مجله تحقیقات نظام سلامت حکیم
سال نوزدهم شماره 3 (پیاپی 74، پاییز 1395)

The content of the fifth Goal of the Millennium Development Goals Declaration in 2000 (MDG 5) was to improve maternal health by reducing maternal mortality and achieving to the universal coverage of reproductive health services and all countries were committed to achieve this goal by 2015. This study aimed to assess the Iran’s achievement of this goal.
Data were extracted from national and international data sources including World Report from United Nations on maternal mortality Trends, database of the World Bank, World Health Organization and UNICEF, the maternal mortality surveillance system of the Ministry of Health and Medical Education, the national Demographic and Health Surveys in 2000 and 2010, yearbooks of National Organization for Civil Registration and Statistics Center of Iran. Data were analyzed using Excel 2013 software to produce descriptive statistics.
Indicators related to maternal health in the Islamic Republic of Iran between the years 1990-2015 has improved substantially. The coverage of at least one prenatal care reached to 97 %, and maternal mortality decreased by 80% compared to the baseline. A set of hospital and outpatient care program and establishment of the maternal mortality surveillance system contributed to improvement in maternal health.
The efforts of the Islamic Republic of Iran to improve maternal health over the past quarter century can inspire other countries to improve maternal health.

Successful implementation of clinical governance improves the quality and safety of healthcare services and enhances the accountability of managers and employees. This study aimed to examine the success of clinical governance implementation in Tehran hospitals.
A valid and reliable questionnaire was used for the aim of this study. 144 questionnaires were distributed among the hospital managers. Data analysis was performed using SPSS software and descriptive and analytical statistics.
92 questionnaires were returned and analyzed. Clinical governance implementation was moderately successful in Tehran hospitals (the mean score of 2.82 out of 5). The most and least success were achieved in patient involvement and clinical audit respectively. Managers and employees’ commitment in implementing clinical governance was assessed as moderate. The involvement of about 70 percent of physicians was less than average. There was a statistical meaningful correlation between managers’ commitment and clinical governance success.
Implementation of clinical governance in Tehran city hospitals was not successful. Using an appropriate model for implementing clinical governance, management and leadership commitment, clinical staff involvement and information and process management are necessary for successful implementation of clinical governance.

Geographic information system is a modern technology that helps to make sound policy and decisions to promote patients’ health. This systematic review was carried out to determine the application of GISs in health in Iran.
Material & In the current study, English and Persian databases were systematically searched using predefined key terms. All relevant studies utilizing GISs in the field of health in Iran were retrieved. Then, a data extraction form that its reliability was approved by experts was applied to extract the data. Data regarding GIS capabilities, the sources of data used, and the fields that GISs were applied for were extracted from the papers. Data were analyzed and reported using descriptive statistics.
Totally, 33 out of 119 retrieved articles were selected as eligible and reviewed by the authors. The subject area of almost half of the studies was noninfectious diseases. Cancer (21%) was the most common disease analyzed by GIS in Iran. Eighty-five percent of the studies used mapping and locating capabilities of GIS software.
The use of GIS in health in Iran is still in the preliminary stage. GIS as an applied software is considered as a valuable tool to present geographical distribution of diseases and produce geospatial data to improve health and health care systems.

Leishmaniosis is a common parasitic disease in tropical and subtropical areas of the world caused by protozoan of the genus Leishmania and transmitted to human via the bite of the species of sandflies. This is a zoonotic disease subsumed by the World Health Organization (WHO) in the list of 6 important infectious diseases in the world. The population of the insect vector of this disease is influenced by changes in climate, and has a very strong relationship with climatic factors. The current study aimed at verifying and explaining the feasibility and capability of satellite imagery and data to contribute to identifying, analyzing, and explaining the impacts of climatic factors, and its spatial distribution on the prevalence of leishmaniosis in Ilam province, Iran.
For this purpose, the climatic data including air temperature, soil temperature, relative humidity, precipitation, wind speed, and global solar radiation from 8 meteorological synoptic stations along with the NDVI and LST products of the MODIS sensor for a 3-year period, from 2011 to 2013, were gathered and used. To carry out the current study, at first, raster of all the data were created in Arc GIS 10.2; then, the correlation between the average of raster’s pixels of satellite and stationary data with the raster of leishmaniasis prevalence in a seasonal and temporal scale was verified and analyzed, using the Pearson correlation coefficient. At the end, to identify and model the variables affecting the incidence of leishmaniasis, a multivariate regression model of the prevalence of leishmaniosis was designed for the studied area, based on the correlated variables.
The results for the entire studied area in a seasonal temporal scale showed a negative strong correlation between leishmaniasis prevalence and soil temperature, air temperature, and wind speed (with correlation coefficients of -0.760, -0.756, and -0.691, respectively), and a strong positive correlation with relative humidity and precipitation (with correlation coefficients of 0.660 and 0.662, respectively). Also, wind speed was verified as a limiting factor for leishmaniasis prevalence.
The obtained result showed that the remote sensing data, particularly the LST product from MODIS sensor and rainfall data from TRMM satellite, had acceptable capabilities to be replaced with meteorological stationary data and they also helped to explain and identify factors influencing the prevalence and distribution of spatial patterns of the disease.

Access to dental insurance is related to the utilization of more dental services and better oral and dental health. The current study aimed at addressing the 2 following questions: how much are the premium households willing to pay for dental insurance, and which factors are associated with their willingness to pay for this insurance coverage.
In the current survey study, data were collected through a self-reporting questionnaire based on the contingent valuation method. The open-ended question method was applied to elicit willingness to pay in a sample of 385 respondents attending Isfahan dental clinics, Iran, in 2015. The linear regression approach was used to address factors related to willingness to pay for dental insurance. Data analysis was performed using Stata version 11.
The median and 5% trimmed mean of willingness to pay for dental insurance per person per month was $US 2.74 and 51.10, respectively. The result of regression analysis indicted that the subjects older than 40 revealed significantly less willingness to pay for dental insurance. No significant association was found between willingness to pay for dental insurance and variables of households’ health status, households’ economic status, as well as households’ demographic characteristics.
From a policy point of view, willingness to pay can be used as a guide to set a premium for dental insurance. Almost all potential factors made no contribution to willingness to pay. Thus, in order to expand this insurance coverage, government policies should be adopted to improve people awareness about oral and dental health.

Empowering females is one of the developmental goals of the millennium and a factor to achieve global welfare. Empowerment in breast-feeding plays a key role in promoting breastfeeding, and identifying its factors can be helpful for its improvement. The current study aimed at exploring empowerment in breastfeeding.
The current study employed the qualitative approach and content analysis; 39 subjects (18 mothers, 5 key family members, and 16 breastfeeding consultants) participated in 33 individual interviews and 2 focus group. At the same time, the data were collected and analyzed using the Hiseh and Shannon method.
Analysis of data led to the emergence of 3 main categories as health system factors, family and personal factors, and social and cultural factors that indicated the factors of empowerment of breastfeeding from the participants’ perspective.
According to the viewpoint of participants, providing breastfeeding services in hospitals, breastfeeding counseling in health centers, and conflicting advice and information of health systems about breastfeeding are the key factors in the empowerment of breastfeeding. Also, mothers` efficacy in breastfeeding and families` help and supports in this regard play an important role in strengthening breastfeeding. In addition, positive cultural belief about the breastfeeding and educating and informing society facilitate the empowerment in breastfeeding continuity. It is recommended to improve breastfeeding and consider the comprehensive program of empowerment in this regard.