Review of the effect cultural capital and subjective socioeconomic status on life satisfaction in Iran: the mediating role of health-promoting lifestyle and the moderating role of ethnicity.

INTRODUCTION: Health-promoting lifestyle can leads to improving the quality of life, life satisfaction, well-being and reducing the burden of health care in the society. This study was carried out to investigate the mediating role of health-promoting lifestyle and moderating role of ethnicity in the effect of cultural capital and subjective socioeconomic status on life satisfaction in Iran. METHODS: This cross-sectional study was conducted with 800 respondents in the cities of Kermanshah with Kurdish ethnicity and Tabriz with Azeri ethnicity. The data gathering tool was a questionnaire in five section including demographic checklist, cultural capital questionnaire (2015),Diener's life satisfaction scale, and health-promoting lifestyle questionnaire (HPLP II), and socioeconomic status scale. Data were analyzed by SPSS and AMOS software. RESULTS: Life satisfaction had the highest correlation with the objective dimension of cultural capital (p < 0.001 r = 0.298). The direct standardized coefficient of the path of cultural capital to health-promoting lifestyle was 0.44 (P < 0.001). Also the direct standardized coefficient of cultural capital on Life satisfaction was 0.04 that was not significant. The standard coefficient of the path of cultural capital on life satisfaction through health-promoting lifestyle was 0.27(P < 0.001). Ethnicity variable did not moderate the effect of cultural capital on life satisfaction (p > 0.05). CONCLUSION: The results of this study showed that paying attention to the concept of health-promoting lifestyle is a necessity to affect life satisfaction. It can play a role as a mediator for the path of cultural capital and socio-economic status on life satisfaction. This study also showed the role of ethnicity as a moderating variable in the relationship between socio-economic status and health-promoting lifestyle.

Spatiotemporal clustering of suicide attempt in Kermanshah, West-Iran.

Background: A suicide attempt is a major societal problem because it imposes high costs on societies worldwide. This paper analyses the spatiotemporal clustering of suicide attempt in Kermanshah, Iran from 2006-14. Methods: This study draws on 18,333 individuals (7,234 males and 11,097 females) who attempted suicide across the Kermanshah province. Data was collected from the records of individuals registered in hospitals across the Kermanshah province between 2006 and 2014. Mean Center, Standard Deviational Ellipse (SDE), Moran's I and Kernel Density Estimation (KDE) in Arc/GIS10.6 software were used for the analysis of the spatial distribution of suicide attempt, while the chi-squared test in SPSS was used to examine the different demographic variables between groups within/outside spatial clusters of suicide. Results: The results show that a total of 18,331 suicide attempts (39.46% male and 60.53% female) were reported between 2006 and 2014 in the Kermanshah province. The spatial pattern of suicide attempts was clustered in 16 clusters (6 high clusters and 10 low clusters) and statistically significant differences were found within and outside the hotspots of suicide attempts. Most hot spots were formed in and around cities. Younger people were at a greater risk. The rate of suicide attempts reduced in illiterate people and increased in people with university degrees. Unmarried people were associated with a higher risk of suicide attempt than was married status for both males and females. Conclusion: The results of this study could help public health practitioners and policymakers in Iran prioritize resources and target efforts for suicide attempt prevention.

Exploring the epidemiology of suicide attempts: Risk modeling in Kermanshah-Iran.

