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.

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 objec-tives. 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 eval-uation 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.

Contexte : Le suivi et l’évaluation des réformes des systèmes de santé sont essentiels pour garantir la bonne réalisation des objectifs que celles-ci se sont fixés. La dernière réforme du système de santé en République islamique d’Iran, appelée Plan de transformation sanitaire, a été lancée en 2014. La République islamique d’Iran a commencé à mettre en œuvre ce plan en vue de réaliser la couverture sanitaire universelle (CSU).Objectifs : La présente étude avait pour objectif d’élaborer un plan d’action de suivi et d’évaluation du Plan de transformation sanitaire le plus approprié qui soit, conformément aux priorités et aux objectifs mondiaux et nationaux, ainsi que d’identifier les lacunes à combler en matière de données concernant ce processus de suivi et d’évaluation.Méthodes : Une étude de cas et une approche reposant sur des bases factuelles ont été appliquées pour le cadre susmentionné. Le modèle proposé par la Banque mondiale et l’Organisation mondiale de la Santé (OMS) pour le suivi et l’évaluation de la couverture sanitaire universelle (CSU) a été utilisé pour servir de base à une liste possible d’indicateurs. Des documents d’orientation clés ont ainsi été passés en revue. Le processus de formulation du cadre d’action a été mené au moyen d’une série de réunions entre experts et hauts responsables travaillant dans différents départements du ministère de la Santé et de l’Éducation médicale dont les perspectives sur la fonctionnalité et l’utilisation du cadre d’action étaient considérées comme utiles. Le projet final a été présenté aux responsables de l’élaboration des politiques en vue d’obtenir leurs contributions et leur approbation.Résultats : Une cartographie des données a révélé qu’au moins neuf études nationales étaient requises pour obtenir les indicateurs permettant un suivi efficace. À l’étape de la conception du cadre d’action, de nombreux indicateurs n’étaient pas disponibles ou n’avaient pas été mis à jour depuis plusieurs années du fait de l’absence de source de données fiables.Conclusions : Les résultats ont indiqué que le système d’information sanitaire du pays comportait de nombreuses lacunes nécessitant d’être comblées afin de permettre d’évaluer les progrès effectués sur la voie de la réalisation des objectifs de la CSU et d’appréhender la réussite du plan. La mise en œuvre du cadre d’action proposé permettrait d’augmenter la comparabilité des indicateurs sanitaires du pays au niveau mondial et de préciser la voie à emprunter pour atteindre les objectifs annoncés dans la réforme.

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.