Author: "Bakhtiar PIROOZI" / Language: english - Searchworks@Jio Institute Digital Library Search Results

Your search keyword '"Bakhtiar PIROOZI"' showing total 47 results

Start Over Author "Bakhtiar PIROOZI" Language english

47 results on '"Bakhtiar PIROOZI"'

1. Is the surge in cesarean section rates during the COVID-19 pandemic truly substantiated?

Author: Bakhtiar Piroozi, Ghobad Moradi, Kimya Khoramipoor, Hassan Mahmoodi, Farnaz Zandvakili, Ali Ebrazeh, Azad Shokri, and Farhad Moradpour
Subjects: Cesarean section, Primigravid women, COVID-19 pandemic, Interrupted Time Series, Kurdistan Province., Gynecology and obstetrics, RG1-991
Abstract: Abstract Background Cesarean section (C-section) rates, deemed a critical health indicator, have experienced a historical increase. The advent of the COVID-19 pandemic significantly impacted healthcare patterns including delays or lack of follow-up in treatment and an increased number of patients with acute problems in hospitals. This study aimed to explore whether the observed surge is a genuine consequence of pandemic-related factors. Methods This study employs an Interrupted Time Series (ITS) design to analyze monthly C-section rates from March 2018 to January 2023 in Kurdistan province, Iran. Segmented regression modeling is utilized for robust data analysis. Results The C-section rate did not show a significant change immediately after the onset of COVID-19. However, the monthly trend increased significantly during the post-pandemic period (p
Published: 2024
Full Text: View/download PDF

2. Socioeconomic inequality in unmet outpatient healthcare needs among people living in urban informal settlements in Sanandaj city, Iran

Author: Bakhtiar Piroozi, Hossein Safari, Amjad Mohamadi Bolbanabad, Ghobad Moradi, Yadolah Zarezadeh, Azad Shokri, and Farhad Moradpour
Subjects: Unmet healthcare needs, Access, Informal settlements, Health inequality, Public aspects of medicine, RA1-1270
Abstract: Abstract Background The growing trend of informal settlements is a serious humanitarian crisis. Unmet need for health care services is an indicator to measure the state of equality and access to healthcare services. This study, for the first time in Iran, examined the prevalence of unmet needs for outpatient healthcare services and related socioeconomic inequalities among residents of informal settlements in Sanandaj city. Methods This cross-sectional study was conducted on informal settlements of Sanandaj city with a sample size of 1345 people. Data were collected using a questionnaire. Multivariate logistic regression was used to determine significant predictors of unmet needs for healthcare services. Concentration index (C) and concentration curve (CC) were calculated to measure inequality in the prevalence of unmet needs for healthcare services. Results The prevalence of unmet needs for outpatient healthcare services was 31.7%. Financial and physical barriers were the most common reasons for not using the needed services. The highest unmet need was related to dental (80.6%) and rehabilitation services (78.8%). Being elderly with about 2.3 times (OR: 2.37, 95% CI: 1.19–4.75), not having a job with about 1.7 times (OR: 1.70, 95% CI: 1.13–2.57) and having a low economic status with about 4 times (OR: 4.46, 95% CI: 2.39–9.70) increased the odds of experiencing unmet need for outpatient healthcare services. The value of concentration index showed that unmet need for outpatient healthcare services was significantly concentrated among people with lower economic status (C= -0.330, 95% CI: -0.432 to -0.227). Conclusion The unmet need is high among people living in informal settlements of Sanandaj city and a significant part of the residents of these settlements does not have access to required healthcare services. Regardless of the needs of people living in these settlements, who constitute a large population of Iran, access to universal health coverage is not possible in such areas. Removing the identified obstacles and causes behind the unmet needs requires the interdisciplinary participation of all actors, including the government, the nation, and civil society.
Published: 2023
Full Text: View/download PDF

3. The impact of COVID-19 pandemic on hospital admissions for nine diseases in Iran: insight from an interrupted time series analysis

Author: Sina Ahmadi, Ali Kazemi-Karyani, Nasim Badiee, Sarah Byford, Ali Mohammadi, Bakhtiar Piroozi, and Satar Rezaei
Subjects: COVID-19 pandemic, Hospitalization rate, Interrupted time series analysis, Iran, Medicine (General), R5-920
Abstract: Abstract Background Associations between the COVID-19 pandemic and hospitalizations have not been studied Iran. This study aimed to examine the impact of the COVID-19 pandemic on hospital admissions for nine categories of disease in seven public hospitals in Kermsnahah city, the capital of Kermsnahah province, in the west of Iran. Methods Data on monthly hospitalization rates (number of hospitalizations per 100,000 population) were collected for nine categories of disease for a period of 40 months (23 months before and 17 months after the COVID-19 outbreak in Iran) from the health information systems of all seven public hospitals in Kermanshah city. Categories of disease included those related to pregnancy, childbirth and the puerperium period, neoplasms, diseases of the digestive, respiratory, circulatory, genitourinary and nervous systems, mental and behavioural disorders, and infectious and parasitic diseases. Population data were extracted from the Statistics Centre of Iran. An interrupted time series analysis with segmented regression was used to examine the impact of COVID-19 on hospital admissions. Findings Average monthly hospitalization rates fell for all nine categories of disease included in the study after the onset of the pandemic, with overall rates of 85.5 per 100,000 population in the period before the COVID-19 outbreak and 50.4 per 100,000 population after the outbreak began. The relative reduction in hospitalizations for the nine diseases was 56.4%. Regression analysis of monthly data indicated a sharp decrease in hospitalisations during the first month after the COVID-19 outbreak, which was statistically significant for all diseases (p
Published: 2022
Full Text: View/download PDF

4. Prevalence of prediabetes, diabetes, diabetes awareness, treatment, and its socioeconomic inequality in west of Iran

Author: Farhad Moradpour, Satar Rezaei, Bakhtiar Piroozi, Ghobad Moradi, Yousef Moradi, Negar Piri, and Azad Shokri
Subjects: Medicine, Science
Abstract: Abstract We aim to estimate the prevalence of prediabetes, and diabetes mellitus (DM). We estimated awareness, treatment, plasma glucose control, and associated factors in diabetes, as well as, socioeconomic-related inequality in the prevalence of diabetes and prediabetes. Data for adults aged 35–70 years were obtained from the baseline phase of the Dehgolan prospective cohort study (DehPCS). Diabetes status was determined as fasting plasma glucose (FPG) of ≥ 126 mg/dl and/or taking glucose lowering medication confirmed by a medical practitioner. Prediabetes was considered as 100 ≤ FPG ≤ 125 mg/dl. The relative concentration index (RCI) was used to exhibit socioeconomic inequality in the prevalence of prediabetes and DM. Prevalence of prediabetes and DM, diabetes awareness and treatment, and glycemic control of DM 18.22%, 10.00%, 78.50%, 68.91% and, 28.50%, respectively. Increasing age (p
Published: 2022
Full Text: View/download PDF

5. An assessment of the relationship between national rates of Covid‐19 incidence and mortality as reported to an international comparison database: An ecological study

Author: Azad Shokri, Hassan Mahmoodi, Bakhtiar Piroozi, Yousef Moradi, Farhad Moradpour, Ghobad Moradi, Ali Ebrazeh, and Parisa Daftarifard
Subjects: Covid‐19, fatality rate, incidence rate, mortality rate, World Development Indicators, Medicine
Abstract: Abstract Background and Aims Making a judgment only based on formal national reports can be misleading. We aimed to assess the relationship between countries' development indicators and reported coronavirus disease 2019 (Covid‐19)‐related incidences and death. Methods Covid‐19 related incidence and death cases were extracted from the updated Humanitarian Data Exchange Website on October 8, 2021. Univariable and multivariable negative binomial regression were utilized to investigate the relationship between development indicator and incidence and mortality from Covid‐19 by calculating the Incidence rate ratio (IRR), mortality rate ratio (MRR), and fatality risk ratio (FRR). Results Very high human development index (HDI) compared with low HDI (IRR:3.56; MRR:9.04), the proportion of physicians (IRR:1.20; MRR:1.16), besides extreme poverty (IRR:1.01; MRR:1.01) were independently correlated with the mortality and incidence rate of Covid‐19. Very high HDI and population density were inversely correlated with the fatality risk (FRRs of 0.54 and 0.99). The cross‐continental comparison shows Europe and the North Americas, had significantly higher incidence and mortality rates with IRR of 3.56 and 1.84 as well as MRRs of 6.65 and 3.62, respectively. Also, they inversely correlated with the fatality (FRR:0.84 and 0.91, respectively). Conclusion A positive correlation between the fatality rate ratio based on countries' development indicators and the reverse for the incidence and mortality rate was found. Developed countries with sensitive healthcare systems can diagnose infected cases as soon as possible. Also, the mortality rate of Covid‐19 will be accurately registered and reported. Due to more access to diagnostic tests, patients are diagnosed at the initial stages and will have a better opportunity to receive treatment. This leads to higher reports of incidence/and/or mortality rates and lower fatality of COVID‐19. In conclusion, more Covid‐19 incidence and mortality cases in developed countries can result from a more comprehensive care system and a more accurate recording procedure.
Published: 2023
Full Text: View/download PDF

6. Has Iran achieved the goal of reducing the prevalence of households faced with catastrophic health expenditure to 1%?: A national survey

Author: Azad Shokri, Amjad Mohamadi Bolbanabad, Satar Rezaei, Ghobad Moradi, and Bakhtiar Piroozi
Subjects: catastrophic health expenditure, financial protection, health care expenditure, Iran, Medicine
Abstract: Abstract Background and Aims One of the goals of the Islamic Republic of Iran is to reduce the prevalence of catastrophic health expenditures among Iranian households to 1% by the end of the sixth 5‐year development plan (2016−2021). This study was conducted to evaluate the level of access to this goal in the final year of this program. Methods A national cross‐sectional study was conducted on 2000 Iranian households in five provinces of Iran in 2021. Data were collected through interviews using the World Health Survey questionnaire. Data from households whose health care costs were more than 40% of their capacity to pay were included in the group of households with catastrophic health expanditure (CHE). Determinants of CHE were identified using univariate and multivariate regression analysis. Results 8.3% of households had experienced CHE. The variables of being a female head of household (odd ratio [OR] = 2.7), use of inpatient (OR = 1.82), dental (OR = 3.09), and rehabilitation services (OR = 6.12), families with disabled members (OR = 2.03) and low economic status of the households (OR = 10.73) were significantly associated with increased odds of facing CHE (p
Published: 2023
Full Text: View/download PDF

7. Epidemiology, clinical characteristics, and outcome of hospitalized COVID-19 patients in Kurdistan Province, Iran

Author: Abbas Aghaei, Bakhtiar Piroozi, Jalil Adabi, Hossein Safari, Sediq Jadidoleslami, Ghobad Moradi, Zeinab Bahmani, Reza Pira, Azad Shokri, and Shina Amirihosseini
Subjects: covid-19, sars-cov-2, Medicine
Abstract: BACKGROUND: The present study aimed to evaluate the epidemiology, clinical characteristics, and outcome of confirmed and suspected hospitalized coronavirus disease 2019 (COVID-19) cases in Iran hospitals affiliated with the Kurdistan University of Medical Sciences, Sanandaj, Iran. METHODS: This cross-sectional study was performed on all confirmed and suspected hospitalized COVID-19 cases in hospitals affiliated with the Kurdistan University of Medical Sciences between March and September 2020. Required data were obtained from the Hospital Intelligent Management System of hospitals. Independent t-test, chi-square test, Fisher's exact test, and one-way analysis of variance (ANOVA) were used for univariate analysis. Variables with P-value < 0.3 in univariate analysis were entered into the multivariate model, and the adjusted odds ratio (AOR) was calculated. RESULTS: Out of 9176 cases, 3210 cases (35.03%) were confirmed with COVID-19. The mean and standard deviation (SD) of age of the cases was 56.5 ± 19.3 in the confirmed and 57.5 ± 20.6 in the suspected cases. The confirmed and suspected cases’ mortality rate was 15.0% and 10.2%, respectively. In both groups, the most common symptoms of admission to the hospital were respiratory distress, coughing, fever, and muscular pain. The variables of older age, male gender, being transferred to hospitals by ambulance, intensive care unit (ICU) hospitalization, being intubated, blood oxygen saturation level less than 93, and having an underlying disease were statistically associated with an increased chance of death. CONCLUSION: The mortality rate among both confirmed and suspected hospitalized COVID-19 cases was significant, and this rate was higher for the confirmed cases. Death-related risk factors should be considered in resource allocation, management, and patient prioritization to reduce the outcome of death.
Published: 2022
Full Text: View/download PDF

8. Burden of COVID‐19 disease in Kurdistan province in west of Iran using disability‐adjusted life years

Author: Cyrus Alinia, Amjad M. Bolbanabad, Ghobad Moradi, Azad Shokri, Ebrahim Ghaderi, Jalil Adabi, Satar Rezaei, and Bakhtiar Piroozi
Subjects: burden of disease, COVID‐19, disability‐adjusted life years, Iran, years of life lost, Medicine
Abstract: Abstract Background and Aims During the coronavirus disease 2019 (COVID‐19) pandemic, about seven million people were infected with the disease, of which more than 133,000 died. Health policymakers need to know the extent and magnitude of the disease burden to decide on how much to allocate resources for disease control. The results of this investigation could be helpful in this field. Methods We used the secondary data released by the Kurdistan University of Medical Sciences between February 2020 to October 2021 to estimate the age‐sex standardized disability‐adjusted life years (DALY) by the sum of the years of life lived with disability (YLD) and the years of life lost (YLL). We also applied the local and specific values of the disease utility in the calculations. Results The total DALY was estimated at 23316.5 and 1385.5 per 100,000 populations The YLD and YLL constituted 1% and 99% of the total DALY, respectively. The DALY per 100,000 populations was highest in the men and people aged more than 65 years, but the prevalence was the highest in people under the age of 40. Conclusions Compared to the findings of the “burden of disease study 2019,” the burden of COVID‐19 in Iran is ranked first and eighth among communicable and noncommunicable diseases, respectively. Although the disease affects all groups, the elderly suffer the most from it. Given the very high YLL of COVID‐19, the best strategy to reduce the burden of COVID‐19 in subsequent waves should be to focus on preventing infection in the elderly population and reducing mortality.
Published: 2023
Full Text: View/download PDF

9. Prevalence of elective cosmetic surgery and its relationship with socioeconomic and mental health: A cross‐sectional study in west of Iran

Author: Ahoora Ghorbani, Bakhtiar Piroozi, Hossein Safari, Azad Shokri, Abbas Aqaei, Fayegh Yousefi, Maziar Nikouei, and Mahdi Rafieemovahhed
Subjects: cosmetic surgery, Iran, mental health, spiritual health, Medicine
Abstract: Abstract Background and Aims The aim of this study was to investigate the prevalence and desire towards performing elective cosmetic surgery and its relationship with socioeconomic, mental, and spiritual health in Sanandaj, the capital of Kurdistan province in the west of Iran. Methods This cross‐sectional descriptive‐analytical study was performed on 492 subjects in Sanandaj using multistage sampling method. Data collection tools included two checklists and two questionnaires. Data analysis was performed using the Chi‐square test and multiple logistics regression model by the help of SPSS software version 20. Results The mean (standard deviation) age of participants was 32.58 (9.67) years. The prevalence of cosmetic surgery and the desire to perform it were 12.8% (n = 63) and 19.1% (n = 94), respectively. The most common type of cosmetic surgery was rhinoplasty with 5.5% (n = 27). The prevalence of symptoms of mental disorders among people with cosmetic surgery and people willing to perform cosmetic surgery was significantly higher than all subjects (p
Published: 2022
Full Text: View/download PDF

10. Physician induced demand for knee replacement surgery in Iran

Author: Cyrus Alinia, Amirhossein Takian, Nasser Saravi, Hasan Yusefzadeh, Bakhtiar Piroozi, and Alireza Olyaeemanesh
Subjects: Knee replacement surgery, Physician induced demand, Iran, Panel data, GMM, Public aspects of medicine, RA1-1270
Abstract: Abstract Background The structure of the Iranian health system has raised this hypothesis that a part of the Knee Replacement Surgery (KRS) services are provided due to Physician-Induced Demand (PID). Methods This paper used an unbalanced individual panel data covering the steady-state 15,729 KRSs performed by 995 surgeons provided by the Armed Forces Insurance Organization at the provincial level over the 60 months (2014–2018). We use a generalized method of moment’s system (GMM-SYS) to obtain consistent and asymptotically efficient estimates, which provide a vital instrument for our dynamic panel data. Results The outcomes show that with unequal increasing orthopedic surgeons to population ratio, both the number and size of KRS services were increased significantly at a 1 % level. Given that the positive elasticity obtained for the service size was significantly larger than the number of services, the findings give strong support for the existence of PID in the Iran system for KRS care. Also, the raw and population-adjusted number of KRS, cost, and the surgery per active physician increased significantly at the monthly province level. Conclusions This is the first time that the existence of PID in the Iranian health system is investigated using approved econometric models. The findings indicate that the health system structure has been provided the conditions for aggressive, costly, and high-risk services such as KRS to be exposed to PID.
Published: 2021
Full Text: View/download PDF

11. Unmet health care needs among pregnant women during COVID‐19 pandemic and its determinants in Kurdistan province, Iran: A cross‐sectional study

Author: Abdorrahim Afkhamzadeh, Azad Shokri, Hossein Safari, Elham Nouri, Amjad Mohamadi Bolbanabad, Shina Amirihosseini, and Bakhtiar Piroozi
Subjects: access, COVID‐19, equity, unmet healthcare needs, utilization, Medicine
Abstract: Abstract Background and Aims The aim of this study was to assess unmet needs for health care and its determinants during COVID‐19 pandemic among pregnant women in Iran. Methods This cross‐sectional study was performed among pregnant women in Kurdistan province in 2020 with a sample size of 800 people who were selected by multistage sampling method. Data were collected using a structured questionnaire that was completed through interviews. Also, multiple logistic regression was used to determine the relationship between independent variables and outcome variable. Statistical tests were performed using Stata software package. Results The highest unmet needs for health care were related to dental services with 66%, rehabilitation services with 58.6%, and psychological services with 43.2% and the lowest were related to hospital services with 12%, midwifery services with 15.6%, and physician visit services with 39.1%. The most important reasons for unmet needs for health care were fear of getting COVID‐19 and the cost of the services. The variables of age group and spouse education for physician visit services; age group for midwifery services; age group, education and employment status for dental services; age group, supplementary insurance and economic status for rehabilitation services; and age group and economic status for psychological services were significantly associated with unmet needs for health care (p
Published: 2022
Full Text: View/download PDF

12. The health-related quality of life in Iranian patients with COVID-19

Author: Cyrus Alinia, Safura Yaghmaei, Farman Zahir Abdullah, Asad Ahmadi, Nasrin Samadi, Sima Pourteymour, Hossein Safari, Hassan Mahmoudi, Ghobad Moradi, and Bakhtiar Piroozi
Subjects: COVID-19, Health-related quality of life, Utility value, Disease disutility, Infectious and parasitic diseases, RC109-216
Abstract: Abstract Background COVID-19 is a public health emergency with a high mortality rate and it reduces the patient’s Health-Related Quality of Life (HRQoL) significantly. This effect is measured in the current study. Methods In a cross-sectional study in Iran, 320 randomly selected treated patients from COVID-19 were studied. To collect the required data, we applied a questionnaire that included socio-demographic factors, clinical characteristics, and questions on the patients’ HRQoL. Time trade-off (TTO) approach was used to measure the lost HRQoL attributed to COVID-19. Besides, we applied a two-limit Tobit regression model to determine the effects of the socio-demographic factors on patients’ health utility and the visual analogue scale approach was used to estimate the perceived total current health status. Results The overall mean (SE) and median (IQR) of the health utility values were 0.863 (0.01) and 0.909 (0.21) respectively. These values for the traders (those who were willing to lose a part of their remaining time of life to avoid the disease) were estimated at 0.793 (0.01) and 0.848 (0.17), respectively. The lowest amount of utility value belonged to the elderly (mean (SE) = 0.742 (0.04); median (IQR) = 0.765 (0.42)) and those living in rural areas (mean (SE)) = 0.804 (0.03); median (IQR) = 0.877 (0.30)). The univariate analysis showed that age, place of residence, and household size had a statistically significant effect on health utility. Moreover, findings of the regression analysis indicated that the participants’ age and hospitalization status were the key determinants of COVID-19 health utility value. Conclusion COVID-19 is associated with a substantial and measurable decrease in HRQoL. This decline in HRQoL can be directly compared with that induced by systemic health states.
Published: 2021
Full Text: View/download PDF

13. The Burden of Stroke in Kurdistan Province, Iran From 2011 to 2017

Author: Shahram Moradi, Ghobad Moradi, and Bakhtiar Piroozi
Subjects: stroke, burden of disease, incidence, non-communicable diseases, iran, Medicine, Public aspects of medicine, RA1-1270
Abstract: Objectives The aim of this study was to calculate the burden of stroke in Kurdistan Province, Iran between 2011 and 2017. Methods Incidence data extracted from the hospital information system of Kurdistan Province and death data extracted from the system of registration and classification of causes of death were used in a cross-sectional study. The World Health Organization method was used to calculate disability-adjusted life years (DALYs). Results The burden of stroke increased from 2453.44 DALYs in 2011 to 5269.68 in 2017, the years of life lost increased from 2381.57 in 2011 to 5109.68 in 2017, and the years of healthy life lost due to disability increased from 71.87 in 2011 to 159.99 in 2017. The DALYs of ischaemic stroke exceeded those of haemorrhagic stroke. The burden of disease, new cases, and deaths doubled during the study period. The age-standardised incidence rate of ischaemic stroke and haemorrhagic stroke in 2017 was 21.72 and 20.72 per 100 000 population, respectively. Conclusions The burden of stroke is increasing in Kurdistan Province. Since health services in Iran are based on treatment, steps are needed to revise the current treatment services for stroke and to improve the quality of services. Policy-makers and managers of the health system need to plan to reduce the known risk factors for stroke in the community. In addition to preventive interventions, efficient and up-to-date interventions are recommended for the rapid diagnosis and treatment of stroke patients in hospitals. Along with therapeutic interventions, preventive interventions can help reduce the stroke burden.
Published: 2021
Full Text: View/download PDF

14. Burden of pediatric asthma in Kurdistan Province, West of Iran

Author: Rasoul Nasiri-Kalmarzi and Bakhtiar Piroozi
Subjects: asthma, pediatrics, children, burden of illness, iran, Medicine
Abstract: BACKGROUND: Asthma is the most common chronic respiratory disease (CRD) and one of the most serious and important pediatric diseases in developing countries. The present study aims to estimate the burden of asthma among children in Kurdistan Province, Iran. METHODS: Disability-adjusted life year (DALY) was used in order to estimate the burden of asthma. In a cross-sectional study, with a sample size of 4000, and using the multi-stage sampling method and Asthma and Allergies in Childhood (ISAAC) questionnaire, the prevalence of asthma was estimated for two 6-7 and 13-14 age groups in Kurdistan Province in 2013. In addition, some necessary data were extracted from the death registration system in Kurdistan Provincial Health Center and Statistical Center of Iran (SCI). RESULTS: Burden of asthma for 6-7 age group was 71.6 DALYs in boys (2.77 DALYs per 1000 population) and 48 in girls (2.22 DALYs per 1000 population) with a total burden of 119.6 DALYs (2.52 DALYs per 1000 population). Moreover, its burden for 13-14 age group was 121.1 DALYs in boys (4.86 DALYs per 1000 population) and 82.3 in girls (3.98 DALYs per 1000 population) with a total burden of 203.4 DALYs (4.46 DALYs per 1000 population). CONCLUSION: Considering the significant prevalence of asthma and its burden among children in Kurdistan Province, it is suggested that prevention and management of this disease be considered as a priority by policy makers and in health programs, in addition to attempting to prevent and reduce its burden by setting out effective interventions.
Published: 2021
Full Text: View/download PDF

15. The prevalence of physical inactivity in Iranian adolescents and the impact of economic and social inequalities on it: results of a National Study in 2018

Author: Ghobad Moradi, Farideh Mostafavi, Bakhtiar Piroozi, Bushra Zareie, Marzieh Mahboobi, and Mohammad Aziz Rasouli
Subjects: Socioeconomic status, Inequalities, Physical inactivity, Concentration index, Adolescent, Iran, Public aspects of medicine, RA1-1270
Abstract: Abstract Background This study aims to determine the prevalence of physical inactivity in Iranian adolescents aged 10–12 years and the impact of socioeconomic inequality on it. Methods In this descriptive study, the study population consisted of 10–12 years old adolescents from an Iranian population from Kurdistan, Fars and Markazi provinces in 2018. The sample size was 1590 individuals. The sampling method was cluster sampling. Data was collected using demographic questionnaire, modifiable activity questionnaire (MAQ) and socioeconomic questionnaire. Cut points on the MAQ for light activity, moderate activity and heavy activity were MET 6, respectively. Linear and logistic regression were used to estimate the final model and the Oaxaca analysis method was applied. All analyses were performed in Stata/SE 14.0. Results Of the 1590 participants, 52.82% were male. The results showed that 25.79% of the subjects were physically inactive and 7.30% engaged in moderate physical activity during the week. The average physical activity during 1 week was more in boys than in girls (P-value
Published: 2020
Full Text: View/download PDF

16. Assessing horizontal equity in health care utilization in Iran: a decomposition analysis

Author: Farideh Mostafavi, Bakhtiar Piroozi, Paola Mosquera, Reza Majdzadeh, and Ghobad Moradi
Subjects: Health inequalities, SOCIO-ECONOMIC, SOCIAL INEQUALITIES, HEALTH SERVICES, Public aspects of medicine, RA1-1270
Abstract: Abstract Background Despite the goal of horizontal equity in Iran, little is known about it. This study aimed i) to assess socioeconomic inequality and horizontal inequity in the healthcare utilization; and ii) to explore the contribution of need and non-need variables to the observed inequalities. Methods This study used national cross sectional dataset from Utilization of Health Services survey in 2015. Concentration Index (C), Concentration Curve (CC) and Horizontal Inequity index (HI) were calculated to measure inequality in inpatient and outpatient health care utilization. Decomposition analysis was used to determine the contribution of need and non-need factors to the observed inequalities. Result Results showed the pro-poor inpatient services in both rural (C = − 0.079) and non-rural areas (C = − 0.096) and the pro-rich outpatient services in both rural (C = 0.038) and non-rural (C = 0.007). After controlling for need factors, HI was positive and significant for outpatient services in rural (HI = 0.039) and non-rural (HI = 0.008), indicating that for given need, the better off especially in rural make greater use of outpatient services. The HI was pro-poor for inpatient services in both rural (HI = − 0.068) and non-rural (HI = -0.090), was significant only in non-rural area. Non-need factors were the most important contributors to explain inequalities in the decomposition analysis. Conclusion Disentangle the different contribution of determinants, as well as greater HI in rural areas for outpatient and in non-rural areas for inpatient services, provide helpful information for decision makers to re-design policy and re-distribute resource allocation in order to reduce the socioeconomic gradient in health care utilization.
Published: 2020
Full Text: View/download PDF

