Outcomes of Health Care Reform Implementation in Slum Areas of Isfahan: a qualitative study

Background & Objectives: In slum areas, due to the economic, cultural and social reasons and how health services are delivered, the health status of people needs serious attention. Implementation of health reform plan in Iran led to increased attention to the health of slum area population. The present study was conducted to assess the outcomes of implementation of primary health care services reform in comprehensive health service centers at slum areas in Isfahan. Methods: This qualitative research with phenomenology approach was conducted in 2018. Study samples consisted of 21 experts of health deputy and health providers of comprehensive health services centers in Isfahan University of Medical Sciences selected using purposive and snowball sampling methods. Data gathering was done by semi-structure interview. Data analysis was done using content analysis and through the 10th version of MAXQD software. Results: The outcomes of health Reform Plan implementation in primary health care services provision, at Isfahan's slum area Health Services Centers were organized and classified in 6 main themes and 51 sub-themes. Main themes were promotion of health care availability, private sector participation, management, improvement of staff education and providing resources based on the needs and establishing electronic health records with 51 sub-themes. Conclusion: Feasibility of using public-private partnership models in building, operating, transferring, needs assessing, system evaluation and monitoring of the Comprehensive Health Service Center and compiling the required human resources chart can improve the outcomes of this plan. Key­words: Milestones, Health care reform, Primary health care, Private sector, Slum area Citation: Raeisi AR, Shaarbafchizadeh N, Aghdak P, Fouladi Z. Outcomes of Health Care Reform Implementation in Slum Areas of Isfahan: a qualitative study. Journal of Health Based Research 2019; 5(1): 81-100. [In Persian

The consistency rate of causes of Death in different components of child mortality Surveillance System in hospitals affiliated with the Shahrekord University of Medical Sciences

Background and aims: Child mortality Surveillance System is Iranian children mortality database nationwide and internationally. The aim of this study was to investigate one of the the most important features of data quality, i.e. Accuracy, through examining the consistency rate between the underlying mortality causes registered in the software and those extracted from medical records among children. Methods: This descriptive, analytical study was performed by census and the medical files of all 104 children aged 1-59 months died between March 21, 2013 and September 22, 2015 in six hospitals affiliated with the Shahrekord University of Medical Sciences were studied. The data were gathered by a researcher-developed questionnaire under supervision of a pediatrician. To investigate the consistency rate of mortality causes, chi-square and Fisher's Exact test and Kappa coefficient in SPSS was used. Results: The consistency rate between the mortality causes registered in the software and the underlying mortality causes extracted from the medical Records, and death certificate was 0.60 and 0.57, respectively. These consistency rates are considered moderate. The consistency rate between the underlying mortality causes recorded in the death certificates and the medical files was derived 0.84, considered an optimal level of consistency. Conclusion: According to the findings, it is essential to develop certain interventions such as training and requiring operators to be adequately tactful for recording underlying mortality causes with reference to death certificates and medical files, hiring operators who are knowledgeable about the international protocols of selection of mortality cause or planning for use of the underlying causes registered in the encoding unit of the software, and enhancing the software and accuracy of information elements registered in the software

Do Intervention Strategies of Women Healthy Heart Project (WHHP) Impact on Differently on Working and Housewives?

<p class="abstract"><strong>BACKGROUND:</strong> The purpose of this study is to evaluate the possible difference of the impact of Women Healthy Heart Project on lifestyle, as well as physical/biochemical parameters of working women and housewives.</p> <p><strong>&nbsp;&nbsp; METHODS:</strong><strong> </strong>This was a community-based intervention study conducted over 5 years (2002-2007) in the counties of Isfahan and Najafabad (intervention areas) and Arak (control). Pre-study situation analysis of women was followed by 5 years of wide-ranging interventions (educational/environmental) conducted by various organizations using different methodologies. The interventions were aimed at modifying/improving lifestyle by increasing physical activity, encouraging healthy eating, and tobacco use cessation. The organizations involved in performing the interventions included the local radio and television authority, health/treatment centers, the Red Crescent Society, Municipalities, the Relief Committee, the Center for Retirees&rsquo; Welfare, and the Literacy Campaign Organization. After 5 years, final phase same as first phase was planed. The subjects studied in all phases` the pre- and post-intervention phases consisted of 10586 women aged above 18 years. Demographic data, obesity index, smoking, physical activity and eating habit were assessed before and after the study. Data were analyzed using SPSS-15 using Student&rsquo;s t-test, chi-square test, the general linear model of ANOVA, and logistic regression.</p> <p class="abstract"><strong>&nbsp;&nbsp; RESULTS:</strong> We studied 10586 women (6105 and 4481 women, pre- and post-intervention, respectively). Mean age of working women was 34.14 &plusmn; 10.09 and 34.08 &plusmn; 9.35 years before and after the study, respectively. Mean age of housewives before and after the study was 40.05 &plusmn; 14.61 and 40.36 &plusmn; 15.32 years, respectively. Interventions conducted during 5 years improved eating habits and decreased tobacco use in working women and housewives. In every phase of the study, there was a significant age difference between housewives and working women (P &lt; 0.001). Hence data were adjusted according to age in each phase. Overall physical activity of housewives and working women increased, but the percentage of passive smokers among housewives remained unchanged. Waist circumference and waist-to-hip ratio changed significantly in housewives following interventions (P &lt; 0.001). The parameter which improved significantly in working women was waist circumference (P &lt; 0.05). However, after adjusting for age, no significant difference was seen between working women and housewives following interventions.<strong></strong></p> <p class="abstract"><strong>&nbsp;&nbsp; </strong><strong>CONCLUSION:</strong> Community-based interventions, especially those directed at housewives, can lead to significant improvements in lifestyle and cardiovascular risk reduction. It seems that working women require tailored interventions to suit their conditions. Although short-term outcomes may seem insignificant, persistence and continuity of lifestyle changes may lead to reduced prevalence of cardiovascular diseases. Then longer-term studies are warranted.</p><p class="abstract"><strong>Keywords:</strong> Women, housewives, working, risk factors, lifestyle modification.</p

