Trends in the drowning mortality rate in Iran.

OBJECTIVE: The WHO estimates the global incidence of death by drowning to be about 300 000 cases per year. The objective of this study was to estimate the trend in mortality due to drowning in all provinces of Iran in all age groups and both genders from 1990 to 2015. STUDY DESIGN: The National and Subnational Burden of Diseases (NASBOD) project is a comprehensive project in Iran. It is based on the Global Burden of Disease study and includes novel methods to estimate the burden of diseases in Iran. METHODS: This study used the results of the mortality rate due to drowning as part of NASBOD and investigated the causes behind the mortality rates. The data set recorded mortality rates by 19 age groups and two genders with the corresponding subnational pattern during the time period from 1990 to 2015. RESULTS: The drowning mortality rate decreased in Iran from 1990 to 2015. From 1990 to 2015, the annual percentage change for males and females was -5.28% and -10.73%, respectively. There were 56 184 male and 21 589 female fatalities during the study period. The highest number of deaths was seen in 1993 with 4459, and the lowest number of fatalities was observed in 2015 with 903 deaths. CONCLUSION: Our data showed a decline in drowning mortality in Iran from 1990 to 2015, but the rates and declines varied by province. Our findings are of great importance to health officials and authorities in order to further reduce the burden of drowning.

Physical and mental growth and development in children with congenital hypothyroidism: a case-control study.

INTRODUCTION: The clinical complications of congenital hypothyroidism such as brain disorders are very subtle and are not recognizable in infancy period. They are recognizable when it is too late for treatment or prevention. General screening of newborns is effective in diagnosing congenital hypothyroidism and initiating initial treatment. The aim of this study is to compare the physical and mental growth pattern of children with congenital hypothyroidism with healthy ones. METHODS: This case-control study was performed on 34 patients and 68 healthy children who were matched in terms of inclusion and exclusion criteria. Children development screening test (ASQ), children development assessment test (Bayley), preschool Wechsler intelligence scale (WPPSI) and age and steps questionnaire of emotional social development (ASQ-SE) were completed by trained questioners. Data were analyzed using STATA software. RESULTS: The results indicated that there was no significant difference between the mean of verbal (P = 0.77), non-verbal (P = 0.81) and general (P = 0.66) IQ in permanent and transient patients and healthy individuals. Also, there was no significant difference between the mean of different ranges of ASQ test (including communication, delicate and large movements, problem solving and social) at 12 months and 42 months (P < 0.05). According to Bayley test, there was no significant difference between the cases (permanent and transient) and controls in the cognitive (P = 0.42) and expressive (P = 0.38) categories. The difference was significant in the perceptual (P = 0.011), large (P = 0.03) and delicate (P = 0.04) movements categories. CONCLUSION: This study emphasized on the high effectiveness of neonate hypothyroidism screening program, so that the difference between 3.5 years old children with and without this disease has decreased significantly. Early diagnosis of the patients, while creating beneficial effects for patients and increasing quality of life, cause reduction in the long-term costs of the health system.

Mortality Attributable to Nutritional Deficiencies among Iranian Children under the Age of Five at National and Subnational Level: 1995-2015.

BACKGROUND: Under-five mortality is considered an indicator of population well-being and health equality in societies. Under-five mortality caused by nutritional deficiencies is a public health concern in developing countries. In this study, we aimed to report the trend and mortality rate of nutritional deficiencies from 1995 to 2015 in children aged under five years. METHODS: In this study, we used the death registration system (DRS) data to estimate age- and sex-specific nutritional deficiency mortality rates at national and sub-national levels in Iran from 1995 to 2015. The Iranian DRS used the 10th revision of International Classification of Diseases (ICD-10) but we report our results based on Global Burden of Diseases (GBD) study codes. We used the average annual percent change (AAPC) to quantify trend in under-five mortality rate attributable to nutritional deficiencies from 1995 to 2015. RESULTS: At national level, mortality rates in both sexes were 8.53 (95% uncertainty interval [UI]: 7.69-9.47), 1.04 (0.86-1.36), and 0.37 (95% UI: 0.28-0.57) per 100,000 in 1995, 2005, and 2015, respectively. AAPC was estimated between 1995 and 2015. At sub-national level, the highest and lowest mortality rates across provinces ranged from 17.7 per 100000 in 1995 to 1.1 per 100000 in 2015. In the latest years, protein-energy malnutrition (PEM) was the most frequent cause of mortality among other nutritional deficiencies. CONCLUSION: The results show a substantial reduction in terms of mortality caused by nutritional deficiencies at national, as well as provincial, level among children under-five years of age.

