فهرست مطالب elham ahmadnezhad

The Urban Family Physician Program (UFPP) has been implemented in Fars and Mazandaran provinces of Iran since 2013 with the aim of improving access and utilization of health services, with a particular focus on children and adolescents. In order to evaluate the effectiveness of the program in achieving this goal, this study aimed to compare the access and utilization of health services among children living in areas covered by the UFPP with those living in other regions of Iran.

A secondary analysis was performed using data from the 2015 National Health Utilization Survey. The data of people aged under 18 were extracted and indicators on the use of health services based on three main models of health service provisions were compared:(1) cities in Fars and Mazandaran provinces (UFPP implemented);(2) cities in other Iranian provinces (excluding Fars and Mazandaran); and (3) villages and cities with a population under 20,000.

The study included 20,689 children. The outpatient and inpatient visits in children living in Fars and Mazandaran provinces were higher than in children from other provinces and smaller towns (11.89 vs. 7.92 and 7.21 for outpatient and 4.74 vs. 3.51 and 4.27 for inpatient, respectively). Furthermore, UFPP was found to be associated with a higher utilization of health services in children residing in cities (odds ratio=1.50 (1.98-1.15)). Additionally, the cost of outpatient and inpatient health services in areas where the UFPP was implemented was lower compared to other parts of the country.

The urban family physician program has been successful in increasing the access to health services and reducing health costs in children.

Practical Implications: 

The findings suggest that the urban family physician program can be an effective strategy for improving healthcare access and reducing costs, especially in areas with high population density. Policymakers and healthcare providers can use the results of this study to inform the development and implementation of similar programs in other countries, with the aim of improving healthcare access and reducing healthcare costs in children and adolescents.

The primary health care (PHC) approach is widely acknowledged as a fundamental element in achieving universal health coverage (UHC) goals. Consequently, numerous countries have undertaken efforts to restructure their health systems based on PHC principles. This study aims to evaluate geographic disparities in essential maternal and child indicators provided at the PHC level, focusing on both crude and effective coverage. Additionally, it seeks to explore the association between effective coverage and health expenditures within the national and sub-national contexts of Iran.

This research employed a secondary analysis approach to investigate the spatial distribution of maternal and child health (MCH) indicators in Iran's provinces, utilizing the latest available data from the 2010 Demographic Health Survey (DHS). To provide a comprehensive understanding of MCH indicators, the study calculated composite indicators, crude, and effective coverage. The provinces' situations were compared using the median cut-off method. Additionally, the study examined the association between coverage indicators and total health expenditure per-capita.

At the national level, the crude and the effective composite coverage were 89.56% and 77.22%, respectively. Also, the medians of composite crude and effective service coverage in the provinces were 90.25% and 77.62%, respectively. There was no significant difference between urban and rural areas.

This study has revealed a notable difference between the crude and effective service coverage of the selected MCH indicators. While the coverage of maternal services was generally higher than that of child services, there were significant geographic disparities in the coverage of key indicators of MCH services across provinces. Despite the provision of free services in rural areas, their coverage was not higher than that of urban areas. These findings suggest that PHC services in Iran are still far from achieving the desired coverage and UHC goals. Policymakers and stakeholders need to focus on addressing the gaps in effective coverage and geographic disparities to improve access to essential maternal and child health services and achieve UHC in Iran.

In May 2014, the Iranian government announced it would cover all uninsured Iranians. Despite free-of-charge insurance, the studies found that the coverage still needed to be completed (93%). This study aimed to understand why certain population groups remain without insurance despite the accessibility of free-of-charge coverage. This issue is not unique to Iran; it is prevalent in many other countries where, despite free coverage, not all individuals avail themselves of it, thereby exposing themselves to risks.

In a matched case-control study, 89 non-insured patients were compared with 178 hospital-based controls with health insurance (2:1). The samples were recruited at one of the leading public hospitals in the country (Imam Khomeini Hospital Complex in Tehran) in 2019. Two insured controls were selected and matched for age (± five years) and sex for each person without insurance. A conditional logistic regression was performed to assess the magnitude of effects and the goodness of fit test used to examine the model.

