eHealth tools to assess the neurological function for research, in absence of the neurologist - a systematic review, part I (software).

BACKGROUND: Neurological disorders remain a worldwide concern due to their increasing prevalence and mortality, combined with the lack of available treatment, in most cases. Exploring protective and risk factors associated with the development of neurological disorders will allow for improving prevention strategies. However, ascertaining neurological outcomes in population-based studies can be both complex and costly. The application of eHealth tools in research may contribute to lowering the costs and increase accessibility. The aim of this systematic review is to map existing eHealth tools assessing neurological signs and/or symptoms for epidemiological research. METHODS: Four search engines (PubMed, Web of Science, Scopus & EBSCOHost) were used to retrieve articles on the development, validation, or implementation of eHealth tools to assess neurological signs and/or symptoms. The clinical and technical properties of the software tools were summarised. Due to high numbers, only software tools are presented here. FINDINGS: A total of 42 tools were retrieved. These captured signs and/or symptoms belonging to four neurological domains: cognitive function, motor function, cranial nerves, and gait and coordination. An additional fifth category of composite tools was added. Most of the tools were available in English and were developed for smartphone device, with the remaining tools being available as web-based platforms. Less than half of the captured tools were fully validated, and only approximately half were still active at the time of data collection. INTERPRETATION: The identified tools often presented limitations either due to language barriers or lack of proper validation. Maintenance and durability of most tools were low. The present mapping exercise offers a detailed guide for epidemiologists to identify the most appropriate eHealth tool for their research. FUNDING: The current study was funded by a PhD position at the University of Groningen. No additional funding was acquired.

Clinical and Socio-Demographic Variables Associated With Long COVID-19: A Cross-Sectional Study.

Considering the importance of long COVID-19 (LC), this study aimed to investigate the relationship between clinical/sociodemographic factors and LC symptoms (LCS). This online cross-sectional study was conducted on 308 people infected with COVID-19 in Alborz, Iran, from April 1 to June 1, 2022. Multivariable logistic regression models were applied to measure the association between the LCS with other variables. Overall, 76.6% of participants had at least one LCS. Results from the multivariate logistic regression analysis showed that females (crude odds ratio [OR] [95% confidence interval (CI)]: 2.725 [1.42, 5.22]), educated persons (3.747 [1.58, 8.84]), people with a higher number of COVID-19 reinfection (2.280 [1.30, 3.97]), having an underlying disease (1.996 [1.01, 3.93]), and COVID-19 severity (3.321 [1.037, 10.635]) had higher odds of LC than others (all p < .05). Study findings provide additional clinical/sociodemographic data on risk for LC. These data may inform future research and clinical practice for potential risk identification and early intervention.

The effect of social determinants of health on quality of life among Afghan refugees in Iran during the COVID-19 pandemic: a path analysis.

BACKGROUND: The COVID-19 pandemic has created significant challenges in 2020 in the world and Iran. To help vulnerable groups such as refugees during the response and recovery phases of the COVID-19 pandemic, identifying the quality of life (QOL) and its associated factors is helpful. Considering that research in this field is limited, this study evaluated the effect of social determinants of health on the quality of life among Afghan refugees in Iran during the COVID-19 pandemic. METHODS: We conducted a cross-sectional study on 300 Afghan refugees and migrants in Alborz province, Iran, from February to May 2022 using Convenience sampling. Data were completed using the socioeconomic status scale (SES), World Health Organization's quality of life -BREF (WHOQOL), Depression, Anxiety and Stress Scale-21 Items (DASS-21), and COVID-19 Post-Traumatic Stress Disorder Checklist (COVID-PTSD). In addition, path analysis was applied to evaluate the relationships among the research variables with quality of life. RESULTS: 64.3% of the study participants were male, with a mean of 29.29 ± 9.64 years. The path analysis showed that SES had the most positive relationship (B = .266), and the number of COVID-19 cases had the most negative relationship (B = -.169) with the quality of life from both paths. The self-rated health had the most positive relationship (B = .25), and the DASS score had the most negative relationship (B = -.2) with the quality of life through only one path. Access to medical services was the only variable that indirectly had a positive causal relationship with QOL (B = .044). CONCLUSION: We provided an empirical model that illustrates the relationships between quality of life and social determinants of health among Afghan refugees and migrants during the Covid19 pandemic. The negative emotional states of Depression, Anxiety, and Stress (DAS) as a mediator play an essential role in the quality of life and other variables.

eHealth tools to assess neurological function: a systematic review protocol for a mapping exercise.

