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Volume 4, Issue 1 (5-2011)
Background and Objectives: Heavy metal pollution has always been a major cause contamination of environment and considered as a major concern for food health. Rice is the most popular food among Iranians and presence of heavy metals in trace level in rice has received special attention because they are directly related to health.The aim of this research was to investigate the concentration of Pb, Cd, Cr, Ni in rice prevalent in the market of Iran.
Materials and Methods: 20 of the most widely consumed brands of Iranian rice were purchased from local market in Iran. 3 samples of each brand were collected and certain volumes of each sample were digested with acid. Heavy metal contents in the digested samples were determined by atomic absorption spectrometry.
Results :The results showed that mean concentration Pb , Cr , Ni in rice samples respectively was 0.387 , 0.683, 0.019 ( mg/kg )
Conclusion: Notably the Ni and Cr content in the rice samples was found to be below the food sanitary standards in India rice . In the other hand 50% samples content Pb was found to be upper the food sanitary (Pb: 0.3 mg/kg). The result indicated that weekly intake of heavy metal by rice was below the provisional tolerable weekly intake recommended by WHO/FAO. However, risk assessments needs considerable attention and better prevention this low pollution.
Volume 5, Issue 2 (10-2012)
MicrosoftInternetExplorer4 Background and Objective: Dioxins and Furans are dangerous and highly toxic compounds entering to the environment from natural and manmade sources. Having high stability and half-life, these compounds remain for a long period in the medium and bring about severe effects on human beings and the environment. The aim of this study was to identify dioxins and furans emission sources in Iran and to estimate their contribution in emission rate.
Materials and Methods: First, we identified the emission sources of dioxins and furans and then necessary data was gathered by referring to the authorized organizations and filling the prepared UNEP questionnaires. We used Excel software to analyze the data collected.
Results: According to the results obtained, total dioxins and furan emission in Iran in 2010, was 1957 g TEQ/yr out of this amount, 705.8 g TEQ is emitted to the atmosphere and 643.2 g TEQ is residual ash. Therefore, dioxins and furans emission rate was 26.4 µg TEQ/capita in Iran. The most rates of emissions were associated with uncontrolled open burning (732.8 g TEQ/yr) and ferrous and nonferrous metal production (635.7 g TEQ/yr) such as cupper, iron, and steel.
Conclusion: Our findings showed that the emission rate of Dioxins and Furans is much higher in Iran compared with other countries and appropriate management strategies are required to control these dangerous pollutants.
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Volume 6, Issue 2 (9-2013)
Background and objectives: In this research, an innovative drinking water quality index for assessing water resources as “modified drinking water quality index (MDWQI)” was developed and applied for evaluating all of the groundwater resources utilized for community water supply in urban areas of Iran during 2011. Materials and methods: Twenty-three water quality parameters and relevant Iranian standards for drinking water quality were selected as input parameters and benchmarks respectively. The MDWQI is calculated using three factors including the number of parameters that excurse benchmarks, the number of measurements in a dataset that excurse benchmarks and the magnitude of excursions. The MDWQI scores range from 0 to 100 and classify water quality in five categories as excellent (95-100), good (80-94), fair (65-79), marginal (45-64), and poor (0-44). Results: According to the MDWQI value, about 95% of the groundwater resources were in the good condition and the others were in the fair or marginal condition also the best and the worst water quality of water resources were observed in Ardebil Province and Qom Province respectively. The three parameters of fluoride, magnesium, and nitrate recorded the highest rates of violation to be 74, 32, and 13% respectively. Conclusion: The nationwide average score of the MDWQI was 85 (good description). This study indicated that the MDWQI and its sub-indices could describe the overall water quality of water bodies easily, reliably and correctly and have the potential suitability for extensive application all over the world.
Volume 7, Issue 1 (7-2014)
Background and aim: Traditional cheese has a special place in the diets of our community because of cultural, favorite taste, odor and its nutritional values as an important protein source. However, its pathogenic infection can endanger the human being health and cause serious economic losses. The aim of this study was measurement and determination of microbial infection in traditional cheese distributed in Markazi province in 2010. Material and methods: Markazi Province was divided into 10 districts eight sample were chosen from each district at summer, 2011. Samples were transferred to the laboratory under sterile conditions and were analyzed by microbiological tests. The data were analyzed statistically by T-test using SAS software. Results: The results indicated that all of samples had coliform, staphylococcus aurous, mold, and yeast contamination greater than Iranian standards (P<0.001). It was found that 34 percent of the samples had E.coli contamination moreover, 24 and 8 percent of samples had Coagulase-positive staphylococcal and salmonella contamination respectively. Conclusion: These results indicate a notable contamination of traditional cheese with microbial infection in Markazi province.
