Background: One of the main objectives of health systems is the financial protection against out-... more Background: One of the main objectives of health systems is the financial protection against out-of-pocket (OOP) health expenditures. OOP health expenditures can lead to catastrophic payments, impoverishment or poverty among households. In Iran, health sector evolution plan (HSEP) has been implemented since 2014 in order to achieve universal health coverage and reduce the OOP health expenditures as a percentage of total health expenditures. This study aimed to explore the percentage of households facing catastrophic health expenditures (CHE) after the implementation of HSEP and the factors that determine CHE. Methods: A total of 663 households were selected through a cluster sampling based on the census framework of Sanandaj Health Center in July 2015. Data were gathered using face-to-face interviews based on the household section of the World Health Survey questionnaire. In this study, according to the World Health Organization (WHO) definition, if household health expenditures were equal to or more than 40% of the household capacity to pay, household was considered to be facing CHE. The determinants of CHE were analyzed using logistic regression model. Results: The rates of households facing CHE were 4.8%. The key determinants of CHE were household economic status, presence of elderly or disabled members in the household and utilization of inpatient or rehabilitation services. Conclusion: The comparison of our findings and those of other studies carried out using a methodology comparable with ours in different parts of Iran before the implementation of HSEP suggests that the implementation of recent reforms has reduced CHE at the household level. Utilization of inpatient and rehabilitation services, the presence of elderly or disabled members in the household and the low economic status of the household would increase the likelihood of facing CHE. These variables should be considered by health policy-makers in order to review and revise content of recent reform, thus financially protecting public against CHE.
HIV/AIDS epidemic is concentrated among injecting drug users in Iran. Like many other countries w... more HIV/AIDS epidemic is concentrated among injecting drug users in Iran. Like many other countries with HIV/AIDS concentrated epidemic, prisons are high risk areas for spreading HIV/AIDS. The aim of this paper was to study the trend of HIV/AIDS prevalence and related interventions administered in prisons of Iran during a 13 years period. This cross sectional study was conducted using the data collected from the sentinel sites in all prisons in the country and it also used the data about Harm Reduction interventions which has been implemented by Iran Prisons Organization. To evaluate the correlation between the prevalence and each of administered interventions in prisons the Correlation Coefficient Test was used for the second half of the mentioned time period. The prevalence of HIV/AIDS in prisons had increased rapidly in the early stages of epidemic, so that in 2002 the prevalence raised to 3.83%. Followed by the expansion of Methadone Maintenance Therapy and development of Triangular...
International Journal of Preventive Medicine, 2015
HIV/AIDS is one of the diseases which not only makes threats to physical health, but also, due to... more HIV/AIDS is one of the diseases which not only makes threats to physical health, but also, due to the negative attitudes of people and the social stigma, affects the emotional and social health of patients. The aim of this study was to identify the psychological, social, and family problems of people living with HIV/AIDS (PLWHA) in Iran. In this qualitative study, we used purposive sampling to enroll PLWHA, their families, and physicians and consultants in two cities of Kermanshah and Tehran. Each group of PLWHA, their families, physicians, and consultants participated in two focus group discussions (FGDs), and a total of eight FGDs were conducted. Six interviews were held with all key people, individually. Based on the views and opinions of various groups involved in the study, the main problems of PLWHA were: Ostracism, depression, anxiety, a tendency to get revenge and lack of fear to infect others, frustration, social isolation, relationship problems, and fear due to the social stigma. Their psychological problems included: Marriage problems, family conflict, lack of family support, economic hardships inhibiting marriage, and social rejection of patient's families. Their family problems were: Unemployment, the need for housing, basic needs, homelessness, and lack of social support associations. It seems that the identification and focusing on psychological, social, and family problems of affected people not only is an important factor for disease prevention and control, but also enables patients to have a better response to complications caused by HIV/AIDS.
Background: HIV/AIDS has been concentrated among injecting drug users in the country. This study ... more Background: HIV/AIDS has been concentrated among injecting drug users in the country. This study aimed to investigate and identify health and treatment needs of people living with HIV/AIDS in Iran. Methods: This qualitative study was conducted in 2012 in Iran. The study groups consisted of experts, practitioners, and consultants working with People Living with HIV/AIDS and their families. Data was collected through Focus Group Discussions and deep interviews. Data were analyzed using content analysis method. Results: The findings of this study included the needs of people living with HIV/AIDS, which were classified in three main categories. The first category was prevention and counseling services with several sub-groups such as education and public and available consultation, distribution of condoms to vulnerable groups, increasing counseling centers in urban areas, providing appropriate psychological and supportive counseling, and family planning services. The second category included diagnostic and treatment services and had several sub-groups such as full retroviral treatment, Tuberculosis treatment and continuing care, providing care and treatment for patients with hepatitis, and providing dental services. The third category included rehabilitation services and had some sub-categories such as home care, social and psychological support, nutritional support, and empowering positive clubs. Conclusions: This study puts emphasis on making plans based on the priorities to meet the needs of people living with HIV/AIDS in Iran.
