بهزاد پویا

Community assessment is a key tool for improving and promoting the health of the community. The role of community assessment is to identify the most important factors affecting the population health. To get a comprehensive picture of problems, priorities and suggested community health action plans in Iran, this review aims to summarize community assessments in various areas of Iran conducted between 1992 – 2013. This study was a retrospective review in which community assessments were compared and the results of several studies conducted in different regions of the country covering both rural and urban health centers were analyzed. Since 1999, department of Epidemiology and Biostatistics has conducted these community assessments in eight phases and follows 2002 North Carolina Community Health Assessment model. Assessment teams typically included MPH students and/ or PhD and masters (epidemiology) students from the School of Public Health. Data was collected through observation, interview, and focus group discussion. Assessment teams in each region prioritized the list of problems using Hanlon method and Nominal Group Technique. The results identified substance abuse, economical, and water-related problems as the most important problems in different parts of the country which indicates the need for developing a comprehensive action plan andimplementing measures. A review of the community assessments performed in this study shows the ability of community assessment to detect community health problems in all aspects. Therefore, this approach is recommended to evaluate and prioritize health problems and to formulate action plans.

Malnutrition is a major health problem in Iran. A nationwide survey (ANIS) in 1998 revealed that over 800 000 children in this country were suffering from moderate or severe malnutrition. The southern province of Hormozgan is one of the most severely affected regions, so there is a need to determine disease associations and risk factors for child malnutrition in this area. In this case-control study, we selected 1725 children aged 6 to 30 months from both rural and urban areas of Hormozgan. Data for the study were obtained by filling questionnaires and studying family health files. Using the weight-for-age Z score (WAZ) as outcome measure, we examined the effects of 21 different variables, including putative risk factors, confounders, and background variables. Father's job (p<0.004), parent's education, interval between pregnancies, urban versus rural residence (p<0.001), family size (p<0.03), and misconceptions regarding the growth chart were recognized as risk factors for malnutrition. Moreover, the mean age of the cases was 2.3 years higher than that of the controls (p<0.001). Complete vaccination (p<0.018) and attending day care centers (p<0.005) emerged as protective factors. Poverty (low-income jobs, rural residence, large family size, etc) is an important factor causing malnutrition among children in Hormozgan. In contrast, immunization and mother's knowledge of the child's growth chart are major protective factors. Therefore, the health system must continue its support for the current immunization program. It should also try to improve the quality of its health education programs targeted at mothers attending state-run health and medical clinics.