INTRODUCTION: Population-based epidemiological studies investigating risk/protective factors are outlining prevention strategies for neurological conditions that often do not have effective treatment. However, ascertaining neurological outcomes can be a time consuming and expensive process, often requiring specialised personnel and/or equipment. Thus, collecting neurological data on a large scale has been an ongoing challenge for clinicians and researchers alike. The development of new technology and the emergence of several opportunities to adapt it to the health research and practice (eHealth) can be a promising solution to this problem. Several neurological eHealth tools have been developed, with many others being currently planned. METHODS AND ANALYSIS: We propose a systematic review mapping the available eHealth tools for assessing the different aspects of neurological function. The search aims at identifying studies published in peer-reviewed journals, which focused on the development or implementation of eHealth for assessing neurological signs or symptoms. Four engine databases are being considered (PubMed, EBSCOhost, Web of Science and Scopus), and data extraction will follow a process aimed at classifying them by their characteristics and purposes. ETHICS AND DISSEMINATION: This mapping exercise will be made available to researchers in order to aid them in successfully ascertaining neurological outcomes in large population-based epidemiological studies. Given the nature of this study, no ethical clearance was needed to conduct the review.

Climate Change and Respiratory Diseases: Relationship between SARS and Climatic Parameters and Impact of Climate Change on the Geographical Distribution of SARS in Iran.

Climate change affects human health, and severe acute respiratory syndrome (SARS) incidence is one of the health impacts of climate change. This study is a retrospective cohort study. Data have been collected from the Iranian Ministry of Health and Medical Education between 17 February 2016 and17 February 2018. The Neural Network Model has been used to predict SARS infection. Based on the results of the multivariate Poisson regression and the analysis of the coexistence of the variables, the minimum daily temperature was positively associated with the risk of SARS in men and women. The risk of SARS has increased in women and men with increasing daily rainfall. According to the result, by changes in bioclimatic parameters, the number of SARS patients will be increased in cities of Iran. Our study has shown a significant relationship between SARS and the climatic variables by the type of climate and gender. The estimates suggest that hospital admissions for climate-related respiratory diseases in Iran will increase by 36% from 2020 to 2050. This study demonstrates one of the health impacts of climate change. Policymakers can control the risks of climate change by mitigation and adaptation strategists.

A Safe Home? A Qualitative Study into the Experiences of Adolescents Growing Up in the Dutch Area Impacted by Earthquakes Induced by Gas Extraction.

For decades, the Netherlands has experienced minor earthquakes due to gas extraction. This study aims to obtain insight into the experiences of adolescents and the impact of these earthquakes on their well-being and living environment. Focus groups were held with 24 adolescents, and interviews were held with 3 adolescents (N = 27; M = 15 years). Through qualitative analysis, we identified six themes. The adolescents shared experiences of anxiety related to the earthquakes and their consequences and considered these to be a normal part of their life. Anxiety and feelings of endangerment not only related to their own experiences but were also connected to the impact of earthquakes on their social environment, such as the restoration of buildings. Several sources of support (e.g., talking, social cohesion) were mentioned to deal with the negative consequences of the earthquakes. A lack of trust in the government was an additional main theme, with adolescents mentioning several needs, potentially relevant to policymakers in the Netherlands. Growing up in the gas extraction area of Groningen had many consequences on the adolescents in the study, who felt inhibited from expressing feelings of anxiety and fear. To support their needs, interventions at the individual, family, educational, societal, and policy levels are recommended.

Disaster Risk Reduction in Iranian Primary and Secondary School Textbooks: A Content Analysis.

OBJECTIVE: School textbooks have a significant role in transferring knowledge to the students and changing their behavior. This work aims to analyze school textbooks to find the representation of natural hazards in Iran, which is vital for supporting children in disaster situations. METHODS: In this study, a qualitative content analysis was used. Data were analyzed qualitatively by using MAXQDA 2018 software. For the 2019-2020 school year, 300 Iranian school textbooks in Persian language were collected. RESULTS: Findings of this work show that students receive information about disaster risk reduction (DRR) education through the primary and secondary grade levels in all 12 grades. The educational content covers various types of natural hazards, including geophysical, hydrological, climatological, meteorological, and biological disasters. In addition, the textbooks contain discussions about local hazards, causes and effects of disasters, and the disaster management cycle. CONCLUSIONS: The coverage of DRR and the relevant contents in school textbooks reveals that the discourse of natural hazards is important for Iranian authorities, especially in the education system. This study helps decision-makers and practitioners design more effective interventions to prepare children for disasters.

