Iranian Journal of Public Health
Volume:43 Issue: 9, Sep 2014

Since it was first diagnosed in 1914 in Marrakesh, schistosomiasis has been a public health problem in Morocco for decades. A national control program launched in 1982 has led to a considerable reduction in the incidence and morbidity associated with the disease. Consequently, the program has shifted from disease control to an elimination process launched in 1994. This process aimed to eliminate disease transmission by the end of 2004 and has helped to clear all known foci. Mobile teams were a key element that contributed to the success of this program. They played three important roles: monitoring and control, response, and the transmission of messages.

Bacterial meningitis is still the leading cause of high morbidity and mortality among the children. The present study was conducted to determine the epidemiology, clinical characteristics of bacterial meningitis and to evaluate the risk factors associated with developing the infection. This cross sectional study was conducted in three hospitals of Gaza strip –Palestine during the period 2009. All the children with clinical diagnosis of meningitis /meningoencephalitis admitted to these hospitals were included in the study. They were subjected to clinical examination as well as CSF bacteriological and serological investigations. During the period (2009), 1853 patients were admitted to the hospitals with suspect of meningitis by pediatricians, 73 (3.9%) proved by culture to be acute bacterial meningitis, of these patients 62% were males and 38% were females. The common isolated pathogens were Neisseria meningitides (47.9%), Streptococcus pneumonia (15.1%), Haemophillus influenza (13.7%), E. coli (11.0%), Enterobacter spp. (6.8%), Citrobacter spp. (2.7%), Providencia spp. (1.4%), and Pseudomonas aeruginosa (1.4%). The common recorded symptoms were fever (78%), neck stiffness (47%), vomiting (37%), poor feeding (19%), and irritability (16%). Statistical analysis showed that there was statistical significance associated developing of infection with malnutrition (low hemoglobin level), high house crowdness and irritability (P-value <0.05). The ANOVA statistical analysis showed that S. pneumonia has an impact on developing low hemoglobin level and leukocytosis. N. meningitides is still dominant and needs vaccination. The risk factors should be taken into consideration in any future plan.

Children and adolescents are vulnerable to violent situations in their social, family and school environment. The aim of the study was to characterize morbidity due to violence in Brazilian children and adolescents. A cross-sectional study through the analysis of 1,356 corpus delicti medical reports and police reports of children and adolescents aged 0-19 years, victims of interpersonal violence was conducted from January 2008 to December 2011. Sociodemographic variables related to victims, offenders and aggressions were analyzed. There was a prevalence of females over males (56.9% vs. 43.1%) with age between 15 and 19 years (64.7%). There was a significant association between variables age of the victim and place of occurrence, sex and type of aggression, sex and number of lesions, presence of fracture, maxillofacial injury, oral cavity lesion and physical violence; physical violence and involvement of face, neck, abdomen and back (P < 0.001). Public streets (56.4%) were the main place of occurrence of events, followed by home (33.1%). Family members accounted for 26.48% of aggressions. The face was the most affected body region (43.36%), with 12.61% of records referring to oral cavity lesions. Violence was responsible for a large number of non-fatal injuries to children and adolescents, affecting mainly females aged 15 and 19 years. The occurrence of such events is more frequent on public streets and at home. Most victims had multiple injuries and the face was the most affected body region.

Malaria is one the major health problem in Nigeria. During pregnancy, it poses serious threat to the survival of both unborn foetus and the mothers. This study determined the effect of adequate malaria knowledge and pregnancy status of women on use of mosquito nets and reported malaria fever morbidity. The data were collected during the Malaria Indicator Survey (MIS) from 4632 women. Data analyses were carried out with descriptive statistics and Seemingly Unrelated Bivariate Probit regression. Results show that 13.19% of the women were pregnant, of which about one-third slept under mosquito nets. Also, 25.26% reported malaria associated fever in the previous two weeks to the time of interview, while 78.28% correctly answered that mosquitoes are responsible for malaria. Knowledge on malaria prevention was low with 55.70% and 14.93% indicating sleeping under mosquito nets and ITN, respectively. Probability of sleeping under mosquito nets significantly increased with knowing that sleeping under mosquito nets and ITN could prevent malaria while it decreased with having fever, age, urban residence and knowing that use of mosquito spray and coil can prevent malaria. The probability of having fever increased significantly with household size, being pregnant and age at first birth but decreased with age, knowing that sleeping under ITN, cutting grasses and closing door/windows would prevent malaria. Use of mosquito nets among the women was low. Also, efforts to enhance their knowledge on malaria prevention and ensuring adequate access to mosquito nets especially for pregnant women would curtail the impact of malaria.