17. Estimating utility value for female genital mutilation

Author: Cyrus Alinia, Bakhtiar Piroozi, Fariba Jahanbin, Hossein Safari, Amjad Mohamadi-Bolbanabad, Ali Kazemi-Karyani, Ghobad Moradi, Fariba Farhadifar, and Mohammad Ebrahimi
Subjects: Female genital mutilation, Circumcision, Disease utility, DALY, Women’s health, Public aspects of medicine, RA1-1270
Abstract: Abstract Background Female genital mutilation/cutting (FGM/C) is a clear violation of women’s rights and can have adverse and irreversible health effects as well. Worldwide, more than 200 million women and girls have undergone FGM/C. Utility value of FGM/C has not been estimated yet, so we designed this study to extract the health utility value of FGM/C for the first time in the world. Methods In a cross-sectional study in Iran, 125 girls and women who underwent FGM/C procedure were examined by the trained midwives in order to determine its type. In addition, a questionnaire was completed for identifying the socio-demographic factors and extracting the health utility of these individuals. Health utility was measured using Time Trade-off method and also to determine the effects of the socio-demographic factors on the health utility a two-limit censored regression model was applied. Results The mean and median of the health utility of women with FGM/C were 0.971 (SE: 0.003) and 0.968 (IQR: 1–0.95), respectively. Number of non-traders was 58 (46.4%) who reported perfect health utility. However, the mean of health utility among traders was 0.946 (SE: 0.002). Only type 1 (Clitoridectomy) and type 2 (Excision) FGM/C were seen in this study. Women with Type 1 FGM/C had significantly lower health utility value (Mean: 0.968, Median: 0.957) than their type 2 counterparts (Mean: 0.987, Median: 1.00). Moreover, women in the age group of 31–45 years (Mean: 0.962, Median: 0.956), single (Mean: 0.950, Median: 0.954), divorced (Mean: 0.951, Median: 0.950), employed (Mean: 0.959, Median: 0.956), and with supplementary insurance (Mean: 0.962, Median: 0.950) had significantly lower health utility than their counterparts. Conclusion FGM/C affects physical and psychological well-being of these individuals, resulting in a lack of personal and marital satisfaction, which ultimately leads to a 3% reduction in their health related quality of life. Therefore, preventing from this practice is very important and should be considered by health system policy makers more than before.
Published: 2020
Full Text: View/download PDF

18. The Dehgolan Prospective Cohort Study (DehPCS) on non-communicable diseases in a Kurdish community in the west of Iran

Author: Farhad Moradpour, Ebrahim Ghaderi, Ghobad Moradi, Mojdeh Zarei, Amjad Mohamadi Bolbanabad, Bakhtiar Piroozi, and Azad Shokri
Subjects: cohort study, non communicable disease, persian cohort, risk factors, Medicine
Abstract: The Dehgolan Prospective Cohort Study (DehPCS) was conducted to examine and identify risk factors for the most prevalent non-communicable diseases (NCDs). In addition, in order to examine participants’ health status, socioeconomic status, behavioral factors, nutritional status, and environmental exposures, the DehPCS collected, analyzed, and stored blood, urine, nail, and hair samples to conduct genetic studies and identify biomarkers and other biological determinants of NCDs. In total, 3,996 adults aged 35 to 70 from the general population participated in the study from February 2018 to March 2019. Of them, 43.7% were women. The first follow-up wave was conducted with 3,995 participants. Information on a wide range of variables was collected, including on socioeconomic status, lifestyle, nutritional status, habits, physical examination findings, medication use, and medical history. Proxy variables such as body mass index, metabolic equivalent task score, wealth index, and macronutrients and micronutrients were calculated. The most common self-reported diseases in descending order were kidney stones, hypertension, and fatty liver. The prevalence of diabetes and hypertension was 9.3% and 33.4%, respectively. All data, samples, and measurements will be collected again at 5-year intervals. Thus, it will be possible to examine time-dependent changes in the risk factors of NCDs. The DehPCS can be used to study the relationships among genetics, lifestyle, socioeconomic status, and environmental risk factors and the most prevalent NCDs in case-cohort studies using a nested case-control design that will be applied to the cohort infrastructure. Researchers can also submit pre-proposals via the following web address: http://c.ddrc.ac.ir/persianaccess/Account/Login.
Published: 2021
Full Text: View/download PDF

19. The Burden of Cancer in a Sample of Iranian Population

Author: Shahram Moradi, Ghobad Moradi, Bakhtiar Piroozi, Ebrahim Ghaderi, Daem Roshani, and Arian Azadnia
Subjects: Burden of disease, Gastrointestinal tract, Cancer, Noncommunicable disease, Iran, Public aspects of medicine, RA1-1270
Abstract: Background: We aimed at estimating the burden of cancer in Kurdistan Province, western Iran during 2011-2017. Methods: In this cross-sectional study, incidence data extracted from the cancer registry system and death data were extracted from the system of registration and classification of causes of death of Kurdistan Province. We applied the WHO’ methods to calculate the disability-adjusted life year (DALYs). Results: The burden of cancer increased from a DALYs of 12309 in 2011 to 13969 in 2017, the YLL from 11644 in 2011 to 12951 in 2017 and the YLD from 665 in 2011 to 1018 in 2017. The top five cancers, according to DALYs (%) in both sex during 2011-2017 were: stomach (25%), lung (14%), liver (9%), esophagus (6%), and colon (6%). The most burden of cancer related to gastrointestinal tract (54% vs. 45%). Totally, more than 25% of DALYs were related to stomach cancer. Conclusion: The increasing DALYs of cancer in Kurdistan Province is one of the major public health concerns as in most developed countries. More than half of the burden of cancer in the Kurdistan Province is related to gastrointestinal tract. Stomach cancer, is accounting for more than 25% of the burden in both sexes. Urgent policy, management and public health measures such as general education, screening, early detection and effective treatment are recommended to reduce the burden of cancers and especially gastrointestinal tract malignancies.
Published: 2021
Full Text: View/download PDF

20. The Burden of Cardiovascular Diseases in the Kurdistan Province, Iran, from 2011 through 2017

Author: Shahram Moradi, Ghobad Moradi, and Bakhtiar Piroozi
Subjects: Cardiovascular diseases, Incidence, Iran, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Background: Calculating the burden of diseases is essential for their monitoring. The burden of cardiovascular diseases in Kurdistan Province has not been reported. This study aimed at calculating the burden of cardiovascular diseases in the Kurdistan Province from 2011 through 2017. Methods: In this cross-sectional study, incidence data were extracted from registration systems. The methods of the World Health Organization (WHO) were employed to calculate disability-adjusted life years (DALYs) of cardiovascular diseases in the Kurdistan Province. DALYs were calculated by summing the years of life lost (YLLs) and the years of life lived with disability (YLDs) for sex, age group, and year. Results: The burden of cardiovascular diseases increased from 18569.1 DALYs in 2011 to 34929.8 DALYs in 2017. The highest increase and the largest decrease in DALY according to the all age-standardized DALYs index were related to acute myocardial infarction and heart failure in women, respectively. The highest DALYs in both sexes were in the age group of over 80 years. Conclusion: The burden of cardiovascular diseases is increasing in the Iranian province of Kurdistan. It is, therefore, essential to implement appropriate and adequate interventions such as lifestyle modification, extensive screening, public education promotion, and operational plan development. We hope our results will aid decision-makers in performing urgent interventions.
Published: 2021
Full Text: View/download PDF

21. Evaluating the quality of care for patients with type 2 diabetes mellitus based on the HbA1c: A national survey in Iran

Author: Ghobad Moradi, Azad Shokri, Amjad Mohamadi-Bolbanabad, Bushra Zareie, and Bakhtiar Piroozi
Subjects: Diabetes mellitus type 2, HbA1c, Quality of health care, Iran, Science (General), Q1-390, Social sciences (General), H1-99
Abstract: Objective: The present study was conducted to evaluate the quality of care for type2 diabetic patients based on the HbA1c in Iran. Materials and methods: This cross-sectional study was conducted in 2019 among patients with type 2 diabetes in Iran. The data were collected through a three-part questionnaire including demographic information, disease-related records, and HbA1C status of patients. Multiple logistic regression was used to investigate the relationship between the outcome variable (HbA1c status) and the independent variables in Stata 12. Results: The mean HBA1c was 8.01 ± 1.76% among 1,198 diabetic patients, and more than 66% of them had HBA1c above 7%, i.e. they had uncontrolled blood sugar levels. HBA1c has the highest average among people with more than 10 years of diabetes (8.47 ± 1.77%), self-employed people (8.36 ± 1.94%), illiterate people or those with elementary education (8.13 ± 1.76%) and people with poor economic status (8.12 ± 1.79%). Also, in the final model, people with more than 10 years of disease history had the highest prevalence of HBA1C > 7 with a chance ratio of 3.28 (P < 0.001, 95%CI: 2.37–4.53) and followed by illiterate people or those with elementary education with a chance ratio of 1.6 (P = 0.020, 95%CI: 1.08–2.39) compared to those with high school diploma or academic education. Conclusion: The prevalence of adverse HBA1c in 66% of the studied subjects indicates an inappropriate status of diabetes control in Iran. This indicates the poor quality of services provided to the diabetics. This is a warning sign and requires appropriate interventions to improve the quality of services provided to diabetic patients.
Published: 2021
Full Text: View/download PDF

22. Mapping geographical inequalities in oral rehydration therapy coverage in low-income and middle-income countries, 2000–17

Author: Kirsten E Wiens, Paulina A Lindstedt, Brigette F Blacker, Kimberly B Johnson, Mathew M Baumann, Lauren E Schaeffer, Hedayat Abbastabar, Sr, Foad Abd-Allah, Ahmed Abdelalim, Ibrahim Abdollahpour, Kedir Hussein Abegaz, Ayenew Negesse Abejie, Lucas Guimarães Abreu, Michael R M Abrigo, Ahmed Abualhasan, Manfred Mario Kokou Accrombessi, Dilaram Acharya, Maryam Adabi, Abdu A Adamu, Oladimeji M Adebayo, Rufus Adesoji Adedoyin, Sr, Victor Adekanmbi, Olatunji O Adetokunboh, Sr, Beyene Meressa Adhena, Mohsen Afarideh, Sohail Ahmad, Keivan Ahmadi, Anwar E Ahmed, Muktar Beshir Ahmed, Rushdia Ahmed, Temesgen Yihunie Akalu, Fares Alahdab, Ziyad Al-Aly, Noore Alam, Sr, Samiah Alam, Genet Melak Alamene, Turki M Alanzi, Jacqueline Elizabeth Alcalde-Rabanal, Beriwan Abdulqadir Ali, Mehran Alijanzadeh, Vahid Alipour, Syed Mohamed Aljunid, Ali Almasi, Sr, Amir Almasi-Hashiani, Hesham M Al-Mekhlafi, Khalid A Altirkawi, Nelson Alvis-Guzman, Nelson J Alvis-Zakzuk, Saeed Amini, Sr, Arianna Maever L Amit, Sr, Catalina Liliana Andrei, Sr, Mina Anjomshoa, Amir Anoushiravani, Sr, Fereshteh Ansari, Carl Abelardo T Antonio, Benny Antony, Ernoiz Antriyandarti, Jalal Arabloo, Hany Mohamed Amin Aref, Sr, Olatunde Aremu, Bahram Armoon, Amit Arora, Sr, Krishna K Aryal, Afsaneh Arzani, Mehran Asadi-Aliabadi, Hagos Tasew Atalay, Seyyed Shamsadin Athari, Sr, Seyyede Masoume Athari, Sachin R Atre, Marcel Ausloos, Nefsu Awoke, Beatriz Paulina Ayala Quintanilla, Getinet Ayano, Martin Amogre Ayanore, Sr, Yared Asmare Aynalem IV, Samad Azari, Peter S Azzopardi, Ebrahim Babaee, Tesleem Kayode Babalola, Alaa Badawi, Sr, Mohan Bairwa, Shankar M Bakkannavar, Senthilkumar Balakrishnan, Ayele Geleto Bali, Maciej Banach, Sr, Joseph Adel Mattar Banoub, Sr, Aleksandra Barac, Till Winfried Bärnighausen, Huda Basaleem, Sanjay Basu, Vo Dinh Bay, Mohsen Bayati, Estifanos Baye, Neeraj Bedi, Mahya Mahya Beheshti Beheshti, Masoud Behzadifar, Meysam Behzadifar, Bayu Begashaw Bekele, Yaschilal Muche Belayneh, Michellr L Bell, Sr, Derrick A Bennett, Sr, Dessalegn Ajema Berbada, Robert S Bernstein, Anusha Ganapati Bhat, Sr, Krittika Bhattacharyya, Sr, Suraj Bhattarai, Soumyadeep Bhaumik, Zulfiqar A Bhutta, Ali Bijani, Boris Bikbov, Binyam Minuye Birihane IV, Raaj Kishore Biswas, Somayeh Bohlouli, Hunduma Amensisa Amensisa Bojia I, Soufiane Boufous, Oliver J Brady, Nicola Luigi Bragazzi, Andrey Nikolaevich Briko, Nikolay Ivanovich Briko, Gabrielle B Britton, Sharath Burugina Nagaraja, Sr, Reinhard Busse, Sr, Zahid A Butt, Luis LA Alberto Cámera, Sr, Ismael R Campos-Nonato, Sr, Jorge Cano, Josip Car, Rosario Cárdenas, Felix Carvalho, Sr, Carlos A Castañeda-Orjuela, Sr, Franz Castro, Wagaye Fentahun Chanie, Sr, Pranab Chatterjee, Vijay Kumar Chattu, Tesfaye Yitna Yitna Chichiabellu, Jr, Ken Lee Chin, Sr, Devasahayam J Christopher, Dinh-Toi Chu, Natalie Maria Cormier, Vera Marisa Costa, Carlos Culquichicon, Matiwos Soboka Daba, Giovanni Damiani, Sr, Lalit Dandona, Rakhi Dandona, Anh Kim Dang, Aso Mohammad Darwesh, Amira Hamed Darwish, Ahmad Daryani, Sr, Jai K Das, Rajat Das Gupta, Aditya Prasad Dash, Gail Davey, Claudio Alberto Dávila-Cervantes, Adrian C Davis, Sr, Dragos Virgil Davitoiu, Fernando Pio De la Hoz, Asmamaw Bizuneh Demis, Dereje Bayissa Demissie, Getu Debalkie Demissie, Gebre Teklemariam Demoz, Sr, Edgar Denova-Gutiérrez, Sr, Kebede Deribe, Sr, Assefa Desalew, Aniruddha Deshpande, Samath Dhamminda Dharmaratne, Preeti Dhillon, Meghnath Dhimal, Govinda Prasad Dhungana, Daniel Diaz, Sr, Isaac Oluwafemi Dipeolu, Shirin Djalalinia, Kerrie E Doyle, Eleonora Dubljanin, Bereket Duko, Andre Rodrigues Duraes, Mohammad Ebrahimi Kalan, Hisham Atan Edinur, Sr, Andem Effiong, Sr, Aziz Eftekhari, Nevine El Nahas, Iman El Sayed, Maysaa El Sayed Zaki, Maha El Tantawi, Teshome Bekele Elema I, Hala Rashad Elhabashy, Sr, Shaimaa I El-Jaafary, Hajer Elkout, Aisha Elsharkawy, Iqbal RF Elyazar, Aklilu Endalamaw, Daniel Adane Endalew, Sr, Sharareh Eskandarieh, Alireza Esteghamati, Sadaf Esteghamati, Sr, Arash Etemadi, Oluchi Ezekannagha, Mohammad Fareed, Roghiyeh Faridnia, Farshad Farzadfar, Mehdi Fazlzadeh, Valery L Feigin, Sr, Seyed-Mohammad Fereshtehnejad, Eduarda Fernandes, Irina Filip, Florian Fischer, Nataliya A Foigt, Morenike Oluwatoyin Folayan, Sr, Masoud Foroutan, Richard Charles Franklin, Takeshi Fukumoto, Mohamed M Gad, Reta Tsegaye Gayesa, Teshome Gebre, Sr, Ketema Bizuwork Gebremedhin, Gebreamlak Gebremedhn Gebremeskel, Sr, Hailay Abrha Gesesew, Kebede Embaye Gezae, Keyghobad Ghadiri, Sr, Ahmad Ghashghaee, Pramesh Raj Ghimire, Sr, Paramjit Singh Gill, Sr, Tiffany K Gill, Themba G G Ginindza, Nelson G M Gomes, Sameer Vali Gopalani, Alessandra C Goulart, Bárbara Niegia Garcia Goulart, Ayman Grada, Mohammed Ibrahim Mohialdeen Gubari, Harish Chander Gugnani, Sr, Davide Guido, Rafael Alves Guimarães, Yuming Guo, Sr, Rajeev Gupta, Nima Hafezi-Nejad, Dessalegn H Haile, Sr, Gessessew Bugssa Hailu, Arvin Haj-Mirzaian, Arya Haj-Mirzaian, Randah R Hamadeh, Samer Hamidi, Demelash Woldeyohannes Handiso, Hamidreza Haririan, Sr, Ninuk Hariyani, Ahmed I Hasaballah, Md Mehedi Hasan, Edris Hasanpoor, Amir Hasanzadeh, Hadi Hassankhani, Hamid Yimam Hassen, Mohamed I Hegazy, Behzad Heibati, Behnam Heidari, Delia Hendrie, Sr, Nathaniel J Henry, Claudiu Herteliu, Fatemeh Heydarpour, Hagos Degefa de Hidru I, Thomas R Hird, Chi Linh Hoang, Enayatollah Homaie Rad, Praveen Hoogar, Mohammad Hoseini, Naznin Hossain, Mostafa Hosseini, Mehdi Hosseinzadeh, Mowafa Househ, Mohamed Hsairi, Sr, Guoqing Hu, Mohammedaman Mama Hussen, Segun Emmanuel Ibitoye, Ehimario U Igumbor, Sr, Olayinka Stephen Ilesanmi, Milena D Ilic, Mohammad Hasan Imani-Nasab, Usman Iqbal, Seyed Sina Naghibi Irvani, Sheikh Mohammed Shariful Islam, Chinwe Juliana Iwu, Neda Izadi, Sr, Anelisa Jaca, Nader Jahanmehr, Mihajlo Jakovljevic, Amir Jalali, Achala Upendra Jayatilleke, Ravi Prakash Jha, Vivekanand Jha, John S Ji, Sr, Jost B Jonas, Jacek Jerzy Jozwiak, Ali Kabir, Zubair Kabir, Sr, Amaha Kahsay, Hamed Kalani, Tanuj Kanchan, Behzad Karami Matin, André Karch, Mohd Anisul Karim, Hamidreza Karimi-Sari, Surendra Karki, Amir Kasaeian, Gebremicheal Gebreslassie Kasahun, Yawukal chane Kasahun, Habtamu Kebebe Kasaye, Gebrehiwot G Kassa, Getachew Mullu Kassa, Gbenga A Kayode, Ali Kazemi Karyani, Mihiretu M Kebede, Peter Njenga Keiyoro, Abraham Getachew Kelbore, Sr, Andre Pascal Kengne, Sr, Daniel Bekele Ketema, Yousef Saleh Khader, Morteza Abdullatif Khafaie, Nauman Khalid, Rovshan Khalilov, Ejaz Ahmad Khan, Sr, Junaid Khan, Md Nuruzzaman Khan I, Muhammad Shahzeb Khan, Khaled Khatab, Sr, Amir M Khater, Mona M Khater, Maryam Khayamzadeh, Mohammad Khazaei, Salman Khazaei, Mohammad Hossein Khosravi, Jagdish Khubchandani, Ali Kiadaliri, Yun Jin Kim, Ruth W Kimokoti, Adnan Kisa, Sezer Kisa, Niranjan Kissoon, Sr, Shivakumar KM Marulasiddaiah M KMShivakumar, Sr, Sonali Kochhar, Tufa Kolola, Sr, Hamidreza Komaki, Soewarta Kosen, Parvaiz A Koul, Ai Koyanagi, Moritz U G Kraemer, Kewal Krishan, Nuworza Kugbey, G Anil Kumar, Manasi Kumar, Sr, Pushpendra Kumar, Vivek Kumar, Dian Kusuma, Carlo La Vecchia, Ben Lacey, Sheetal D Lad, Dharmesh Kumar Lal, Felix Lam, Faris Hasan Lami, Sr, Prabhat Lamichhane, Van Charles Lansingh, Savita Lasrado, Avula Laxmaiah, Paul H Lee, Sr, Kate E LeGrand, Mostafa Leili, Tsegaye Lolaso Lenjebo, Cheru Tesema Leshargie, Sr, Aubrey J Levine, Shanshan Li, Sr, Shai Linn, Shiwei Liu, Simin Liu, Rakesh Lodha, Joshua Longbottom, Jaifred Christian F Lopez, Hassan Magdy Abd El Razek, Muhammed Magdy Abd El Razek, D R Mahadeshwara Prasad, Phetole Walter Mahasha, Sr, Narayan B Mahotra, Azeem Majeed, Reza Malekzadeh, Sr, Deborah Carvalho Malta, Abdullah A Mamun, Sr, Navid Manafi, Sr, Ana Laura Manda, Narendar Dawani Dawanu Manohar, Mohammad Ali Mansournia, Chabila Christopher Mapoma, Joemer C Maravilla, Gabriel Martinez, Sr, Santi Martini, Francisco Rogerlândio Martins-Melo, Anthony Masaka, Benjamin Ballard Massenburg, Manu Raj Mathur, Benjamin K Mayala, Mohsen Mazidi, Colm McAlinden, Birhanu Geta Meharie, Man Mohan Mehndiratta, Sr, Kala M Mehta, Tefera C Chane Mekonnen, Gebrekiros Gebremichael Meles, Peter T N Memiah, Ziad A Memish, Sr, Walter Mendoza, Ritesh G Menezes, Seid Tiku Mereta, Tuomo J Meretoja, Sr, Tomislav Mestrovic, Bartosz Miazgowski, Kebadnew Mulatu Mihretie, Sr, Ted R Miller, GK Mini, Erkin M Mirrakhimov, Babak Moazen, Bahram Mohajer, Amjad Mohamadi-Bolbanabad, Dara K Mohammad, Karzan Abdulmuhsin Mohammad, Yousef Mohammad, Naser Mohammad Gholi Mezerji, Roghayeh Mohammadibakhsh, Noushin Mohammadifard, Jemal Abdu Mohammed, Sr, Shafiu Mohammed, Farnam Mohebi, Ali H Mokdad, Mariam Molokhia, Lorenzo Monasta, Yoshan Moodley, Sr, Catrin E Moore, Sr, Ghobad Moradi, Masoud Moradi, Mohammad Moradi-Joo, Maziar Moradi-Lakeh, Paula Moraga, Linda Morales, Ilais Moreno Velásquez, Abbas Mosapour, Simin Mouodi, Seyyed Meysam Mousavi, Miliva Mozaffor I, Kindie Fentahun Muchie, Sr, Getahun Fentaw Mulaw, Sr, Sandra B Munro, Moses K Muriithi, Christopher J L Murray, GVS Murthy, Kamarul Imran Musa, Ghulam Mustafa, Sr, Saravanan Muthupandian, Sr, Ashraf F Nabhan, Mehdi Naderi, Ahamarshan Jayaraman Nagarajan, Kovin S Naidoo, Gurudatta Naik, Farid Najafi, Vinay Nangia, Sr, Jobert Richie Nansseu, Bruno Ramos Nascimento, Sr, Javad Nazari, Duduzile Edith Ndwandwe, Sr, Ionut Negoi, Sr, Henok Biresaw Netsere Netsere, Sr, Josephine W Ngunjiri, Sr, Cuong Tat Nguyen, Huong Lan Thi Nguyen, Trang Huyen Nguyen, Dabere Nigatu, Solomon Gedlu Nigatu, Dina Nur Anggraini Ningrum, Chukwudi A Nnaji, Marzieh Nojomi, Vuong Minh Nong, Ole F Norheim, Sr, Jean Jacques Noubiap, Soraya Nouraei Motlagh, Bogdan Oancea, Okechukwu Samuel Ogah, Felix Akpojene Ogbo, In-Hwan Oh, Andrew T Olagunju, Tinuke O Olagunju, Bolajoko Olubukunola Olusanya, Jacob Olusegun Olusanya, Obinna E Onwujekwe, Sr, Eyal Oren, Doris V V Ortega-Altamirano, Sr, Osayomwanbo Osarenotor, Frank B Osei, Sr, Mayowa O Owolabi, Mahesh P A, Sr, Jagadish Rao Padubidri, Smita Pakhale, Sangram Kishor Patel, Angel J Paternina-Caicedo, Sr, Ashish Pathak, Sr, George C Patton, Deepak Paudel, Sr, Kebreab Paulos, Sr, Veincent Christian Filipino Pepito, Alexandre Pereira, Norberto Perico, Aslam Pervaiz, Julia Moreira Pescarini, Bakhtiar Piroozi, Meghdad Pirsaheb, Maarten J Postma, Hadi Pourjafar, Farshad Pourmalek, Sr, Akram Pourshams, Hossein Poustchi, Sergio I Prada, Sr, Narayan Prasad, Liliana Preotescu, Hedley Quintana, Navid Rabiee, Amir Radfar, Alireza Rafiei, Fakher Rahim, Afarin Rahimi-Movaghar, Vafa Rahimi-Movaghar, Mohammad Hifz Ur Rahman, Muhammad Aziz Rahman, SHAFIUR Rahman, Fatemeh Rajati, Sr, Saleem Muhammad Rana, Sr, Chhabi Lal Ranabhat, Davide Rasella, David Laith Rawaf, Salman Rawaf, Sr, Lal Rawal, Wasiq Faraz Rawasia, Vishnu Renjith, Andre M N Renzaho, Sr, Serge Resnikoff, Sr, Melese Abate Reta, Negar Rezaei, Mohammad sadegh Rezai, Seyed Mohammad Riahi, Ana Isabel Ribeiro, Jennifer Rickard, Sr, Maria Rios-Blancas, Leonardo Roever, Luca Ronfani, Elias Merdassa Roro, Sr, Jennifer M Ross, Enrico Rubagotti, Salvatore Rubino, Anas M Saad, Yogesh Damodar Sabde, Siamak Sabour, Ehsan Sadeghi, Sr, Yahya Safari, Roya Safari-Faramani, Rajesh Sagar, Amirhossein Sahebkar, Mohammad Ali Sahraian, S Mohammad Sajadi, Mohammad Reza Salahshoor, Nasir Salam, Sr, Payman Salamati, Hosni Salem, Marwa R Rashad Salem I, Yahya Salimi, Hamideh Salimzadeh, Abdallah M Samy, Juan Sanabria, Sr, Milena M Santric-Milicevic, Bruno Piassi Sao Jose, Sivan Yegnanarayana Iyer Saraswathy, Kaushik Sarkar, Sr, Abdur Razzaque Sarker, Nizal Sarrafzadegan I, Benn Sartorius, Brijesh Sathian, Thirunavukkarasu Sathish, Monika Sawhney, Sonia Saxena, Sr, David C Schwebel, Sr, Anbissa Muleta Senbeta IV, Subramanian Senthilkumaran, Sadaf G Sepanlou, Edson Serván-Mori, Sr, Hosein Shabaninejad, Azadeh Shafieesabet, Sr, Masood Ali Shaikh, Ali S Shalash, Sr, Seifadin Ahmed Shallo, Mehran Shams-Beyranvand, MohammadBagher Shamsi, Morteza Shamsizadeh, Mohammed Shannawaz, Kiomars Sharafi, Hamid Sharifi, Hatem Samir Shehata, Sr, Aziz Sheikh, B Suresh Kumar Shetty, Sr, Kenji Shibuya, Sr, Wondimeneh Shibabaw Shiferaw, Sr, Desalegn Markos Shifti, Mika Shigematsu, Jae Il Shin, Rahman Shiri, Sr, Reza Shirkoohi, Soraya Siabani, Tariq Jamal Siddiqi, Diego Augusto Santos Silva, Ambrish Singh, Jasvinder A Singh, Narinder Pal Singh, Virendra Singh, Malede Mequanent Sisay, Eirini Skiadaresi, Mohammad Reza Sobhiyeh, Sr, Anton Sokhan, Shahin Soltani, Ranjani Somayaji, Moslem Soofi, Muluken Bekele Sorrie, Sr, Ireneous N Soyiri, Chandrashekhar T Sreeramareddy, Agus Sudaryanto, Mu'awiyyah Babale Sufiyan, Sr, Hafiz Ansar Rasul Suleria, Marufa Sultana, Bruno Fokas Sunguya, Bryan L Sykes, Rafael Tabarés-Seisdedos, Takahiro Tabuchi, Degena Bahrey Tadesse, Jr, Ingan Ukur Tarigan, Aberash Abay Tasew, Yonatal Mesfin Tefera, Sr, Merhawi Gebremedhin Tekle, Mohamad-Hani Temsah, Berhe Etsay Tesfay I, Fisaha Haile Haile Tesfay, Belay Tessema, Zemenu Tadesse Tessema, Kavumpurathu Raman Thankappan, Nihal Thomas, Alemayehu Toma Toma, Sr, Roman Topor-Madry, Marcos Roberto Roberto Tovani-Palone, Eugenio Traini, Bach Xuan Tran, Khanh Bao Tran, Irfan Ullah, Bhaskaran Unnikrishnan, Muhammad Shariq Usman, Sr, Benjamin S Chudi Uzochukwu, Sr, Pascual R Valdez, Santosh Varughese, Sr, Francesco S Violante, Sr, Sebastian Vollmer, Sr, Feleke Gebremeskel W/hawariat, Sr, Yasir Waheed, Mitchell Taylor Wallin, Yafeng Wang, Yuan-Pang Wang, Marcia Weaver, Bedilu Girma Weji, Girmay Teklay Weldesamuel, Catherine A Welgan, Andrea Werdecker, Ronny Westerman, Sr, Taweewat Wiangkham, Charles Shey Wiysonge, Sr, Haileab Fekadu Wolde, Sr, Dawit Zewdu Wondafrash, Tewodros Eshete Wonde, Sr, Getasew Taddesse Worku, Sr, Ai-Min Wu, Gelin Xu, Ali Yadollahpour, Seyed Hossein Yahyazadeh Jabbari, Tomohide Yamada, Sr, Hiroshi Yatsuya, Alex Yeshaneh, Christopher Sabo Yilgwan, Mekdes Tigistu Yilma, Paul Yip, Sr, Engida Yisma, Naohiro Yonemoto, Sr, Seok-Jun Yoon, Mustafa Z Younis, Mahmoud Yousefifard, Hebat-Allah Salah A Yousof, Chuanhua Yu, Hasan Yusefzadeh, Siddhesh Zadey, Zoubida Zaidi, Sojib Bin Zaman, Mohammad Zamani, Hamed Zandian, Nejimu Biza Zepro, Taddese Alemu Zerfu, Yunquan Zhang, Xiu-Ju George Zhao, Arash Ziapour, Sanjay Zodpey, Sr, Yves Miel H Zuniga, Simon I Hay, and Robert C Reiner, Jr
Subjects: Public aspects of medicine, RA1-1270
Abstract: Summary: Background: Oral rehydration solution (ORS) is a form of oral rehydration therapy (ORT) for diarrhoea that has the potential to drastically reduce child mortality; yet, according to UNICEF estimates, less than half of children younger than 5 years with diarrhoea in low-income and middle-income countries (LMICs) received ORS in 2016. A variety of recommended home fluids (RHF) exist as alternative forms of ORT; however, it is unclear whether RHF prevent child mortality. Previous studies have shown considerable variation between countries in ORS and RHF use, but subnational variation is unknown. This study aims to produce high-resolution geospatial estimates of relative and absolute coverage of ORS, RHF, and ORT (use of either ORS or RHF) in LMICs. Methods: We used a Bayesian geostatistical model including 15 spatial covariates and data from 385 household surveys across 94 LMICs to estimate annual proportions of children younger than 5 years of age with diarrhoea who received ORS or RHF (or both) on continuous continent-wide surfaces in 2000–17, and aggregated results to policy-relevant administrative units. Additionally, we analysed geographical inequality in coverage across administrative units and estimated the number of diarrhoeal deaths averted by increased coverage over the study period. Uncertainty in the mean coverage estimates was calculated by taking 250 draws from the posterior joint distribution of the model and creating uncertainty intervals (UIs) with the 2·5th and 97·5th percentiles of those 250 draws. Findings: While ORS use among children with diarrhoea increased in some countries from 2000 to 2017, coverage remained below 50% in the majority (62·6%; 12 417 of 19 823) of second administrative-level units and an estimated 6 519 000 children (95% UI 5 254 000–7 733 000) with diarrhoea were not treated with any form of ORT in 2017. Increases in ORS use corresponded with declines in RHF in many locations, resulting in relatively constant overall ORT coverage from 2000 to 2017. Although ORS was uniformly distributed subnationally in some countries, within-country geographical inequalities persisted in others; 11 countries had at least a 50% difference in one of their units compared with the country mean. Increases in ORS use over time were correlated with declines in RHF use and in diarrhoeal mortality in many locations, and an estimated 52 230 diarrhoeal deaths (36 910–68 860) were averted by scaling up of ORS coverage between 2000 and 2017. Finally, we identified key subnational areas in Colombia, Nigeria, and Sudan as examples of where diarrhoeal mortality remains higher than average, while ORS coverage remains lower than average. Interpretation: To our knowledge, this study is the first to produce and map subnational estimates of ORS, RHF, and ORT coverage and attributable child diarrhoeal deaths across LMICs from 2000 to 2017, allowing for tracking progress over time. Our novel results, combined with detailed subnational estimates of diarrhoeal morbidity and mortality, can support subnational needs assessments aimed at furthering policy makers' understanding of within-country disparities. Over 50 years after the discovery that led to this simple, cheap, and life-saving therapy, large gains in reducing mortality could still be made by reducing geographical inequalities in ORS coverage. Funding: Bill & Melinda Gates Foundation.
Published: 2020
Full Text: View/download PDF

