Epidemiology of animal bite in Iran: A Systematic review and meta-analysis.

Background: Despite a lot of efforts made in the rabies health-care system, Iran is still in an endemic region and millions are spent annually to prevent rabies. Materials and Methods: Searching in national and international databases has been performed. The preferred reporting items for systematic reviews and meta-analyses protocol were followed. To assess heterogeneity, the I-index was calculated. In addition, sensitivity analysis was performed by the remove-one method. The publication bias was also investigated by Egger's regression test, and the trim and fill method. To perform a meta-analysis, CMA version 2 software was used. Results: Totally, 33 studies with 250,980 animal-bite cases were meta-analyzed. A summary estimate of the incidence of 1200 per 100,000 population (95% CI 1000, 1500) with a mean age of 29.97±15.13years (95%CI: 29.33, 30.61) was estimated. The rate in men was higher 76.7% (95%CI 74.7%, 78.8%) than in women and in the rural 49.7% (95%CI: 42.8%, 58.6%) was equal in the urban. Most bites occurred in the spring and summer 20.5% (95%CI: 16.1%, 25.9%). The highest of job-related bites was in students 20.1% (95%CI: 19%, 23%). The highest rate of bite location and the animal type were estimated in the order of lower limbs and by dogs respectively. The rate of complete vaccination 61% (95%CI: 43%, 76%) and immunoglobulin injection 39% (95%CI: 22%, 59%), were estimated respectively. Conclusion: Estimates reveal that there has been little change in the animal bites over the years. It is necessary to take special actions to control the disease at the national and international levels.

Recruitment and selection of community health workers in Iran; a thematic analysis.

BACKGROUND: In Iran, community health workers (CHWs) are selected and employed according to the instructions of the Ministry of Health (MOH). The present study aimed to investigate the views of different stakeholders regarding the selection criteria, as well as the competency of CHWs. METHODS: This study was conducted using a qualitative thematic analysis in Golestan Province, Iran. Data were collected using semi-structured interviews with managers, supervisors, CHWs, and common people in 2021. The interviews were recorded and then transcribed. To extract key themes, the six-step Brown model was used, which involved becoming acquainted with the data, meaningful organization of transcripts, extracting primary open codes, searching for themes in an iterative approach, theme extraction, defining themes, and preparing a report. The relationships between codes and sub-themes and themes were represented using ATLAS.ti version 8. RESULTS: Data saturation was achieved after interviewing 22 people. The extracted data included 340 open codes, two main sub-themes of "CHW effectiveness" and "CHW sustainability", and three main themes of "criteria for employing competent people", "barriers to employing competent people", and "identifying the barriers to employing competent people", according to the MOH instructions. CONCLUSION: In the present study, local hiring was one of the major challenges in the competency-based selection of CHWs. One of the most repeated codes was expanding the local hiring concept and its requirements. Since different regions of Iran have different climatic, economic, cultural, and social conditions, the selection and hiring criteria for CHWs should be tailored to the needs of the community.

Effect of the jigsaw technique as a cooperative learning approach on motivation and job performance of community health workers: A quasi-experimental study.

BACKGROUND: In Iran, community health workers (CHWs) are native and are only employed in the health-care system. Therefore, the training and empowerment of these staff are essential. The present study was aimed to develop cooperative learning techniques in CHWs to improve both cognitive and noncognitive aspects such as accountability and other social skills in learners. METHODOLOGY: This study employed a quasi-experimental pre- and post-test design with a control group that was conducted in Kangavar City, Iran, in 2019. Forty-four CHWs were selected using a two-stage cluster sampling, of whom 22 were randomly assigned to the experimental group where the jigsaw technique was applied and the rest to the control group where the lecture method was applied. The aim was to identify job performance and motivation among the CHWs after instruction and compare the two groups. Pre- and posttests were applied to the groups before and after an in-service training course using valid questionnaires. Data analysis was performed on both descriptive and inferential statistics such as mean and standard deviation, paired t-test, and covariance analysis with the confidence level of 95%. RESULTS: The findings showed that the intervention significantly increased the mean score of motivation and performance in the experimental group. Covariance analysis with the removal of the pretest effect was also statistically significant (P = 0.01). Moreover, the MANCOVA test showed the jigsaw technique effect considering motivation and performance with a confidence level of 95%. CONCLUSION: Given the well-known effect of cooperative learning techniques and since CHWs have multi roles and tasks, it is necessary to use such techniques so that they can be accountable for developing health indicators in local areas.

Rethinking interdisciplinarity: Proposing a multilayered model.