Excess sodium intake can lead to hypertension, the primary risk factor for cardiovascular disease. The aim of this study was to investigate the sodium and potassium contents of foodstuff used by infants and children of Pakistan. We analyzed the sodium and potassium contents of infant milk formula (<6 months), follow up milk formula (>6 months), baby food (cereals), biscuits, fruit juices, potato chips (crisps), cheese puffs, roasted cereals (salty), ice cream cones (kulfi) all of which are the processed food extensively used by the children. The amount of sodium and potassium contents in drinking water of few cities of Pakistan were also considered to assess the additional sodium/potassium in the preparation of milk using infant milk formula. Na to K ratio (Na:K) was determined 0.3-1.23, 0.3-1.16, 0.33-0.82, 0.54-2.68, 0.51-0.85, 2.86 and 1.02 for infant milk formula (<6 months), follow up milk formula (>6 months), baby food (cereals), biscuits, fruit juices, potato chips (crisps, cheese puffs, roasted cereals), ice cream cones (kulfi), respectively. The higher sodium content is present than most of the quoted values; whereas lower potassium is present than the recommended values. The higher Na:K ratio indicates the severity of the situation where it is commonly stated that “higher an individual’s salt intake, the higher an individual’s blood pressure”. Present study indicates that nearly all Pakistani children consume substantially more salt than they need which will affect health status in later life.

Currently, obesity has become a worldwide health problem and yet little is known about the impact of changes in obesity indicator on incident hypertension. The aim of this study was to compare the impact of changes in the WC and BMI on incident hypertension in a cohort population. After a baseline investigation, we conducted the first and the second follow-up assessments for subjects after 2 and 5 years, respectively. The associations between the changes in the WC and BMI (measured as the D-value, i.e., the value at the first follow-up minus the value at baseline) and the hazard ratio (HR) of incident hypertension were analyzed with a multilevel Cox proportional hazards regression model. Among 2778 participants without hypertension, 660 developed hypertension between the first and the second follow-up assessments. When both the BMI and WC D-values were included in the regression model, the WC D-value was a predictor of hypertension incidence in both sexes (OR= 1.03 and P values < 0.05 for men and women), but the BMI D-value was no longer a predictor of hypertension incidence in either sex (OR=1.04 for men and 1.01 for women, both P values >0.05). In both sexes, hypertension risk was higher for subjects whose BMI was modified but WC was categorically increasing than for subjects whose WC and BMI were both modified. Both WC and BMI changes were associated with hypertension, but a change in the WC was a better predictor of the hypertension.

To assess the health impact of air pollution on Bejaia population in the north of Algeria, we carried out a descriptive epidemiologic inquiry near the medical establishments of three areas. From hospital admissions registers, we collected data on the hospital mortality and admissions relating to the various cardiorespiratory pathologies generated by this type of pollution. In parallel, data on the automobile fleet of Bejaia and other measurements were exploited to show that the pollutants concentrations are strongly correlated with the urban traffic concentration. This study revealed that the whole of the population is touched, but the sensitivity to pollution can show variations according to the age, the sex and the residence place. Population of Bejaia town marked the most raised death and morbidity rates, followed by that of Kherrata. Weak rates are recorded for the rural population of Feraoun. Stronger correlation (>0.9) is evident amongst CO and deaths due to asthma and COPD in Béjaia city. This approach enables us to conclude that the population of Béjaia could not escape the urban pollution generated by her old automobile fleet. Installation of a monitoring and measuring site of air pollution in this city could provide a beneficial tool to protect its inhabitants by informing on air quality they breathe and the measures to following order to minimize the impacts on their health and by alerting the authorities during the critical situations.

During the last few decades, focus of rehabilitation outcome has been redirected to the lifetime monitoring of quality of life. The purpose of this study was to investigate the differences in quality of life perceptions between participants with spinal cord injury and participants of typical population. This cross-sectional controlled study of 100 adults aged 18–65 years was based on two questionnaires, Short Form-36 Health Survey (SF-36) and Spinal Cord Injury Quality of Life Questionnaire (QL-23), completed by 23 participants with paraplegia, 21 participants with tetraplegia, and 56 participants of typical population. Mann-Whitney U-test for planned comparison between groups and χ2 test were used to analyze the differences between research groups. Participants from control group perceived their general quality of life at higher level in comparison to participants with spinal cord injury (U=415.000, z=-5.804, P<0.000). Negative influence of spinal cord injury was detected in six domains (physical functioning, physical role, bodily pain, vitality, social functioning, mental health). Statistical differences between participants with paraplegia and participants with tetraplegia only in domain of functional limitations (U=103.000, z=-3.256, P<0.005). The participants with spinal cord injury perceived both health-related and general quality of life at a lower level in comparison to controls. However, the injury level only partially determined the estimated quality of life.

