Assessing the impact of small-research grants supported by WHO in the Eastern Mediterranean Region 2010–2018

Background: For decades, WHO has been providing targeted funding for health research on priority areas of public health in the Eastern Mediterranean Region through different grant schemes. Aims: This paper investigated the impact of WHO/EMRO’s funding schemes and factors facilitating or hindering such impact. Methods: We assessed the impact of health research funded by WHO/EMRO during 2010–2018 from the health, economic, decision-making, and knowledge translation perspectives, emphasizing accountability and analysis, using the Payback framework, mixed-method approach (quantitative, qualitative), and triangulation. Results: Principal investigators of 45 (45.9%) out of the 98 funded projects responded to the questionnaire. Almost all (88.0%) the 45 projects reported developing at least one decision-making document. Less than half reported producing peer-reviewed documents and conducting target group empowerment, while 24.0% said they secured research funds from other organizations. For 23 projects (51.0%), research results could have had a direct impact on health and on economy, and 25 (56.0%) projects conducted at least one active knowledge translation activity. Using multiple logistic regression, there was no significant association between the country of research and impact on decision-making and implementation of result if health or economic impact was expected. Conclusion: To strengthen the impact of research, WHO/EMRO should embark on a series of interventions to guide and empower countries in the use of research results. Discrepancies between health research systems in the Eastern Mediterranean Region and differences in individual and organizational capacities in the different countries require targeted interventions.

Global epidemiology of SARS-CoV-2 infection: a systematic review and meta-analysis of standardized population-based seroprevalence studies, Jan 2020-Oct 2021

BackgroundOur understanding of the global scale of SARS-CoV-2 infection remains incomplete: routine surveillance data underestimates infection and cannot infer on population immunity, there is a predominance of asymptomatic infections, and uneven access to diagnostics. We meta-analyzed SARS-CoV-2 seroprevalence studies, standardized to those described in WHOs Unity protocol for general population seroepidemiological studies, two years into the pandemic, to estimate the extent of population infection and remaining susceptibility. Methods and FindingsWe conducted a systematic review and meta-analysis, searching MEDLINE, Embase, Web of Science, preprints, and grey literature for SARS-CoV-2 seroprevalence published between 2020-01-01 and 2022-05-20. The review protocol is registered with PROSPERO, (CRD42020183634). We included general population cross-sectional and cohort studies meeting an assay quality threshold (90% sensitivity, 97% specificity; exceptions for humanitarian settings). We excluded studies with an unclear or closed population sample frame. Eligible studies - those aligned with the WHO Unity protocol - were extracted and critically appraised in duplicate, with Risk of Bias evaluated using a modified Joanna Briggs Institute checklist. We meta-analyzed seroprevalence by country and month, pooling to estimate regional and global seroprevalence over time; compared seroprevalence from infection to confirmed cases to estimate under-ascertainment; meta-analyzed differences in seroprevalence between demographic subgroups such as age and sex; and identified national factors associated with seroprevalence using meta-regression. The main limitations of our methodology include that some estimates were driven by certain countries or populations being over-represented. We identified 513 full texts reporting 965 distinct seroprevalence studies (41% LMIC) sampling 5,346,069 participants between January 2020 and April 2022, including 459 low/moderate risk of bias studies with national/sub-national scope in further analysis. By September 2021, global SARS-CoV-2 seroprevalence from infection or vaccination was 59.2%, 95% CI [56.1-62.2%]. Overall seroprevalence rose steeply in 2021 due to infection in some regions (e.g., 26.6% [24.6-28.8] to 86.7% [84.6-88.5%] in Africa in December 2021) and vaccination and infection in others (e.g., 9.6% [8.3-11.0%] to 95.9% [92.6-97.8%] in Europe high-income countries in December 2021). After the emergence of Omicron, infection-induced seroprevalence rose to 47.9% [41.0-54.9%] in EUR HIC and 33.7% [31.6-36.0%] in AMR HIC in March 2022. In 2021 Quarter Three (July to September), median seroprevalence to cumulative incidence ratios ranged from around 2:1 in the Americas and Europe HICs to over 100:1 in Africa (LMICs). Children 0-9 years and adults 60+ were at lower risk of seropositivity than adults 20-29 (p<0.0001 and p=0.005, respectively). In a multivariable model using pre-vaccination data, stringent public health and social measures were associated with lower seroprevalence (p=0.02). ConclusionsIn this study, we observed that global seroprevalence has risen considerably over time and with regional variation, however around 40 % of the global population remains susceptible to SARS-CoV-2 infection. Our estimates of infections based on seroprevalence far exceed reported COVID-19 cases. Quality and standardized seroprevalence studies are essential to inform COVID-19 response, particularly in resource-limited regions.