Psychosocial Safety Climate of Employees During the COVID-19 Pandemic in Iran: A Policy Analysis.

OBJECTIVE: Iran is among the top 15 countries in the world in terms of coronavirus disease (COVID-19) infection rates. The numbers of infections and deaths are still increasing in September 2020. This study aims to investigate the impact of the policies on terminating the quarantine period on the perception of psychosocial safety by employees and workers in Iran. METHODS: In this study, policy announcements and regulations, media reports, and the results were collected from 2 previously published population surveys that collected employees' views of the government approach to quarantine. The information thus collected was then analyzed using the "What is the Problem Represented (WPR)" approach for data analysis introduced by Carol Bacchi, and focuses on the question, "What effects are produced by the representation of the problem?" RESULTS: The Iranian Government decided to quarantine people and close most sectors during the New Year holidays in Iran in March 2020. The duration of quarantine was only 2 weeks, and the government then ordered government organizations and industrial companies to reopen. The advantage of a short quarantine period is assumed to be the reinstatement of productivity while the disadvantage is the likely risk of further transmission of the virus. CONCLUSION: The government approach to and communication about the quarantine period has neglected to consider the psychosocial safety climate of employees, who have to go to their workplaces using buses, subways, or other vehicles, and who are under pressure mentally because of fear of infection, dismissal for non-attendance, and the consequent economic problems. The government approach necessarily impacts on the perceived psychosocial safety climate of employees, and hence influences the causes of work stress. If the psychosocial safety climate is not considered and improved, it may reduce the quality of services and products, and increase accidents.

School-Based Education Programs for Preparing Children for Natural Hazards: A Systematic Review.

Schools have a significant role in disaster education to children. This study investigates the research works about school-based education programs in order to discover challenges and best practices. We conducted a systematic review of English language papers published in peer-review journals.The search identified 2577 publications and 61 articles meeting selection criteria and included in the review. Reviewed studies indicated that disaster education in schools is effective but yet insufficient in many countries. Lack of equipment, financial resources, policy gaps, and teachers' knowledge are common problems in programs. Main outcomes of this systematic review are showing methods used for health emergency preparedness of children of different ages and gender differences in school-based disaster preparedness, as well as the difference in their lifesaving skills in disasters.This study shows that some disaster education programs reported in the papers reviewed were not high-quality enough, which may lead to insufficient preparedness of children in disasters and consequently may put their health at risk, considering the increasing number of natural hazards.

Mobile applications for prematurity: a systematic review protocol.

Background: Premature birth is a global epidemic of significant public health concern. Counselling and education of pregnant women at risk of preterm birth or mothers with premature infants are essential to improve mother and infant health. Mobile applications are an increasingly popular tool among parents to receive health information and education. This study aims to evaluate the usages and the effects of a mobile application designed for premature births in order to improve health outcomes. Methods: This review will include all studies of different designs which evaluated the use and impact of interventions provided via mobile applications on pregnant women at risk of preterm birth or mothers with premature infants in order to address all health outcomes. A combination of keywords and MeSH(Medical Subject Headings) terms is used in the search strategy. Literature databases including Scopus, PubMed, ISI Web of Science, ProQuest, CINAHL and Cochrane Library will be searched to May 2021. Furthermore, eligible studies will be chosen from the reference list of retrieved papers. Two researchers will independently review the retrieved citations to decide whether they meet the inclusion criteria. Mixed Methods Appraisal Tool (MMAT) V.2018 will be used to assess the quality of studies. Relevant data are collected in a data extraction form and analysed. Results are reported under the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Discussion: This systematic review will recognize and combine evidence about the usages and impact of mobile application interventions on the health improvement of pregnant women at risk of preterm birth or mothers with premature infants.

A Survey of implementation status of child nutrition surveillance systems, registry systems and information systems: a scoping literature review protocol.