23. Do the current cases reported to the WHO provide a realistic incidence rate of countries infected with COVID-19?

Author: Ghobad Moradi, Amjad Mohamadi Bolbanabad, Bakhtiar Piroozi, Ehsan Mostafavi, Arshad Veysi, and Azad Shokri
Subjects: covid-19, emerging infectious disease, infectious disease reporting, international health regulations, Infectious and parasitic diseases, RC109-216
Published: 2020
Full Text: View/download PDF

24. Out-of-Pocket and Informal Payment Before and After the Health Transformation Plan in Iran: Evidence from Hospitals Located in Kurdistan, Iran

Author: Bakhtiar Piroozi, Arash Rashidian, Ghobad Moradi, Amirhossein Takian, Hooman Ghasri, and Tayyeb Ghadimi
Subjects: Informal Payment, Health System Reform, Out-of-Pocket (OOP) Payment, Health Expenditure, Public aspects of medicine, RA1-1270
Abstract: Background One of the objectives of the health transformation plan (HTP) in Iran is to reduce out-of-pocket (OOP) payments for inpatient services and eradicate informal payments. The HTP has three phases: the first phase (launched in May 5, 2014) is focused on reducing OOP payments for inpatient services; the second phase (launched in May 22, 2014) is focused on primary healthcare (PHC) and the third phase utilizes an updated relative value units for health services (launched in September 29, 2014) and is focused on the elimination of informal payments. This aim of this study was to determine the OOP payments and the frequency of informal cash payments to physicians for inpatient services before and after the HTP in Kurdistan province, Iran. Methods This quasi-experimental study used multistage sampling method to select and evaluate 265 patients discharged from hospitals in Kurdistan province. The study covered 3 phases (before the HTP, after the first, and third phases of the HTP). Part of the data was collected using a hospital information system form and the rest were collected using a questionnaire. Data were analyzed using Fisher exact test, logistic regression, and independent samples ttest. Results The mean OOP payments before the HTP and after the first and third phases, respectively, were US$59.4, US$17.6, and US$14.3 in hospital affiliated to the Ministry of Health and Medical Education (MoHME), US$39.6, US$33.7, and US$13.7 in hospitals affiliated to Social Security Organization (SSO), and US$153.3, US$188.7, and US$66.4 in private hospitals. In hospitals affiliated to SSO and MoHME there was a significant difference between the mean OOP payments before the HTP and after the third phase (P < .05). The percentage of informal payments to physicians in hospitals affiliated to MoHME, SSO, and private sector, respectively, were 4.5%, 8.1%, and 12.5% before the HTP, and 0.0%, 7.1%, and 10.0% after the first phase. Contrary to the time before the HTP, no informal payment was reported after the third phase. Conclusion It seems that the implementation of the HTP has reduced the OOP payments for inpatient services and eradicated informal payments to physician in Kurdistan province.
Published: 2017
Full Text: View/download PDF

25. Correction to: The health-related quality of life in Iranian patients with COVID-19

Author: Cyrus Alinia, Safura Yaghmaei, Farman Zahir Abdullah, Asad Ahmadi, Nasrin Samadi, Sima Pourteimour, Hossein Safari, Hassan Mahmoodi, Ghobad Moradi, and Bakhtiar Piroozi
Subjects: Infectious and parasitic diseases, RC109-216
Published: 2021
Full Text: View/download PDF

26. Incidence, Mortality, and Burden of Acute Watery Diarrhea and Its Geographical Distribution in Iran during 2009-2016

Author: Ghobad MORADI, Bakhtiar PIROOZI, Hossein SAFARI, Cyrus ALINIA, Mohammad Mehdi GOUYA, Nooshin AGHILI, Siroos HEMMATPOUR, Bushra ZAREI, Farzad KAVEH, Abbas NOROUZINEJAD, and Babak ESHRATI
Subjects: Incidence, Mortality, Disability-adjusted life years, Acute watery diarrhea, Iran, Public aspects of medicine, RA1-1270
Abstract: Background: Diarrhea is a major cause of public health burden, especially in children under 5 yr of age. This study aimed at estimating the incidence, mortality, burden, and geographical distribution of Acute Watery Diarrhea (AWD) in Iran from 2009 to 2016. Methods: This study was conducted in 2018. The data on the incidence and mortality from 2009 to 2016 was obtained from AWD surveillance system of the Centre for Communicable Diseases Control (CCDC), Ministry of Health and Medical Education (MOHME) of Iran. Disability Adjusted Life Years (DALYs) was used to estimate the burden of AWD. The DALYs-related AWD was calculated using a method developed by WHO. The average duration of the disease and its disability weight, respectively, were set at 5 d (0.0137 years) and 0.093 for all age groups. Results: The incidence of AWD had an ascending trend over the studied period. Forty cases of deaths from AWD were reported. The lowest and highest burdens of AWD, respectively, were 436.1 DALYs in 2010 and 975.9 DALYs in 2015. The incidence and burden of AWD did not have an equal distribution across the country, between the provinces. Conclusion: The incidence of AWD had an ascending trend over the studied period that can be attributed to the improvements in the disease surveillance system. Moreover, the incidence, mortality, and burden of AWD did not have an equal distribution in Iran. Hence, it is recommended to strengthen AWD surveillance system. In addition, it is suggested to adopt proper interventions for controlling the disease in areas with a high burden of AWD.
Published: 2019

27. Incidence, Mortality, and Burden of Crimean Congo Hemorrhagic Fever and Its Geographical Distribution in Iran during 2009-2015

Author: Ghobad MORADI, Bakhtiar PIROOZI, Cyrus ALINIA, Hossein SAFARI, Mahmood NABAVI, Mohammad ZEINALI, Mahbobeh Katohn GHANBRI, Amjad MOHAMADI BOLBANABAD, Bushra ZAREI, and Mohammad Mehdi GOUYA
Subjects: Incidence, Mortality, Disability-adjusted life years, Crimean Congo hemorrhagic fever, Iran, Public aspects of medicine, RA1-1270
Abstract: Background: This study aimed at estimating the incidence, mortality, burden, and geographical distribution of Crimean Congo Hemorrhagic Fever (CCHF) using Disability Adjusted Life Years (DALYs) in Iran 2009-2015. Methods: CCHF-related DALYs was calculated using a method developed by WHO for the investigation of Global Burden of Diseases (GBD). DALYs was calculated through adding years of life lost due to premature death (YLLs) to years lived with disability (YLDs). To calculate YLD, the average duration of the disease and its disability weight were set at 25 d and 0.613, respectively. The data on the incidence and mortality were collected from the CCHF surveillance system from the governmental section. Results: The highest and the lowest incidence rates of CCHF were observed in 2009 (122 cases) and 2010 (254 cases), respectively. Moreover, the lowest and highest mortality rates were reported in 2009 (20 cases) and 2012 (52 cases), respectively. The mean rate of fatality from CCHF observed between 2009 and 2015 was about 21.1%. In addition, the lowest and highest DALYs were observed in 2009 (483 cases) and 2010 (1156 cases), respectively. CCHF incidence, DALYs, and mortality rate over the studied period were higher among males than females. CCHF-related DALYs did not have an equal distribution in all provinces of Iran; some provinces were suffering from a higher burden of the disease. Conclusion: It is recommended to improve the CCHF surveillance system, identify high-risk areas, practice early diagnosis and intervention, develop vaccines, control, and fight tick, and screen livestock to control and prevent the spread of this disease.
Published: 2019

28. Incidence, Mortality, and Burden of Hepatitis B and C and Geographical Distribution in Iran during 2008-2015

Author: Ghobad MORADI, Bakhtiar PIROOZI, Cyrus ALINIA, Hossein SAFARI, Parvin MOHAMADI, Fatemeh AZIMIAN ZAVAREH, Rashid RAMEZANI, Mohammad Mehdi GOUYA, and Mahmood NABAVI
Subjects: Incidence, Mortality, Disability-adjusted life years, Hepatitis, Iran, Public aspects of medicine, RA1-1270
Abstract: Background: This study aimed at estimating the incidence, mortality, and burden of Hepatitis B (HBV) and Hepatitis C (HCV) viruses and their trends from 2008 to 2015. Methods: The Disability Adjusted Life Year (DALYs) index was applied to calculate the burden of the diseases by age, sex, time, and locations. The incidence and demographic data were obtained from HBV and HCV surveillance system, and the data on natural history was extracted from the cohort studies; moreover, the data on the standard life expectancy was obtained from the Iranian life table 2016. The two values of 0.03 and 21.5 yr were set as the discount rate and mean standard duration of the disease for both types of hepatitis. Results: The burden of HBV decreased from 13735 to 78277.6 yr, but there was an increase in the burden of HCV from 5174 to 14395 yr over the studied period. The burden of both types of hepatitis was higher among males than females. The incidence of HBV increased from 46611 to 22996 cases, and the incidence of HCV increased from 1210 to 3939 cases. The HBV decreased from 1925 to 1394 cases; however, the number of deaths caused by HCV increased from 197 to 583 cases over the studied period. The share of YLLs raised from 5% to 10% for HBV whereas it changed from 23% to 62% for HCV over the studied years. Tehran, Khorasan Razavi, and Golestan had the highest and Chaharmahal and Bakhtiari, Kurdistan, and Kermanshah had the lowest adjusted burden of HBV per 1000 population. Conclusion: Although the incidence, mortality, and burden of HBV declined over the eight studied years, these values increased dramatically for HCV.
Published: 2019

29. Incidence, Mortality, and Burden of Human Brucellosis and Its Geographical Distribution in Iran during 2009-2015

Author: Bakhtiar PIROOZI, Ghobad MORADI, Hossein SAFARI, Parvin MOHAMADI, Cyrus ALINIA, Mohammad Reza SHIRZADI, Mahmood NABAVI, Siamak VAHEDI, and Mohammad Mehdi GOUYA
Subjects: Incidence, Mortality, Disability-adjusted life years, Brucellosis, Iran, Public aspects of medicine, RA1-1270
Abstract: Background: Human brucellosis is the most common zoonotic disease worldwide. This study aimed at estimating the incidence, mortality, and burden of human brucellosis as well as its distribution in Iran from 2009 to 2015. Methods: Disability Adjusted Life Years (DALYs) index was used to estimate the burden of human brucellosis. To calculate DALYs, years lost due to disability (YLDs) was added to years of life lost due to premature death (YLLs); they were calculated based on the Global Burden of Disease (GBD) formula recommended by the WHO. The data on incidence and mortality were collected from the national surveillance system of brucellosis disease in the Center for Communicable Diseases Control (CCDC), Ministry of Health and Medical Education (MOHME), expert panels, and related literature. Results: There is an increasing trend in human brucellosis-related DALYs (34.6 per 100,000 in 2009, and 71.4 per 100,000 in 2015), incidence (88450 in 2009, and 198030 in 2015), and mortality (244 in 2009, and 578 in 2015) from 2009 to 2015. Human brucellosis-related DALYs, incidence, and mortality were higher among males than females. About 51% of DALYs was attributed to YLLs. The burden of human brucellosis disease was not equally distributed among all provinces of Iran and it was largely concentrated in a number of provinces. Conclusion: Burden of human brucellosis is significantly high in Iran, and it has also increased during the recent years. It is alarming for health system managers and policymakers, and they are recommended to pay more attention to this issue.
Published: 2019

30. Incidence, Burden, and Trend of Cutaneous Leishmaniasis over Four Decades in Iran

Author: Bakhtiar PIROOZI, Ghobad MORADI, Cyrus ALINIA, Parvin MOHAMADI, Mohammad Mehdi GOUYA, Mahmood NABAVI, Faranak GHARACHORLOO, Mohammad Bagher KHADEM ERFAN, and Mohammad Reza SHIRZADI
Subjects: Cutaneous leishmaniasis, Incidence, Disability adjusted life year (DALY), Burden, Iran, Public aspects of medicine, RA1-1270
Abstract: Background: Iran is among the first six countries in the world with the highest annual incidence of cutaneous leishmaniasis. This study aimed at estimating the incidence, burden, and trend of cutaneous leishmaniasis at the national level in Iran from 1977 to 2015. Methods: This study was conducted in 2017, used Disability Adjusted Life Years (DALYs) index, recommended by the WHO for assessing the Global Burden of Diseases, to estimate the burden of cutaneous leishmaniasis. The data on the incidence of the disease and the number of cases was obtained from the communicable diseases surveillance system (Center for Communicable Diseases Control (CCDC), Ministry of Health and Medical Education (MOHME) of Iran) that routinely collects data from all over the country; in addition, some data was extracted by reviewing the texts. Considering the views expressed in a panel of experts, to calculate the actual incidence of the disease, the number of registered cases was multiplied by 5. Results: The incidence of cutaneous leishmaniasis varied from approximately 50 to 250 cases per 100,000 population during the studied period. During these years, the incidence of the disease was higher in males than females. Moreover, the burden of cutaneous leishmaniasis varied between 1.18 and 5.7 DALYs per 100000 population during the studied period. The incidence and burden of cutaneous leishmaniasis have not significantly decreased in recent years. Conclusion: Despite the implementation of a program for controlling cutaneous leishmaniasis in Iran since 1977, the incidence and burden of the disease are still high in the country; it is seriously alarming for policy makers and managers of the health system in Iran, indicating the presence of some problems in controlling the disease.
Published: 2019

31. Incidence, Mortality, and Burden of Severe Acute Respiratory Infection in Iran in 2015

Author: Bakhtiar PIROOZI, Cyrus ALINIA, Ghobad MORADI, Hossein SAFARI, Payman HEMMATI, Mahmoud SEROUSH, Hossein ERFANI, Hossein AKBARI, Farshid REZAEI, Mohammad Naser DADRAS, Siroos HEMMATPOUR, and Rasool NASIRI KALMARZI
Subjects: Incidence, Mortality, Disability adjusted life years, Severe acute respiratory infection, Iran, Public aspects of medicine, RA1-1270
Abstract: Background: Severe Acute Respiratory Infection (SARI) is responsible for mortality and hospital admissions in millions of people across the world. The present study, for the first time, aimed at estimating the incidence, mortality, and burden of SARI in Iran in 2015. Methods: Disability Adjusted Life Years (DALYs) was used as an index to estimate the burden of SARI. The SARI-related DALYs was calculated using a method developed by the WHO for assessing the Global Burden of Diseases. DALYs are calculated as the sum of the Years Lost due to Disability (YLDs) and the Years of Life Lost (YLLs) due to premature mortality. The data on the incidence and mortality were obtained from the SARI surveillance system of Iran's Ministry of Health and Medical Education. The average duration until remission or death and the disease disability weight were set at four weeks and 0.373, respectively. Results: In 2015, the incidence of SARI was 21309 and 20885 among males and females, respectively. Moreover, 773 males and 737 females died from this disease (Case fatality rate was about 0.035). Total SARI-related DALYs in males and females was 17264 and 16720, respectively. Furthermore, YLLs was responsible for more than 96% of SARI-related DALYs in 2015. Conclusion: There was no significant difference between males and females in terms of the incidence, mortality, and burden of SARI in 2015. Epidemiological data are required to adopt appropriate policies and responses to prevent and control SARI. The incidence, mortality, fatality, and burden of SARI are significant in Iran. It is necessary to develop appropriate strategies, such as vaccination against major pathogens of the disease at least in high-risk groups, strengthening the disease surveillance system, and attracting the attention of policy makers and health authorities of the country.
Published: 2019

32. Incidence, Mortality, and Burden of HIV/AIDS and Its Geographical Distribution in Iran during 2008-2016

Author: Ghobad MORADI, Bakhtiar PIROOZI, Cyrus ALINIA, Samaneh AKBARPOUR, Mohammad Mehdi GOUYA, Sima SAADI, Amjad MOHAMADI BOLBANABAD, and Parvin AFSAR KAZAEROONI
Subjects: AIDS, HIV, Disability-adjusted life years, Burden of disease, Iran, Public aspects of medicine, RA1-1270
Abstract: Background: This study aimed at estimating the incidence, mortality, burden, and geographical distribution of HIV/AIDS in Iran at national and provincial level during 2008-2016. Methods: We applied the Disability Adjusted Life Years (DALYs) index to assess the burden of HIV/AIDS on the basis of Years of Life Lost (YLLs) and Years Lived with Disability (YLDs). We used the Iranian life table of 2016 for treated and a fixed figure of 8 years as remaining length of life in untreated patients, 0.03 as discount rate, and 0.504 as disability weigh in both treated and untreated cases. The primary data was obtained from HIV/AIDS surveillance system. Results: The incidence of HIV/AIDS increased from 4440 cases in 2008 to 4928 cases in 2016. The mortality rate was 259 and 288 cases in 2008 and 2016, respectively, which was always higher among males than females. The burden of HIV/AIDS increased from 26231 DALYs in 2008 to 29114 DALYs in 2016. In addition, the population-adjusted burden of HIV/AIDS was not equally distributed among different provinces of Iran, and it was more concentrated in western regions of the country during the studied period. Conclusion: Although the trend of the national burden of HIV/AIDS did not change significantly over the past decade, it was alarming especially among males and among people living in some provinces such as Kermanshah, Lorestan, Hormozgan, and Tehran.
Published: 2019

33. Incidence, Mortality, and Burden of Malaria and Its Geographical Distribution in Iran during 2002-2015

Author: Bakhtiar PIROOZI, Ghobad MORADI, Hossein SAFARI, Leila FARAJI, Sima SADI, Cyrus ALINIA, and Ahmad RAEISI
Subjects: Incidence, Mortality, Disability adjusted life years, Malaria, Iran, Public aspects of medicine, RA1-1270
Abstract: Background: This study aimed at estimating the incidence, mortality, burden, and geographical distribution of malaria between 2002 and 2015 in Iran. Methods: DALYs index was used to estimate the burden of malaria. DALYs-related malaria was calculated using a method developed by (WHO) for investigating the Global Burden of Disease (GBD); it was calculated through adding Years of Life Lost (YLLs) due to premature death to Years Lived with Disability (YLDs).The data on the incidence and mortality were collected from the malaria surveillance system in the Center for Communicable Diseases Control (CCDC), Ministry of Health and Medical Education (MOHME). Results: The incidence of malaria had a decreasing trend over the studied period and it reduced from 15378 cases in 2002 to 777 cases in 2015. Overall, 28 cases of mortality were observed between 2002 and 2015. In addition, disease burden decreased from 90.78 DALYs in 2002 to 22.38 DALYs in 2015.Overall, there were 949.2 DALYs due to malaria from 2002 to 2015. The incidence and burden of malaria were not equally distributed among all the provinces in Iran and some areas were suffering from the highest burden of the disease. Conclusion: The incidence and burden of malaria have had a decreasing trend over the years of the study and Iran has little to do in order to eradicate malaria. Since the disease is not equally distributed among various provinces of Iran, health policymakers must direct health resources towards specific areas of the country (Sistan and Baluchistan, Kerman, and Hormozgan) with high concentration of cases of malaria.
Published: 2019

34. Catastrophic Health Expenditure After the Implementation of Health Sector Evolution Plan: A Case Study in the West of Iran

Author: Bakhtiar Piroozi, Ghobad Moradi, Bijan Nouri, Amjad Mohamadi Bolbanabad, and Hossein Safari
Subjects: Catastrophic Health Expenditures (CHE), Health System Reforms, Health Expenditures, Iran, Public aspects of medicine, RA1-1270
Abstract: Background: One of the main objectives of health systems is the financial protection against out-of-pocket (OOP) health expenditures. OOP health expenditures can lead to catastrophic payments, impoverishment or poverty among households. In Iran, health sector evolution plan (HSEP) has been implemented since 2014 in order to achieve universal health coverage and reduce the OOP health expenditures as a percentage of total health expenditures. This study aimed to explore the percentage of households facing catastrophic health expenditures (CHE) after the implementation of HSEP and the factors that determine CHE. Methods: A total of 663 households were selected through a cluster sampling based on the census framework of Sanandaj Health Center in July 2015. Data were gathered using face-to-face interviews based on the household section of the World Health Survey questionnaire. In this study, according to the World Health Organization (WHO) definition, if household health expenditures were equal to or more than 40% of the household capacity to pay, household was considered to be facing CHE. The determinants of CHE were analyzed using logistic regression model. Results: The rates of households facing CHE were 4.8%. The key determinants of CHE were household economic status, presence of elderly or disabled members in the household and utilization of inpatient or rehabilitation services. Conclusion: The comparison of our findings and those of other studies carried out using a methodology comparable with ours in different parts of Iran before the implementation of HSEP suggests that the implementation of recent reforms has reduced CHE at the household level. Utilization of inpatient and rehabilitation services, the presence of elderly or disabled members in the household and the low economic status of the household would increase the likelihood of facing CHE. These variables should be considered by health policy-makers in order to review and revise content of recent reform, thus financially protecting public against CHE.
Published: 2016
Full Text: View/download PDF