Effect of pre-conception care protocol on women\'s awareness

Introduction:Pre conception care is set of care services to assess the risks for pregnancy, it provide training and diagnostic measures, therapeutic and pharmaceutical interventions for improving health woman. In addition to improving health and performing medical care in Pre conception care, main point is to empower individual to maintain their health through providing education and counseling. Therefore, according to recommendations presented in the guidelines, the protocol of Pre conception care was prepared. This study aimed to assess the Effect of this protocol on eligible women's awareness. Methods:This is a Field trial were performed in 1385 to 1386 in the Shahreza (one of the Isfahan cities). Four hundred eighty (480) married women aged 49-15 who referred to health units for getting family planning services referred to health units and were selected randomly. Study was designed in three stages. In the first stage in four health-centers (two urban and two rural centers) basic knowledge of study sample were determined. Protocol of pre- pregnancy care for all spacing women in case centers (a urban center and a rural center) was implemented. Then in the second and third stages (three and six months after implementation of the protocol) women’s awareness was measured again. Results (post Test and lasting knowledge test) in the case and control groups, also before, and after the protocol were compared. Data collection was done by a questionnaire. Validity of questionnaire was confirmed through expert opinion and reliability was confirmed through calculating Cronbach's Alpha (0.8). Data analysis was done by SPSS software using t-test. Results: Results showed that pre-pregnancy care protocol implementation leading to significant increasing of secondary awareness and lasting knowledge in case group (Respectively p<0/0007, p<0/001) Discussion:Since the implementation of the protocol will lead to increased awareness of mothers, health workers must try to implement these cares completely and properly

The frequency of hypertensive disorders during pregnancy in maternal deaths in Isfahan Province, Iran

&nbsp;&nbsp; BACKGROUND: The findings of incidence or prevalence studies can help managers and policy makers evaluate the degree of changes and its relation with the performed interventions. This study aimed to determine the frequency of hypertensive disorders during pregnancy in maternal deaths that occurred during 2006-10 in Isfahan Province, Iran. &nbsp;&nbsp; METHODS: This descriptive, cross-sectional study assessed all maternal deaths that occurred during 2006-10 in Isfahan. Data was collected by reviewing available documents using a checklist whose validity has been approved by experts. Data was analyzed by descriptive statistics and chi-square and Fisher's exact tests in SPSS12. &nbsp;&nbsp; RESULTS: In total, 58 women who had died due to complications of pregnancy and childbirth were studied. The mean age of the subjects was 30.2 &plusmn; 6.5 years (range: 17-45 years). From 22.4% of maternal deaths which were due to gestational hypertension, 92.3% were preeclampsia and eclampsia. One case of chronic hypertension (7.7%) was also observed. Other types of hypertension in pregnancy were not detected. The first direct cause of maternal death was hypertension disorders. Underlying diseases (36.2%) and bleeding (18.9%) were the other major causes of death. &nbsp;&nbsp; CONCLUSION: The number of deaths caused by blood pressure disorders, as a direct and important factor in maternal deaths, reduced during the 5-year course of study. In order to improve pregnancy outcomes, measures should be taken for early detection and diagnosis of these disorders. &nbsp; &nbsp; &nbsp; Keywords: Hypertension, Pregnancy, Maternal Mortality Rate, Preeclampsia, Eclampsia</p

Master of public health) MPH( Modular Need Analysis Course with Management Orientation and Health System Reforms for the Talented Students