Evaluating the tuberculosis (TB) status of the Economic Cooperation Organization (ECO) member cou... more Evaluating the tuberculosis (TB) status of the Economic Cooperation Organization (ECO) member countries relation to goal 6-c of the third millennium, which includes that TB incidence, prevalence, and death rates should be halved by 2015, compared with their level in 1990. In 2009, we have critically reviewed the countries' Millennium Development Goals (MDGs) reports and extracted the data from the surveillance system and published and unpublished data. The main stakeholders, from both governmental and international organizations in the country have been visited and interviewed by the research team as part of the data validation process. The TB incidence is very heterogeneous among ECO countries, which differ from 21.7 in Iran to 230.7 per 100,000 in Tajikistan. TB incidence (per 100,000) is more than 100 in six countries and is from 50 to 100 in two countries and is less than 30 in two countries. Only in two countries the crude death rate (CDR) is higher than 70%. In seven count...
International Journal of Health Policy and Management, 2015
Background: As one of the most important components of harm reduction strategy for high-risk grou... more Background: As one of the most important components of harm reduction strategy for high-risk groups, following the HIV epidemics, Methadone Maintenance Treatment (MMT) has been initiated in prisoners since 2003. In this paper, we aimed to assess the advantages and shortcomings of the MMT program from the perspective of people who were involved with the delivery of prison healthcare in Iran. Methods: On the basis of grounded theory and through conducting 14 Focus Group Discussions (FGDs), 7 FGDs among physicians, consultants, experts, and 7 FGDs among directors and managers of prisons (n= 140) have been performed. The respondents were asked about positive and negative elements of the MMT program in Iranian prisons. Results: This study included a total of 48 themes, of which 22 themes were related to advantages and the other 26 were about shortcomings of MMT programs in the prisons. According to participants' views "reduction of illegal drug use and high-risk injection", "reduction of potentially high-risk behaviors" and "making positive attitudes" were the main advantages of MMT in prisons, while issues such as "inaccurate implementation", "lack of skilled manpower" and "poor care after release from prison" were among the main shortcomings of MMT program. Conclusions: MMT program in Iran's prisons has achieved remarkable success in the field of harm reduction, but to obtain much more significant results, its shortcomings and weaknesses must be also taken into account by policy-makers.
The most fundamental way to decrease the burden of noncommunicable diseases (NCDs) is to identify... more The most fundamental way to decrease the burden of noncommunicable diseases (NCDs) is to identify and control their related risk factors. The goal of this study is to determine socioeconomic inequalities in risk factors for NCDs using concentration index based on Non-Communicable Disease Surveillance Survey (NCDSS) data in Kurdistan province, Islamic Republic of Iran in 2005 and 2009. The required data for this study are taken from two NCDSSs in Kurdistan province in 2005 and 2009. A total of 2,494 persons in 2005 and 997 persons in 2009 were assessed. Concentration index was used to determine socioeconomic inequality. To assess the relationship between the prevalence of each risk factor and socioeconomic status (SES), logistic regression was used and odds ratio (OR) was calculated for each group, compared with the poorest group. The concentration index for hypertension was -0.095 (-0.158, -0.032) in 2005 and -0.080 (-0.156, -0.003) in 2009. The concentration index for insufficient ...
Objective: Skin manifestations are common clinical features among HIV positive patients. The aim ... more Objective: Skin manifestations are common clinical features among HIV positive patients. The aim of this study was to document skin manifestations and their relationships with CD4 cell counts among HIV positive patients in Sanandaj. Methodology: This was a descriptive study. The patients were examined for skin disorders by a dermatologist and CD4 counts were obtained from the patient's medical records. Independent samples T test were used for data analysis. Results: In this study 66 (94.3%) patients had at least one skin problem. Fungal infections were the most common cause. The eight most common types of mucocutaneous problems were gingivitis, pallor, itching, photosensitivity, seborrheic dermatitis, candidiasis, folliculitis and tinea versicolor. The most common manifestation was gingivitis. Mean CD4 cell counts were lower in individuals with viral and bacterial skin diseases (P <0.05). Conclusion: The results of this study indicated that skin problems were common among HIV...
The aim of this study was to determine the socioeconomic inequalities in nonuse of seatbelts in c... more 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. T...
