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

Relationship between structural social determinants of health and women's empowerment in reproductive health

Masoumeh Simbar

Background and Aim : Empowering women means enabling them to decide independently on the basic issues of life. The great challenge of fertility and reproductive health of women is indicative of their inability to make decisions . The third objective of the Millennium Development Goals is empowerment of women and the effect of social determinants of health in this regard has been recognized. This study was conducted to assess the relationship between structural social determinants of health and women's empowerment in reproductive health.

Materials and Methods: This was a descriptive-correlation study including 400 women consulting the Shahid-Beheshti University of Medical Sciences health centers in Tehran, Iran. In the first stage, the health centers were selected by the simple random method, followed by quota sampling the f inal sampling was done by the convenience sampling method. The tools for data collection were demographic and socio-economic questionnaires, as well as a questionnaire to obtain data on women's empowerment in reproductive health . Data were analyzed using SPSS-17.

Results: That data showed that the women’s empowerment in reproductive health was at an intermediate level. Structural social determinants of health were correlated with women’s empowerment in reproductive health the highest correlation was found to be with women’s education level (r= 0.44, P< 0.001).

Conclusions: Women's general empowerment, as well as their empowerment and in family planning needs special attention. Structural social determinants of health are correlated with women's empowerment in reproductive health . Thus, policies should be adopted and plans executed aiming at strengthening the role of women in the family and the society .

Factors affecting self-care in women with osteoporosis: a qualitative study with the content analysis approach

Arezoo Fallahi

Background and Aim: Although self-care is known to affect favorably the control and treatment of osteoporosis, the effective factors from the patients’ viewpoint have not been investigated. The aim of this study was to explore factors affecting self-care from the viewpoint of women suffering from osteoporosis.

Materials and methods: This was a qualitative study conducted with a content analysis approach in 2014, including 15 women consulting the bone mass densitometry centers in Sanandaj, Iran, selected by purposeful sampling. The inclusion criteria were women aged &ge 50 years suffering from osteoporosis diagnosed definitively at least 6 months before, a T-score index > -2.5 (lower back or hip bone), taking drugs upon a physician^’s advice, ability to speak, and willingness to participate in the study. Data were collected through face-to-face and group semi-structured in-depth interviews and analyzed using the content analysis method. The accuracy and rigor of the data were confirmed based on such criteria as credibility, confirmability and transferability.

Results: Five main categories were extracted including “ background factors of the disease ”, “hope and weakness in confrontation with the disease”, “role of the physician”, “role of the family”, and “administrative centers and organizations”. Based on further analysis of the data, 11 subcategories were emerged including “cultural issues”, “lack of knowledge”, “non-priority of health”, “weakness and fear”,

“hope for the future” , “positive role of the physician”, “negative role of the physician”, “ active role of the family”, “ passive role of the family”, “ role of the media”, and “information centers”.

Conclusion: The finding of the study show that the responsibility of women suffering from osteoporosis towards their health is not a single-factor, but rather a multifactorial, phenomenon. Pre-requisites for empowering women to adopt self-care behaviors include increasing their hope to live longer, physician’s attention to the patient’s needs, increasing health promotion programs in the media, and strengthening role of the family (particularly role of men).

Study of Malaria Elimination program Efficacy on Quality of Malaria Surveillance System in Iran

Leila Faraji

Background and Aim : The National Malaria Control Program was developed, in 2011, into the National Malaria Surveillance Program. It is one of the most comprehensive surveillance systems in Iran. The aim of this study was to evaluate the impact of malaria elimination program on data quality and accuracy in the national malaria surveillance system.

Materials and Methods : This was a cross-sectional study conducted in four malaria-prone provinces in Iran to determine and assess the completeness and accuracy of the information collected in the malaria surveillance system. The purpose was to compare data reporting forms 3 and 4 (reporting positive cases from selected district health centers) between two time points, namely, 2009-2010 (before starting the program) and 2010-2012 (after starting the program).

