M Aram Ahmadi , A Bahrampour,
Volume 11, Issue 3 (11-2015)
Abstract
Background and Objectives: Diabetes is a chronic and common metabolic disease which has no curative treatment. Logistic regression (LR) is a statistical model for the analysis and prediction in multivariate statistical techniques. Discriminant analysis is a method for separating observations in terms of dependent variable levels which can allocate any new observation after making discriminating functions. The aim of this study was to compare and determine the effective variables in type 2 diabetes.
Methods: The data included 5357 persons obtained through a cohort study in Kerman, southeastern Iran, in 2009-11. Diabetes was considered the response variable. The independent variables after deleting colinearity and correlated variables included height, waist circumference, age, gender, occupation, education, drugs, systolic blood pressure, HDL, LDL, drug abuse, activities, and triglyceride. Sensitivity, specificity, accuracy, and ROC curve were applied for determining and comparing the prediction power of the models.
Results: The results in the reduced model with extracted significant variables from the full model, the sensitivity of the LR model and DA was 74% and 22.4%, the specificity of the LR model and DA was 71.1 % and 95.4 %, the prediction accuracy of the LR model and DA was 71.5% and 85.3%, and the ROC curve of the LR model and DA was 80.3% and 80.1%, respectively.Simulation showed the sensitivity, specificity, accuracy, and ROC curve was 99.18%, 98.49%, 98.59%, and 99.9% for the LR model and 92.62%, 99.19%, 98.26%, and 99.56% for DA, respectively.
Conclusion: The results showed that the risk factors of diabetes in the logistic regression reduced model were waist circumference, age, gender, LDL level, systolic pressure, and drugs. Also, the sensitivity of the LR model was more than DA while DA had a higher specificity and prediction accuracy. Comparison of the ROC curve showed that the prediction estimated values were rather similar in both models, but the two models were the same asymptotically.
P Kimyaiee, M Bakhtiyari, M Mirzamoradi, S Ashrafivand, Ma Mansournia,
Volume 11, Issue 3 (11-2015)
Abstract
Background and Objectives: GTN is a general term for an extensive range of malignant trophoblastic diseases including invasive mole, choriocarcinoma, epithelioid trophoblastic tumors and placental site trophoblastic tumors. The aim of this study was to predict the risk of GTN in patients with molar pregnancy in Tehran.
Methods: All cases with partial and complete mole with a record of at least 4 titers of β-hCG were included in this study. Before and after fitting the appropriate model for calculating the area under the curve of each predictor variable, the type of the relationship (linear or non-linear) was first determined using locally weighted scatter plot smoothing (Lowess Smoother) and fractional polynomial regression (Fracpoly); then, a model tailored to data processing was used for drawing the ROC diagram.
Results: Nonparametric chi-square analysis indicated no significant difference between the components of high-risk molar pregnancy and GTN (P=0.39). Generally, among 201 cases of molar pregnancy, 61 (30%) had one of the components of high-risk molar pregnancy. The ROC curve with an AUC of 0.86 showed that the regression slope of β-hCG with 73% sensitivity and 88% specificity could be used as a predictor.
Conclusion: The serum β-hCG measurement after 21 days of molar pregnancy evacuation and the slope of the linear regression line of β-hCG were found be good tests to distinguish between patients who will benefit from spontaneous disease remission and patients developing GTN.
S Masudi, Y Mehrabi, D Khalili, P Yavari,
Volume 11, Issue 4 (3-2016)
Abstract
In epidemiologic studies, the measurement of characteristics of interest is almost always subject to random measurement error. This error and its effects are usually overlooked by researchers. One of its effects is a widespread statistical phenomenon that is well known as regression to the mean. This phenomenon occurs whenever an extreme group of people is selected from a population based on their measurements of a variable. If a second measurement is taken in this group, the mean of the second measurement will be closer to the mean of the population. In interventional studies, this increase (decrease) might be regarded as the effect of intervention, when in fact it has had no effect. Ignoring regression to the mean will lead to the erroneous conclusions and interpretation of the results of epidemiologic studies and affects the decisions in evidence-based medicine and planning for preventive and public health measures. This paper highlights the importance of this problem and its effects in epidemiologic studies and the ways to avoid it.
B Piroozi, A Mohamadi Bolban Abad , Gh Moradi,
Volume 11, Issue 4 (3-2016)
Abstract
Background and Objectives: Responsiveness is a response to the reasonable expectations of people about non-clinical aspects of the health system. The purpose of this paper was to assess the responsiveness of the health system after the first year of the health system reform in Sanandaj in 2015.