The Effect of Access to Primary Care Physicians on Avoidable Hospitalizations: A Time Series Study in Rural Areas of Tehran Province, Iran / 가정의학회지

Background@#Avoidable hospitalizations (AHs) are defined as hospitalizations that could have been prevented through timely and effective services. AHs are, therefore, an indicator used to evaluate the access and effectiveness of primary health care services. @*Methods@#A retrospective time-series study spanning 8 years (2006–2013) was conducted to determine the relationship between AHs and gender, age, and access to primary health care physicians in rural areas in Tehran province, the capital of Iran. The total number of avoidable hospitalizations was 22,570; logistic regression was estimated for each year separately. @*Results@#Total hospitalizations and AHs increased during the study period, especially during the first 3 years of the study. AHs, as a percentage of total hospitalizations, did not change significantly throughout the study years. This value was 22.3% during the first year of study and varied between 17% and 19.6% from 2007 to 2013. No statistically significant relationship was seen between AH occurrence and access to a physician during the study years. @*Conclusion@#Increasing access to primary health care physicians cannot necessarily result in decreased AHs. Considering the factors influencing AHs while designing and implementing the family physicians program is important to achieve the expected results regarding the effectiveness of primary health care services.

Effects of the Health Transformation Plan on caesarean section rate in the Islamic Republic of Iran: an interrupted time series

Background: In recent decades, the rate of caesarian section (C-section) has increased in the Islamic Republic of Iran. A reform in the Iranian health system – the Health Transformation Plan (HTP) – was launched in 2014 in which one of the objectives of HTP is decreasing the rate of C-section.Aims: This study aimed to assess the effects of the Health Transformation Plan (HTP) on the C-section rate in the Islamic Republic of Iran. Methods: This study was an interrupted time series analysis that used segmented regression analysis to assess the im-mediate and long-term effects of the HTP on C-section rate in two groups of hospitals affiliated and not affiliated to the Ministry of Health and Medical Education (MoHME) in Kurdistan province. Study samples were selected using the data on monthly C-section rate collected over a period of four years.Results: We observed significant decreases in C-section rate immediately after the HTP in both groups of hospitals by 0.0629 and 0.0013, respectively (P < 0.05). In the long run, we observed no significant decrease in the regression slope of C-section rate in both groups.Conclusions: The implementation of HTP decreased the C-section rate. However, the reduction does not meet expecta-tions.

Contexte : Au cours des dernières décennies, on a observé une augmentation du taux de césarienne en République islamique d’Iran. Une réforme du système de santé iranien – le plan national de transformation du secteur de la santé – a été lancée en 2014. L’un des objectifs de ce plan vise à réduire le taux de césarienne.Objectifs : La présente étude vise à évaluer les effets du plan national de transformation du secteur de la santé sur le taux de césarienne en République islamique d’Iran. Méthodes : La présente étude constitue une analyse d’une série chronologique interrompue basée sur une analyse de régression segmentée afin d’évaluer les effets immédiats et à long terme du plan de transformation du secteur de la santé sur le taux de césarienne dans deux groupes d’hôpitaux affiliés et non affiliés au ministère de la Santé et de l’Éducation médicale dans la province du Kurdistan. Les échantillons de l’étude ont été choisis en utilisant les données relatives au taux mensuel de césariennes, collectées sur une période de quatre ans.Résultats : Nous avons observé une diminution sensible du taux de césarienne immédiatement après la mise en place du plan de transformation du secteur de la santé dans les deux groupes d'hôpitaux, s’élevant respectivement à 0,0629 et 0,0013, (p < 0,05). À long terme, nous n’avons observé aucune diminution importante de la pente de régression du taux de césarienne dans les deux groupes.Conclusions : La mise en œuvre de ce plan de transformation du secteur de la santé a permis de diminuer le taux de césarienne. Cependant, cette réduction est en deçà des attentes.

