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

Burden of pediatric asthma in Kurdistan Province, West of Iran

BACKGROUND: Asthma is the most common chronic respiratory disease (CRD) and one of the most serious and important pediatric diseases in developing countries. The present study aims to estimate the burden of asthma among children in Kurdistan Province, Iran.METHODS: Disability-adjusted life year (DALY) was used in order to estimate the burden of asthma. In a cross-sectional study, with a sample size of 4000, and using the multi-stage sampling method and Asthma and Allergies in Childhood (ISAAC) questionnaire, the prevalence of asthma was estimated for two 6-7 and 13-14 age groups in Kurdistan Province in 2013. In addition, some necessary data were extracted from the death registration system in Kurdistan Provincial Health Center and Statistical Center of Iran (SCI).RESULTS: Burden of asthma for 6-7 age group was 71.6 DALYs in boys (2.77 DALYs per 1000 population) and 48 in girls (2.22 DALYs per 1000 population) with a total burden of 119.6 DALYs (2.52 DALYs per 1000 population). Moreover, its burden for 13-14 age group was 121.1 DALYs in boys (4.86 DALYs per 1000 population) and 82.3 in girls (3.98 DALYs per 1000 population) with a total burden of 203.4 DALYs (4.46 DALYs per 1000 population).CONCLUSION: Considering the significant prevalence of asthma and its burden among children in Kurdistan Province, it is suggested that prevention and management of this disease be considered as a priority by policy makers and in health programs, in addition to attempting to prevent and reduce its burden by setting out effective interventions

Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017

A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of <5% in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8–38.5) million) in 2000 to 6.0% (55.5 (44.8–67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic

Exploring socioeconomic inequalities in the use of medicinal herbs among Iranian households: evidence from a national cross-sectional survey

Background: Association between socioeconomic status and medicinal herbs (MH) are rarely documented in Iran. Our goal was to measure and decompose socioeconomic inequalities in MH use among Iranian households. Methods: The data used in this cross-sectional study were extracted from the 2018 Household Income and Expenditure Survey (HIES) (N = 38,859). Data on MH use, age, gender, and education status of the head of household; a constructed wealth index of household (as a proxy for household’s socioeconomic status); and place of residence (urban or rural) were obtained from the survey. Publicly available province-level data on Human Development Index (HDI) were obtained from the Institute for Management Research at Radbound University. We used the concentration curve and the normalized concentration index (Cn) to measure the magnitude of socioeconomic inequalities in MH among Iranian households. The Cn was decomposed to identify the main determinants of socioeconomic inequalities in MH in Iran. Results: The overall prevalence of MH use among Iranian households was 4.7% (95% confidence interval [CI]: 4.5 to 4.9%) in the last month before data collection. The Cn for MH use for the whole of samples was 0.1519; 95% CI = 0.1254 to 0.1784; suggesting a higher concentration of MH use among the households with high socioeconomic level. The decomposition analysis indicated that the main contributing factors to the concentration of MH use were the economic status of households, development status of the province, and education level of the household head. Conclusions: This study demonstrated that MH use is more concentrated among socioeconomically advantaged households in Iran and its provinces. This finding might contrast with the widespread belief that wealthy and socioeconomically advantaged populations, compared to low SES groups, tend to seek disproportionately more modern medical treatments and medications than MH. Understanding the factors affecting MH use, socioeconomic inequality in use of MH and its determinants provide an opportunity for health policymakers to design effective evidence-based interventions among providers and consumers of MH

Prevalence of Workplace Violence of Emergency Medical Staff and Relevant Factors in Sanandaj, Iran in 2016

Background & Aim: In the past years, workplace violence in the area of health has been reported with an upward trend. This study aimed to evaluate the frequency of dealing with workplace violence in emergency medical staff of Sanandaj, Iran and relevant factors. Materials & Methods: This descriptive, analytical, and cross-sectional research was conducted in the emergency medical centers of Sanandaj in 2016. Considering the limited research population, census method was applied and all 126 staff of these centers were selected. Data were collected via a self-report questionnaire. In addition, data analysis was performed in SPSS version 20 using Chi-square and Fisher&rsquo;s exact tests. Results: In this research, 84% (95% CI=75-90) of the participants had an experience of workplace violence in the past year, 42% (95% CI=32-52) of which has been physical and 81% (95% CI=72-88) has been verbal violence. In addition, 59.4% (N=47) of the staff reported the source of violence to be the companions of patients. Moreover, 87% of the participants believed that there is no proper procedure to report workplace violence. Results were indicative of no significant relationship between workplace violence in the emergency medical staff and variables of age, marital status, work experience, and having work shift (P>0.05). Conclusion: According to the results of the study, there is an alarmingly high rate of workplace violence in the emergency medical centers of Sanandaj. This level of violence might reduce care quality and increase occupational stress. Considering the high rate of accidents in Iran and the necessity of composure for the staff, management interventions (e.g., public community education, creation of a suitable report system for the personnel and review of reports) are required to improve this area