Volume 7, Issue 2 (10-2014)
The objective of this study was to collect all the conducted studies on nitrate concentration in water resources of Iran. To achieve this purpose, the published papers in ISC and ISI journals as well as conferences and seminars were evaluated. The results of this survey showed that 116 studies have been carried out in 26 provinces of Iran. But,there was no published paper in Ilam, Alborz, South Khorasan, Kohgiluyeh and Boyer-Ahmad, and Lorestan provinces. According to these studies, the largest number of studies was performed in Hamadan province (14 cases), Khuzestan, and Mazandaran provinces (10 cases) and the least number of studies was conducted in Ardabil, Bushehr, Qazvin, Qom, and Kermanshah provinces. In Hamadan province, more than 1435 water samples were collected from water resources of this province, which is representative of large number of studies in this region. Maximum nitrate concentration (318 mg/L) was reported in Isfahan province and then in Zahedan city (295 mg/L), Sistan and Baluchestan Province. Based on the reported results in these studies, the nitrate pollution in water resources of Iran is at medium level. In most of the studies, high nitrate concentrations are due to lack of sewage collection network, discharge of urban and industrial sewage to water resources, and agricultural activities, which use high amounts of manure and fertilizer.
Volume 8, Issue 1 (8-2015)
Background & Objectives: Dust storms happening frequently in arid and semiarid regions of the world carry huge amount of particulate matters hence, these are recognized as one of the most important environmental issues at regional and international scales. This study aimed to evaluate heavy metals laden dustfall particles in Sanandaj, Khoramabad, and Andimeshk cities, West Iran. Materials & Methods: Sampling of dustfall particles was conducted once every 10 days from June 20, 2012 for one year at three stations of Sanandaj, Khorramabad, and Andimeshk simultaneously using Deposit Gauge Method. The concentration of Fe and Mn were measured using Flame Atomic Absorption Spectroscopy and Furnace Atomic Absorption Spectroscopy was used for analyzing Ni, Cr, Ag, As, Cu, and Zn. Then, pollution levels for the heavy metals were evaluated using Geo-Accumulation Index (Igeo) and Integrated Pollution Index (IPI). Mineralogy and morphology of the dustfall particles were inspected using X-ray diffraction and scanning electron microscopy. Results: Igeo index indicated that levels of pollution for Ag and Cu were higher than As and Zn among the dustfall particles of the three stations whereas the concentrations of the other heavy metals were not evaluated as contaminant. Moreover, means of IPI values calculated for stations of Sanandaj, Khorramabad, and Andimeshk were 2.86, 1.55 and 1.40 respectively. X-ray diffraction revealed abundance of silicate (quartz) and carbonate (calcite) minerals in dustfall particles. Additionally, scanning electron microscopy emphasized on similarity of shape of dustfall particles in the three stations. Conclusion: Although mean of dustfall particles on area unit in Sanandaj station was less than Khorramabad and Andimeshk, heavy metals concentration was relatively higher among the sampled dustfall particles.
Volume 9, Issue 3 (12-2016)
Background and Objective: Malaria is a disease affecting 300–500 million people in tropical and subtropical regions and causes approximately 2.7 million deaths annually. Currently, no vaccine protects against malaria and resistance to anti-malaria drugs such as chloroquine is increasing and spreading geographically. Moreover, anti-malarial drugs are expensive and often unaffordable to low-income populations. A better understanding of the relationship between the El Niño Southern Oscillation (ENSO), the climatic anomalies it engenders, and malaria epidemic could help mitigate the world-wide increase in incidence of this mosquito transmitted disease. There is evidence of a relationship between climate variability and the transmission of mosquito-transmitted diseases. Therefore, in this study we intended to analyze the relationship between ENSO events and annual malaria occurrence (AMO) in Iran to assess the possibility of using ENSO forecasts for improving malaria control.
