Journal of School of Public Health and Institute of Public Health Research

A QUALITATIVE ASSESSMENT OF URBAN FAMILY PLANNING FACILITIES HAMADAN, MAY – SEPTEMBER 2003

A Shahidzadeh

This cross-sectional study was conducted from May to September 2003, with the aim of determining quality of service in 25 State-run family planning clinics in Hamadan city. A total of 400 consultations were observed and assessed using UNICEF quality checklists. Results showed that less than 50% of the clients are receiving service of a satisfactory quality areas of care where quality was worst included history taking, physical examination and counseling. It became apparent that care providers with higher education had lower performance levels compared to their less educated colleagues. Service for new clients was of poorer quality than for those who had requested a change of contraceptive method. Furthermore, earlier hours of a work shift (before 10 o’clock) were associated with better service quality than later hours. Altogether, the study reveals serious flaws in areas such as training of family health workers and human resource management within the current system. To address these shortcomings, we recommend a more client-oriented approach in health care, use of supplementary material to promote client knowledge, and training of health workers with due emphasis on effective communication and performance.

USING DIFFERENT REFERENCE VALUES TO DETERMINE PREVALENCE OF OBESITY AMONG SCHOOLCHILDREN IN AHWAZ

M Tabatabaei

The increasing prevalence of adult obesity, and its individual as well as public consequences has always been a major concern for nutrition and health specialists. The last decade has also witnessed a sharp rise in childhood obesity rates worldwide. There is little reliable information on childhood obesity rates in Iran, hence the need for prevalence studies in different parts of this country. These studies are complicated by a paucity of baseline (reference) data on obesity in Iranian children. This study aims to determine the prevalence of obesity in Ahwaz primary school pupils by using three different sets of baseline values, namely IOTF, CDC and local data from Iran. Using two-stage cluster sampling, a total of 3482 students aged 6-12y (1843 boys & 1639 girls) were randomly selected from Ahwaz primary schools. Weight and height were measured and BMI calculated. Obesity was defined as having a BMI ≥ 95th percentile of each of the three sets of reference values. Prevalence rates according to Iranian reference data, CDC 2000, and IOTF 2000 were %10/9, %5/2, and %3/6 respectively. Obesity is quite common among school children in Ahwaz and further studies are required to determine risk factors. In addition, different reference data produce different prevalence estimates.

ANALYSIS OF ANGINA PECTORIS STATUS BASED ON THE PROBABILITY OF MISCLASSIFYING THE RISK FACTOR: TEHRAN LIPID AND GLUCOSE STUDY

A Abadi

Misclassification of disease status and risk factors is one of the main sources of error in studies. Wrong assignment of individuals into exposed and non-exposed groups may seriously distort the results in case-control studies. This study investigates the effect of misclassification error on odds ratio estimates and attempts to introduce a correction method. Data on 3332 men aged 30-69 years from Tehran Lipid and Glucose Study (TLGS) were considered for investigating the relationship between angina pectoris and smoking. The “Rose” questionnaire was used to evaluate angina status. Two different definitions of smoking were included: I) active smokers versus non-smokers, II) active and ex-smokers versus never smoked. The relation between variables was assessed both with and without considering misclassification in smoking. Definition I (commonly used in many epidemiologic studies), resulted in a non-significant OR=1.09 (95% CI: 0.84, 1.41). Using the correction method based on the principle of non-differential misclassification, the OR increased to 1.13 (95% CI: 0.89, 1.43), which was still non-significant. However, a correction procedure that included the probability of differential misclassification produced a significant OR=1.46 (95% CI: 1.15, 1.85), p<0.05. It is evident that misclassification in risk factors can lead to inaccurate results. This study showed that the relation between variables may have not been discovered if the probability of misclassification was ignored. Moreover, in case of probable differential misclassification, applying correction methods for non-differential misclassification would be inefficient.

EVALUATION OF OCCUPATIONAL HEARING LOSS IN FIRE FIGHTERS IN TEHRAN

F Asghari

Hearing loss is a controversial occupational disease in fire fighters because exposure to hazardous levels of noise in this job is so variable and unpredictable. In this study, audiometric assessments were performed on 117 fire fighters to evaluate their hearing loss. The results showed that the average fire fighter has a characteristic noise-induced threshold shift, with maximum hearing loss occurring at 6000 Hz. The hearing loss at the test frequencies was related to age, although the association exceeded that of general population only in 6000 Hz frequency in left ear (p=0.021). Despite finding a pattern of threshold shift typical of occupational hearing loss, it must be noted that after controlling for age, there was no strong relation between length of time on the job and the degree of hearing loss. It seems that more extensive studies are needed to evaluate this relationship.