Introduction: The Master of Public Health (MPH) course in the Iranian health system is known as the training course for managers. The MPH course, is mainly used to empower students in the managerial and analytical skills of the community health system. The this study endeavored to to analyze the needs of the MPH course to launch a course for talented general medical students at Isfahan University of Medical Sciences. Methods: This need analysis study was conducted through the modified Delphi technique. Initially, the literature was reviewed. During the search phase, curricula of this course were extracted from national (Hamedan, Shiraz, Shahid Beheshti and Tehran) and international (Arizona and Miami) universities where the MPH management course is offered. The results of literatures review were summarized in the focus group session and developed as a questionnaire. The questionnaire was distributed among 25 general practitioners and the gathered data were analyzed through descriptive statistics (frequency). Results: The results of the literature review were described and a questionnaire was developed by forming a three-focus-group session. The results of the distribution of the questionnaire among 25 general practitioners and the analysis of its data were like this: Disaster management, crisis management, maternal health, children, the elderly, nutrition and addiction, social determinants of health, community health management, population and aging, health education and health promotion, environmental health education, school health, occupational health and statistics and research methods Conclusion: The results revealed that the selected topics except the dissertation are of importance for more than 70% of the samples

Death portrait of Isfahan Province in years 2007-2011

Background: The rapid rise in noncommunicable diseases (NCDs) is one of the main health challenges affecting the global development in the present era. This raising challenge is a major threat to countries′ socioeconomic development as well as millions of people health. Methods: It was a retrospective study with analysis of reported death in Isfahan Province during a 5-year period from 2007 to 2011. Required data were collected from statistics provided by Deputy of Health in Kashan and Isfahan Universities of Medical Sciences in 2012. Excel software was used for data analysis. Results: During this period, the cardiovascular events, cancers and tumors, unintentional injuries, respiratory diseases, and prenatal mortality were the main reasons of mortality in Isfahan Province. The overall rate of cardiovascular events rose 5.10% in the 5-years of the study observation, and Khor - Biabanak was on the top of the list; while in cancer rating Khor - Biabanak, Golpayegan, and Khansar both stood at the outset (per 1,000 people). For injuries, the highest rate belonged to Golpayegan, Tiran-Kervan, and Chadegan. Meanwhile, for mental illnesses, the highest rate was observed in Khomeini Shahr. Moreover, the highest maternal and fetal mortality was reported in Fereydunshahr, Khor - Biabanak and Mobarakeh. Conclusions : Given the sharp rise of NCD, programs by health care system should be directed toward lifestyle modification while a proper framework should be determined to deal with these kinds of disease. Furthermore, optimal allocation of resources based on needs can provide better facilities for different cities

The Effect of Prenatal Care Group Education on Pregnant Mothers\' Knowledge, Attitude and Practice

Introduction: Effective prenatal education may play an important role in decreasing diseases and morbidity and therefore promoting mother's health. The aim of this study was to examine the effect of group education (by a standard teaching model) on knowledge, attitude and practice of pregnant mothers. Methods: This study was a field trial which was performed on 60 pregnant women in their 6th to 8th gesta-tional age. Samples were divided into two groups randomly. The experiment group was instructed using the standard protocol developed by maternal health unit of Isfahan Provincial Health Center and the control group received the routine prenatal instructions. In the standard protocol, the educational needs during the first, second and third trimesters of pregnancy were determined and 14 training sessions with prepared lesson plans were designed. The data were gathered by a questionnaire. Results: Mother's knowledge in second and third trimester was significantly higher in intervention group compared to the control group. Also, it was almost significant in the first trimester. But, the educational program had no effect on mothers' attitude and no difference between the attitude of the two groups of intervention and control was observed. In contrast, the education had a positive effect on mothers' practice and a significant difference was revealed between the practices of the two groups. Conclusion: Considering the special features of this educational model, implementing this program as a continuous intervention in all health care centers could improve the quality of prenatal care

Common and Important Signs, Symptoms and Diseases that a General Practitioner Should Know: One Step Toward Socially Accountable Education

Introduction: Social accountability is a fundamental feature in medical education. In this regard, the aim of this study was to explore the views of general practitioners in Isfahan about GP’s minimum learning essentials based on common and important signs, symptoms and diseases to be used in the revised curriculum in accordance with social accountability. Methods: This cross-sectional descriptive study was carried out in 2015-16 in two phases. The research tool was developed in the first phase by reviewing the literature, documents and experiences. In the second phase, the field study was conducted on general practitioners working in private and public sectors of Isfahan University of Medical Sciences. A sample of 462 subjects were selected through systematic random cluster sampling. Data were analyzed using descriptive statistical methods. Results: A total of 619 questionnaires were analyzed. 46.7% of the participants were female and 37.5% worked as a family physician. Based on the interaction between subjects’ encounters with diseases, signs and symptoms and the importance of each case, 136 topics were identified as educational priority. Conclusion: Since high prevalence of a disease and its importance for education have been accepted as the criteria to determine learning needs, educational priorities for general practitioners were determined based on the interaction of these two criteria. Further research is recommended to determine the opportunities for teaching these priorities and their appropriate educational content