Background: Suicide attempt is a serious global public health issue. The patterns of suicide may vary depending on the individual characteristics, methods, causes, and the geographical area-also socio-cultural context that determine it. This study identifies the spatial patterns of suicide attempts in Kermanshah province, Iran. Method: The sample size of this cross-sectional study is 18,331 people (7234 males and 11097 females) who attempted suicide in Kermanshah province between 2006 and 2014. Data was collected from the records of patients referred to the emergency department of hospitals in Kermanshah and analyzed using tests of Mean Center, Standard Distance, and Average Nearest Neighbor. Results: The results of the mean center and standard distance tests show that drug overdose, poisoning with toxins and pesticides, and chemicals mostly were used in the central areas of Kermanshah province. The mean center of suicide attempts by self-immolation, hanging and firearms was in the western parts of the province, while the suicide attempts with narcotic drug were concentrated in the eastern regions of the province. Out of the 18,331 cases, 74% attempted suicide with drug overdose, 13% with toxins and pesticides, 0.59% with chemicals, 4% with fire, 1% by self-immolation, 1% by hanging, 0.16% with firearms and 0.7% with cold weapons. The spatial pattern of all suicide attempts in Kermanshah was clustered (Z-score < -2.58). Conclusion: The results of this study show that the methods of suicide attempt vary with geographical areas in the province. Therefore, it is suggested that planning tailored to the geographical location can reduce suicide attempts in Kermanshah.

Investigating Global Spatial Patterns of Diarrhea-Related Mortality in Children Under Five.

Objective: Investigating the trends of child diarrhea-related mortality (DRM) is crucial to tracking and monitoring the progress of its prevention and control efforts worldwide. This study explores the spatial patterns of diarrhea-related mortality in children under five for monitoring and designing effective intervention programs. Methods: The data used in this study was obtained from the World Health Organization (WHO) public dataset that contained data from 195 countries from the year 2000 to 2017. This dataset contained 13,541,989 DRM cases. The worldwide spatial pattern of DRM was analyzed at the country level utilizing geographic information system (GIS) software. Moran's I, Getis-Ord Gi, Mean center, and Standard Deviational Ellipse (SDE) techniques were used to conduct the spatial analysis. Results: The spatial pattern of DRM was clustered all across the world during the study period from 2000 to 2017. The results revealed that Asian and African countries had the highest incidence of DRM worldwide. The findings from the spatial modeling also revealed that the focal point of death from diarrhea was mainly in Asian countries until 2010, and this focus shifted to Africa in 2011. Conclusion: DRM is common among children who live in Asia and Africa. These concentrations may also be due to differences in knowledge, attitude, and practices regarding diarrhea. Through GIS analysis, the study was able to map the distribution of DRM in temporal and spatial dimensions and identify the hotspots of DRM across the globe.

Investigating geographical accessibility and site suitability of medical laboratories in Kermanshah-Iran.

Introduction: One of the major challenges in developing countries is the inappropriate spatial distribution of medical laboratory centers (MLCs) which can lead to injustice in access to health services. This study aimed to investigate the accessibility to and site suitability of MLCs in Kermanshah Metropolis by GIS. Materials and methods: In this cross-sectional study, data were collected from the Iran Statistical Center and Deputy of Treatment of Kermanshah University of Medical Sciences. We used Arc/GIS 10.6 software, AHP technique, and network analysis tools to determine the access status of Kermanshah citizens to MLCs in 2019 and site selection for MLCs. The layers used in this study included population density, city development trends, compatible and incompatible land uses, pathways, land slope, river area, and access radius. Results: About 70% of households had inappropriate access to all MLCs in walking scenario. This ratio was 31.26% for 5 min, 9.58% for 10 min, and 6.09% for 15 min driving. Comparisons between public and private MLCs showed that in walking scenario, 88% of households had improper access to public and 80% to private MLCs. Based on 5 and 10 min of driving, 57 and 19% of households had inappropriate access to public MLCs, and 45 and 17% to private MLCs, respectively. Also, with 15 min of driving, 8% of households had improper access to public and 18% to private MLCs. Findings showed that scores provided for population density criteria were (0.298), distance from existing laboratories (0.213), proximity to pathways (0.175), consistent land use (0.129), city development trend (0.087), distance from riverfront (0.053), distance from incompatible land uses (0.015), and land slope (0.03). The final model was obtained by overlaying the layers. The model showed a 9-degree range from very bad to very good in Kermanshah city for the construction of laboratory centers (CR<0.01). Conclusion: The site selection model showed that the location of the proposed centers can be in the north and outskirts of the city to facilitate citizens' access to the MLCs. These results emphasize the justice in the spatial distribution of MLCs for the benefit of deprived populations as a global value.