35. Socioeconomic Inequalities in Different Types of Disabilities in Iran

Author: Ghobad MORADI, Farideh MOSTAFAVI, Mohammad HAJIZADEH, Mohammad AMERZADE, Amjad MOHAMMADI BOLBANABAD, Cyrus ALINIA, and Bakhtiar PIROOZI
Subjects: Socioeconomic status, Inequalities, Disabilities, Concentration index, Iran, Public aspects of medicine, RA1-1270
Abstract: Background: This study measured socioeconomic inequalities in different types of disabilities in Iran. We also examined the prevalence of disabilities across different socio-demographic groups in Iran in 201 Methods: This was cross-sectional study using secondary data analysis on all Iranian. Data related to disability prevalence and socioeconomic status (SES) of each province was extracted from the 2011 National Census of Population and Housing (NCPH) and the 2011 Households Income and Expenditure Survey (HIES), conducted by Statistical Center of Iran (SCI). The concentration index and concentration curve were used to measure and illustrate socioeconomic inequalities in different types of disabilities. Chi-squared test was also used to examine the relationship between the socio-demographic variables (age-groups, sex, education level, employment status) and disability. Results: The results suggested the existence of socioeconomic inequalities in blindness, deafness, vocal disorders and hand disorders in Iran. The concentration index for these four disabilities were -0.0527 (95% confidence interval [CI]: -0.0881, -0.0173), -0.0451 (CI: -0.0747, -0.0156), -0.0663 (CI: -0.1043, -0.0282) and -0.0545 (CI: -0.0940, -0.0151), respectively. There were also significant associations between the demographic variables such as age-groups, sex, education level, employment status and disability (P
Published: 2018

36. Comparison of quality of work life in rural family physicians and other general physicians in Iran

Author: Amjad Mohammadi Bolbanabad, Ghobad Moradi, Mohammad Amerzadeh, Samira Mohammadi Bolbanabad, and Bakhtiar Piroozi
Subjects: Quality of Work Life, Rural Family Physician, General Physician, Iran, Public aspects of medicine, RA1-1270
Abstract: Background: Job satisfaction of physicians in family physician team is considered as one of the important factors for health system. The aim of the preent study was to compare the quality of work life (QoWL) in rural family physicians and general physicians with private clinics in Kurdistan province. Methods: A cross-sectional study was conducted among 103 general physicians including 50 rural family physicians and 53 general physicians with private clinics in Kurdistan province in 2016. The data were collected using QoWL questionnaire and analyzed using SPSS, v. 16. Descriptive statistics including frequency, percentage, mean, and standard deviation (SD) were used to describe the data and to examine the relationship between the variables, T-test was run. Results: The QoWL of rural family physicians with a mean of 55 (SD = 7.6) was higher than average scores. But QoWL of other general physicians with a mean of 47.7 (SD = 13.5) was lower than average scores. The results of t-test showed that there was a significant difference between QoWL of family physicians and other general physicians (t = 82.3, p = 0.001). In rural family physicians, there is a significant association between the QoWL and gender (t=2.7, P = 0.009) as well as native status (t=2.53, P = 0.004). In general physicians with private clinics, the QoWL of native physicians was higher than that of non-native physicians (t = 4.3, P = 0.001). Conclusion: The QoWL of rural family physicians is better than that of others general physicians, even though it is unsatisfactory in both studied groups. Therefore, improving the QoWL of rural family physicians, especially female and non-native rural family physicians, is recommended because promoting the rural family physicians' satisfaction can decrease the likelihood of turnover, and thus increase service quality and responsiveness, as a goal of the health system.
Published: 2018
Full Text: View/download PDF

37. Assessment of the Efficiency of Hospitals Before and After the Implementation of Health Sector Evolution Plan in Iran Based on Pabon Lasso Model

Author: Ghobad MORADI, Bakhtiar PIROOZI, Hossein SAFARI, Nader ESMAIL NASAB, Amjad MOHAMADI BOLBANABAD, and Arezoo YARI
Subjects: Pabon lasso model, Hospital, Utilization, Health system reform, Iran, Public aspects of medicine, RA1-1270
Abstract: Background: Pabon Lasso model was applied to assess the relative performance of hospitals affiliated to Kurdistan University of Medical Sciences (KUMS) before and after the implementation of Health Sector Evolution Plan (HSEP) in Iran. Methods: This cross-sectional study was carried out in 11 public hospitals affiliated to KUMS in 2015. Twelve months before and after the implementation of the first phase of HSEP, a checklist was used to collect data from computerized databases within the hospitals' admission and discharge units. Pabon Lasso model includes three indices: bed turnover, bed occupancy ratio, and average length of stay. Results: Analysis of hospital performance showed an increase in mean of bed occupancy and turnover ratio, which changed from 65.40% and 86.22 times/year during 12 months before to 69.97% and 90.98 times/year during 12 months after HSEP, respectively. In line with Pabon Lasso model, before the implementation of HSEP, 27.27% and 36.36% of the hospitals were entirely efficient and inefficient, respectively, whilst after the implementation of HSEP, their condition changed to 18.18% and 27.27%, in order. Conclusion: Indicators of bed occupancy and turnover ratio had a 4% increase in the studied hospitals after the implementation of HSEP. Number of the hospitals in the efficient zone reduced because of the relative measurement of efficiency by Pabon Lasso model. Since more than 50% of the hospitals in the studied province have not yet reached their optimal bed occupancy ratio (more than 70%), short-term and suitable strategy for improving the efficiency is to stop further expansion of hospitals as well as developing the number of hospital beds.
Published: 2017

38. Estimating utility value for female genital mutilation

Author: Ali Kazemi-Karyani, Fariba Jahanbin, Cyrus Alinia, Ghobad Moradi, Hossein Safari, Amjad Mohamadi-Bolbanabad, Mohammad Ebrahimi, Fariba Farhadifar, and Bakhtiar Piroozi
Subjects: Adult, Clitoridectomy, Female circumcision, medicine.medical_specialty, Health utility, Cost-Benefit Analysis, Iran, Women’s health, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, Circumcision, Surveys and Questionnaires, Epidemiology, medicine, Humans, 030212 general & internal medicine, Female genital mutilation, 030219 obstetrics & reproductive medicine, DALY, business.industry, Public health, lcsh:Public aspects of medicine, Public Health, Environmental and Occupational Health, lcsh:RA1-1270, Middle Aged, Disease utility, Cross-Sectional Studies, Socioeconomic Factors, Marital satisfaction, Circumcision, Female, Female, Biostatistics, business, Value (mathematics), Research Article, Demography
Abstract: Background Female genital mutilation/cutting (FGM/C) is a clear violation of women’s rights and can have adverse and irreversible health effects as well. Worldwide, more than 200 million women and girls have undergone FGM/C. Utility value of FGM/C has not been estimated yet, so we designed this study to extract the health utility value of FGM/C for the first time in the world. Methods In a cross-sectional study in Iran, 125 girls and women who underwent FGM/C procedure were examined by the trained midwives in order to determine its type. In addition, a questionnaire was completed for identifying the socio-demographic factors and extracting the health utility of these individuals. Health utility was measured using Time Trade-off method and also to determine the effects of the socio-demographic factors on the health utility a two-limit censored regression model was applied. Results The mean and median of the health utility of women with FGM/C were 0.971 (SE: 0.003) and 0.968 (IQR: 1–0.95), respectively. Number of non-traders was 58 (46.4%) who reported perfect health utility. However, the mean of health utility among traders was 0.946 (SE: 0.002). Only type 1 (Clitoridectomy) and type 2 (Excision) FGM/C were seen in this study. Women with Type 1 FGM/C had significantly lower health utility value (Mean: 0.968, Median: 0.957) than their type 2 counterparts (Mean: 0.987, Median: 1.00). Moreover, women in the age group of 31–45 years (Mean: 0.962, Median: 0.956), single (Mean: 0.950, Median: 0.954), divorced (Mean: 0.951, Median: 0.950), employed (Mean: 0.959, Median: 0.956), and with supplementary insurance (Mean: 0.962, Median: 0.950) had significantly lower health utility than their counterparts. Conclusion FGM/C affects physical and psychological well-being of these individuals, resulting in a lack of personal and marital satisfaction, which ultimately leads to a 3% reduction in their health related quality of life. Therefore, preventing from this practice is very important and should be considered by health system policy makers more than before.
Published: 2020

39. The prevalence of physical inactivity in Iranian adolescents and the impact of economic and social inequalities on it: results of a National Study in 2018

Author: Bakhtiar Piroozi, Bushra Zareie, Marzieh Mahboobi, Farideh Mostafavi, Ghobad Moradi, and Mohammad Aziz Aziz Rasouli
Subjects: Male, medicine.medical_specialty, Adolescent, 030209 endocrinology & metabolism, Concentration index, Iran, Logistic regression, 03 medical and health sciences, 0302 clinical medicine, Epidemiology, medicine, Prevalence, Humans, 030212 general & internal medicine, Child, Socioeconomic status, Exercise, Physical inactivity, business.industry, Public health, lcsh:Public aspects of medicine, Public Health, Environmental and Occupational Health, lcsh:RA1-1270, Cross-Sectional Studies, Socioeconomic Factors, Sample size determination, Population study, Cluster sampling, Female, Biostatistics, Inequalities, Sedentary Behavior, business, Demography, Research Article
Abstract: Background This study aims to determine the prevalence of physical inactivity in Iranian adolescents aged 10–12 years and the impact of socioeconomic inequality on it. Methods In this descriptive study, the study population consisted of 10–12 years old adolescents from an Iranian population from Kurdistan, Fars and Markazi provinces in 2018. The sample size was 1590 individuals. The sampling method was cluster sampling. Data was collected using demographic questionnaire, modifiable activity questionnaire (MAQ) and socioeconomic questionnaire. Cut points on the MAQ for light activity, moderate activity and heavy activity were MET 6, respectively. Linear and logistic regression were used to estimate the final model and the Oaxaca analysis method was applied. All analyses were performed in Stata/SE 14.0. Results Of the 1590 participants, 52.82% were male. The results showed that 25.79% of the subjects were physically inactive and 7.30% engaged in moderate physical activity during the week. The average physical activity during 1 week was more in boys than in girls (P-value Conclusion One-fourth of the study population had physical inactivity in this age group. Socioeconomic levels, parental literacy, and sex of adolescents were associated with the level of physical activity.
Published: 2020

40. Mapping geographical inequalities in childhood diarrhoeal morbidity and mortality in low-income and middle-income countries, 2000-17: analysis for the Global Burden of Disease Study 2017

Author: Manisha Dubey, Fatemeh Rajati, Mehran Shams-Beyranvand, Amir Khater, Reza Shirkoohi, Segun Emmanuel Ibitoye, David C. Schwebel, Milena Ilic, Kebede Embaye Gezae, Ali Akbar Fazaeli, Ronny Westerman, Taye Abuhay Zewale, Ravi Mehrotra, Sezer Kisa, Junaid Khan, Jost B. Jonas, Dian Kusuma, Marcel Ausloos, Getnet Gedefaw, Hamed Zandian, Edward J Mills, Aparna Lal, Atalay Goshu Muluneh, Leeberk Raja Inbaraj, Edgar Denova-Gutiérrez, Jacqueline Elizabeth Alcalde Rabanal, Yousef Veisani, Sharath Burugina Nagaraja, Christopher Troeger, Ismael R. Campos-Nonato, Kidane Tadesse Gebremariam, Maysaa El Sayed Zaki, Oliver J. Brady, David Laith Rawaf, Tamer H. Farag, Simin Mouodi, Hafiz Ansar Rasul Suleria, Saleh Salehi Zahabi, Soumyadeep Bhaumik, Samad Azari, Getinet Ayano, Faris Lami, Raaj Kishore Biswas, Maryam Adabi, Alaa Badawi, Saravanan Muthupandian, Amir Hasanzadeh, Martin Amogre Ayanore, Maziar Moradi-Lakeh, Mohamad-Hani Temsah, Kavumpurathu Raman Thankappan, Bineyam Taye, Nader Jafari Balalami, Hamid Yimam Hassen, Karzan Abdulmuhsin Mohammad, Paul H. Lee, Emerito Jose A. Faraon, Kewal Krishan, Muhammad Ali, Ehsan Sadeghi, Richard C. Franklin, Dara K. Mohammad, Naznin Hossain, Lal B. Rawal, Alyssa N. Sbarra, Behnam Heidari, Dietrich Rothenbacher, Hagos Tasew Atalay, Eric L. Ding, Noushin Mohammadifard, Nihal Thomas, Man Mohan Mehndiratta, Sanghamitra Pati, Addisu Melese, Niranjan Kissoon, Farzad Manafi, Carl Abelardo T. Antonio, Morteza Abdullatif Khafaie, Meysam Behzadifar, Mohammad Reza Sobhiyeh, Frank B. Osei, Koku Sisay Tamirat, Yahya Salimi, Pranab Chatterjee, Gebreamlak Gebremedhn Gebremeskel, Olatunji O. Adetokunboh, Benjamin K. Mayala, Bhaskaran Unnikrishnan, Zahid A Butt, Olufemi Ajumobi, Fiseha Wadilo Wada, Shafiu Mohammed, Charles Shey Shey Wiysonge, Félix Carvalho, Masresha Tessema Anegago, Yun Jin Kim, Ai-Min Wu, Ketema Bizuwork Gebremedhin, Paulina A. Lindstedt, Ana-Laura Manda, Aziz Eftekhari, Rakhi Dandona, Mehdi Fazlzadeh, Nicole Davis Weaver, Muluken Bekele Sorrie, Marwa Rashad Salem, Kassawmar Angaw Bogale, Dongyu Zhang, Saeed Safari, Vivekanand Jha, Keivan Ahmadi, Turki Alanzi, Amir Jalali, Hamidreza Haririan, Chukwudi A Nnaji, Kebadnew Mulatu Mihretie, Lucas Guimarães Abreu, Gessessew Bugssa Hailu, Surendra Karki, Kirsten E. Wiens, Boikhutso Tlou, Soraya Siabani, Muluken Azage Yenesew, Asnakew Achaw Ayele, Ayalew Jejaw Zeleke, Osayomwanbo Osarenotor, Susanna Dunachie, Marcos Roberto Tovani-Palone, Daniel Bekele Ketema, Tissa Wijeratne, Dessalegn Ajema Berbada, André Karch, Ebrahim Babaee, Akram Pourshams, Seyyed Meysam Mousavi, Bal Govind Chauhan, Giuseppe Remuzzi, Vera Marisa Costa, Mehdi Yaseri, Tahereh Pashaei, Benn Sartorius, Helen Derara Diro, Anelisa Jaca, Mostafa Hosseini, Nikolay Ivanovich Briko, Franz Castro, Cuong Tat Nguyen, Chalachew Genet Akal, Natalie Maria Cormier, Ghulam Mustafa, Sonia Lewycka, Achala Upendra Jayatilleke, David L. Smith, Ibrahim A Khalil, Genet Melak Alamene, George C Patton, Andem Effiong, Gebrekiros Gebremichael Meles, Collins Chansa, Tsegaye Lolaso Lenjebo, Van C. Lansingh, Chabila C Mapoma, Olayinka Stephen Ilesanmi, Aso Mohammad Darwesh, Aubrey J. Levine, Miliva Mozaffor, Till Bärnighausen, Ali Rostami, André Faro, Rushdia Ahmed, Colm McAlinden, Duduzile Ndwandwe, Neeraj Bedi, Irfan Ullah, Winfried März, Rajeev Gupta, Masood Ali Shaikh, Catalina Liliana Andrei, Ali Kazemi Karyani, Shaimaa I. El-Jaafary, Abbas Mosapour, Javad Nazari, Obinna Onwujekwe, Narinder Pal Singh, Dabere Nigatu, Tanuj Kanchan, Jagdish Khubchandani, Aklilu Endalamfaw, Hajer Elkout, Michelle L. Bell, Beyene Meressa Adhena, Evanson Z. Sambala, Nelson Alvis-Guzman, Nefsu Awoke, Mohammad Ali Sahraian, Muki Shey, Christiane Dolecek, Kedir Hussein Abegaz, Syed Ather Hussain, Birhan Tamene Alemnew, Arash Etemadi, Anwar E. Ahmed, Vinay Nangia, Sachin R Atre, Roghiyeh Faridnia, Robert C. Reiner, Rajat Das Gupta, Aniruddha Deshpande, Sanjay Zodpey, Birhanu Geta, Amaha Kahsay, Muktar Beshir Ahmed, Kiana Ramezanzadeh, Jacek Jerzy Jozwiak, Chi Linh Hoang, Bahram Armoon, Manfred Accrombessi, Christopher J L Murray, Ebrahim M Yimer, Rashmi Gupta, Ahmed Omar Bali, Dadi Marami, Arash Tehrani-Banihashemi, Getnet Mengistu, Govinda Prasad Dhungana, Fereshteh Ansari, Dina Nur Anggraini Ningrum, Mu'awiyyah Babale Sufiyan, Harish Chander Gugnani, Ali S. Akanda, Satar Rezaei, Wondimeneh Shibabaw Shiferaw, Irina Filip, Mohammad Fareed, Hagos Degefa Hidru, Morteza Shamsizadeh, Mojtaba Hoseini-Ghahfarokhi, Yared A Asmare Aynalem, Gelin Xu, Zubair Kabir, Khalid A Altirkawi, Beatriz Paulina Ayala Quintanilla, Kenean Getaneh Tlaye, Devasahayam J. Christopher, Malede Mequanent Sisay, Yibeltal Alemu Bekele, Mika Shigematsu, Bryan L. Sykes, Quique Bassat, Jemal Abdu Mohammed, Seyed Mostafa Mir, Moslem Soofi, Nuruzzaman Khan, Ensiyeh Jenabi, Seyed-Mohammad Fereshtehnejad, Alireza Esteghamati, Paramjit Gill, Nathaniel J Henry, Meghnath Dhimal, Hosein Shabaninejad, Trang Huyen Nguyen, Amjad Mohamadi-Bolbanabad, Eugenio Traini, Mohammad Zamani, Arianna Maever L. Amit, Mehran Alijanzadeh, Florian Fischer, Rafael Moreira Claro, Pushpendra Kumar, Shai Linn, Lucas Earl, Haileab Fekadu Wolde, Getenet Dessie, Doris D. V. Ortega-Altamirano, John S. Ji, Moritz U. G. Kraemer, Saeed Amini, Ziad A. Memish, Aisha Elsharkawy, Ken Lee Chin, Mustafa Z. Younis, Daniel Diaz, Hebat Allah Salah A. Yousof, Seifadin Ahmed Shallo, Tomohide Yamada, Adrian Pana, Salman Rawaf, Amir Almasi-Hashiani, Platon D. Lopukhov, Alireza Rafiei, Dragos Virgil Davitoiu, Hossein Poustchi, Ayele Geleto Bali, Francesco Saverio Violante, Leonardo Roever, Giovanni Damiani, Maha El Tantawi, Nuworza Kugbey, Hadi Pourjafar, Michael R.M. Abrigo, Dinh-Toi Chu, Farkhonde Salehi, Phetole Walter Mahasha, Farnam Mohebi, Sathish Thirunavukkarasu, Dharmesh Kumar Lal, Senbagam Duraisamy, Demelash Woldeyohannes Handiso, Eleonora Dubljanin, Takeshi Fukumoto, Biruck Desalegn Yirsaw, Fakher Rahim, Jasvinder A. Singh, Jai K Das, Savita Lasrado, Ana Isabel Ribeiro, Santosh Varughese, Adnan Kisa, Laurie B. Marczak, Amira Shaheen, Peter Njenga Keiyoro, Nader Jahanmehr, Yuming Guo, Arash Ziapour, Alex Yeshaneh, Ninuk Hariyani, Seyed Sina Naghibi Irvani, Sameer Vali Gopalani, Joel M. Francis, Asmamaw Demis, Ahamarshan Jayaraman Nagarajan, Praveen Hoogar, Nicola Luigi Bragazzi, Yunquan Zhang, Yousef Mohammad, Iman El Sayed, Vafa Rahimi-Movaghar, Anbissa Muleta Senbeta, Subramanian Senthilkumaran, Marzieh Nojomi, Tewodros Eshete Wonde, Sameh Magdeldin, Anton Sokhan, Nauman Khalid, Nima Hafezi-Nejad, Ben Lacey, Luca Ronfani, James Albright, Senthilkumar Balakrishnan, Ejaz Ahmad Khan, Khanh Bao Tran, Guoqing Hu, Yousef Khader, Parvaneh Mirabi, Boris Bikbov, Feleke Mekonnen Demeke, Assefa Desalew, Yasir Waheed, Berhe Etsay Tesfay, Julio Cesar Campuzano Rincon, Ernoiz Antriyandarti, Brian J. Hall, James A Platts-Mills, Gbenga A. Kayode, Jan-Walter De Neve, Maria Jesus Rios-Blancas, Navid Manafi, Ravi Prakash Jha, Yilma Chisha Dea Geramo, Hamideh Salimzadeh, Fisaha Haile Tesfay, Abdullah Al Mamun, Ali Bijani, Hedley Quintana, Shanshan Li, Kebreab Paulos, Joan B. Soriano, Victor Adekanmbi, Oladimeji Adebayo, David Teye Doku, Brijesh Sathian, Bakhtiar Piroozi, MohammadBagher Shamsi, Netsanet Fentahun, Shymaa Enany, Ayman Grada, Salvatore Rubino, Kenji Shibuya, Norberto Perico, Sergio I. Prada, Andrea Farioli, Gebremicheal Gebreslassie Kasahun, Mohsen Afarideh, Maciej Banach, Andrey Nikolaevich Briko, Mohsen Asadi-Lari, Rakesh Lodha, David M. Pigott, Bárbara Niegia Garcia de Goulart, Hadi Hassankhani, Daniel Adane Endalew, Siamak Sabour, Yoshan Moodley, Preeti Dhillon, Dilaram Acharya, Anas M. Saad, Ibrahim Abdelmageed Ginawi, Theo Vos, Tuomo J. Meretoja, Ireneous N. Soyiri, Hasan Yusefzadeh, Mohammad Rabiee, Ajay Patle, Rahman Shiri, Girmay Teklay Weldesamuel, Sivan Yegnanarayana Iyer Saraswathy, Mekdes Tigistu Yilma, Davide Guido, Chuanhua Yu, Abdallah M. Samy, Ali Talha Khalil, Ashish Awasthi, Pascual R. Valdez, Nelson G.M. Gomes, Nejimu Biza Zepro, Taweewat Wiangkham, Anthony Masaka, Afsaneh Arzani, Ayesha Humayun, Michael Tamene Haile, Huyen Phuc Do, Krittika Bhattacharyya, Maryam Khayamzadeh, Seth Christopher Yaw Appiah, Mehdi Ahmadi, Farah Daoud, QuynhAnh P Nguyen, Suleman Atique, Sheikh Mohammed Shariful Islam, Indang Trihandini, Mario Poljak, Bartosz Miazgowski, Huda Basaleem, Rafael Alves Guimares, Mina Anjomshoa, Peng Jia, Yafeng Wang, Erkin M. Mirrakhimov, Seyed Hossein Yahyazadeh Jabbari, Itamar S. Santos, Alireza Khatony, Desalegn Tadese Mengistu, Samath D Dharmaratne, S. Mohammad Sajadi, Francisco Rogerlândio Martins-Melo, Shankar M Bakkannavar, Konrad Pesudovs, Tina Beyranvand, Liliana Preotescu, Leticia Avila-Burgos, Enrico Rubagotti, Amira Hamed Darwish, Mahdi Safdarian, Ali Yadollahpour, Vijay Kumar Chattu, Moses K. Muriithi, Azmeraw T. Amare, Si Si, Joshua Longbottom, Somayeh Bohlouli, Khaled Khatab, Masoud Behzadifar, Anusha Ganapati Bhat, G Anil Kumar, Margaret Kosek, Mona M. Khater, Reta Tsegaye Gayesa, Ghobad Moradi, Srinivas Goli, Ruth W Kimokoti, Jalal Arabloo, Kimberly B. Johnson, Andrew T Olagunju, Mowafa Househ, In-Hwan Oh, Arya Haj-Mirzaian, Desta Haftu Hayelom, Jae Il Shin, Ahmed Abdelalim, Catherine A. Welgan, Veincent Christian Filipino Pepito, Andre Rodrigues Duraes, Yuan-Pang Wang, Rosario Cárdenas, Mohammad Khazaei, Sebastian Vollmer, Xiu-Ju Zhao, Mihajlo Jakovljevic, Degu Abate, Ali S. Shalash, Davide Rasella, Melese Abate Reta, Hedayat Abbastabar, Manu Raj Mathur, Aliasghar Ahmad Kiadaliri, Ritesh G. Menezes, Molly K. Miller-Petrie, Beriwan Abdulqadir Ali, Ahmed I. Hasaballah, Joseph Frostad, Eirini Skiadaresi, Aleksandra Barac, Simon I. Hay, Deborah Carvalho Malta, Brigette F. Blacker, Carlo La Vecchia, Eduarda Fernandes, Chandrashekhar T Sreeramareddy, Zewdie Aderaw Alemu, Foad Abd-Allah, Elias Merdassa Roro, Agus Sudaryanto, Fariba Ghassemi, Behzad Karami Matin, Mohsen Naghavi, Maarten J. Postma, Chhabi Lal Ranabhat, Maheswar Satpathy, Mahesh P A, Carlos Miguel Rios González, Pallab K. Maulik, Amir Kasaeian, Ali H. Mokdad, Alemayehu Toma Mena, Tamirat Tesfaye Dasa, Abdur Razzaque Sarker, Andre M. N. Renzaho, Muhammad Aziz Rahman, Ali Kabir, Josephine W. Ngunjiri, Aberash Abay Tassew, Kala M. Mehta, Ionut Negoi, Hosni Salem, Hesham M. Al-Mekhlafi, Sharareh Eskandarieh, Rufus A. Adedoyin, Saleem M Rana, Engida Yisma, Sahel Valadan Tahbaz, Hossein Farzam, Krishna K. Aryal, Lalit Dandona, Masoud Moradi, Juan Sanabria, Gebre Teklemariam Demoz, Naser Mohammad Gholi Mezerji, Shirin Djalalinia, Suraj Bhattarai, Ammas Siraj Mohammed, Claudiu Herteliu, Dawit Zewdu Wondafrash, Mohsen Bayati, Arvin Haj-Mirzaian, Gulfaraz Khan, Mostafa Leili, Nasir Salam, Ehsan Khodamoradi, Jean Jacques Noubiap, Vahid Alipour, Mohammad Ali Mansournia, Rajesh Sagar, Jagadish Rao Padubidri, Manasi Kumar, Mehdi Sharif, Fatemeh Heydarpour, Navid Rabiee, Gvs Murthy, Hamed Kalani, Mayowa O. Owolabi, Claudio Alberto Davila, Oluchi Okpala, Shivakumar K.M. Kondlahalli, Mathew M. Baumann, Bereket Duko Adema, Lorenzo Monasta, Paul S. F. Yip, Mohammad Hossein Khosravi, Rizwan Suliankatchi Abdulkader, Ibrahim Abdollahpour, Dhirendra N Sinha, Farid Najafi, Kebede Deribe, Paula Moraga, Mehedi Hasan, Mohammad Moradi-Joo, Melkamu Merid Mengesha, Temesgen Yihunie Akalu, Vishnu Renjith, Syed Mohamed Aljunid, Zemenu Tadesse Tessema, Amir Radfar, Nuno Taveira, Masoud Foroutan, Demelash Abewa Elemineh, Chinwe Juliana Iwu, Kamarul Imran Musa, Getaneh Alemu Abebe, Farshad Pourmalek, Olatunde Aremu, Mohammad Reza Salahshoor, Derrick A Bennett, Ahmad Daryani, Alebachew Fasil Ashagre, Apurba Shil, Narayan Bahadur Mahotra, Nelson J. Alvis-Zakzuk, Lauren E. Schaeffer, Alexandre C. Pereira, Mehdi Naderi, Mehdi Hosseinzadeh, Rovshan Khalilov, Ai Koyanagi, Salman Khazaei, Jennifer Rickard, Ali Almasi, Sandra B. Munro, Carlos Zambrana-Torrelio, Naohiro Yonemoto, Ahmad Ghashghaee, Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Value, Affordability and Sustainability (VALUE), Microbes in Health and Disease (MHD), Instituto de Saúde Pública da Universidade do Porto, Local Burden Dis Diarrhoea, Department of Earth Observation Science, UT-I-ITC-ACQUAL, Faculty of Geo-Information Science and Earth Observation, GeoHealth, Reiner, Robert C, Wiens, Kirsten E, Deshpande, Aniruddha, Baumann, Mathew M, Adema, Bereket Duko, Yirsaw, Biruck Desalegn, Yisma, Engida, Hay, Simon I, Local Burden of Disease Diarrhoea Collaborators, Tampere University, Health Sciences, University of Helsinki, Institute for Molecular Medicine Finland, Clinicum, HUS Comprehensive Cancer Center, Local Burden of Disease Diarrhoea Collaborator, and Violante FS
Subjects: Low income countries, medicine.medical_treatment, 030204 cardiovascular system & hematology, Global Health, THERAPY, Global Burden of Disease, 0302 clinical medicine, Prevalence, Global health, Medicine, WATER, 030212 general & internal medicine, Children, 11 Medical and Health Sciences, Incidence, Mortality rate, Incidence (epidemiology), 1. No poverty, General Medicine, 3142 Public health care science, environmental and occupational health, Diarrhoea, 3. Good health, Child, Preschool, Middle income countries, A990 Medicine and Dentistry not elsewhere classified, TERRITORIES, Life Sciences & Biomedicine, Infants, Diarrhea, AFRICA, medicine.medical_specialty, Childhood deaths, RJ, sanitation, Developing country, Childhood diarrhoeal morbidity, ITC-HYBRID, 03 medical and health sciences, Medicine, General & Internal, General & Internal Medicine, Environmental health, SYSTEMATIC ANALYSIS, Life Science, Humans, Healthcare Disparities, Oral rehydration therapy, Risk factor, hand washing, Developing Countries, Disease burden, Global Nutrition, Wereldvoeding, Science & Technology, SEX-SPECIFIC MORTALITY, business.industry, CHOLERA, Public health, Bayes Theorem, diarrheal disease, Local Burden of Disease Diarrhoea Collaborators, ITC-ISI-JOURNAL-ARTICLE, NA, Human medicine, Diarrea, business
Abstract: Background: Across low-income and middle-income countries (LMICs), one in ten deaths in children younger than 5 years is attributable to diarrhoea. The substantial between-country variation in both diarrhoea incidence and mortality is attributable to interventions that protect children, prevent infection, and treat disease. Identifying subnational regions with the highest burden and mapping associated risk factors can aid in reducing preventable childhood diarrhoea. Methods: We used Bayesian model-based geostatistics and a geolocated dataset comprising 15 072 746 children younger than 5 years from 466 surveys in 94 LMICs, in combination with findings of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, to estimate posterior distributions of diarrhoea prevalence, incidence, and mortality from 2000 to 2017. From these data, we estimated the burden of diarrhoea at varying subnational levels (termed units) by spatially aggregating draws, and we investigated the drivers of subnational patterns by creating aggregated risk factor estimates. Findings: The greatest declines in diarrhoeal mortality were seen in south and southeast Asia and South America, where 54·0% (95% uncertainty interval [UI] 38·1-65·8), 17·4% (7·7-28·4), and 59·5% (34·2-86·9) of units, respectively, recorded decreases in deaths from diarrhoea greater than 10%. Although children in much of Africa remain at high risk of death due to diarrhoea, regions with the most deaths were outside Africa, with the highest mortality units located in Pakistan. Indonesia showed the greatest within-country geographical inequality; some regions had mortality rates nearly four times the average country rate. Reductions in mortality were correlated to improvements in water, sanitation, and hygiene (WASH) or reductions in child growth failure (CGF). Similarly, most high-risk areas had poor WASH, high CGF, or low oral rehydration therapy coverage. Interpretation: By co-analysing geospatial trends in diarrhoeal burden and its key risk factors, we could assess candidate drivers of subnational death reduction. Further, by doing a counterfactual analysis of the remaining disease burden using key risk factors, we identified potential intervention strategies for vulnerable populations. In view of the demands for limited resources in LMICs, accurately quantifying the burden of diarrhoea and its drivers is important for precision public health. This work was primarily supported by a grant from the Bill & Melinda Gates Foundation (OPP1132415). S Aljunid reports additional funding from the International Centre for Casemix and Clinical Coding, Faculty of Medicine, National University of Malaysia and Department of Health Policy and Management, Faculty of Public Health, Kuwait University for the approval and support to participate in this research project outside of the study. A Awasthi is supported by the Department of Science and Technology, Government of India, New Delhi, through the INSPIRE Faculty Program outside of the study. A Badawi reports additional funding from the Public Health Agency of Canada outside of the study. A Barac reports additional funding from the Project of Ministry of Education, Science and Technology of the Republic of Serbia (no III45005) outside of the study. T Bärnighausen reports additional funding by the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award, funded by the German Federal Ministry of Education and Research outside of the study. F Carvalho and E Fernandez report additional funding from the Portuguese national funds (UID/MULTI/04378/2019 and UID/QUI/50006/2019) outside of the study. V M Costa reports additional funding from Fundação da Ciência e Tecnologia (FCT) for her grant (SFRH/BPD/110001/2015), which was funded by national funds through FCT – Fundação para a Ciência e a Tecnologia, IP, under the Norma Transitória – DL57/2016/CP1334/CT0006 outside of the study. J De Neve reports additional funding from the Alexander von Humboldt Foundation outside of the study. K Deribe reports additional funding from the Wellcome Trust (grant number 201900) as part of his International Intermediate Fellowship outside of the study. D Endalew and M Moradi report additional funding from Wolkite University. M Ausloos, C Herteliu, and A Pana report additional funding from the Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI (project number PN-III-P4-ID-PCCF-2016-0084) outside of the study. C Herteliu reports additional funding from the European Fund for Regional Development through Operational Program for Competitiveness (Project ID P_40_382) and the European Fund for Regional Development, through InterReg Romania-Hungary (project code EMS ROHU 217) outside of the study. P Hoogar reports additional funding from the Centre for Holistic Development and Research (CHDR), Kalaghatagi and The Department of Studies in Anthropology, Karnatak University, D S Islam reports additional funding from the National Heart Foundation of Australia and the Institute for Physical Activity and Nutrition, Deakin University outside of the study. A Khatony reports additional funding from the Clinical Research Development Center of Imam Reza Hospital in Kermanshah outside of the study. J Khubchandani reports additional funding from Merck Research Laboratories outside of the study. K Krishan reports additional funding from the UGC Center of Advanced Study (CAS II) awarded to the Department of Anthropology, Panjab University, Chandigarh, India outside of the study. M Kumar reports additional funding from the Fogarty Foundation/NIH through a K43 award (TW010716-01A1) outside of the study. B Lacey reports additional funding from the National Institute for Health Research Oxford Biomedical Research Centre and the British Heart Foundation Centre of Research Excellence (Oxford, UK) outside of the study. A M Samy reports additional funding from the Egyptian Fulbright Mission Program (EFMP) outside of the study. S Seyedmousavi reports additional funding from the Intramural Program of National Institute of Health Clinical Center, Bethesda, MD, USA outside of the study. M Shey reports additional funding from the Wellcome Trust Kenji Shibuya reports additional funding from Japan's Ministry of Health, Labour and Welfare and Japan's Ministry of Education, Culture, Sport, Science and Technology outside of the study. M Sobhiyeh reports additional funding from the Clinical Research Development Center of Imam Reza Hospital, Kermanshah University of Medical Sciences outside of the study. J Soriano reports additional funding from Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain outside of the study. N Taveira reports additional funding from the LIFE study (RIA2016MC-1615) of the European and Developing Countries Clinical Trials Partnership (EDCTP) program supported by the European Union outside of the study. B Unnikrishnan reports additional funding from the Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India outside of the study. T Wijeratne reports additional funding from the Department of Medicine, Faculty of Medicine, University of Rajarata, Saliyapura, Sri Lanka outside of the study. C S Wiysonge reports additional funding from the South African Medical Research Council and the National Research Foundation of South Africa outside of the study.
Published: 2020