Martials and Methods: Two types of data were used: The data of annual malaria incidence in Iran were collected from the national and international reports of malaria occurrence in Iran; the annual malaria occurrence data for 38 years (1974-2013) were collected from related sources. ENSO is a cyclic phenomenon, which its frequency is 2 to 7 years (i.e., irregular) and is the second strongest natural driver of climate variability, the first being normal seasonal variability. This oscillation has two different phases: a warm episode known as El Niño; and a cold episode called La Niña, where warm and cold refer to the direction of departure from average of the equatorial Pacific Sea surface temperature (SST), a fundamental indicator of the ENSO state. The Pearson correlation analysis at 0.95 confident level (P-value=0.05) on monthly timescale was used in order to understand the relationship between ENSO and annual malaria occurrence in Iran. The 2-tailed independent parametric T-test was used knowing that whether there is a significant difference between the La Nina years occurrence and El Nino years occurrence.
Results: The results indicated that a slight negative association could be detected between ENSO and annual Malaria occurrence in Iran. Our finding showed that the detected correlation between monthly ENSO and annual malaria occurrence is statistically significant only in months October and May while no significant relationship between ENSO and AMO at 0.95 confident level was found for other months.. The inverse relationship between ENSO and AMO means that the years having higher malaria occurrence coincides with the warm ENSO phases or EL Nino episode while the years having lower malaria occurrence coincides with the cool ENSO phases or La Nina episode. In El Niño episode, the annual occurrence of malaria is about 0.2 to 0.3 higher than La Niña episode years.
Conclusion: The positive association between El Niño and rainfall of Iran resulted in higher occurrence of malaria by proliferation of Anopheles mosquito especially in southern and southeastern region of Iran.
Volume 10, Issue 1 (6-2017)
Background and Objective: Identification of potential risks in laboratories and trying to create safe conditions for the staff is very important from different aspects. The main objective of this study was to evaluate the potential risks in the laboratories of three research centers affiliated to Iranian Fisheries Science Research Institute.
Materials and Methods: In order to assess and classify risks associated with working in the laboratories (11 laboratories of the Persian Gulf and Oman Sea Ecological Research Center, 9 laboratories of National Shrimp Research Center and 2 laboratories of National Aquatic Organisms Processing Center), the method of "Failure Mode Effects Analysis" (FMEA) as well as statistical methods (concerning compare means) were used.
Results: The risk levels in all the laboratories of the Persian Gulf and Oman Sea Ecological Research Center, except for benthos laboratory, could be evaluated as moderate or high. Only in the case of the sample preparation laboratory, significant differences between the values of RPN before and after corrective action was observed. However, in this case the corrective actions have not been effective in decreasing the risk level. In most laboratories of National Shrimp Research Center, the corrective actions were effective in reducing the risk levels (with the exception of three laboratories). In both laboratories of National Aquatic Organisms Processing Center, after the corrective actions, the risk levels were sharply reduced.
Conclusion: Considering the high level of risk in many evaluated laboratories, appropriate corrective actions were proposed. But after the second-stage evaluation, it was realized that the proposed corrective measures in some laboratories (especially in the Persian Gulf and Oman Sea Ecological Research Center) were notperformed sufficiently and hence the risk still was remained at critical or semi-critical level
Volume 10, Issue 2 (9-2017)
Materials and Methods: 36 samples were taken from the central district in Bandar Abbas county to investigate the degree of contamination, sources and health risk of polycyclic aromatic hydrocarbons (PAHs). Analysis of the samples was performed using gas chromatography. خطای ترجمهAlso, PMF Model was used to determine the possible sources.
Results: The total PAHs concentration had a mean value of 1.48 mg/kg in the soil samples. The total incremental life time cancer risk (ILCR) due to exposure to PAHs in soil is 1.06 × 10−6 for an adult and 4.95 × 10−6 for children. The results estimated for ILCR indicated that residents live in the central district of Bandar Abbas county are potentially exposed to cancer risk via both dust ingestion and dermal contact.
Conclusion: The ecological risk assessment of PAHs showed that the levels of all types of PAHs were lower than the lower value of effects range, except for dibenzo(a,h) antheracene and acenaphthene. The estimated results of ILCR indicated that Bandar Abbas county central district residents are potentially exposed to cancer risk via both ingestion and dermal contact. The PMF analysis identified four sources that were included fossil fuel combustion (14%), biomass combustion (13%), vehicular emissions (36%) and fossil fuel combustion/unburned petroleum (37%).
