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Kourosh Holakoie Naieni, Ahmad Raeisi, Leila Faraji,
Volume 13, Issue 2 (9-2015)
Abstract
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.
Afsaneh Motevalli Haghi, Mohammad Delavari, Mehdi Nateghpour, Mohammad Shekari, Habiballah Turki, Ahmad Raeisi, Azam Roshan,
Volume 13, Issue 2 (9-2015)
Abstract
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.
Behzad Damari, Abbas Vosough Moghaddam, Ahmad Hajebi, Mohammad Hossein Salarian Zadeh, Habib Emami,
Volume 13, Issue 3 (12-2015)
Abstract
Background and Aim: The Pars Energy-Economic Special Zone, as the energy capital of Iran, needs a healthy productive workforce. In order to be able to promote equitable health indicators of the Zone, it is essential to first obtain information about the situation of the health system in the region.
Material and Methods: This was a cross-sectional qualitative study. Data were collected using an essential public health services (EPHS) performance assessment questionnaire and a researcher-developed questionnaire for strengths, weaknesses, opportunities and threats (SWOT) analysis of the Zone health system. In the next phase, stakeholder analysis was done: the major stakeholders were invited and asked, after explaining the methodology to them, to complete, individually, the EPHS performance assessment and the SWOT analysis questionnaires, followed by grouping and summarizing the results. Finally, content analysis of results of the group discussions was done and the main domainsا extracted.
Results: The EPHS overall average score was 37.8 (out of 100, the standard score). The greatest weakness was allocated to information functioning. Delivering public health services by the district health networks was the most important strength. Further analysis of the data showed that the far external environment in all the subdomains was the major threat to the public health in the zone.
Conclusion: Based on the findings, it can be said that the organizational status of the Zone is in a weak and threat position. One of the root causes is poor functioning of the public health system. It is essential that the Ministry of Petroleum and the Ministry of Health and Medical Education find effective ways for integrated leadership of the public health services in the Zone.
Elliyeh Hojjatzadeh, Alireza Heydari, Tahereh Samavat,
Volume 13, Issue 4 (3-2016)
Abstract
Background and Aim: Hypertension is a major risk factor for cardiovascular diseases. Its control decreases the risk of likely complications. The aim of this study was to determine the effect of behvarz’ education level on blood pressure control among hypertensive patients in the rural areas of Qazvin city, Iran.
Materials and Methods: This cross-sectional study, including 300 hypertensive patients and 18 behvarz selected by multi-stage sampling, was conducted in health houses of the rural areas of Qazvin city in 2010. Usning standard methods and technics, weight, height and blood pressure were measured. Data were collected by interviews (using questionnaires) and observations and anlyzed using the SPSS software and the Chi Square test as the statistical test (level of sinnificance 0.05 ).
Results: The prevalence of hypertension was 13.2% and 8.7% in the populations under coverage of the health houses manned by community behvarz with a high school diploma and those with an education level below high school diploma, repectively. Only 14.7% of the patienes studied had their blood pressure controlled. There was no statistically significant association between the extent of patients’ blood pressure control and behvarz’ educationl level.
Coclusion: It can be concluded that education level of the behvarz has no effect on hypertensive patients' blood pressure control. In any case, it is recommended to pay more attention to the education and literacy of peripheral health workers and put emphasis on the personnel in-service training, regular monitoring and supervision, as well as health indices assessment.
Behzad Damari, Abbas Vosough Moghaddam, Kamel Shadpoor, Mohammad Hossein Salarian Zadeh, Davood Moghimi,
Volume 13, Issue 4 (3-2016)
Abstract
Background and Aim: One of the main functions of municipalities, as a social institution, is providing, maintaining and improving health of citizens. Scattered attempts have been made with the objective of expanding equitable health service networks in cities, particularly suburban areas. The present study aimed at designing an integrated system for urban health managent center.
Material and Methods: This was a descriptive-analytical study. Based on the viewpoints of experts and relevant stakeholders, global evidence, national experience, and existing legislations, a conceptual framework for designing an urban health management center was developed and requirements for its implementation were determined. On the basis of the conceptual framework, regulations for designing model for a regional urban health management center (RUHMC) was prepared.
Results: The proposed model has 5 important characteristics which would provide an excellent opportunity as a response to the existing challenges of the health network in cities through active participation of the municipality, as a social institution, and other organizations:
1. Facilitating intersectoral collaboration, as against individual movements of the
governmental health sector;
2. Defining and providing social health services and influencing the social determinants of health components;
3. Providing active, rather than passive, services;
4. Decentralization by forming a board of trustees and/or coordination council;
5. Direct community participation in all phases, from decision-making (membership in the coordination council) to service provision.