The aim of this study was to determine the socioeconomic inequalities in nonuse of seatbelts in cars and helmets on motorcycles in Kurdistan Province, west of Iran, 2009. The data used in this study was collected from the data gathered in non-communicable disease surveillance system (NCDSS) in 2009 in Kurdistan. A total of 1000 people were included in this study. The outcome variable of this study was the nonuse of seatbelts and helmets. The socio-economic status (SES) was calculated based on participants’ residential area and assets using Principal Component Analysis (PCA) method. The concentration index, concentration curve, and comparison of Odds Ratio (OR) in different SES groups were used to measure the socioeconomic inequalities using logistic regression. In order to determine the contribution of determinants of inequality, decomposition analysis was used. The prevalence of nonuse of seatbelts in cars and helmets on motorcycles were 47.5%, 95%CI [44%, 55%], respectively. The Concentration index was -0.097, CI [-0.148, -0.046]. The OR of nonuse of seatbelts in cars and helmets on motorcycles in the richest group compared with the poorest group was 0.39, 95%CI [0.23, 0.68]. The results of the decomposition analysis showed that 34% of inequalities were due to SES, 47% were due to residential area, and 12% were due to unknown factors. There is a reverse association between SES and nonuse of seatbelts in cars and helmets on motorcycles. This issue must be considered while planning to reduce traffic accidents injuries.

The aim of this study was to determine adherence and attrition rates in a lifestyle intervention for people with metabolic syndrome. Adherence and attrition data from a randomized controlled trial were collected. Participants were classified as adherence group if they completed assessments at 3 and 6 months follow-up and as attrition group if they did not. Physical activity and quality of life was measured using the International Physical Activity Questionnaire (IPAQ) and the Short Form Health Survey (SF-36). Generalized Estimating Equations (GEE) was used to explore predictors of attrition. The mean age of participants (n=160) was 44.1 years. Attrition rate in the intervention and control groups at first follow-up were the same (20%). However, the control group had significantly higher attrition rate (%33.7) compared to the intervention group (%20) at 6 months follow up. Results showed that low educated participants were more likely to not stay in the study than better educated participants (OR=2.95,CI:1.39-6.33,P=0.05). According with length of the study, attrition was decreased at six month (OR=0.66,CI:0.52-0.83,P<0.001). Also, some aspects of health-related quality of life contributed to the attrition rate. Those who had higher scores on general health (OR=0.66,CI:0.54-0.97,P=0.023), social functioning (OR=0.44,CI:0.40-0.76,P=0.032), role emotional (OR=0.74,CI:0.54-0.98,P=0.18), vitality (OR=0.55,CI:0.38-0.90,P=0.015) and mental health (OR=0.63,CI:0.45-0.85,P=0.033) were more likely to stay in the study. It remains a concern that Web-based lifestyle programs may fail to reach those who need it most. Participant in the study generally had better quality of life than those who were lost to follow up.

The aim of this study was to investigate the trends in mortality from road traffic accidents (RTA) in Fars Province, southern Iran. The Age and sex-standardized mortality rate attributed to RTA from 2004 to 2010 in Fars Province was calculated using world standard population. We also used linear regression and chi-squared tests. Over the period of study (7 years), 12954 people died in RTA. The age- and sex-standardized mortality rate was 27 per 100,000. While the rate of death due to RTA had an incremental rate in age group 18-30 years and among women, it had a decreasing trend in age groups 35-45, under18 and among men. An increase in mortality rate of RTA among people aged 18-30 yr and women need to be addressed by health policy makers and other involved sections.

Health care systems should assign quality improvement as their main mission. Clinical governance (CG) is a key strategy to improve quality of health care services. The Iranian Ministry of Health and Medical Education (MOHME) has promoted CG as a framework for safeguarding quality and safety in all hospitals since 2009. The purpose of this study was to explore perceived facilitators and barriers to implementing CG by deputies for curative affairs of Iranian medical universities. A qualitative study was conducted using face to face interviews with a purposeful sample of 43 deputies for curative affairs of Iranian Medical Universities and documents review. Thematic analysis was used to analyze the data Five themes were explored including: knowledge and attitude toward CG, culture, organizational factors, managerial factors and barriers. The main perceived facilitating factors were adequate knowledge and positive attitude toward CG, supporting culture, managers’ commitment, effective communication and well designed incentives. Perceived barriers were the reverse of facilitators noted above in addition to insufficient resources, legal challenges, workload and parallel quality programs. Successful implementation of CG in Iran will require identifying barriers and challenges existing in the way of CG implementation and try to mitigate them by using appropriate facilitators.

