Burden of sexually transmitted infections in Iran from 1990 to 2010: Results from the global burden of disease study 2010

The present study describes the epidemiological status of sexually transmitted infections (STIs) in Iran based on the Global Burden of Disease study 2010 (the GBD 2010), and compares this with those of other neighboring countries. Methods: The burden of STIs from 1990 to 2010 in Iran was derived from a systematic study, namely the GBD 2010, which was conducted by the Institute for Health Metrics and Evaluation (IHME). Using a model-based estimation, Disability Adjusted Life Years (DALYs) were calculated on the basis of the prevalence of STIs. The GBD 2010 used disability weights, and a mortality rate that was obtained from the vital registration system of Iran. We review the results of the GBD 2010 estimations for STIs in Iran. Results: The trend of DALYs attributable to STIs (107. 3 and 26. 47 per 100, 000 people in 1990 and 2010, respectively) and deaths (1. 13 and 0. 12 per 100, 000 people in 1990 and 2010, respectively) decreased dramatically in Iran during the last two decades. The majority of individuals affected by STI DALYs were aged 1-4 and 20-24 years. Conclusion: Since the majority of DALYs attributed to STIs were observed among those aged 1-4 years and young people, the economic burden of STIs will remain high in Iran. Therefore, effective evidence-based planning is critical to allocate the essential budget for utilizing treatment and prevention approaches

Care Seeking Patterns of STIs-Associated Symptoms in Iran: Findings of a Population-Based Survey

Background: Understanding the prevalence of symptoms associated with sexually transmitted infections (STIs) and how care is sought for those symptoms are important components of STIs control and prevention. People’s preference between public and private service providers is another important part of developing a well-functioning STIs surveillance system. Methods: This cross-sectional survey was carried out in spring 2011, using a nonrandom quota sample of 1190 participants (52% female) in 4 densely-populated cities of Tehran, Kerman, Shiraz, and Babol. Two predictive logistic regression models were constructed to assess the association between the socio-demographic determinants (independent variables) and the dependent variables of history of STIs-associated symptom and seeking care. Results: Around 57% (677 out of 1190; men: 29.70% and women: 81.80%) had experienced at least one STIsassociated symptom during the previous year. History of experiencing STIs-associated symptoms among men, was negatively significantly associated with older age (adjusted odds ratio [AOR]=0.34, CI 95%: 0.17-0.67). Women who were married, in older ages, and had higher educations were more likely to report a recent (past year) STIs symptom, however all were statistically insignificant in both bivariate and multivariable models. Among those who have had STIs-associated symptoms in the last year, 31.15% did nothing to improve their symptoms, 8.03% attempted self-treatment by over-the-counter (OTC) medications or traditional remedies, and 60.93% sought care in health facilities. In both bivariate and multivariable analyses, care seeking among men was insignificantly associated with any of the collected demographic variables. Care seeking among women was positively significantly associated with being married (AOR=2.48, 95% CI: 1.60-3.84). Conclusion: The reported prevalence of STIs-associated symptoms among our participants is concerning. A considerable number of participants had delayed seeking care and treatment or self-medicated. People should be informed about their sexual health and the consequences of delaying or avoiding seeking care for STIs. Participants preferred seeking care at private sectors which calls for engaging both public and private health sectors for reporting and following up STIs cases

Prevalence and correlates of psychiatric disorders in a national survey of Iranian children and adolescents

Objective: Considering the impact of rapid sociocultural, political, and economical changes on societies and families, population-based surveys of mental disorders in different communities are needed to describe the magnitude of mental health problems and their disabling effects at the individual, familial, and societal levels. Method: A population-based cross sectional survey (IRCAP project) of 30 532 children and adolescents between 6 and 18 years was conducted in all provinces of Iran using a multistage cluster sampling method. Data were collected by 250 clinical psychologists trained to use the validated Persian version of the semi-structured diagnostic interview Kiddie-Schedule for Affective Disorders and Schizophrenia-PL (K-SADS-PL). Results: In this national epidemiological survey, 6209 out of 30 532 (22.31%) were diagnosed with at least one psychiatric disorder. The anxiety disorders (14.13%) and behavioral disorders (8.3%) had the highest prevalence, while eating disorders (0.13%) and psychotic symptoms (0.26%) had the lowest. The prevalence of psychiatric disorders was significantly lower in girls (OR = 0.85; 95% CI: 0.80-0.90), in those living in the rural area (OR = 0.80; 95% CI: 0.73-0.87), in those aged 15-18 years (OR = 0.92; 95% CI: 0.86-0.99), as well as that was significantly higher in those who had a parent suffering from mental disorders (OR = 1.96; 95% CI: 1.63-2.36 for mother and OR = 1.33; 95% CI: 1.07-1.66 for father) or physical illness (OR = 1.26; 95% CI: 1.17-1.35 for mother and OR = 1.19; 95% CI: 1.10-1.28 for father). Conclusion: About one fifth of Iranian children and adolescents suffer from at least one psychiatric disorder. Therefore, we should give a greater priority to promoting mental health and public health, provide more accessible services and trainings, and reduce barriers to accessing existing services. © 2019 Tehran University of Medical Scienc