Volume 12, Issue 1 (5-2019)
Materials and Methods: In this research, the nitrate content of four vegetables including Iranian leek, Basil, Mint and Radish (tuber and leaves) cultivated from olericulture field on Khorramabad and Poledokhtare were measured. A 2kg edible portion of vegetables was randomly collected for each species in triplicate and carried out to the laboratory. The nitrate content was measured according to the instructions of the Institute of Water and Soil of Iran. For this purpose, after preparation of the samples, a spectrophotometer was used to measure absorption at 580 nm. The nitrate content in different vegetables was estimated using a standard curve.
Results: The nitrate mean concentration of the studied vegetables from khorramabad city was 27017 mg/kg for Radish tuber, 9500 mg/kg for Basil, 8408 mg/kg for Iranian leek, 98231 mg/kg for Radish leaves and 5450 mg/kg for Mint. The values for the samples taken from Poledokhtare city were 12933 mg/kg for Radish tuber, 9063 mg/kg for Basil, 6708 mg/kg for Iranian leek, 6296 mg/kg for Radish leaves and 5454 mg/kg for Mint (5454 mg/kg). The values were all higher than the recommended doses for consumption. In control field, the nitrate mean concentration were 1586, 1134, 906, 794 and 662 mg/kg for Radish tuber, Basil, Iranian leek, Radish leaves and Mint, respectively. The values were within the range of recommended doses.
Conclusion: The amounts of nitrate measured in 100g of green tissue in Radish tuber, Basil, Iranian leek, Radish leaf and Mint were 7.36, 3.37, 2.74, 2.64, and 1.98 times more than the daily allowance limit, respectively. Given the high nitrate content in the studied vegetables, it is recommended that cautious is taken for consumption of the vegetables and nitrate content of the vegetables produced in Lorestan province in different seasons should be monitored.
Volume 12, Issue 1 (5-2019)
Materials and Methods: In this study, a review was initially conducted on the basis of indices conducted in the world, the status of ambient air pollution and its effects on health in Iran and other countries, and then the status of ambient air quality and its effects on health in Tehran metropolitan between 2006 and 2017 were shown, based on the results of the studies conducted by the Environmental Research Institute of Tehran University of Medical Sciences.
Results: The results showed that the annual mean of ambient air population-weighted PM2.5 exposure concentration in Iran was about 48 μg/m3, which is relatively lower than its global mean concentration (51 μg/m3). Based on the most recent study (in 2018) about 8.9 (7.5-10.3) million deaths in those aged above 25 years were attributed to exposure to outdoor air PM2.5 in the world. Although there are substantial differences between the results of studies have been done regarding the number of air pollution attributed deaths, numerous studies showed that air pollution is a major cause of death. Results regarding temporal variations of air quality in Tehran that is performed by the Institute for Environmental Research (IER) of Tehran University of Medical Sciences (TUMS), indicated that PM concentration had an increasing trend from 2006 to 2011. The maximum mean concentration of PM2.5 over the past 12 years has occurred in 2011, which was 38 μg/m3. The PM concentration had a decreasing trend from 2012 to 2015, reaching about 30 μg/m3. However, in the years 2016 and 2017, the annual mean PM2.5 concentration in Tehran was increased compared to its corresponding value in 2015. Furthermore, results of this study demonstrated that, in Tehran, not even one day was classified as "good” (AQI=0-50) from 2011 to 2017 based on the air quality index (AQI), but the number of days in which AQI was “moderate” (AQI=51-100) was increased from 2011 to 2015, and the number of days with the AQI of “moderate” reached 80 in 2015, while the rest of the days having an unhealthy air quality. In 2017, AQI was “moderate” in 20 days, “unhealthy for sensitive groups” in 237 days, “unhealthy” in 107 days, and "very unhealthy” in 1 day. The obtained results indicated that about 4878 (3238, 6359( of deaths due to all (natural) causes were attributable to long-term exposure to PM2.5 in Tehran in 2017.
Conclusion: Studies showed that air pollution has a considerable share in the number of attributed deaths. Moreover, there were substantial differences between the results of national and international studies in the burden of disease attributed to air pollution. Therefore, there is a crucial need for accessing to reliable data on air pollution as well as baseline mortality and morbidity in order to study the status of air quality and its effects on health over the country.
