Developing a model of public health system strengthening during pandemic of new emerging respiratory diseases for Iran: A protocol study.

The objective of this article is to propose a protocol for developing a model for strengthening the public health system in Iran. Currently, there is no clearly articulated model for strengthening public health systems during the pandemic of new emerging respiratory diseases in Iran. The protocol described here aims to: (1) identify components for strengthening public health systems, during the pandemic of new emerging respiratory diseases worldwide, (2) identify components for strengthening Iran's public health system, and (3) design a model for strengthening the public health system in Iran during the pandemic of new emerging respiratory diseases. The protocol proposes three phases. In the first phase, a realistic review will be conducted to identify components for strengthening public health systems worldwide based on six building block framework. In the second phase, a qualitative study will be used to identify components for strengthening public health systems in Iran during the pandemic of new emerging respiratory diseases. In the third phase, an initial model will be designed, and the Delphi technique will be used to finalize the model. Due to fragility and the significant strain that public health systems experienced during the pandemic, it is imperative to introduce a model that strengthens public health systems through some initiatives and strategies and explains the mechanisms by which they operate. A realist review and qualitative study will provide the evidence needed to support the effective implementation of public health interventions, taking into consideration the diverse contexts of these interventions in Iran.

A Scoping Review of Possible Solutions for Decreasing Socioeconomic Inequalities in Type 2 Diabetes Mellitus.

Background: As socioeconomic inequalities are key factors in access and utilization of type 2 diabetes (T2D) services, the purpose of this scoping review was to identify solutions for decreasing socioeconomic inequalities in T2D. Methods: A scoping review of scientific articles from 2000 and later was conducted using PubMed, Web of Science (WOS), Scopus, Embase, and ProQuest databases. Using the Arksey and O'Malley framework for scoping review, articles were extracted, meticulously read, and thematically analyzed. Results: A total of 7204 articles were identified from the reviewed databases. After removing duplicate and nonrelevant articles, 117 articles were finally included and analyzed. A number of solutions and passways were extracted from the final articles. Solutions for decreasing socioeconomic inequalities in T2D were categorized into 12 main solutions and 63 passways. Conclusions: Applying identified solutions in diabetes policies and interventions would be recommended for decreasing socioeconomic inequalities in T2D. Also, the passways could be addressed as entry points to help better implementation of diabetic policies.

Designing Iranian hospital organizational charts: Global comparisons.

BACKGROUND: Hospitals should have effective and efficient organizational charts to face the changing healthcare environment. Thus, for this purpose, the present study seeks to compile an organizational chart for Iranian hospitals. MATERIALS AND METHODS: The present study was conducted in two phase overview and qualitative (using focus group discussion). In the overview phase, the organizational charts of hospitals were analyzed in terms of complexity (i.e., degree of horizontal and vertical separations), and the initial hospital organizational chart was developed based on the results. Subsequently, experts were interviewed in a focus group discussion to finalize and validate the initial organizational chart. RESULTS: The final organizational chart was designed to contain features such as internal divisions, specialization, reduction of organizational hierarchies, expansion of supervision scope, and moderate-sized organizational pyramid. CONCLUSION: Using designed organizational chart would eliminate the redundant managerial levels since it reduces organizational hierarchies to two levels of management, expands the supervision scopes, fosters a moderate-sized organizational pyramid, and catalyzes communications.

Hesitancy among Iranian nursing students regarding future career trajectory: a qualitative analysis.

BACKGROUND: The shortage of skilled nurses is a major concern for health systems worldwide. This may be partly due to the hesitancy of some nurses to enter or remain in the nursing career. This shortage consequently reduces the quality of standard patient care, increases patients' length of stay in a hospital, increases medical costs, and results in patients' dissatisfaction. This study aimed to explore hesitancy among senior undergraduate nursing students to pursue a career in nursing. METHODS: This qualitative study adopted a thematic analysis approach. The population comprised senior undergraduate nursing students at Isfahan University of Medical Sciences, Iran, who indicated that they were hesitant to pursue a career in nursing. The study sampling was performed from May 2021 till February 2022 and continued until data saturation. Twenty-four interviews were conducted with the selected students. The attributes related to hesitancy among senior undergraduate nursing students to pursue a career in nursing were extracted as themes and sub-themes. RESULTS: Four themes were identified: academic idiosyncrasies, individual characteristics, poor nursing market regulations (sub-themes: nursing as a tough and intense career, and unfavorable employment contracts), and the peculiarities of the workplace (sub-themes: conflict within work environment, and barriers to professional nursing practice). CONCLUSIONS: The findings of this study showed that senior undergraduate nursing students weigh their future career options from various academic, personal, professional, and work environment dimensions. The findings provide new insights for decision makers to design and implement innovative strategies to promote retention in nursing careers. We recommend to provide academic counseling for all students and applicants of nursing before they enter the nursing education. Furthermore, we suggest to improve study and work environments, and to implement incentive programs to enhance enthusiasm of nursing students for pursuing a nursing career.