Nonalcoholic fatty liver disease (NAFLD) is one of the aspects of metabolic syndrome (MetS). Due to the increase of MetS in Iran, this study was conducted to determine the prevalence of NAFLD, its potential predictors and their sex distribution in north of Iran, Amol. In 2008 this population based cross-sectional study included 5023 adult individuals who were randomly selected from Amol healthcare centers. Blood analysis and hepatic sonography was performed for each individual and Clinical histories were reviewed. MetS was defined according to the National Cholesterol Education Program Adult Treatment Panel III. Chi-square test, univariate and multivariate logistic regression were used to analyze data. The prevalence of NAFLD and metabolic syndrome was 43.8% and 29.6% respectively. Both NAFLD and metabolic syndrome were significantly more prevalent in women. There was a stronger association between these two factors in women which may indicate MetS has a much more potency to result in NAFLD in women. The strongest predictors of NAFLD in men were waist circumference>102 cm, serum ALT ≥40 (U/L) and the age group of 40-60 years. The strongest predictors of NAFLD in women were waist circumference>88 cm, the age groups of 40-60 and >60 years. The observed prevalence is alarming because almost 7out of 10 subjects with MetS had NAFLD. As high waist circumference was an important predictor of NAFLD in both sexes, health care policies to reduce the incidence of obesity in the country will have an important impact on the occurrence of NAFLD.

Streptococcus pneumoniae is an important problem worldwide and nasopharyngeal colonization plays significant role in pneumococcal infections. The aims of this study were to determine the nasopharyngeal colonization rate, serotyping, antibiotics susceptibility and study the risk factors for nasopharyngeal colonization with S. pneumoniae in students in Kashan, Iran. A cross-sectional study was conducted on children aged 7 to 19 years from December 2011 to November 2012. Nasopharyngeal swabs were plated onto brain heart infusion agar plates with 5% sheep blood and 4μg/ml of gentamycin. Antimicrobial susceptibility profiles were determined on Mueller-Hinton agar in accordance with CLSI. S. pneumoniae strains were investigated for the presence of the most common pneumococcal serotypes using a multiplex polymerase chain reaction. 13.9% were found to be carriers. The most prevalent serogroups were 19F (30%), 6A/B (18.9%), 15A (16.5%), 11 (11.3%), 23F (8.2%), 1 (6.2%), 19A (3.4%), and 35B (2.4%). Nine strains (3.1%) were non-typeable. The carrier rate was significantly higher in 12 to15 year old age group. Upper respiratory tract infections within the last month (OR=1.5, P<0.011), previous hospitalization (OR=1.6, P<0.001), previous antibiotic usage last two weeks (OR=1.89, P<0.001), rhinorea (OR=1.9 P<0.001), male sex (OR=3.5 P< 0.001) and passive smoking (OR=1.56, P< 0.001) have been determined to be risk factors for S. pneumoniae carriage. The highest pneumococcal resistance was to tetracycline (25.4%). All strains were susceptible to linezolid and levofloxacin. Our information leads to an important source to screen the future impact of pneumococcal vaccination on bacterial colonization.

A 73-year-old female patient developed a generalized tonic-clonic seizure on the 6th day after treatment with moxifloxacin 400 mg daily intravenously for appendicitis. This patient had atrial fibrillation and history of a surgery for intracerebral hemorrhage, with impaired renal function and liver function, but without history of seizures. Moxifloxacin was discontinued and switched to cefuroxime. The patient remained seizure-free at discharge four days later. The naranjo adverse drug reaction probability scale score was 4, indicating a possible adverse reaction to moxifloxacin. The potential risk factors related to moxifloxacin-induced seizures are discussed. It highlights that pre-existing central nervous system disease, elderly female with lower bodyweight and severe renal impairment may be the risk factors involved in moxifloxacin-induced seizures.

Hydatid cyst disease should be considered in differential diagnosis in many doubtful clinical situations as can present with non-specific symptoms especially in the endemic areas. Cardiac involvement should be considered in patients with history of previous hydatid cyst disease.. Cardiac hydatid cysts account for less than 2% of all hydatid diseases. In this report we aimed to present a case of 14-year-old boy with the diagnosis of occlusion of artery of the right lower extremity. Surgical exploration of the femoral artery revealed multiple hydatid cysts. Echocardiography showed a mobile mixed mass lesion. Complete resection of the mass was done from interventricular septum. Histopathological examination of the removed tissue revealed a complicated hydatid cyst and complete mass excision was confirmed. In this case a 7 year clinical and serological tests evaluation follow-up after surgical treatment showed no evidence of recurrence. The finding of this case emphasizes that in endemic countries, primary cardiovascular echinococcosis should be considered in differential diagnosis.