Methods: This descriptive-analytic and cross-sectional study was conducted on 646 households in Sanandaj. The World Health Survey (WHS) questionnaire was used to collect the data. The data was analyzed with SPSS 16 as well as descriptive statistics and ANOVA.
Results: All dimensions of responsiveness, except for choice, were 100% important according to the respondents. In inpatient services, social support (100%) and confidentiality (96%) had the best performance while communication had the worst performance (49%). In outpatient services, confidentiality (100%) and autonomy (42%) had the best and worst performance, respectively. In inpatient wards, a significant difference only in “quick attention” dimension was observed among responsiveness dimensions with regards to proprietorship of the health care center (P-value=0.03). On the contrary, this difference was not significant in outpatient wards.
Conclusion: In this study, communication (time to ask questions about health problem/treatment, clarity of providers explanations), autonomy (participation in treatment decision-making, possibility of obtaining information on other types of treatment) and quality of basic amenities (cleanliness inside the health facility, available space in waiting and examination rooms) were identified as priority areas for actions to improve the responsiveness of the health care services.
A Nikfarjam, Ar Shamshiri, Z Hasanpour, M Khalili,
Volume 11, Issue 4 (3-2016)
Abstract
Background and Objectives: Children immunization program is one of the most successful and most cost-effective public health interventions and medical programs. The study was designed and conducted in order to assess the vaccination coverage in areas covered by Tehran University of Medical Sciences (TUMS).
Methods: This study was a cross-sectional study of children aged 24 months to 6 years living in urban areas and high-risk and marginal areas covered by TUMS. Six hundred and thirty children were sampled in 90 clusters in urban areas and cluster sampling as probability proportional to size sampling was performed in high risk areas and a sample size of 768 children was determined. The questionnaires were completed by interview.
Results: In high risk 750 children (97.7%, 95% CI: 96.32-98.60%) and 616 children (97.8%, 95% CI: 96.3-98.78%) in urban areas had complete immunization histories. Furthermore, 98.4% of the Iranian children and 95.0% of foreign children (P=0.019) in marginal areas and 98.1% of the Iranian children and 92.1% of the foreign children (P=0.046) in urban areas had complete immunization histories.Ignorance of immunization program (%50) was addressed as the main reason for incomplete immunization.
Conclusion: Universal mass vaccination coverage of the children and equal coverage in marginal and urban areas indicated the success of the authorities in the implementation of this program. Organizing training courses for mothers on the immunization program, providing the required facilities and services, monitoring and supervision of vaccination and also considering the immunization status of foreign children seem to be essential in maintaining and improving the existing status.
R Ghahremani, P Yavari, S Khodakarim, K Etemad, A Khosravi, R Ramezani Daryasari, Ma Pour Hossein Gholi ,
Volume 11, Issue 4 (3-2016)
Abstract
Background and Objectives: Colorectal cancer is the fourth leading cause of cancer death worldwide. Annually 1430000 cases would be diagnosed and half of these people would die of the disease. In Iran, colorectal cancer is the fifth common cancer among men and is the thirdamong women. This study was designed to estimate survival rates for patients with colorectal cancer and related factors.
Methods: During the 1384 to 1388 years 24,807 patients diagnosed with colorectal cancer were recorded in the Cancer Registry of the Ministry of Health and Medical Education. Age, gender, marital status, education, occupation, place of residence, tumor diagnosis, the clinical and demographic factors in colorectal cancer as effective on survival entered in Aalen’s additive hazard model and diagram Aalen's was used to study the effects of these factors over time. R 3.2.0 software was used for data analysis.
Results: Stage of tumor had a significant association with survival rates. In this study 1 to 5 year survival rate for patients with stage II tumors, was 100%, 98%, 96%, 93% and 93% respectively and for patients with stage III tumors 99%, 97%, 94%, 90% and 84%, respectively.
Conclusion: In spite of using Cox model in survival analysis by many researchers, Aalen’s model may yield new insights in prognostic studies of survival time of patients with colorectal cancer over time. Our results suggest that early detection of patients in primary stage is important to increase survival.
Mr Aflatoonian, M Khalili, M Rahanjam, B Aflatoonian,
Volume 11, Issue 4 (3-2016)
Abstract
Background and Objectives: Q fever is a zoonosis with a worldwide distribution; this disease is a public health concern in many countries. The aim of this study was to determine the association between risk factors with Q fever seropositivity among veterinarians and vet staff in Southern Khorasan.