Effects of Iranian Economic Reforms on Equity in Social and Healthcare Financing: A Segmented Regression Analysis / 예방의학회지

OBJECTIVES: One of the main objectives of the Targeted Subsidies Law (TSL) in Iran was to improve equity in healthcare financing. This study aimed at measuring the effects of the TSL, which was implemented in Iran in 2010, on equity in healthcare financing. METHODS: Segmented regression analysis was applied to assess the effects of TSL implementation on the Gini and Kakwani indices of outcome variables in Iranian households. Data for the years 1977-2014 were retrieved from formal databases. Changes in the levels and trends of the outcome variables before and after TSL implementation were assessed using Stata version 13. RESULTS: In the 33 years before the implementation of the TSL, the Gini index decreased from 0.401 to 0.381. The Gini index and its intercept significantly decreased to 0.362 (p < 0.001) 5 years after the implementation of the TSL. There was no statistically significant change in the gross domestic product or inflation rate after TSL implementation. The Kakwani index significantly increased from -0.020 to 0.007 (p < 0.001) before the implementation of the TSL, while we observed no statistically significant change (p=0.81) in the Kakwani index after TSL implementation. CONCLUSIONS: The TSL reform, which was introduced as part of an economic development plan in Iran in 2010, led to a significant reduction in households’ income inequality. However, the TSL did not significantly affect equity in healthcare financing. Hence, while measuring the long-term impact of TSL is paramount, healthcare decision-makers need to consider the efficacy of the TSL in order to develop plans for achieving the desired equity in healthcare financing.

Self-reported health-related quality of life (HRQoL) and factors affecting HRQoL among individuals with health insurance in Iran / 한국역학회지

OBJECTIVES: The aim of this study was to measure the health-related quality of life (HRQoL) and to evaluate the factors affecting HRQoL in individuals with health insurance in Tehran, Iran. METHODS: A cross-sectional analytical study was conducted using the 3-level EuroQol 5-dimensions (EQ-5D) questionnaire. In order to estimate the determinants of HRQoL, information about participants’ demographic, socioeconomic, and health status was gathered. The cluster sampling technique was used to collect data from May to June, 2016. The chi-square test and weighted least squares method were employed for data analysis. Data were analyzed using Stata version 11.0. RESULTS: A total of 600 Iranians with insurance completed the study, of whom 327 (54.5%) were male and 273 (45.5%) were female. The mean age of the participants was 41.48 years (standard deviation [SD], 14.60 years). Meanwhile, the mean duration of education was 12.36 years (SD, 4.68 years). The mean EQ-5D score was 0.74 (SD, 0.16). The most common health problems in the participants were anxiety/depression (42.3%), followed by pain/discomfort (39.2%). Sex, age, years of schooling, income, chronic disease, and body mass index had a significant effect on HRQoL (p<0.05). Healthy insured individuals, on average, had a HRQoL score 0.119 higher than that of people with a chronic disease, all else being equal (p<0.001). CONCLUSIONS: Among all determinants of HRQoL, chronic disease was found to be the highest priority for interventions to improve the health status of Iranians with insurance. This finding can help policymakers and health insurance organizations improve their planning to promote the HRQoL of individuals with insurance and society as a whole in Iran.

