Methanol mass poisoning in Iran: Role of case finding in outbreak management

Background There are no guidelines addressing the public health aspects of methanol poisoning during larger outbreaks. The current study was done to discuss the role of active case finding and a national guideline that organizes all available resources according to a triage strategy in the successful management of a methanol mass poisoning in Rafsanjan, Iran, in May 2013. Methods A retrospective cross-sectional study was performed reviewing the outbreak Emergency Operation Center files. The objectives were to describe the characteristics, management and outcome of a methanol outbreak using Active Case Finding to trace the victims. Results A total of 694 patients presented to emergency departments in Rafsanjan after public announcement of the outbreak between 29th May and 3rd June 2013. The announcement was mainly performed via short message service (SMS) and local radio broadcasting. A total of 361 cases were observed and managed in Rafsanjan and 333 were transferred to other cities. Seventy-five and 100 patients underwent hemodialysis (HD), retrospectively. The main indication for HD was refractory metabolic acidosis. Eight patients expired due to the intoxication. Except for the deceased cases, no serum methanol level was available. Conclusion In developing countries, where diagnostic resources are limited, use of active case finding and developing national guidelines can help in the management of large outbreaks of methanol poisonings. © 2014 The Author 2014. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: [email protected]

National population size estimation of illicit drug users through the network scale-up method in 2013 in Iran

Background For a better understanding of the current situation of drug use in Iran, we utilized the network scale-up approach to estimate the prevalence of illicit drug use in the entire country. Methods We implemented a self-administered, street-based questionnaire to 7535 passersby from the general public over 18 years of age by street based random walk quota sampling (based on gender, age and socio-economic status) from 31 provinces in Iran. The sample size in each province was approximately 400, ranging from 200 to 1000. In each province 75 of sample was recruited from the capital and the remaining 25 was recruited from one of the large cities of that province through stratified sampling. The questionnaire comprised questions on demographic information as well as questions to measure the total network size of participants as well as the network size in each of seven drug use groups including Opium, Shire (combination of Opium residue and pure opium), Crystal Methamphetamine, heroin/crack (which in Iranian context is a cocaine-free drug that mostly contains heroin, codeine, morphine and caffeine with or without other drugs), Hashish, Methamphetamine/LSD/ecstasy, and injecting drugs. The estimated size for each group was adjusted for transmission and barrier ratios. Results The most common type of illicit drug used was opium with the prevalence of 1500 per 100,000 population followed by shire (660), crystal methamphetamine (590), hashish (470), heroin/crack (350), methamphetamine, LSD and ecstasy (300) and injecting drugs (280). All types of substances were more common among men than women. The use of opium, shire and injecting drugs was more common in individuals over 30 whereas the use of stimulants and hashish was largest among individuals between 18 and 30 years of age. Conclusion It seems that younger individuals and women are more desired to use new synthetic drugs such as crystal methamphetamine. Extending the preventive programs especially in youth as like as scaling up harm reduction services would be the main priorities in prevention and control of substance use in Iran. Because of poor service coverage and high stigma in women, more targeted programs in this affected population are needed. © 2016 Elsevier B.V