Analysis of vaginal delivery promotion package in the National Health System Reform Plan in Iran: a qualitative study

Background: The Vaginal Delivery Promotion Package was a part of the National Health System Reform Plan in Iran, which was implemented to reduce the rate of cesarean sections. The aim of the present study was to examine the views of the beneficiaries on the implementation of the promotion of natural vaginal delivery in the hospitals affiliated to Tehran University of Medical Sciences.  Methods: A qualitative study conducted in 2016 using semi-structured interviews for data collection. The sampling method was purposeful with maximum variation of the beneficiaries. After doing 35 interviews, the data reached a saturation point. Data analysis was done through content analysis method using MAXQDA 10 software.   Results: The package beneficiaries believed that it was successful in achieving its goal to reduce cesarean sections. Their perspectives were classified into two categories (strengths and weaknesses), eight themes (package design, achieving the goals, education and persuasion, package comprehensiveness, monitoring, infrastructures, plan implementation, and service quality), and 24 sub-themes. The most important weaknesses of this package were the payments and supervisions.  Conclusion: Officials and policymakers can improve the package by continuous monitoring, providing necessary feedback to the staff, and modifying the payments. Besides, paying attention to midwives and health workers, the first contact point for pregnant mothers with service providers, can increase the effectiveness of this package

Patrick-Murray Administration Issues South Coast Rail Executive Order and Awards Technical Assistance

BACKGROUND:The migration of healthcare specialists from developing countries has increased in recent years. This has caused a rapid reduction in the access to and quality of healthcare services in such countries. The aim of this study is to evaluate the factors affecting the migration of specialist human resources in Iran's healthcare system. METHODS:This is a qualitative study, which was carried out through semi-structured interviews between 2015 and 2016. For sampling, purposive sampling method with maximum variation sampling was used. Further, data saturation was observed by conducting 21 interviews, and data analysis was performed using the MAXQDA10 content analysis software. RESULTS:Factors affecting the migration of specialists were classified into five key themes, including structural, occupational, personal, socio-political and economic factors. These themes consisted of 12 categories and 50 subcategories. The most important factors affecting the migration of our study population were structural issues, occupational problems, and personal concerns. CONCLUSION:Identification of factors influencing migration is the first step to prevent the migration of specialist human resources. Implementing the recommendations proposed in this study would assist to prevent migration of medical professionals

Socioeconomic Inequality in Malnutrition in Under-5 Children in Iran: Evidence From the Multiple Indicator Demographic and Health Survey, 2010

Objectives The aim of this study was to assess the socioeconomic inequality in malnutrition in under-5 children in Iran in order to help policymakers reduce such inequality. Methods Data on 8443 under-5 children were extracted from the Iran Multiple Indicator Demographic and Health Survey. The wealth index was used as proxy for socioeconomic status. Socioeconomic inequality in stunting, underweight, and wasting was calculated using the concentration index. The concentration index was calculated for the whole sample, as well as for subcategories defined in terms of categories such as area of residence (urban and rural) and the sex of children. Results Stunting was observed to be more prevalent than underweight or wasting. The results of the concentration index at the national level, as well as in rural and urban areas and in terms of children’s sex, showed that inequality in stunting and underweight was statistically significant and that children in the lower quintiles were more malnourished. The wasting index was not sensitive to socioeconomic status, and its concentration index value was not statistically significant. Conclusions This study showed that it can be misleading to assess the mean levels of malnutrition at the national level without knowledge of the distribution of malnutrition among socioeconomic groups. Significant socioeconomic inequalities in stunting and underweight were observed at the national level and in both urban and rural areas. Regarding the influence of nutrition on the health and economic well-being of preschool-aged children, it is necessary for the government to focus on taking targeted measures to reduce malnutrition and to focus on poorer groups within society who bear a greater burden of malnutrition

The impact of disease characteristics on multiple sclerosis patients’ quality of life

OBJECTIVES The aim of this study was to assess the quality of life (QoL) of patients with multiple sclerosis (MS), and to investigate the effects of characteristics of MS such as disease course, severity, and relapses on patients’ QoL. METHODS This was a cross-sectional study, in which 171 patients were enrolled. Health-related QoL was assessed using the Persian version of the Multiple Sclerosis Quality of Life-54 questionnaire. To measure patients’ disability status, we used the Expanded Disability Status Scale. Other variables included in the study were disease course and relapses of the disease. RESULTS The average scores for patients’ physical and mental QoL were 60.9±22.3 and 59.5±21.4, respectively. In a bivariate analysis, disease course, severity of the disease, and relapses were significantly associated with the physical and mental health composite scores. In a hierarchal regression analysis, disease course, severity of the disease, and relapses were responsible for 38 and 16% of the variance in physical and mental QoL, respectively. It was also observed that relapses were a strong predictor of both physical and mental QoL. CONCLUSIONS Our results showed that disease characteristics significantly affected both dimensions of QoL. It is therefore suggested that health care providers should be aware of these characteristics of MS to more successfully improve MS patients’ QoL

Characteristics of the participants in the study.

<p>Characteristics of the participants in the study.</p

Factors affecting the migration of human resources in the health system of Iran–Themes 1–3.

<p>Factors affecting the migration of human resources in the health system of Iran–Themes 1–3.</p

Factors affecting the migration of human resources in the health system of Iran–Themes 4–5.

<p>Factors affecting the migration of human resources in the health system of Iran–Themes 4–5.</p