Journal of School of Public Health and

Background and Aim: Mortality from cardiovascular and other chronic diseases has increased in Iran. Our aim was to estimate the effects of smoking and high systolic blood pressure (SBP), fasting plasma glucose (FPG), total cholesterol (TC), and body mass index (BMI) on mortality and life expectancy, nationally and sub-nationally using representative data and comparable methods.

Materials and Methods: We used data from the Non-Communicable Disease Surveillance Survey to estimate means and standard deviations for the metabolic risk factors, nationally and by region. Lung cancer mortality was used to measure cumulative exposure to smoking. We used data from the death registration system to estimate age-, sex-, and disease-specific numbers of deaths in 2005, adjusted for incompleteness using demographic methods. We used systematic reviews and meta-analyses of epidemiologic studies to obtain the effect of risk factors on disease specific mortality. We estimated deaths and life expectancy loss attributable to risk factors using the comparative risk assessment framework.

Results: In 2005, high SBP was responsible for 41,000 (95% uncertainty interval: 38,000, 44,000) deaths in men and 39,000 (36,000, 42,000) deaths in women in Iran. High FPG, BMI, and TC were responsible for about one-third to one-half of deaths attributable to SBP in men and/or women. Smoking was responsible for 9,000 deaths among men and 2,000 among women. If SBP were reduced to optimal levels, life expectancy at birth would increase by 3.2 years (2.6, 3.9) and 4.1 years (3.2, 4.9) in men and women, respectively the life expectancy gains ranged from 1.1 to 1.8 years for TC, BMI, and FPG. SBP was also responsible for the largest number of deaths in every region, with age-standardized attributable mortality ranging from 257 to 333 deaths per 100,000 adults in different regions.

Conclusion: Management of blood pressure through diet, lifestyle, and pharmacological interventions should be a priority in Iran. Interventions for other metabolic risk factors and smoking can also improve population health.

Background and Aim: Prenatal and neonatal care provides an opportunity for counseling, resulting in reduction of pregnancy-related and neonatal complications. It is expected that such care would result in promoting the health status of these vulnerable groups and improving the relevant indicators.

Materials and Methods: This was a cross-sectional survey including 668 mothers and 2-month-old children. Data were collected using questionnaires and structured interviews.

Results: On the whole, 35.9%, 21.0% and 5.1% of the mothers reported, at least, one pregnancy, one complication, and one neonatal complication, respectively. Results of the logistic regression model showed that the odds ratio of reporting at least one of the pregnancy complications increased by more than double in women who had a medical history or a high-risk pregnancy, increase decreased by 63% in those who had continuous care during pregnancy, decreased by 40% in those who had received thorough prenatal care, and increased by 0.05% for every unit increase in age. The odds ratio of reporting at least one postpartum complication increased by 70% per unit of in the density of health workers. Moreover, the odds ratio of reporting at least one neonatal complication decreased by 48% in women who had received full neonatal care and by 50% per every unit of increase in the density of health workers.

Conclusion: The findings of this study show the important role of behvarzes (community health workers) in detecting postpartum and neonatal complications, as well as the importance of antenatal care and quality of antenatal care as regards detecting at-risk women and neonates and prevention of pregnancy and antenatal complications.