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

Primary Health Care Strengthening Strategies in Iran: A Realistic Review

Parvaneh Esfahani

Background and Aim: The Primary Health Care (PHC) system is the most comprehensive, equitable and efficient way to promote people's health and social welfare by providing preventive, curative, rehabilitative and palliatvie services in a place close to where people live and work. Iran's PHC system faces challenges that limit its effectiveness and efficiency. The aim of this study was to identify strategies to strengthen Iran's PHC system.
Materials and Methods: A realistic review method was used in this research. Published articles on strategies to strengthen the PHC system between 1978 and 2019 were searched in eight databases and Google scholar search engine. Finally, 29 articles were found to be eligible for inclusion in this study; framework analysis was done using the MAXQDA-10 software.
Results: Twenty-nine strategies were identified for strengthening the PHC system. A well designed PHC system is one with the following characteristics: realistic goals and appropriate strategies equipped with necessary resources, organized in multidisciplinary teams that provide comprehensive and quality health services (intervention program), with strong governance and leadership, financing, work force, equipment and medicines, information systems and robust health services delivery processes and well adpated to the external environment (context). Such a PHC system will increase healthcare providers’ satisfaction and commitment, as well as the patients’ trust, participation and satisfaction (the mechanism) and, finally, promotes, restores, and maintains the people health (result).
Conclusion: A strong PHC system is a pre-requisite for strengthening a health system. Various strategies such as strengthening management and leadership, improving organizational structure and culture, improving the information system, empowering human resources and increasing population coverage can lead to an improved PHC system. Historical, social, cultural and economic factors affecting the health system should be considered in redesigning and stregtening a PHC system.

Risk Factors for Growth Failure of One-Year Old Children in the Suburbs of Bandar Abbas City: A Population-Based Prospective Cohort Study in the South of Iran, Conducted by Bandar Abbas Health Research Station

Kourosh Holakouie-Naieni

Background and Aim: The aim of this study was to determine the risk factors of growth failure of one-year old children in the suburban regions of Bandar-e-Abbas City based on a population-based cohort study conducted by Bandar Abbas Health Research Station, affiliated to School of Public Health, Tehran University of Medical Sciences in the south of Iran.
Materials and Methods: In this prospective cohort study in 2021, data on the growth of 540 one-year old infants obtained in a cohort study aiming to identify contributors to mother and child health in the suburbs of Bandar-e-Abbas City, Iran were used. The outcomes included weight, height, and head circumference growth failures among one-year infants. Data analysis was performed using the STATA software version 14, the statistical tests being descriptive statistics and univariate and multiple logistic regressions.
Results: Low birth weight was found to increase the odds of one-year-old children’s weight growth failure 3.05 times (the adjusted odds ratio, OR = 3.05; 95% CI: 8.91-1.04). A low socioeconomic status reduced the odds of head circumference growth failure 59% (the adjusted OR = 0.41; 95% CI: 0.19-0.89), and a low birth weight increased the odds of head circumference growth failure 2.46 times (adjusted OR = 2.46; 95% CI: 1.01-5.97). None of the maternal and childhood factors were related to the one-year-old child height growth failure.
Conclusion: The findings of this study show that low birth weight increases the odds of normal body growth and head circumference growth failures at the age on one year, while a low socioeconomic status reduces the odds of head circumference growth failure. There are no relations between any of the maternal and childhood factors and height growth failure at the age of one year.

The Effect of Breastfeeding Intervention on Knowledge, Attitude and Practice Among Mothers in the Third Trimester of Pregnancy: Application of the Transtheoretical Model

Roya Sadeghi

Background and Aim: The practice of breastfeeding among mothers is affected by their knowledge of, and attitude to, it. Therefore, this study aimed to determine the effect of intervention, using the transtheoretical model (TTM), on the knowledge, attitude and practice of exclusive breastfeeding among pregnant women in the third trimester referred to Golestan University of Medical Sciences in hospitals in 2021.
Materials and Methods: This quasi-experimental intervention was conducted on 120 pregnant women in the third trimester of pregnancy randomly assigned to an intervention (n = 60) or a control (n = 60) group using the permuted block randomization. The data collection tools were a two-part questionnaire to collect data on demographic and obstetric characteristics and a researcher-made questionnaire based on the TTM. Due to the coronavirus Epidemic the education was conducted partly face-to face in five 30-minute sessions three times a week observing the health protocols and partly virtually via WhatsApp and Telegram messenger (audio file, video tutorial, electronic pamphlets and posters). The data collected one and six months after the intervention were analyzed using the SPSS software version 16, the tests being descriptive and inferential tests.
Results: The mean scores of knowledge, attitude, practice and the TTM constructs were not statistically significant between the intervention and control groups before the education intervention. One and six months after the intervention the mean scores of knowledge, attitude and practice and the TTM constructs, as well as perceived barriers and benefits in decision-making and self-efficacy were found to be significantly different between the intervention and control groups (p< 0.001).
Conclusion: Based on the findings it seems that breastfeeding education of pregnant women based on the transtheoretical model can improve their knowledge, attitude and practice as regards exclusive breastfeeding.

