Efficiency of Iranian Hospitals Before and After Health Sector Evolution Plan: A Systematic Review and Meta-Analysis Study.

Purpose: Aging, chronic diseases, and development of expensive and advanced technologies has increased hospitals costs which have necessitated their efficiency in utilization of resources. This systematic review and meta-analysis study has assessed the efficiency of Iranian hospitals before and after the 2011 Health Sector Evolution Plan (HSEP). Methods: Internal and external databases were searched using specified keywords without considering time limitations. The retrieved articles were entered into EndNote considering inclusion and exclusion criteria, and the final analysis was performed after removing duplicates. Heterogeneity between the studies was assessed using Q and I2 tests. A forest plot with 95% confidence intervals (CI) was used to calculate different types of efficiency. The data were analyzed using STATA 14. Results: Random pooled estimation of hospitals technical, managerial, and scale efficiencies were 0.84 (95%CI = 0.78, 0.52), 0.9 (95%CI = 0.85, 0.94), and 0.88 (95%CI = 0.84, 0.91), respectively. Sub-group analysis on the basis of study year (before and after HSEP in 2011) indicated that random pool estimation of technical (0.86), managerial (0.91), and scale (0.90) efficiencies of Iranian hospitals for 2011 and before were better than technical (0.78), managerial (0.86), and scale (0.74) efficiencies after 2011. Conclusion: Type of hospital ownership was effective on hospital efficiency. However, HSEP has not improved hospital efficiency, so it is necessary for future national plans to consider all aspects.

Clinical Characteristics and Reproduction Number of Coronavirus Disease (COVID-19) Cases in Markazi Province in Iran.

BACKGROUND: The first case of Coronavirus Disease (COVID-19) was reported in Iran on February 19, 2020. This study aimed to assess the characteristics and reproduction number (R) of COVID-19 in Markazi province in Iran. METHODS: This is a cross-sectional study. Confirmed cases (N=2430) in the regions covered by Arak University of Medical Sciences from Feb 20 to Aug 26, 2020 were enrolled in the study. The included variables were clinical and demographic characteristics of COVID-19 patients. The case fatality rate (CFR), incidence rates, and R were estimated based on the daily reported data. For estimating R, generation time was assumed on multi scenarios. R was estimated by R0-package. Moreover, Chi square test was applied. All the analyses were performed in STATA, Excel, ArcMap and R. A p-value less than 0.05 was considered as statistically significant. CONCLUSION: As R is slightly high, the risk of epidemic has reduced gradually. However, observing social distance and related guidelines are still recommended.

Knowledge, Attitudes, and Practices Toward Coronavirus Disease 2019 in the Central Area of Iran: A Population-Based Study.

Background: The spread of the coronavirus disease 2019 (COVID-19) pandemic has imposed high threats on global health, life and work style, and social and economic development. The current study aimed to extract knowledge, attitudes, and practices related to COVID-19 among the general population in the central area of Iran. Method: A cross-sectional study was conducted in Arak City between April and May 2020. Stratified random sampling was applied to select the study participants. Phone interview was applied to collect the data. Data were collected using a questionnaire that was constructed and validated in this study. The questionnaire included demographic variables and items about knowledge, attitudes, and practices toward COVID-19. Descriptive and inferential analyses were conducted in STATA software. Results: In total, 544 participants completed the questionnaire; 76% of the participants accounted COVID-19 as a high threat 1 month from the onset of COVID-19. From the maximum attainable scores of 1, 6, and 6, for COVID-19-related knowledge, attitudes, and practices, means of 0.77 (0.13), 4.97 (0.63), and 5.35 (0.70) were obtained, respectively. Females had a higher practice score (5.4 ± 0.6). The participants with a family history of heart and respiratory diseases had significantly higher attitude and practice scores. SMS from the Ministry of Health had a significant impact on knowledge, attitude, and practice scores (p < 0.05). Conclusion: Higher attention should be given to increase the knowledge, attitudes, and practices of men and the housewife group. COVID-19 preventive messaging from the Ministry of Health was among the most influential methods of increasing knowledge that attracted public attention.

World one-hundred days after COVID-19 outbreak: Incidence, case fatality rate, and trend.

BACKGROUND: The prevalence of viral diseases is on the rise and has caused many problems for public health. COVID-19 is a new viral outbreak in the world. This study aimed to investigate the trends of incidence and case fatality rate (CFR) of COVID-19 in the world by April 30, 2020. METHODS: This was a descriptive-analytical study. We investigated the number of cases and deaths in 35 selected countries and regions of the WHO that had at least 10,000 cases by the time of the study. In addition, the incidence and CFR of COVID-19 were investigated. Finally, time trends of the number of cases, deaths, and CFR were investigated using ordinary least squares regression models. RESULTS: The total number of confirmed cases of COVID-19 was 3,090,184. The European region had the highest number of COVID-19 patients (1,434,649 [46.43%]). Ukraine with 10,406 and the USA with 1,003,974 cases have reported the lowest and highest confirmed cases, respectively. In addition, the European region and the African region with 157.13 and 2.50 patients per 100,000 population had the highest and the lowest incidence rate, respectively. India (2.44) and Spain (455.69) had the lowest and the highest incidence rate per 100,000 population, respectively. In the world, 217,759 deaths have happened, of which 135,961 (62.44%) were reported in the European region. Furthermore, the USA had the highest number of deaths (52,428) due to COVID-19. CFR was 7.05% in the world, which ranged from 3.74% in the African region and 9.48% in the European region. The number of patients and deaths due to COVID-19 had increasing trends in all countries, and the trend of CFR just for Iran and Ukraine was negative. CONCLUSION: The countries had different trends in the morbidity and mortality of COVID-19. However, regarding the increasing trend of the disease in the world, it will be more important to rely on public prevention strategies. It is necessary to apply and continue public health policies at national and global levels till the control of the disease.