Unemployment (Odds Ratio (OR)=8.33, 95% Confidence interval (CI): 1.05-50.0), being single (OR=3.69, CI: 1.18-11.55), low economic status (OR=1.85, CI: 1.02-3.33) and attitude towards performance of health insurance (OR=0.86, CI: 0.75-0.99) were affected not having health insurance.

Approaches that cover the entire population may struggle to ensure no one is left without needed services. There is a need for greater focus on vulnerable groups to achieve universal health coverage conscientiously. Moreover, improved services and education can positively shape public perceptions of insurance efficacy, affecting their enrollment choices.Health sector reform

Universal health coverage is a critical goal for low- and middle-income countries, with equitable access to healthcare services being essential to achieving this objective. With the elderly population requiring greater healthcare services, it is crucial to plan for their healthcare needs. This study aims to evaluate the determinants of out-of-pocket payment (OOP) and catastrophic healthcare expenditure among households with elderly individuals in Iran.

This study analyzed the 2018 Household Income-Expenditure Survey in Iran to examine the socio-economic factors affecting OOP (per purchasing power parity International Doller – PPP. Int $) and catastrophic healthcare expenditure in households with elderly members. Using survey probit regression model with Heckman selection, the study identified determinants of OOP and catastrophic healthcare expenditures. A survey probit regression model with Heckman selection has been applied to identify the determinants of out-of-pocket (OOP) and catastrophic healthcare expenditures. The approach allowed for the examination of variables that may have impacted the likelihood of incurring OOP and catastrophic healthcare expenditures, while accounting for potential selection bias.

Rural households (with difference 60.78 PPP. Int$) and non-owning homes (with difference 98.83 PPP.Int$) had higher OOP than their urban and owning counterparts, respectively. Larger households also had higher OOP, with those with five or more members having the highest. High-income households also had higher OOP. Additionally, smaller households had a lower chance of facing catastrophic healthcare expenses. Lastly, the Mills ratio was negative.

Our study reveals insufficient observed out-of-pocket (OOP) payments for healthcare in Iran to cover the "needed" OOP, indicating a possible financial burden on households. This highlights the need to address inequalities in healthcare access and expenditure for households with elderly individuals, particularly in rural areas and larger households. Policymakers should implement targeted interventions to reduce OOP for these vulnerable groups. Future research should include socio-economic factors that affect access to healthcare services.

Context: 

In the first stage of viral replication, COVID-19 may cause a remarkable inflammatory response in patients. Paxlovid is an oral antivirus medicine that functions through the inhibition of one of the essential enzymes to viral replication, called protease. The present study intends to help policymakers decide on using Paxlovid in COVID-19 treatment.

Evidence Acquisition:

 This rapid review searched databases including Cochrane, PubMed, and Google Scholar by the end of July 2022. The inclusion criteria were randomized clinical trials investigating the safety and effectiveness of Paxlovid oral medicine at different doses in COVID-19 patients, compared with placebo or other routine care methods.

Based on the results (from three studies meeting the inclusion criteria), Paxlovid has no serious side effects, but when used, the patients must be checked for renal and hepatic failure, as well as drug interactions. Patients treated with this medicine within five days after the symptom onset were hospitalized, with 1% (6/607) in the Paxlovid group and 6.7% (41/612) in the placebo group. Also, no fatalities were reported in the Paxlovid group until day 28, while 10 (1.6%) patients died in the placebo group.

Paxlovid is very effective in outpatient treatment and comes in a combination pack containing nirmatrelvir 150 mg and ritonavir 100 mg film-coated tablets, to be taken twice daily for five days after the symptom onset in adults and children (over 12 years old and a minimum weight of 40 kg) who have mild to moderate symptoms of COVID-19 in order to prevent severe disease, which may lead to hospitalization and death. However, there is high uncertainty about the possibility of drug interactions.