Catastrophic Health Expenditure After the Implementation of Health Sector Evolution Plan: A Case Study in the West of Iran

Background: One of the main objectives of health systems is the financial protection against out-of-pocket (OOP) health expenditures. OOP health expenditures can lead to catastrophic payments, impoverishment or poverty among households. In Iran, health sector evolution plan (HSEP) has been implemented since 2014 in order to achieve universal health coverage and reduce the OOP health expenditures as a percentage of total health expenditures. This study aimed to explore the percentage of households facing catastrophic health expenditures (CHE) after the implementation of HSEP and the factors that determine CHE. Methods: A total of 663 households were selected through a cluster sampling based on the census framework of Sanandaj Health Center in July 2015. Data were gathered using face-to-face interviews based on the household section of the World Health Survey questionnaire. In this study, according to the World Health Organization (WHO) definition, if household health expenditures were equal to or more than 40% of the household capacity to pay, household was considered to be facing CHE. The determinants of CHE were analyzed using logistic regression model. Results: The rates of households facing CHE were 4.8%. The key determinants of CHE were household economic status, presence of elderly or disabled members in the household and utilization of inpatient or rehabilitation services. Conclusion: The comparison of our findings and those of other studies carried out using a methodology comparable with ours in different parts of Iran before the implementation of HSEP suggests that the implementation of recent reforms has reduced CHE at the household level. Utilization of inpatient and rehabilitation services, the presence of elderly or disabled members in the household and the low economic status of the household would increase the likelihood of facing CHE. These variables should be considered by health policy-makers in order to review and revise content of recent reform, thus financially protecting public against CHE

Has Iran achieved the goal of reducing the prevalence of households faced with catastrophic health expenditure to 1%?: A national survey

Abstract Background and Aims One of the goals of the Islamic Republic of Iran is to reduce the prevalence of catastrophic health expenditures among Iranian households to 1% by the end of the sixth 5‐year development plan (2016−2021). This study was conducted to evaluate the level of access to this goal in the final year of this program. Methods A national cross‐sectional study was conducted on 2000 Iranian households in five provinces of Iran in 2021. Data were collected through interviews using the World Health Survey questionnaire. Data from households whose health care costs were more than 40% of their capacity to pay were included in the group of households with catastrophic health expanditure (CHE). Determinants of CHE were identified using univariate and multivariate regression analysis. Results 8.3% of households had experienced CHE. The variables of being a female head of household (odd ratio [OR] = 2.7), use of inpatient (OR = 1.82), dental (OR = 3.09), and rehabilitation services (OR = 6.12), families with disabled members (OR = 2.03) and low economic status of the households (OR = 10.73) were significantly associated with increased odds of facing CHE (p < 0.05). Conclusion In the final year of the sixth 5‐year development plan, Iran has not yet achieved its goal of “reducing the percentage of households exposed to CHE to 1%.” Policymakers should pay attention to factors increasing the odds of facing CHE in designing interventions

Socioeconomic Inequalities in the Oral Health of People Aged 15-40 Years in Kurdistan, Iran in 2015: A Cross-sectional Study

Objectives The aim of this study was to evaluate socioeconomic inequalities in the prevalence of dental caries among an urban population. Methods This study was conducted among 2000 people 15-40 years of age living in Kurdistan, Iran in 2015. Using a questionnaire, data were collected by 4 trained dental students. The dependent variable was the decayed, missing, and filled teeth (DMF) index. Using principal component analysis, the socioeconomic status (SES) of families was determined based on their household assets. Inequality was measured using the concentration index; in addition, the Oaxaca analytical method was used to determine the contribution of various determinants to the observed inequality. Results The concentration index for poor scores on the DMF index was -0.32 (95% confidence interval [CI], -0.40 to -0.36); thus, poor DMF indices had a greater concentration in groups with a low SES (p<0.001). Decomposition analysis showed that the mean prevalence of a poor DMF index was 43.7% (95% CI, 40.4 to 46.9%) in the least privileged group and 14.4% (95% CI, 9.5 to 9.2%) in the most privileged group. It was found that 85.8% of the gap observed between these groups was due to differences in sex, parents’ education, and the district of residence. A poor DMF index was less prevalent among people with higher SES than among those with lower SES (odds ratio, 0.31; 95% CI, 0.19 to 0.52). Conclusions An alarming degree of SES inequality in oral health status was found in the studied community. Hence, it is suggested that inequalities in oral health status be reduced via adopting appropriate policies such as the delivery of oral health services to poorer groups and covering such services in insurance programs