TSP AND PM10 MEASUREMENT AND DESCRIPTION OF AIR QUALITY INDEX (AQI) IN THE AMBIENT AIR IN SHARIATI HOSPITAL DISTRICT

M Kermani

Apparently, breathing clean air is of significant importance to human beings and thus attention to what enters our body through inhalation is on the increase. Tehran’s air pollution has received considerable media coverage in recent years: Since particulate matter (TSP and PM10) is one of the important pollutants in this city, an attempt was made to study TSP and PM10 concentrations and to make a qualitative assessment of air using the Air Quality Index (AQI), with TSP and PM10 sampling both daily and on a monthly basis. Shariati Hospital district was selected as study area from 22 December 2001 to 20 April 2002. To determine the amount of TSP and PM10 according to EPA and WHO standards, 61 samples were taken for TSP and 61 samples for PM10 with High Volume Sampler. The results indicated that: • As for TSP and PM10, the period extending from 20 February to 20 March (Esfand) was the most heavily polluted one in this study. The cleanest spell was observed from 21 March to 20 April (Farvardin). • Saturdays and Mondays were the most polluted days of the week for TSP and PM10 and Fridays were the cleanest. • As for TSP, In 51 percent of the samples the Air Quality Index (AQI) was below 100 (AQI<100) and in the remaining 49 percent, AQI was above 100 (AQI>100). • In the case of PM10, in 75.5 percent of samples the Air Quality Index (AQI) was below 100 (AQI<100) and in the remaining 24.5 percent AQI was above 100 (AQI>100).

EVALUATION OF THE EFFECTIVENESS OF ETHANOLIC EXTRACT OF PEGANUM HARMALA L. AGAINST PLASMODIUM BERGHEI IN COMPARISON WITH CHLOROQUINE IN SOURIAN MICE USING INVIVO TESTS

A Motevalli haghi

Owing to importance of employing native and traditional medicinal plants with good efficacy against malaria parasites, an ethanolic extract of Peganum harmala L. was tested on Plasmodium berghei in sourian mice and a comparison was made with the effect of chloroquine on the same parasite. In this study 56 sourian mice were divided into 8 groups, each consisting of seven animals. The first 7 groups were infected with P. berghei and the last group was used as control. The first seven groups were given chloroquine, Peganum harmala at four different concentrations (20, 100, 300, 600 mg/kg) and placebo, respectively and the seventh group did not receive any treatment. The evaluation was done by Rane test. In each group the level of parasitaemia was determined on days 4 & 7, and compared with values from Day 0 (just before treatment) in order to record the decline in parasitaemia in treated groups. Results were analysed using SPSS soft ware and one-way analysis of variance (ANOVA). The results indicated that, although all the four concentrations of the Peganum harmala extract significantly reduced parasitaemia in the infected subjects, the 100 mg/kg solution showed optimal effectiveness on the parasites in comparison with other concentrations and the no-treatment option. We conclude that although the ethanolic extract of peganum harmala is not as effective as chloroquine in reducing parasitaemia, it can nonetheless cause a significant decrease when compared to control and placebo groups.

MULTINOMIAL LOGISTIC REGRESSION MODEL WITH MISSING DATA AND ITS APPLICATION TO GOITER DISEASE DATA

K Azam

In large–scale sampling opeartions (e.g. nation-wide health surveys) we always face the problem of non-response item(s) and/or non-response unit(s). In fitting a model to the data we have two groups of variables, namely dependent and independent variables. Non-response may occur for any of these groups of variables. In this paper we assume Y as a categorical dependent variable with three levels, Z and X as independent variables from any kind: scale, categorical, ordinal, etc. We have complete data on the first two variables and we assume that the missing items follow a random pattern (MAR). Then a model is devised based on the likelihood function for the whole data set (including missing values) and estimates of parameters are compared with those obtained by statistical programs such as SPSS, which are only based on completely observed data and ignore units with missing data. Our results show that the likelihood-based model is superior to the standard approach utilized by the software packages. The comparison is made using data on thyriod disease (goiter) obtained by a health survey in Gazvin province.

ANTHROPOLOGICAL STUDY OF THE BELIEFS AND BEHAVIORS OF WOMEN ABOUT ABORTION IN AZARBAYEJAN NEIGHBORHOOD IN AN AREA IN DOWNTOWN TEHRAN

M Chinichian

Anthropology is concerned with description and interpretation of various aspects of social life it is an attempt to understand and assess the origin of different social phenomena. In this research we have studied the abortion beliefs and behaviors of women in reproductive age, and we also tried to explain how these beliefs and behaviors were changing with time. Considering the in-depth nature of anthropological research, Azarbayejan, an old and traditional neighborhood in downtown Tehran was chosen as the setting for this work. Besides the local women who came from different backgrounds we interviewed other groups of people for their views on reproductive health. These included health care professionals, community health liaison workers, psychologists and marriage guidance counselors, social workers, midwives and physicians. The individual in-depth interviews were completed by a simultaneous literature and document review. It became apparent that women’s beliefs on abortion form a wide spectrum, from outright condemnation to complete acceptance. Also in spite of the illicit and socially forbidden nature of abortion, there are widely different types of behavior among women. A host of medications, from herbal/traditional to modern, are being used for inducing abortion. Histories taken from patients have revealed many of these behaviors and their varieties. Existence of a certain type of behavior is an indication of its function in community. To conclude, in spite of these beliefs, abortion not only exists, but is often practiced in an unhealthy manner. So a more pragmatic approach (promoting quality of life) may be indicated.