alireza mahdavi hezaveh

Using the WHO STEPwise approach to NCD risk factor surveillance (STEPS), first round of Iran’s STEPS completed in 2005. It has been repeated six times afterward. Here we report the results of 2016 round on the population characteristics and prevalence of diabetes and prediabetes, along with an assessment of the country-level performance on diabetes care in Iran.

Using a proportional-to-size cluster random sampling method, the STEPS 2016 included 18947 subjects aged≥25 years who matched the criteria (non-missing information on diabetes self-report, and biomarkers). For the analyses, survey design methods with weighted samples were employed. Different definitions of diabetes (biomarker-based, self-report, anti-diabetes medication use, or a combination) and prediabetes (different cutpoints of the biomarker) were calculated and presented.

An estimated 5171035 persons aged≥25 years or 10.6% (95% CI: 10.0%–11.1%) had diabetes according to the serologic diagnosis of diabetes (FPG≥126 mg/dL) or the use of at least one anti-diabetes medication (1896 out of 18947). Employing the serologic diagnosis of diabetes among those who responded no to the self-reported question, 2.7% (2.5%–3.0%) of the population were not aware of their diabetes compared to 11.5% (10.9%-12.0%) who were diabetics according to the just self-reported question. Defining prediabetes as 100≤FPG<126 mg/dL or 5.7≤HbA1c<6.5%, an estimated 15244299 persons had prediabetes (5885 out of 18947). Overall, 52.1% (49.4%–54.7%) of patients with self-reported diabetes were under strict glycemic control (HbA1c<7%). Poor diabetes control (HbA1c>9%) was found in 18.4% (16.3%-20.6%) of the patients with self-reported diabetes.

Since 2005, the prevalence of diabetes in Iran has been on a gradual increase in both genders with an increasing gap between females and males.

Regarding the growing burden of non-communicable diseases (NCDs) and exposure to their risk factors, and the continuous need for nationwide data, we aimed to develop the latest round of the STEPwise Approach to NCD Risk Factor Surveillance (STEPS) survey in 2021 in Iran, while the COVID-19 pandemic was still present.

In addition to the three main steps of this survey, including questionnaires, physical measurements, and laboratory assessments, we adapted the survey with the situation caused by the COVID-19 pandemic, by adding to various aspects of study phases and changing some scientific and executive procedures in this round of STEPS survey in Iran. These changes were beyond the initial novelties embedded within the survey before the pandemic, by refining the study protocol benefiting from the previous experiences of the STEPS survey.

By amending the required changes, we could include a total of 27874 individuals in the first step of the survey. This number was 27745 and 18119 for the second and third steps. Comparing the preliminary results with the previous nationwide surveys, this study was highly representative on both national and provincial levels. Also, implementing the COVID-19 prevention and control strategies in all stages of survey led to the least infection transmission between the study investigators and participants.

The novel initiatives and developed strategies in this round of Iran STEPS survey provide a state-of-the-art protocol for national surveys in the presence of an overwhelming catastrophe like the COVID-19 pandemic and the triggered limitations and shortages of resources.

The COVID-19 pandemic has caused significant disruptions in the provision of non-communicable disease (NCDs) prevention and control services in many countries, and there is a concern that it would lead to long-term complications of the diseases. The aim of this study is to assess the changes in the provisions of selected NCD services before and after the COVID-19 epidemic in Iran’s primary healthcare system.

In this descriptive-analytical retrospective study, the number of eight NCD services provided during the first 10 months of the COVID-19 pandemic from Feb 2020 to Dec 2020 were compared with the same period in the previous year using the data from the Iranian integrated electronic health record system (SIB) and also the association between the number of deaths due to COVID-19 and a sample of NCD services were assessed using cross-correlation analysis. The statistical analysis was performed in Stata Software v.14.

The NCD services have decreased by an average of 18.89% compared to the same period in the previous year; this decline was much more severe at the beginning of the epidemic period (up to 75% in some services) and was greater in physician-provided services than in non-physician services. Also, examining the course of the selected services during this period, a gradual compensation was evident after the initial reduction.

