Exploring hospitals' functional preparedness effective factors in response to disasters: a qualitative study in a lower middle-income country.

BACKGROUND: Medical services are among the most urgent needs of the disaster-affected population. Consequently, hospital preparedness -as the main health services provider- is one of the vital factors in effective response to disasters. The present study aims to explore the perspectives of study participants about the influential factors of hospital functional preparedness in a lower middle-income country. METHODS: In this qualitative study, data were collected through 17 semi-structured interviews with disaster management authorities selected by purposive sampling. Content-Analysis was used to analyze the data. RESULTS: 138 codes were developed and categorized into ten categories and 34 subcategories. The main categories were: 1- leadership, command, and coordination (4 subcategories); 2- risk assessment (3 subcategories); 3- legislating and developing protocols, guidelines, and programs (3 subcategories); 4- estimating and storing the necessary supplies and equipment (3 subcategories); 5- human resource management (4 subcategories); 6- education, training, and development of staff (6 subcategories); 7- vital routes and facilities (3 subcategories); 8- communication (3 subcategories); 9- security, safety and locating of safe zones (3 subcategories); 10- underlying disaster risk factors (2 subcategories). CONCLUSION: According to the participants of this study, ten categories of factors can affect hospitals' functional preparedness; hospital managers and decision-makers can consider these factors to ensure the proper provision of medical services during disasters.

Factors Affecting the Functional Preparedness of Hospitals in Response to Disasters: A Systematic Review.

Objective: This study aimed to comprehensively determine the factors that affect the hospitals' functional preparedness in response to disasters. Methods: A systematic review of studies published in English and Persian up to the end of 2022 was performed by searching PubMed Central, Web of Science, Scopus, ProQuest, SID, and Elmnet databases. Articles that assessed hospitals' functional preparedness were searched by using a combination of medical subject heading terms and keywords including disaster, emergency, preparedness, hospital preparedness, health care facilities preparedness, hospital functional preparedness, health care facilities functional preparedness, readiness, and effective factors. Additionally, journals and gray literature were manually searched. Two independent reviewers screened the eligible papers. The inclusion criteria were the full text should be published up to the end of 2022, in both Persian and English, and focus on hospital preparedness. The extracted data were manually analyzed, summarized, and reported using the content analysis method. Results: Of the 3465 articles, 105 studies were eventually included in the final analysis. Eighty-two influential factors were identified and classified into seven categories: government, coordination, control, and commanding (7 factors), existing guidelines and preparedness plans (12 factors), regulations (6 factors), supplying of resources (37 factors), education and training (8 factors), multi-layered information management and communication systems (8 factors), and contextual factors (4 factors). Conclusion: There are different dimensions of hospital preparedness for disasters, each of which is influenced by several independent factors. Addressing these factors will enhance the actual functional preparedness of hospitals encountering disasters.

Models and components in disaster risk communication: A systematic literature review.

BACKGROUND AND AIM: Risk communication is considered a major factor in disaster risk management by the concerned policymakers and researchers. However, the incoherence of variables affecting risk communication in various studies makes it difficult to plan for disaster risk communication. This study aims to identify and classify the influential components in disaster risk communication. MATERIALS AND METHODS: This systematic review was conducted in 2020. Databases included PubMed, Scopus, and Web of Science. In searching for articles, there was no limit on the date of publication and the language of the article. The research addressed both natural and man-made disasters. The Preferred reporting items for systematic review and meta-analysis protocols (PRISMA) checklist was followed throughout the research, and the quality of the papers was assessed using the mixed methods evaluation tool (MMAT). RESULTS: In searching the articles, 3956 documents were obtained, of which 1025 duplicated articles were excluded. The titles and abstracts of the remaining documents (2931) were examined, of which 2822 were deleted, and the full text of 109 documents was studied for further assessment. Finally, after applying the inclusion and exclusion criteria and reviewing the full texts, 32 documents were considered to extract the data and for quality assessment. On studying the full text of the obtained documents, 115 components were found, which were classified into five groups (message, message sender, message receiver, message environment, message process) and 13 subgroups. In addition, the obtained components were classified as those proposed by the authors of the article and those obtained from disaster risk communication models. CONCLUSION: Identifying the effective components in the disaster risk communication gives a more comprehensive view of risk communication to the disaster managers and executives and provides the decision-makers with an important platform to be able to use the components of risk communication and increase the impact of messages and ultimately increase people's preparedness for disasters in planning operations for the risk communication.

