Animal bites management in Northern Iran: Challenges and solutions.

Objectives: Animal bite is considered a serious social, economic, and health risk for societies with poor animal bites and population management. The objective of this study was to propose a model for animal bites management in Golestan Province. Methods: The present study is a multi-method study conducted quantitatively and qualitatively. First, as a cross-sectional study, the animal bites in Golestan Province and the country were calculated and their trend was predicted. Secondly, in the qualitative study (content analysis), the challenges, barriers, and methods of animal bite control were extracted through conducting semi-structured interviews and focused group discussion meetings. Finally, the model of animal bite management was developed and it was confirmed by Round Delphi. The data were analyzed via content analysis using MAXQDA18. The participants in this study consisted of university professors, managers, and executive officers involved in animal bite and rabies control plans. Results: This study revealed that the animal bite in Golestan Province had an upward trend, as in the country, and dogs were the main cause of bites (90%). The obstacles and challenges of current animal bites control program in eight areas were expressed by the participants. Also, the animal bite management model, which was obtained from the data of different stages of this study, included nine fields and 41 sub-fields. The fields of the animal bite management model included: providing a cultural package, resolving barriers to animal population control plans, wide coverage of dog vaccination, passing and enacting preventive laws, attracting financial support, constructing standard equipment, providing proper medical services, enhancing inter-departmental coordination, and controlling rabies in the wild. This model was confirmed in a Delphi round. Conclusion: Our study indicated that Golestan Province with an average bite higher than twice the country's average is one of the leading provinces in this regard. Thus, revising the animal bite and animal population control plans in this province is necessary. The model designed in this study can be used as a practical guide by policy makers and officials to manage animal bite and related consequences in this province.

Trend and epidemiological patterns of animal bites in Golestan province (Northern Iran) between 2017 and 2020.

BACKGROUND: Rabies is one of the oldest zoonosis viral diseases, which still remains as one of the most important threats to public health in the 21st century. METHODS: This cross-sectional study examined epidemiologic features of all 33,996 cases of persons bitten by animals and referred to the rabies prophylaxis centers in Golestan province between March 2017 and March 2020. Factors included demographic information of the victim (age, gender, and occupation), type of invasive animals (dog, cat, and other types), time of bite (year, month, and hour), place of residence (urban or rural), and injury and treatment statuses. We also obtained national and provincial animal bite incidence data for all of Iran and for Golestan province for the longer interval 2013-2020 to examine broader time trends. We used SPSS version 19, QGIS version 3.1, and Excel 2013 to generate frequency distributions and descriptive statistics. RESULTS: The incidence rates of animal bites in Golestan province and Iran as a whole both increased smoothly. The latest incidence rate of animal bites in Golestan was 652 per 100,000 people, almost three times the overall national figure for 2020. Most cases of animal bites (67.6%) occurred in rural areas, and 36% of the victims aged under 19 years old. Dog and cat bites accounted for the great majority of cases (89% and 8%, respectively). The highest rate of animal bites was reported in the spring (30.8%). The lower limb was the most commonly bitten area in these individuals (64.6%). Of note, 87% of the cases received incomplete prophylactic post-exposure treatment, and 18% received immunoglobulin. CONCLUSION: The increasing rates of animal bites in the study area as well as the higher rate compared to the national average indicates the need for further review of animal bite control programs.

Cost of Tuberculosis Treatment: Evidence from Iran's Health System.

OBJECTIVES: This study aimed to estimate the cost of smear-positive drug-susceptible pulmonary tuberculosis (TB) treatment of the patients in the Azadshahr district, Golestan Province, Iran. METHODS: In this retrospective study, all new smear positive pulmonary TB patients who had been registered at the district's health network between April, 2013 and December, 2015 and had successfully completed their treatment were entered into the study (45 patients). Treatment costs were estimated from the provider's perspective using an activity-based costing (ABC) method. RESULTS: The cost of treating a new smear-positive pulmonary TB patient was US dollar (USD) 1,409.00 (Iranian Rial, 39,438,260), which can be divided into direct and indirect costs (USD 1,226.00 [87%] and USD 183.00 [13%], respectively). The highest cost (58.1%) was related to care and management of TB patients (including 46.1% human resources costs and 12% directly-observed treatment, short course implementation) and then respectively related to hospitalization (12.1%), supportive activity centers (11.4%), transportation (6.5%), medicines (5.3%), and laboratory tests and radiography (3.2%). CONCLUSION: Using disease-specific cost studies can help the healthcare system management to have correct insight into the financial burden created by the disease. This can subsequently be used in prioritization, planning, operational budgeting, economic evaluation of programs, interventions, and ultimately in disease management.