Results: The total number of reporting forms included in the study was 1927, nearly 54% from the initial time point and the rest from the final time point. The highest and lowest proportions were 94.78% and 17.30% from Iranshahr and Hormozgan University health centers, respectively. On the whole, the degree of completeness of the forms was 84% (83.7% and 85% before and after starting the program, respectively). Based on the Chi-square test, the differences were not statistically significant.

Conclusion: Only a minor change occurred in the degree of completeness of the forms between the two time points: a 4% increase in form 4 and a 3% decrease in form 3. It can be concluded, then, that the elimination program h ad no significant effect on the completeness and accuracy of the reporting forms.

Effect of an educational intervention based on the theory of planned behavior on milk and dairy products consumption by girl-pupils

Hassan Eftekhar ardebili

Background and Aim : Milk and dairy products provide more than 50% of the calcium requirement in the daily diet of Iranians. In order to promote adolescents’ health and prevent the devastating effects of osteoporosis in adulthood, appropriate action should be taken to increase milk consumption among adolescents. The objective of this study was to increase milk and dairy products consumption among eighth-grade girl-pupils in Kamyaran City, Iran through designing and implementing an educational program based on the theory of planned behavior (TPB).

Materials and Methods : This was a quasi-experimental study conducted in 2014, including a total of 168 eighth-grade girl-pupils from two (out of six) schools, one as the intervention and the other as the control group, selected randomly by cluster sampling. The intervention group received education in 4 sessions, the educational tools being a pamphlet and a poster. Data were collected on the TPB constructs, food intake (by 24-hour dietary recall), and frequency of milk and dairy product intakes during the previous 3 days. All the participants completed the questionnaires at the beginning and 3 months after the intervention. The data were analyzed using the SPSS-18 software, the statistical tests being chi-square, independent-t and paired t-tests.

Results : The intervention brought about statistically significant increases in the mean scores of behavior intention, attitude, subjective norms, and perceived behavioral control (p<0/001). In addition, an increase was observed in the frequency of milk and dairy product intake, which was 0.36 units per day initially (p<0/001).

Conclusion : Considering the effectiveness and low cost of this intervention, expanding this program can potentially lead to a rise in milk and dairy products consumption among the pupils.

The effect of an educational program based on the BASNEF model on the nutritional behavior of guidance school female pupils

Hassan Eftekhar ardebili

Background and Aim: Nutritional knowledge acquired by young girls as would-be mothers will play an important role in children’s and family health protection and promotion in the future. The purpose of this study was to determine the effects of an educational program based on the BASNEF model on the nutritional behavior among guidance school first-grade female-students.

Materials and Method: This was an interventional study carried out in the form of a clinical trial including 160 female-pupils divided into two groups ─ a case and a control group ─ randomly selected by two-stage sampling, namely, classification and cluster sampling. The data gathering tool was a questionnaire. Education about healthy nutrition was imparted to the case group in 4 60-minute sessions in the form of lectures, group discussions, and question-answer in addition, pamphlets were distributed among the subjects. Data were collected and analyzed using the SPSS-18 software, the statistical tests being Chi-square, fisher , independent and paired t-tests.

Results: The data showed that the mean scores of knowledge and BASNEF model components as regards nutritional behavior increased after the intervention in the case, they being higher significantly in the case group as compared to the controls. The most important subjective norms after the intervention were the pupils’ parents .

Conclusions : The findings indicate that a 3-month educational intervention based on the BASNEF model can bring about desirable changes in some of the undesirable nutritional behaviors in guidance school pupils, and that designing and implementing interventions of this kind, with the support of health and school authorities, is quite feasible.