International Journal of High Risk Behaviors and Addiction, 2015
Background: Participation and to stay in a health program depends on many factors. One of these p... more Background: Participation and to stay in a health program depends on many factors. One of these programs is Needle Exchange Program (NEP) in prisons. Objectives: The current study aimed to evaluate the retention of injecting drug prisoners and find the related factors in Iran. Patients and Methods: This cohort study analyzed data about injecting drug male prisoners who were participated in NEP in three Iranian prisons. Data was collected from October 2009 to June 2010. A proper approach of survival analyses including Kaplan-Meier method, Log-Rank test, and Cox Proportional Hazard Model were used to evaluate Injecting Drug Users (IDUs) retention in NEP and its determinants. Results: Out of 320 prisoners, 167 were from Isfahan Central Prison, 82 from Tehran-Ghezel-Hesar Prison, and 71 from Hamadan Central Prison. Two-hundred and fifty prisoners (78.4%) had history of drug injection; and drug injection was the most common choice for 115 persons (35.9%). Participants were followed up for 29 weeks, the mean (SD) time of retention in the program was 24.1 (0.6) weeks. There was a significant relationship between age, number of used needles per week, duration of addiction, age of addiction onset, as well as imprisonment age, main method of drug use, type of main using drug, Hepatitis B Virus (HBV) infection, job status, reason of arrestment, history of involvement in harm reduction programs, and the length of retention (P < 0.05). There was also significant relationship between the history of using harm reduction services (P = 0.007), tattooing (P = 0.01), longer durations of addiction (P = 0.048), and retention. Conclusions: Tattooing and longer duration of addiction were two important factors that significantly increased retention in the program. In contrast, history of using harm reduction services was the factor that decreased persistence. The risk of quitting the program may decrease about 68% in those who did not involve in harm reduction programs.
HIV/AIDS has been concentrated among injecting drug users in the country. This study aimed to inv... more HIV/AIDS has been concentrated among injecting drug users in the country. This study aimed to investigate and identify health and treatment needs of people living with HIV/AIDS in Iran. This qualitative study was conducted in 2012 in Iran. The study groups consisted of experts, practitioners, and consultants working with People Living with HIV/AIDS and their families. Data was collected through Focus Group Discussions and deep interviews. Data were analyzed using content analysis method. The findings of this study included the needs of people living with HIV/AIDS, which were classified in three main categories. The first category was prevention and counseling services with several sub-groups such as education and public and available consultation, distribution of condoms to vulnerable groups, increasing counseling centers in urban areas, providing appropriate psychological and supportive counseling, and family planning services. The second category included diagnostic and treatment ...
Based on some estimation more than two million peoples in Iran are affected by Type 2 diabetes. T... more Based on some estimation more than two million peoples in Iran are affected by Type 2 diabetes. The present study was designed to evaluate the status of diabetes control among Type 2 diabetes patients in Kurdistan, west of Iran and its associated factors. In our cross sectional study conducted in 2010, 411 Type 2 diabetes patients were randomly recruited from Sanandaj, Capital of Kurdistan. Chi square test was used in univariate analysis to address the association between HgAlc and FBS status and other variables. The significant results from Univariate analysis were entered in multivariate analysis and multinomial logistic regression model. In 38% of patients, FBS was in normal range (70-130) and in 47% HgA1c was <7% which is normal range for HgA1c. In univariate analysis, FBS level was associated with educational levels (P=0.001), referral style (P=0.001), referral time (P=0.009), and insulin injection (P=0.016). In addition, HgA1c had a relationship with sex (P=0.023), age (P=0...
International journal of preventive medicine, 2013
The most fundamental way to decrease the burden of noncommunicable diseases (NCDs) is to identify... more The most fundamental way to decrease the burden of noncommunicable diseases (NCDs) is to identify and control their related risk factors. The goal of this study is to determine socioeconomic inequalities in risk factors for NCDs using concentration index based on Non-Communicable Disease Surveillance Survey (NCDSS) data in Kurdistan province, Islamic Republic of Iran in 2005 and 2009. The required data for this study are taken from two NCDSSs in Kurdistan province in 2005 and 2009. A total of 2,494 persons in 2005 and 997 persons in 2009 were assessed. Concentration index was used to determine socioeconomic inequality. To assess the relationship between the prevalence of each risk factor and socioeconomic status (SES), logistic regression was used and odds ratio (OR) was calculated for each group, compared with the poorest group. The concentration index for hypertension was -0.095 (-0.158, -0.032) in 2005 and -0.080 (-0.156, -0.003) in 2009. The concentration index for insufficient ...
Metabolic syndrome is a common nmetabolic ndisorder, which leads to early Cardio Vascular Disease... more Metabolic syndrome is a common nmetabolic ndisorder, which leads to early Cardio Vascular Disease and diabetes type II. The goal of this study was to determine the prevalence of metabolic syndrome and its risk factors in Kurdistan, Iran. The data was extracted from provincial section of Iranian national non-communicable surveillance survey conducted in 2005. The study was a population-based survey with multi-stage cluster sampling method. Adult Treatment Panel-III measures were used for assessing the prevalence of metabolic syndrome among residents of Kurdistan Province aged 25 to 64 yr. EPI-Info 6 was used to enter the data and the data was analyzed using SPSS 11.5. Totally, 1194 participants were recruited in our survey. The prevalence of metabolic syndrome was 29.1%. The prevalence was 41.3% among women and 17.1% among men (P= 0.001). As we go higher among age groups, the prevalence increases. This is the first study to investigate the metabolic syndrome in Kurdistan and Kurd eth...