41. Do the current cases reported to the WHO provide a realistic incidence rate of countries infected with COVID-19?

Author: Amjad Mohamadi Bolbanabad, Ghobad Moradi, Bakhtiar Piroozi, Ehsan Mostafavi, Azad Shokri, and Arshad Veysi
Subjects: 2019-20 coronavirus outbreak, international health regulations, Coronavirus disease 2019 (COVID-19), 040301 veterinary sciences, Epidemiology, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), education, 030231 tropical medicine, Infectious and parasitic diseases, RC109-216, Environmental Science (miscellaneous), World health, International Health Regulations, 0403 veterinary science, 03 medical and health sciences, 0302 clinical medicine, Environmental health, Medicine, infectious disease reporting, business.industry, Member states, COVID-19, 04 agricultural and veterinary sciences, emerging infectious disease, Editorial, Infectious disease reporting, Emerging infectious disease, business
Abstract: In compliance with the International Health Regulations (IHR), endorsed by 196 countries in 2005, it has been agreed that all World Health Organization (WHO) member states will contribute to preven...
Published: 2020

42. Mapping geographical inequalities in oral rehydration therapy coverage in low-income and middle-income countries, 2000-17

Author: Ninuk Hariyani, Benjamin Uzochukwu, Anas M. Saad, Sivan Yegnanarayana Iyer Saraswathy, Amirhossein Sahebkar, Behzad Karami Matin, Abdallah M. Samy, Roman Topor-Madry, Nelson G.M. Gomes, Afsaneh Arzani, Simin Liu, Maryam Khayamzadeh, Ejaz Ahmad Khan, Asmamaw Bizuneh Demis, Anelisa Jaca, Amir Kasaeian, Fereshteh Ansari, Abdur Razzaque Sarker, Ali Kabir, Jorge Cano, Marcos Roberto Tovani-Palone, Tufa Kolola, Josephine W. Ngunjiri, Roghiyeh Faridnia, Kedir Hussein Abegaz, Hosni Salem, Sharareh Eskandarieh, Norberto Perico, Sergio I. Prada, Fisaha Haile Tesfay, Jai K Das, Ana Isabel Ribeiro, Sameer Vali Gopalani, Dessalegn Haile, Shivakumar Km Marulasiddaiah M. KMShivakumar, Narayan Prasad, Pranab Chatterjee, Shafiu Mohammed, Ravi Prakash Jha, Xiu Ju George Zhao, Farshad Farzadfar, Ahmad Daryani, Pramesh Raj Ghimire, Abbas Mosapour, Ebrahim Babaee, Rajat Das Gupta, Jean Jacques Noubiap, Daniel Bekele Ketema, Teshome Bekele Elema I, Erkin M. Mirrakhimov, Seyed Hossein Yahyazadeh Jabbari, Muktar Beshir Ahmed, Wondimeneh Shibabaw Shiferaw, Mehran Asadi-Aliabadi, Mohamed M. Gad, Eugenio Traini, Milena Santric-Milicevic, Bakhtiar Piroozi, Mohsen Afarideh, Duduzile Ndwandwe, Ibrahim Abdollahpour, Aisha Elsharkawy, Bárbara Niegia Garcia de Goulart, Soufiane Boufous, Obinna Onwujekwe, Seyyed Meysam Mousavi, Azeem Majeed, Meghnath Dhimal, Bruno F. Sunguya, Daniel Adane Endalew, Hosein Shabaninejad, Siddhesh Zadey, Takahiro Tabuchi, Gebrekiros Gebremichael Meles, Davide Guido, Trang Huyen Nguyen, Yonatal Mesfin Tefera, Hala Elhabashy, Devasahayam J. Christopher, Malede Mequanent Sisay, Davide Rasella, Hedayat Abbastabar, Maziar Moradi-Lakeh, Anthony Masaka, Wagaye Fentahun Chanie, B. Suresh Kumar Shetty, Matiwos Soboka Daba, Tesfaye Yitna Yitna Chichiabellu, Arianna Maever L. Amit, Tomohide Yamada, Alireza Rafiei, Reinhard Busse, Abdullah Al Mamun, Genet Melak Alamene, George C Patton, Andem Effiong, Rushdia Ahmed, Jagadish Rao Padubidri, Mohamad-Hani Temsah, Nizal Sarrafzadegan I, Francesco Saverio Violante, Monika Sawhney, Eyal Oren, Kimberly B. Johnson, Benn Sartorius, Shirin Djalalinia, Mohsen Bayati, Merhawi Gebremedhin Tekle, Navid Rabiee, Javad Nazari, Krishna K. Aryal, Kavumpurathu Raman Thankappan, Yoshan Moodley, Anh Kim Dang, Mohammad Khazaei, Parvaiz A Koul, Edson Serván-Mori, Foad Abd-Allah, Seyed Mohammad Riahi, Nader Jahanmehr, Yuming Guo, Sonia Saxena, Bayu Begashaw Bekele, Hagos Degefa de Hidru I, Enayatollah Homaie Rad, Richard C. Franklin, Dara K. Mohammad, Naznin Hossain, Oliver J. Brady, Natalie Maria Cormier, Ghulam Mustafa, Samiah Alam, Guoqing Hu, Yousef Khader, Mohsen Mazidi, Hamed Kalani, Hamideh Salimzadeh, Mayowa O. Owolabi, Ali Bijani, Getu Debalkie Demissie, Tsegaye Lolaso Lenjebo, German Martinez, Elias Merdassa Roro, Hamidreza Komaki, Giovanni Damiani, Nelson Alvis-Guzman, Reza Shirkoohi, Aditya Prasad Dash, Benny Antony, Cheru Tesema Leshargie, Josip Car, Turki Alanzi, Amir Jalali, Shahin Soltani, Arvin Haj-Mirzaian, John S. Ji, Nima Hafezi-Nejad, S. Mohammad Sajadi, Khalid A Altirkawi, Shanshan Li, Hunduma Amensisa Amensisa Bojia I, Estifanos Baye, Hany Aref, Kebreab Paulos, Francisco Rogerlândio Martins-Melo, Shankar M Bakkannavar, Felix Lam, Themba G.G. Ginindza, Behnam Heidari, Chukwudi A Nnaji, Kebadnew Mulatu Mihretie, Mostafa Leili, Sohail Ahmad, Babak Moazen, Samad Azari, Feleke Gebremeskel W, Jacqueline Elizabeth Alcalde-Rabanal, Khanh Bao Tran, Okechukwu S Ogah, Bruno Ramos Nascimento, Tefera Chane Mekonnen, Irina Filip, Bogdan Oancea, Lalit Dandona, Desalegn Markos Shifti, Nasir Salam, Binyam Minuye Birihane, Mohammad Ali Mansournia, Mohammad Ebrahimi Kalan, Sheetal D. Lad, Michael R.M. Abrigo, Ken Lee Chin, Masoud Moradi, Temesgen Yihunie Akalu, Behzad Heibati, Ole Frithjof Norheim, Man Mohan Mehndiratta, Mahya Beheshti, Ali Yadollahpour, Gelin Xu, Siamak Sabour, Neda Izadi, Carlos Culquichicón, Tuomo J. Meretoja, Ireneous N. Soyiri, Jacob Olusegun Olusanya, Félix Carvalho, Hamid Yimam Hassen, Dereje Bayissa Demissie, Yun Jin Kim, Rajesh Sagar, Fakher Rahim, Catrin E. Moore, Thomas R. Hird, Amjad Mohamadi-Bolbanabad, Naser Mohammad Gholi Mezerji, Ahamarshan Jayaraman Nagarajan, Anton Sokhan, Faris Lami, Masoud Behzadifar, Ritesh G. Menezes, Amira Hamed Darwish, Mohammad Zamani, Tesleem Kayode Babalola, Navid Manafi, Charles Shey Wiysonge, Diego Augusto Santos Silva, Daniel Diaz, Eleonora Dubljanin, Soraya Nouraei Motlagh, Suraj Bhattarai, Getasew Taddesse Worku, Noore Alam, Jasvinder A. Singh, Catalina Liliana Andrei, Ali Kazemi Karyani, Robert C. Reiner, Mohammedaman Mama Hussen, Fatemeh Heydarpour, Nuruzzaman Khan I, Bach Xuan Tran, Lal B. Rawal, Bereket Duko, Joemer C. Maravilla, Rakhi Dandona, Sandra B. Munro, Jae Il Shin, Julia Moreira Pescarini, Claudiu Herteliu, Ahmed Abdelalim, Manasi Kumar, Pushpendra Kumar, Saleem Muhammad Rana, Hedley Quintana, Akram Pourshams, Franz Castro, Muhammad Aziz Rahman, Beyene Meressa Adhena, Aberash Abay Tasew, Linda Morales, Dawit Zewdu Wondafrash, Wasiq Faraz Rawasia, David Laith Rawaf, Zoubida Zaidi, Tomislav Mestrovic, Rajeev Gupta, Seyyede Masoume Athari, Peter Njenga Keiyoro, Andrea Werdecker, Santi Martini, Fatemeh Rajati, Andre Pascal Kengne, Victor Adekanmbi, Seid Tiku Mereta, Yared Asmare Aynalem, Kewal Krishan, Marzieh Nojomi, Yves Miel H Zuniga, Mohammad Reza Sobhiyeh, Frank B. Osei, Nefsu Awoke, Randah R. Hamadeh, G. K. Mini, Edris Hasanpoor, Ayele Geleto Bali, Moslem Soofi, Prabhat Lamichhane, Peter Azzopardi, Amir Khater, G Anil Kumar, Catherine A. Welgan, Abraham Getachew Kelbore, Jaifred Christian F. Lopez, Senthilkumar Balakrishnan, Mohammad Ali Sahraian, Ahmed I. Hasaballah, Virendra Singh, Arash Ziapour, Zahid A Butt, Hebat Allah Salah A. Yousof, Tewodros Eshete Wonde, Sanjay Zodpey, Amaha Kahsay, Achala Upendra Jayatilleke, Segun Emmanuel Ibitoye, Beriwan Abdulqadir Ali, Simin Mouodi, Salman Rawaf, Iqbal R. F. Elyazar, Ai-Min Wu, Seyed Sina Naghibi Irvani, Yasir Waheed, Delia Hendrie, Hadi Pourjafar, Farnam Mohebi, Naohiro Yonemoto, Ahmad Ghashghaee, Veincent Christian Filipino Pepito, Paulina A. Lindstedt, Nauman Khalid, Sezer Kisa, Chi Linh Hoang, Niranjan Kissoon, Kindie Fentahun Muchie, Valery L. Feigin, Mathew M. Baumann, Alemayehu Toma, Andre Rodrigues Duraes, Benjamin B. Massenburg, Santosh Varughese, Yuan-Pang Wang, Ingan Ukur Tarigan, Ali Kiadaliri, Hamed Zandian, Demelash Woldeyohannes Handiso, Hassan Magdy Abd El Razek, Ketema Bizuwork Gebremedhin, Hafiz Ansar Rasul Suleria, Oluchi Ezekannagha, Getinet Ayano, Bolajoko O. Olusanya, Manu Raj Mathur, Manfred Accrombessi, Christopher J L Murray, Moritz U. G. Kraemer, Saeed Amini, Ziad A. Memish, Yousef Mohammad, Luis Camera, Ernoiz Antriyandarti, Ronny Westerman, Meghdad Pirsaheb, Negar Rezaei, Ted R. Miller, Aziz Eftekhari, Nevine El Nahas, Sebastian Vollmer, Sanjay Basu, Hesham M. Al-Mekhlafi, D. R. Mahadeshwara Prasad, Rufus A. Adedoyin, Miliva Mozaffor I, Mihiretu Kebede, Preeti Dhillon, Dilaram Acharya, Iman El Sayed, Narendar Manohar, Paul S. F. Yip, Ben Lacey, Felix Akpojene Ogbo, Adrian Davis, Dinh-Toi Chu, Ranjani Somayaji, Raaj Kishore Biswas, Taddese Alemu Zerfu, Claudio Alberto Dávila-Cervantes, Sharath Burugina Nagaraja, Getachew Mullu Kassa, Mohan Bairwa, Gurudatta Naik, André Karch, Gudlavalleti V S Murthy, Avula Laxmaiah, Farid Najafi, Birhanu Geta Meharie, Lorenzo Monasta, Amit Arora, Christopher S Yilgwan, Samer Hamidi, Keivan Ahmadi, Kebede Deribe, Ehimario U. Igumbor, Engida Yisma, Henok Biresaw Netsere, Mihajlo Jakovljevic, Ali S. Shalash, Thirunavukkarasu Sathish, Sachin R Atre, Mohamed I Hegazy, Mehedi Hasan, Hamidreza Haririan, Lucas Guimarães Abreu, Nejimu Biza Zepro, Surendra Karki, Krittika Bhattacharyya, Hiroshi Yatsuya, Gbenga A. Kayode, Osayomwanbo Osarenotor, Paul H. Lee, Deepak Paudel, Hagos Tasew Atalay, Hatem S Shehata, Mohammad Fareed, Adnan Kisa, Hisham Atan Edinur, Mehran Alijanzadeh, Shafiur Rahman, Mohammad Hossein Khosravi, Anusha Ganapati Bhat, Bahram Mohajer, Narinder Pal Singh, Shai Linn, Savita Lasrado, Joseph Adel Mattar Banoub, Amir Almasi-Hashiani, Mohd Anisul Karim, Praveen Hoogar, Kerrie E. Doyle, Bedilu Girma Weji, Juan Sanabria, Olatunji O. Adetokunboh, Mohamed Hsairi, Alireza Esteghamati, Seok Jun Yoon, Paramjit Gill, Dabere Nigatu, Tariq Jamal Siddiqi, Muhammad Usman, Rafael Alves Guimarães, Zemenu Tadesse Tessema, Aziz Sheikh, Florian Fischer, Peter Memiah, Rakesh Lodha, Nihal Thomas, Karzan Abdulmuhsin Mohammad, Mohammad Sadegh Rezai, Tanuj Kanchan, Vinay Nangia, Ashraf Nabhan, Gebre Teklemariam Demoz, Eirini Skiadaresi, Aleksandra Barac, Simon I. Hay, Sadaf G. Sepanlou, Michellr L. Bell, Nicola Luigi Bragazzi, Aklilu Endalamaw, Vishnu Renjith, Chinwe Juliana Iwu, Gabrielle B. Britton, Colm McAlinden, Ayenew Negesse Abejie, Smita Pakhale, Doris V.V. Ortega-Altamirano, Noushin Mohammadifard, Deborah Carvalho Malta, Vo Dinh Bay, Kirsten E. Wiens, Hamidreza Karimi-Sari, Mustafa Z. Younis, Shaimaa I. El-Jaafary, Morenike Oluwatoyin Folayan, Phetole Walter Mahasha, Mu'awiyyah Babale Sufiyan, Harish Chander Gugnani, Mohammad Hifz Ur Rahman, Sheikh Mohammed Shariful Islam, Maarten J. Postma, Usman Iqbal, Abdu A. Adamu, Marwa R.Rashad Salem I, Fares Alahdab, Vafa Rahimi-Movaghar, Zulfiqar A. Bhutta, Masoud Foroutan, Muhammad Shahzeb Khan, In-Hwan Oh, Yahya Salimi, Takeshi Fukumoto, Chhabi Lal Ranabhat, Tiffany K. Gill, Angel Paternina-Caicedo, Walter Mendoza, Sojib Bin Zaman, Olayinka Stephen Ilesanmi, Brigette F. Blacker, Anbissa Muleta Senbeta, Subramanian Senthilkumaran, Ambrish Singh, Mehdi Fazlzadeh, Mahesh P A, Carlo La Vecchia, Alex Yeshaneh, Benjamin K. Mayala, Aniruddha Deshpande, Agus Sudaryanto, Neeraj Bedi, Morteza Shamsizadeh, Jemal Abdu Mohammed, Vahid Alipour, Haileab Fekadu Wolde, Boris Bikbov, Ahmed Abualhasan, Ali H. Mokdad, Eduarda Fernandes, Chandrashekhar T Sreeramareddy, Jacek Jerzy Jozwiak, Alessandra C. Goulart, Mahmoud Yousefifard, Masood Ali Shaikh, Roya Safari-Faramani, MohammadBagher Shamsi, Aso Mohammad Darwesh, Amir Anoushiravani, Kebede Embaye Gezae, Degena Bahrey Tadesse, Paula Moraga, Maha El Tantawi, Rosario Cárdenas, Assefa Desalew, Vivek Kumar, Mina Anjomshoa, Junaid Khan, Jagdish Khubchandani, Marcel Ausloos, Soraya Siabani, Anwar E. Ahmed, Mohammed Ibrahim Mohialdeen Gubari, Andre M. N. Renzaho, Vuong Minh Nong, Kaushik Sarkar, Bruno Piassi Sao Jose, Yafeng Wang, Mitchell T. Wallin, Edgar Denova-Gutiérrez, Mohammad Hasan Imani-Nasab, Melese Abate Reta, Kala M. Mehta, Yahya Safari, Marufa Sultana, David C. Schwebel, Roghayeh Mohammadibakhsh, Samath D Dharmaratne, Maysaa El Sayed Zaki, Shiwei Liu, Gail Davey, Milena Ilic, Yunquan Zhang, Bahram Armoon, Seyed-Mohammad Fereshtehnejad, Jost B. Jonas, Dian Kusuma, Yawukal chane Kasahun, Beatriz Paulina Ayala Quintanilla, Mohammad Moradi-Joo, Gebrehiwot G. Kassa, Maria Jesus Rios-Blancas, Serge Resnikoff, Seifadin Ahmed Shallo, Bartosz Miazgowski, Huda Basaleem, Jobert Richie Nansseu, Enrico Rubagotti, Carl Abelardo T. Antonio, Morteza Abdullatif Khafaie, Meysam Behzadifar, Maryam Adabi, Saravanan Muthupandian, Soumyadeep Bhaumik, hawariat, Carlos A Castañeda-Orjuela, Bhaskaran Unnikrishnan, Martin Amogre Ayanore, Dragos Virgil Davitoiu, Hossein Poustchi, Moses K. Muriithi, Dharmesh Kumar Lal, Ayman Grada, Rafael Tabarés-Seisdedos, Seyyed Shamsadin Athari, Ashish Pathak, Salvatore Rubino, Kenji Shibuya, Ana Laura Manda, Muluken Bekele Sorrie, Vivekanand Jha, Habtamu Kebebe Kasaye, Mohammad Hoseini, Sonali Kochhar, Van C. Lansingh, Ali Almasi, Amir Radfar, Till Bärnighausen, Marcia R. Weaver, Mowafa Househ, Arya Haj-Mirzaian, Gebremicheal Gebreslassie Kasahun, Arash Etemadi, Getahun Fentaw Mulaw, Zubair Kabir, Cuong Tat Nguyen, Chabila C Mapoma, Aubrey J. Levine, Solomon Gedlu Nigatu, Aslam Pervaiz, Muhammed Magdy Abd El Razek, Nataliya A. Foigt, Andrey Nikolaevich Briko, Sadaf Esteghamati, Chuanhua Yu, Pascual R. Valdez, Jennifer Rickard, Jennifer M. Ross, Ionut Negoi, Hailay Abrha Gesesew, Kamarul Imran Musa, Farshad Pourmalek, Kiomars Sharafi, Sangram Kishor Patel, Vera Marisa Costa, Mostafa Hosseini, Hajer Elkout, Mika Shigematsu, Bryan L. Sykes, Afarin Rahimi-Movaghar, Nuworza Kugbey, Vijay Kumar Chattu, Payman Salamati, Mona M. Khater, Reta Tsegaye Gayesa, Ehsan Sadeghi, Andrew T Olagunju, Govinda Prasad Dhungana, Dina Nur Anggraini Ningrum, Yaschilal Muche Belayneh, Leonardo Roever, Luca Ronfani, Nathaniel J. Henry, Brijesh Sathian, Hamid Sharifi, Liliana Preotescu, Joshua Longbottom, Somayeh Bohlouli, Huong Lan Thi Nguyen, Khaled Khatab, Ziyad Al-Aly, Ghobad Moradi, Ruth W Kimokoti, Jalal Arabloo, Mariam Molokhia, Maciej Banach, Hasan Yusefzadeh, Rahman Shiri, Girmay Teklay Weldesamuel, Mekdes Tigistu Yilma, Taweewat Wiangkham, Soewarta Kosen, Kovin Naidoo, Fernando de la Hoz, Mohammed Shannawaz, Berhe Etsay Tesfay I, Yogesh Sabde, Syed Mohamed Aljunid, Belay Tessema, Reza Malekzadeh, Tinuke O Olagunju, Olatunde Aremu, Mohammad Reza Salahshoor, Derrick A Bennett, Oladimeji M. Adebayo, Teshome Gebre, Narayan Bahadur Mahotra, Nelson J. Alvis-Zakzuk, Lauren E. Schaeffer, Alexandre C. Pereira, Mehdi Naderi, Mehdi Hosseinzadeh, Mehran Shams-Beyranvand, Ilais Moreno Velásquez, Rovshan Khalilov, Ai Koyanagi, Salman Khazaei, Ismael R. Campos-Nonato, Alaa Badawi, Amir Hasanzadeh, Gebreamlak Gebremedhn Gebremeskel, Gessessew Bugssa Hailu, Dessalegn Ajema Berbada, Kate E. LeGrand, Azadeh Shafieesabet, Nikolay Ivanovich Briko, Robert S. Bernstein, Irfan Ullah, Isaac Oluwafemi Dipeolu, Hadi Hassankhani, Keyghobad Ghadiri, Local Burden of Disease Diarrhoea Collaborator, Violante FS, Wiens, KE, Lindstedt, PA, Blacker, BF, Johnson, KB, Yisma, E, Ahmed, Muktar Beshir, Reiner, Robert C, Duko, Bereket, Local Burden of Disease Diarrhoea Collaborators, Microbes in Health and Disease (MHD), Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Value, Affordability and Sustainability (VALUE), Local Burden Dis Diarrhoea, Department of Earth Observation Science, UT-I-ITC-ACQUAL, Faculty of Geo-Information Science and Earth Observation, GeoHealth, HUS Comprehensive Cancer Center, Clinicum, Institute for Molecular Medicine Finland, Department of Oncology, University of Helsinki, and Instituto de Saúde Pública da Universidade do Porto
Subjects: RJ101, medicine.medical_treatment, CHILDREN, ZINC, 0302 clinical medicine, 030212 general & internal medicine, media_common, Geography, lcsh:Public aspects of medicine, 1. No poverty, Low income and middle income countries, General Medicine, 3142 Public health care science, environmental and occupational health, 3. Good health, Child, Preschool, A990 Medicine and Dentistry not elsewhere classified, Geographical inequalities, 0605 Microbiology, Diarrhea, AFRICA, Inequality, DEATHS, media_common.quotation_subject, 030231 tropical medicine, Developing country, Article, RS, 1117 Public Health and Health Services, 03 medical and health sciences, MORBIDITY, Environmental health, DIARRHEAL DISEASE, medicine, Humans, Oral rehydration therapy, Healthcare Disparities, Developing Countries, Models, Statistical, CHOLERA, MORTALITY, Infant, Newborn, Infant, lcsh:RA1-1270, Bayes Theorem, Middle income, GLOBAL BURDEN, Child mortality, 0605 Microbiology, 1117 Public Health and Health Services, Health Care Surveys, ITC-ISI-JOURNAL-ARTICLE, Fluid Therapy, NA, Human medicine, ITC-GOLD
Abstract: Background: Oral rehydration solution (ORS) is a form of oral rehydration therapy (ORT) for diarrhoea that has the potential to drastically reduce child mortality; yet, according to UNICEF estimates, less than half of children younger than 5 years with diarrhoea in low-income and middle-income countries (LMICs) received ORS in 2016. A variety of recommended home fluids (RHF) exist as alternative forms of ORT; however, it is unclear whether RHF prevent child mortality. Previous studies have shown considerable variation between countries in ORS and RHF use, but subnational variation is unknown. This study aims to produce high-resolution geospatial estimates of relative and absolute coverage of ORS, RHF, and ORT (use of either ORS or RHF) in LMICs. Methods: We used a Bayesian geostatistical model including 15 spatial covariates and data from 385 household surveys across 94 LMICs to estimate annual proportions of children younger than 5 years of age with diarrhoea who received ORS or RHF (or both) on continuous continent-wide surfaces in 2000-17, and aggregated results to policy-relevant administrative units. Additionally, we analysed geographical inequality in coverage across administrative units and estimated the number of diarrhoeal deaths averted by increased coverage over the study period. Uncertainty in the mean coverage estimates was calculated by taking 250 draws from the posterior joint distribution of the model and creating uncertainty intervals (UIs) with the 2·5th and 97·5th percentiles of those 250 draws. Findings: While ORS use among children with diarrhoea increased in some countries from 2000 to 2017, coverage remained below 50% in the majority (62·6%; 12 417 of 19 823) of second administrative-level units and an estimated 6 519 000 children (95% UI 5 254 000-7 733 000) with diarrhoea were not treated with any form of ORT in 2017. Increases in ORS use corresponded with declines in RHF in many locations, resulting in relatively constant overall ORT coverage from 2000 to 2017. Although ORS was uniformly distributed subnationally in some countries, within-country geographical inequalities persisted in others; 11 countries had at least a 50% difference in one of their units compared with the country mean. Increases in ORS use over time were correlated with declines in RHF use and in diarrhoeal mortality in many locations, and an estimated 52 230 diarrhoeal deaths (36 910-68 860) were averted by scaling up of ORS coverage between 2000 and 2017. Finally, we identified key subnational areas in Colombia, Nigeria, and Sudan as examples of where diarrhoeal mortality remains higher than average, while ORS coverage remains lower than average. Interpretation: To our knowledge, this study is the first to produce and map subnational estimates of ORS, RHF, and ORT coverage and attributable child diarrhoeal deaths across LMICs from 2000 to 2017, allowing for tracking progress over time. Our novel results, combined with detailed subnational estimates of diarrhoeal morbidity and mortality, can support subnational needs assessments aimed at furthering policy makers' understanding of within-country disparities. Over 50 years after the discovery that led to this simple, cheap, and life-saving therapy, large gains in reducing mortality could still be made by reducing geographical inequalities in ORS coverage. This work was primarily supported by a grant from the Bill & Melinda Gates Foundation (OPP1132415). L G Abreu has received support from Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Finance Code 001), Conselho Nacional de Desenvolvimento Científico e Tecnológico and Fundação de Amparo à Pesquisa do Estado de Minas Gerais. O O Adetokunboh acknowledges the South African Department of Science and Innovation and the National Research Foundation. S M Aljunid acknowledges the Department of Health Policy and Management, Faculty of Public Health, Kuwait University and International Centre for Casemix and Clinical Coding, Faculty of Medicine, National University of Malaysia for the approval and support to participate in this research project. H T Atalay acknowledges Aksum University. M Ausloos and C Herteliu are partially supported by a grant of the Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084. P S Azzopardi was supported by an Australian National Health and Medical Research Council (NHMRC) early career fellowship. A Badawi is supported by the Public Health Agency of Canada. T W Bärnighausen was supported by the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award, funded by the German Federal Ministry of Education and Research; the EU; the Wellcome Trust; and from National Institute of Child Health and Human Development of National Institutes of Health (NIH; R01-HD084233), National Institute on Aging of NIH (P01-AG041710), National Institute of Allergy and Infectious Diseases of NIH (R01-AI124389 and R01-AI112339), as well as Fogarty International Center of NIH (D43-TW009775). G B Britton is supported by Sistema Nacional de Investigación (SNI) de la Secretaría Nacional de Ciencia, Tecnología e Innovación (SENACYT) of Panamá. A Barac is funded by the Project of Ministry of Education, Science and Technology of the Republic of Serbia (number III45005). D A Bennett was supported by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre. The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR, or the UK Department of Health and Social Care. V M Costa acknowledges her grant (SFRH/BHD/110001/2015), received by Portuguese national funds through Fundação para a Ciência e Tecnologia (FCT), IP, under the Norma Transitória DL57/2016/CP1334/CT0006. F Carvalho acknowledges UID/MULTI/04378/2019 and UID/QUI/50006/2019 support with funding from FCT/Ministério da Ciência, Tecnologia e Ensino Superior through national funds. K Deribe is supported by a Wellcome Trust grant (number 201900/Z/16/Z) as part of his International Intermediate Fellowship. C Herteliu is partially supported by a grant co-funded by European Fund for Regional Development through the Operational Program for Competitiveness (project ID P_40_382). P Hoogar thanks Centre for Bio Cultural Studies, Directorate of Research, Manipal Academy of Higher Education, Manipal and Centre for Holistic Development and Research, Kalaghatgi-Karnataka. S M S Islam is funded by a Fellowship from National Heart Foundation of Australia and Deakin University. M Jakovljevic and the Serbian part of this GBD contribution was co-funded through grant OI175014 of the Ministry of Education Science and Technological Development of the Republic of Serbia. A P Kengne is supported by the South African Medical Research Council. Y J Kim's work was supported by the Research Management Centre, Xiamen University Malaysia, grants number XMUMRF/2018-C2/ITCM/0001. K Krishan is supported by a DST PURSE grant and UGC Center of Advanced Study awarded to the Department of Anthropology, Panjab University, Chandigarh, India. M Kumar acknowledges K43 TW010716-03. B Lacey acknowledges support from the NIHR Oxford Biomedical Research Centre and the British Heart Foundation Centre of Research Excellence, Oxford. P T N Memiah acknowledges the Council for the Development of Social Science Research in Africa. M Molokhia is supported by the NIHR Biomedical Research Center at Guy's and St Thomas' National Health Service Foundation Trust and King's College London. I Moreno Velásquez is supported by the Sistema Nacional de Investigación (SENACYT, Panamá). G C Patton is funded by an NHMRC Fellowship. A M Samy received a fellowship from the Egyptian Fulbright Mission programme. M M Santric-Milicevic acknowledges the support of the Ministry of Education, Science and Technological Development of the Republic of Serbia (contract number 175087). A Sheikh acknowledges the support of Health Data Research UK. M R Sobhiyeh acknowledges the Clinical Research Development Center of Imam Reza Hospital, Kermanshah University of Medical Sciences for their wise advice. R Tabarés-Seisdedos was supported in part by grant PI17/00719 from Instituto de Salud Carlos III–FEDER. B Unnikrishnan acknowledges Manipal Academy of Higher Education, Manipal. M R Weaver was supported by the Bill & Melinda Gates Foundation grant OPP1127433. C S Wiysonge was supported by the South African Medical Research Council.
Published: 2020