Use agricultural-industrial wastes to produce the enzyme xylanase by native Basillus subtilis S7e

Maryam Hashemi

Background and Aim: Xylanases are widely used in various food industries, including livestock and poultry feed industries, the pulp and paper industry, as well as the pharmaceutical industry. Several strains of microorganisms are capable of producing this enzyme by different mechanisms, Bacilliaceae being one of its important sources at the commercial scale. The culture medium for xylan is expensive and, therefore, it is not economical to use in producing xylanase by Bacillus subtilis S7e. The purpose of this study was to explore the possibility of using industrial-agricultural wastes as a source of carbon and nitrogen in submerged fermentation, for producing xylanase in amounts higher than that which can be produced by xylan culture (10048 U/).

Materials and methods: The indigenous strain of Bacillus subtilis S7e was cultured in the xylan medium, followed by incubation at 30°, 37° and 40° C. Then the nitrogen sources (rapeseed meal, soybean meal, tomato seeds, tea seeds, peptone, Vinas alcohol, casein, and ammonium sulfate) and carbon sources (molasses, wheat bran, rice bran, rice industry waste, gluten waste, malt waste, whey powder, and bagasse) were substituted for the meat and yeast extracts and the xylan culture medium, respectively.

Results : The maximum enzyme activity was observed at 30° C after 48 hours of incubation (6183U/l). Rapeseed meal with an enzyme activity of 10048U/l and molasses with an enzyme activity of 3759U/l were found to be the best nitrogen and carbon sources for Bacillus subtilis S7e , respectively.

Conclusion: Based on the findings of this study, f rom an economic point of view, agricultural-industrial wastes (rapeseed meal and molasses) are an excellent substitute for the more expensive culture media currently in use for producing the enzyme xylanase.

Ecological risk assessment of cadmium and lead in urban and forest park soils in Asadabad City, Iran

Eisa Solgi

Background and Aim : Contamination of the surface soils of the urban ecosystem with heavy metals poses potential ecological risks. In this research, a preliminary investigation was carried out to evaluate the potential ecological risk of cadmium and lead contamination in urban park soils in Assadabed City, Iran.

Materials and Methods : Soil samples were taken from the urban parks of Asadabad city and analyzed for heavy metals using atomic absorption spectrometry. Based on the concentrations of Cd and Pb in the soils, contamination factor (CF), contamination degree (Cdeg) and potential ecological risks status (RI) of the soils were calculated.

Results : Preliminary results showed a low degree of contamination of urban parks of of Asadabad City. Assessment of the potential ecological risk index (RI) indicated that the cumulative heavy metal contents of the soil do not pose any significant ecological risks. In any case, further analysis of the data showed that the potential ecological risk posed by cadmium was higher than that by lead.

Conclusion : The findings indicate that although urban park soils may be polluted due to presence of certain heavy metals, on the whole their ecological risk is insignificant. These findings can help greatly environmental managers in planning, risk assessment and decision-making in the area.

Asymptomatic malaria control program in high risk Jask district Hormozgan Province Iran

Mehdi Nateghpour

Background and Aim : Asymptomatic malaria is a great challenge in the control, elimination and eradication programs of the disease in the endemic areas. The infected individuals with asymptomatic malaria are not cured and are, consequently, a potential source for contamination of the mosquito vectors and spread of the disease in the area. Therefore, detection of asymptomatic infected people is very important as regards combating the disease. This study was conducted to determine the presence and prevalence of asymptomatic malaria in Jask district, Hormozgan Province, Iran during 2012-13, in the hope that the results will help in designing strategies to eliminate the disease in the area.

Materials and Methods: A total of 200 persons under coverage of health centers in Jask district were selected randomly and enrolled in the study. From each subject a 5-ml blood sample was taken in 3 occasions (total number of samples = 600), slides p repared and examined using microscopic and molecular (PCR) methods, as well as rapid diagnostic (RDT) tests.

Results: None of the 600 slides prepared microscopically showed any positive malaria case. Neither did any of those prepared by RDTs or Nested-PCR.

Conclusion : The findings of this study indicate that implementation of the malaria control program has been successful in the area therefore the malaria elimination program should continue.