Iranian Health System Response to the COVID-19 Pandemic.

Introduction: The COVID-19 pandemic has created several challenges for countries all over the world. Different countries have taken different measures to fight this pandemic and reduce its challenges depending on their cultural, economic, and social structures. This study aims to understand and explain the Iranian health system's response to fighting the COVID-19 pandemic from the managers' and authorities' perspective. Method: This study is a basic applied research performed under a qualitative approach. In the survey, 30 experts including the managers of health centers and deputies and heads of the Ministry of Health and Medical Education and Medical Universities were selected by purposive snowball sampling and participated in semi-structured interviews from March to May 2020. The researchers explained the actions of the Iranian health system in fighting the COVID-19 pandemic in 2020 by content analysis. Results: As a result, 14 subthemes were found and classified into four major themes, including the informative and regulative actions (two subthemes), administrative and supportive actions (six subthemes), preventive and curative actions (three subthemes), and resource-related actions (three subthemes). Conclusions: Due to its strong health structures, such as urban and rural health networks, various general and specialized hospitals, experienced doctors, and committed health staff, Iran has taken practical actions in fighting the COVID-19 pandemic. However, the findings of this study and its relevant measures can help combat this pandemic in countries with similar social and cultural structures or counter future similar crises.

Explaining the challenges of the Iranian Health System in fighting the COVID-19 pandemic: A Qualitative Study.

Introduction: The COVID-19 pandemic has become a global threat for the general public and health care workers, and it has created major challenges for all healthcare sectors. The challenges created by this disease can vary in different countries depending on cultural, social, and economic factors. The purpose of this study was to explain the challenges of the Iranian health system in fighting the COVID-19 pandemic from the managers' and executive authorities' viewpoints. Methods: The present study was a basic-applied research performed using a qualitative approach. It has studied 30 hospitals and medical centers' managers, deputies of the Ministry of Health, and the universities of medical sciences, which were selected by purposive and snowball sampling with the maximum variety in March-September 2020. Data collection was done through semi-structured interviews and content analysis was used to explain the challenges of the Iranian health system in fighting the COVID-19 pandemic (2020). Results: Most of the interviewees (34%) had a Ph.D. degree, and 40% of the participants were graduated in management and health economy and policymaking fields. Analysis and synthesis of the data collected from the interviews led to the creation of 19 sub-themes and 12 main themes classified into four general scopes: organizational factors, resources, management factors, and other factors. Conclusion: Identifying the mentioned challenges can provide helpful information for the managers and policy-makers to develop appropriate plans, take the necessary measures to resolve the challenges, and use the available resources to provide the most effective services.

Low birth weight in Iran: Implications from a systematic review of the literature and meta-analysis in the period 1999-2017.

Background: Low birth weight (LBW), a crucial determinant of neonatal complications, represents a major public health concern worldwide. Epidemiological research is of crucial importance for designing and implementing ad hoc interventions for this issue, helping and guiding decision- and policy-makers in each country to prevent the increased prevalence of LBW in infants through estimating the prevalence rate, identifying and controlling major risk factors. The present investigation aimed to systematically assess LBW prevalence rate in Iran and its determinants. Methods: PubMed/Medline via Ovid, Embase, Web of Science and Scopus as well as Magiran, SID and Irandoc were searched from inception until November 2016. Also, the grey literature (via Google Scholar) was mined. The DerSimonian-Laird model was exploited. The I2 and Q-test tests were used to investigate heterogeneity between the studies. Sensitivity and subgroup analyses were performed to ensure the robustness and validity of our findings. Different cumulative meta-analyses were conducted stratifying according to the year of publication and sample size. Any potential bias in publication was assessed carrying out the Egger's test. Results: LBW prevalence rate was estimated to be 8% (95%CI: 7-9) in Iran. Sensitivity analysis confirmed the stability of finding. Studies were cumulated by the year of publication, and the results did not change pre- and post-cumulative meta-analysis. No publication bias could be observed. Conclusion: LBW prevalence rate in Iran is well comparable with the prevalence figures of both developed and developing countries. This could be due to the health reforms implemented in Iran throughout the years.

Prevalence of nosocomial infections in Iran: A systematic review and meta-analysis.