Survey on the indexes of health equity in the physical environment and infrastructures of Kermanshah province, Iran.

BACKGROUND: Health equity is directly associated with the proper distribution of resources, the existence of infrastructures, and the balanced physical environment. The present study aimed to survey the indexes of health equity in the physical environment and infrastructures of Kermanshah province based on the national indexes. RESULTS: The results revealed that access to transportation, health centers, solid waste management, and green and sports per capita had the least distance from the negative ideal whereas the noise pollution index had the greatest distance. However, house hygiene and air pollution indexes were within the negative and positive ideal ranges. CONCLUSIONS: The health equity indexes were not distributed equitably across counties and geographical regions of Kermanshah province.

Spatial modeling of mortality from acute lower respiratory infections in children under 5 years of age in 2000-2017: a global study.

BACKGROUND: Over the past few decades, various goals have been defined to reduce the mortality of children caused by acute lower respiratory infections (ALRIs) worldwide. However, few spatial studies to date have reported on ALRI deaths. PURPOSE: We aimed to assess the spatial modeling of mortality from ALRI in children under 5 years of age during 2000-2017 using a global data. METHODS: The data on the mortality of children under 5 years old caused by ALRI were initially obtained from the official website of the World Health Organization. The income status of their home countries was also gathered from the Country Income Groups (World Bank Classification) website and divided into 5 categories. After that, in the ArcGIS 10.6 environment, a database was created and the statistical tests and related maps were extracted. The Global Moran's I statistic, Getis-Ord Gi statistic, and geographically weighted regression were used for the analyses. In this study, higher z scores indicated the hot spots, while lower z scores indicated the cold spots. RESULTS: In 2000-2017, child mortality showed a downward trend from 17.6 per 100,000 children to 8.1 and had a clustered pattern. Hot spots were concentrated in Asia in 2000 but shifted toward African countries by 2017. A cold spot that formed in Europe in 2007 showed an ascending trend by 2017. Based on the results of geographically weighted regression test, the regions identified as the hot spots of mortality from ALRI in children under 5 years old were among the middle-income countries (R2=0.01, adjusted R2=8.77). CONCLUSION: While the total number of child deaths in 2000-2017 has decreased, the number of hot spots has increased among countries. This study also concluded that, during the study period, Central and Western Africa countries became the main new hot spots of deaths from ALRI.

Using a geographic information system to identify the number and location of new health centres needed in the city of Kermanshah, Islamic Republic of Iran.

BACKGROUND: Inappropriate distribution of health centres can increase inequities in health care. A geographic information system (GIS) is a useful tool to help plan, monitor and evaluate health systems by analysing and visualizing geospatial data. AIMS: This study aimed to propose an optimal model for establishing new health centres in the city of Kermanshah, Islamic Republic of Iran using GIS. METHODS: In this descriptive analytical study, the number and location of health centres and people's access to them across Kermanshah were evaluated using the GIS system, ArcGIS 10.3, for the years 1997, 2007 and 2012. To determine the best locations for establishing health centres, five principles were considered: access, distance, service delivery radius, proximity to areas of compatible and incompatible land-use, and population density. RESULTS: In spite of an increase in the number of health centres in Kermanshah between 1997 and 2012, the population without access to such centres also increased, and this varied by age group. Based on the final map of all the land in Kermanshah, 6% of the land was considered unsuitable or very unsuitable, 16% medium suitability, and 78% good or very good for the location of health centres in Kermanshah city. CONCLUSION: The spatial distribution of health centres (in terms of the radius of access) and compatibility of the land-use were not properly considered over the 15-year period. To provide health coverage for the current population in the city of Kermanshah, 13 new health centres are needed in suitable locations.

