Journal of School of Public Health and

Background and Aim: Rabies, a viral and zoonotic disease, causes acute and fetal encephalitis in humans and other mammals and is a cause of death in developing countries. It is usually transmitted by animal bite, but other routes of transmission are mucus membranes, breathing, placenta, contaminated instruments, and organ implanting. This study shows the mapping of geographical distribution of animal bite cases, rabies, and death due rabies in 3 Caspian Sea littoral provinces, namely, Golestan, Mazandaran, and Gilan.

Materials and Methods: Data on human and animal rabies cases and animal bites were collected from the Reference Rabies Center of the Pasteur Institute in Tehran and the Rabies Diagnosis Section of the Amol Research Center during 2002-2007.The data was analyzed by the SPSS (11.5) software and mapping was done by Arc GIS 9.2.

Results: During the 6-year period, of the 670,743 animal bite cases reported in Iran 63890 (9.5%) had occurred in Golestan, 25,767 (3.8%) in Mazandaran, and 22,874 (3.4%) in Gilan. The distribution of animal bite cases in the 3 provinces was as follows: Agh ghala, Bandar Torkaman, Azad shahr and Kolaleh in Golestan Galugah, Behshahr, Ramsar and Neka in Mazandaran and Shaft, Masal, Siahkal and Fuman in Gilan. The data also showed that of the total 2,312 animal rabies cases, in Iran, 9.22% had been reported from Golestan, 4% from Mazandaran, and 2.6% from Gilan. Furthermore, animal rabies cases had occurred mostly in Gonbadekavoos, Bandar Torkaman, Gorgan and Kolaleh in the Golestan Province Behshahr, Neka and Chalus in the Mazandaran Province and Masal, Fuman and Rezvanshahr in the Gilan Province. The most important disease vector (91.3%) for both human and animal rabies was the dog. A total of 41 human deaths due to rabies had been reported during the period, 2 being from Mazandaran.

Conclusion: The results show that a more effective disease control and surveillance system is essential and can help improve planning for service provision in the health care centers.

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.