Challenges of Emergency Medical Services Response to Arasbaran Twin Earthquakes; a Content Analysis.

Introduction: One of the most important concerns in responding to disasters is providing Basic Life Support (BLS) services. Considering the key role of Emergency Medical Services (EMS) in providing BLS, the purpose of this study is to investigate the experience of provincial EMS during their response to the Arasbaran twin earthquakes and its challenges in Iran. Methods: This study was conducted using a qualitative approach and the conventional content analysis method. Data were collected through Focused Group Discussions (FGD) and semi-structured in-depth interviews with purposively-selected EMS paramedics and officials in East Azerbaijan Province, Iran. To form the main categories, the interviews were encoded in three stages and the similar codes were placed under the same subcategories and merged. Results: A total of 26 EMS paramedics participated in the study. The codes extracted from the interviews, after three stages of reduction, were placed in the top ten categories, including the lack of preparedness and coordination, dead bodies' management challenges, responders' psychosocial support, deficiencies in supplies and ambulances, difficulty of access to rural areas, volunteer management, non-documentation of the experiences, communication challenges, recalling, and deploying of EMS responders. Conclusion: Timely response of the EMS and paramedics' sense of responsibility for providing services were positive and successful points about the emergency response operations. The weaknesses of EMS should, therefore, be addressed through transferring of experiences and by planning and arranging training courses.

Integrated operations for natural disaster management: A systematic Review.

Background: This study aimed to conduct a systematic review of models describing the integrated logistics operations performed as a response to natural disasters, with the hope to identify the challenges and limitations of healthcare systems in natural disaster management. Methods: A systematic literature search was carried out in PubMed/Medline, Scopus, Google Scholar, and bibliographies of retrieved articles using MeSH headings and keywords such as natural disaster, logistics, model. A total of 98 publications were identified through the search process. Seven potentially relevant articles met the inclusion criteria. The key demographic, clinical, and pathological information of all qualified studies were extracted from the full-text articles. Results: Among the seven included studies, six had either model data or considerations on distribution methods. Storage, human resources, infrastructures, primary priority items, coordination of organizations, and information and communication with the media were also the focus of studies. The articles were mainly from Iran (n=2), the United States (n=2), and Indonesia (n=2). The models presented in the studies has mainly focused on a specific aspect of disaster management, such as smart government development, use of military services, people with logistic training and/or medical team model. Conclusion: This study systematically highlighted the crucial points that should be considered in managing natural disasters including human resources, infrastructure, storage, priority items, distribution, access system, coordination of organizations, information, and communication with the media. In this regard, we prepared a comprehensive comparison of possible models and logistics.

Cardiovascular Diseases in Natural Disasters; a Systematic Review.

INTRODUCTION: As a result of destruction and lack of access to vital infrastructures and mental stress, disasters intensify cardiovascular diseases (CVDs) and hence management of CVDs becomes more challenging. The aim of this study is investigating incidence and prevalence of CVDs, morbidity and mortality of CVDs, treatment and management of CVDs at the time of natural disasters. METHODS: In the present systematic review, the articles published in English language until 28. 11. 2020, which studied CVDs in natural disasters were included. The inclusion criteria were CVDs such as myocardial infarction (MI), acute coronary syndrome (ACS), hypertension (HTN), pulmonary edema, and heart failure (HF) in natural disasters such as earthquake, flood, storm, hurricane, cyclone, typhoon, and tornado. RESULT: The search led to accessing 4426 non-duplicate records. Finally, the data of 104 articles were included in quality appraisal. We managed to find 4, 21 and 79 full text articles, which considered cardiovascular diseases at the time of flood, storm, and earthquake, respectively. CONCLUSION: Prevalence of CVD increases after disasters. Lack of access to medication or lack of medication adjustment, losing home blood pressure monitor as a result of destruction and physical and mental stress after disasters are of the most significant challenges of controlling and managing CVDs. By means of quick establishment of health clinics, quick access to appropriate diagnosis and treatment, providing and access to medication, self-management, and self-care incentives along with appropriate medication and non-medication measures to control stress, we can better manage and control cardiovascular diseases, particularly hypertension.