Volume 12, Issue 4 (2-2020)
Background and Objective: Global macro trends on the one hand, and domestic trends and effective factors on the other, have put the future of the Iran's environment in a state of uncertainty with concern. In a complex and unpredictable environment, the use of scenario thinking (based on identifying and detecting future drivers and uncertainties) can provide tangible and comprehensible images of consistent or probable futures in multiple scenarios. The purpose of this study was to describe the stories and develop images of the future of the Iran's environment in the form of consistent and probable scenarios.
Materials and Methods: The method used in this study was a scenario-based planning which was designed and implemented in eight steps. The method of data collection in this study was qualitative using interview, expert panel and Delphi survey. Micmac software and Scenario wizard software were used for data analysis.
Results: The findings of this study can be divided into two parts. The first section included identifying and classifying key factors, driving forces and related uncertainties. In this regard, five driving forces including "population", "global warming", "environmental discourse", "development process management" and "technologies" were identified and the influence/dependence relationships among the factors were analyzed. The second section identified and described possible and consistent scenarios based on the relevant drivers and uncertainties.
Conclusion: Based on the research findings, five probable and consistent scenarios including: (a) the secret of survival, (b) management against the land, (c) climate migration, (d) the return of the cranes and (e) technology against the land, were explained and compared. Understanding the narratives of each scenario and comparing their desirability enable actors and decision makers to influence the process of creating the future. Accordingly, the development of environmentally friendly technologies as well as eco management, are the basis for planning future actions in this field.
Volume 13, Issue 2 (8-2020)
Materials and Methods: The score of indicators in environmental health area; air quality (including household solid fuels, exposure to PM2.5, and PM2.5 exceedance), water and sanitation (including drinking water and sanitation) and heavy metals (including lead) were extracted for all studied countries as well as for the last and baseline (generally ten years prior to last report) years from EPI 2018 database. According to EPI scores, the performance of the studied countries in each indicator was ranked. The percent change in the score of each indicator from baseline to current year was calculated and compared with the mean percent change for all studied countries.
Results: Iran ranked 7th regarding air quality in 2016. Also, it ranked 6th, 8th, and 9th in terms of household solid fuels, exposure to PM2.5, and PM2.5 exceedance, respectively. The EPI score for Iran regarding water and sanitation was 54.4 in 2005 and 58.74 in 2016 (percent change=7.98%). Iran ranked 21st in 2005 regarding lead exposure index. Although this index showed a growth of 100% in 2016, which is very desirable compared to the average growth of all countries (34.47%), but only leads to one step up in the ranking of Iran and was ranked 20th in comparison with other countries.
Conclusion: Totally, according to EPI 2018, Iran ranked 6th in the field of environmental health issues among 23 countries of “Iran’s perspective document in 1404”. However, there is uncertainty in the accuracy of the EPI raw data used for calculating index scores. Hence, caution should be exercised in their interpretation.
Volume 15, Issue 2 (8-2022)
Materials and Methods: All articles affiliated with Iran in the field of climate change have been cited in Scopus databases from 1991 to December 9, 2019, and were retrieved by using keywords like "climate change", "global warming", "global change", "climate variability", "greenhouse gas". The data were analyzed using R software.
Results: The total number of documents was 2253. The trend of document production in the field of climate change in Iran follows an increasing exponential trend. Iran's collaboration with other countries in the field of climate change studies was significant so around 25% of scientific productions have been produced jointly with other countries. Keywords analysis showed a greater frequency for keywords including “downscaling”, “energy”, “global warming” and “uncertainty”. However, despite the importance of issues such as “adaptation” and “vulnerability” concerning climate change in Iran, the frequency of these keywords in climate change studies in Iran is low.
Conclusion: Based on the results of this study and considering the importance of climate change and its effects on the country, also the importance of greenhouse gases including CO2, and the rank of Iran as the eighth country in the emission of these gases, it is recommended to pay more attention to issues such as “vulnerability”, “adaptability”, analysis of “greenhouse gases production”, “management of energy consumption” and the use of “renewable energies” in future studies.
Volume 16, Issue 4 (3-2024)
Materials and Methods: This study was conducted as a case-control study in all flood-affected areas of Iran that experienced flood-related deaths from 2002-2018. The sample size of the study was 369 (123 cases and 246 controls) from 12 provinces and 30 counties. The study measured the impact of demographic characteristics on flood-related deaths using a valid and reliable tool.