Introduction: Child malnutrition in all forms is known globally as the leading cause of poor health. Planning and solving this challenge require sources that collect data accurately. Nutrition surveillance systems (NSS), nutrition registry systems (NRS) and nutrition information systems (NIS) collect and analyse data on nutrition status. Unfortunately, these systems only exist in a few countries. The methods that these systems use significantly differ and their effectiveness is also scarcely researched. This scoping literature review aimed to conduct a survey on NSS, NRS and NIS that collect data on children's nutrition at national and international levels, along with their attributes. Methods and analysis: The methods and analyses of this scoping review follow the Arksey and O'Malley's methodology. This scoping literature review will be conducted in five stages based on this method. (1) The main research question and subquestions are identified. (2) Relevant studies are extracted. In this step, we will search electronic databases including PubMed, Scopus and ISI Web of Science. A manual search will also be performed in Google Scholar, grey literature, and the websites of organisations such as WHO, UNICEF, Centers for Disease Control and Prevention, National Health Service, International Food Policy Research Institute, Food and Agriculture Organization, Food and Nutrition Technical Assistance, United Nations World Food Programme, and United Nations System Standing Committee on Nutrition. (3) Extracted studies are separately reviewed by two reviewers based on inclusion and exclusion criteria, and eligible studies are then selected. A third reviewer resolves disagreements. (4) A checklist is developed to extract the features. Data of included systems are separately extracted and entered into a checklist by two reviewers. A third reviewer then resolves any disagreement. (5) Data are summarised and analysed and are presented in tables and figures. Discussion: This scoping literature review provides strong evidence of the status of systems that collect data on the status of child nutrition. This evidence can help select best practices which can be applied to develop future systems. It can also be a positive step towards achieving an integrated system.

Efficiency of COVID-19 Testing Centers in Iran: A Data Envelopment Analysis Approach.

OBJECTIVE: The purpose of this study is to investigate the efficiency of the Iranian Red Crescent Society (IRCS) in managing their nonmonetary resources involved in coronavirus disease 2019 (COVID-19) response. METHODS: For this purpose, the data envelopment analysis approach was used to measure the efficiency, considering the number of personnel and vehicles and screened passengers as the input and output parameters, respectively. It was examined the efficiency of 10 IRCS's branches given 17 d of screening operation. For the analysis, the DEA SolverPro software 15a version was used. RESULTS: The results show that only 1 branch had been fully efficient in using the resources, while 5 branches showed less than 50% efficiency. This study reveals that it is unnecessary to use a fixed number of volunteers at different stations with different passenger numbers. CONCLUSIONS: Using resources without efficient planning can lead to direct costs such as food, transportation, and maintenance, as well as indirect costs such as burnout, fatigue, and stress when responding to the COVID-19 pandemic. This analysis should support IRCS's managers to move their valuable resources from inefficient to efficient centers to increase the screening rate and reduce the fatigue of aid workers for the next pandemic rounds.

Rapid Assessment of COVID-19 Screening Program for Travelers in Iran: A Qualitative Study.

OBJECTIVE: Coronavirus disease 2019 (COVID-19) screening stations set up by Iranian Red Crescent Society have been available for 17 d with the aim of identifying and treating people with coronavirus, reducing road trips, and sensitizing people to the problem. This study aims to investigate the challenges of the procedure. METHODS: A qualitative study was used to find the challenges of the COVID-19 screening centers. Volunteers, branch managers, and headquarter managers of the Iranian Red Crescent Society participated in this study applying snowball sampling. Data were collected by means of in-depth semi-structured telephone interviews in April 2020 after completion of the fever screening plan. All interviews were recorded and transcribed verbatim, always with prior permission of interviewees. RESULTS: The interviews with 20 participants in the plan indicated 6 relevant challenges, including logistics, lack of planning, lack of coordination, legal challenges, mental health, and ethical challenges. CONCLUSIONS: The results indicated that, although establishing fever detection centers in Iran was a rapid response to COVID-19, it had significant flaws in the structure and adversely affected volunteers' and staff's health and financial resources. Therefore, well-structured protocols are required for similar responses in the future.

Child Abuse in Natural Disasters and Conflicts: A Systematic Review.

Violence against children affects a significant portion of youth around the world. Emergencies and natural disasters escalate the risk due to weakened child protection systems and disruption of preventative mechanisms. In this systematic review, 692 related papers were searched in various databases in the initial search. After review, 11 papers were finally selected for full review. These papers were selected based on publication date, relevance to emergencies, their geographical area type of violence, age of subjects, and their gender. Most families affected by natural disasters, especially those in lower socioeconomic status, face greater social and economic pressures. The families that are more vulnerable to loss of food and shelter commit violence against children more frequently. On the other hand, while the rate of violence increases in emergencies, the reported rate of violence is less than the actual rate due to lack of required infrastructure and reporting mechanisms. The emergency housing increased risk of some types of child abuse. The history of exposure to violence, parental substance abuse, poverty, and child labor were predictors of increased violence against children in emergency situations. Sexual violence against girls after conflicts and physical violence against boys after emergencies are common forms of violence. Poverty as another predictor exposes children to more violence due to limited family economic resources and support. Given the identified predictors of violence, humanitarian organizations can come closer to providing appropriate plans to reduce the risk during and postdisaster.