Preventing and controlling water pipe smoking: a systematic review of management interventions.

BACKGROUND: Water pipe smoking (WPS) is re-gaining widespread use and popularity among various groups of people, especially adolescents. Despite different adverse health effects of WPS, many of the WPS interventions have failed to control this type of tobacco smoking. This study was conducted to identify experienced management interventions in preventing and controlling WPS worldwide. METHODS: A systematic literature review was conducted. Electronic databases were searched for recordes which were published from beginning 1990 to August 2018. Studies aiming at evaluating, at least, one intervention in preventing and controlling WPS were included in this review, followed by performing the quality assessment and data extraction of eligible studies by two independent investigators. Finally, interventions that were identified from the content analysis process were discussed and classified into relevant categories. RESULTS: After deleting duplications, 2228 out of 4343 retrieved records remained and 38 studies were selected as the main corpus of the present study. Then, the identified 27 interventions were grouped into four main categories including preventive (5, 18.51%) and control (8, 29.62%) interventions, as well as the enactment and implementation of legislations and policies for controlling WPS at national (7, 25.92%) and international (7, 25.92%) levels. CONCLUSION: The current enforced legislations for preventing and controlling WPS are not supported by rigorous evidence. Informed school-based interventions, especially among adolescents can lead to promising results in preventing and controlling WPS and decreasing the effects of this important social and health crisis in the global arena.

Determining factors in the retention of physicians in rural and underdeveloped areas: a systematic review.

BACKGROUND: Imbalance in distribution of Health Care Workers (HCWs) in a country is a global challenge. Almost all of the rural and underdeveloped areas are struggling with the shortage of HCWs, especially physicians. Therefore, this study aimed to identify factors governing the retention of physicians in rural and underdeveloped areas. METHODS: International databases including Scopus, PubMed, Web of Science, Proquest, and Embase were searched using Mesh terms in order to find peer-reviewed journal articles addressing physicians' retention factors in rural and underdeveloped areas. The records were screened, and any duplicate results were removed. The quality of the studies was assessed according to the Critical Appraisal Skills Program developed for different types of studies. Then, through content analysis, the related factors were identified from finally selected papers, coded, and categorized. RESULTS: The initial search resulted in 2312 relevant articles. On the basis of specific selection criteria, 35 full-text articles were finally reviewed.. The major affecting factors in physicians' retention in rural and underdeveloped regions were classified into the following six categories: 1) financial; 2) career and professional; 3) working conditions; 4) personal; 5) cultural; and 6) living conditions factors. CONCLUSION: There is a complex interplay of factors governing physicians' retention in rural and underdeveloped areas. If health organizations are concerned with physicians' retention in deprived areas, they should take into account these main factors. Moreover, they should develop policies and strategies to attract and retain physicians in rural and underdeveloped areas.

Factors related to delay in initiating post-exposure prophylaxis for rabies prevention among animal bite victims: a cross-sectional study in Northwest of Iran.

OBJECTIVES: The aim of the present study was to identify factors associated with h delayed initiation of post-exposure prophylaxis (PEP) among animal bite victims. METHODS: This cross-sectional study assessed biting patterns among 3032 cases that were referred to Tabriz Rabies Center. The delay was described as the initiation of PEP more than 48 hours (h) after possible exposure to the rabies virus. Determinants of delay in initiating PEP were recognized by a decision tree model. RESULTS: Totally, 8.5% of the victims who were bitten by an animal had a delay of more than 48 h in the initiation of PEP. The relative frequency of a delay more than 48 h in females was higher than in males (12.9% compared to 8.5%) (p-value= 0.004). Relative frequency of a delay of more of 48 h from carnivorous (dog, jackal, fox) was significantly less than others (p-value< 0.001). Of the decision tree, the overall classification accuracy was 89.5%, with 44.1% sensitivity and 92.3% specificity. The identified variables included gender, biting place (rural, urban), and type of animal. CONCLUSION: according to the results of the present study, among the various variables that affect the delayed initiation of PEP, rural residents and being female, in particular, were the major factors associated with a delay in the initiation of PEP for rabies prevention. We found relatively low rates of vaccine completion. Our findings indicat that providing training and patient education are required to ensure the completion of appropriate treatment.