Decomposing socioeconomic inequality in poor mental health among Iranian adult population: results from the PERSIAN cohort study.

BACKGROUND: Socioeconomic inequality in mental health in Iran is poorly understood. This study aimed to assess socioeconomic inequality in poor mental health among Iranian adults. METHODS: The study used the baseline data of PERSIAN cohort study including 131,813 participants from 17 geographically distinct areas of Iran. The Erreygers Concentration index (E) was used to quantify the socioeconomic inequalities in poor mental health. Moreover, we decomposed the E to identify factors contributing to the observed socioeconomic inequality in poor mental health in Iran. RESULTS: The estimated E for poor mental health was - 0.012 (95% CI: - 0.0144, - 0.0089), indicating slightly higher concentration of mental health problem among socioeconomically disadvantaged adults in Iran. Socioeconomic inequality in poor mental health was mainly explained by gender (19.93%) and age (12.70%). Region, SES itself, and physical activity were other important factors that contributed to the concentration of poor mental health among adults with low socioeconomic status. CONCLUSION: There exists nearly equitable distribution in poor mental health among Iranian adults, but with important variations by gender, SES, and geography. These results suggested that interventional programs in Iran should focus on should focus more on socioeconomically disadvantaged people as a whole, with particular attention to the needs of women and those living in more socially disadvantaged regions.

The Relationship between Life Satisfaction and Quality of Life among People Living with HIV/AIDS in Kermanshah-West of Iran.

Since the late 20th century, identifying the multidimensional nature of HIV/AIDS and its negative effects on mental health and quality of life (QOL) in patients has prompted specialists to identify and control the psychological and behavioural variables resulting from this disorder. Thus, the current study aimed to assessing the relationship between life satisfaction (LS) and QOL among people living with HIV/AIDS in Kermanshah. This descriptive-correlation study was conducted on 364 HIV/AIDS patients referred to the Voluntary Counseling and Testing Center (VCT) in Kermanshah in 2016-2017, selected by convenience sampling method. Data gathering tools included Satisfaction with Life Scale (SWLS), World Health Organization Quality of Life-HIV Brief (WHOQOL-HIV BREF) questionnaire and demographic checklist. The Cronbach's alpha reliability coefficient varied from 0.70 to 0.83 for the five subscales of WHOQOL-HIV BREF questionnaire. The result showed that out of 364 patients, 38.19% were women. There was a positive correlation between LS and QOL in patients with HIV/AIDS in Kermanshah (p < .001), and LS was associated with the QOL. Furthermore, the results indicated that LS and QOL in patients with HIV/AIDS were at low levels.

Socioeconomic-related inequalities in oral hygiene behaviors: a cross-sectional analysis of the PERSIAN cohort study.

BACKGROUND: Socioeconomic-related inequality in oral hygiene behaviors in Iran is poorly understood. This study aims to measure and decompose socioeconomic-related inequalities in oral hygiene behaviors among middle-aged and elderly adults in Iran. METHODS: A cross-sectional analysis was performed using data from the Prospective Epidemiological Research Studies in IrAN (PERSIAN), a large national cohort study. A total of 130,016 individuals aged 35 years and above from 17 cohort centers in Iran were included in the study. The normalized concentration index (Cn) was used to measure the magnitude of inequality in oral hygiene behaviors, i.e. brushing at least twice and flossing once daily, among middle-aged and elderly Iranian adults included in the cohort centers. Decomposition analysis was performed to quantify the contribution of each determinant to the observed inequality in oral hygiene behaviors. RESULTS: Totally, 65.5% of middle-aged and elderly adults brushed their teeth twice a day or more, 7.6% flossed at least once a day and 3.48% had both habits. The estimated Cn of the two habits combined, i.e. tooth brushing and dental flossing, for all provinces taken part in the PERSIAN cohort study was 0.399 (95% confidence interval [CI]: 0.383 to 0.417), indicating that the prevalence of the two habits combined is more concentrated among individuals with higher socioeconomic status. Inequality in oral hygiene behaviors was pro-rich in all cohort centers. The decomposition results suggested socioeconomic status as the main factor contributing to the overall inequality, followed by the level of education, and the province of residence. CONCLUSION: A low prevalence of oral hygiene behaviors among middle-aged and elderly Iranian adults was observed. There was also a pro-rich inequality in oral hygiene behaviors among middle-aged and elderly adults in all cohort centers. These results suggest an urgent need for targeted policy interventions to increase the prevalence of preventive oral hygiene behaviors among the poor and less-educated middle-aged and elderly adults in Iran.

