Iranian Journal of Epidemiology

The Surveillance System of Poliomyelitis/Acute Flaccid Paralysis in the Islamic Republic of Iran: History, Structures and Achievements

KH Rahmani

Background and Objectives: : According to the global strategy for polio eradication, targeted surveillance of the disease is one of the main tasks of the health system. The purpose of this study was to review the status and surveillance of poliomyelitis/acute flaccid paralysis (AFP) in Iran.

Methods: The present study was a review on the processes, structures and achievements of the poliomyelitis/AFP surveillance system in Iran during 2017-2019. The data of this study were obtained from the surveillance system of the Center for Communicable Disease Control; a review of the records, documents, books and published articles; and interviews with process owners and experts of poliomyelitis/AFP surveillance.

Results: The polio eradication program in Iran is based on the action plan of the World Health Organization that was introduced initially in 1988. Currently, the surveillance system of AFP is active at three levels: country, university, and city. The number of poliomyelitis cases in the country decreased from 50 cases per year in 1985 to zero in 2001, and Iran has been a polio-free country since 2001. The final report on polio eradication in Iran was approved by the regional commission on polio detection in April 2006.

Conclusion: The surveillance system of AFP has had a proper effectiveness throughout the country. Maintaining this situation in the country requires an increase in the sensitivity of the surveillance system of the disease, regular monitoring of vaccine coverage, strict implementation of international health regulations, especially on the eastern borders of the country, and providing technical assistance to neighboring countries.

Multiple Indicator Clustar Survey and Demographic and Health Survey in the Eastern Mediterranean Region: What Is the Iran’s Situation in Terms of Implementation?

E Ahmadnezhad

Background and Objectives: One of the data sources for monitoring the progress towards Sustainable Development Goals and Universal Health Coverage (UHC) is household surveys such as Multiple Indicator Cluster Survey (MICS) and Demographic and health Survey (DHS). This study was conducted to assess the implementation of these surveys in the Eastern Mediterranean Region (EMR) to evaluate the experience of Iran in conducting these surveys and to propose one of them as the best option for implementation in Iran.

Methods: In this review article, by reviewing the databases of the relevant organizations, the implementation history, instructions, protocols, and the generated indicators of these two surveys were assessed.

Results: So far, 26 standard DHS and 56 standard MICS have been implemented in the EMR. Iraq implemented the highest number of MICS and Egypt carried out the highest number of DHS. In the global reports, no DHS/MICS surveys were conducted in Iran after 2000 However, according to the official reports, Iran conducted two rounds of a survey called MIDHS (a combination of DHS and MICS) in 2010 and 2015.

Conclusion: The EMR has performed well in implementing these surveys. According to the findings, DHS is more suitable for Iran. However, right now, what is important is not to decide which survey to be conducted. Considering the international commitments for monitoring the progress towards UHC, it is important to conduct either one in 2020 in Iran.

Inequality-Adjusted Human Development Index as an Important Predictor of Deaths Caused by Non-Communicable Diseases in the World and Iran: An Ecological Study

M Hadian

Background and Objectives: The main purpose of this study was to compare the predictive power of the Inequality-adjusted Human Development Index (IHDI) with the Human Development Index (HDI) with regard to the share of deaths caused by Non-Communicable Diseases (NCD) among all deaths in the world and Iran.

Methods: The data required for this cross-sectional ecological study were extracted from the reports of the United Nations Human Development Program and the WHO in 2015. Pearson correlation test was used to investigate the correlation of HDI and IHDI with the share of deaths caused by NCDs and linear regressions models were used to determine the associations of IHDI and HDI with the dependent variable.

Results: At a significant level of P<0.01, the dependent variable showed a strong positive correlation with HDI (0.892) and IHDI (0.899). Simple linear regression showed that HDI alone predicted the dependent variable well (Adj.R2=0.794, P<0.001).However, according to the multivariate linear regression model, when IHDI and HDI were included in the model, IHDI was able to predict the dependent variable well (Adj.R2=0.809, P=0.001), while the relationship between HDI and the dependent variable was no longer significant.

Conclusion: Although HDI alone is an important predictor of NCD status, it loses its influence in the presence of IHDI. Therefore, in addition to HDI, IHDI that illustrates the impact of inequality on human development can provide more information on the status of deaths caused by NCDs.

Validation and Psychometric Properties of Self-Confidence Questionnaire (PEI)

S Nejat

Background and Objectives: Self-confidence is an individual characteristic in students that enables them to have a positive or realistic view of themselves. The purpose of present study was to evaluate the validity and psychometric properties of the Self-confidence Questionnaire (PEI)

Methods: This cross-sectional study was conducted on 100 students of four medical universities. Validation of this questionnaire included the steps of translation, content validity, face validity, repeatability and internal consistency.

Results: The mean age of the participants in this study was 32.1 (SD = 5.5) years. The majority of the students were postgraduate students (47%) and the least (11%) were undergraduate students. The results of this study showed that the overall relevancy and clarity of the questions were 92% and 83%, respectively. The percentage of agreement on overall comprehensiveness was 100%. Cronbach's alpha coefficient and interclass correlation coefficient were higher than 0.7 in all domains. The ICC of each question was also between 0.72 and 0.98.

