Iranian Journal of

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Background & Objective: Malnutrition is one of the main nutritional problems among children under 5 years especially in developing countries. The effects of malnutrition in this range of age group includes disorder of mental and physical growth and development, increase in the morbidity and mortality, decrease of the learning capacity. A detailed epidemiological picture of the prevalent malnutrition status among children under 5 years in different regions of Iran enables health policy makers to identify priorities, establish political commitment and design appropriate interventional programs to prevent and control malnutrition and improve nutritional status of children. To determine the prevalence rate of malnutrition among children under 5 years.
Methods: Demographic data, weight and height of 34200 Iranian children between 0-72 months old in 28 provinces of the country in 2005 year based on a cluster sampling were gathered. The subjects' weight and height were measured by trained staff. Prevalence of underweight, stunting, and wasting indicators was determined by measuring the weight and height of subjects in urban and rural areas. EPI6 statistical software, version b6/04, was used for all statistical analyses.
Results: 4.7% of the children aged less than five years suffered from stunting (95% CI: 4.5- 4.9%) The prevalence of this type of malnutrition among urban children is significantly less than rural children (95% CI: 3.1- 3.5% and 6.5-7.1% respectively). Meanwhile the prevalence of underweight was 5.2% in the country (95% CI: 5.1-5.4% while the prevalence of this type of malnutrition was significantly less among urban children than those in rural ones. Moreover, the prevalence of wasting was 3.7% (95%CI: 3.5-3.9%) and there was a significant difference in this regard between the urban and rural children. Thus this indicator was significantly higher among urban children than those in rural areas (95%CI: 3.8-4.3% and 3.0-3.5% respectively).
Conclusion: The results of the study show that the prevalence of protein-energy malnutrition was low among Iranian children under five years old. In comparison with previous studies, it is felt that there has been a prudent decrease in all malnutrition in all levels. However, there were significant differences in the prevalence of malnutrition in different provinces, which has resulted in the differences in their developmental stages as well. It appears that subjective strategies are required to improve the nutritional and health status among children under five in all provinces.

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Background & Objectives: Increasing in prevalence of juvenile myopia in recent decades in eastern and western countries, especially in urban elementary school children, suggests that changing in early life style may play an important role in development of myopia. Our aim was to determine the relationships between myopia and overweight in elementary school children of Eslamshahr a city near Tehran, Iran Methods: In a case control study, 240 new myopic primary school children (grade 2-4) identified as cases and 240 children without myopia in the same schools enrolled as control group. Anthropometric information was completed from schools’. Other information about pre-entrancing to school was collected by interviewing their parents. Children having a Body mass index BMI>=85th CDC2000 percentile were identified as overweight. Adjusted odds ratio for overweight was estimated after adjusting other potential risk factors.
Results: Of total 53.3% were girls. 23.8% of children in case group and 10.1% of them in control group were categorized in overweight group. After adjusting for other potential risk factors (family history, breast milk intake, near works, mother`s job and financial position) being overweight was independently associated to myopia (OR: 3.10, 95% CI: 1.9-5.03).
Conclusion: It is concluded that overweight in children in preschool age, is independently associated with increased risk of myopia in primary school children. Therefore health promotion programs in order to change of the life style in this group of children should be considered.

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Background & Objectives: Evaluating the performance of outbreak detection methods using real data testing provide the highest degree of validity. The aim of this study was to determine the performance of the Exponentially Weighted Moving Average (EWMA) in real time detection of two local outbreaks in Iran.

Methods: The EWMA algorithm (both ƛ= 0.3 and 0.6) applied on daily counts of suspected cases of measles to detect local outbreaks which had been occurred in Mashhad and Bandar Abbas cities during 2010. The performance of The EWMA algorithms were evaluated using real data testing approach and reported by correlation analysis.

 Results: Mashhad outbreak was detected with a delay of about 2 to 7 days using EWMA algorithms as outbreak detection method while the utility of EWMA algorithms in real time detection of Bandar Abbas’ outbreak were on time good optimal. Maximum correlation value for EWMA 2 in relation to Mashhad outbreak was 0.60 at lag 2.

Conclusion: Applying the EWMA algorithm as an outbreak detection method at local levels is not suggested. However the characteristics of data are determinant of the performance of such detection methods.