Utilization of dental care among adult populations: a scoping review of applied models.

BACKGROUND: The timely and appropriate utilization of dental health care is essential to the prevention and accurate treatment of oral diseases. Therefore, it is crucial that managers, health professionals and healthcare providers be fully aware of the predictors encouraging the utilization of dental services and reduce social inequalities. In this scoping review, we aimed to analyze the published articles and reports to find out the factors associated with dental services utilization and the comprehensiveness of the applied models among general adult populations. MATERIALS AND METHODS: This scoping study was based on the 5-steps of Arksey and O'Malley framework. Keywords were selected under two main concepts: determinants of dental care utilization and the concept of the applied models. Searches were conducted in some electronic databses including PubMed, Google Scholar and Scopus with variations, and a combination of the keywords under the two main afore-mentioned concepts. All the relevant articles reporting the utilization of dental care and its potential predictors among adult populations were chosen. No restrictions involving terms of study time, location or methodological aspects of oral health utilization were considered. Using tables and charts mapping, we tried to group the studies based on the year of their publication, geographic distribution, the range of included indices and the type of their measurement. Also, a directed content analysis method was used to investigate the comprehensiveness of the studies in regard to considering the determinant factors at different levels suggested by the Andesen model. RESULTS: Fifty-two articles were included in the analysis. Thirty-six (69%) had been published between 2016 and 2020. The United States had conducted the most research in this scope. About 30% of studies had mentioned all three domains of demographics, social structure and beliefs, simultaneously. To evaluate the enabling factors, in 84.61% and 59.61% of studies, the income levels and insurance feature were assessed, respectively. 57.69% of the retrieved studies considered the perceived need features and 38.46% referred to the evaluated ones. The dental services utilization, in terms of the last visit during the "past 12 months", was assessed more commonly. Only 11.54% of studies did evaluate the contextual characteristics and about 71.15% of articles were relatively comprehensive. CONCLUSION: Overall, it seems that in most of the studies, not all of the determinant factors at different levels of the Andersen model have been considered. In order to discover the conceptual linkages and feedback loops of the model, it is essential to conduct more comprehensive research in the future.

Risk and protective factors related to having a child with congenital heart diseases (CHD): a case-control study in Iran.

Background: The heart is the first fully developed organ in early pregnancy, especially in the first trimester of pregnancy, so any factor that contributes to heart failure is life-threatening. Thus, it is important to identify the risk and preventive factors related to this disease and to provide a scientific basis for the control, prevention, management and treatment of Child with Congenital Heart Diseases (CHD). Objectives: As the etiology of CHD is multifactorial, to identify the risk and preventive factors, this study aimed to investigate the factors related to CHD in Tehran, Iran. Methods: The present case-control study was performed on 600 people including 200 mothers of children with CHD. Simple random sampling was performed in 2020. The control group was matched with the case group, and the data were analyzed by SPSS software at a significance level of 0.5. Results: The results showed that low socioeconomic status, low education, history of abortion, smoking, alcohol consumption are risk factors, and consumption of folic acid, and prenatal care are the protective factors against CHD. Conclusion: According to the findings, our emphasis should be on preventive strategies, education of mothers and public health experts on the need for folic acid and pregnancy care, and cessation or reduction of alcohol and tobacco use, especially in families with low socioeconomic status and low level of education.

Male patients' preferences for opioid use treatment programs.