Methods: Questionnaires were prepared and 92 blood samples were obtained from all veterinary staff in the South Khorasan (East of Iran). The serum samples were tested with an indirect ELISA kit (anti body phase II); then, SPSS version 19.0 was employed to analyze the data using descriptive statistics and a confidence interval of 95%, chi-square test, and logistic regression.
Results: The results showed that 50 serum samples (54.35%) were positive and the results of data analysis with logistic regression indicated an association between seropositivity and contact with animal secretions and abortive materials. There was no correlation between seroprevalence and age, gender, work experience, education, use of unpasteurized dairy products, knowledge of disease, and clinical findings.
Conclusion: In conclusion, the present study showed a high seropositivity rate among vet staff which indicates that further attention should be paid to this disease in these groups.
H Hatami, B Kalantari, Ar Farsar, A Asgari, S Karkhaneh,
Volume 11, Issue 4 (3-2016)
Abstract
Background and Objectives: Acute gastroenteritis is mainly caused by some viruses and often NoVs. In January 2014, an outbreak of gastroenteritis occurred in Pardis City, in Tehran and that made 5064 patients visit health centers. The purpose of this study was to investigate the epidemiology of the disease in this region.
Methods: This cross sectional study was done to evaluate the outbreak of gastroenteritis in Pardis City in January 2014. In this outbreak, the data of 1150 out of 5064 patient was collected by health centers. The inclusion criterion was residing in the location for at least ten days before its occurrence. The exclusion criterion was incomplete recorded data. A number of 126 human samples underwent laboratory investigation. The data collection tool was was line listings and data analysis was done with Excel 2010 and SPSS21 software.
Results: female and male patients comprised 57.8 and 42.2% of the study population and 59.7% of the subjects were under 27 years of age. The most prominent symptoms were vomiting (94.9%), diarrhea (37.7%), abdominal pain (18.8%), and fever (0.6%). The results showed that bacterial contamination, parasites, serologic tests for hepatitis E (IgM-HEV) and hepatitis A (IgM-HAV) and RT-PCR for hepatitis E and A were negative but 6 out of 9 fecal samples were positive for NoVs using molecular RT-PCR.
Conclusion: The results revealed the role of NoVs in Pardis City in 2014. Moreover, clinical and epidemiological characteristics of the population, season, and the environment of this diagnosis were confirmed.
M Teimouri , E Ebrahimi, Sm Alavinia,
Volume 11, Issue 4 (3-2016)
Abstract
Background and Objectives: Diabetic patients are always at risk of hypertension. In this paper, the main goal was to design a native cost sensitive model for the diagnosis of hypertension among diabetics considering the prior probabilities.
Methods: In this paper, we tried to design a cost sensitive model for the diagnosis of hypertension in diabetic patients, considering the distribution of the disease in the general population. Among the data mining algorithms, Decision Tree, Artificial Neural Network, K-Nearest Neighbors, Support Vector Machine, and Logistic Regression were used. The data set belonged to Azarbayjan-e-Sharqi, Iran.
Results: For people with diabetes, a systolic blood pressure more than 130 mm Hg increased the risk of hypertension. In the non-cost-sensitive scenario, Youden's index was around 68%. On the other hand, in the cost-sensitive scenario, the highest Youden's index (47.11%) was for Neural Network. However, in the cost-sensitive scenario, the value of the imposed cost was important, and Decision Tree and Logistic Regression show better performances.
Conclusion: When diagnosing a disease, the cost of miss-classifications and also prior probabilities are the most important factors rather than only minimizing the error of classification on the data set.
S Masoudi, F Pourdanesh, A Biglarian, M Rahgozar,
Volume 11, Issue 4 (3-2016)
Abstract
Background and Objectives: The aim of this study was to analyze the risks of local recurrence, second primary tumor, and metastasis in oral squamous cell carcinoma (OSCC) patients and to present their prognosis after treatment.
Methods: In this retrospective cohort study, 147 patients with oral squamous cell carcinoma (OSCC) who were older than 40 years were included using the data of 1973–2010 Surveillance, Epidemiology, and End Results (SEER) Program in the United States. The variables included gender, race, stage, histologic grade, tumor site, treatment modalities, and dates of diagnosis and death. Markov Multistate model was used for analysis.