A study of 0-14-year-old children's access to health centers in rural areas using a buffer model (a case study of villages based in Kermanshah province, Iran).

INTRODUCTION: Children are among the most vulnerable groups in society, whose health is of prominent significance. Moreover, as a group of clients with special needs in the health care system, they require special attention. Therefore, the present study aimed to investigate the 0-14-year-old children's access to health centers in rural areas of Kermanshah Province, Iran. MATERIALS AND METHODS: In the present cross-sectional study, both the latest published demographic statistics related to the Population and Housing Census, announced by the Statistical Center of Iran in 2011, and the information about the public and private hospitals in the province, collected by Kermanshah University of Medical Sciences, were used as the basis for the analyses. In addition, given the importance of the spatial nature of the research, geographic information system was used for data analysis, and a buffer model was also applied. RESULTS: The results revealed that out of the total population of 0-14-year-old children residing in rural areas within 15,000 and 30,000-km radii of Kermanshah Province, 87.94% and 75.11% of girls versus 88.15% and 75.38% of boys lacked access to health centers, respectively. CONCLUSION: It was found out that the 0-14-year-old children's access to health centers was in poor condition in rural areas of Kermanshah Province, which would endanger the health of this age group.

Health-related quality of life in informal settlements in Kermanshah, Islamic Republic of Iran: role of poverty and perception of family socioeconomic status.

BACKGROUND: Quality of life is an important indicator for measuring health status, and information on quality of life of different groups in society can be used to assess the effect of interventions on health. AIMS: This study aimed to assess the relationship between urban poverty and perception of family socioeconomic status, and health-related quality of life in residents of informal settlements. METHODS: A cross-sectional study was conducted among 432 residents of two neighbourhoods of informal settlements in Kermanshah in 2015. To measure poverty, the 16 indicators of 2011 Iranian census were used. The neighbourhoods were classified into three groups: high poverty (9.3%), middle poverty (49.2%) and low poverty (41.5%) levels. Health-related quality of life was assessed with the SF-36 questionnaire. The Pearson correlation coefficient was calculated and regression and ANOVA analyses were done. RESULTS: There were no statistically significant differences between the SF-36 scores for the three poverty levels, and no relationship between poverty and the health-related quality of life subscales (P > 0.05). A significant positive correlation was found between perception of family socioeconomic status and health-related quality of life (P < 0.05). In regression analysis, having a chronic illness, perception of family socioeconomic status, age and sex predicted the physical health domain of the SF-36, whereas perception of family socioeconomic status and having a chronic illness predicted the mental health domain. CONCLUSIONS: Subjective perception of family socioeconomic status can explain differences in health-related quality of life of low-income people.

Women's Quality of Life in Menopause with a Focus on Hypertension.