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Background & Objectives: Malnutrition among children under five year is a significant public health index. The aim of study was to estimate the prevalence of malnutrition in under 5 years old children in Chadegan (area district city) parish of in Isfahan, Iran.
Methods: This was a community-based cross-sectional study. It was carried out on all randomly selected households with children age under five years old in rural and urban area of Chadegan in 2010 year. Demographic information was collected via household and a standardized questionnaire was administered to mothers or guardians and trained personnel measured weight and height or length. Results: The results revealed that prevalence of malnutrition’s based on wasting, underweighting and stunting and obesity were 17.8%, 34.5%, 37% and 2.2% respectively. The main contributing factors for wasting were found to be child’s age, habitat, onset of complementary food, history of disease, hospitalization (P<0.05). Gender, father's job, mother’s education, ethnic, habitat, history of disease were found to be correlated with stunting as well. (P< 0.05).
Conclusion: Development programs should focus on the disadvantaged rural and urban arears of people to improve their nutritional status. Intervention strategies and programs should be developed to target the preventable risk factors.

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  Background and Objectives : Failure to gain weight (FTG) is one of the predominant health issues in children. The aim of this study is application of longitudinal transition model in determining the prognostic factors for failure to gain weight in children under two years.

  Methods: In this study, 363 children under 2 years that were visited at the health centers in the east of Tehran were studied. Samples were selected using the two stage clustering method. The study variables were measured repeatedly in 18 consecutive times. Since the data was longitudinal and are dependent, first order transition model was used to determine the risk factors of failure to gain weight. All analyses conducted in R.

  Results : The mean (±sd) birth weight was 3057gr(± 838) and 6.9% of the children weighed less than 2500gr at birth. Moreover, 231 children (63.6 %) had no FTW until 2 years of age while 23 ( 6.3 %) had three or more episodes of FTW. Diarrhea (P<0.001), weaning (P<0.001), catching cold (<0.001), and teething (P<.001) were significant risk factors of failure to gain weight. To measure the association between weight loss and the weight in the previous visit, the logarithm of odds ratios was used that was significant (P=0.039).

  Conclusion: The association between two consecutive measurements showed that any failure in weight would affect weight gain in the next period of time and the effect of weight deficiency remains for at least one month.

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Background and Objectives: Disorders of height and weight growth are the most important health disorders affecting children younger than two in developing societies. Failure to treat these disorders can lead to the increased mortality and mental, emotional or physical disability. The objective of this study was to investigate the growth trends of children and the factors affecting it.

Methods: This retrospective cohort study was conducted on 2030 children younger than two in Khorramabad, Iran who were selected using stratified and cluster sampling. Based on household records, the weight growth trend was recorded as a four-level variable (decline, stagnation, slowness and desirable) and the the height growth trend was recorded as a three-level variable (stagnation, slowness and desirable); finally, the data were modeled using a longitudinal marginal model and the SAS software version 9.2.

Results: The incidence of at least one decline in the weight growth curve and one stagnation in the height growth curve was 14.2% and 10.4%, respectively. The child’s age and the maternal educational level had a significant effect on the growth trends. However, the sex, parity and the exclusive breastfeeding during the first six months had no significant relationship with the growth trends.

Conclusion: Given the results and the relatively high prevalence of growth disorders among children, it seems that increasing the awareness of low literate women about feeding of the children is the most important approach to manage growth disorders. Additionally, health-care professionals should mostly focus on monitoring the growth of children older than 12 months.

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Background and Objectives: Food is one of the major needs of the humans that is defined in the context of food security. The objective of this study was to find the relationship between food insecurity and stunting combined with obesity and overweight in children aged 7-11 years old in Zabol.

Methods: This study had two phases. In the first phase (cross-sectional), 3443 students aged 7-11 years old were selected with stratified – cluster sampling. In the second phase, all of the children with stunting and obesity or overweight based on the CDC growth chart comprised the case group and 112 students with normal height and weight based on the CDC growth chart comprised the control group. The case and control groups were matched in terms of age, sex, and school. The food security USDA questionnaire that consists of 18 items was completed through interview with mothers to evaluate the family food security.

Results: The prevalence of stunting, obesity, and overweight was 17.95%, 4.56%, and 10.98% respectively and the prevalence of stunting combined with obesity and overweight was 1.71% in the first phase of the study. There was a significant relationship between food insecurity and stunting combined with obesity and overweight. Food insecurity had a significant relationship with low economic status, living in rented homes, labor job and unemployment of the household head, and low education level of the household head in the case group.

Conclusion: Because of the significant relationship between food insecurity and stunting combined with obesity and overweight, it is necessary to design interventional programs to prevent or reduce food insecurity.