Results: At a median follow-up of 33 months, local recurrence, second primary tumor, and distant metastasis rates were 34.01%, 85.03%, and 17.01% respectively and 40.13% of the patients died. Patients with cervical lymph nodes were at risk of second primary tumor 1.37 (1.05-2.05) times higher than early stage patients and were 2.33 (1.29-4.18) times more likely to die. After one year, the risk of death for patients with local recurrence or second primary tumor was almost similar but after 5 years, the risk of death was higher for local recurrence than second primary tumor.
Conclusion: Awareness of the next state and its time with respect to the patient’s clinical status can be one of the appropriate methods for timely diagnosis and treatment to reduce the mortality rate of OSCC patients.
Mh Mehrolhassani, Aa Haghdoost, M Emami,
Volume 12, Issue 0 (3-2017)
Abstract
Good governance promotion in the health sector needs effective policies and evidence-based decision making. Using efficient and effective information is an important issue so that planners will not be confused amid many figures and numbers and also the main problem will not be marginalized. Hence, having a common language and consensus between policy makers and decision makers about the cycle (collecting and processing information, analysis, and judgment) and decision-making tools (criterion, indicator, index, and variable) is an initial and crucial step in evidence-based decision making. The main challenge for creating such an information system is the lack of a common language among scientific and executive experts; so the aim of this study was to provide a perspective of the concept of decision-making and the main components of its cycle and tools and to review these concepts in health care financing system.
Mh Mehrolhassani, Aa Haghdoost, R Dehnavieh, M Abolhallaje, M Emami,
Volume 12, Issue 0 (3-2017)
Abstract
Governance and leadership are seen as the most important function in the realization and promotion of community health. This two components through legislation must identify present situation, determine the desirable situation, provide infrastructures and implementation mechanisms and in accordance with stated policies and planning, they should apply necessary monitoring and control. In this regard, the most important challenge is a comprehensive and evidence-based identification and analysis, which can consider all functions in relation to the objectives at a general and coherent glance and assess the functions of the health system.
Mh Mehrolhassani, M Emami, Aa Haghdoost, R Dehnavieh, S Amanpour, F Sabbah, M Bazrafshan,
Volume 12, Issue 0 (3-2017)
Abstract
Background and Objectives: Universities of medical sciences play a vital role in promoting population health and without a doubt, their performance should be measured and evaluated.
Methods: The study was a mixed method study (consecutive combination) and the universities were examined by census. In the qualitative phase of the study, by examining the documents and focused group discussions, the basic framework of the performance evaluation model and its associated challenges were elicited. Then, the policies, objectives, and strategies related to each dimension were extracted and finally, key indicators were selected. Finally, by running Analytic Hierarchy Process method, the weight of dimensions and their key aspects were calculated and the model was implemented.
Results: BSC was designed in accordance with the universities. In this model, four main aspects including population health, services, finance, and development were identified. Then, by reviewing the documents, key policies and strategies, key policies and criteria, primary and secondary strategies were extracted. 13 key indicators were chosen as the final indexes. Moreover, 3 main challenges and 11 secondary challenges were identified. The results of the AHP-BSC model indicated that categorizing (ranking) universities had an impact on their functional status.
Conclusion: The main challenge for evaluating the performance of universities was the presence of a logical connection between policies, strategies, and criteria to have comprehensive and concise indexes for evaluation and ranking.
R Goudarzi, Mh Mehrolhassani, R Dehnavieh, A Darvishi,
Volume 12, Issue 0 (3-2017)
Abstract
Background and Objectives: Efficiency measurement can be used for all decision-makers and planners for useful resource allocation. Social Security Organization as a health service provider, provides part of health care services in indirect sector. This study aimed to assess the performance of provincial units of Social Security Organization in the indirect health services sector.
Methods: This descriptive analytical study was conducted based on the available data of Social Security Organization in 2014. To assess efficiency and super-efficiency, the DEA-VRS and Anderson-Peterson rating model were used, respectively. Factors affecting the efficiency was evaluated using multivariate regression.
Results: The primary efficacy analysis showed that 61% of the provincial units of Social Security had maximum efficiency. Average efficiency was 0.94. After super-efficiency analysis, it was found that Markazi and Kerman provincial units were the most efficient and the most inefficient units, respectively. Additionally, none of the variables had a significant impact on the efficiency.