Liver cirrhosis mortality at national and provincial levels in Iran between 1990 and 2015: A meta regression analysis.

BACKGROUND: Liver cirrhosis mortality number has increased over the last decades. We aimed to estimate the liver cirrhosis mortality rate and its trends for the first time by sex, age, geographical distribution, and cause in Iran. METHOD: Iranian Death Registration System, along with demographic (Complete and Summary Birth History, Maternal Age Cohort and Period methods) and statistical methods (Spatio-temporal and Gaussian process regression models) were used to address the incompleteness and misclassification and uncertainty of death registration system to estimate annual cirrhosis mortality rate. Percentages of deaths were proportionally redistributed into cirrhosis due to hepatitis B, C and alcohol use based on the data from the Global Burden of Disease (GBD) 2010 study. RESULTS: Liver cirrhosis mortality in elder patients was 12 times higher than that in younger patients at national level in 2015. Over the 26 years, liver cirrhosis mortality in males has increased more than that in females. Plus, the percentage of change in age adjusted mortality rate at provincial levels varied between decreases of 64.53% to nearly 17% increase. Mortality rate has increased until 2002 and then decreased until 2015.The province with highest mortality rate in 2015 has nearly two times greater rate compare to the lowest. More than 60% of liver cirrhosis mortality cases at national level are caused by hepatitis B and C infection. The rate of hepatitis B mortality is four times more than that from hepatitis C. CONCLUSION: This study demonstrated an increasing and then decreasing pattern in cirrhosis mortality that could be due to national vaccination of hepatitis B program. However monitoring, early detection and treatment of risk factors of cirrhosis, mainly in high risk age groups and regions are essential. Cirrhosis mortality could be diminished by using new non-invasive methods of cirrhosis screening, hepatitis B vaccination, definite treatment of hepatitis C.

Annual Trends of Gastrointestinal Cancers Mortality in Iran During 1990-2015; NASBOD Study.

BACKGROUND: Gastrointestinal (GI) neoplasms are among the most common cancers in Iran. This study aimed to measure annual trends in mortality rates from GI cancers in Iran between 1990 and 2015. METHODS: This study was part of an ongoing study termed the 'National and Subnational Burden of Diseases' study in Iran. Data used in this study was obtained from the Iranian Death Registration System (1995 to 2010) and from 2 major cemeteries in Tehran (1995 to 2010) and Isfahan (2007 to 2010). All-cause mortality rates were estimated using the spatio-temporal model and the Gaussian process regression model. Age-standardized mortality rates (ASMR) per 100 000 person-years was calculated using data from Iran and the standard world population for comparison. RESULTS: Among GI cancers, gastric cancer represented the leading cause of mortality followed by cancers of the esophagus, liver, and colorectal cancers with the ASMR of 20.5, 5.8, 4.4, and 4.0 per 100 000 persons-years, respectively, between 1990 and 2015. While a decreasing trend occurred in mortality of esophageal, gastric, and colorectal cancers, particularly in the recent decade, we recorded an upward pattern and steady rise in mortality rates from liver, pancreatic, and gallbladder cancers during the study period. The ASMR of all studied causes were enhanced by advancing age and were found to be more prominent in adults aged 50 or older. Among all age-groups, higher death rates were detected in males versus females for all studied cancers except for gallbladder and biliary tract cancers. CONCLUSION: Gastric cancer mortality is still high and death rates from several other GI cancers are increasing in the nation. Interventions for cancer prevention, early detection, and access to high quality cancer treatment services are needed to reduce GI cancer burden and death rates in Iran and in the region.

National and Subnational Patterns of Cause of Death in Iran 1990-2015: Applied Methods.

BACKGROUND: Causes of death statistics provide crucial health intelligence in national and international communities. An efficient death registration system provides reliable information for health policy system. In many developing countries, death registration systems face a degree of misclassification and incompleteness. There are many impediments to putting an estimate of cause-specific death rates. Addressing those challenges could prevent misleading results. METHODS: Our data was collected by Ministry of Health and Medical Education, Tehran and Isfahan cemeteries from 1995 to 2010. After converting ICD codes of Iran's death registration into GBD codes, 170 underlying causes of deaths were recognized in the available data. A wide range of methods were applied for preparing the data. We used several statistical models to estimate mortality rates in age-sex-province groups for all causes of deaths. The considerable number of combinations for age, sex, cause of death, year, and province variables made further complicated model selection and evaluation of the results. RESULTS: Totally, 58.91% of deaths were related to males. The majority of cases of death were classified as NCDs (77.83%) and injuries (14.80%). We extrapolated 71.76% and 14.71% of causes of death by mixed effect model, spline model with parameter 0.9 and 0.6, respectively. CONCLUSION: A comprehensive and unique registration system is able to solve many DRS issues. It is necessary to assess the quality and validity of cause of death data. Scientific methods like analyzing mortality level and cause-of-death data are used to provide an overview for better decisions.