Conclusion: Pilot implementation and evaluation of the proposed RUHMC model is recommended before expanding it to other parts of the city. In addition, it is essential that, before expanding the model to the other cities, the final regulations be examined and ratified by the High Council of Health and Food Security.
Behzad Damari, Abbas Vosough Moghaddam, Narges Rostami Gooran, Mohammad Javad Kabir,
Volume 14, Issue 2 (9-2016)
Abstract
Background and Aim: The most important healthcare reform in Iran during the last decade has been implementation of the family physician and referral system in rural areas and small towns with a population of less than 20000. The program was expanded (as a pilot project), with small modifications, to rural areas of 2 provinces, namely, Fars and Mazandaran. This study was initiated to assess the achievements, challenges and weak points of the pilot project before deciding to expand it to other provinces.
Materials and Methods: This qualitative study was conducted in winter 2013. Data were collected using document desk reviews, semi-structured interviews with key informants, and focus-group discussions. Relevant family health policy makers, managers and service providers in the two provinces were invited to the meetings. The data were analyzed and categorized based on the content analysis method.
Results: The data showed that the family physician program is faced with several challenges regarding objectives; stewardship; service providing; and human, financial and information resources. It is to be noted, however, that the program has had achievements such as increased access to services, increased coordination among insurance organizations and medical universities, and organizing and managing health files.
Conclusion: The program should not be expanded to other provinces before redesigning in order to assure that it is more complete and comprehensive and create commitment and adequate guarantee among stakeholders. It is essential that all the stakeholders agree on general and specific objectives of a 5-year program and prepare an operational plan for each specific objective.
Batool Hossein Rashidi, Hossein Malek Afzali, Fedyeh Haghollahi, Mina Naghi Jaffarabadi, Mohammad Eslami, Mahdieh Yazdanpanah, Mohammad Mehdi Naghizadeh,
Volume 14, Issue 2 (9-2016)
Abstract
Background and Aim: Over 200 million pregnancies occur worldwide annually; one third are unwanted and half end up in abortion. This study aimed to determine the prevalence of unwanted pregnancies and induced abortions during women’s childbearing age over a period of 30 years (divided into 5-year intervals) in Tehran, Iran.
Materials and Methods: This cross-sectional study was conducted in 2014 on 518 married women 15 to 55 years old living in Tehran with a history of at least one pregnancy. A questionnaire containing two sets of questions on individual and demographic characteristics and women’s abortion history was used to collect the data for a period of 30 years (divided into 5-year intervals). The data collected were analyzed using SPSS 16 (the significance level was a p-value of <0.05).
Results: Of the 966 pregnancies among the 518 women studied, 665 (68.4%) were planned and 307 (31.6%) unwanted. There were 249 abortions, 108 (43.4%) of which were miscarriages, 41 cases (16.5%) for medical reasons, and 100 cases (40.2%) induced (deliberate). The proportion of induced abortions in unwanted pregnancies increased from 0.0% in 1981-1986 to 41.7% in 2011-2014.
Conclusion: Based on the findings it can be concluded that due to changes in family planning program effectiveness and accessibility of contraception methods in Iran unwanted pregnancies and the subsequent abortions have become more common.
Narges Rostamigooran, Abbas Vosoogh-Moghaddam, Mohammadhossein Salarianzadeh, Hamid Esmailzadeh, Behzad Damari,
Volume 14, Issue 3 (12-2016)
Abstract
Background and Aim: Considering the key role of the Ministry of Health and Medical Education (MOHME) in the implementation and follow-up of the health system reform, its organizational culture can play an important role in the success of this transformation. The aim of this study was to determine the dimensions and orientations of the current organizational culture of the MOHME headquarters.
Materials and Methods: This was a cross-sectional descriptive and explorative study. The study population was the central staff of MOHME. Data were collected using a questionnaire and analyzed by SPSS version 11.5. Descriptive statistical methods (mean, standard deviation, coefficient of variation and interval) were used to describe quantitatively the cultural dimensions, followed by a qualitative analysis as well.
Results: Analysis of the data showed the following: 1. Organizational cultural dimensions existing at a high level include self-supervision and identity; 2. Organizational cultural dimensions existing at a moderate level include authority and freedom in operations, clear goals and expectations, communication, coordination and coherence; and 3. Organizational cultural dimensions existing at a low level include innovation, learning, fair reward system, acceptance of change, management support and criticism.