In the first stage of viral replication, Covid-19 may cause a remarkable inflammatory response in patients. Molnupiravir is an oral antiviral medicine which functions through inhibiting the viral replication of RNA viruses including Corona virus (SARS-CoV-2). The present study intends to help the policymakers decide on using of this medication in Iran. This study is conducted on Jan. 22, 2022 (from Jan. 2014 -the year of molnupiravir production for treatment of RNA virus diseases), using a rapid review of evidence as well as reviewing reliable databases including the Cochrane library, PubMed and Google scholar. The inclusion criteria were the randomized controlled trials that investigated the safety and efficacy of Molnupiravir at different doses in patients with Covid-19, comparing with placebo or other routine care methods (Population: Covid-19 patients, Intervention: molnupiravir, Control: placebo or other routine care methods, Outcome: Safety, Efficacy and Economic status, Study design: the randomized controlled trials or HTA reports). Prescription for oral administration in 800 mg dose twice daily for 5 days to inpatients and outpatients with mild, moderate or severe symptoms in the early stages of the disease (viral phase) had the most desirable level of efficacy. This medicine has no serious side effects; since the mutations caused by this medication have not been clarified yet, it is not recommended during pregnancy and/or for women planning to become pregnant. According to the manufacturing company, in the United States, each drug package is priced at $712 for a 5-day treatment period. Molnupiravir can be used in outpatients and inpatients (Over 18 years old) with moderate or severe symptoms in the early stages of the disease. But it is not recommended during pregnancy and/or for women planning to become pregnant.

The Ministry of Health and Medical Education for the first time drafted and communicated the National Nutrition and Food Security Document in order to implement targeted programs. This study aims to evaluate the provincial nutrition and food security document and outline strategies to improve the efficiency and effectiveness of provincial document deployment at the organizational, inter-organizational and community level.

Documents received by the universities / colleges of medical sciences were classified for evaluation purposes. The studied dimentions consisted of the provincial document cut-off, the beneficiaries of the program, the establishment and implementation of the submitted documents. In the next step, self-declaration compliance assessment and scoring were performed.

Out of 28 provincial documents (90%), 60% were documented, 21% provincial data were not used, and desirable measures were taken to attract stakeholders. No effective measures were taken to evaluate the results as the most important pillar of the document. Among 255 projects anticipated, 7 were documented and 6 were approved, and only 4 projects were submitted to the researchers, and for 5 projects had written

Despite the relatively favorable performance in most of the documented and targeted areas of the document at the national level, assessments show that this trend has not been very successful at the provincial level. This study clearly shows policy makers' lack of support for nutrition programs and poorly evaluates nutrition support.

Quality Assessment Frameworks (QAFs) are essential in monitoring progress in the primary health care (PHC) system. Different QAFs are used in countries to assess PHC quality.

This study aimed to review and compare the QAFs and highlight the most frequent quality indicators and dimensions.

This state-of-the-art review was conducted on PHCQAFs. Required data were collected through search in Scopus, Web of Science, and PubMed databases, World Health Organization and World Bank websites, and Ministry of Health websites up to January 2022. The main keywords were quality, “primary healthcare”, PHC, “primary care”, “primary health services”, “basic healthcare”, assessment, evaluation, monitoring, measurement, improvement, indicator, OR index, pattern, framework, and model. Comparative tables were used to compare the defined quality dimensions (QDs) and quality assessment indicators (QAIs).

Finally, 14 PHCQAFs were retrieved, containing 94 QDs and 785 QAIs. Three PHCQAFs were proposed at the international level and others at the national level. Accessibility, coordination, and safety were the most frequent QDs, and QAIs related to smoking, alcohol and substance abuse, diabetes care, vaccination, chronic heart disease care, respiratory/infectious disease care, hypertension care, population coverage, community participation, customer satisfaction, maternal and child health, adverse event, health information management, staff empowerment, referral system, and patient rights were the most frequent among PHCQAFs.

The current study illustrates the similarities and differences between PHCQAFs and highlights important QDs and QIs in PHC. Also, it provides a ready way for health policymakers to address key quality aspects that can help countries accelerate progress in the quality of PHC

One of the most important 2015-post agendas of countries’ health systems is achieving Universal Health Coverage (UHC), so the countries should monitor the taken activities. Ths study aimed to investigate the Universal UHC status two years after Health Transformation Plan in Iran.

Household Income and Expenditure Survey were used to estimate financial protection indicators in 2016. Estimation for service coverage index provided by international databases was applied at the country level. Indicators of financial protection and service coverage were evaluated in relation to each other using the World Health Organization joint levels assessment method, which indicates UHC attainment in terms of a plot with four zones. The relationship was estimated for the entire population, first quintile, and fifth quintile in 2000, 2017, and 2030.