Evaluating the malaria status of the Economic Cooperation Organization (ECO) member countries rel... more Evaluating the malaria status of the Economic Cooperation Organization (ECO) member countries relation to goal 6 of 3rd Millennium Development Goals (MDGs) which includes have halted by 2015 and begun to reverse the incidence of malaria. By 2009, we reviewed the MDGs reports, extracted the data from surveillance system, published, and unpublished data. The main stakeholders, from both governmental and international organizations in the country have been visited and interviewed by the research team as part of the data validation process. The malaria incidence is very heterogeneous among ECO countries, which differ less than 200 cases in total country in Kazakhstan, Kyrgyzstan, Turkey, Turkmenistan, Uzbekistan, and Azerbaijan to 82,564 cases (2,428/100,000) in Afghanistan and 59,284 cases (881/100,000) in Pakistan and about 18/100,000 in Iran in 2008. Malaria has been a major public health problem in Pakistan and Afghanistan and will continue to pose serious threat to millions of peop...
International journal of preventive medicine, 2012
Evaluating the tuberculosis (TB) status of the Economic Cooperation Organization (ECO) member cou... more Evaluating the tuberculosis (TB) status of the Economic Cooperation Organization (ECO) member countries relation to goal 6-c of the third millennium, which includes that TB incidence, prevalence, and death rates should be halved by 2015, compared with their level in 1990. In 2009, we have critically reviewed the countries' Millennium Development Goals (MDGs) reports and extracted the data from the surveillance system and published and unpublished data. The main stakeholders, from both governmental and international organizations in the country have been visited and interviewed by the research team as part of the data validation process. The TB incidence is very heterogeneous among ECO countries, which differ from 21.7 in Iran to 230.7 per 100,000 in Tajikistan. TB incidence (per 100,000) is more than 100 in six countries and is from 50 to 100 in two countries and is less than 30 in two countries. Only in two countries the crude death rate (CDR) is higher than 70%. In seven count...
Background: One of the main objectives of health systems is the financial protection against out-... more Background: One of the main objectives of health systems is the financial protection against out-of-pocket (OOP) health expenditures. OOP health expenditures can lead to catastrophic payments, impoverishment or poverty among households. In Iran, health sector evolution plan (HSEP) has been implemented since 2014 in order to achieve universal health coverage and reduce the OOP health expenditures as a percentage of total health expenditures. This study aimed to explore the percentage of households facing catastrophic health expenditures (CHE) after the implementation of HSEP and the factors that determine CHE. Methods: A total of 663 households were selected through a cluster sampling based on the census framework of Sanandaj Health Center in July 2015. Data were gathered using face-to-face interviews based on the household section of the World Health Survey questionnaire. In this study, according to the World Health Organization (WHO) definition, if household health expenditures were equal to or more than 40% of the household capacity to pay, household was considered to be facing CHE. The determinants of CHE were analyzed using logistic regression model. Results: The rates of households facing CHE were 4.8%. The key determinants of CHE were household economic status, presence of elderly or disabled members in the household and utilization of inpatient or rehabilitation services. Conclusion: The comparison of our findings and those of other studies carried out using a methodology comparable with ours in different parts of Iran before the implementation of HSEP suggests that the implementation of recent reforms has reduced CHE at the household level. Utilization of inpatient and rehabilitation services, the presence of elderly or disabled members in the household and the low economic status of the household would increase the likelihood of facing CHE. These variables should be considered by health policy-makers in order to review and revise content of recent reform, thus financially protecting public against CHE.
HIV/AIDS epidemic is concentrated among injecting drug users in Iran. Like many other countries w... more HIV/AIDS epidemic is concentrated among injecting drug users in Iran. Like many other countries with HIV/AIDS concentrated epidemic, prisons are high risk areas for spreading HIV/AIDS. The aim of this paper was to study the trend of HIV/AIDS prevalence and related interventions administered in prisons of Iran during a 13 years period. This cross sectional study was conducted using the data collected from the sentinel sites in all prisons in the country and it also used the data about Harm Reduction interventions which has been implemented by Iran Prisons Organization. To evaluate the correlation between the prevalence and each of administered interventions in prisons the Correlation Coefficient Test was used for the second half of the mentioned time period. The prevalence of HIV/AIDS in prisons had increased rapidly in the early stages of epidemic, so that in 2002 the prevalence raised to 3.83%. Followed by the expansion of Methadone Maintenance Therapy and development of Triangular...