BACKGROUND: A patient-centered approach to the treatment of substance use is helpful in achieving positive treatment outcomes. This study aimed to explore male patients' preferences for opioid use treatments. METHODS: A qualitative study was conducted in Isfahan, a city in the center of Iran. The study sample included 64 male participants who had started treatment for opioid use disorder (OUD). Using a purposive maximum variation sampling procedure, seven treatment centers were selected as interview venues. The semi-structured face-to-face interviews were conducted in a private room in the selected centers. A hybrid inductive/deductive approach was used to thematize the interview transcripts. RESULTS: A total of three themes and 13 subthemes on opioid treatment preferences were identified: treatment concerns (anonymity, social stigma, fear of treatment distress, and family concerns), treatment attributes (treatment cost, location of the treatment center, treatment period, frequency of attendance, informed treatment, and treatment personnel), and treatment type (maintenance or abstinence and residential and community treatments). The study showed that all treatment programs were perceived to have their own strengths and weaknesses. CONCLUSIONS: The results showed that patients with OUD carefully compare the positive and negative aspects of existing treatment programs, and they consider a treatment program to be a package of favorable and non-favorable qualities. The identified themes could inform policymakers about the treatment preferences of male patients and provide an opportunity to promote better treatment options for OUD.

Investigating the relationship between socioeconomic status and domestic violence against women in Isfahan, Iran in 2021: A cross-sectional study.

Background and Aims: Domestic violence can include controlling or coercive behaviors and acts, as well as physical, sexual, psychological, and financial elements. Given the significance of domestic violence against women and its complications, this study looked into the relationship between socioeconomic status and domestic violence against women in Isfahan in 2019. Methods: In 2021, a cross-sectional study of 427 married women referred to comprehensive health centers in Isfahan, Iran, was carried out. The available sampling method was chosen. To collect data, a domestic violence questionnaire and a socioeconomic status index were used. The data were analyzed using SPSS and Latent GOLD software. Results: The average age of the women in this study was 33.21, 37% worked, and 63 were housewives. Based on Latent class analysis method, women were classified into two groups of high or low socioeconomic status class. The findings revealed a significant relationship between socioeconomic status and different types of violence against women, including light physical violence, emotional violence, verbal violence, and sexual violence (p < 0.05). Conclusion: The findings revealed that there is a significant relationship between socioeconomic status and domestic violence against women in Isfahan, with women from lower socioeconomic backgrounds being more vulnerable to violence. Given the prevalence of violence against women in the family and its consequences, policy makers should look for the causes of this type of violence as well as solutions to reduce this health and social problem. Factors such as the expansion of counseling and treatment centers in health care facilities, as well as education and life skills training, are particularly important in reducing this phenomenon in society.

Descriptive phenomenology study of the reasons for the low uptake of free health service package among type II diabetic patients.

BACKGROUND: Although several diabetes management and control programs are introduced in Iran, rate of using such cares in patients with Type II Diabetic in Ahvaz is low and they show no tendency for receiving free diabetes service package. The aim of this study was to identify reasons behind low uptake of free health service package among T2DM patients in Ahvaz, Iran. METHODS: This descriptive phenomenology study based on semi-structured guided interviews of patients with Type II Diabetic in Ahvaz, was carried out in the year 2021. Through purposeful sampling, 495 patients with diabetics who not received health services package more than 6 months were interviewed until the data saturation. The gathered data were analyzed through conventional content analysis. RESULTS: Reasons were categorized into three themes which include 13 subthemes and 57 codes. Themes included individual, accessibility, and structural factors. Besides, subthemes were lack of awareness, poor health literacy, adverse patients experience, difficulties to use services, verbal miscommunication cultural barriers, low trust, geographic barriers, time barriers, financial difficulties, lack of human resources, poor service delivery, and organizational factors were as barriers to participation. CONCLUSION: Regarding individual level, there is a need for further training of diabetic patients. Besides, for accessibility and structural factors Iranian healthcare system needs a comprehensive integrated care for the management of diabetes, this underlines the collaboration for improving patients' uptake of free health service package.

Socioeconomic difference in physical activity in children and their parents: The childhood and adolescence surveillance and prevention of adult noncommunicable disease study.