Prevalence and predictors of iron-deficiency anemia: Women's health perspective at reproductive age in the suburb of dried Urmia Lake, Northwest of Iran.

BACKGROUND: Dried Urmia Lake in the northwest of Iran is a major regional source of sodium and toxic metal aerosols which may cause numerous health problems. The aim of this study was to evaluate iron-deficiency anemia (IDA) and some related risk factors among women of reproductive age in the suburb of dried Urmia Lake to provide the information about the problem to the health-care providers. METHODS: This cross-sectional study was conducted on 278 healthy nonpregnant, nonlactating women aged 18-45 years, living in the rural area of the Salmas city, closest to the Urmia Lake between February and June 2017. The study participants were selected using a stratified random sampling method with proportional allocation from seven villages. A general questionnaire was completed for each participant to collect sociodemographic information and a 3-day dietary recall questionnaire to obtain daily dietary intakes. IDA was defined as a hemoglobin (Hb) level of <12 g/dl and ferritin concentration of <15 µg/l. Spearman's correlation coefficient and Fisher's exact test were applied to determine sociodemographic factors associated with the serum Hb and ferritin levels. RESULTS: The prevalence of overall anemia (Hb <12 g/dl) was 7.9%. IDA was determined in 4.3% and iron deficiency (ID) in 19.1% (serum ferritin <15 µg/l) of the participants. There was a significant positive correlation between serum Hb concentrations and the mean daily intakes of protein and iron (P < 0.001). Similarly, a significant positive correlation was observed between serum ferritin levels and body mass index (P < 0.001). Significant inverse associations were found between Hb concentrations and the number of pregnancies and children (P < 0.001), as well as the number of family members (P < 0.05). CONCLUSIONS: Results indicated a mild prevalence of IDA and a relatively high rate of ID among studied participants. Educational programs are needed to improve nutritional habits as well as the use of contraceptives to promote women's health.

Exploring the barriers to patient engagement in the delivery of safe care in Iranian hospitals: A qualitative study.

Aim: To investigate barriers to patient engagement in the delivery of safe hospital care. Design: Qualitative exploratory study. Methods: A qualitative study with 35 Iranian health professionals was conducted from February to April 2019 using semi-structured interviews to elicit their opinions. MAXQDA 11 software was used for data management, and the data were analysed using framework analysis. Results: Barriers, which potentially have negative impact on patient engagement in the delivery of safer care, were categorized into four themes. The first category included patient-related barriers such as low levels of health literacy, ineffective education, patient unwillingness and cultural barriers. The second category included staff-related barriers such as the existence of negative attitudes towards engaging patients in matters relating to patient safety, ineffective communication, high workload and the reluctance on the part of physicians to engage with patients. Barriers created by limited resources and inadequate training provided by universities and in the workplace formed the third category and community-related barriers such as the inadequate dissemination of information via the mass media and a lack of community-based services formed the fourth category. Conclusion: Results demonstrate the multilayered nature of the significant barriers to the engagement of patients in the delivery of safe care and reflect the need for a collaborative approach between the recipients of care, researchers, care providers and policy makers if these are to be overcome.

Communicable Disease Surveillance Systems in Disasters: Application of the Input, Process, Product, and Outcome Framework for Performance Assessment.

OBJECTIVE: One of the most important measures following disasters is setting up a communicable disease surveillance system (CDSS). This study aimed to develop indicators to assess the performance of CDSSs in disasters. METHOD: In this 3-phase study, firstly a qualitative study was conducted through in-depth, semistructured interviews with experts on health in disasters and emergencies, health services managers, and communicable diseases center specialists. The interviews were analyzed, and CDSS performance assessment (PA) indicators were extracted. The appropriateness of these indicators was examined through a questionnaire administered to experts and heads of communicable diseases departments of medical sciences universities. Finally, the designed indicators were weighted using the analytic hierarchy process approach and Expert Choice software. RESULTS: In this study, 51 indicators were designed, of which 10 were related to the input (19.61%), 17 to the process (33.33%), 13 to the product (25.49%), and 11 to the outcome (21.57%). In weighting, the maximum score was that of input (49.1), and the scores of the process, product, and outcome were 31.4, 12.7, and 6.8, respectively. CONCLUSION: Through 3 different phases, PA indicators for 4 phases of a chain of results were developed. The authors believe that these PA indicators can assess the system's performance and its achievements in response to disasters. (Disaster Med Public Health Preparedness. 2019;13:158-164).