Conclusion: Considering the key role of the MOHME headquarters staff in designing and implementing health promotion programs, bringing about changes in the organizational culture should be a top priority of the ministerial high authorities.
Behzad Damari, , Narges Rostamigooran, Mohammad Hossein Salarianzadeh, Sheyda Malekafzali,
Volume 18, Issue 1 (5-2020)
Abstract
Background and Aim: For achievement of equity in the population health the implementation of health in all policies is essential. The most crucial intervention in this approach is inter-sectoral collaboration.
Materials and Methods: This was a qualitative study based on the national policy framework. Data were collected using literature review, in-depth interviews and focus group discussions with the stakeholders. The results were categorized into three sections, namely, situational analysis and factors affecting it, developing goals and objectives, and requirements and interventions.
Results: Currently inter-sectoral collaboration in the Iranian health system potentially allows to have health in all policies policy in terms of explicit legislative support, national macro-policies/upstream documents and organizational structure. It will require proper planning as regards designing and institutionalizing appropriate mechanisms for collaboration, as well as cultural and skills capacity building, for stakeholders within and outside the health sector.
Conclusion: The findings of this study can be used in annual operational planning of the High Council of Health and Food Security secretariat.
Ahmad Nejati, Alireza Asgari Golzardi, Farshad Khodakhah, Katayoun Samimi-Rad, Seyedeh Maryam Yousefi, Yaghoub Mollaei-Kandelousi, Maryam Keyvanlou, Mohammad Razaghi, Parastoo Soheili, Delaram Yaghoubzadeh, Nastaran Ghavami, Susan Mahmoudi, Seyed Mohsen Zahraei, Shohreh Shahmahmoodi,
Volume 21, Issue 3 (12-2023)
Abstract
Background and Aim: During the COVID-19 pandemic public health measures and protocols such as regular hand washing and wearing a face mask were recommended at the national level. The implementation of these health protocols reduced the prevalence of respiratory diseases, but no study has been conducted to investigate the impact of the implementation of these protocols on the spread of viruses that are transmitted through fecal-oral route. Considering that non-polio enteroviruses (NPEVs) are mainly transmitted through fecal-oral route, this study was conducted to determine the prevalence of non-polio enteroviruses in patients with acute flaccid paralysis (AFP) in Iran before and during the COVID-19 pandemic.
Materials and Methods: To detect non-polio enteroviruses stool samples of AFP cases received by Iran National Polio Laboratory in 2019 (before the COVID-19 pandemic) and 2021 (during the COVID-19 pandemic) were tested. To isolate NPEVs by cell culture, the WHO standard protocol was used, and the TaqMan One-Step Real Time PCR was used for molecular testing.
Results: In 2019, a sample of 21 out of 1070 patients and a sample of 12 out of 100 patients were found to be positive for non-polio enterovirus by cell culture and the molecular method, respectively; these ratios decreased to10 out of 678 and 3 out of 100 in 2021.
Conclusion: Based on the findings of this study, it can be concluded that the observance of personal hygiene and public health protocols during the COVID-19 epidemic have, in addition to the general reduction of respiratory transmission of viruses, also affected the faecal-oral transmission of viruses.
Hamed Moslehi, Reyhaneh Fayyaz, Zahra Validabadi, Iman Zaghian,
Volume 21, Issue 3 (12-2023)
Abstract
Background and Aim: The objective of this study was to gain a deep understanding of the importance (expected services) and performance (services provided) of mental health services to determine the priority indicators of mental health to help design higher quality and more effective community mental health interventions.
Materials and Methods: This was a mixed-method study including all the mental health executives and practitioners (n=998) in Iran. In the quantitative part, the Importance-Performance Analysis (IPA) model was used to determine the importance and performance of the current mental health programs in the primary health care (PHC) system, and in the qualitative part complementary explanations were analyzed using the thematic analysis method.
Results: The findings show that there were gaps between the expected services and the services provided in the mental health program. Thus, the following points should be taken into account to be able to improve the mental health services: 1. Strengthening the domestic violence prevention program as regards spouse misbehavior and misbehavior towards children; 2. Continuation of lifestyle skills and parenting programs, 3. Self-care in mental health and drug use programs; 4. psychiatric disorders diagnosis and care and a healthy adolescents program is desirable and necessary, but revising and modifying the suicide prevention program (as regards costs and treatment) are essential. 5. In addition, the psycho-social intervention programs in disasters, addiction harm reduction program, strengthening family foundation and the Competent Family Program are of low importance in formulating a strategy.
Conclusion: Corrective actions based on the prioritizations determined can be included in the working agenda of the managers of mental health care systems at the primary levels to improve the quality of mental health services.