Conclusion: Evaluation of the general performance of provincial units reflected the good state of technical efficiency in the indirect health service sector. On the other hand, the scale efficiency of inefficient units compared with managerial efficiency had a higher share of inefficiency. Optimum performance can be achieved through modification of managerial practices for optimal utilization of resources and factors.
Mh Mehrolhassani, B Najafi, V Yazdi Feyzabadi, M Abolhallaje, M Ramezanian, R Dehnavieh, M Emami,
Volume 12, Issue 0 (3-2017)
Abstract
Background and Objectives: Timely access to required health services without any financial hardship is necessary to achieve public health. Therefore, the aim of present study was to review the policies and plans adopted in the health financing system.
Methods: The qualitative study with a policy research approach reviewed upstream laws, policies, and plans in Iranian health financing. Then, by holding seven focused group discussions with 28 participants who represented various stakeholders, financing policies and programs were identified. Using framework analysis, the data were coded and categorized.
Results: In response to health financial protection indexes improvement, policies and plans in this field were defined in 10 themes and 4 categories: resources collection, resources management and pooling, resources allocation, and strategic purchasing of health services. The most important policies and plans were integration of insurance funds, increasing sustainable financial resources and targeted allocation of subsidies, services priority setting, establishment and improvement of a performance-based payment system with emphasis on integration of the professional element in the public and private sectors.
Conclusion: There is no gap for documented laws and policies in the Iranian health financing system. The main barriers are the method of implementation and adequate commitment to laws that have created major difficulties in relation to financial protection. Resolving these barrierrs requires sufficient political support and a common understanding between stakeholders at different levels of policymaking and implementation and designing programs based on the infrastructures.
Gh Moradi, M Sehat, Aa Haghdoost, M Karami, R Chaman, Z Khazaei, E Goudarzi, M Asadi Lari, E Mostafavi, K Holakouie Naieni ,
Volume 12, Issue 0 (3-2017)
Abstract
Background and Objectives: Epidemiology is a tool and a field of science which provides evidences necessary to make decisions. It is known as one of the basic sciences of public health. This study aimed to identify strategies for the promotion of epidemiology by Iranian Epidemiological Association so that people graduated in this field would become able to play an effective and positive role in different parts of the country.
Methods: This study was conducted in 2015. The views and opinions of the members of Iranian Epidemiological Association were collected by email. The views of the members were classified using qualitative methods.
Results: The results of this study helped to identify some of the strategies for the promotion of the position of epidemiology in Iran’s health system by the members of Iranian Epidemiological Association.
Conclusion: Iranian Epidemiological Association can play a more effective role in the promotion of epidemiology in the health system. Effective communication with the members, holding group meetings, advocacy and negotiation, reporting the activities of the Association continuously, identifying national problems and seeking solutions are some of the strategies that can help to enhance the role of the Association and promote the position of epidemiologists in Iran.
V Montazeri, F Jafarpour Sadegh , S Hosseinpour, Hr Mirzaei, E Akbari, M Ehsani, S Akbari, N Asadi, M Mahmoudinezhad, E Mirtaheri, Z Sanaat, S Pirouzpanah,
Volume 12, Issue 1 (6-2016)
Abstract
Background and Objectives: Reproductive factors are in close relationship with breast carcinogenesis. This matched case-control study was conducted to study the association of reproductive risk factors with the risk of breast cancer (BC) among women in Tehran and northwest of Iran.
Methods: This hospital-based case-control study was performed on a total of 432 patients diagnosed with BC with confirmed histopathology who were recruited from hospitals affiliated with Shahid Beheshti and Tabriz University of Medical Sciences between 2007 and 2012, and 543 regionally matched controls without a prior history of BC.
Results: The average number of pregnancy and breast-fed children were significantly higher in cases than controls (P<0.01). The duration of breast-feeding was longer in patients (18.0±8.4 months) than controls (16.0±9.1; P<0.001). Most of the patients were diagnosed with BC above the age of 48 years old which was higher than the mean age of the recruited matched controls. Older age was associated with a 3.87 higher risks of BC development (95% CI: 2.94-5.10). The higher frequency of lactation in patients was significantly associated with the elevated risk (OR=2.22, 95% CI 1.62-3.04). The duration of breast-feeding within14-24 months was correlated with OR=0.52 to protect BC development during the reproductive age
(<48 years) (95% CI: 0.32-0.86).
Conclusion: High frequency of pregnancy, lactation, and older ages at first pregnancy are associated with the risk of BC, while older age at puberty, menopause, and longer duration of breast-feeding (age above 48 years) have inverse associations with the risk of BC.