A systematic evidence review of the effect of climate change on malaria in Iran.

Climate is an effective factor in the ecological structure which plays an important role in control and outbreak of the diseases caused by biological factors like malaria. With regard to the occurring climatic change, this study aimed to review the effects of climate change on malaria in Iran. In this systematic review, Cochrane, PubMed and ScienceDirect (as international databases), SID and Magiran as Persian databases were investigated through MESH keywords including climate change, global warming, malaria, Anopheles, and Iran. The related articles were screened and finally their results were extracted using data extraction sheets. Totally 41 papers were resulted through databases searching process. Finally 14 papers which met inclusion criteria were included in data extraction stage. The findings indicated that Anopheles mosquitoes are present at least in 115 places in Iran; they are compatible with climatic zones of Iran. Malaria and it's vectors are affected by climate change. Temperature, precipitation, relative humidity, wind intensity and direction are the most important climatic factors affecting the growth and proliferation of Anopheles, Plasmodium and the prevalence of malaria. The transmission of malaria in Iran is associated with the climatic factors of temperature, rainfall, and humidity. Therefore, with regard to the occurring climatic change, the incidence of the disease may also change which needs to be taken into consideration while planning of malaria control.

Women's Challenges and Capabilities in Disasters: A Case Report of the Twin Earthquakes of Eastern Azerbaijan, Iran.

Introduction: The twin earthquakes of eastern Azerbaijan induced considerable devastations of many villages and cities. About 70% of all victims were women and children. The present case report was aimed at describing the lessons learnt from both capabilities and challenges of girls and women after the twin earthquakes of eastern Azerbaijan. Methods: A qualitative approach using in-depth unstructured interviews was used for this study. A total of 13 participants (two men and 11 women), affected by the quakes, were interviewed applying the purposeful sampling method. A manifest content analysis was performed for analyzing the transcribed interviews Case presentation: Two categories of women's capabilities and challenges and four subcategories of women's participation in community reconstruction, livelihood efforts, aggravated poverty and violence were extracted from the data which were gathered in the destroyed fields of eastern Azerbaijan. Lessons learnt: Women can play an important role in post-disaster recovery. Consequently, ignoring the challenges and capabilities of women may impede post-disaster development processes, which would adversely affect the whole community.

Challenges of Hospital Response to the Twin Earthquakes of August 21, 2012, in East Azerbaijan, Iran.

OBJECTIVE: As the cornerstone of any health system, hospitals have a crucial role in response to disasters. Because hospital experiences in disaster response can be instructive, this study examined the challenges of hospital response to the twin earthquakes of 2012 in East Azerbaijan, Iran. METHODS: In this qualitative study, the challenges of hospital response in the East Azerbaijan earthquakes were examined through focus group discussions. Participants were selected purposefully, and focus group discussions continued until data saturation. The data were manually analyzed by using Strauss and Corbin's recommended method. RESULTS: Hospitals were faced with 6 major challenges: lack of preparedness, lack of coordination, logistic deficiencies, patient/injured management, communication management, and other smaller challenges that were categorized in the "other challenges" category. The main theme was the lack of preparedness for disasters. CONCLUSION: Although hospital preparedness is emphasized in credible references, this study showed that lack of preparedness is a major challenge for hospitals during disasters. Thus, it seems that hospital officials' disaster risk perception and hospital preparedness should be improved. In addition, hospital preparedness assessment indexes should be included in the hospital accreditation process. (Disaster Med Public Health Preparedness. 2017;11:422-430).

Developing a Performance Assessment Framework and Indicators for Communicable Disease Management in Natural Disasters.