International Journal of Preventive Medicine, 2015
HIV/AIDS is one of the diseases which not only makes threats to physical health, but also, due to... more HIV/AIDS is one of the diseases which not only makes threats to physical health, but also, due to the negative attitudes of people and the social stigma, affects the emotional and social health of patients. The aim of this study was to identify the psychological, social, and family problems of people living with HIV/AIDS (PLWHA) in Iran. In this qualitative study, we used purposive sampling to enroll PLWHA, their families, and physicians and consultants in two cities of Kermanshah and Tehran. Each group of PLWHA, their families, physicians, and consultants participated in two focus group discussions (FGDs), and a total of eight FGDs were conducted. Six interviews were held with all key people, individually. Based on the views and opinions of various groups involved in the study, the main problems of PLWHA were: Ostracism, depression, anxiety, a tendency to get revenge and lack of fear to infect others, frustration, social isolation, relationship problems, and fear due to the social stigma. Their psychological problems included: Marriage problems, family conflict, lack of family support, economic hardships inhibiting marriage, and social rejection of patient&#39;s families. Their family problems were: Unemployment, the need for housing, basic needs, homelessness, and lack of social support associations. It seems that the identification and focusing on psychological, social, and family problems of affected people not only is an important factor for disease prevention and control, but also enables patients to have a better response to complications caused by HIV/AIDS.
Background: HIV/AIDS has been concentrated among injecting drug users in the country. This study ... more Background: HIV/AIDS has been concentrated among injecting drug users in the country. This study aimed to investigate and identify health and treatment needs of people living with HIV/AIDS in Iran. Methods: This qualitative study was conducted in 2012 in Iran. The study groups consisted of experts, practitioners, and consultants working with People Living with HIV/AIDS and their families. Data was collected through Focus Group Discussions and deep interviews. Data were analyzed using content analysis method. Results: The findings of this study included the needs of people living with HIV/AIDS, which were classified in three main categories. The first category was prevention and counseling services with several sub-groups such as education and public and available consultation, distribution of condoms to vulnerable groups, increasing counseling centers in urban areas, providing appropriate psychological and supportive counseling, and family planning services. The second category included diagnostic and treatment services and had several sub-groups such as full retroviral treatment, Tuberculosis treatment and continuing care, providing care and treatment for patients with hepatitis, and providing dental services. The third category included rehabilitation services and had some sub-categories such as home care, social and psychological support, nutritional support, and empowering positive clubs. Conclusions: This study puts emphasis on making plans based on the priorities to meet the needs of people living with HIV/AIDS in Iran.
Evaluating the tuberculosis (TB) status of the Economic Cooperation Organization (ECO) member cou... more Evaluating the tuberculosis (TB) status of the Economic Cooperation Organization (ECO) member countries relation to goal 6-c of the third millennium, which includes that TB incidence, prevalence, and death rates should be halved by 2015, compared with their level in 1990. In 2009, we have critically reviewed the countries' Millennium Development Goals (MDGs) reports and extracted the data from the surveillance system and published and unpublished data. The main stakeholders, from both governmental and international organizations in the country have been visited and interviewed by the research team as part of the data validation process. The TB incidence is very heterogeneous among ECO countries, which differ from 21.7 in Iran to 230.7 per 100,000 in Tajikistan. TB incidence (per 100,000) is more than 100 in six countries and is from 50 to 100 in two countries and is less than 30 in two countries. Only in two countries the crude death rate (CDR) is higher than 70%. In seven count...
International Journal of Health Policy and Management, 2015
Background: As one of the most important components of harm reduction strategy for high-risk grou... more Background: As one of the most important components of harm reduction strategy for high-risk groups, following the HIV epidemics, Methadone Maintenance Treatment (MMT) has been initiated in prisoners since 2003. In this paper, we aimed to assess the advantages and shortcomings of the MMT program from the perspective of people who were involved with the delivery of prison healthcare in Iran. Methods: On the basis of grounded theory and through conducting 14 Focus Group Discussions (FGDs), 7 FGDs among physicians, consultants, experts, and 7 FGDs among directors and managers of prisons (n= 140) have been performed. The respondents were asked about positive and negative elements of the MMT program in Iranian prisons. Results: This study included a total of 48 themes, of which 22 themes were related to advantages and the other 26 were about shortcomings of MMT programs in the prisons. According to participants' views "reduction of illegal drug use and high-risk injection", "reduction of potentially high-risk behaviors" and "making positive attitudes" were the main advantages of MMT in prisons, while issues such as "inaccurate implementation", "lack of skilled manpower" and "poor care after release from prison" were among the main shortcomings of MMT program. Conclusions: MMT program in Iran's prisons has achieved remarkable success in the field of harm reduction, but to obtain much more significant results, its shortcomings and weaknesses must be also taken into account by policy-makers.