Conclusion: Based on the results of this study, the Persian version of the PEI questionnaire has an appropriate reliability for use in the student population of Iranian universities.

Investigation of Health, Safety and Environment Indicators in Tehran Municipality Organizations: Challenges, Weaknesses, Strengths and Corrective Strategies

SS Hashemi Nazari

Background and Objectives: The purpose of this study was to investigate the status of HSE indices in a number of organizations affiliated with Tehran Municipality.

Methods: In this cross-sectional study, the study population included all organizations affiliated with Tehran Municipality HSE performance was assessed through an 18-item checklist. The content validity of this checklist was examined by obtaining the opinions of experts in the field. The data of this study were analyzed using the SPSS software version 22.

Results: The results of this study showed that three organizations, namely Suburbs Bus Company, Urban Planning Organization, and Terminals and Parks Organization had the best HSE performance with indexes of 63.6%, 57.485 and 52.59%, respectively. Among the 18 items of HSE performance, the HSE policy had the highest score (68.6%).

Conclusion: Based on the findings of this study, the value of the HSE index was not complete in any of the fields. The results of this study showed that although the foundation of the HSE system was implemented in many units of Tehran Municipality, it is still a long way before the desired point is reached. Therefore, it is necessary to formulate and implement appropriate action plans and to evaluate the effectiveness of control measures to improve the HSE indicators.

Investigation of Health, Safety and Environment Indicators in Tehran Municipality Organizations: Challenges, Weaknesses, Strengths and Corrective Strategies

A Abadi

Background and Objectives: Cancer is a complex disease with a lengthy and expensive course of treatment that causes many problems for the community. Knowledge of oral cancer plays an important role in early diagnosis. The aim of this study was to determine the level of knowledge about the symptoms and risk factors of oral cancer and assess the related factors.

Methods: In this study, 671 parents of primary school children were randomly selected from primary schools in four districts of Tehran. The participants were asked to answer questions related to demographic characteristics and knowledge of the risk factors and symptoms of oral cancer. Data analysis was done using Poisson regression model and multi-level Poisson regression model using SPSS and STATA software. The AICI Akaike Information Criterion (AIC) was applied to evaluate the models.

Results: The mean score of knowledge was 3.7 with a standard deviation of 6.7. Among the studied variables, female gender, advanced age, a higher SES score, and a higher welfare index had positive effects on oral cancer knowledge (P <0.05).

Conclusion: The results of this study showed that demographic, social and economic factors of parents were effective on oral cancer. It can be statistically concluded that a multilevel Poisson regression model is more suitable for analyzing this data.

Determining the Days of Disability and the Severity of Injuries Caused by Driving Accidents in Patients Admitted to Imam Khomeini Hospital, Urmia in 2016

SH Salari Lak

Background and Objectives: Traffic accidents are a leading cause of disability and mortality worldwide. This study was conducted to determine the days of disability and severity of injuries caused by traffic accidents in patients admitted to Imam Khomeini Hospital, Urmia in 2016.

Methods: This cross-sectional study was performed on 1705 traffic accident victims admitted to Imam Khomeini Hospital, Urmia in 2016. Data were collected using a checklist containing demographic information, accident, severity of injury, and days of disability along with a telephone follow-up after 3 months upon return to work or school. The ISS (Injury Severity Score) was categorized from 1 to 6 according to the experts’ opinions.

Results: The results showed that 1231 subjects (72.1%) were male and the mean and SD age of the participants was 33.63 (30.00) years. Moreover, 77 (0.04%) of the subjects died and 593 (42.5%) resumed a normal life after two months. The mean time to resuming a normal life was 86.78 (24.104) days. Most of the subjects had mild limb injury, while the majority of the deaths had life-threatening injuries.

Conclusion: In this study, most of the victims were male, married, young, and concerned about financial compensation. The majority of the deceased had life-threatening injuries requiring vital measures to return to work quickly.

Quality Assessment of Published Clinical Trials of Mashhad University of Medical Sciences Between 1999 and 2018

L Jarahi

Background and Objectives: Clinical trials are used extensively in the compilation of systematic review studies and clinical guidelines. Critical appraisal of articles is a part of systematic review writing and also effective in citation. This study aimed to evaluate quality of randomized clinical trial articles of Mashhad University of Medical Sciences with consideration report of randomized, blindness, and allocation concealment methods in them.

Methods: In this study, all randomized clinical trials with Mashhad University of Medical Sciences affiliation indexed in PubMed by 2018 were evaluated.
Results: Of 257 eligible articles, dentistry (n=44 , 17.1%) , obstetrics and gynecology (n=28 , 10.9%) and internal medicine (n=23 , 8.9%) had the highest relative frequency of published randomized clinical trial articles. Eithy-three articles (32.3%) reported the randomization method and most of them (86.9%) used simple randomization. Blinding was done in 138 papers (53.7%) with double blinding being the most common (70.2%). Only three articles (1.2%) reported allocation concealment.

Conclusion: The report of "random allocation and randomization" in articles was far less than acceptable. It may seem that there may be different biases in the methodology. Upholding the principles of scientific writing and avoiding errors and biases increase the validity of the scientific articles and citation, which is one of the criteria of the scientific ranking of top universities.