The general trend of the selected services of prevention and control of NCDs in the PHC system of Iran within 10 months after the onset of COVID-19 showed a sharp decline and subsequent gradual compensation. Although the process of compensation in some services may be considered somewhat reassuring, in the case of some essential services, more effort and attention to the implementation of programs or compensatory policies seem necessary.

 Annually, over 131000 new cases of cancer have been identified in Iran, with an increasing trend that is predicted to grow by 40% by 2025. The most important contributing factors to this increase are the improvement of the health service delivery system, increased life expectancy, and the aging of the population. The aim of this study was to develop Iran's "National Cancer Control Program" (IrNCCP).

 The present study is a cross-sectional study that was conducted in 2013 using the method of reviewing studies and documents and focused group discussions and a panel of experts. In this study, the available evidence related to cancer status and its care in Iran and other countries, as well as national and international upstream documents, were reviewed and analyzed. Then, by analyzing the current situation in Iran and other countries and conducting stakeholder analysis with the strategic planning approach, the IrNCCP was developed with a 12-year horizon consisting of goals, strategies, programs, and performance indicators.

 This program has 4 main components, including Prevention, Early Detection, Diagnosis and Treatment, and Supportive and Palliative care, as well as 7 supporting components including Governance and policy-making, Cancer Research, Developing facilities, equipment, and service delivery network, Providing and managing human resources, Providing and managing financial resources, Cancer information system management and registry, and Participation of NGOs, charities, and the private sector.

 Iran's National Cancer Control Program has been developed comprehensively with cross-sectoral cooperation and stakeholder participation. However, like any long-term health intervention, strengthening its governance structure both in terms of implementation and achievement of expected goals and evaluation and modification during the implementation of the program is essential.

This study aimed to investigate the economic evaluation of remote monitoring of type 2 diabetic patients for controlling glycosylated hemoglobin compared to routine care for type 2 diabetics.

Economic evaluation was carried out to calculate the unit cost of the remote monitoring technology and the routine treatment for type 2 diabetics, incremental cost-effectiveness ratio, and sensitivity analysis using the key variables such as population size and cost items (in five categories of equipment and devices, building, staff, overhead costs, and consumables costs).

Considering the incremental cost-effectiveness ratio in the base-case model and in comparison with routine treatment of type 2 diabetes, remote type 2 diabetes monitoring system was placed in the second quarter (more effective and affordable technology) of the graph as the most dominant alternative (RPM vs. Routine care: Total annual cost difference: -38476.477 US$ / “Unit- reduction in HbA1C” difference: 0.488).  The results of the sensitivity analysis revealed that in all scenarios, RPM was dominant compared to the routine treatment (The optimum ICER: -610.128 US$ per “Unit reduction in HbA1C” for the scenario with A 10% increase in the costs of the control and intervention group).

Remote patient monitoring is a dominant alternative compared to routine treatment. Results indicated that remote type 2 diabetes monitoring interventions play an effective role in reducing HbA1c, which may be considered the rationale for policymakers to use this technology.

Covid-19 pandemic has caused significant disruptions in the provision of non-communicable disease prevention and management services in many countries and there is a concern that this disorder will lead to long-term complications of these diseases; This study aimed to quantitatively analyze the status of some prevention and management services of non-communicable diseases in the primary health care system of Iran during the Covid-19 pandemic.

In this study, the routine data of 8 services related to the prevention and management of non-communicable diseases in the integrated electronic health record system (SIB) within 10 months after the outbreak of Covid-19 were compared to the same period last year.

Non-communicable disease prevention and management services have decreased by an average of 18.89% compared to the same period last year; this decrease was much more severe at the beginning of the epidemic period (up to 75% in some services) and more in the services provided by physicians than in the services provided by non-physicians. Also, observation of the course of selected services during this period showed that after the initial reduction of services, a process of gradual compensation is evident.

like other areas involved in the pandemic, the effect of the Covid-19 epidemic on non-communicable disease prevention and management services in the primary health care system of Iran, has been significant and although partial compensation of some services is promising, more attention and effort is needed to revive the other programs.