BACKGROUND: One-third of each woman's life is naturally during her menopause. This study was conducted to determine the factors related to the quality of life in postmenopausal women. MATERIALS AND METHODS: This cross-sectional study was carried out using cluster sampling method on 218 postmenopausal women aged 40-60 years old in Kermanshah in 2014. The data were collected through interview and with the standard questionnaire of Menopausal Quality (MENQOL) of Life and analyzed using SPSS software version 19. RESULTS: The mean age of menopause was 50.03 ± 4.48 years. Mean scores of quality of life and four domains, vasomotor, psychosocial, physical and sexual were 3.15±0.970, 3.71 ± 1.81, 3.32±0.959, 2.91 ± 1.06, 3.74 ±1.59, respectively. CONCLUSION: Chronic conditions such as hypertension in postmenopausal women can lead to lower quality of life. Therefore, provision of coherent support programs for controlling chronic diseases requires serious intervention from health care providers.

Inequalities in access to hospitals: a case study in the Islamic Republic of Iran 1997-2012.

BACKGROUND: Nowadays, the significance of applying Geographic information system (GIS) to survey accessibility to hospitals and understanding disparities in this regard has increased. AIMS: The main aim of this descriptive-analytical research was to study the spatial accessibility of the population of Kermanshah for 3 years 1997 (n=693157), 2007 (n=794863), and 2012 (n=851 405) to hospitals based on age and gender groups through GIS. METHODS: The study was conducted based on network analysis models, mean centre, and standard distance in the environment of Arc/GIS. A standard radius of 1500 metres was set for the medical centres, and a 25-minute walking span was set for the distance of each person from home to the nearest hospital. RESULTS: The results of the network analysis demonstrated that the hospitals were inaccessible to the populations according to our criteria, and their geographical access to hospitals measured 68.80%, 64.23% and 66.20% in 1997, 2007, and 2012, respectively. Women aged 65 years and above were more at risk in this regard. CONCLUSIONS: Over the total period under study, the results revealed that hospitals were concentrated in the central and southern areas of Kermanshah.

A Comparative Study of Spatial Distribution of Gastrointestinal Cancers in Poverty and Affluent Strata (Kermanshah Metropolis, Iran).

INTRODUCTION: The trend of cancers has witnessed a twofold rise in the last three decades, which is expected to be fivefold by 2030. On the other hand, gastrointestinal cancers have turned into one of the health issues in many societies. Given the presence of gastrointestinal cancer hot spots and evidence of health inequalities across Kermanshah Metropolis and the results of studies signaling the association between gastrointestinal cancers and socioeconomic status of individuals as well as evidence of unequal socioeconomic opportunities in this metropolis, the present study aimed to investigate the spatial distribution of gastrointestinal cancers in the poverty and affluent strata of Kermanshah Metropolis, Iran. MATERIALS AND METHODS: In this descriptive-analytical study, the recorded data of patients, suffering from gastrointestinal cancers, in Kermanshah-based Pathology Centers and Vice Chancellery of Kermanshah University of Medical Sciences (2007-2012) were used. Moreover, to examine the status of gastrointestinal cancers in socioeconomic classes based on the census data collected during 2007-2012, 33 social, cultural, and structural indexes were extracted from the statistical blocks. Additionally, for data analysis and factor analysis, Kruskal-Wallis Test in the environment of SPSS and kernel density estimation (KDE) and Moran's I tests in the GIS environment were employed. FINDINGS: The results of the present study revealed that the distribution of poverty (Z score = 48.916518, p value = 0.000000) and affluent strata (Z score = 14.345028, p value = 0.000000) followed clustered patterns (p < 0.01). Additionally, the results indicated that the spatial distribution pattern of the upper gastrointestinal cancer was clustered (Z score = 1.896996, p value = 0.007828), whereas the spatial distribution pattern of the lower gastrointestinal cancer was inclined to a randomized clustered pattern (Z score = 1.338121, p value = 0.000857) (p < 0.01). Finally, seven main hot spots were identified from the poverty stratum in Kermanshah, which perfectly overlapped the hot spots of upper gastrointestinal cancer. Similarly, four main hot spots were identified from the affluent stratum in Kermanshah, which overlapped the hot spots of lower gastrointestinal cancer. The results of the Kruskal-Wallis Test demonstrated that the poverty and affluent strata were significantly different from each other in terms of gastrointestinal cancer: upper gastrointestinal cancer (p < 0.05 and X2=10.064) and lower gastrointestinal cancer (p < 0.05 and X2=10.253). CONCLUSION: The results of the present study showed that the ratio of patients with lower gastrointestinal cancers was higher than the incidence of upper gastrointestinal cancers over the 5-year period under study. Moreover, in Kermanshah Metropolis, there was a significant difference between the upper gastrointestinal cancer in the poverty stratum and the lower gastrointestinal cancer in the affluent stratum. Hence, it is suggested that GIS be applied as a tool for identifying the patterns of effective factors of this type of cancer in each social class, and it is recommended that some effective policies be presented and adopted by health managers according to the role and importance of socioeconomic, environmental, and nutritional factors in the poverty and affluent strata of society, and people at risk be equipped with preventive training programs in this respect.

