Primary health care and immunisation in Iran.

The Primary Health Care (PHC) network of Iran consists of a rural and an urban branch. While the rural branch presently covers a sizeable portion of the rural population, the urban PHC project is in its early stages of implementation. The Expanded Programme on Immunisation (EPI) in Iran, which started as an independent and vertical project in early 1983, is being gradually integrated into the PHC network as the latter expands. Results of the second PHC programme review of Iran shows that immunisation coverage of children has improved appreciably since the first PHC review, especially for BCG which stands at 56.3%. Complete immunisation at first birthday in the rural areas with the PHC services is 44.1%, whereas for urban areas other than Teheran it is 28.1%. While the high coverage in the rural areas is attributed to the 'active' approach and vigilance of the providers of immunisation (i.e. the community health workers and the vaccinators of the mobile teams), the higher coverage in the capital city of Teheran is attributed to the involvement of private paediatricians and the generally higher social, economic, and educational status as well as higher interest of mothers. It is noticed that the results of cluster sampling for determination of immunisation coverage in large metropolitan areas of the developing world must be interpreted with much care. The reason is that in these areas extreme fluctuations in the crude birth rate are common and therefore results tend to over-represent the attributes of the segment of population with lower birth rate. It is also argued that complete immunisation might not be the best indicator for assessing the progress of the immunisation efforts. These and other findings are discussed in detail. are discussed in detail.

PIP: Childhood immunization in Iran was assessed by a WHO EPI (World Health Organization, Expanded Program on Immunization) cluster survey method covering 2118 children aged 12-23 months in 1987. Complete immunization was defined as a minimum of 3 DPT (diphtheria, pertussis, tetanus), 3 OPV (oral polio vaccine), 1 BCG (Bacillus Calmette-Guerin), and 1 live attenuated measles vaccine by age 1 year. Iran's Primary Health Care system consists of a rural branch operated by mobile male and female teams, and an urban branch still in the process of changing from cure-oriented care to emphasis on health education, nutrition, and maternal-child health services. Complete immunization coverage by age 1 was better in rural areas, 44.1%, than in urban areas, 28.2%, and Teheran 34.9%. There was no relationship between immunization coverage and infant mortality rate, which is dominated by diarrhea. The reason for better coverage in rural areas is that village workers actively search out, visit and immunize children, while in urban areas provide physicians dominate care, but do not insist on immunization. Furthermore, in Teheran, BCG is not routinely given, which lowered the overall immunization coverage rate there.