Response to the Bam Earthquake: A Qualitative Study on the Experiences of the Top and Middle Level Health Managers in Kerman, Iran

Introduction: The 2003 Bam, Iran earthquake resulted in high casualties and required international and national assistance. This study explored local top and middle level managers’ disaster relief experiences in the aftermath of the Bam earthquake. Methods: Using qualitative interview methodology, top and middle level health managers employed during the Bam earthquake were identified. Data were collected via in-depth interviews with participants. Data were analysed using thematic analysis. Results: Results showed that the managers interviewed experienced two main problems. First, inadequacy of preparation of local health organisations, which was due to lack of familiarity of the needs, unavailability of essential needs, and also increasing demands, which were above the participants’ expectations. Second, inappropriateness of delivered donations was perceived as a problem; for example, foods and sanitary materials were either poor quality or expired by date recommended for use. Participants also found international teams to be more well-equipped and organised. Conclusions: During the disaster relief period of the response to the Bam earthquake, local health organizations were ill prepared for the event. In addition, donations delivered for relief were often poor quality or expired beyond a usable date

‫"بام"‬ ‫لزلزال‬ ‫حالة‬ ُ ‫دراسة‬ ‫للكوارث:‬ ‫األمد‬ ‫الطويلة‬ ‫التأثريات‬ ‫رصد‬ ‫يف‬ ‫األمهات‬ ‫وفيات‬ ‫نسبة‬ ‫أمهية‬ ‫تقييم‬ Evaluation of the usefulness of maternal mortality ratio for monitoring long-term effects of a disaster: case study on the Bam e

ABSTRACT The maternal mortality ratio is an important indicator of socioeconomic conditions in a country or area. This study in Kerman province aimed to compare maternal mortality ratios from different data sources and examine deficiencies in vital data collection in the Islamic Republic of Iran in the context of the Bam earthquake disaster (December 2003). Annual data were collected from documents before and after the earthquake and interviews were conducted with key informants. There was a large difference in maternal mortality ratios in the year of the earthquake and the year after the earthquake comparing the 2 main data sources (the family unit under the supervision of the Ministry of Health and Medical Education and the civil registry under the supervision of the Ministry of Interior). The reasons for this are discussed. This study also highlighted problems in collaboration between international aid agencies that hindered routine data collection

Letters to the Editor: In response to questions about the article Relationship between Body Image and Social Participation in Pregnant Women of Jahrom City, Iran

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Sequential ambiguity and uncertainty in the early stage of a disaster relief: A case study of the Bam earthquake

This study aimed to identify issues that arose during the early response stage of the Bam earthquake as perceived by the aid workers. Eleven people who had been involved in the Bam earthquake response, and who were working for the Red Crescent in Iran or the Kerman University of Medical Science teams, were interviewed. These groups were two of the main organizations providing assistance to victims of the Bam earthquake. The authors used two nonrandom sampling methods, namely, purposive and snowball sampling. The interviewees identified two main barriers for achieving an effective response at the early stage aftermath of the earthquake, as follows: first, the lack of accurate information on the location and extent of the earthquake due to shortage in communication tools and, second, inadequate training on different challenges posed in relation to the disaster, before the earthquake occurred. © 2020 Weston Medical Publishing. All rights reserved

Out-of-Pocket Costs and Importance of Nonmedical and Indirect Costs of Inpatients

Objectives: Out-of-pocket (OOP) costs are a major part of the expenditures for healthcare services. In most cases, patient financial protection plans cover only direct medical costs and not other expenses by patients. Methods: This cross-sectional study was conducted on 800 patients referring medical centers of Kerman to analyse all aspects of OOP, especially after the Health Transformation Plan in Iran. Using the probability proportional to the size of the medical center, samples from each ward in each medical center were determined in accordance with the previous year's patient number. Randomly selected medical records of the last 2 weeks of patients discharged were collected, information was extracted, and telephone interviews were conducted. Results: The mean total OOP costs of a one-time hospitalization in all medical centers in Kerman was equal to 7 561 977 Iranian rials. Assuming a 5 threshold, 37 of patients in public centers were faced with catastrophic health expenditures for a one-time hospitalization. Based on the results of the regression model, reduction of length of stay, elimination of the need for the presence of next of kin, and provision of healthcare services out of hospitals can greatly reduce OOP expenditures. Conclusion: Although direct medical costs are of special importance, and it is very necessary to protect patients against such costs, patients usually incur a variety of costs when receiving inpatient services. Inattention to direct nonmedical costs and indirect costs due to patients� and their next of kin's absenteeism may cause households to face catastrophic expenditures. © 2020 ISPOR�The professional society for health economics and outcomes researc