Measuring universal health coverage to ensure continuing care for older people: a scoping review with specific implications for the Iranian context

Background: To measure progress towards universal health coverage (UHC) in the context of ageing, it is necessary to develop suitable monitoring frameworks. The global UHC monitoring framework is focused on priorities for younger populations and does not adequately address issues relevant to ageing populations. Aims: This study aims to propose a framework to measure UHC in a way that is relevant to health systems responding to population ageing. Methods: Based on a search strategy focusing on measures of UHC in relation to older people’s care, we searched electronic databases and screened the records to qualitatively analyse the data. We also conducted 2 rounds of expert panel consultations to discuss the findings and examine the feasibility of the recommended indicators using the case of the Islamic Republic of Iran as an example. Results: We identified main themes and classified core indicators under each theme. Besides 25 indicators for quality of care, there were 22 indicators for financial protection. Ten indicators were retrieved measuring coverage and access to long-term care. Some indicators were excluded owing to limited data availability or absence of related programmes and some alternate indicators were proposed. Conclusions: We identified several indicators which could be used to measure progress toward UHC in the context of population ageing. However, not all of these indicators are feasible in context of low- and middle-income countries. This study could offer useful general guidance on how to define the exact set of measures in a specific country context.

Effects of Air Pollution on Public and Private Health Expenditures in Iran: A Time Series Study (1972-2014) / 예방의학회지

OBJECTIVES: Environmental pollution is a negative consequence of the development process, and many countries are grappling with this phenomenon. As a developing country, Iran is not exempt from this rule, and Iran pays huge expenditures for the consequences of pollution. The aim of this study was to analyze the long- and short-run impact of air pollution, along with other health indicators, on private and public health expenditures. METHODS: This study was an applied and developmental study. Autoregressive distributed lag estimating models were used for the period of 1972 to 2014. In order to determine the co-integration between health expenditures and the infant mortality rate, fertility rate, per capita income, and pollution, we used the Wald test in Microfit version 4.1. We then used Eviews version 8 to evaluate the stationarity of the variables and to estimate the long- and short-run relationships. RESULTS: Long-run air pollution had a positive and significant effect on health expenditures, so that a 1.00% increase in the index of carbon dioxide led to an increase of 3.32% and 1.16% in public and private health expenditures, respectively. Air pollution also had a greater impact on health expenditures in the long term than in the short term. CONCLUSIONS: The findings of this study indicate that among the factors affecting health expenditures, environmental quality and contaminants played the most important role. Therefore, in order to reduce the financial burden of health expenditures in Iran, it is essential to reduce air pollution by enacting and implementing laws that protect the environment.

Cost of Tuberculosis Treatment: Evidence from Iran’s Health System

OBJECTIVES: This study aimed to estimate the cost of smear-positive drug-susceptible pulmonary tuberculosis (TB) treatment of the patients in the Azadshahr district, Golestan Province, Iran. METHODS: In this retrospective study, all new smear positive pulmonary TB patients who had been registered at the district’s health network between April, 2013 and December, 2015 and had successfully completed their treatment were entered into the study (45 patients). Treatment costs were estimated from the provider’s perspective using an activity-based costing (ABC) method. RESULTS: The cost of treating a new smear-positive pulmonary TB patient was US dollar (USD) 1,409.00 (Iranian Rial, 39,438,260), which can be divided into direct and indirect costs (USD 1,226.00 [87%] and USD 183.00 [13%], respectively). The highest cost (58.1%) was related to care and management of TB patients (including 46.1% human resources costs and 12% directly-observed treatment, short course implementation) and then respectively related to hospitalization (12.1%), supportive activity centers (11.4%), transportation (6.5%), medicines (5.3%), and laboratory tests and radiography (3.2%). CONCLUSION: Using disease-specific cost studies can help the healthcare system management to have correct insight into the financial burden created by the disease. This can subsequently be used in prioritization, planning, operational budgeting, economic evaluation of programs, interventions, and ultimately in disease management.

The impact of disease characteristics on multiple sclerosis patients' quality of life / 한국역학회지

OBJECTIVES: The aim of this study was to assess the quality of life (QoL) of patients with multiple sclerosis (MS), and to investigate the effects of characteristics of MS such as disease course, severity, and relapses on patients' QoL. METHODS: This was a cross-sectional study, in which 171 patients were enrolled. Health-related QoL was assessed using the Persian version of the Multiple Sclerosis Quality of Life-54 questionnaire. To measure patients' disability status, we used the Expanded Disability Status Scale. Other variables included in the study were disease course and relapses of the disease. RESULTS: The average scores for patients' physical and mental QoL were 60.9±22.3 and 59.5±21.4, respectively. In a bivariate analysis, disease course, severity of the disease, and relapses were significantly associated with the physical and mental health composite scores. In a hierarchal regression analysis, disease course, severity of the disease, and relapses were responsible for 38 and 16% of the variance in physical and mental QoL, respectively. It was also observed that relapses were a strong predictor of both physical and mental QoL. CONCLUSIONS: Our results showed that disease characteristics significantly affected both dimensions of QoL. It is therefore suggested that health care providers should be aware of these characteristics of MS to more successfully improve MS patients' QoL.

