus-pertussis vaccination coverage, and antenatal care. In contrast, Iran performed worse than other countries with respect to under-5 wasting, under-5 stunting, and care-seeking behavior for children.CONCLUSIONS: Overall, among the 11 indicators surveyed, Iran has attained better-than-average results and seems to be improving. We recommend that Iran continue interventions in the field of maternal and child health.

Evaluating maternal and child health indicators for the Sustainable Development Goals in 2018: what is Iran's position? / 한국역학회지

OBJECTIVES@#Since many Millennium Development Goals (MDGs) were not achieved, countries including Iran—despite achieving some of the MDGs—need regular planning to achieve the Sustainable Development Goals (SDGs) by 2030. This article examines maternal and child health indicators in the early years of the SDGs in Iran relative to several other countries.@*METHODS@#This study was carried out through a secondary analysis of maternal and child health indicators in Iran. The results were compared with data from other countries divided into three groups: countries with upper-middle income levels, countries in the Eastern Mediterranean region, and the countries covered by the Outlook Document 1,404 (a regional classification). Then, the relationship between these indicators and the Human Development Index was investigated.@*RESULTS@#Iran has attained better results than other countries with respect to maternal mortality, family planning, skilled birth attendance, under-5 deaths, incidence of hepatitis B, diphtheria-tetanus-pertussis vaccination coverage, and antenatal care. In contrast, Iran performed worse than other countries with respect to under-5 wasting, under-5 stunting, and care-seeking behavior for children.@*CONCLUSIONS@#Overall, among the 11 indicators surveyed, Iran has attained better-than-average results and seems to be improving. We recommend that Iran continue interventions in the field of maternal and child health.

Developing a framework for the monitoring and evaluation of the Health Transformation Plan in the Islamic Republic of Iran: lessons learned

Background: Monitoring and evaluation of health system reforms are essential to ensure the achievement of their objectives. The latest heath sector reform in the Islamic Republic of Iran, namely, the Health Transformation Plan (HTP), was launched in 2014 and the country is embarking on the HTP to achieve universal health coverage (UHC).

Aims: The study aimed to develop the most appropriate monitoring and evaluation framework for the HTP in accordance with national and global goals and priorities, and to identify data gaps in its monitoring and evaluation.

Method: A case study and evidence-based approach was applied to develop the monitoring and evaluation framework. The model that was proposed jointly by the World Bank and the World Health Organization for monitoring and evaluation of UHC was used as the basis for the potential list of the indicators and key policy documents were reviewed, accordingly. The framework formulation process was carried out through a series of meetings with experts and senior managers working at the Ministry of Health and Medical Education, whose perspectives on the frameworks functionality and usage were regarded as valuable. The final draft was presented to policy-makers for input and approval.

Results: A data mapping revealed that at least nine national surveys were required to obtain the indicators for effective monitoring. At the time of framework designing, many indicators were not available or had not been updated for several years due to lack of available and appropriate data sources.

Conclusions: Results indicated that the country’s health information system had many information gaps that should be filled to enable the tracking of UHC goals and measuring the success of the plan. Applying the proposed framework would increase the comparability of the country’s health indicators at the global level and specify a path to successfully achieve the objectives of the reform

community assessment model appropriate for the Iranian community

Community assessment is one of the core competencies for public health professionals; mainly because it gives them a better understanding of the strengths and drawbacks of their jurisdictions. We planned to recognize an appropriate model that provides a conceptual framework for the Iranian community. This study was conducted in Tehran, during 2009-2010 and consisted of two parts: a review of the literature and qualitative interview with selected experts as well as focus group discussion with health field staff. These steps were done to develop a conceptual framework: planning for a steering committee, forming a working committee, re-viewing community assessment models and projects, preparing the proposed model draft, in-depth interview and focused group discussions with national experts, finalizing the draft, and preparing the final model. Three different models published and applied routinely in different contexts. The 2008 North Carolina Community Assessment model was used as a reference. Ten national and 18 international projects were compared to the reference and one and six projects were completely compatible with this model, respectively. Our final proposed model takes communities through eight steps to complete a collaborative community assessment: form a community assessment team, solicit community participation and gain inter-sectoral collaboration, establish a working committee, empower the community, collect and analyze community's primary and secondary statistics, solicit community input to select health priorities, evaluate the community assessment and develop the community assessment document, an develop the community action plans

Excess mortality during heat waves, Tehran Iran: an ecological time-series study

In the past three decades, Tehran, capital of Iran, has experienced warmer summers so we need to determine heat-related mortality to establish appropriate public health activities during hot summers. The aim of this study was to detect heat waves during the last decades and then determine excess mortality in immediate and lagged times. An ecological study based on time-series model was conducted in Tehran for re-cent decade using generalized linear lagged model [GLLM] with Poisson regression in 2001-2011. Maximum daily temperature was heat exposure for death outcome on the same day [lag 0], 3 [lag 01] and also 7 [lag 02] day moving average. Relative risk with 95% confidence was reported to quantify for increasing of daily mortalities for 1[degree sign]C risen exposure. Air pollutants considered as confounders in final model. Total excess mortality during 17 heat waves was 1069 [8.9 deaths/Heat wave days]. All non-external cause of death increased significantly during heat waves [3%-9%] with [RR= 1.03, 95% CI: 1.01, 1.05 and RR=1.09, 95% CI: 1.07, 1.09] and after adjusting for ozone and PM10 raised. Cause-specific deaths [especially circulatory disease] and death among elderly increased during heat waves [especially in the hottest wave]. The largest positive lagged effect of hot temperature although seen during hottest waves for all mortalities. Three waves had the most harvest effect for all categories of mortalities. This study showed excess mortalities resulted from hot temperatures and exacerbated with air pollutants in Tehran in the context of climate change. Forward displacement mortality and lagged mortalities were seen, but our results were not conclusive about the displacement pattern of mortalities