43. Mapping 123 million neonatal, infant and child deaths between 2000 and 2017

Author: Mohsen Bayati, Arvin Haj-Mirzaian, Mehran Asadi-Aliabadi, Maziar Moradi-Lakeh, Nasir Salam, Mohamad-Hani Temsah, Fatemeh Heydarpour, Davide Rasella, Kavumpurathu Raman Thankappan, Ghulam Mustafa, Sergey Konstantinovitch Vladimirov, Fereshteh Ansari, Dina Nur Anggraini Ningrum, Leonardo Roever, Oghenowede Eyawo, Koustuv Dalal, Ana-Laura Manda, Ritesh G. Menezes, Molly K. Miller-Petrie, Javad Yoosefi Lebni, Gebreamlak Gebremedhn Gebremeskel, Aziz Eftekhari, Oleguer Plana-Ripoll, Jon Wakefield, Sanjay Zodpey, Birhanu Geta, Amaha Kahsay, Edris Hasanpoor, Brijesh Sathian, Kala M. Mehta, Moritz U. G. Kraemer, Saeed Amini, Hesham M. Al-Mekhlafi, Abbas Yadegar, João Pedro Silva, Desmond Kuupiel, Anvar Asadi, Hamid Sharifi, Ebrahim Babaee, Dessalegn Ajema Berbada, Taddese Alemu Zerfu, Ian Davis, Mostafa Qorbani, Fatemeh Rajati, Samer Hamidi, Parvaiz A Koul, Foad Abd-Allah, Mojisola Oluwasanu, Syed Mohamed Aljunid, Elias Merdassa Roro, Mihaela Hostiuc, Robert S. Bernstein, Vahid Yazdi-Feyzabadi, Gebre Teklemariam Demoz, Irina Filip, Mu'awiyyah Babale Sufiyan, Amir Khater, Lidia Morawska, Sangram Kishor Patel, Robert C. Reiner, Joshua O. Akinyemi, Telma Zahirian Moghadam, Ali Akbar Fazaeli, Reza Malekzadeh, Olatunde Aremu, Mohammad Reza Salahshoor, Irfan Ullah, Gabrielle B. Britton, Gelin Xu, Nathaniel J Henry, Thomas R. Hird, Ronny Westerman, Vera Marisa Costa, Reza Assadi, Tiffany K. Gill, Chhabi Lal Ranabhat, Meysam Olfatifar, Sezer Kisa, Grant Rodgers Kemp, Mahmoud Yousefifard, Aleksandra Barac, Simon I. Hay, Walter Mendoza, Mohammad Zamani, Nader Jafari Balalami, Mahdi Safdarian, Manfred S. Green, Mahesh P A, Nahid Neamati, Pallab K. Maulik, Ali H. Mokdad, Joshua Longbottom, Somayeh Bohlouli, Ahmad Daryani, Ibrahim Abdollahpour, Mostafa Hosseini, Deborah Carvalho Malta, Nick Golding, Sheikh Mohammed Shariful Islam, Shirin Nosratnejad, Haidong Wang, Shadi Rahimzadeh, Pushpendra Kumar, Mehdi Noroozi, Andre M. N. Renzaho, Brent Bell, Huong Lan Thi Nguyen, Khaled Khatab, Meghdad Pirsaheb, Yousef Veisani, Katie R Nielsen, Ionut Negoi, Seyyed Meysam Mousavi, Amir Ashraf-Ganjouei, Mohammad Hassan Emamian, Joseph L Ward, Sharath Burugina Nagaraja, Songhomitra Panda-Jonas, Ettore Beghi, Azeem Majeed, Ivy Shiue, Delia Hendrie, Roghiyeh Faridnia, Seyed Mostafa Mir, Moslem Soofi, Ghobad Moradi, Mahsa Ghajarzadeh, Chandrashekhar T Sreeramareddy, Milad Hasankhani, Mohamed I Hegazy, Mika Shigematsu, Bryan L. Sykes, Vahid Alipour, Ruth W Kimokoti, Afshin Maleki, Nafiseh Baheiraei, Noore Alam, Jalal Arabloo, Mariam Molokhia, Kimberly B. Johnson, Amber Sligar, Nicole Davis Weaver, Kerem Shuval, Malede Mequanent Sisay, Paul H. Lee, Reza Ghadimi, Mahbobeh Faramarzi, Natalia V. Bhattacharjee, Ehsan Sadeghi, Brandon V. Pickering, Animika Pandey, Ana Isabel Ribeiro, Felix Greaves, Sameer Vali Gopalani, Joel M. Francis, Alyssa N. Sbarra, Yun Jin Kim, Agus Sudaryanto, Hebat Allah Salah A. Yousof, Hadi Pourjafar, Tomohide Yamada, Alireza Rafiei, Rosario Cárdenas, Mohammad Khazaei, Hasan Yusefzadeh, Rahman Shiri, Girmay Teklay Weldesamuel, Zahra Jorjoran Shushtari, Michael Collison, Stanislav S. Otstavnov, Narayanaswamy Venketasubramanian, Yahya Salimi, Naohiro Yonemoto, Ahmad Ghashghaee, Soewarta Kosen, Al Artaman, Surendra Karki, Tariq Jamal Siddiqi, Lorenzo Monasta, Amit Arora, Christopher S Yilgwan, Ahamarshan Jayaraman Nagarajan, Adnan Kisa, Gholamreza Roshandel, Vahid Rashedi, Daniel Diaz, Amir Vahedian-Azimi, Erkin M. Mirrakhimov, Nuworza Kugbey, Zohreh Arefi, Benjamin B. Massenburg, Robert G. Weintraub, Lauren E. Schaeffer, Alexandre C. Pereira, Mehdi Hosseinzadeh, Milena M Santric Milicevic, Ai Koyanagi, Mehran Shams-Beyranvand, Salman Khazaei, Olalekan A. Uthman, Mohamed Hsairi, Nuno Taveira, Masoud Foroutan, Jayendra Sharma, Hanna Demelash Desyibelew, Max Roser, Keivan Ahmadi, Yousef Khader, Hamideh Salimzadeh, Ali Bijani, Shanshan Li, Mehran Alijanzadeh, Florian Fischer, Aziz Sheikh, Eun-Kee Park, Stefan Listl, Smita Pakhale, Brian J. Hall, Alireza Zangeneh, Ravi Mehrotra, Kidu Gidey Weldegwergs, Mahdi Afshari, Son Hoang Nguyen, Francisco Rogerlândio Martins-Melo, Rupak Desai, Aziz Rezapour, Hassan Magdy Abd El Razek, Gillian I. Hollerich, Reza Saeedi, Iman El Sayed, Olayinka Stephen Ilesanmi, Ben Lacey, Soheil Ebrahimpour, Laura Dwyer-Lindgren, Roya Ebrahimi, Bolajoko O. Olusanya, Tommi Vasankari, Siamak Sabour, Theo Vos, Tuomo J. Meretoja, Job F M van Boven, Nataliya Foigt, Mojtaba Hoseini-Ghahfarokhi, Saleh Salehi Zahabi, Mehdi Fazlzadeh, Neeraj Bedi, Hamed Mirjalali, Payman Salamati, P N Sylaja, Ted R. Miller, George J. Milne, Alaa Badawi, Muhammad Usman, Amir Hasanzadeh, Michelle L. Bell, Giang Thu Vu, Masoud Behzadifar, Manasi Kumar, Mona M. Khater, Josip Car, Nafis Sadat, Mostafa Leili, Mehdi Sharif, Hadi Hassankhani, Mowafa Househ, Joshua A. Salomon, Morteza Mansourian, G Anil Kumar, João C. Fernandes, Tufa Kolola, Arya Haj-Mirzaian, Masood Ali Shaikh, Keyghobad Ghadiri, Andrew T Olagunju, Bahram Armoon, Beatriz Paulina Ayala Quintanilla, Samantha Perkins, Mohsen Mazidi, Stefan Lorkowski, Sagnik Dey, Edward J Mills, Ali Kabir, Maryam Khazaei-Pool, Mohammad Rabiee, Arianna Maever L. Amit, John S. Ji, Sivan Yegnanarayana Iyer Saraswathy, Fares Alahdab, Vafa Rahimi-Movaghar, Martin McKee, Hadi Parsian, Ejaz Ahmad Khan, Amirhossein Sahebkar, Paramjit Gill, Dara K. Mohammad, Naznin Hossain, Karen M. Tabb, Annie J. Browne, Abdallah M. Samy, Elham Ehsani-Chimeh, Nelson G.M. Gomes, Destallem Gebremedhin Gebre, Fakher Rahim, Sheetal D. Lad, Rajat Das Gupta, Yash Jobanputra, Rajesh Sharma, Davoud Adham, Richard Ofori-Asenso, Farah Daoud, Aso Mohammad Darwesh, Meghnath Dhimal, Pranab Chatterjee, Javad Javidnia, Shafiu Mohammed, Amir Abdoli, Josep Maria Haro, Stefanie Watson, Behnam Nabavizadeh, Masoumeh Abbasi, Kefyalew Addis Alene, Marzieh Nojomi, G. K. Mini, Abbas Mosapour, Cyrus Cooper, Yirga Legesse Nirayo, Jagdish Khubchandani, Muhammed Magdy Abd El Razek, Faramarz Shaahmadi, Satar Rezaei, Mahdi Sharif-Alhoseini, Francesco Saverio Violante, Eyal Oren, Erfan Zabeh, Atte Meretoja, Nicholas Graetz, Kris J. Krohn, Anthony Masaka, Oladimeji Adebayo, Mikk Jürisson, Faris Lami, Marcos Roberto Tovani-Palone, Chloe Shields, Yahya Safari, Yasir Waheed, Dilaram Acharya, Seyed Mohammad Riahi, Jan-Walter De Neve, Carlos A Castañeda-Orjuela, Alberto Ortiz, Samad Azari, Shymaa Enany, Maha Ezalarab, Salvatore Rubino, Enayatollah Homaie Rad, Roghayeh Khabiri, Seyed-Mohammad Fereshtehnejad, Yuming Guo, Sonia Saxena, Nicholas J K Breitborde, Takeshi Fukumoto, Hamid Yimam Hassen, Thomas Pilgrim, Yasser Vasseghian, Dragos Virgil Davitoiu, Farid Najafi, Sathish Thirunavukkarasu, Ali Rostami, Efat Mohamadi, Sameh Magdeldin, Hedley Quintana, Cyrus Alinia, Rodrigo Sarmiento-Suarez, Roya Safari-Faramani, Leila Doshmangir, Kewal Krishan, Karen Sliwa, Nazrul Islam, Neal Marquez, Genet Melak Alamene, Andem Effiong, Khanh Bao Tran, Amir Kasaeian, Adeladza Kofi Amegah, Hamidreza Haririan, Maha El Tantawi, Anders Larsson, André Faro, Rushdia Ahmed, Amir Shamshirian, Josephine W. Ngunjiri, Yousef Moradi, Sharareh Eskandarieh, Evanson Z. Sambala, Nelson Alvis-Guzman, Mehdi Moradinazar, Lauren Woyczynski, Parul Puri, Yunquan Zhang, Navid Manafi, Vinay Nangia, Joan B. Soriano, Victor Adekanmbi, Sofia Androudi, Carl Abelardo T. Antonio, Morteza Abdullatif Khafaie, Netsanet Fentahun, Achala Upendra Jayatilleke, David L. Smith, Solomon Sisay, Giuseppe Gorini, Meysam Behzadifar, Charles Shey Wiysonge, Bach Xuan Tran, Lal B. Rawal, Arefeh Babazadeh, Damaris K. Kinyoki, Morteza Shamsizadeh, Ziad El-Khatib, Zohreh Anbari, Abdol Sattar Pagheh, Ranjani Somayaji, Frank B. Osei, Nancy Fullman, Zahid A Butt, Ai-Min Wu, Tahereh Pashaei, Benn Sartorius, Aaron Osgood-Zimmerman, Sachin R Atre, Mehdi Ahmadi, Chalachew Genet Akal, Aubrey J. Levine, Mohammad Fareed, Quique Bassat, Khalid A Altirkawi, Ensiyeh Jenabi, Daem Roshani, Mina Anjomshoa, Jasvinder A. Singh, Yafeng Wang, Samath D Dharmaratne, Enrico Rubagotti, Ruxandra Irina Negoi, Reinhard Busse, Abdullah Al Mamun, Yoshan Moodley, Mohammed Almalki, Peter W. Gething, Alireza Khatony, Usman Iqbal, Soraya Nouraei Motlagh, Roy Burstein, Hamed Zandian, Rakhi Dandona, Mojtaba Bagherzadeh, Majid Pirestani, Jaifred Christian F. Lopez, Chuanhua Yu, Arash Ziapour, Seyed Sina Naghibi Irvani, Bárbara Niegia Garcia Goulart, Pascual R. Valdez, Amir Jalali, Chukwudi A Nnaji, Kelechi Elizabeth Oladimeji, Tomislav Mestrovic, Isidora S. Vujcic, Osayomwanbo Osarenotor, Azin Nahvijou, Chi Linh Hoang, Christopher J L Murray, Mustafa Z. Younis, Veincent Christian Filipino Pepito, Andre Rodrigues Duraes, Yuan-Pang Wang, Felix Akpojene Ogbo, Aniruddha Deshpande, Nicholas J Kassebaum, Jacek Jerzy Jozwiak, Soghra Bagheri, Paul S. F. Yip, Sree Bhushan Raju, Sadaf G. Sepanlou, Kebede Deribe, Junaid Khan, Mohammad Aghaali, Lalit Dandona, Masoud Moradi, Molly R Nixon, Bruno Piassi Sao Jose, Atalay Goshu Muluneh, Mohammad Hasan Imani-Nasab, Naser Mohammad Gholi Mezerji, Abdullah Sulieman Terkawi, Sojib Bin Zaman, Muhammad Shahzeb Khan, Maysaa El Sayed Zaki, Gebrekiros Gebremichael Meles, Suraj Bhattarai, Yared Belete Belay, Ammas Siraj Mohammed, Dawit Zewdu Wondafrash, Abbas Balouchi, Silvano Gallus, Mohammad Abdollahi, Long Hoang Nguyen, Zulfiqar A Bhutta, Jean Jacques Noubiap, Mehdi Naderi, Bernhard T. Baune, Lucas Earl, Doris D. V. Ortega-Altamirano, Michael R.M. Abrigo, Farkhonde Salehi, Hamed Kalani, Mayowa O. Owolabi, Feleke Mekonnen Demeke, Lee Ling Lim, Ulrich O Mueller, Laurie B. Marczak, Peter Njenga Keiyoro, Ehsan Ahmadpour, Navid Rabiee, Dinh-Toi Chu, Vasily Vlassov, Bradford D Gessner, Tsegaye Tewelde Gebrehiwot, Sorin Hostiuc, Bakhtiar Piroozi, Mahdieh Abbasalizad-Farhangi, Takahiro Tabuchi, Philimon Gona, Bahar Ataeinia, Azra Ramezankhani, Duduzile Ndwandwe, Obinna Onwujekwe, Zohreh Rahimi, Seyedmojtaba Seyedmousavi, Wagaye Fentahun Chanie, Neda Kianipour, Rizwan Suliankatchi Abdulkader, Dhirendra N Sinha, Young-Ho Khang, Paula Moraga, Manoochehr Karami, Solomon Olum, Rafael Tabarés-Seisdedos, Zemenu Tadesse Tessema, Amir Radfar, Kiomars Sharafi, Rohollah Kalhor, Benjamin K. Mayala, Mahmood Moosazadeh, David C. Schwebel, Jost B. Jonas, Quyen G. To, Ester Cerin, Martin Amogre Ayanore, Value, Affordability and Sustainability (VALUE), Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Groningen Research Institute for Asthma and COPD (GRIAC), Veritati - Repositório Institucional da Universidade Católica Portuguesa, Department of Earth Observation Science, Faculty of Geo-Information Science and Earth Observation, UT-I-ITC-ACQUAL, GeoHealth, HUS Neurocenter, Department of Neurosciences, Neurologian yksikkö, Clinicum, HUS Comprehensive Cancer Center, Staff Services, Department of Surgery, University of Helsinki, Islam, Nazrul [0000-0003-3982-4325], Apollo - University of Cambridge Repository, Burstein R., Henry N.J., Collison M.L., Marczak L.B., Sligar A., Watson S., Marquez N., Abbasalizad-Farhangi M., Abbasi M., Abd-Allah F., Abdoli A., Abdollahi M., Abdollahpour I., Abdulkader R.S., Abrigo M.R.M., Acharya D., Adebayo O.M., Adekanmbi V., Adham D., Afshari M., Aghaali M., Ahmadi K., Ahmadi M., Ahmadpour E., Ahmed R., Akal C.G., Akinyemi J.O., Alahdab F., Alam N., Alamene G.M., Alene K.A., Alijanzadeh M., Alinia C., Alipour V., Aljunid S.M., Almalki M.J., Al-Mekhlafi H.M., Altirkawi K., Alvis-Guzman N., Amegah A.K., Amini S., Amit A.M.L., Anbari Z., Androudi S., Anjomshoa M., Ansari F., Antonio C.A.T., Arabloo J., Arefi Z., Aremu O., Armoon B., Arora A., Artaman A., Asadi A., Asadi-Aliabadi M., Ashraf-Ganjouei A., Assadi R., Ataeinia B., Atre S.R., Quintanilla B.P.A., Ayanore M.A., Azari S., Babaee E., Babazadeh A., Badawi A., Bagheri S., Bagherzadeh M., Baheiraei N., Balouchi A., Barac A., Bassat Q., Baune B.T., Bayati M., Bedi N., Beghi E., Behzadifar M., Belay Y.B., Bell B., Bell M.L., Berbada D.A., Bernstein R.S., Bhattacharjee N.V., Bhattarai S., Bhutta Z.A., Bijani A., Bohlouli S., Breitborde N.J.K., Britton G., Browne A.J., Nagaraja S.B., Busse R., Butt Z.A., Car J., Cardenas R., Castaneda-Orjuela C.A., Cerin E., Chanie W.F., Chatterjee P., Chu D.-T., Cooper C., Costa V.M., Dalal K., Dandona L., Dandona R., Daoud F., Daryani A., Das Gupta R., Davis I., Davis Weaver N., Davitoiu D.V., De Neve J.-W., Demeke F.M., Demoz G.T., Deribe K., Desai R., Deshpande A., Desyibelew H.D., Dey S., Dharmaratne S.D., Dhimal M., Diaz D., Doshmangir L., Duraes A.R., Dwyer-Lindgren L., Earl L., Ebrahimi R., Ebrahimpour S., Effiong A., Eftekhari A., Ehsani-Chimeh E., El Sayed I., El Sayed Zaki M., El Tantawi M., El-Khatib Z., Emamian M.H., Enany S., Eskandarieh S., Eyawo O., Ezalarab M., Faramarzi M., Fareed M., Faridnia R., Faro A., Fazaeli A.A., Fazlzadeh M., Fentahun N., Fereshtehnejad S.-M., Fernandes J.C., Filip I., Fischer F., Foigt N.A., Foroutan M., Francis J.M., Fukumoto T., Fullman N., Gallus S., Gebre D.G., Gebrehiwot T.T., Gebremeskel G.G., Gessner B.D., Geta B., Gething P.W., Ghadimi R., Ghadiri K., Ghajarzadeh M., Ghashghaee A., Gill P.S., Gill T.K., Golding N., Gomes N.G.M., Gona P.N., Gopalani S.V., Gorini G., Goulart B.N.G., Graetz N., Greaves F., Green M.S., Guo Y., Haj-Mirzaian A., Hall B.J., Hamidi S., Haririan H., Haro J.M., Hasankhani M., Hasanpoor E., Hasanzadeh A., Hassankhani H., Hassen H.Y., Hegazy M.I., Hendrie D., Heydarpour F., Hird T.R., Hoang C.L., Hollerich G., Rad E.H., Hoseini-Ghahfarokhi M., Hossain N., Hosseini M., Hosseinzadeh M., Hostiuc M., Hostiuc S., Househ M., Hsairi M., Ilesanmi O.S., Imani-Nasab M.H., Iqbal U., Irvani S.S.N., Islam N., Islam S.M.S., Jurisson M., Balalami N.J., Jalali A., Javidnia J., Jayatilleke A.U., Jenabi E., Ji J.S., Jobanputra Y.B., Johnson K., Jonas J.B., Shushtari Z.J., Jozwiak J.J., Kabir A., Kahsay A., Kalani H., Kalhor R., Karami M., Karki S., Kasaeian A., Kassebaum N.J., Keiyoro P.N., Kemp G.R., Khabiri R., Khader Y.S., Khafaie M.A., Khan E.A., Khan J., Khan M.S., Khang Y.-H., Khatab K., Khater A., Khater M.M., Khatony A., Khazaei M., Khazaei S., Khazaei-Pool M., Khubchandani J., Kianipour N., Kim Y.J., Kimokoti R.W., Kinyoki D.K., Kisa A., Kisa S., Kolola T., Kosen S., Koul P.A., Koyanagi A., Kraemer M.U.G., Krishan K., Krohn K.J., Kugbey N., Kumar G.A., Kumar M., Kumar P., Kuupiel D., Lacey B., Lad S.D., Lami F.H., Larsson A.O., Lee P.H., Leili M., Levine A.J., Li S., Lim L.-L., Listl S., Longbottom J., Lopez J.C.F., Lorkowski S., Magdeldin S., Abd El Razek H.M., Abd El Razek M.M., Majeed A., Maleki A., Malekzadeh R., Malta D.C., Mamun A.A., Manafi N., Manda A.-L., Mansourian M., Martins-Melo F.R., Masaka A., Massenburg B.B., Maulik P.K., Mayala B.K., Mazidi M., McKee M., Mehrotra R., Mehta K.M., Meles G.G., Mendoza W., Menezes R.G., Meretoja A., Meretoja T.J., Mestrovic T., Miller T.R., Miller-Petrie M.K., Mills E.J., Milne G.J., Mini G.K., Mir S.M., Mirjalali H., Mirrakhimov E.M., Mohamadi E., Mohammad D.K., Darwesh A.M., Mezerji N.M.G., Mohammed A.S., Mohammed S., Mokdad A.H., Molokhia M., Monasta L., Moodley Y., Moosazadeh M., Moradi G., Moradi M., Moradi Y., Moradi-Lakeh M., Moradinazar M., Moraga P., Morawska L., Mosapour A., Mousavi S.M., Mueller U.O., Muluneh A.G., Mustafa G., Nabavizadeh B., Naderi M., Nagarajan A.J., Nahvijou A., Najafi F., Nangia V., Ndwandwe D.E., Neamati N., Negoi I., Negoi R.I., Ngunjiri J.W., Thi Nguyen H.L., Nguyen L.H., Nguyen S.H., Nielsen K.R., Ningrum D.N.A., Nirayo Y.L., Nixon M.R., Nnaji C.A., Nojomi M., Noroozi M., Nosratnejad S., Noubiap J.J., Motlagh S.N., Ofori-Asenso R., Ogbo F.A., Oladimeji K.E., Olagunju A.T., Olfatifar M., Olum S., Olusanya B.O., Oluwasanu M.M., Onwujekwe O.E., Oren E., Ortega-Altamirano D.D.V., Ortiz A., Osarenotor O., Osei F.B., Osgood-Zimmerman A.E., Otstavnov S.S., Owolabi M.O., Mahesh P.A., Pagheh A.S., Pakhale S., Panda-Jonas S., Pandey A., Park E.-K., Parsian H., Pashaei T., Patel S.K., Pepito V.C.F., Pereira A., Perkins S., Pickering B.V., Pilgrim T., Pirestani M., Piroozi B., Pirsaheb M., Plana-Ripoll O., Pourjafar H., Puri P., Qorbani M., Quintana H., Rabiee M., Rabiee N., Radfar A., Rafiei A., Rahim F., Rahimi Z., Rahimi-Movaghar V., Rahimzadeh S., Rajati F., Raju S.B., Ramezankhani A., Ranabhat C.L., Rasella D., Rashedi V., Rawal L., Reiner Jr R.C., Renzaho A.M.N., Rezaei S., Rezapour A., Riahi S.M., Ribeiro A.I., Roever L., Roro E.M., Roser M., Roshandel G., Roshani D., Rostami A., Rubagotti E., Rubino S., Sabour S., Sadat N., Sadeghi E., Saeedi R., Safari Y., Safari-Faramani R., Safdarian M., Sahebkar A., Salahshoor M.R., Salam N., Salamati P., Salehi F., Zahabi S.S., Salimi Y., Salimzadeh H., Salomon J.A., Sambala E.Z., Samy A.M., Santric Milicevic M.M., Jose B.P.S., Saraswathy S.Y.I., Sarmiento-Suarez R., Sartorius B., Sathian B., Saxena S., Sbarra A.N., Schaeffer L.E., Schwebel D.C., Sepanlou S.G., Seyedmousavi S., Shaahmadi F., Shaikh M.A., Shams-Beyranvand M., Shamshirian A., Shamsizadeh M., Sharafi K., Sharif M., Sharif-Alhoseini M., Sharifi H., Sharma J., Sharma R., Sheikh A., Shields C., Shigematsu M., Shiri R., Shiue I., Shuval K., Siddiqi T.J., Silva J.P., Singh J.A., Sinha D.N., Sisay M.M., Sisay S., Sliwa K., Smith D.L., Somayaji R., Soofi M., Soriano J.B., Sreeramareddy C.T., Sudaryanto A., Sufiyan M.B., Sykes B.L., Sylaja P.N., Tabares-Seisdedos R., Tabb K.M., Tabuchi T., Taveira N., Temsah M.-H., Terkawi A.S., Tessema Z.T., Thankappan K.R., Thirunavukkarasu S., To Q.G., Tovani-Palone M.R., Tran B.X., Tran K.B., Ullah I., Usman M.S., Uthman O.A., Vahedian-Azimi A., Valdez P.R., van Boven J.F.M., Vasankari T.J., Vasseghian Y., Veisani Y., Venketasubramanian N., Violante F.S., Vladimirov S.K., Vlassov V., Vos T., Vu G.T., Vujcic I.S., Waheed Y., Wakefield J., Wang H., Wang Y., Wang Y.-P., Ward J.L., Weintraub R.G., Weldegwergs K.G., Weldesamuel G.T., Westerman R., Wiysonge C.S., Wondafrash D.Z., Woyczynski L., Wu A.-M., Xu G., Yadegar A., Yamada T., Yazdi-Feyzabadi V., Yilgwan C.S., Yip P., Yonemoto N., Lebni J.Y., Younis M.Z., Yousefifard M., Yousof H.-A.S.A., Yu C., Yusefzadeh H., Zabeh E., Moghadam T.Z., Bin Zaman S., Zamani M., Zandian H., Zangeneh A., Zerfu T.A., Zhang Y., Ziapour A., Zodpey S., Murray C.J.L., and Hay S.I.
Subjects: Survival, RJ101, Mortalidad Infantil, HB, UNDER-5 MORTALITY, Global Health, Pediatrics, 0302 clinical medicine, 3123 Gynaecology and paediatrics, Child death, Infant Mortality, Epidemiology, Global health, Middle income country, Nacimiento vivo, 030212 general & internal medicine, 10. No inequality, Child, POPULATION, Developing world, education.field_of_study, Public health, Multidisciplinary, Geography, Mortality rate, wa_900, 1. No poverty, SUCCESS, Pediatrik, A900 Others in Medicine and Dentistry, 3142 Public health care science, environmental and occupational health, 3. Good health, Child Mortality, Death children, VACCINATION, HEALTH, ws_100, INTERVENTIONS, AFRICA, medicine.medical_specialty, United Nations, General Science & Technology, 030231 tropical medicine, Population, Developing country, Article, Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18], ITC-HYBRID, 03 medical and health sciences, All institutes and research themes of the Radboud University Medical Center, Social Justice, Recién nacido, Neonatal deaths, medicine, SYSTEMATIC ANALYSIS, Organizational Objectives, Humans, education, Developing Countries, business.industry, Infant, Newborn, Infant, CIVIL REGISTRATION, Paediatrics, Child survival, Newborn, PREVENTION, Infant mortality, wa_320, ws_200, Child mortality, Socioeconomic Factors, ITC-ISI-JOURNAL-ARTICLE, Human medicine, Paediatrics, Public health, Developing world, business, Demography
Abstract: Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2—to end preventable child deaths by 2030—we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000–2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations., A high-resolution, global atlas of mortality of children under five years of age between 2000 and 2017 highlights subnational geographical inequalities in the distribution, rates and absolute counts of child deaths by age.
Published: 2019