Population-based survey on STI-associated symptoms and health-seeking behaviours among Iranian adults

BACKGROUND: Qualified decision-making for the improved management of sexually transmitted infections (STIs) requires various sources of information. We aimed to estimate the STI-associated symptom prevalence and care-seeking patterns in the general population of Iran. METHODS: In 2014, using a street-based survey with a standard gender-specific questionnaire on STI-associated symptoms and willingness to seek treatment, we interviewed 9166 Iranian participants, who were selected from among the 18-60-year-old population using multistage sampling. Data were analysed via generalised estimating equation and survey analysis, taking into account a 95% confidence coefficient. RESULTS: About 67.3% of participants, mean age 33 years, were 'assumed sexually active' and were therefore eligible for inclusion. Approximately 39.9% (95% CI 28.4% to 51.4%) of women and 17.6% (95% CI 13.9% to 21.6%) of men reported at least one STI-associated symptom in the current week. The occurrence of symptoms decreased with an increase in age in both genders (p<0.05). About 21.2% (95% CI 13.3% to 29.1%) of women and 7.1% (95% CI 5.4% to 7.8%) of men treated symptoms themselves after symptoms first appeared. Of the women and men with symptoms, 37.4% (95% CI 24.8% to 50.0%) and 46.8% (95% CI 39.7% to 51.4%), respectively, sought care. Most women visited a gynaecologist and midwife; men tended to visit a general practitioner and urologist after their symptoms appeared. CONCLUSIONS: The prevalence of STI-associated symptoms in Iranian adults is considerable. The results emphasise the need for appropriate and timely STI care and more attention to sexual health promotion to mitigate onward and future infections. Attention to the care-seeking pattern is fundamental to policymaking and planning

Estimation of Prevalence and Incidence of Sexually Transmitted Infections in Iran; A model-based approach

BACKGROUND: Routine reporting of sexually transmitted infections (STIs) in Iran is one of the main information sources on STIs, endures some diminution under influence of several factors. We aimed to adjust registered STI data with a model-based approach and estimate the incidence and prevalence of STIs in Iran. METHODS: In this cross-sectional study, we developed a stochastic compartmental model considering effects of influential factors on STI reporting process to adjust registered STI data. We reviewed literature and used Delphi method to collect data and estimate model parameters. We calibrated the model using Monte Carol simulation with 95% confidence interval (CI). Finally, we validated the models by comparing their output with investigational data. RESULTS: The estimated prevalence of male urethral discharge was 0.40% (95% CI: 0.26%, 0.65%); the prevalence of genital ulcers was 3.68% (95% CI: 2.31%, 6.43%) in women and 0.16% (95% CI: 0.10%, 0.27%) in men. The estimated incidence for Neisseria gonorrhoeae, Chlamydia trachoma and syphilis per 1000 women was 2.44 (95% CI: 1.17, 6.65), 5.02 (95% CI: 2.78, 10.16) and 0.04 (95% CI: 0.02, 0.05) respectively; the corresponding figures per 1000 men were 0.43 (95% CI: 0.26, 0.80), 0.82 (95% CI: 0.42, 1.92) and 0.005 (95% CI: 0.003, 0.008). CONCLUSIONS: Various factors are responsible for the obvious underestimation in the number of STIs registered in Iran. Notwithstanding this underestimation, our models offer an indirect method of estimating the prevalence of STIs in the country. Providing policymakers and STI experts with more realistic estimates might prompt policymakers and STI experts to recognize the importance of STIs in Iran and help them to develop appropriate prevention and control programs

Care Seeking Patterns of STIs-Associated Symptoms in Iran: Findings of a Population-Based Survey

Background: Understanding the prevalence of symptoms associated with sexually transmitted infections (STIs) and how care is sought for those symptoms are important components of STIs control and prevention. People’s preference between public and private service providers is another important part of developing a well-functioning STIs surveillance system. Methods:This cross-sectional survey was carried out in spring 2011, using a nonrandom quota sample of 1190 participants (52% female) in 4 densely-populated cities of Tehran, Kerman, Shiraz, and Babol. Two predictive logistic regression models were constructed to assess the association between the socio-demographic determinants (independent variables) and the dependent variables of history of STIs-associated symptom and seeking care. Results:Around 57% (677 out of 1190; men: 29.70% and women: 81.80%) had experienced at least one STIsassociated symptom during the previous year. History of experiencing STIs-associated symptoms among men, was negatively significantly associated with older age (adjusted odds ratio [AOR] = 0.34, CI 95%: 0.17-0.67). Women who were married, in older ages, and had higher educations were more likely to report a recent (past year) STIs symptom, however all were statistically insignificant in both bivariate and multivariable models. Among those who have had STIs-associated symptoms in the last year, 31.15% did nothing to improve their symptoms, 8.03% attempted self-treatment by over-the-counter (OTC) medications or traditional remedies, and 60.93% sought care in health facilities. In both bivariate and multivariable analyses, care seeking among men was insignificantly associated with any of the collected demographic variables. Care seeking among women was positively significantly associated with being married (AOR = 2.48, 95% CI: 1.60-3.84). Conclusion:The reported prevalence of STIs-associated symptoms among our participants is concerning. A considerable number of participants had delayed seeking care and treatment or self-medicated. People should be informed about their sexual health and the consequences of delaying or avoiding seeking care for STIs. Participants preferred seeking care at private sectors which calls for engaging both public and private health sectors for reporting and following up STIs cases