Qualitative content analysis as a research method to investigate hazards information in school textbooks.

This study explains how qualitative content analysis was applied to investigate natural hazards in textbooks for children with intellectual disabilities in Iran. Qualitative content analysis of textbooks is one of the ways for understanding the priorities of Iranian education system with regard to natural hazards. Data samples included whole textbooks for children with intellectual disabilities in all grades during school year 2020-2021 in Iran. Data were collected by transferring textbooks to MAXQDA 2018 software and coding themes with the software. A narrative format was used for analyzing qualitative data. Examples were presented along with tables and quotations in the study. Peer checking and expert check were employed to ensure trustworthiness of the study. The above research design showed the strengths and weaknesses of information provided in Iranian textbooks on natural hazards and disasters management. Iran is a disaster-prone country and various natural hazards happen in Iran every year including earthquake, flood, drought, and extreme weather. Children are a vulnerable population in disasters. One of the most important issues for children's health is disaster preparedness. Intersection of age with other social determinants such as disability, gender, and ethnicity can increase vulnerability. This method was recommended to researchers investigating representation of natural hazards in textbooks of children in different countries, grades, and textbooks. Furthermore, it is possible to use this method for a comparative analysis of information in two or more countries, or different school years in a country.•Explicit and implicit information on natural hazards in textbooks could be investigated with qualitative content analysis.•This method could facilitate cross-country comparisons by providing a framework to investigate the content of textbooks for children without disabilities and/or with disabilities.•It is a valuable method for evaluation of disaster programs for children in local, national, and global levels.

Public-Private-People Partnerships (4P) for Improving the Response to COVID-19 in Iran.

The Public-Private-People partnership (4P) is a significant element in disaster response. Coronavirus disease (COVID-19) as a pandemic has been the worst disaster in the last decades in Iran in terms of exposure and magnitude. In order to respond effectively, the Iranian Government needs an extra capacity, which may be provided by the private sector and people. This study aims to collect evidences of 4P pertaining to the COVID-19 response in Iran from February to April 2020. Partnership case studies are classified into 3 categories: (1) Public-private partnerships; (2) public-people partnerships; and (3) private-people partnerships. It was found that the Iranian Government has removed or diminished some of the barriers to cooperation. There was also more cooperation between the people, the private sector, and the public sector than during normal times (vs disasters). People participated in the response procedure through some associations or groups, such as religious and ethnic communities, as well as through non-governmental organizations. It has been shown that 4P is vital in disaster response and, in particular, to epidemics. The government can be more active in partnerships with the private sector and people in emergencies, such as the COVID-19 pandemic. Enhancing social capital, institutionalization, and developing required infrastructures by the government will improve public-private partnerships.

Students' preparedness for disasters in schools: a systematic review protocol.

INTRODUCTION: Children are one of the most vulnerable groups in disasters. Improving students' knowledge and skills to prepare for disasters can play a major role in children's health. School as a place to teach children can make a significant contribution to provide the necessary skills. This study aims to identify the effects, strengths and weaknesses of interventions in schools to prepare children for disasters. METHODS AND ANALYSIS: We use Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to develop a protocol for this systematic review. The included studies will report on the results of interventions targeting 'schoolchildren' defined as individuals between 4 and under 18 years old studying in schools. Different electronic databases will be used for a comprehensive literature search, including MEDLINE, Web of Science, CINAHL, PsycINFO, Cochrane Register of Controlled Trials and EMBASE to identify the records that match the mentioned inclusion criteria published till December 2020. The main search terms are 'disaster', 'preparedness', 'children' and 'school'. Four types of data will be extracted from the qualified studies including study characteristics (study design, year of publication and geographical region where the study was conducted), participant characteristics (sample size, age and gender), intervention characteristics (aim of intervention, intervention facilitators and barriers) and intervention outcomes. The quality appraisal of the selected papers will be conducted using Cochrane Collaboration's Risk of Bias for quantitative studies and Critical Appraisal Skills Programme checklist for qualitative studies. We use a narrative synthesis for this systematic review. The narrative synthesis refers to an approach to systematic reviews which focuses mostly on applying words and texts to summarise and explain findings. ETHICS AND DISSEMINATION: This paper is a part of a Ph.D. thesis of Hamed Seddighi at University of Social welfare and Rehabilitation Sciences with ethics code IR.USWR.REC.1399.008 approved by the Ethics Committee of the above-mentioned university. PROSPERO REGISTRATION NUMBER: CRD42020146536.

