Health system-related barriers to prenatal care management in low- and middle-income countries: a systematic review of the qualitative literature.

BACKGROUND: Appropriate prenatal care (PNC) is essential for improving maternal and infant health; nevertheless, millions of women in low- and middle-income countries (LMICs) do not receive it properly. The objective of this review is to identify and summarize the qualitative studies that report on health system-related barriers in PNC management in LMICs. METHODS: This systematic review was conducted in 2022. A range of electronic databases including PubMed, Web of Knowledge, CINHAL, SCOPUS, Embase, and Science Direct were searched for qualitative studies conducted in LMICs. The reference lists of eligible studies also were hand searched. The studies that reported health system-related barrier of PNC management from the perspectives of PNC stakeholders were considered for inclusion. Study quality assessment was performed applying the Critical Appraisal Skills Programme (CASP) checklist, and thematic analyses performed. RESULTS: Of the 32 included studies, 25 (78%) were published either in or after 2013. The total population sample included 1677 participants including 629 pregnant women, 122 mothers, 240 healthcare providers, 54 key informed, 164 women of childbearing age, 380 community members, and 88 participants from other groups (such as male partners and relatives). Of 32 studies meeting inclusion criteria, four major themes emerged: (1) healthcare provider-related issues; (2) service delivery issues; (3) inaccessible PNC; and (4) poor PNC infrastructure. CONCLUSION: This systematic review provided essential findings regarding PNC barriers in LMICs to help inform the development of effective PNC strategies and public policy programs.

A Systematic Review and Meta-Analysis of the Prevalence of Malnutrition Among 6-14-Year-Old Children in Iran.

Background: Malnutrition is a major public health issue worldwide. It has significant consequences, including weakened immune systems, which may lead to increased incidences of infectious disease and higher mortality, particularly in children. A systematic review and meta-analysis were conducted to estimate the overall prevalence of malnutrition (wasting, underweight, and stunting) among children of 6-14 years of age in Iran. Methods: Data were collected in 2018 based on searches of the PubMed, Science Direct, Scopus, Google Scholar, Science Information Database (SID), Magiran, Irandoc, and Iranmedex databases using the following keywords: childhood, childhood malnutrition, children, nutrition, malnutrition, wasting, underweight, stunting, child, student, boy, girl, cause, prevalence, and Iran, in order to identify studies eligible for inclusion in the review. Comprehensive Meta-Analysis, version 2 (CMA: 2) was used to estimate the overall prevalence of malnutrition. Results: Nine out of 328 articles were included in our analyses. The overall of wasting among children of 6-14 years of age in Iran based on the random-effects model (according to nine studies and 18,296 participants) was 12.5% (95% Confidence Interval, 7.1-21.2). The overall prevalence of underweight based on the random-effects model (according to 10 studies and 19,185 participants) was 19% (95% CI, 8.1-38.6). Also, the overall prevalence of stunting based on the random-effects model (according to 10 studies and 19,185 participants) was 20% (95% CI, 9.4-37.8). Conclusions: The results of this study show that the prevalence of malnutrition among 6-14-year-old children in Iran is similar to the global average. We need solutions that can be used for both prevention and reduction of malnutrition, especially in areas with middle or low socioeconomic status. It is necessary to identify factors associated with malnutrition in various geographic regions in order to implement appropriate programs based on factors with the highest impact in each region.

Developing a hospital accreditation model: a Delphi study.

BACKGROUND: Hospital accreditation (HA) is an external evaluation of a hospital's structures, processes and results by an independent professional accreditation body using pre-established optimum standards. The Iranian hospital accreditation system faces several challenges. The overall aim of this study was to develop a model for Iran national hospital accreditation program. METHODS: This research uses the modified Delphi technique to develop and verify a model of hospital accreditation. The first draft of the HA model was introduced through a critical review of 20 pioneer accreditation models and semi-structured interviews with 151 key informants from Public, private, semi-public, charity and military hospitals in Iran. Three rounds of Delphi were conducted with 28 experts of hospital accreditation to verify the proposed model. Panel members were selected from authors of research articles and key speakers in the area of hospital accreditation, senior managers of the country's health system, university professors in the fields of health policy and management across the country. RESULTS: A comprehensive model for hospital accreditation was introduced and verified in this study. The HA model has ten constructs of which seven are enablers ("Management and leadership", "Planning", "Education and Research", "employee management", "patient management", "resource management", and "process management") and three are the results ("employee results", "patient and society results" and "hospital results"). These constructs were further broken into 43 sub-constructs. The enablers and results scored 65 and 35% of the model's total scores respectively. Then, about 150 accreditation standards were written and verified. CONCLUSIONS: A comprehensive hospital accreditation model was developed and verified. Proper attention to structures, processes and outcomes and systemic thinking during the development of the model is one of the advantages of the hospital accreditation model developed in this study. Hospital accreditation bodies can use this model to develop or revise their hospital accreditation models.

Challenges of routine diabetes care during COVID-19 era: A systematic search and narrative review.

BACKGROUND: The world is facing the current COVID-19 pandemic. The pandemic response is affecting routine health care provision all over the world. We aimed to review the relevant literature and highlight challenges in the provision of routine care for patients with diabetes during the COVID-19 outbreak. METHODS: We systematically searched PubMed, ScienceDirect, and Embase databases up till August 13, 2020 and retrieved relevant articles published on difficulties on routine diabetes management during the COVID-19 pandemic. RESULTS: Through our reading of the recent literature discussing the difficulties of routine healthcare provision for patients with diabetes amid the COVID-19 pandemic, we have identified nine themes as follows: lockdown of standard outpatient clinics, decreased inpatient capacity, staff shortage, medicine shortage, unaffordable medicine, delayed care seeking, limited self-care practice, transport difficulties, and undiagnosed cases/events. CONCLUSION: Diabetes management during lockdown is particularly challenging. This review specified a summary of difficulties of diabetes care during COVID-19 pandemic. Healthcare policy makers as well as healthcare providers could take advantage of the results of this review to mitigate the adverse effect of the crisis on provision of routine care for diabetes as well as other chronic conditions.

Iran hospital accreditation standards: challenges and solutions.

OBJECTIVE: The purpose of this study was to identify the challenges of Iranian hospital accreditation standards and provide solutions. DESIGN: A qualitative research design was used in this study. Open and semi-structured interviews were conducted in 2018. Thematic analysis was used to analyse qualitative data. SETTING: Public, private, semi-public, charity and military hospitals in Tehran, Iran. PARTICIPANTS: A pluralistic evaluation approach was employed and 151 participants including policy makers, hospital management and staff, accreditation surveyors and university professors participated in this study. RESULTS: Challenges of hospital accreditation standards were grouped into two groups: standards development process and standards content. Lack of an independent standards development committee, insufficient expertise of committee members, inconsistencies among the standards' constructs, inappropriate standard classification, ambiguity of standards, unmeasurable standards, vague and inflexible scoring system, and inability to use some standards were the main challenges of Iran hospital accreditation standards. Establishing a scientific committee consisting of representative from hospitals, health insurance companies, professional and scientific associations and universities for standard development, training the committee members, and utilizing hospital's feedback will help address these problems. CONCLUSION: Iran's hospital accreditation standards face challenges that prevent them from achieving their goals, that is, improving the quality, safety, effectiveness and efficiency of hospital services. Necessary measures should be taken to solve these problems.