Correlates of HIV Testing among Female Sex Workers in Iran: Findings of a National Bio-Behavioural Surveillance Survey.

Female sex workers (FSWs) are the second most affected population by HIV in Iran. However, their HIV testing practices are poorly understood. The aim of this study was to investigate testing and its associated factors among HIV negative FSWs

Care Seeking Patterns of STIs-Associated Symptoms in Iran: Findings of a Population-Based Survey

BACKGROUND: Understanding the prevalence of symptoms associated with sexually transmitted infections (STIs) and how care is sought for those symptoms are important components of STIs control and prevention. People's preference between public and private service providers is another important part of developing a well-functioning STIs surveillance system. METHODS: This cross-sectional survey was carried out in spring 2011, using a nonrandom quota sample of 1190 participants (52% female) in 4 densely-populated cities of Tehran, Kerman, Shiraz, and Babol. Two predictive logistic regression models were constructed to assess the association between the socio-demographic determinants (independent variables) and the dependent variables of history of STIs-associated symptom and seeking care. RESULTS: Around 57% (677 out of 1190; men: 29.70% and women: 81.80%) had experienced at least one STIs-associated symptom during the previous year. History of experiencing STIs-associated symptoms among men, was negatively significantly associated with older age (adjusted odds ratio [AOR] = 0.34, CI 95%: 0.17-0.67). Women who were married, in older ages, and had higher educations were more likely to report a recent (past year) STIs symptom, however all were statistically insignificant in both bivariate and multivariable models. Among those who have had STIs-associated symptoms in the last year, 31.15% did nothing to improve their symptoms, 8.03% attempted self-treatment by over-the-counter (OTC) medications or traditional remedies, and 60.93% sought care in health facilities. In both bivariate and multivariable analyses, care seeking among men was insignificantly associated with any of the collected demographic variables. Care seeking among women was positively significantly associated with being married (AOR = 2.48, 95% CI: 1.60-3.84). CONCLUSION: The reported prevalence of STIs-associated symptoms among our participants is concerning. A considerable number of participants had delayed seeking care and treatment or self-medicated. People should be informed about their sexual health and the consequences of delaying or avoiding seeking care for STIs. Participants preferred seeking care at private sectors which calls for engaging both public and private health sectors for reporting and following up STIs cases

Sexualized Substance Use among Female Sex Workers in Iran: Findings from a Nationwide Survey.

Background: Female sex workers (FSWs) are at higher risk of HIV due to high-risk sexual and drug use related behaviors. This study characterized sexualized substance use among FSWs in Iran. Methods: In 2015, 1,337 FSWs were recruited from centers for vulnerable women and through outreach efforts in 13 major cities in Iran. Data were collected via face-to-face interviews from consenting FSWs on a range of socio-demographic and behavioral characteristics. The primary outcome of interest was sexualized substance use, defined as reporting alcohol or drug use before or during sex in the past month. Bivariable and multivariable modified Poisson regression models were used to assess the correlates of sexualized substance use. Adjusted prevalence ratio (aPR) and 95% confidence interval (CI) were reported. Results: The prevalence of sexualized substance use was 31.3% (95% CI: 28.7, 34.0). Inconsistent condom use during sex with clients in the past month (aPR = 1.31; 95% CI: 1.01, 1.71), regular (i.e., at least weekly in the past month) alcohol use (aPR = 2.87; 95% CI: 2.17, 3.80), regular opioid use (aPR = 2.09; 95% CI: 1.45, 3.02), regular stimulant use (aPR = 2.68; 95% CI: 2.12, 3.39), and self-reported HIV negative status (aPR= 1.88; 95% CI: 1.14, 3.10) were significantly and positively associated with sexualized substance use. Conclusions: Sexualized substance use was associated with riskier sexual behavior and self-reported HIV sero-negativity. Harm reduction messaging to FSWs needs to go beyond focusing on sexual health promotion and further highlight the risks associated with sexualized substance use

Recent HIV testing among different subgroups of FSWs in Iran’s first national bio-behavioural surveillance survey (2010).

<p>Recent HIV testing among different subgroups of FSWs in Iran’s first national bio-behavioural surveillance survey (2010).</p