A Ahmadi, H Soori, Y Mehrabi, K Etemad,
Volume 12, Issue 1 (6-2016)
Abstract
Background and Objectives: Determining and monitoring the age at myocardial infarction (MI) and its comparison in various regions is one of the vital and basic principles for the management of MI.This study was conducted to determine the age at the first MI in Iran.
Methods: In this cross-sectional, analytical study at a national level, the data of 20750 new MI patients registered in 2012 in 31 provinces of Iran according to the cardiologist’s diagnosis, World Health Organization criteria, and the codes ICD10: I21-I22 were used. The calculations were done using the Stata 12 software.
Results: The mean±SD of age at the first MI was 61.2±13.4 years in all patients in Iran. Moreover, 15033 (72.4%) patients were male with a mean age of 59.6±13.3 years. The mean age at MI in men was lower than women (65.4±12.6 years), showing a statistical significance (P<0.001).The mean age at MI was different among Iran provinces, with a statistical significance (P<0.001). The lowest mean age at the first MI was seen in the patients living in Semnan (59.1±12.9 years), followed by Tehran (60.4±13.5 years), Sistan va Balouchestan (60.3±13.9 years), and Lorestan (60.1±14.5 years), with a significant difference from the mean age of the patients in Ardabil (63.2±15.1 years) and Zanjan (64.4±112.8 years) (P<0.019).
Conclusion: Our study demonstrated that the age at MI was approximately five years younger in men than women. This studyprovided the ground for monitoring the age at MI, and more effective management of cardiovascular diseases in Iran.
Mh Fallah Mehrabadi , Ar Bahonar, F Tehrani, M Vasfi Marandi , A Sadrzadeh, M Shabani ,
Volume 12, Issue 1 (6-2016)
Abstract
Background and Objectives: Influenza is an acute, highly contagious disease of a variety of both domestic and wild bird species. The aim of this study was to estimate subclinical infections or previous exposure to H5 and H7 subtypes and to discover potentially important determinants of the prevalence of this disease in industrial and backyard poultry in Iran.
Methods: A survey was conducted from September to December 2014 in Iran using a cross-sectional design throughout the entire country. The Enzyme-Linked Immunosorbent Assay (ELISA) was used as the screening test and all ELISA-positive samples were examined with the HI test to differentiate H5 and H7. A total of 1378 places and 31547 birds were sampled.
Results: One place (bird garden) out of 1378 was positive for the H7 subtype and six places (2 bird gardens, 3 villages, and 1 ostrich farm) out of 1378 were positive for the H5 subtype on HI test. The results of this study showed that the presence of a lake (OR=12.20, CI 95% 2.19-68.09) and live bird marketing (11.73, CI 95% 1.32-104.42) were risk factors for the H5 subtype.
Conclusion: Sampling migratory waterfowl birds is recommended for early detection of probable infections and preventing the spread of infection to the backyard and industrial poultry because of their role in the transmission of the disease and probability of circulation of the virus.
Mr Aflatoonian, I Sharifi, Mr Shirzadi, B Aflatoonian,
Volume 12, Issue 1 (6-2016)
Abstract
Background and Objectives: Anthroponotic cutaneous leishmaniasis (ACL) is restricted to humans; thus, prompt diagnosis and early treatment are significant measures to control the disease. This study was conducted to determine the effect of direct active case- detection and early treatment on the control of ACL in Bam District.
Methods: This retrospective cohort study was performed based on intervention and nonintervention. After the 2003 earthquake, an equipped treatment center was established to actively detect CL cases following the CL epidemic. This intervention was carried out in 2007 and the suspected cases were referred to the center for diagnosis and treatment Another comparable CL treatment center was selected as the control in Kerman. The recorded data of the patients were analyzed with statistical tests at p<0.05.
Results: The incidence rate steadily increased to 30% from 2003 to 2007 whereas the incidence gradually decreased to 1% after the intervention. However, by contrast, the incidence rate increased significantly in the control area. The treatment failure and relapse rate of ACL showed no significant difference with the control group before and after the intervention. The effectiveness of the intervention was calculated to be 85%.
Conclusion: Active case-detection and early treatment of ACL could be an effective measure in controlling ACL, particularly during epidemics. Lessons learned from the 2003 Bam earthquake could be used as a suitable model for ACL endemic areas, nationally and globally.