Results: The findings of this study revealed that individuals under the age of 15 face a 31.974 times higher risk of flood-related death compared to individuals over 65. The young population, specifically those aged 15 to 29 in Iran, have a 1.475 times higher risk. Drivers face a 13.874 times higher risk, while individuals involved in agriculture, shepherding, and livestock farming have a 0.947 times higher risk compared to homeowners.
Conclusion: Among the demographic characteristics, children, young adults, and engaging in certain high-risk occupations such as driving or agriculture increase the risk of flood-related deaths. Therefore, it is recommended to prioritize protection, education, and vulnerability reduction measures for these individuals, especially in flood-prone areas.
Volume 16, Issue 4 (3-2024)
Materials and Methods: In this systematic review, the keywords Microplastic*, Air*, Atmosphere*, Dust, Indoor, Outdoor, Iran, and their corresponding Persian equivalents were searched until Dec 1, 2023, in Scopus, PubMed, Web of Science, Google Scholar, Magiran, and SID databases. Obtained articles from the databases were analyzed in order to find the eligible ones.
Results: Overall, 175 articles were found in the initial search, and after removing the duplicates and nonrelevant, 13 eligible articles were included in the study. In most of the studies, the samples were digested with H2O2, and the microplastics were mainly analyzed using a variety of microscopes and µRaman spectroscopy. The abundance of microplastics in the indoor environment was much higher than in the outdoor environment.
Conclusion: The results of this study showed that there is the required equipment for the sampling and analysis of microplastics in air and settled dust in Iran, and these pollutants have been detected in both indoor and outdoor environments.
Volume 17, Issue 1 (6-2024)
Materials and Methods: This research is a descriptive, cross-sectional, and empirical study that utilizies questionnaires, field visits, weight analysis, sampling, and determination of the physicochemical characteristics of waste. The questionnaire includes questions about the production rate, source reduction, separation, recycling, collection, storage location, transportation outside the complex, and final disposal of waste.
Results: The amount of waste generated from the Azadi Sports Complex was 449.87±4.83kg/day, with the highest waste production observed from the Wrestling Federation (95.37 kg/day) and the lowest from the Kung Fu Federation (12.75 kg/day) and the clinic (12 kg/day). The results of the physicochemical characteristics indicated that the average moisture content was 47%. Combustible materials accounted for 67% with a high calorific value of 12807 kcal/kg, and the ash content was 42%. The dry and wet wastes were collected daily, mixed together, and stored together in an enclosed area.
Conclusion: The results showed that the waste separation, recycling, and storage practices in the Azadi Sports Complex are unsatisfactory. Additionally, there is no existing program for waste reduction at the source or recycling. Therefore, the establishment of a proper waste management system to mitigate the waste volumes in this complex is necessary.
Volume 17, Issue 2 (9-2024)
Materials and Methods: Bibliographic information related to scientific documents indexed in the Web of Science database until September 12, 2022, was analyzed and visualized using Citespace and Biblioshiny software.
Results: A total of 1,212 documents were retrieved. These documents were published in 629 sources with the participation of 8,461 authors. The average publication year of the documents was 2010. The top three ranks of organizational affiliations were as follows: Tehran University of Medical Sciences (747 documents), Isfahan University of Medical Sciences (436 documents), and Shahid Beheshti University of Medical Sciences (393 documents). Iran's cooperation network with other countries indicates substantial joint researchbetween Iran and the main countries in this network. Over time, the co-occurrence network of keywords has evolved from outcomes (such as cardiovascular diseases, cancers, etc.) to environmental exposure factors, especially air pollutants, heavy metals, and food-borne pathogens factors. Risk assessment has also been a category of interest in recent years.
Conclusion: Scientometric analysis showed that environmental health studies in prevention and control of diseases related to environmental factors in Iran are young and still progressing. In the early years, studies were mainly focused on diseases as an outcome, while in recent years, they have focused more on exposure factors or environmental pathogens. It is suggested that the future studies based on the retrieved keywords should be more mission-oriented and the priority of solving the problems of environmental pollutants affecting people's health in the country based on the extent and scope of the problems of each province should be considered by policy makers and researchers.
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