The most fundamental way to decrease the burden of noncommunicable diseases (NCDs) is to identify... more The most fundamental way to decrease the burden of noncommunicable diseases (NCDs) is to identify and control their related risk factors. The goal of this study is to determine socioeconomic inequalities in risk factors for NCDs using concentration index based on Non-Communicable Disease Surveillance Survey (NCDSS) data in Kurdistan province, Islamic Republic of Iran in 2005 and 2009. The required data for this study are taken from two NCDSSs in Kurdistan province in 2005 and 2009. A total of 2,494 persons in 2005 and 997 persons in 2009 were assessed. Concentration index was used to determine socioeconomic inequality. To assess the relationship between the prevalence of each risk factor and socioeconomic status (SES), logistic regression was used and odds ratio (OR) was calculated for each group, compared with the poorest group. The concentration index for hypertension was -0.095 (-0.158, -0.032) in 2005 and -0.080 (-0.156, -0.003) in 2009. The concentration index for insufficient ...
Objective: Skin manifestations are common clinical features among HIV positive patients. The aim ... more Objective: Skin manifestations are common clinical features among HIV positive patients. The aim of this study was to document skin manifestations and their relationships with CD4 cell counts among HIV positive patients in Sanandaj. Methodology: This was a descriptive study. The patients were examined for skin disorders by a dermatologist and CD4 counts were obtained from the patient's medical records. Independent samples T test were used for data analysis. Results: In this study 66 (94.3%) patients had at least one skin problem. Fungal infections were the most common cause. The eight most common types of mucocutaneous problems were gingivitis, pallor, itching, photosensitivity, seborrheic dermatitis, candidiasis, folliculitis and tinea versicolor. The most common manifestation was gingivitis. Mean CD4 cell counts were lower in individuals with viral and bacterial skin diseases (P <0.05). Conclusion: The results of this study indicated that skin problems were common among HIV...
The aim of this study was to determine the socioeconomic inequalities in nonuse of seatbelts in c... more 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. T...
International Journal of High Risk Behaviors and Addiction, 2015
Background: Participation and to stay in a health program depends on many factors. One of these p... more Background: Participation and to stay in a health program depends on many factors. One of these programs is Needle Exchange Program (NEP) in prisons. Objectives: The current study aimed to evaluate the retention of injecting drug prisoners and find the related factors in Iran. Patients and Methods: This cohort study analyzed data about injecting drug male prisoners who were participated in NEP in three Iranian prisons. Data was collected from October 2009 to June 2010. A proper approach of survival analyses including Kaplan-Meier method, Log-Rank test, and Cox Proportional Hazard Model were used to evaluate Injecting Drug Users (IDUs) retention in NEP and its determinants. Results: Out of 320 prisoners, 167 were from Isfahan Central Prison, 82 from Tehran-Ghezel-Hesar Prison, and 71 from Hamadan Central Prison. Two-hundred and fifty prisoners (78.4%) had history of drug injection; and drug injection was the most common choice for 115 persons (35.9%). Participants were followed up for 29 weeks, the mean (SD) time of retention in the program was 24.1 (0.6) weeks. There was a significant relationship between age, number of used needles per week, duration of addiction, age of addiction onset, as well as imprisonment age, main method of drug use, type of main using drug, Hepatitis B Virus (HBV) infection, job status, reason of arrestment, history of involvement in harm reduction programs, and the length of retention (P < 0.05). There was also significant relationship between the history of using harm reduction services (P = 0.007), tattooing (P = 0.01), longer durations of addiction (P = 0.048), and retention. Conclusions: Tattooing and longer duration of addiction were two important factors that significantly increased retention in the program. In contrast, history of using harm reduction services was the factor that decreased persistence. The risk of quitting the program may decrease about 68% in those who did not involve in harm reduction programs.
HIV/AIDS has been concentrated among injecting drug users in the country. This study aimed to inv... more HIV/AIDS has been concentrated among injecting drug users in the country. This study aimed to investigate and identify health and treatment needs of people living with HIV/AIDS in Iran. This qualitative study was conducted in 2012 in Iran. The study groups consisted of experts, practitioners, and consultants working with People Living with HIV/AIDS and their families. Data was collected through Focus Group Discussions and deep interviews. Data were analyzed using content analysis method. The findings of this study included the needs of people living with HIV/AIDS, which were classified in three main categories. The first category was prevention and counseling services with several sub-groups such as education and public and available consultation, distribution of condoms to vulnerable groups, increasing counseling centers in urban areas, providing appropriate psychological and supportive counseling, and family planning services. The second category included diagnostic and treatment ...
Based on some estimation more than two million peoples in Iran are affected by Type 2 diabetes. T... more Based on some estimation more than two million peoples in Iran are affected by Type 2 diabetes. The present study was designed to evaluate the status of diabetes control among Type 2 diabetes patients in Kurdistan, west of Iran and its associated factors. In our cross sectional study conducted in 2010, 411 Type 2 diabetes patients were randomly recruited from Sanandaj, Capital of Kurdistan. Chi square test was used in univariate analysis to address the association between HgAlc and FBS status and other variables. The significant results from Univariate analysis were entered in multivariate analysis and multinomial logistic regression model. In 38% of patients, FBS was in normal range (70-130) and in 47% HgA1c was <7% which is normal range for HgA1c. In univariate analysis, FBS level was associated with educational levels (P=0.001), referral style (P=0.001), referral time (P=0.009), and insulin injection (P=0.016). In addition, HgA1c had a relationship with sex (P=0.023), age (P=0...