Measuring Iran's success in achieving Millennium Development Goal 4: a systematic analysis of under-5 mortality at national and subnational levels from 1990 to 2015.

BACKGROUND: Child mortality as one of the key Millennium Development Goals (MDG 4-to reduce child mortality by two-thirds from 1990 to 2015), is included in the Sustainable Development Goals (SDG 3, target 2-to reduce child mortality to fewer than 25 deaths per 1000 livebirths for all countries by 2030), and is a key indicator of the health system in every country. In this study, we aimed to estimate the level and trend of child mortality from 1990 to 2015 in Iran, to assess the progress of the country and its provinces toward these goals. METHODS: We used three different data sources: three censuses, a Demographic and Health Survey (DHS), and 5-year data from the death registration system. We used the summary birth history data from four data sources (the three censuses and DHS) and used maternal age cohort and maternal age period methods to estimate the trends in child mortality rates, combining the estimates of these two indirect methods using Loess regression. We also used the complete birth history method to estimate child mortality rate directly from DHS data. Finally, to synthesise different trends into a single trend and calculate uncertainty intervals (UI), we used Gaussian process regression. FINDINGS: Under-5 mortality rates (deaths per 1000 livebirths) at the national level in Iran in 1990, 2000, 2010, and 2015 were 63·6 (95% UI 63·1-64·0), 38·8 (38·5-39·2), 24·9 (24·3-25·4), and 19·4 (18·6-20·2), respectively. Between 1990 and 2015, the median annual reduction and total overall reduction in these rates were 4·9% and 70%, respectively. At the provincial level, the difference between the highest and lowest child mortality rates in 1990, 2000, and 2015 were 65·6, 40·4, and 38·1 per 1000 livebirths, respectively. Based on the MDG 4 goal, five provinces had not decreased child mortality by two-thirds by 2015. Furthermore, six provinces had not reached SDG 3 (target 2). INTERPRETATION: Iran and most of its provinces achieved MDG 4 and SDG 3 (target 2) goals by 2015. However, at the subnational level in some provinces, there is substantial inequity. Local policy makers should use effective strategies to accelerate the reduction of child mortality for these provinces by 2030. Possible recommendations for such strategies include enhancing the level of education and health literacy among women, tackling sex discrimination, and improving incomes for families. FUNDING: Iran Ministry of Health and Education.

Burden of Vaccine-Preventable Diseases-Measles, Tetanus, Diphtheria and Whooping Cough-in Iran: Findings from the GBD study 2010.

BACKGROUND: Vaccination has been one of the most successful and cost-effective public health interventions in the last century and has saved millions of lives. In 1984, the Expanded Program on Immunization (EPI) was launched in Iran as one of the main components of Primary Health Care (PHC).  OBJECTIVES: We aimed to investigate the burden of four vaccine-preventable diseases from 1990 to 2010 in Iran. METHODS: GBD study 2010 includes death rates, Years of Life Lost (YLLs), Years Lived with Disability (YLDs) and Disability Adjusted Life Years (DALYs). YLLs is calculated through multiplying the number of deaths in each age group by a reference life expectancy for the same age group, while YLDs can be obtained from the prevalence of a disease multiplied by the disability weight (DW) for the same disease. The sum of these two indices yields DALYs. In the present study, we tried to produce new graphs and explain more about Iran results.  We also describe the GBD study limitations. RESULTS: Regardless of gender differences, DALYs rates for measles at all ages were 86.1220 and 5.5703 per 100 000 in 1990 and 2010, respectively, indicating approximately 94% decrease in this disease. The maximum and minimum rates of deaths from whooping cough for males aged under 5 was 4.0674 and 0.2713 per 100 000 in 1990 and 2000, respectively, which shows 93% decline in whooping cough from in this period. CONCLUSION: This study demonstrated that vaccination has had a positive impact on the control of communicable diseases. But the results of this study have some limitations similar to GBD study which may pave the way for decision makers about other public health interventions. Moreover, since measuring the impact of various diseases on health plays an important role in public health, it can be an important step toward prioritization in health.