Climate Change and the Challenges of Quantitative Assessment of Urban Climate Change: A Case Study in Tehran Metropolis

Rasul Nasiri

Background and Aim: Climate change on the earth is changing faster than ever before in the history. Cities are highly vulnerable to this climate change. Therefore, the present study aimed to investigate climate change in the metropolis of Tehran during the period 1991-2020 and help understand the limitations that cities may have in confronting climate change.
Materials and Methods: This descriptive-analytical study was performed based on the information obtained from the synoptic stations in the Tehran metropolis. First the relevant indicators were determined based on the opinions of experts and the existing literature, followed by analyzing the descriptive and analytical data on climate using the EXCEL-2016 software. Finally, based on reviewing the studies in the literature and analysis of climate data in the metropolis of Tehran, a single protocol was arrived at to study climate change in the city (microclimate) and how to reduce, and adapt with, the impacts of climate change in cities.
Results: Analysis of the data showed that the metropolis of Tehran had been facing an increase in temperature and a decrease in humidity over the preceding 30 years. The average monthly temperature increase and humidity decrease had been about 1.5° C and nearly 15%, respectively.
Conclusion: Tehran metropolis is faced with an increase in temperature and a decrease in humidity levels, the intensity of both of which will further increase in the future. Dense urban population areas will experience more intense climate change due to the formation of heat islands. To deal with this problem urban planners must consider urban socio-economic development in the context of adapting to climate change and reducing its impacts in various urban areas.

The Trend of Referrals and Identification of Covid-19 Patients in Selected Comprehensive Health Service Centers of Tehran University of Medical Sciences

Yousef Alimohammadi

Background and Aim: The process of identifying Covid 19 cases over time (the trend) can provide valuable information about the coverage of diagnostic and screening programs over time. This study aimed to investigate the outpatient trend of Covid-19 in selected comprehensive health service centers of Tehran University of Meical Sciences, Tehran, Iran.
Materials and Methods: This was a descriptive cross-sectional study. The data collected inculded the number of referalls and Polymerase Chain Reaction (PCR)-positive individuals between April 13 and December 25, 2020. Central and dispersion indices (mean, median, standard deviation and interquartile range) were used to describe quantitative variables. In addition, linear and bar charts were used to describe the trend of the variables over time. All analyses were performed using the Excel 2016 and SPSS 22 software.
Results: The highest numbers of suspected cases of Covid-19 were found to be in April, June and October. There were 2 peaks in the trend of positive cases of Covid 19, and the highest proportions of daily positive cases of Covid 19 was seen in late June and early July, as well as in late September, October, and December. The highest numbers of individuals referred and tested were observed in the South of Tehran Health Center.
Conclusion: Considering the occurrence of two epidemic peaks during the study period, the occurrence of further epidemic peaks is almost certain to occur if there is no proper planning for public health services and primary health care by the responsible health authorities and policy-makers.

Identification of a Set of Activities to Be Collectively Considered as an Integrated System for Registering Pharmaceutical Supplies in the Ministry of Health and Medical Education, Iran