Prevalence of anemia and correlated factors in the reproductive age women in rural areas of Tabas

To find out the prevalence and relationship of anemia in reproductive age women in rural area of Tabas, center of Iran. Iron deficiency anemia is the most common nutritional problem, affecting about 41.8% of pregnant and 30.2% of non-pregnant women worldwide. A cross-sectional study was conducted on the random sample of 382 reproductive age women in rural areas of Tabas in March 2010. Independent sample t-test, one way analysis of variance [ANOVA] and logistic regression were applied for the data analysis. The obtained data revealed a total response rate of 13.8% for prevalence of anemia, while 14.5% and 5.9% belonged to non-pregnant and pregnant participants, respectively. Low socioeconomic status [odds ratio 3.35] and high parity index [odds ratio 2.31] were associated with higher prevalence of anemia. Although this study was conducted in a rural area of Tabas, where their average incomes were lower than average income of major cities in Iran, the prevalence of anemia was lower than the rate reported in previous studies carried out in other locations of Iran, even in high risk [pregnant women] groups

Higher education initiatives for disaster and emergency health in Iran

Iran's health system is expanding the disaster and emergency higher education programs over the country to enhance the capacity of human resources for effective and efficient disaster mitigation, preparedness, response and recovery. In this article we present an overview about the initiatives and progress of disaster and emergency health higher education in Iran. Following the Bam earthquake, in collaboration with the Ministry of Health and Medical Education and National Institute of Health Research, School of Public Health at the Tehran University of Medical Sciences, Iran took the initiative to develop a Master of Public Health [MPH] with disaster concentration in 2006, a PhD in disaster and emergency health in 2011, and a well constructed certificate course in 2008 entitled Disaster Health Management and Risk Reduction [DHMR]. Iran, Kerman and Shahid Beheshti Universities of Medical Sciences and University of Social Welfare and Rehabilitation are other academia that joined this initiative. Regarding the importance of programs evaluation, we have planned for a comprehensive evaluation of MPH and DHMR programs in 2013-4 and the Accreditation and Evaluation Board of Disaster and Emergency Health, based in MOH and ME, is responsible for evaluation of the PhD program in 3-5 years from initiation

Thematic analysis of Iranian female adolescents' perceptions about HIV/AIDS: a qualitative study

HIV/AIDS continues to be a major global health problem. The aim of this study was to evaluate common opinions and beliefs about HIV/AIDS among Iranian teenager girls. This Qualitative study [face-to-face interviews with tape recording] was conducted among fifty female teenager school students inUrmia-Iran. The thematic analysis indicated the main information sources for HIV/AIDS among teenage girls to be their mother and teachers. The participants had little concern about the dissemination of HIV/AIDS in Iran. Using a common syringe is mentioned as the main risk factor for HIV transmission. There were some misconceptions about the at-risk group among teenage girls. Considering the misconceptions among the teenage girls, their beliefs should be reformed and reorganized in order to reduce the risk of exposure to HIV. The best practice is training life skills in the school level

Important risk factors of mortality among children aged 1-59 months in rural areas of Shahroud, Iran: a community-based nested case-control study

The aim of the study was to evaluate potential risk factors of children mortality between 1-59 months of age. This nested case-control study was conducted among children born from June 1999 to March 2009 in rural areas of Shahroud, located in the central region of Iran using health care visit reports and follow-up data available in household health records. Mortality was significantly associated with breastfeeding duration [OR: 0.87, 95% CI: 0.81-0.93], total health care visits [OR: 0.90, 95% CI: 0.83-0.98] and low birth weight [LBW] [OR: 7.38, 95% CI: 1.37-39.67]. In our study, a longer breastfeeding period and more frequent health care visits were two important protective factors, while LBW was an important risk factor for 1-59 month child mortality. It seems, that complex and multiple factors may be involved in mortality of under 5-year-old children, so combined efforts would be necessary to improve child health indicators

Evaluation and cost analysis of national health policy of Thalassaemia screening in west-Azerbaijan province of Iran

Thalassaemia is one of the most common Mendelian disorders in Mediterranean area. Iran has about 26,000 Thalassaemic patients, so it is one of the most affected countries. The aim of this study was to evaluate the screening program and cost analysis of Thalassaemia prevention program in West-Azerbaijan province of Iran. This study evaluated the efficacy of Health system's Thalassaemia prevention program with a sensitivity analysis for its costs. The second five years of the program was evaluated. The economic burden of Thalassaemia is determined by the birth prevalence of the affected infants and the cost that is accrued to treat the infected individuals and was compared with the total cost of screening the couples for thalassemia trait. The average incidence rate of major Thalassaemia was 19.8 per 100,000 live births and mean coverage rate of program was 74%. The rate of canceling the marriage among carrier couples was 53%. Cost analysis showed that the cost of screening and prenatal diagnosis program was much lower than the cost of treatment in potential thalassaemic patients. The prevention program of Thalassaemia including a premarital and pre-natal screening in west Azerbaijan province is demonstrated to be cost-effective. Taking some actions in order to increase the coverage of pre-marital screening, providing prenatal diagnosis in private and public sector, complete insurance coverage for the high-risk couples to perform the investigations more easily, were recommended