Life and health satisfaction in the adult population of Iran / 한국역학회지

OBJECTIVES: Increasing interest has emerged in the use of subjective well-being as a development indicator and for the evaluation of public policies. The aim of this study was to assess life and health satisfaction and their determinants in the adult population of Iran. METHODS: We conducted a survey of a sample of 3,150 adults at least 18 years of age in Tehran, the capital of Iran. The subjects were selected using a stratified random sampling method, and they were interviewed face-to-face at their usual residence by trained interviewers. Life satisfaction was used as a measure of subjective well-being. We used ordinary least square regression models to assess the associations of life and health satisfaction with socio-demographic variables. RESULTS: On a 0-10 scale, the mean (standard deviation) scores for life and health satisfaction were 6.93 (2.54) and 7.18 (1.97), respectively. The average score for life satisfaction in females was 0.52 points higher than in males. A U-shaped relationship was found between age and life satisfaction, with respondents 35 to 44 years of age having the lowest average level of life satisfaction. Satisfaction with life and health among divorced respondents was significantly lower than among never-married and married participants. The scores for life satisfaction in respondents who rated their health status as poor were 3.83 points lower than in those who rated their health status as excellent. CONCLUSIONS: The majority of the population of Tehran was satisfied with their life and health. Self-rated health status had the greatest impact on life satisfaction.

A Qualitative Inquiry Into the Challenges of Medical Education for Retention of General Practitioners in Rural and Underserved Areas of Iran / 예방의학회지

OBJECTIVES: General practitioners (GPs) retention in rural and underserved areas highly effects on accessibility of healthcare facilities across the country. Education seems to be a critical factor that affects GPs retention. Thus, the present study aimed at inquiry into medical education challenges that limit their retention in rural and underserved areas. METHODS: A qualitative approach was applied for the aim of this study. Data were gathered via 28 semi-structured interviews with experts at different levels of Iran’s health system as well as GPs who retained and refused to retain working in rural settings. Interviews mainly were performed face-to-face and in some cases via telephone during 2015 and then coded and analyzed using content analysis approach. RESULTS: Iran’s medical education is faced with several challenges that were categorized in four main themes including student selection, medical students’ perception about their field of study, education setting and approach, curriculum of medical education. According to experts this challenges could results in making GP graduates disinterested for practicing in rural and underserved areas. CONCLUSIONS: Challenges that were found could have negative effects on retention. Modification in student’s perception about rural practice could be done via changing education setting and approach and curriculum. These modifications could improve GPs retention in rural and underserved areas.

Demonstration of malaria situation analysis, stratification and planning in Minab District, southern Iran.

OBJECTIVE: To demonstrate malaria situation analysis, stratification and planning for an endemic area in southern Iran. METHODS: Data on health system, population, meteorological parameters, malaria cases, anopheline vectors, and control activities during 2005-2007 was obtained from Minab Health Center, Minab Meteorological Station and published documents about malaria elements in the study area. A datasheet was created in excel 2003 for analysis. RESULTS: There were 644 health staff working in Minab District including 99 health staff in malaria control program. The health facilities are distributed as follow: 1 hospital with 96 beds, 23 health centers including private centers (10 in Minab city and 13 in rural area of Minab District) and 119 health houses in rural areas of Minab District. A nopheles stephensi was the dominant species in Minab District, however, Anopheles dthali, Anopheles superpictus, Anopheles fluviatilis, Anopheles multicolor, Anopheles pulcherrimus and Anopheles turkhudi can also be found in the area. Anopheles stephensi was reported susceptible to malathion, propoxur, primphos-methyl, lambda-cyhalothrin permethrin and deltamethrin, and resistant to DDT and dieldrin in the area. During the study period a total of 10 665 positive cases were reported, mainly due to local transmission (99.6%). Plasmodium vivax was the main causative agent followed by Plasmodium falciparum. There were reports about drug resistance of Plasmodium falciparum in the area. CONCLUSIONS: Using different parameters, Minab was classified into 3 strata. A plan was designed based on described goal, objectives and targets. The approaches of this plan were categorized into: health education, early detection and correct treatment, and vector control. Main constraints of these approaches are population movement between Iran, Pakistan and Afghanistan; vector control challenges at district, inadequate skilled medical staff in malaria case management and weak inter-sectorial coordination for malaria control, especially in urban areas.