Mohammadjafar Tarokh

Background and Aim: One of the complex processes in the Ministry of Health and Medical Education in Iran is the process of registering pharmaceutical supplies. Currently the registration process is a multi-stage process, resulting in parallel services, a waste of time and unnecessary expenses. Therefore, an integrated system will improve the relevant service delivery. The purpose of this study was to identify a set of activities that could be collectively considered as a single service to create an integrated system for registering pharmaceutical supplies in the Ministry of Health and Medical Education, Iran.
Materials and Methods: This was an applied research, beginning with collecting information about the registration processes for 20 different products. In order to identify the services/steps of an integrated system for recording pharmaceutical supplies, first the Gray-Wolf multi-objective optimization (GWO) algorithm was proposed. Then the values of the algorithm parameters were extracted by the goal-based requirements analysis method and the algorithm was implemented. Finally the best services were extracted by the hierarchical analysis process.
Results: Through the proposed algorithm seven services were identified, including product class inquiry, document registration, document review according to license type and product class, licensing, laboratory services, clinical studies and payment service. These services were carefully approved with a precision of 97.3 by the experts of the Ministry of Health. The proposed framework for recording drug requirements was found to be effective and could facilitate the process by up to 90%, reduce the processing time by 80% and reduce the processing costs by 65%.
Conclusion: Creating an integrated system for registering pharmaceutical supplies is one of the important challenges of the Ministry of Health and Medical Education. This can be achieved by identifying services and combining these services to create an integrated system.

The Effect of Different Components of Perceived Social Support on Fertility Intention: A Study on Ever-Married Women Aged 18-44 Years in the Urban Areas of Bushehr Province, Iran

Ahmad Dorahaki

Background and Aim: Fertility declining to a level too low for replacement and preventing its negative consequences have led to changes in the country's population policies. Understanding the causes of declining fertility and proper policymaking to increase it requires prompt action on the part of researchers and policymakers in different social and health fields. The purpose of this study was to investigate the effect of different components of perceived social support ̶ instrumental support, material support and emotional support ̶ on women's fertility intention.
Materials and Methods: This was a survey conducted in the suburban areas of Bushehr Province, Iran. Using multi-stage cluster sampling a total of 600 eligible women aged 18-44 years old were selected. The questions used to measure fertility intention and social support dimensions of the women were extracted from the standard questionnaire used in international research.
Results: The data showed thaBackground and Aim: Fertility declining to a level too low for replacement and preventing its negative consequences have led to changes in the country's population policies. Understanding the causes of declining fertility and proper policymaking to increase it requires prompt action on the part of researchers and policymakers in different social and health fields. The purpose of this study was to investigate the effect of different components of perceived social support ̶ instrumental support, material support and emotional support ̶ on women's fertility intention.
Materials and Methods: This was a survey conducted in the suburban areas of Bushehr Province, Iran. Using multi-stage cluster sampling a total of 600 eligible women aged 18-44 years old were selected. The questions used to measure fertility intention and social support dimensions of the women were extracted from the standard questionnaire used in international research.
Results: The data showed that about 89% of those women who had had one child declared their intention to have a second child, while only 38% of those with 2 children had the intention to have a third child. Multivariate analysis using logistic regression indicated that increased instrumental support will, through controlling the number of currently living children, their education and employment status, increase the likelihood of women's fertility intentions to 1.445.
Conclusion: The instrumental support and the relevant support that can be obtained from social network members can facilitate the transition to higher fertility sequences.
t about 89% of those women who had had one child declared their intention to have a second child, while only 38% of those with 2 children had the intention to have a third child. Multivariate analysis using logistic regression indicated that increased instrumental support will, through controlling the number of currently living children, their education and employment status, increase the likelihood of women's fertility intentions to 1.445.
Conclusion: The instrumental support and the relevant support that can be obtained from social network members can facilitate the transition to higher fertility sequences.

The Relationship Between Job Stress and Emotional Fatigue with Due Consideration of the Mediating Role of Resilience in an Organization

Akbar Bahmani

Background and Aim: The present study was conducted to investigate the relationship between job stress and emotional fatigue with due consideration of the mediating role of resilience in an organization.
Materials and Methods: This applied research project was a descriptive survey, the statistical population being all the staff (n = 360) of Shahid Modarres Hospital in Saveh, Iran. The sample size, using the Krejcie and Morgan table, was 186 individuals selected by a simple random method. The field data were collected using a standard questionnaire.
Results: Analysis of the data showed a statistically significant positive relationship between job stress and emotional fatigue (coefficient +0.514), as well as negative relationships between resilience on the one hand and job stress (coefficient -0.503) and emotional fatigue (coefficient -0.395) on the other. The findings also showed that resilience played a mediating role in the relationship between job stress and its effect on emotional fatigue.
Conclusion: In can be concluded that job stress has a direct positive relationship with emotional fatigue and an inverse relation with resilience; resilience is also inversely related to job stress among employees.