Evidence shows that COVID-19 pandemic affects non-communicable diseases (NCDs), significantly. This study aimed to analyze the status of prevention and management services of NCDs at the level of primary health care (PHC) system during the COVID-19 pandemic.

In this situation analysis study, first the circulars communicated at the level of PHC system from beginning of the pandemic to the end of September 2020 were manually and electronically retrieved, and those which included a decision or action in terms of governance and coordination mechanisms to provide NCDs in crisis and reopening stages, were analyzed. Then, the plans of major NCDs services in low-risk, intermediate, and high-risk conditions were developed and finalized based on the circulars. Finally, situation analysis was performed using SWOT analysis, and proposed strategies were extracted.

25 out of 199 circulars were analyzed. In the crisis phase, most screening, risk assessment and diagnostic services were suspended, and the follow-ups and care of patients with NCDs were mainly done by telephone. In the reopening phase, general strategies were adopted to increase capacity and to compensate delayed care, and the plan of major NCDs services at the PHC system was developed in the three-pandemic settings. Finally, main strategies were proposed with integration approach and focusing on essential services, considering vulnerable groups and the use of E-health technologies.

The results indicated an interruption in NCDs services during the crisis phase, while adopting strategies to respond to the pandemic. Revision of the COVID-19 guides with a particular focus on NCDs prevention and management services is recommended in national response plan.

Tobacco smoking is one of the most important avoidable causes of mortality from non-communicable diseases (NCDs). This study aimed to report the crude and standardized prevalence of current, ever, and secondhand smoking at national and provincial levels.

This study was performed through an analysis of the results of the STEPs survey 2016, which was conducted as a cross-sectional national study. The samples were selected via multistage cluster sampling and they were representative of general population aged ≥18 years in all provinces of Iran. All the data were analyzed via survey analysis while considering population weights. Age-standardized prevalence was also calculated for the Iranian national population in 2016 and the World Health Organization (WHO) Population 2000-2025.

A total of 29963 subjects aged ≥18 years from all provinces of Iran, except for Qom, participated in this study. The age standardized prevalence of current tobacco smoking among adult males and females were 24.4% (95% CI: 23.6%–25.1%) and 3.8% (95% CI: 3.5%–4.1%), respectively. Among the participants, the majority of the current smokers were among those aged 45-54 years (14.5%; 95% CI: 13.6%–15.5%). With increase in age, the prevalence of secondhand smoking decreased to 34.8% (95% CI: 33.3%–36.7%) among people aged 18–24 years and to 22·6% (95% CI: 21.0%–24.3%) among subjects over 70 years.

The result of the study can be used to inform policy makers about the status of smoking and help them to design policies for setting rules on and limiting the import of cigarettes and their components to the country.

No Abstract

Given the importance of access to information and the need for reliable data, systematic approaches to evaluation of national surveys such as NCD risk factor surveillance system (STEPs) is a priority. Benefiting from partnership of all of stakeholders, present paper provides a practical framework of the strengths and weaknesses of planning and conduction of vast investigation. In addition, it can offer solutions for improving operational and scientific protocols.
The aim to the comprehensive review and analysis of 6 rounds implementations of STEPs, related documents, along with the findings of a qualitative study of the expert opinions were analyzed. The results were presented corresponding to the strengths, weaknesses, and challenges, with proposed approaches.
The results of this study show that in the years of 2004 - 2009 as well as 2011, the same questions have different codes in the questionnaire and in the data files. Based on the results, over the past 6 years, there are more than 240 distinct options in the questions. Accordingly, under 2 main axes of content and implementation, the findings were presented in accordance with the strengths, challenges, and suggested solutions, which includes the areas of questions, anthropometric, biological measurements, and sampling.
Development and standardization of administrative and scientific protocols of STEPs, along with the management of levels of security and availability of data proposed as long-term policies for better conduction and promotion of the study.