About 15.85% of households endured catastrophic health expenditures at the 10% threshold. Accordingly, Iran is on the border between zones 1 and 2 in 2017 in terms of achieving UHC and will move to zone 1 in 2030 with the current trend.

Iran did not attain UHC in 2000. It seems and has not achieved UHC in 2017 either. Even with improved service coverage, achieving UHC by 2030 may seem impossible with the current trends.

Tobacco use is an established preventable risk factor for many noncommunicable diseases and is considered as an important indicator for monitoring progress towards Universal Health Coverage (UHC) and Sustainable Development Goals (SDGs). This study aimed to determine the situation of tobacco use among Iranian adults using 2016 household survey.

This is a secondary analysis of the data from 2016 nationally representative STEPwise approach to Surveillance (STEPs) survey with a sample size of 31,050. The data on tobacco consumption was gathered using questions incorporated in the survey questionnaire.

The prevalence of current tobacco use in Iran was 25.2 % (24.4‑25.9) in men versus 4% (3.7‑4.3) in women. The prevalence was higher in rural areas and among second wealth group. The prevalence of current daily cigarette smoking was 20.1% (19.4‑20.7) in men versus 0.9% (0.8‑1.1) in women). Average number of cigarettes per day among current cigarette smokers was 14.5% (14.1‑14.9), mean age at start smoking among daily cigarette smokers was 21.6% (21.1‑22), and 95.2% (94.4‑96) of daily current daily cigarette smokers attempted for cessation during past 12 months. Prevalences of exposure to secondhand cigarette smoke among nonsmokers at homes and workplaces were 23.21% (22.65‑23.76) and 18.04% (17.2‑18.87), respectively.

There was a large difference between the prevalence of tobacco use between men and women (25.2% vs. 4%). Higher prevalences of tobacco use in rural areas and among lower wealth quintiles require more equity‑based approaches in tobacco combatting actions.

Spiritual health is recognized as one of the dimensions of health in Iran and in recent years many studies are conducted in this field in the country. This study aimed to review the experience of developing a five-year strategic plan and a one-year operational plan for the Spiritual Health Research Center (SHRC) of Iran University of Medical Sciences.

The study was conducted in three phases in a qualitative approach. first, researches on spiritual health in Iran, upstream documents, and stakeholders in this area were reviewed. Then the situation of SHRC was analyzed. Based on the information obtained in the previous phases, the center’s strategic plan was developed including vision, mission, and values ​​of the SHRC along with strategic objectives until 2023. The plan was presented during a focused group discussion meeting to the members of the research council of SHRC and finalized after receiving feedback.

Totally, 23 strategic five-year objectives were set for the SHRC to be archived by 2023. Then, the specific goals, activities, outcomes and indicators for the evaluation for the first year were determined.

This study proposed a methodology for developing strategic and operational plan for research institutes. The methodology presented here can be applied to other national and international bodies and institutions.

Following his inauguration in late 2013, President Rouhani aimed to boost quality and equity in thehealth care delivery system. To fulfill this aim, a set of interventions, called Health TransformationPlan (HTP), were implemented. So far, it has been a heated debate whether HTP breathes a spiritof a new reform. HTP has targeted long‑standing historical deficits of the Iranian health systemas well as urgent problems, both of which have been, to some extent, resolved. To decreaseOut‑Of‑Pocket (OOP) health expenditures, HTP has presented new financing mechanisms to expanda safety net to Iranian citizens fundamentally. HTP also encompassed interventions to overcomeproblems in the provision of health care by recruitment of health workforces, establishing newhealth facilities, and expanding primary health care to urban and peri‑urban areas. Furthermore,performance indicators including access, quality, and patient satisfaction have been affected. Giventhese changes, HTP is entitled to be a health system reform. However, a new agenda within HTP isrequired so that the Iranian health system can obtain better value for money that is to be spendingon it.

The aim of this study was to evaluate the health status of the Iranians following the sustainable development goals’ (SDGs) introduction and the recent health reform implementation in Iran and to compare with those of the Middle East and North Africa region (MENA) and global average.