Background: As a health-related behavior, physical activity (PA) differs according to individual's socioeconomic status (SES). This study aimed to assess the socioeconomic difference in leisure-time PA among Iranian students and their parents at national and regional levels. Study Design: Nationwide cross-sectional study. Methods: This study was conducted as part of a national survey conducted in 2015 among 14400 Iranian students and their parents. Total PA level was measured as the average hours spent on PA per week. Nonlinear principal component analysis was used to construct the households' SES based on household's assets, type of house ownership, occupation of fathers and the educational levels of fathers and mothers. Concentration index was applied to measure the inequality in the PA level in parents and students. Results: Complete data of 13313 students and their parents were available. At the national level, students spent more hours of PA per week (3.753 h per week [h/w]) as compared to their parents. Moreover, PA h/w was higher in fathers (3.488 h/w) as compared to mothers (2.763 h/w). The lowest means of mother's and student's PA were found in the highest SES region. At national level, the concentration indices (CI) of father's and mother's PA were -0.050 (95% CI = -0.067 ~ -0.030) and -0.028 (95% CI = -0.044 ~ -0.012), respectively, indicating pro-poor inequality, but the CI value of student PA was non-significant (CI = -0.007, 95% CI = -0.023-0.008). Conclusions: Given that the mother's and student's PA level was low in the high SES regions, it is suggested that focused PA planning may further increase the level of PA across higher SES regions and might be effective in reducing the PA inequality.

"To enroll or not to enroll": a qualitative study on preferences for dental insurance in Iran.

BACKGROUND: Oral public health services are included in primary healthcare. Although oral diseases are preventable, improving oral health has become a concern in many countries. Evidence shows that functioning insurance coverage can significantly increase the use of dental health services, improve quality of services, and reduce financial barriers to utilization. Little evidence exists on households' preferences for dental insurance in Iran. This study seeks to identify the households' preferences for dental insurance in Tehran-Iran. METHOD: This is a qualitative study. We interviewed 84 participants who visited selected public and private dental clinics in Tehran-Iran, from October 2018 until January 2019. All interviews were recorded and transcribed verbatim. We used a mixed inductive/deductive approach for thematic analysis of the interviews. RESULTS: We identified two main themes and 12 sub-themes: pecuniary attributes (insurance premium, coinsurance, insurance coverage granted, discounting option, reimbursement of expenses), and non-pecuniary attributes (notification status, ethical issues, benefits package, contract providers with health insurance, quality of service centers, administrative process, and dental insurance scheme). CONCLUSION: Our participants considered both pecuniary and non-pecuniary attributes for choosing a dental insurance package. Our findings could help, we envisage, policymakers understand Iranian households' preferences for a dental insurance scheme that they afford to buy.

Idea Generation Through Hackathon Event in Emergencies and Disasters, with Emphasis on Managing Flash Flood Disaster.

OBJECTIVE: This study was intended to demonstrate the applicability of the hackathon in idea generation for managing emergencies and disasters with a particular focus on flash floods. METHODS: A 4-day hackathon event was held, having 60 students, 9 mentors and 6 judges gathered to explore different ideas, and to solve problems of Iran flooding from mid-March to April, 2019. Of these, 10 teams with 6 students were accordingly formed to brainstorm and discuss the idea, while 9 mentors offered advice and guided them to manage their ideas. Then, all teams focused on designing their business models. Finally, the hackathon teams finalized their lean canvas and presented their ideas to the judging panel and the other participants. RESULTS: A total of 10 ideas were presented, and based on the knowledge and experience of the judges, 3 ideas that were more practical and useful were selected. CONCLUSIONS: As participants in a hackathon identify and present real-world problems, while ensuring that the prototype solutions address the end-user's needs, it could be used to drive innovation, generate ideas, promote change in emergencies and disasters, and can increase our preparedness for future events. It helps us to develop tools and applications to better respond to these events.

Socioeconomic inequality in congenital heart diseases in Iran.

INTRODUCTION: Social-economic factors have an important role in shaping inequality in congenital heart diseases. The current study aimed to assess and decompose the socio-economic inequality in Congenital Heart Diseases (CHDs) in Iran. METHODS: This is a cross-sectional research conducted at Shahid Rajaie Cardiovascular Medical and Research Center in Tehran, Iran, as one of the largest referral heart hospitals in Asia. Data were collected primarily from 600 mothers who attended in pediatric cardiology department in 2020. The polychoric principal component analysis (PCA) and Errygers corrected CI (ECI) were used to construct household socioeconomic status and to assess inequality in CHDs, respectively. A regression-based decomposition analysis was also applied to explain socioeconomic-related inequalities. To select the explanatory social, medical/biological, and lifestyle variables, the chi-square test was first used. RESULTS: There was a significant pro-rich inequality in CHDs (ECI = -0.65, 95% CI, - 0.72 to - 0.58). The social, medical/biological, and lifestyle variables accounted for 51.47, 43.25, and 3.92% of inequality in CHDs, respectively. Among the social variables, family SES (about 50%) and mother's occupation (21.05%) contributed the most to CHDs' inequality. Besides, in the medical/biological group, receiving pregnancy care (22.06%) and using acid folic (15.70%) had the highest contribution. CONCLUSION: We concluded that Iran suffers from substantial socioeconomic inequality in CHDs that can be predominantly explained by social and medical/biological variables. It seems that distributional policies aim to reduce income inequality while increasing access of prenatal care and folic acid for disadvantaged mothers could address this inequality much more strongly in Iran.