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One of the traditional methods used for the analysis of survival data is the Cox regression technique. This method calculates the conditional risk ratio. However, when the aim of the study is to estimate the effect of exposure in the total population level, using these conditional methods is not apposite. Furthermore, the hazard ratio has disadvantages of its own such as being non-collapsible, having the risk of structural selection bias and variability in time. Given the limitations, it is recommended to use the marginal hazard ratio, which estimates the average causal effect of exposure in the total population level.
This study introduces the inverse probability treatment weighting (IPTW) as a method of estimating the marginal causal effect. Finally, to illustrate IPTW method, we used Golestan Cohort Study and estimated the marginal causal effect of smoking on time to death due to the upper gastrointestinal cancer (esophageal-gastric).

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Background and Objectives: Anthropometric indices, especially weight, provide useful information for the care and treatment of newborn infants and can be used to identify infants at risk. Therefore, this study was conducted to examine the mean weight, height and head circumference measurements of infants and some related factors.
 
Methods: This cross-sectional study was performed to investigate the anthropometric indices (weight, height and head circumference), demographic characteristics, and delivery data of 1484 newborns in 2016 using multi-stage sampling. Moreover, the predictors of these indices were analyzed using a linear regression model.
 
Results: The mean weight, height and head circumference of the newborn infants was 3185 ± 465 g, 49.92 ± 2.92 cm, and 34.58 ± 2.29 cm respectively, and 7% of newborns were low birth weight. The male newborns weighed 57.29 g more than females on average at birth (p <0.05). Besides, the height and head circumference of the male newborns were 0.15 and 0.10 cm larger than the female newborns respectively but the difference was not statistically significant. In addition to gender, gestational age at birth (week) and type of delivery correlated with all three anthropometric indices in multivariate analysis.
 
Conclusion: Identifying and controlling largely adjustable risk factors can make it possible to prevent low anthropometric parameters, particularly low birth weight.

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Background and Objectives: The incidence of colorectal cancer has increased significantly in Iran in recent decades. The pattern of occurrence varies in different populations. A study was conducted to perform a spatial analysis of colorectal cancer and some of its risk factors in Iran using GIS.
 
Methods: The data of this descriptive-analytic study included colorectal cancer incidence as a dependent variable and physical activity, Body Mass Index and smoking as independent variables recorded by the Cancer Department, Center for Non-Communicable Diseases Management, the Ministry of Health and Medical Education and the care system for non-communicable disease risk factors according to province and gender in 2009. Data was analyzed using the ArcGIS 10.3 software and spatial correlation analysis, hot spots analysis, and geographic weighted regression model.
 
Results: The spatial relationship between the disease and some of its risk factors was confirmed by the model of geographical weight regression, according to which the northern and central provinces had the highest risk of colorectal cancer compared to other regions of the country.
 
Conclusion: The results of this study showed that spatial analysis could be useful in identifying disease patterns, prioritizing the factors affecting it, and controlling the disease through strategic planning and interventions.

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Background and Objectives: Pre-natal mental health problems are major causes of disease burden, especially in lower socio-economic groups of population. The present study used data of a prospective cohort study to estimate the risk of mental health problems, including depression, anxiety, and stress, on birth weight.
 
Materials and Methods: This study used data of 398 pregnant women who were participants of the Bandar Abbas Pregnancy Cohort Study (BAPC) during 2017-2020. Data of depression, anxiety, and stress were collected using DASS-21items questionnaire in pregnancy. Low Birth Weight (LBW), as birthwieght below 2500 grams, was calculated according to infant`s vaccination log. Modified Poisson regression models with logarithm link function and significance level of 5% were applied to estimate the effect of depression, anxiety and stress on LBW.
 
Results: Compared to the subjects without mental health problems, the risk of LBW increased by 8.03 times in the severe depression (95% CIs: 5.55-11.62), by 8.06 times in the moderate stress (95% CIs: 5.64-11.51), by 3.13 times in the severe anxiety (95% CIs: 1.18-8.31), and by 8.43 in the highly severe anxiety (95% CIs: 5.80-12.25).
 
Conclusions: Severe and moderate levels of depression, anxiety, and stress all had statistically significant effects on LBW. Pre-natal screening services can help mitigate the burden of mental health by timely detection and referral. Moreover, designing and implementing consultation programs for pregnant women and their fsmilies, expecially their spouses, to provide emotional support and to improve marital relationship are amongst the suggestions.