Background: One of the efforts that solve complex real-world problems is to use an interdisciplinary approach. However, the contradictions among different disciplines and the absence of a theoretical model add to the difficulty of interdisciplinary activities. When interdisciplinary researchers face a complex problem, they need to integrate several different disciplines. It seems the first step in interdisciplinary activities is to have a theoretical model to understand and examine by what content and method the processes of integrating and crossing the disciplinary boundaries are done. The purpose of this study is to propose a new theoretical model for interdisciplinary development. It also show that a multilayered model can be formed based on the boundaries of scientific disciplines. Methods: In this study, the critical review strategy of Carnwell and Daly has been used to synthesize the theoretical model using online databases. The method consists of 5 stages: defining the scope of the review, identifying the sources of relevant information, reviewing the literature, writing the review, and applying the literature to the proposed study. Results: The results of this study showed for interdisciplinarity, the artificial boundaries of disciplines must be broken. Therefore, we first began to explain the disciplinary boundaries in 13 levels, then, we proposed interdisciplinary development by examining the views of the experts in this field and with the synthesis opinion of researchers of this study on each of the disciplinary boundaries of the multilayered model. Conclusion: This model can effectively support interdisciplinary programs and can bring the goals of interdisciplinary programs closer to practical reality.

The effectiveness of in-service training "pharmacopeia home health" based on Kirkpatrick's model: A quasi-experimental study.

BACKGROUND: Assessing the effectiveness of in-service training courses in order to achieve the desired goals and reduce the waste of costs and opportunities in the system is necessary. The purpose of this study was to determine the effectiveness of the "pharmacopeia home health" course considering its importance in different aspects using the Kirkpatrick model. MATERIALS AND METHODS: The present study was a quasi-experimental conducted at community health workers (CHWs) on three levels of reaction, learning, and behavior. In each phase, a valid questionnaire was used to measure the outcome according to the Ministry of Health guidelines with pretest and posttest measurements. The data were analyzed through SPSS 23, using descriptive statistics and repeated measures test and general linear model. RESULTS: The results of the study showed that at the level of reaction in terms of content and holding, conditions of implementation were favorable. Findings at the level of learning showed that the training course was only effective in enhancing the knowledge and awareness about drug maintenance and had no significant effect on other areas. In the third level, the results of the CHWs' performance showed that in some areas, the results were influenced by the demographic variables. CONCLUSION: The present study showed the effectiveness of education in different areas using on the Kirkpatrick model. Given the lack of impact of education in some areas in the present study and on the other, it is necessary to consider cooperative learning methods in order to develop the effectiveness of the courses.

The Novel Coronavirus Disease (COVID-19): A PRISMA Systematic Review and Meta-Analysis of Clinical and Paraclinical Characteristics.

An outbreak of pneumonia, caused by a novel coronavirus (SARS-CoV-2), was identified in China in December 2019. This virus expanded worldwide, causing global concern. Although clinical, laboratory, and imaging features of COVID-19 are characterized in some observational studies, we undertook a systematic review and meta-analysis to assess the frequency of these features. We did a systematic review and meta-analysis using three databases to identify clinical, laboratory, and computerized tomography (CT) scanning features of rRT-PCR confirmed cases of COVID-19. Data for 3420 patients from 30 observational studies were included. Overall, the results showed that fever (84.2%, 95% CI 82.6-85.7), cough (62%, 95% CI 60-64), and fatigue (39.4%, 95% CI 37.2-41.6%) are the most prevalent symptoms in COVID-19 patients. Increased CRP level, decreased lymphocyte count, and increased D-dimer level were the most common laboratory findings. Among COVID-19 patients, 92% had a positive CT finding, most prevalently ground-glass opacification (GGO) (60%, 95% CI 58-62) and peripheral distribution opacification (64%, 95% CI 60-69). These results demonstrate the clinical, paraclinical, and imaging features of COVID-19.

Educational Needs Assessment of General Practitioners in Tuberculosis Control and Management.

BACKGROUND: Tuberculosis is one of the top 10 causes of mortality worldwide. It is also the leading cause of death in HIV-positive patients. In this study, we aimed to assess the educational needs of general practitioners regarding tuberculosis in the North Health Center of Tehran, Iran. MATERIALS AND METHODS: This quantitative and qualitative study was conducted in 2017. In the quantitative phase, 31 general practitioners from the North Health Center of Tehran were included. The educational needs assessment was performed using the knowledge assessment and self-assessment scales. Data were entered in SPSS version 21 and analyzed using descriptive tests and Pearson's correlation coefficient test. In the qualitative phase, data were collected by interviewing six managers of tuberculosis monitoring program and analyzed using the content analysis method. RESULTS: The mean score of the knowledge assessment scale was 22.8±6.4. The most and the least important educational needs were related to treatment and general information about tuberculosis, respectively. Moreover, tuberculosis treatment and general information about tuberculosis were the most and the least important educational needs in the self-assessment scale, respectively. There was a poor correlation between the mean scores of self-assessment scale and knowledge assessment scale regarding tuberculosis prevention (P=0.01, r=0.27). Also, a moderate correlation was found regarding tuberculosis screening (P=0.001, r=0.56). However, no significant correlation was found in terms of general information (P=0.31), diagnosis (P=0.43), and treatment (P=0.29) of tuberculosis. Five major themes were extracted in the qualitative phase of the study, including "training time", "educational content", "educational references", "teaching method", and "organizational factors". CONCLUSION: An appropriate educational program should be developed for general practitioners in form of continuing education and educational reform.