44. Out-of-Pocket and Informal Payment Before and After the Health Transformation Plan in Iran: Evidence from Hospitals Located in Kurdistan, Iran

Author: Arash Rashidian, Ghobad Moradi, Hooman Ghasri, Amirhossein Takian, Bakhtiar Piroozi, and Tayyeb Ghadimi
Subjects: Hospital information system, Economic growth, Health (social science), National Health Programs, Primary health care, Iran, Letter to Editor, Health services, 0302 clinical medicine, Health Information Management, Residence Characteristics, 030212 general & internal medicine, Child, health care economics and organizations, media_common, Aged, 80 and over, 030503 health policy & services, Health Policy, Health System Reform, lcsh:Public aspects of medicine, Middle Aged, Hospitalization, Child, Preschool, Out-of-Pocket (OOP) Payment, Christian ministry, Original Article, 0305 other medical science, Adult, medicine.medical_specialty, Financing, Personal, Adolescent, Leadership and Management, media_common.quotation_subject, Management, Monitoring, Policy and Law, Informal Payment, 03 medical and health sciences, Young Adult, medicine, Humans, Aged, Inpatients, Primary Health Care, Significant difference, lcsh:RA1-1270, Private sector, Payment, Social security, Health Expenditure, Health Planning, Socioeconomic Factors, Family medicine, Health Care Reform, Business, Health Expenditures
Abstract: Background One of the objectives of the health transformation plan (HTP) in Iran is to reduce out-of-pocket (OOP) payments for inpatient services and eradicate informal payments. The HTP has three phases: the first phase (launched in May 5, 2014) is focused on reducing OOP payments for inpatient services; the second phase (launched in May 22, 2014) is focused on primary healthcare (PHC) and the third phase utilizes an updated relative value units for health services (launched in September 29, 2014) and is focused on the elimination of informal payments. This aim of this study was to determine the OOP payments and the frequency of informal cash payments to physicians for inpatient services before and after the HTP in Kurdistan province, Iran. Methods This quasi-experimental study used multistage sampling method to select and evaluate 265 patients discharged from hospitals in Kurdistan province. The study covered 3 phases (before the HTP, after the first, and third phases of the HTP). Part of the data was collected using a hospital information system form and the rest were collected using a questionnaire. Data were analyzed using Fisher exact test, logistic regression, and independent samples ttest. Results The mean OOP payments before the HTP and after the first and third phases, respectively, were US$59.4, US$17.6, and US$14.3 in hospital affiliated to the Ministry of Health and Medical Education (MoHME), US$39.6, US$33.7, and US$13.7 in hospitals affiliated to Social Security Organization (SSO), and US$153.3, US$188.7, and US$66.4 in private hospitals. In hospitals affiliated to SSO and MoHME there was a significant difference between the mean OOP payments before the HTP and after the third phase (P < .05). The percentage of informal payments to physicians in hospitals affiliated to MoHME, SSO, and private sector, respectively, were 4.5%, 8.1%, and 12.5% before the HTP, and 0.0%, 7.1%, and 10.0% after the first phase. Contrary to the time before the HTP, no informal payment was reported after the third phase. Conclusion It seems that the implementation of the HTP has reduced the OOP payments for inpatient services and eradicated informal payments to physician in Kurdistan province.
Published: 2017

45. Past, present, and future of global health financing: a review of development assistance, government, out-of-pocket, and other private spending on health for 195 countries, 1995–2050

Author: Angela Y. Chang, Krycia Cowling, Angela E. Micah, Abigail Chapin, Catherine S. Chen, Gloria Ikilezi, Nafis Sadat, Golsum Tsakalos, Junjie Wu, Theodore Younker, Yingxi Zhao, Bianca S. Zlavog, Cristiana Abbafati, Anwar E Ahmed, Khurshid Alam, Vahid Alipour, Syed Mohamed Aljunid, Mohammed J. Almalki, Nelson Alvis-Guzman, Walid Ammar, Catalina Liliana Andrei, Mina Anjomshoa, Carl Abelardo T. Antonio, Jalal Arabloo, Olatunde Aremu, Marcel Ausloos, Leticia Avila-Burgos, Ashish Awasthi, Martin Amogre Ayanore, Samad Azari, Natasha Azzopardi-Muscat, Mojtaba Bagherzadeh, Till Winfried Bärnighausen, Bernhard T Baune, Mohsen Bayati, Yared Belete Belay, Yihalem Abebe Belay, Habte Belete, Dessalegn Ajema Berbada, Adam E. Berman, Mircea Beuran, Ali Bijani, Reinhard Busse, Lucero Cahuana-Hurtado, Luis Alberto Cámera, Ferrán Catalá-López, Bal Govind Chauhan, Maria-Magdalena Constantin, Christopher Stephen Crowe, Alexandra Cucu, Koustuv Dalal, Jan-Walter De Neve, Selina Deiparine, Feleke Mekonnen Demeke, Huyen Phuc Do, Manisha Dubey, Maha El Tantawi, Sharareh Eskandarieh, Reza Esmaeili, Mahdi Fakhar, Ali Akbar Fazaeli, Florian Fischer, Nataliya A. Foigt, Takeshi Fukumoto, Nancy Fullman, Adriana Galan, Amiran Gamkrelidze, Kebede Embaye Gezae, Alireza Ghajar, Ahmad Ghashghaee, Ketevan Goginashvili, Annie Haakenstad, Hassan Haghparast Bidgoli, Samer Hamidi, Hilda L. Harb, Edris Hasanpoor, Hamid Yimam Hassen, Simon I. Hay, Delia Hendrie, Andualem Henok, Ileana Heredia-Pi, Claudiu Herteliu, Chi Linh Hoang, Michael K. Hole, Enayatollah Homaie Rad, Naznin Hossain, Mehdi Hosseinzadeh, Sorin Hostiuc, Olayinka Stephen Ilesanmi, Seyed Sina Naghibi Irvani, Mihajlo Jakovljevic, Amir Jalali, Spencer L. James, Jost B. Jonas, Mikk Jürisson, Rajendra Kadel, Behzad Karami Matin, Amir Kasaeian, Habtamu Kebebe Kasaye, Mesfin Wudu Kassaw, Ali Kazemi Karyani, Roghayeh Khabiri, Junaid Khan, Md Nuruzzaman Khan, Young-Ho Khang, Adnan Kisa, Katarzyna Kissimova-Skarbek, Stefan Kohler, Ai Koyanagi, Kristopher J. Krohn, Ricky Leung, Lee-Ling Lim, Stefan Lorkowski, Azeem Majeed, Reza Malekzadeh, Morteza Mansourian, Lorenzo Giovanni Mantovani, Benjamin Ballard Massenburg, Martin McKee, Varshil Mehta, Atte Meretoja, Tuomo J Meretoja, Neda Milevska Kostova, Ted R Miller, Erkin M Mirrakhimov, Bahram Mohajer, Aso Mohammad Darwesh, Shafiu Mohammed, Farnam Mohebi, Ali H Mokdad, Shane Douglas Morrison, Seyyed Meysam Mousavi, Saravanan Muthupandian, Ahamarshan Jayaraman Nagarajan, Vinay Nangia, Ionut Negoi, Cuong Tat Nguyen, Huong Lan Thi Nguyen, Son Hoang Nguyen, Shirin Nosratnejad, Olanrewaju Oladimeji, Stefano Olgiati, Jacob Olusegun Olusanya, Obinna E Onwujekwe, Stanislav S Otstavnov, Adrian Pana, David M. Pereira, Bakhtiar Piroozi, Sergio I Prada, Mostafa Qorbani, Mohammad Rabiee, Navid Rabiee, Alireza Rafiei, Fakher Rahim, Vafa Rahimi-Movaghar, Usha Ram, Chhabi Lal Ranabhat, Anna Ranta, David Laith Rawaf, Salman Rawaf, Satar Rezaei, Elias Merdassa Roro, Ali Rostami, Salvatore Rubino, Mohamadreza Salahshoor, Abdallah M. Samy, Juan Sanabria, João Vasco Santos, Milena M Santric Milicevic, Bruno Piassi Sao Jose, Miloje Savic, Falk Schwendicke, Sadaf G. Sepanlou, Masood Sepehrimanesh, Aziz Sheikh, Mark G Shrime, Solomon Sisay, Shahin Soltani, Moslem Soofi, Vinay Srinivasan, Rafael Tabarés-Seisdedos, Anna Torre, Marcos Roberto Tovani-Palone, Bach Xuan Tran, Khanh Bao Tran, Eduardo A. Undurraga, Pascual R Valdez, Job F M van Boven, Veronica Vargas, Yousef Veisani, Francesco S Violante, Sergey Konstantinovitch Vladimirov, Vasily Vlassov, Sebastian Vollmer, Giang Thu Vu, Charles D A Wolfe, Naohiro Yonemoto, Mustafa Z. Younis, Mahmoud Yousefifard, Sojib Bin Zaman, Alireza Zangeneh, Elias Asfaw Zegeye, Arash Ziapour, Adrienne Chew, Christopher J L Murray, Joseph L Dieleman, Chang A.Y., Cowling K., Micah A.E., Chapin A., Chen C.S., Ikilezi G., Sadat N., Tsakalos G., Wu J., Younker T., Zhao Y., Zlavog B.S., Abbafati C., Ahmed A.E., Alam K., Alipour V., Aljunid S.M., Almalki M.J., Alvis-Guzman N., Ammar W., Andrei C.L., Anjomshoa M., Antonio C.A.T., Arabloo J., Aremu O., Ausloos M., Avila-Burgos L., Awasthi A., Ayanore M.A., Azari S., Azzopardi-Muscat N., Bagherzadeh M., Barnighausen T.W., Baune B.T., Bayati M., Belay Y.B., Belay Y.A., Belete H., Berbada D.A., Berman A.E., Beuran M., Bijani A., Busse R., Cahuana-Hurtado L., Camera L.A., Catala-Lopez F., Chauhan B.G., Constantin M.-M., Crowe C.S., Cucu A., Dalal K., De Neve J.-W., Deiparine S., Demeke F.M., Do H.P., Dubey M., El Tantawi M., Eskandarieh S., Esmaeili R., Fakhar M., Fazaeli A.A., Fischer F., Foigt N.A., Fukumoto T., Fullman N., Galan A., Gamkrelidze A., Gezae K.E., Ghajar A., Ghashghaee A., Goginashvili K., Haakenstad A., Haghparast Bidgoli H., Hamidi S., Harb H.L., Hasanpoor E., Hassen H.Y., Hay S.I., Hendrie D., Henok A., Heredia-Pi I., Herteliu C., Hoang C.L., Hole M.K., Homaie Rad E., Hossain N., Hosseinzadeh M., Hostiuc S., Ilesanmi O.S., Irvani S.S.N., Jakovljevic M., Jalali A., James S.L., Jonas J.B., Jurisson M., Kadel R., Karami Matin B., Kasaeian A., Kasaye H.K., Kassaw M.W., Kazemi Karyani A., Khabiri R., Khan J., Khan M.N., Khang Y.-H., Kisa A., Kissimova-Skarbek K., Kohler S., Koyanagi A., Krohn K.J., Leung R., Lim L.-L., Lorkowski S., Majeed A., Malekzadeh R., Mansourian M., Mantovani L.G., Massenburg B.B., McKee M., Mehta V., Meretoja A., Meretoja T.J., Milevska Kostova N., Miller T.R., Mirrakhimov E.M., Mohajer B., Mohammad Darwesh A., Mohammed S., Mohebi F., Mokdad A.H., Morrison S.D., Mousavi S.M., Muthupandian S., Nagarajan A.J., Nangia V., Negoi I., Nguyen C.T., Nguyen H.L.T., Nguyen S.H., Nosratnejad S., Oladimeji O., Olgiati S., Olusanya J.O., Onwujekwe O.E., Otstavnov S.S., Pana A., Pereira D.M., Piroozi B., Prada S.I., Qorbani M., Rabiee M., Rabiee N., Rafiei A., Rahim F., Rahimi-Movaghar V., Ram U., Ranabhat C.L., Ranta A., Rawaf D.L., Rawaf S., Rezaei S., Roro E.M., Rostami A., Rubino S., Salahshoor M., Samy A.M., Sanabria J., Santos J.V., Santric Milicevic M.M., Sao Jose B.P., Savic M., Schwendicke F., Sepanlou S.G., Sepehrimanesh M., Sheikh A., Shrime M.G., Sisay S., Soltani S., Soofi M., Srinivasan V., Tabares-Seisdedos R., Torre A., Tovani-Palone M.R., Tran B.X., Tran K.B., Undurraga E.A., Valdez P.R., van Boven J.F.M., Vargas V., Veisani Y., Violante F.S., Vladimirov S.K., Vlassov V., Vollmer S., Vu G.T., Wolfe C.D.A., Yonemoto N., Younis M.Z., Yousefifard M., Zaman S.B., Zangeneh A., Zegeye E.A., Ziapour A., Chew A., Murray C.J.L., Dieleman J.L., Global Burden Dis Hlth Financing C, Bill & Melinda Gates Foundation, Chang, A, Cowling, K, Micah, A, Chapin, A, Chen, C, Ikilezi, G, Sadat, N, Tsakalos, G, Wu, J, Younker, T, Zhao, Y, Zlavog, B, Abbafati, C, Ahmed, A, Alam, K, Alipour, V, Aljunid, S, Almalki, M, Alvis-Guzman, N, Ammar, W, Andrei, C, Anjomshoa, M, Antonio, C, Arabloo, J, Aremu, O, Ausloos, M, Avila-Burgos, L, Awasthi, A, Ayanore, M, Azari, S, Azzopardi-Muscat, N, Bagherzadeh, M, Barnighausen, T, Baune, B, Bayati, M, Belay, Y, Belete, H, Berbada, D, Berman, A, Beuran, M, Bijani, A, Busse, R, Cahuana-Hurtado, L, Camera, L, Catala-Lopez, F, Chauhan, B, Constantin, M, Crowe, C, Cucu, A, Dalal, K, De Neve, J, Deiparine, S, Demeke, F, Do, H, Dubey, M, Tantawi, M, Eskandarieh, S, Esmaeili, R, Fakhar, M, Fazaeli, A, Fischer, F, Foigt, N, Fukumoto, T, Fullman, N, Galan, A, Gamkrelidze, A, Gezae, K, Ghajar, A, Ghashghaee, A, Goginashvili, K, Haakenstad, A, Bidgoli, H, Hamidi, S, Harb, H, Hasanpoor, E, Hassen, H, Hay, S, Hendrie, D, Henok, A, Heredia-Pi, I, Herteliu, C, Hoang, C, Hole, M, Rad, E, Hossain, N, Hosseinzadeh, M, Hostiuc, S, Ilesanmi, O, Irvani, S, Jakovljevic, M, Jalali, A, James, S, Jonas, J, Jurisson, M, Kadel, R, Matin, B, Kasaeian, A, Kasaye, H, Kassaw, M, Karyani, A, Khabiri, R, Khan, J, Khan, M, Khang, Y, Kisa, A, Kissimova-Skarbek, K, Kohler, S, Koyanagi, A, Krohn, K, Leung, R, Lim, L, Lorkowski, S, Majeed, A, Malekzadeh, R, Mansourian, M, Mantovani, L, Massenburg, B, Mckee, M, Mehta, V, Meretoja, A, Meretoja, T, Kostova, N, Miller, T, Mirrakhimov, E, Mohajer, B, Darwesh, A, Mohammed, S, Mohebi, F, Mokdad, A, Morrison, S, Mousavi, S, Muthupandian, S, Nagarajan, A, Nangia, V, Negoi, I, Nguyen, C, Nguyen, H, Nguyen, S, Nosratnejad, S, Oladimeji, O, Olgiati, S, Olusanya, J, Onwujekwe, O, Otstavnov, S, Pana, A, Pereira, D, Piroozi, B, Prada, S, Qorbani, M, Rabiee, M, Rabiee, N, Rafiei, A, Rahim, F, Rahimi-Movaghar, V, Ram, U, Ranabhat, C, Ranta, A, Rawaf, D, Rawaf, S, Rezaei, S, Roro, E, Rostami, A, Rubino, S, Salahshoor, M, Samy, A, Sanabria, J, Santos, J, Milicevic, M, Jose, B, Savic, M, Schwendicke, F, Sepanlou, S, Sepehrimanesh, M, Sheikh, A, Shrime, M, Sisay, S, Soltani, S, Soofi, M, Srinivasan, V, Tabares-Seisdedos, R, Torre, A, Tovani-Palone, M, Tran, B, Tran, K, Undurraga, E, Valdez, P, Van Boven, J, Vargas, V, Veisani, Y, Violante, F, Vladimirov, S, Vlassov, V, Vollmer, S, Vu, G, Wolfe, C, Yonemoto, N, Younis, M, Yousefifard, M, Zaman, S, Zangeneh, A, Zegeye, E, Ziapour, A, Chew, A, Murray, C, and Dieleman, J
Subjects: health financing, coverage, 030204 cardiovascular system & hematology, systematic analysis, Global Health, Gross domestic product, DISEASE, burden, project, 0302 clinical medicine, Per capita, Global health, Healthcare Financing, 030212 general & internal medicine, our of pocket, 11 Medical and Health Sciences, Government spending, government, 1. No poverty, Public Health, Global Health, Social Medicine and Epidemiology, General Medicine, Public Assistance, COVERAGE, Models, Economic, 8. Economic growth, health financing, project, government, our of pocket, BURDEN, Life Sciences & Biomedicine, Human, Gross Domestic Product, Department of Error, 03 medical and health sciences, Medicine, General & Internal, General & Internal Medicine, SYSTEMATIC ANALYSIS, Revenue, Humans, medicine (all), Health policy, Finance, sex-specific mortality, Government, disease, Science & Technology, SEX-SPECIFIC MORTALITY, business.industry, Prepaid Health Plan, International health, Global Burden of Disease Health Financing Collaborator Network, Health Expenditure, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Human medicine, Health Expenditures, business, Prepaid Health Plans
Abstract: Published Erratum. Past, present, and future of global health financing: a review of development assistance, government, out-of-pocket, and other private spending on health for 195 countries, 1995-2050. Lancet. 2021 Sep 11;398(10304):956. doi: 10.1016/S0140-6736(21)01806-7. PMID: 34509230. BACKGROUND: Comprehensive and comparable estimates of health spending in each country are a key input for health policy and planning, and are necessary to support the achievement of national and international health goals. Previous studies have tracked past and projected future health spending until 2040 and shown that, with economic development, countries tend to spend more on health per capita, with a decreasing share of spending from development assistance and out-of-pocket sources. We aimed to characterise the past, present, and predicted future of global health spending, with an emphasis on equity in spending across countries. METHODS: We estimated domestic health spending for 195 countries and territories from 1995 to 2016, split into three categories-government, out-of-pocket, and prepaid private health spending-and estimated development assistance for health (DAH) from 1990 to 2018. We estimated future scenarios of health spending using an ensemble of linear mixed-effects models with time series specifications to project domestic health spending from 2017 through 2050 and DAH from 2019 through 2050. Data were extracted from a broad set of sources tracking health spending and revenue, and were standardised and converted to inflation-adjusted 2018 US dollars. Incomplete or low-quality data were modelled and uncertainty was estimated, leading to a complete data series of total, government, prepaid private, and out-of-pocket health spending, and DAH. Estimates are reported in 2018 US dollars, 2018 purchasing-power parity-adjusted dollars, and as a percentage of gross domestic product. We used demographic decomposition methods to assess a set of factors associated with changes in government health spending between 1995 and 2016 and to examine evidence to support the theory of the health financing transition. We projected two alternative future scenarios based on higher government health spending to assess the potential ability of governments to generate more resources for health. FINDINGS: Between 1995 and 2016, health spending grew at a rate of 4·00% (95% uncertainty interval 3·89-4·12) annually, although it grew slower in per capita terms (2·72% [2·61-2·84]) and increased by less than $1 per capita over this period in 22 of 195 countries. The highest annual growth rates in per capita health spending were observed in upper-middle-income countries (5·55% [5·18-5·95]), mainly due to growth in government health spending, and in lower-middle-income countries (3·71% [3·10-4·34]), mainly from DAH. Health spending globally reached $8·0 trillion (7·8-8·1) in 2016 (comprising 8·6% [8·4-8·7] of the global economy and $10·3 trillion [10·1-10·6] in purchasing-power parity-adjusted dollars), with a per capita spending of US$5252 (5184-5319) in high-income countries, $491 (461-524) in upper-middle-income countries, $81 (74-89) in lower-middle-income countries, and $40 (38-43) in low-income countries. In 2016, 0·4% (0·3-0·4) of health spending globally was in low-income countries, despite these countries comprising 10·0% of the global population. In 2018, the largest proportion of DAH targeted HIV/AIDS ($9·5 billion, 24·3% of total DAH), although spending on other infectious diseases (excluding tuberculosis and malaria) grew fastest from 2010 to 2018 (6·27% per year). The leading sources of DAH were the USA and private philanthropy (excluding corporate donations and the Bill & Melinda Gates Foundation). For the first time, we included estimates of China's contribution to DAH ($644·7 million in 2018). Globally, health spending is projected to increase to $15·0 trillion (14·0-16·0) by 2050 (reaching 9·4% [7·6-11·3] of the global economy and $21·3 trillion [19·8-23·1] in purchasing-power parity-adjusted dollars), but at a lower growth rate of 1·84% (1·68-2·02) annually, and with continuing disparities in spending between countries. In 2050, we estimate that 0·6% (0·6-0·7) of health spending will occur in currently low-income countries, despite these countries comprising an estimated 15·7% of the global population by 2050. The ratio between per capita health spending in high-income and low-income countries was 130·2 (122·9-136·9) in 2016 and is projected to remain at similar levels in 2050 (125·9 [113·7-138·1]). The decomposition analysis identified governments' increased prioritisation of the health sector and economic development as the strongest factors associated with increases in government health spending globally. Future government health spending scenarios suggest that, with greater prioritisation of the health sector and increased government spending, health spending per capita could more than double, with greater impacts in countries that currently have the lowest levels of government health spending. INTERPRETATION: Financing for global health has increased steadily over the past two decades and is projected to continue increasing in the future, although at a slower pace of growth and with persistent disparities in per-capita health spending between countries. Out-of-pocket spending is projected to remain substantial outside of high-income countries. Many low-income countries are expected to remain dependent on development assistance, although with greater government spending, larger investments in health are feasible. In the absence of sustained new investments in health, increasing efficiency in health spending is essential to meet global health targets. FUNDING: Bill & Melinda Gates Foundation. Bill & Melinda Gates Foundation Sí
Published: 2019