International journal of preventive medicine, 2013
The most fundamental way to decrease the burden of noncommunicable diseases (NCDs) is to identify... more The most fundamental way to decrease the burden of noncommunicable diseases (NCDs) is to identify and control their related risk factors. The goal of this study is to determine socioeconomic inequalities in risk factors for NCDs using concentration index based on Non-Communicable Disease Surveillance Survey (NCDSS) data in Kurdistan province, Islamic Republic of Iran in 2005 and 2009. The required data for this study are taken from two NCDSSs in Kurdistan province in 2005 and 2009. A total of 2,494 persons in 2005 and 997 persons in 2009 were assessed. Concentration index was used to determine socioeconomic inequality. To assess the relationship between the prevalence of each risk factor and socioeconomic status (SES), logistic regression was used and odds ratio (OR) was calculated for each group, compared with the poorest group. The concentration index for hypertension was -0.095 (-0.158, -0.032) in 2005 and -0.080 (-0.156, -0.003) in 2009. The concentration index for insufficient ...
Metabolic syndrome is a common nmetabolic ndisorder, which leads to early Cardio Vascular Disease... more Metabolic syndrome is a common nmetabolic ndisorder, which leads to early Cardio Vascular Disease and diabetes type II. The goal of this study was to determine the prevalence of metabolic syndrome and its risk factors in Kurdistan, Iran. The data was extracted from provincial section of Iranian national non-communicable surveillance survey conducted in 2005. The study was a population-based survey with multi-stage cluster sampling method. Adult Treatment Panel-III measures were used for assessing the prevalence of metabolic syndrome among residents of Kurdistan Province aged 25 to 64 yr. EPI-Info 6 was used to enter the data and the data was analyzed using SPSS 11.5. Totally, 1194 participants were recruited in our survey. The prevalence of metabolic syndrome was 29.1%. The prevalence was 41.3% among women and 17.1% among men (P= 0.001). As we go higher among age groups, the prevalence increases. This is the first study to investigate the metabolic syndrome in Kurdistan and Kurd eth...
Evaluating the malaria status of the Economic Cooperation Organization (ECO) member countries rel... more Evaluating the malaria status of the Economic Cooperation Organization (ECO) member countries relation to goal 6 of 3rd Millennium Development Goals (MDGs) which includes have halted by 2015 and begun to reverse the incidence of malaria. By 2009, we reviewed the MDGs reports, extracted the data from surveillance system, published, and unpublished data. The main stakeholders, from both governmental and international organizations in the country have been visited and interviewed by the research team as part of the data validation process. The malaria incidence is very heterogeneous among ECO countries, which differ less than 200 cases in total country in Kazakhstan, Kyrgyzstan, Turkey, Turkmenistan, Uzbekistan, and Azerbaijan to 82,564 cases (2,428/100,000) in Afghanistan and 59,284 cases (881/100,000) in Pakistan and about 18/100,000 in Iran in 2008. Malaria has been a major public health problem in Pakistan and Afghanistan and will continue to pose serious threat to millions of peop...
International journal of preventive medicine, 2012
Evaluating the tuberculosis (TB) status of the Economic Cooperation Organization (ECO) member cou... more Evaluating the tuberculosis (TB) status of the Economic Cooperation Organization (ECO) member countries relation to goal 6-c of the third millennium, which includes that TB incidence, prevalence, and death rates should be halved by 2015, compared with their level in 1990. In 2009, we have critically reviewed the countries' Millennium Development Goals (MDGs) reports and extracted the data from the surveillance system and published and unpublished data. The main stakeholders, from both governmental and international organizations in the country have been visited and interviewed by the research team as part of the data validation process. The TB incidence is very heterogeneous among ECO countries, which differ from 21.7 in Iran to 230.7 per 100,000 in Tajikistan. TB incidence (per 100,000) is more than 100 in six countries and is from 50 to 100 in two countries and is less than 30 in two countries. Only in two countries the crude death rate (CDR) is higher than 70%. In seven count...