INTRODUCTION: Communicable disease management (CDM) is an important component of disaster public health response operations. However, there is a lack of any performance assessment (PA) framework and related indicators for the PA. This study aimed to develop a PA framework and indicators in CDM in disasters. METHODS: In this study, a series of methods were used. First, a systematic literature review (SLR) was performed in order to extract the existing PA frameworks and indicators. Then, using a qualitative approach, some interviews with purposively selected experts were conducted and used in developing the PA framework and indicators. Finally, the analytical hierarchy process (AHP) was used for weighting of the developed indicators. RESULTS: The input, process, products, and outcomes (IPPO) framework was found to be an appropriate framework for CDM PA. Seven main functions were revealed to CDM during disasters. Forty PA indicators were developed for the four categories. CONCLUSION: There is a lack of any existing PA framework in CDM in disasters. Thus, in this study, a PA framework (IPPO framework) was developed for the PA of CDM in disasters through a series of methods. It can be an appropriate framework and its indicators could measure the performance of CDM in disasters.

Performance Assessment of a Communicable Disease Surveillance System in Response to the Twin Earthquakes of East Azerbaijan.

OBJECTIVE: Following the twin earthquakes on August 11, 2012, in the East Azerbaijan province of Iran, the provincial health center set up a surveillance system to monitor communicable diseases. This study aimed to assess the performance of this surveillance system. METHODS: In this quantitative-qualitative study, performance of the communicable diseases surveillance system was assessed by using the updated guidelines of the Centers for Disease Control and Prevention (CDC). Qualitative data were collected through interviews with the surveillance system participants, and quantitative data were obtained from the surveillance system. RESULTS: The surveillance system was useful, simple, representative, timely, and flexible. The data quality, acceptability, and stability of the surveillance system were 65.6%, 10.63%, and 100%, respectively. The sensitivity and positive predictive value were not calculated owing to the absence of a gold standard. CONCLUSIONS: The surveillance system satisfactorily met the goals expected for its setup. The data obtained led to the control of communicable diseases in the affected areas. Required interventions based on the incidence of communicable disease were designed and implemented. The results also reassured health authorities and the public. However, data quality and acceptability should be taken into consideration and reviewed for implementation in future disasters.

Performance assessment of communicable disease surveillance in disasters: a systematic review.

BACKGROUND: This study aimed to identify the indices and frameworks that have been used to assess the performance of communicable disease surveillance (CDS) in response to disasters and other emergencies, including infectious disease outbreaks. METHOD: In this systematic review, PubMed, Google Scholar, Scopus, ScienceDirect, ProQuest databases and grey literature were searched until the end of 2013. All retrieved titles were examined in accordance with inclusion criteria. Abstracts of the relevant titles were reviewed and eligible abstracts were included in a list for data abstraction. Finally, the study variables were extracted. RESULTS: Sixteen articles and one book were found relevant to our study objectives. In these articles, 31 criteria and 35 indicators were used or suggested for the assessment/evaluation of the performance of surveillance systems in disasters. The Centers for Disease Control (CDC) updated guidelines for the evaluation of public health surveillance systems were the most widely used. CONCLUSION: Despite the importance of performance assessment in improving CDS in response to disasters, there is a lack of clear and accepted frameworks. There is also no agreement on the use of existing criteria and indices. The only relevant framework is the CDC guideline, which is a common framework for assessing public health surveillance systems as a whole. There is an urgent need to develop appropriate frameworks, criteria, and indices for specifically assessing the performance of CDS in response to disasters and other emergencies, including infectious diseases outbreaks. Key words: Disasters, Emergencies, Communicable Diseases, Surveillance System, Performance Assessment.

Rapid health needs assessment experience in 11 august 2012 East azerbaijan earthquakes: a qualitative study.

INTRODUCTION: In disasters, health care providers need to find out the essential needs of the affected populations through Rapid Health Needs Assessment (RHNA). In East Azerbaijan earthquakes, a rapid assessment was performed by the provincial health system. The main purpose of this study was to explore the RHNA challenges. METHODS: In this qualitative study (Grounded theory), data was collected through semi-structured interviews with purposely selected health care workers. The data collection process continued until data saturation. All interviews were recorded and then transcribed. The Colaizzi's descriptive method was used to analyze the data. RESULTS: The themes emerged from the analysis of the interviews were: 1) Logistic problems 2) Lack of RHNA tools 3) Inherent difficulty of RHNA in disaster situations 4) Lack of preparedness and 5) Lack of coordination between different organizations. These challenges result in inapplicable use of RHNA results. CONCLUSION: The most important challenge in this RHNA process was the lack of East Azerbaijan health center preparedness. Although they were familiar with the importance of RHNA, they did not have any plans for conducting RHNA.