How much the Iranian government spent on disasters in the last 100 years? A critical policy analysis.

BACKGROUND: During the past 20 years, Iran has been experiencing a significant increase in the occurrence of disasters mainly due to the emergence of anthropogenic climate change. This paper aims at analyzing the trend of national budget allocation in Iran over the last 100 years to evaluate the focus of the Iranian state on the four phases of Preparedness, Mitigation, Response, and Recovery and propose modifications. METHODS: It is used a critical policy analysis with what's the problem represented approach. In this approach is focused on problematization and policy gaps. The most important policy statement in any government is the budget. During the first screening, 1028 regulations and laws were found from 1910 to 2020. After full text screening, 494 regulations and laws related to budget allocation to disasters were analyzed. RESULTS: The Iranian government has spent around 29 billion USD on disasters during the last 100 years. Droughts, earthquake and flood have costs the government more than other disasters, accounting for more than 14, 6.9, and 6.1 billion USD, respectively, in the allocated budget. Most of the Iranian government expenditure during the last 100 years on various disasters such as drought, flood, earthquake, and COVID-19 has been spent on involuntary costs including Response and Recovery. Mitigation and Preparedness are the two critical disaster management phases with very small shares of national budgeting. CONCLUSIONS: From policy audit and policy gaps it is concluded that Iranian governments during last 100 years, problematized the issue of "disasters strike" and not "disasters' risks". In time of disasters, governments tried to solve the issues or impacts of disasters with budgeting to response and recovery. Nevertheless, disasters' prevention or mitigation or preparedness was not a problem for Iranian governments from 1920 to 2020.

Preparing children for climate-related disasters.

Climate-related disasters affect different dimensions of children's health and well-being both directly and indirectly. Reducing children's vulnerability and exposure to climate-related disasters is crucial to protect them against risks. Children as climate-change agents and future leaders at local, national and international level can obviously contribute to reduce vulnerabilities in families and communities and transfer knowledge to them. Moreover, children can advocate for climate change mitigation. In the long term, participation of children in the climate change mitigation programmes may lead to fewer disasters and, consequently, less risk to their health. As government policies have failed to fully address and respond to the drivers of climate-related disasters, disasters preparedness and education for children should be considered an essential activity to protect children from disaster's risks. Main factors in shaping children's behaviour and response to disaster are increasing the risk perception and knowledge of the children. When a child perceived likelihood, susceptibility and severity of a disaster (such as earthquake), then they would be able and willing to learn how to prepare for that. So far, disaster education programmes for children have mostly relied on offline school-based training. Different innovative approaches can be applied to continue education within online and digital formats including virtual reality, digital games and online platforms. However, an advocacy support by influential entities such as companies engaged in entertainment industry is required to raise the awareness of public and particularly the children about disaster preparedness.

Health systems efficiency in Eastern Mediterranean Region: a data envelopment analysis.

BACKGROUND: One of the most important issues in public policy and welfare state is health care. Poor management leads to the waste of resources, including money, human resources, facilities, and equipment. AIMS: This paper seeks to answer the question of which eastern Mediterranean countries are more effective in allocating their health resources, and does Iran, in relation to those countries, have an effective health system. METHODS: This study examined technical efficiency among eastern Mediterranean countries in 2018. Data were extracted from Global Health Observatory data World Health Organization. We applied input-oriented Data Envelopment Analysis (DEA) models to estimate efficiency scores. Inputs are Physicians density per 10,000 populations, Total hospital beds per 10,000 populations, Current expenditure on health, % of gross domestic product and outputs are infant survival rate and Life expectancy. RESULTS: The most efficient health systems in the eastern Mediterranean were Bahrain, Egypt, Iran, Lebanon, Morocco, Oman, Pakistan, Qatar, Tunisia and the United Arab Emirates. The inefficient countries are Iraq, Jordan, Kuwait, Libya, Palestine and Saudi Arabia. CONCLUSIONS: Among the efficient countries, one category of high-entry countries such as Bahrain and Qatar with high input especially in health expenditure had higher output. The second group of countries with lower inputs such as Iran and Morocco has been able to produce similar output with other countries. Also, inefficiency in countries such as Saudi Arabia can be attributed to this with higher input such as health expenditure has lower output such life expectancy and infant survival rate.