46. Global, regional, and national incidence, prevalence, and mortality of HIV, 1980–2017, and forecasts to 2030, for 195 countries and territories: a systematic analysis for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017

Author: Ephrem Tsegay Asfaw, Irina Filip, Maciej Banach, Amjad Mohamadi-Bolbanabad, Girmay Teklay Weldesamuel, Joshua A. Salomon, Anemaw A Asrat, Zahra Jorjoran Shushtari, Hamidreza Komaki, Mekdes Tigistu Yilma, Reza Shirkoohi, Mostafa Qorbani, Ahamarshan Jayaraman Nagarajan, Don C. Des Jarlais, Adnan Kisa, Gebreamlak Gebremedhn Gebremeskel, Kidu Gidey Weldegwergs, Amir Kasaeian, Peter Memiah, Son Hoang Nguyen, Segun Emmanuel Ibitoye, Ali Kabir, Subash Thapa, Diego Augusto Santos Silva, Kefyalew Addis Alene, Alireza Rafiei, Huong Lan Thi Nguyen, Erlyn Rachelle King Macarayan, Kelali Kalaye Gebreyohannes, Khaled Khatab, Ghobad Moradi, Noore Alam, Aletta E. Schutte, Sharareh Eskandarieh, H. Dean Hosgood, Rakhi Dandona, Taye Abuhay Zewale, Sezer Kisa, Gessessew Bugssa Hailu, Hedayat Abbastabar, Ketema Bizuwork Gebremedhin, Smita Pakhale, Govinda Prasad Dhungana, Dina Nur Anggraini Ningrum, Bakhtiar Piroozi, Yaschilal Muche Belayneh, Tesfaye Dessale Kassa, Irfan Ullah, Sahar Saeedi Moghaddam, Jean Jacques Noubiap, Mojtaba Bagherzadeh, Akram Pourshams, Alberto L. García-Basteiro, Helen Bitew, Kindie Fentahun Muchie, Mehdi Sayyah, Kevin S Ikuta, Moses K. Muriithi, Aliasghar Ahmad Kiadaliri, Zerihun Menlkalew Zenebe, Cesar Reis, Themba G. Ginindza, Jagadish Rao Padubidri, Yoosik Youm, Saba Abraham Belay, Olayinka Stephen Ilesanmi, Neeraj Bedi, Maziar Moradi-Lakeh, Hamid Sharifi, Nefsu Awoke, Manasi Kumar, Carlos Magis-Rodriguez, Muhammad Shahdaat Bin Sayeed, Maheswar Satpathy, Andrew Blinov, Fiseha Wadilo Wada, Babak Moazen, Hadi Hassankhani, Jae Il Shin, Sanjay Basu, Aziz Eftekhari, Masood Ali Shaikh, Arya Haj-Mirzaian, Laura Dwyer-Lindgren, Haileab Fekadu Wolde, Habtamu Abera Areri, Krista M. Steuben, Lalit Dandona, Keivan Ahmadi, Aso Mohammad Darwesh, Belete Kassa, Keyghobad Ghadiri, Arash Ziapour, Raquel Crider, Alaa Badawi, Tahvi Frank, Amir Hasanzadeh, Marcel Yotebieng, Jemal Abdu Mohammed, Marcos Roberto Tovani-Palone, Emmanuel Peprah, Mekonnen Sisay, Ghulam Mustafa, Oghenowede Eyawo, Seyed Sina Naghibi Irvani, Vahid Alipour, Reza Malekzadeh, Bereket Duko Adema, Direslgne Misker Abyu, Tinuke O Olagunju, Olatunde Aremu, Roghayeh Mohammadibakhsh, Linh Phuong Doan, Mihiretu Kebede, Aman Yesuf Endries, Amira Shaheen, Belete Biadgo, Ali Rostami, Marwa Rashad Salem, Getnet Gedefaw, Stein Emil Vollset, Gurudatta Naik, Veincent Christian Filipino Pepito, Duduzile Ndwandwe, Melese Abate Reta, Aleksandra Barac, Simon I. Hay, Vishnu Renjith, Seifadin Ahmed Shallo, Kebede Deribe, Malihe Nourollahpour Shiadeh, Tewodros Eshete Wonde, Nuno Taveira, Mohammad Ali Sahraian, Marilita M Moschos, Masoud Foroutan, Alebachew Fasil Ashagre, Félix Carvalho, Yun Jin Kim, Farid Najafi, Tukur Dahiru, Chinwe Juliana Iwu, Dharmesh Kumar Lal, Varshil Mehta, Molly R Nixon, Nahla Anber, Seyedmojtaba Seyedmousavi, Mohammad Rabiee, Nauman Khalid, Felix Akpojene Ogbo, Anselm Okoro, Sanjay Zodpey, Birhanu Geta, Kebede Embaye Gezae, Shirin Djalalinia, Amanda E. Smith, Naser Mohammad Gholi Mezerji, Arvin Haj-Mirzaian, Birkneh Tilahun Tadesse, Yared Belete Belay, Saeed Amini, Ziad A. Memish, Stephanie M. Topp, Eduarda Fernandes, Mohammed Suleiman Obsa, Junaid Khan, Andem Effiong, Jane Jean-Hee Lee, Emmanuel Ngassa Laurent Mayenga, Abdallah M. Samy, Anton Sokhan, Rajesh Sagar, Dawit Zewdu Wondafrash, Atalay Goshu Muluneh, Birhan Alemnew, Asmamaw Demis, Samer Hamidi, Getnet Mengistu, Michael Tamene Haile, Gbenga A. Kayode, Huyen Phuc Do, Yoshan Moodley, Mehdi Hosseinzadeh, Moslem Mohammadi, Dayane Gabriele Alves Silveira, Samad Azari, Gulfaraz Khan, Maysaa El Sayed Zaki, Emmanuel Ankrah Odame, Anusha Ganapati Bhat, Louisa Degenhardt, Mu'awiyyah Babale Sufiyan, Harish Chander Gugnani, Sadaf G. Sepanlou, Ai Koyanagi, Ebrahim M Yimer, Maryam Adabi, Javad Nazari, Saravanan Muthupandian, Evanson Z. Sambala, Salman Khazaei, Nelson Alvis-Guzman, Hunduma Amensisa Bojia, Anwar Rafay, Richard Ofori-Asenso, Ehsan Ahmadpour, José Neves, Desalegn Tadese Mengistu, Shafiu Mohammed, Hamid Yimam Hassen, Navid Rabiee, Dinh-Toi Chu, Zoubida Zaidi, Sajjad Ur Rahman, Tilahun Belete Mossie, Olanrewaju Oladimeji, Krittika Bhattacharyya, Gebrekiros Gebremichael Meles, Hassan Magdy Abd El Razek, Stanislav S. Otstavnov, Shaimaa I. El-Jaafary, Habtamu Temesgen, Lolemo Kelbiso Hanfore, Milad Mohammadoo-Khorasani, Muktar Beshir Ahmed, Karzan Abdulmuhsin Mohammad, Carl Abelardo T. Antonio, Morteza Abdullatif Khafaie, Spencer L. James, Bhaskaran Unnikrishnan, Morteza Shamsizadeh, Kenean Getaneh Tlaye, Ziad El-Khatib, Zohreh Anbari, Aisha Elsharkawy, Nancy Fullman, Cuong Tat Nguyen, Chalachew Genet Akal, Chabila C Mapoma, Amir H. Pakpour, Rafael Alves Guimarães, Jalal Arabloo, Eyasu Ejeta Duken, Hailay Abrha Gesesew, Koku Sisay Tamirat, Batool Fatima, Tissa Wijeratne, Addisu Gize Yeshanew, Benn Sartorius, Kathryn H. Jacobsen, Abdullah T Khoja, Morenike Oluwatoyin Folayan, Phetole Walter Mahasha, Takeshi Fukumoto, Maryam Moossavi, Bahram Mohajer, Ravi Prakash Jha, Oladimeji Adebayo, Farshad Farzadfar, Francisco Rogerlândio Martins-Melo, Solomon Sisay, Ensiyeh Jenabi, Bach Xuan Tran, Eleonora Dubljanin, Farnam Mohebi, Jasvinder A. Singh, Barthelemy Kuate Defo, Masoud Behzadifar, Yousef Mohammad, Feleke Mekonnen Demeke, G Anil Kumar, Jan-Walter De Neve, Afshin Zarghi, Hosein Shabaninejad, Trang Huyen Nguyen, Degena Bahrey Tadesse, Monika Sawhney, Eyal Oren, Bayu Begashaw Bekele, Saeed Safari, Salvatore Rubino, Kenji Shibuya, Daniel Diaz, Salman Rawaf, Demelash Woldeyohannes Handiso, Ted R. Miller, Fares Alahdab, Vafa Rahimi-Movaghar, Seyyed Meysam Mousavi, Sonali Kochhar, Azeem Majeed, Till Bärnighausen, Zubair Kabir, Devasahayam J. Christopher, Malede Mequanent Sisay, Adane Teshome Kefale, Shishay Wahdey Tekelemedhin, Tsegaye Lolaso Lenjebo, Yousef Khader, Ali Bijani, Kebreab Paulos, Hagazi Gebre Meles, Euripide Frinel G Arthur Avokpaho, Alireza Ahmadi, Tuomo J. Meretoja, Padukudru Anand Mahesh, Florian Fischer, Mulugeta Melku, Fakher Rahim, Manisha Dubey, Cheru Tesema Leshargie, Vijay Kumar Chattu, Yasir Waheed, Mehdi Noroozi, Austin Carter, Chuanhua Yu, Ronny Westerman, Andualem Henok, Yousef Veisani, Sharath Burugina Nagaraja, Reta Tsegaye Gayesa, Mina Anjomshoa, Andrew T Olagunju, Getachew Mullu Kassa, Belayneh K Gelaw, Jost B. Jonas, Ejaz Ahmad Khan, Adugnaw Berhane, Chukwudi A Nnaji, Daniel Asmelash, Tomislav Mestrovic, Addisu Melese, Stephen S Lim, Yahya Salimi, Chi Linh Hoang, Christopher J L Murray, Mohammad Sadegh Rezai, Bruno F. Sunguya, Herbert C. Duber, Senad Handanagic, Ashish Awasthi, Anthony Masaka, Megha Arora, Sergey Soshnikov, Sangram Kishor Patel, Kwaku Oppong Asante, Haidong Wang, Rajendra Kadel, Bryan L. Sykes, Lucero Cahuana-Hurtado, Afarin Rahimi-Movaghar, Deepa Jahagirdar, Manaye Yihune Teshale, Samantha Leigh Larson, Martin Amogre Ayanore, Sergey K Vladimirov, Gebre Teklemariam Demoz, Fisaha Haile Tesfay, Mohsen Naghavi, Chhabi Lal Ranabhat, Walter Mendoza, Kassawmar Angaw Bogale, Khanh Bao Tran, Berhanu Yazew Wondmagegn, Carlos Miguel Rios González, Ahmad Daryani, Ali H. Mokdad, Julio Cesar Campuzano Rincon, Alemayehu Toma Mena, Navid Manafi, Andre Pascal Kengne, Victor Adekanmbi, Netsanet Fentahun, Olalekan A. Uthman, Desmond Kuupiel, Olatunji O. Adetokunboh, Zahid A Butt, Mohamed Hsairi, Bulat Idrisov, Ranjani Somayaji, Dan J. Stein, Molly H Biehl, Samuel B. Albertson, Laith J. Abu-Raddad, Parvaiz A Koul, Elias Merdassa Roro, Marek Majdan, Dereje Bayissa Demissie, Emilie R Maddison, Naohiro Yonemoto, Ahmad Ghashghaee, Young-Ho Khang, Solomon Olum, Hmwe H Kyu, Amir Radfar, Dirk Douwes-Schultz, Elham Ahmadian, Graduate School, AII - Infectious diseases, APH - Global Health, APH - Methodology, GBD 2017 HIV Collaborators, Clinicum, Institute for Molecular Medicine Finland, HUS Comprehensive Cancer Center, Staff Services, University of Helsinki, Department of Oncology, Adema, Bereket Duko, GBD 2017 HIV collaborators, and Public Health
Subjects: 0301 basic medicine, A300 Clinical Medicine, Epidemiology, CITIES, HIV Infections, Mortalities, Global Burden of Disease, 0302 clinical medicine, Risk Factors, Seroepidemiologic Studies, Cause of Death, Prevalences, Prevalence, Global health, LIFE EXPECTANCY, 030212 general & internal medicine, 10. No inequality, education.field_of_study, CHALLENGES, Incidence, Incidence (epidemiology), Incidences, 1. No poverty, MEN, 3. Good health, AIDS, Infectious Diseases, Life Sciences & Biomedicine, GBD 2017 HIV collaborators, medicine.medical_specialty, Forecasts, Immunology, Population, Cause of Death/trends, UNITED-STATES, Context (language use), History, 21st Century, 03 medical and health sciences, SDG 3 - Good Health and Well-being, Acquired immunodeficiency syndrome (AIDS), Virology, Environmental health, medicine, Humans, education, Global Burden of Disease/trends, Estimation, Science & Technology, SEX-SPECIFIC MORTALITY, business.industry, DISABILITY, Public health, HIV, coverage of antiretroviral therapy, History, 20th Century, medicine.disease, mortality, R1, PREVENTION, TRENDS, 030112 virology, HIV Infections/mortality, 3121 General medicine, internal medicine and other clinical medicine, Life expectancy, Human medicine, business, Forecasting
Abstract: BACKGROUND: Understanding the patterns of HIV/AIDS epidemics is crucial to tracking and monitoring the progress of prevention and control efforts in countries. We provide a comprehensive assessment of the levels and trends of HIV/AIDS incidence, prevalence, mortality, and coverage of antiretroviral therapy (ART) for 1980-2017 and forecast these estimates to 2030 for 195 countries and territories.METHODS: We determined a modelling strategy for each country on the basis of the availability and quality of data. For countries and territories with data from population-based seroprevalence surveys or antenatal care clinics, we estimated prevalence and incidence using an open-source version of the Estimation and Projection Package-a natural history model originally developed by the UNAIDS Reference Group on Estimates, Modelling, and Projections. For countries with cause-specific vital registration data, we corrected data for garbage coding (ie, deaths coded to an intermediate, immediate, or poorly defined cause) and HIV misclassification. We developed a process of cohort incidence bias adjustment to use information on survival and deaths recorded in vital registration to back-calculate HIV incidence. For countries without any representative data on HIV, we produced incidence estimates by pulling information from observed bias in the geographical region. We used a re-coded version of the Spectrum model (a cohort component model that uses rates of disease progression and HIV mortality on and off ART) to produce age-sex-specific incidence, prevalence, and mortality, and treatment coverage results for all countries, and forecast these measures to 2030 using Spectrum with inputs that were extended on the basis of past trends in treatment scale-up and new infections.FINDINGS: Global HIV mortality peaked in 2006 with 1·95 million deaths (95% uncertainty interval 1·87-2·04) and has since decreased to 0·95 million deaths (0·91-1·01) in 2017. New cases of HIV globally peaked in 1999 (3·16 million, 2·79-3·67) and since then have gradually decreased to 1·94 million (1·63-2·29) in 2017. These trends, along with ART scale-up, have globally resulted in increased prevalence, with 36·8 million (34·8-39·2) people living with HIV in 2017. Prevalence of HIV was highest in southern sub-Saharan Africa in 2017, and countries in the region had ART coverage ranging from 65·7% in Lesotho to 85·7% in eSwatini. Our forecasts showed that 54 countries will meet the UNAIDS target of 81% ART coverage by 2020 and 12 countries are on track to meet 90% ART coverage by 2030. Forecasted results estimate that few countries will meet the UNAIDS 2020 and 2030 mortality and incidence targets.INTERPRETATION: Despite progress in reducing HIV-related mortality over the past decade, slow decreases in incidence, combined with the current context of stagnated funding for related interventions, mean that many countries are not on track to reach the 2020 and 2030 global targets for reduction in incidence and mortality. With a growing population of people living with HIV, it will continue to be a major threat to public health for years to come. The pace of progress needs to be hastened by continuing to expand access to ART and increasing investments in proven HIV prevention initiatives that can be scaled up to have population-level impact.FUNDING: Bill & Melinda Gates Foundation, National Institute of Mental Health of the US National Institutes of Health (NIH), and the National Institute on Aging of the NIH.
Published: 2019

47. Can judgments according to case fatality rate be correct all the time during epidemics? Estimated cases based on CFR in different scenarios and some lessons from early case fatality rate of coronavirus disease 2019 in Iran

Author: Ghobad Moradi, Bakhtiar Piroozi, Amjad Mohamadi-Bolbanabad, Hossein Safari, Azad Shokri, and Ramyar Rahimi
Subjects: Coronavirus, Pandemic, Mortality estimated model, COVID-19, Original Article, General Medicine, Iran, Case fatality rates
Abstract: Background: The new Coronavirus disease (COVID-19) was first identified in China in 2019. Case fatality rate (CFR) indicator of the disease is one of the most important indices noticed by experts, policymakers, and managers, based on which daily evaluations and many judgments are made. CFR can change during epidemics. This study aimed to estimate the actual number of COVID-19 cases in Iran and to calculate the early CFR for the disease based on official statistics. Methods: This was a descriptive study whose data were obtained from the website of the Ministry of Health and Medical Education of Iran from February 20, 2020 until March 26, 2020. CFR has been obtained by dividing the total number of deaths by the total number of confirmed cases at one point in time. In this study, the actual number of COVID-19 cases in Iran was estimated based on the mortality model in 4 scenarios. Excel 2013 software was used to analyze the data. Results: According to the findings of this study, In Iran, until March 26, 2020, a total of 27 017 people have been infected by COVID-19 and 2077 died of it. However, CFR indicator had a descending trend in Iran: 100%, 18.6%, 8.8%, 3.3%, 6.9%, and 7.7% on days 1, 5, 10, 20, 30, and 35, respectively. The actual number of COVID-19 cases in Iran was estimated to be 4 789 454, 2 873 673, 1 436 836, and 718418 as of March 26, 2020 according to the 4 scenarios, respectively. Conclusion: In emerging epidemics, CFR indicator must not be used as a basis to judge the performance of a health system unless that epidemic condition has been clarified. Moreover, it is suggested that in the outbreak of an epidemic, specifically emerging diseases, CFR must not be the base of judgment. Making judgments, specifically in the outbreak of emerging epidemics, based on fatality rate can lead to information bias. It is also possible to estimate the total number of patients based on the CFR in circumstances where little information is available on the disease.
Published: 2020

Catalog

Books, media, physical & digital resources

See catalog results

Searchworks

Select search scope, currently: Articles Catalog books, media & more in Jio Institute collections Articles journal articles & other e-resources

Search

Search Constraints

Refine your results

Search Limiters

Topic

Publication Year Range

Publication Type

Journal

Database

Publisher

47 results on '"Bakhtiar PIROOZI"'

Search Results

Catalog

Select search scope, currently: Articles

Catalog

books, media & more in Jio Institute collections

Articles

journal articles & other e-resources