Background: Nosocomial infections represent a serious public health concern worldwide, and, especially, in developing countries where, due to financial constraints, it is difficult to control infections. This study aimed to review and assess the prevalence of nosocomial infections in Iran. Methods: Different databases were searched between January 2000 and December 2017. To determine the pooled prevalence, the stochastic DerSimonian-Laird model was used, computing the effect size with its 95% confidence interval. To examine the heterogeneity among studies, the I2 test were conducted. The reporting of observational studies in epidemiology (STROBE) checklist was used to assess the methodological quality of observational studies. To further investigate the source of heterogeneity, meta-regression analyses stratified by publication year, sample size and duration of hospitalization in the hospital were carried out. Results: 52 studies were included. Based on the random-effects model, the overall prevalence of nosocomial infection in Iran was 4.5% [95% CI: 3.5 to 5.7] with a high, statistically significant heterogeneity (I2=99.82%). A sensitivity analysis was performed to ensure the stability results. After removing each study, results did not change. A cumulative meta-analysis of the included studies was performed based on year of publication and the results did not change. In the present study, a high rate of infections caused by Klebsiella pneumoniae (urinary tract, respiratory tract, and bloodstream infections) was found. Conclusion: Preventing and reducing hospital infections can significantly impact on reducing mortality and health-related costs. Implementing ad hoc programs, such as training healthcare staff on admission to the hospital, may play an important role in reducing infections spreading.

Prevalence of depression in cardiovascular patients in Iran: A systematic review and meta-analysis from 2000 to 2017.

BACKGROUND: In both developed and developing countries, cardiovascular disease is on the rise, representing nowadays one of the main challenges for the health systems worldwide. This increase generates relevant costs. The aim of this study was to conduct a systematic and meta-analytical review of the prevalence of depression in cardiovascular patients in Iran. METHODS: Articles written in English and Persian were searched from January 2000 to July 2017 in different scholarly databases. RESULTS: 12 studies were retained and included in the current meta-analysis. Selected studies were published between 2008 and 2016. The number of patients participating in these studies was 9292. Based on the random-effects model, the prevalence of depression in cardiovascular patients in Iran was 47% [95% confidence interval or CI 38-56], I2=98.2% with P = 0.000. The relative risk (RR) of depression in cardiovascular patients yielded a value of 1.30 [95%CI 1.05-1.62] with P < 0.001. Women are more at risk for depression than men. CONCLUSION: The current meta-analysis estimated the prevalence of depression among cardiovascular patients in Iran. The prevalence found computed by the present study is higher than the figures found in developed countries. Depression with cardiovascular disease causes many problems for these patients, and early diagnosis and treatment significantly helps in improving quality of life, as well as saving costs and resources.

Depression among Iranian nurses: A systematic review and meta-analysis.

Background: Depression is one of the most commonly diagnosed mental disorders. Nurses and other hospital service providers are a group at high risk for developing depression. Thus, knowing the prevalence of depression among nurses can help the health care decisionmakers to plan ad hoc prevention programs to control depression in this group. This study was conducted to quantitatively assess the prevalence of depression in nurses by performing a systematic review and meta-analysis. Methods: ISI/Web of Science (WoS), PubMed/MEDLINE via Ovid, PsychInfo, and Embase, as well as Iranian databases such as Irandoc, SID, and Magiran were searched from January 2000 to March 2017. To calculate the pooled prevalence rate, the random effects model based on the DerSimonian-Laird approach was used. I2 and the Q tests were used to examine heterogeneity among studies. To investigate the causes and sources of heterogeneity, the impact of such variables as quality, sample size, geographic region, and criteria used to diagnose depression was analyzed performing subgroup analyses. The quality of reviewed studies was assessed according to the 22-item STROBE checklist. Sensitivity analysis was performed to investigate the stability and robustness of the obtained results. All data were analyzed using the "meta" package included in the R Software Version 3.4.0. Results: A total of 30 studies were retained in the current investigation. The overall prevalence of depression was 22% [95%CI 19- 27] among nurses, with a high statistically significant heterogeneity (I2= 94% and Q-test= 479.87). Conclusion: This rate was higher than the prevalence of depression among the general population in Iran. Presence of happy nurses with good mental state at hospitals is essential for promoting the care provided to patients.