The role of hackathon in education: Can hackathon improve health and medical education?

To develop the next generation of healthcare innovators, students at all levels of education should be trained and encouraged to employ innovative and entrepreneurial approaches to deal with complicated challenges of today's health system. Applying innovation and entrepreneurship training to solve complex problems and focus on solution design has recently become common in medical universities all over the world. This paper clarifies the role of hackathons as an innovative educational approach in healthcare education systems. We propose a process model concerned with organizing hackathon events in the healthcare education system. This model can be used in the academic and practical design of hackathons for innovation purposes.

Inequality in dental care expenditure in Iranian households: analysis of income quintiles and educational levels.

BACKGROUND: Oral health is a major public health issue which affects the human life. Access to dental care is one of the important factors in maintaining oral health. This study was aimed to investigate inequality in dental care expenditure in Iranian households. METHODS: The present study is a secondary analysis of a national cross-sectional survey. The data collected from the Households Income and Expenditure Survey in 2016 and 2017. The final sample consisted of 54,354 households living in rural and urban regions of all the provinces. Inequalities in household's dental care expenditure per capita in respect to income quintiles and educational level were measured based on the Gini coefficient and concentration index. RESULTS: The results showed that about 8% of households had paid for dental care during the month before sampling. The Gini coefficient value was estimated to be 0.97 and 0.96 for dental care expenditure per capita respectively in absolute and relative measure. It indicated a significant inequality in the dental expenditure among the sample households. The values of concentration index were positive and significant for all dental care subcategories in respect to the provincial and national income quintiles as well as the educational level of the head of the household. CONCLUSIONS: Income and educational inequality in the both absolute and relative dental services expenditure of the Iranian households were in favor of higher income groups as well as higher educational level of household heads. Income inequality was higher in total dental care expenditure per capita and all its subcategories than the educational inequalities of dental expenditure. In order to reduce these inequalities, the policymakers need to pay special attention to low-income households, particularly those with low-educated heads.

Nonmedical Determinants of Congenital Heart Diseases in Children from the Perspective of Mothers: A Qualitative Study in Iran.

INTRODUCTION: Mortality due to noncommunicable diseases has increased in the world today with the advent of demographic shifts, growing age, and lifestyle patterns in the world, which have been affected by economic and social crises. Congenital heart defects are one of the forms of diseases that have raised infant mortality worldwide. The objective of present study was to identify nonmedical determinants related to this abnormality from the mother's perspectives. METHODS: This research was a qualitative study and the data collection method was a semistructured interview with mothers who had children with congenital heart diseases referring to the Shahid Rajaei Heart Hospital in Tehran, Iran. A thematic analysis approach was employed to analyze transcribed documents assisted by MAXQDA Plus version 12. RESULTS: Four general themes and ten subthemes including social contexts (social harms, social interactions, and social necessities), psychological contexts (mood disorders and mental well-being), cultural contexts (unhealthy lifestyle, family culture, and poor parental health behaviors), and environmental contexts (living area and polluted air) were extracted from interviews with mothers of children with congenital heart diseases. CONCLUSIONS: Results suggest that factors such as childhood poverty, lack of parental awareness of congenital diseases, lack of proper nutrition and health facilities, education, and lack of medical supervision during pregnancy were most related with the birth of children with congenital heart disease from mothers' prospective. In this regard, targeted and intersectorial collaborations are proposed to address nonmedical determinants related to the incidence of congenital heart diseases.

Content analysis of the official curriculum of undergraduate degree in Iran's medical sciences universities from the perspective of social health: A qualitative study.