This comparative study used secondary data to investigate socio-demographic and health status indicators. The sources included census, population-based surveys and death registries. Global and regional health status indicators were obtained from international databases including WHO, the World Bank and the Institute for Health Metric and Evaluation (IHME).

Life expectancy and human development index improved following the reform implementation. Among causes of death, 74.6% were attributed to non-communicable diseases (NCDs). There was an increasing trend in risk factors for NCDs in Iran, while at the same time neonatal, infant and under-5 mortality rates reduced. Compared to the MENA, Iran has a lower maternal mortality ratio, neonatal, infant, and under-5 mortality rates, and a higher life expectancy. NCDs and road traffic injuries accounted for a larger portion of disability-adjusted life years in Iran compared to the MENA and worldwide.

Actions against communicable diseases and road traffic injuries are required together with continued efforts to address NCDs. Although based on the results, Iran has relatively high rankings, there is a need to develop a roadmap to accelerate achieving global health goals and SDGs targets.

In the age of sustainable development, paying attention to the quality and quantity of health information is important for designing interventions. The burden of mental disorders has been increasing over the last decade. Therefore, the development of information-gathering systems in this field is necessary. The aim of this study was to evaluate the status of population-based national surveys conducted to assess the status of mental disorders in Iran. This is a review study. The data were obtained from published reports and articles on population-based surveys in international and national databases in both Persian and English. Surveys conducted to assess the status of mental disorders were retrieved and their target groups, used tools, sampling methods, and sample sizes were evaluated and compared. In Iran, four population-based surveys were conducted to assess the status of mental disorders in 1999, 2001, 2011, and 1394. These surveys were performed using different tools and target populations, and among these four surveys, only two studies were similar. According to the results, evaluating the trends in mental disorders in society is currently associated with difficulties. Performing future surveys with similar tools is essential.

Achieving universal health coverage (UHC), which means ensuring access to high quality and equitable services by all without financial hardship, requires local evidence. To find interventions appropriate to local needs, local knowledge and evidence are required in addition to global evidence. Thus, every country should have its own plan for research production and utilization and strengthening researchers’ capacities to achieve UHC. To accomplish the goals of UHC, the research system should be able to determine the research priorities and agenda, collect resources, improve the capacity for evidence generation, and maximally utilize the country’s capacity for finding local solutions by establishing research networks. In this study, inputs for UHC research priority setting in Iran and its challenges have been discussed.

One of the most important measures to ensure achieving Universal Health Coverage (UHC) is expanding health insurance coverage to all population. Accordingly, the present study was conducted with the aim of investigating the effect of having health insurance on the utilization of outpatient services provided by physicians using the data of the utilization of health services survey (2015).

This study is a secondary analysis of the utilization of health services survey data that was conducted in two groups of the insured and uninsured to examine the differences between these two groups in outpatient healthcare utilization provided by physicians. The variables were insurance status as an independent variable and the number of physician visit as a dependent variable. This analysis was disaggregated by place of residence and income.

The visit per capita for outpatient services was lower in all uninsured groups. The visit per capita in insured people was almost two times more than that of uninsured individuals, which was 4.25 and 2.61 among insured and uninsured individuals, respectively. Therefore, the lack of basic health insurance decreased the utilization of outpatient services by 50 percent. General physician visits per capita for insured people living in urban and rural areas were 11.2 and 0.35, respectively.

Based on the results of this study, the visit per capita is directly related to the insurance status of the individuals. Therefore, it is necessary to ensure the equity in utilization of outpatient services provided by the physicians among various groups of population.

With the Eastern Mediterranean Regional Office of World Health Organization co-ordination, a regional meeting was held with the subject of “development road to universal health coverage”, with the presence of senior representatives of member countries (health minister, undersecretary of health minister, and the successor of health minister), on September 2nd to 5th in Salaleh, Oman.
In this meeting, the place of Iran had been considered special and in all of the topics, Iran had been an example stated by the lecturers.
The most important efforts were as followed: (1) The experience of four decades of providing primary health care and the input of health network, (2) financial risk protection, (3) developing the integrated health coverage interventions, and (4) correcting Health Insurance Scheme program. However, it seems that with a careful and accurate manner, deficiencies and limitation in the UHC should be identified and addressed. Some of the most important are as follows: Sustainability of financial resources for health system, improve the allocative and technical efficiency, considering the effective coverage of interventions, proper governance of health services provision, establishment and enhancement of routine health system information, and considering the health workforce distributions.