Acellular pertussis vaccine efficacy: An updated systematic review and meta -analysis.

Background: Recent studies indicate an increased incidence of pertussis disease in recent years. The aim of this study was to evaluate the efficacy of the acellular vaccine for children (as a replacement of current whole cell vaccine in the Expanded Program on Immunization) and for high-risk adults in Iran through updating current best available evidence. Methods: We performed a systematic literature review in relevant databases we focused on previously published systematic reviews to select those that address our questions. The AMSTAR (assessing the methodological quality of systematic reviews) tool was used for screening available reviews. Then search in databases was done until Feb 2014 to update the evidence. We pooled results using meta-analysis methods by Stata statistical package. Results: Eleven systematic review articles were included in the initial evaluation. In the end, two systematic reviews on acellular vaccine booster doses and the acellular vaccine in children were selected as the baseline evidence. In the update phase, new clinical trials were screened, and the results were updated. Overall pooled estimate of relative efficacy of acellular to whole cell was 0.68 (95% CI, 0.55-0.81) for children immunization Pooled estimates for the efficacy of acellular versus placebo were 0.70 (95% CI, 0.60-0.80). Overall pooled estimate of efficacy of booster dose of acellular was 0.87(95% CI, 0.85-0.88) compared to placebo. In addition pooled estimate of acellular vaccine efficacy based on response to antigen was 0.78(95% CI, 0.64-0.93) in highrisk group. Conclusion: The results show higher performance and safety of the acellular vaccine in the prevention of pertussis in children versus the whole cell vaccine. Moreover, the efficacy of the acellular vaccine in high-risk adult groups is acceptable. This study provides evidence in favor of the introduction of an acellular vaccine to the national program of immunization. Studies on cost effectiveness and aspects of policy analysis are recommended.

Cost-Effectiveness of Rotavirus Vaccination for Under-Five Children in Iran.

BACKGROUND: Rotavirus diarrhea is one of the most important causes of death among under-five children. Anti-rotavirus vaccination of these children may have a reducing effect on the disease. OBJECTIVES: this study is intended to contribute to health policy-makers of the country about the optimal decision and policy development in this area, by performing cost-effectiveness and cost-utility analysis on anti-rotavirus vaccination for under-5 children. PATIENTS AND METHODS: A cost-effectiveness analysis was performed using a decision tree model to analyze rotavirus vaccination, which was compared with no vaccination with Iran's ministry of health perspective in a 5-year time horizon. Epidemiological data were collected from published and unpublished sources. Four different assumptions were considered to the extent of the disease episode. To analyze costs, the costs of implementing the vaccination program were calculated with 98% coverage and the cost of USD 7 per dose. Medical and social costs of the disease were evaluated by sampling patients with rotavirus diarrhea, and sensitivity analysis was also performed for different episode rates and vaccine price per dose. RESULTS: For the most optimistic assumption for the episode of illness (10.2 per year), the cost per DALY averted is 12,760 and 7,404 for RotaTeq and Rotarix vaccines, respectively, while assuming the episode of illness is 300%, they will be equal to 2,395 and 354, respectively, which will be highly cost-effective. Number of life-years gained is equal to 3,533 years. CONCLUSIONS: Assuming that the illness episodes are 100% and 300% for Rotarix and 300% for Rota Teq, the ratio of cost per DALY averted is highly cost-effective, based on the threshold of the world health organization (< 1 GDP per capita = 4526 USD). The implementation of a national rotavirus vaccination program is suggested.

Cost-effectiveness analysis of the introduction of rotavirus vaccine in Iran.