BACKGROUND: Social health is considered as an important part of good health both individually and socially. The purpose of this study was to examine the content of the official medical sciences curriculum in undergraduate degrees from a social health perspective. MATERIALS AND METHODS: This qualitative content analysis study was conducted in 2019 at the Isfahan University of Medical Sciences using a deductive approach based on Hsieh and Shannon's directed content analysis. For this purpose, official curricula in the fields of Public Health, Occupational Health, Environmental Health, Nursing, Midwifery, Nutrition Sciences, and Health Services Management were analyzed using MAXQDA 12. RESULTS: The results showed that a total of 136 codes related to the components of social health were identified in the topics of undergraduate medical sciences majors. Most to least relevant topics belonged to the fields of Public Health (61 codes), Midwifery (22 codes), Nursing (16 codes), Occupational Health (12 codes), Environmental Health and Nutrition Sciences (each 10 codes), and Health Services Management (5 codes), respectively. Among the components of social health, only the component related to access to insurance and health services was mentioned in all seven disciplines. However, the components of poverty and inequality were only included in three disciplines (Public Health, Nursing, Midwifery). CONCLUSION: Regarding insufficient focus on social health in curricula, revision of educational curricula is suggested from the perspective of social health, particularly in areas such as poverty and inequality, unemployment, population, violence, and gender discrimination.

Resource generation challenges for burn care in Iran.

BACKGROUND: Given the importance of investment in human and physical resources and knowledge in burn injuries for improving health service performance, this study endeavoured to identify resource production challenges in the burn care of Iran. METHODS: In this descriptive qualitative study, semi-structured interviews were conducted with 21 key informants. The purposive sampling method was applied to select interviewees, and data collection through interviews was continued to achieve data saturation. Using the framework of Adams et al. for health resource production, the directed content analysis approach was undertaken to analyse the qualitative data. RESULTS: Three main themes and seven sub-themes were identified, and the main themes (sub-themes) were human (the lack of motivation, job stressors and the lack of clinical staff), physical (capital resources and consumables) and intellectual (burn care education and staff training) resources. CONCLUSION: In general, investment in different areas would help provide better burn services, including educating and empowering employees, motivating through identifying and defining their needs, and considering points for job stressors as work hardship, burnout and workplace harassment. Other areas of investment are increasing the recruitment of burn section personnel, providing burn specialized equipment and updating them, providing standard physical space, and supplying consumables such as medicines and dressings.

Fairness in household financial contribution to the Iran's healthcare system from 2008 to 2018.

OBJECTIVE: Enhancing financial protection in health is one of the main goals of Iran's health transformation program (HTP), a recent reform conducted in early 2014. This study aimed to measure financial protection using the fair financial contribution index (FFCI) in urban and rural areas before (2008-2013) and after (2014-2018) the HTP implementation. Using a retrospective study on annual national cross-sectional surveys of households' income and expenditure, FFCI was measured. The total sample sizes for urban and rural areas from 2008 to 2018 were 207,980 and 212,249 households, respectively. RESULTS: The worst fair contributions to health expenditure in urban (FFCI = 0.684) and rural areas (FFCI = 0.530) were related to 2010 and 2009, respectively. Otherwise, the best fair contributions for urban (FFCI = 0.858) and rural (FFCI = 0.836) areas were made in 2011. Before the HTP implementation began, FFCI showed minor changes from 0.834 in 2008 to 0.833 in 2013. Following the HTP implementation, the FFCI values in urban and rural populations declined (worsened) from 0.842 to 0.836 and 0.816 to 0.809, respectively.On average more fair financial contributions had been made following five years after the HTP, especially in rural areas, but less than that expected in upstream documents (as determined 0.9).

Contributing factors to the total fertility rate declining trend in the Middle East and North Africa: a systemic review.

BACKGROUND: The total fertility rate (TFR) in the Middle East and North Africa has experienced a declining trend in recent years. Accordingly, the present study was conducted to provide a clear picture of the most critical factors affecting the TFR decline in this region. METHODS: This study was a systematic review between the years 2000 and 2016. The different databases like Cochrane, PubMed, Scopus, and Science Direct and the Google Scholar search engine were used. At first, 270 articles and then 18 articles were selected and meticulously read for the final analysis. RESULTS: The results indicated a declining trend in the TFR in the Middle East and North Africa, as in other parts of the world. Regarding the causes of this declining trend, several factors were identified and categorized into five main factors of health care-related, cultural, economic, social, and political. CONCLUSIONS: While taking advantage of the experiences, it is necessary to identify the five main factors and their related issues and hence consider them in the population policy-making.