  A significant portion of household’s expenses is allocated to health services. This study aimed to investigate the share of health expenditure in total households’ expenditure during 2009 - 2016 and capture the changing patterns of health expenditure associated to the implantation of the Health Transformation Plan. The study relied on data from the Household, Expenditure and Income survey, which the sample size is about 38000 households per year. The average annual out-of-pocket (OOP) expenses paid by households as well as the ratio of necessary expenditure in total consumption expenditure were calculated in order to study the trend of health expenditure. Out of pocket payment among all households has a slow decreasing trend. The ratio of health expenditure to total consumption expenditure in the 10th and 1st declines of urban and rural population was 26% and 1.3%, respectively; the national level was 7% in this period. The difference in OOP between the 1st and 10th decline in urban and rural households was 29942534 Rials and 15441113 Rials, respectively in 2016. The results indicate that there is a considerable difference between OOP paid by the poorest and the richest households. However, the share of health expenditure in total households’ expenditure was almost stable during these years. Despite, the increased coverage of universal health insurance in recent years, the difference between health expenditures among income groups is almost considerable. Nevertheless, health expenditure represents a lower share of total households’ expenditure compared with other expenditures among all expenditure deciles.

The aim of the study was to define the epidemiological characteristics of most important infectious diseases in Iran in recent decades.
Methods & Materials: This was a situation trend analysis of infectious diseases (vector and water borne disease, and food borne diseases) in recent decades based on data availability. Three significance levels were used for Mann-Kendall test (90%, 95% and 99%).
The morbidities of most studied diseases had decreased in whole of the country. Unlike other diseases, coetaneous leishmaniasis had not followed the deacreasing trend. In terms of location, Khorasan-e-Shomali was followed the increasing pattern for in four out of six disaeses [malaria, leishmaniasis (coetaneous and visceral), and typhoid].
In conclusion, there is a significant decreasing trend of most important infectious diseases in Iran. Nevertheless, climate change is already happening and would influence the diseases trends. Hence, developing and implementing adaptation strate ies should be considered.

This study aimed to estimate and project the current and future disability burden of typhoid fever in Iran associated with climate and population to provide best policies for climate change adaptation.Methods & Materials: Years lost due to disabilities (YLDs) were measured as burden estimation in this study. The temperature was selected as climate variable. Future temperature rising (projected for 2030 and 2050) used according to Intergovernmental Panel on Climate Change reports. Typhoid fever incidence in 2010 applied as the baseline data for YLDs calculation. The previous published regression models were considered for YLDs’ future projections. Furthermore, the future demographic change was included for YLDs calculation. Compared with the YLDs in 2010, increasing temperature and demographic change may lead to a 5.5-9% increase in the YLDs by 2030 and a 13.7-22% increase by 2050 if other factors remain constant. The highest YLDs was projected for > 45 years old (56.3%) in 2050 under temperature rising and population change scenario. Climate change and aging may impact on burden of typhoid fever in the future. Adaptive strategies should be considered to prevent and reduce the health burden of climate change.

Following the Bam earthquake, relief teams and individual volunteers’ influx in the scene. We conducted this survey to determine the needs and health status of relief workers when they were in the scene.Methods & Materials: This was a concurrent nested mixed-method survey that the qualitative nested in a quantitative approach. Interviews were through an open-ended semi-structural questionnaire three weeks after Bam earthquake. Respondents were from the relief team who had been staying in Bam at least for one week at the time of interview. We surveyed 235 relief workers and majority of them (75%) were in the scene since the1st or 2nd week of earthquake. Twenty-eight of them experienced illness, and the most common complaint was respiratory track illness. One hundred eighty five of them (79%) expressed their need to a psychology consultation. The results of thematic analysis of qualitative phase of survey were about the 19 themes expressed by the subjects. The results of this study revealed that all relief workers should be trained for self- protection. Preparing the basic needs by him/her-self may maximize the performance of relief workers in disaster regions. The study method design applied was appropriate for the similar situations.