The impact of disease characteristics on multiple sclerosis patients' quality of life / 한국역학회지

OBJECTIVES: The aim of this study was to assess the quality of life (QoL) of patients with multiple sclerosis (MS), and to investigate the effects of characteristics of MS such as disease course, severity, and relapses on patients' QoL.METHODS: This was a cross-sectional study, in which 171 patients were enrolled. Health-related QoL was assessed using the Persian version of the Multiple Sclerosis Quality of Life-54 questionnaire. To measure patients' disability status, we used the Expanded Disability Status Scale. Other variables included in the study were disease course and relapses of the disease.RESULTS: The average scores for patients' physical and mental QoL were 60.9±22.3 and 59.5±21.4, respectively. In a bivariate analysis, disease course, severity of the disease, and relapses were significantly associated with the physical and mental health composite scores. In a hierarchal regression analysis, disease course, severity of the disease, and relapses were responsible for 38 and 16% of the variance in physical and mental QoL, respectively. It was also observed that relapses were a strong predictor of both physical and mental QoL.CONCLUSIONS: Our results showed that disease characteristics significantly affected both dimensions of QoL. It is therefore suggested that health care providers should be aware of these characteristics of MS to more successfully improve MS patients' QoL.

Socioeconomic Inequality in Malnutrition in Under-5 Children in Iran: Evidence From the Multiple Indicator Demographic and Health Survey, 2010 / 예방의학회지

OBJECTIVES: The aim of this study was to assess the socioeconomic inequality in malnutrition in under-5 children in Iran in order to help policymakers reduce such inequality. METHODS: Data on 8443 under-5 children were extracted from the Iran Multiple Indicator Demographic and Health Survey. The wealth index was used as proxy for socioeconomic status. Socioeconomic inequality in stunting, underweight, and wasting was calculated using the concentration index. The concentration index was calculated for the whole sample, as well as for subcategories defined in terms of categories such as area of residence (urban and rural) and the sex of children. RESULTS: Stunting was observed to be more prevalent than underweight or wasting. The results of the concentration index at the national level, as well as in rural and urban areas and in terms of children's sex, showed that inequality in stunting and underweight was statistically significant and that children in the lower quintiles were more malnourished. The wasting index was not sensitive to socioeconomic status, and its concentration index value was not statistically significant. CONCLUSIONS: This study showed that it can be misleading to assess the mean levels of malnutrition at the national level without knowledge of the distribution of malnutrition among socioeconomic groups. Significant socioeconomic inequalities in stunting and underweight were observed at the national level and in both urban and rural areas. Regarding the influence of nutrition on the health and economic well-being of preschool-aged children, it is necessary for the government to focus on taking targeted measures to reduce malnutrition and to focus on poorer groups within society who bear a greater burden of malnutrition.

Dietary predictors of childhood obesity in a representative sample of children in north east of Iran / 中国当代儿科杂志

<p><b>OBJECTIVE</b>The prevalence of obesity is increasing in Iranian youngsters. This study aimed to assess some dietary determinants of obesity in a representative sample of children in Neishabour, a city in northeastern, Iran.</p><p><b>METHODS</b>This case-control study was conducted among 114 school students, aged 6-12 years, with a body mass index (BMI) ≥95th (based on percentile of Iranian children) as the case group and 102 age- and gender-matched controls, who were selected from their non-obese classmates. Nutrient intake data were collected by trained nutritionists by using two 24-hour-dietary recalls through maternal interviews in the presence of their child. A food frequency questionnaire was used for detecting the snack consumption patterns. Statistical analysis was done using univariate and multivariate logistic regression (MLR) by SPSS version 16.</p><p><b>RESULTS</b>In univariate logistic regression, total energy, protein, carbohydrate, fat (including saturated, mono- and poly-unsaturated fat), and dietary fiber were the positive predictors of obesity in studied children. The estimated crude ORs for frequency of corn-based extruded snacks, carbonated beverages, potato chips, fast foods, and chocolate consumption were statistically significant. After MLR analysis, the association of obesity remained significant with energy intake (OR = 2.489, 95%CI: 1.667-3.716), frequency of corn-based extruded snacks (OR = 1.122, 95%CI: 1.007-1.250), and potato chips (OR = 1.143, 95%CI:1.024-1.276). The MLR analysis showed that dietary fiber (OR = 0.601, 95%CI: 0.368-0.983) and natural fruit juice intake (OR = 0.909, 95%CI: 0.835-0.988) were protective factors against obesity.</p><p><b>CONCLUSIONS</b>The findings serve to confirm the role of an unhealthy diet, notably calorie-dense snacks, in childhood obesity. Healthy dietary habits, such as the consumption of high-fiber foods, should be encouraged among children.</p>