Background: One of the main objectives of health systems is the financial protection against out-... more Background: One of the main objectives of health systems is the financial protection against out-of-pocket (OOP) health expenditures. OOP health expenditures can lead to catastrophic payments, impoverishment or poverty among households. In Iran, health sector evolution plan (HSEP) has been implemented since 2014 in order to achieve universal health coverage and reduce the OOP health expenditures as a percentage of total health expenditures. This study aimed to explore the percentage of households facing catastrophic health expenditures (CHE) after the implementation of HSEP and the factors that determine CHE. Methods:A total of 663 households were selected through a cluster sampling based on the census framework of Sanandaj Health Center in July 2015. Data were gathered using face-to-face interviews based on the household section of the World Health Survey questionnaire. In this study, according to the World Health Organization (WHO) definition, if household health expenditures were equal to or more than 40% of the household capacity to pay, household was considered to be facing CHE. The determinants of CHE were analyzed using logistic regression model. Results:The rates of households facing CHE were 4.8%. The key determinants of CHE were household economic status, presence of elderly or disabled members in the household and utilization of inpatient or rehabilitation services. Conclusion:The comparison of our findings and those of other studies carried out using a methodology comparable with ours in different parts of Iran before the implementation of HSEP suggests that the implementation of recent reforms has reduced CHE at the household level. Utilization of inpatient and rehabilitation services, the presence of elderly or disabled members in the household and the low economic status of the household would increase the likelihood of facing CHE. These variables should be considered by health policy-makers in order to review and revise content of recent reform, thus financially protecting public against CHE.
Background: One of the objectives of the health transformation plan (HTP) in Iran is to reduce ou... more Background: One of the objectives of the health transformation plan (HTP) in Iran is to reduce out-of-pocket (OOP) payments for inpatient services and eradicate informal payments. The HTP has three phases: the first phase (launched in May 5, 2014) is focused on reducing OOP payments for inpatient services; the second phase (launched in May 22, 2014) is focused on primary healthcare (PHC) and the third phase utilizes an updated relative value units for health services (launched in September 29, 2014) and is focused on the elimination of informal payments. This aim of this study was to determine the OOP payments and the frequency of informal cash payments to physicians for inpatient services before and after the HTP in Kurdistan province, Iran. Methods: This quasi-experimental study used multistage sampling method to select and evaluate 265 patients discharged from hospitals in Kurdistan province. The study covered 3 phases (before the HTP, after the first, and third phases of the HTP). Part of the data was collected using a hospital information system form and the rest were collected using a questionnaire. Data were analyzed using Fisher exact test, logistic regression, and independent samples t test..4 in private hospitals. In hospitals affiliated to SSO and MoHME there was a significant difference between the mean OOP payments before the HTP and after the third phase (P < .05). The percentage of informal payments to physicians in hospitals affiliated to MoHME, SSO, and private sector, respectively, were 4.5%, 8.1%, and 12.5% before the HTP, and 0.0%, 7.1%, and 10.0% after the first phase. Contrary to the time before the HTP, no informal payment was reported after the third phase. Conclusion: It seems that the implementation of the HTP has reduced the OOP payments for inpatient services and eradicated informal payments to physician in Kurdistan province. Implications for policy makers • It seems that the implementation of the health transformation plan (HTP) reduced the mean out-of-pocket (OOP) payments for inpatient services in Kurdistan province, Iran. • After the implementation of the third phase of the HTP, during the study period, we did not found any informal cash payments to physicians for inpatient services. • Several factors significantly increased the probability of informal payments to physician including the followings: being discharged from private sector and social security hospitals, being discharged from hospitals before the implementation of the HTP, living in rural areas, being visited by an ophthalmologist, urologist or otolaryngologists. • Health policy-makers should pay attention to patients' payments for " bought and brought health care goods " purchased from out-of-hospital supply chain. Implications for the public After the implementation of the health transformation plan (HTP), the amount of out-of-pocket (OOP) payments for inpatient services was reduced. Reduction of OOP payments for inpatient services improves people's access to such services and enhances the equity. After the implementation of the third phase of the HTP no informal cash payments to physician was reported. The elimination of informal payments reduces the probability of corruption in the health system.
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Papers by Ghobad Moradi
health expenditures. OOP health expenditures can lead to catastrophic payments, impoverishment or poverty among
households. In Iran, health sector evolution plan (HSEP) has been implemented since 2014 in order to achieve
universal health coverage and reduce the OOP health expenditures as a percentage of total health expenditures.
This study aimed to explore the percentage of households facing catastrophic health expenditures (CHE) after the
implementation of HSEP and the factors that determine CHE.
Methods:A total of 663 households were selected through a cluster sampling based on the census framework of
Sanandaj Health Center in July 2015. Data were gathered using face-to-face interviews based on the household
section of the World Health Survey questionnaire. In this study, according to the World Health Organization
(WHO) definition, if household health expenditures were equal to or more than 40% of the household capacity to
pay, household was considered to be facing CHE. The determinants of CHE were analyzed using logistic regression
model.
Results:The rates of households facing CHE were 4.8%. The key determinants of CHE were household economic
status, presence of elderly or disabled members in the household and utilization of inpatient or rehabilitation
services.
Conclusion:The comparison of our findings and those of other studies carried out using a methodology
comparable with ours in different parts of Iran before the implementation of HSEP suggests that the
implementation of recent reforms has reduced CHE at the household level. Utilization of inpatient and rehabilitation
services, the presence of elderly or disabled members in the household and the low economic status of the household
would increase the likelihood of facing CHE. These variables should be considered by health policy-makers in order
to review and revise content of recent reform, thus financially protecting public against CHE.