BACKGROUND: Although the mortality from diarrheal diseases has been decreasing dramatically in Iran, it still represents an important proportion of disease burden in children <5 years old. Rotavirus vaccines are among the most effective strategies against diarrheal diseases in specific epidemiological conditions. This study aimed to evaluate the cost-effectiveness of the introduction of rotavirus vaccine (3 doses of pentavalent RotaTeq (RV5)) in Iran, from the viewpoints of Iran's health system and society. METHODS: The TRIVAC decision support model was used to calculate total incremental costs, life years (LYs) gained, and disability-adjusted life years (DALYs) averted due to the vaccination program. Necessary input data were collected from the most valid accessible sources as well as a systematic review and meta-analysis on epidemiological studies. We used WHO guidelines to estimate vaccination cost. An annual discount rate of 3% was considered for both health gain and costs. A deterministic sensitivity analysis was performed for testing the robustness of the models results. RESULTS: Our results indicated that total DALYs potentially lost due to rotavirus diarrhea within 10 years would be 138,161, of which 76,591 could be prevented by rotavirus vaccine. The total vaccination cost for 10 cohorts was estimated to be US$ 499.91 million. Also, US$ 470.61 million would be saved because of preventing outpatient visits and inpatient admissions (cost-saving from the society perspective). We estimated a cost per DALY averted of US$ 2868 for RV5 vaccination, which corresponds to a highly cost-effective strategy from the government perspective. In the sensitivity analysis, all scenarios tested were still cost-saving or highly cost-effective from the society perspective, except in the least favorable scenario and low vaccine efficacy and disease incidence scenario. CONCLUSION: Based on the findings, introduction of rotavirus vaccine is a highly cost-effective strategy from the government perspective. Introducing the vaccine to the national immunization program is an efficient use of available funds to reduce child mortality and morbidity in Iran.

Rotavirus Infection in Children with Acute Gastroenteritis in Iran: A Systematic Review and Meta-analysis.

BACKGROUND: The recent studies show that Rotavirus is important cause of the acute gastroenteritis. The aim of this review is to estimate the number of Rotavirus infection among Iranian children by performing a systematic review and estimating a pooled data. METHODS: We performed a systematic literature review in relevant databases including PUBMED, MEDLINE, OVID, SID, MAGIRAN, and IRANMEDEX. Search in databases was done in October 10, 2013. Meta-analysis was performed using the STATA statistical package version 11. We assessed heterogeneity by Q-test and used random model for pooling measures of proportion of Rotavirus infection among Iranian children with diarrhea (and 95% confidence intervals [CI]). Sub group analysis between in-patient and outpatient group were done and publication bias was assessed by Egger and Begg tests. RESULTS: A total of 154 records were identified in our searching. There were 36 studies including a total of 15,368 children with diarrhea. Out of 15,368 children, 6,338 were positive for Rotavirus gastroenteritis. Overall pooled estimate of infection with Rotavirus among cases of gastroenteritis was 0.35 (95% CI, 0.28-0.41). Pooled estimates for hospitalized children and outpatient subgroups were 0.39 (95% CI, 0.30-0.48), and 0.31 (95% CI, 0.23-0.38), respectively. CONCLUSIONS: This study supports the importance of Rotavirus in the Iranian population such as common cause of diarrhea among children. Therefore, decision to adopt immunization programs to prevent Rotavirus infection might be helpful in Iran.

Immunization against Haemophilus Influenzae Type b in Iran; Cost-utility and Cost-benefit Analyses.

BACKGROUND: Haemophilus Influenzae type b (Hib) is an important cause of morbidity and mortality in children. Although its burden is considerably preventable by vaccine, routine vaccination against Hib has not been defined in the National Immunization Program of Iran. This study was performed to assess the cost-benefit and cost-utility of running an Hib vaccination program in Iran. METHODS: Based on a previous systematic review and meta-analysis for vaccine efficacy, we estimated the averted DALYs (Disability adjusted life years) and cost-benefit of vaccination. Different acute invasive forms of Hib infection and the permanent sequels were considered for estimating the attributed DALYs. We used a societal perspective for economic evaluation and included both direct and indirect costs of alternative options about vaccination. An annual discount rate of 3% and standard age-weighting were used for estimation. To assess the robustness of the results, a sensitivity analysis was performed. RESULTS: The incidence of Hib infection was estimated 43.0 per 100000, which can be reduced to 6.7 by vaccination. Total costs of vaccination were estimated at US$ 15,538,129. Routine vaccination of the 2008 birth cohort would prevent 4079 DALYs at a cost per averted-DALY of US$ 4535. If we consider parents' loss of income and future productivity loss of children, it would save US$ 8,991,141, with a benefit-cost ratio of 2.14 in the base-case analysis. Sensitivity analysis showed a range of 0.78 to 3.14 for benefit-to-cost ratios. CONCLUSION: Considering costs per averted DALY, vaccination against Hib is a cost-effective health intervention in Iran, and allocating resources for routine vaccination against Hib seems logical.