Spatial-temporal cluster analysis of mortality from road traffic injuries using geographic information systems in West of Iran during 2009-2014.

INTRODUCTION: Road traffic injuries (RTIs) are considered as one of the most important health problems endangering people's life. The examination of the geographical distribution of RTIs could help policymakers in better planning to reduce RTIs. This study, therefore, aimed to determine the spatial-temporal clustering of mortality from RTIs in West of Iran. METHODS: Deaths from RTIs, registered in Forensic Medicine Organization of Kermanshah province over a period of six years (2009-2014), were used. Using negative binomial regression, the mortality trend was investigated. In order to investigate the spatial distribution of RTIs, we used ArcGIS. (Version 10.3). RESULTS: The median age of the 3231 people died in RTIs was 37 (IQR = 31) year, 78.4% were male. The 6-year average mortality rate from RTIs was 27.8/100,000 deaths, and the average rate had a declining trend. The dispersion of RTIs showed that most deaths occurred in Kermanshah, Islamabad, Bisotun, and Harsin road axes, respectively. The mean center of all deaths from RTIs occurred in Kermanshah province, the central area of Kermanshah district. The spatial trend of such deaths has moved to the northeast-southwest, and such deaths were geographically centralized. Results of Moran's I with respect to cluster analysis also indicated positive spatial autocorrelations. CONCLUSION: The results showed that the mortality rate from RTIs, despite the decline in recent years, is still high when compared with other countries. The clustering of accidents raises the concern that road infrastructure in certain locations may also be a factor. Regarding the results related to the temporal analysis, it is suggested that the enforcement of traffic rules be stricter at rush hours.

National and sub-national burden of infectious diseases in Iran, 1990 to 2013: the study protocol.

BACKGROUND: To assess the burden of infectious diseases, it is necessary to utilize a systematic approach for data collection and deploying the sophisticated methods to estimate the burden of infectious diseases for health policy making at national level. The present study protocol is aimed to provide a comprehensive explanation of the general structure and method used in the national and sub-national burden of selected infectious diseases study in Iran from 1990 to 2013. METHODS: The trend, burden, and geographical inequality pattern of infectious diseases will be estimated through a comprehensive review of published and unpublished data. Different sources of data including health surveys, surveillance data, hospital data surveys, death registry system, census, household expenditure survey, and published manuscripts will be synthesized to calculate the estimates. All indicators will be reported by gender, age, and geographic area. Two different statistical models include "Spatio-Temporal" and "Bayesian multilevel autoregressive" will be applied to overcome the scarcity and misalignment of the obtained data. DISCUSSION: Estimating the prevalence trend and burden of infectious diseases would be helpful to use more cost-effective interventions considering sub-national variations. Additionally, the information obtained from these studies can depict the ability of health system authorities in controlling these types of diseases.  Overall, the present applied models can be deployed as a part of inputs in further studies to estimate the burden of diseases, not only in Iran but also all around the Middle East countries.