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PURPOSE: Sendai Framework is an international disaster risk reduction strategy that helps prioritization of disaster risk governance in all policies, strategies, and programs. Considering its geographical location and topographic characteristics, Iran experiences numerous hazards. Natural disasters adversely affect the health of population directly through injury and death, increased physical and mental illness, displacement and disruption of social networks. In addition, Iran’s public health facilities have been increasingly impacted by such events during the last decade. This study aimed to investigate the implementation of Sendai framework in health system in Iran. METHODS: In this mixed method study, first, throughout a literature review, all documents related to Disaster Risk Management (DRM) in Iran’s health system were extracted. Then the obstacles and facilitators of DRM were found out based on the literature review and, a two-round Delphi, followed by an expert panel was performed. According to the results of the Delphi and expert panel Pareto analysis, and Fishbone model were used. RESULTS: 85 obstacles and 33 facilitators were extracted in total, which were divided into ten groups include Coordination, Actors, Intervention, Monitoring & Evaluation, Accountability, Attitude, Context, Budget, Idea, and Content. The most important obstacles were attributable to the intervention group, the Context, and the attitudes. The most important facilitators were the intervention group, monitoring and evaluation, and then Actors, policy content and Idea. CONCLUSION: Despite the existing facilitators for the implementation of the Sendai framework in Iran, there are far more obstacles along the pathway. These factors are relevant to all aspects of policy which would require long-term and continuous cultural change and educational planning. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40201-021-00715-9.

Wild rats are known to carry different microorganisms and are considered a reservoir of zoonotic pathogens worldwide. The urban rats were collected from five districts of Tehran and Gram-negative bacteria (GNB) were isolated from fecal samples and were identified using classical biochemical tests. The antibiotic susceptibility patterns of isolated bacteria were determined by Kirby–Bauer disk diffusion method, the results of which were interpreted in line with CLSI guideline. The frequency of antibiotic-resistant genes was identified using multiplex-PCR. Moreover, PCR method was used to identify the frequency of Escherichia coli O157:H7 and main categories of diarrheagenic E. coli including EPEC, ETEC, EIEC, EAEC, and STEC pathotypes. A total of 100 Rattus norvegicus were trapped and fecal samples were collected. Overall, 72 fecal samples were positive for GNB. E. coli (n = 46/72) had the highest frequency among the isolated GNB. Among E. coli isolates, the highest and lowest resistance rates belonged to ampicillin (56.5%) and ceftriaxone (0%), respectively. Klebsiella spp. was 100% resistant to imipenem, and streptomycin (0%) was the most effective antimicrobial agent on Klebsiella spp. Among surveyed genes, blaTEM (95.8%) and blaaadA-1 (58.3%) had the highest frequency, while blaKPC, and blaCMY-2 were not detected among Enterobacteriaceae. Herein, O157: H7 serotype was not detected and aEPEC (87%) was the most common pathotype detected. Results suggested that rodents might be a reservoir of antimicrobial-resistant pathogens and rodent control along with implementation of surveillance programs should be considered as a critical priority for urban health.

Background Ensuring public health is crucial in any policy debate on climate change. Paris Agreement on climate change is a global contract, through which countries have committed themselves to a public health treaty. The agreement has laid the foundation for mitigation and adaptation. This study was conducted to provide an evidence-based framework for policy-making in the health system of Iran in order to reduce the adverse effects of climate change on public health and to increase the adaptation of the health system as a result. Methods This is a qualitative study. We first used Delphi method to extract the components of Paris Agreement on climate change that were related to the functions and policymaking of health system in Iran. Twenty-three experts in health and climate change were identified purposefully and through snowball sampling as participants in Delphi. Data collection instrument was a structured questionnaire. We used SPSS software version 25 for data analysis based on the descriptive indices including the mean, the percentage of consensus above 75%, and the Kendall coordination coefficient. Results Seventy-nine components classified within nine categories were extracted. The most important examples of the implementation of Paris Agreement on climate change in the health system of Iran were: participation in the formulation of strategies for mitigation and adaptation, identifying vulnerable groups, assessing vulnerability, increasing the capacity of health services delivery during extreme events, using early warning systems, using new technologies to increase the adaptation, evaluation of interventions, financial support, increasing the number of researches, increasing the knowledge and skills of staff, and finally public awareness. Conclusions Evidence-based policy-making is pivotal to develop effective programs to control the health effects of climate change. This research provided policy translation and customization of micro and macro provisions of Paris Agreement on climate change, in line with the political context of health system in Iran. Our finding will pave the ground, we envisage, for further steps towards capacity building and enhancement of resiliency of the health system, adaptation interventions, and evaluation, identification of barriers and facilitators for adaptation and decreasing the adverse health effects caused by the climate change, in Iran and perhaps beyond.

BACKGROUND: The consequences of climate change are highly impeding the achievement of Sustainable Development Goals (SDGs) anywhere, especially in low and middle-income countries. While climate change scales up, its health-related risks increase, which in turn leads to cause new challenges for public health. As a second largest country of the Eastern Mediterranean Region of World Health Organization, Iran is highly vulnerable to the effects of climate change. PURPOSE: This study seeks the notion of health risks and challenges of climate change in Iran and provide potential evidence-based remedies to prevent and diminish such destructive effects. METHODS: A comprehensive literature in various computerized databases was conducted, and numerous published original research and review articles about climate change status and evidences of adverse health consequences of climate change in Iran were reviewed. RESULTS: The evidence suggests that the expected health challenges related to climate change in Iran are: rising temperatures; frequent extreme weather events; reduction of air quality; food-borne, water-borne, and vector-borne diseases; mental health and well-being consequences; and the increasing trend of natural disasters and deaths associated with climatological hazards. CONCLUSIONS: By considering the growing burden of diseases associated with climate variability in Iran as well as the interdisciplinary nature of climate change and health issues, an integrated, multi-sectoral, and comprehensive approach for identification, prioritization, and implementation of adaptation options is required by Ministry of Health and Medical Education as a custodian of public health in order to enhance the resiliency and adaption against adverse health effects of climate change.

Background: Floods are kinds of natural disasters that directly threaten human life. To save lives and reduce the number of injured people in floods, it is crucial to determine the underlying factors of flood deaths. This study was conducted to find the causal factors which influence flood deaths in Iran. Methods: The present research was conducted in four separate phases. In the first phase, a systematic review was conducted to determine the risk factors influencing flood death based on the available documents in the globe. In the second phase, using a qualitative study with content analysis method, the underlying factors that might cause flood deaths in different groups of Iranians were identified. In the next phase, a validated tool was developed based on the psychometry method. In the last phase, through a retrospective study using the validated tool, the risk factors affecting flood deaths were identified. Results: The systematic review identified 114 risk factors which were categorized into five groups of vulnerability factors. The results of the qualitative study indicated that a large number of underlying factors lead to flood deaths including the categories of hazard-related features, cultural, economic, social, demographic, management, and physical factors. The results of regression analysis in a retrospective study showed that by increasing some risk factors, the likelihood of flood deaths decreases. While other groups of risk factors increase the risk of flood deaths. Conclusion: Based on the findings of this study, comprehensive and appropriate strategies and interventions can be implemented to reduce and eliminate the impact of flood risk mortality and ultimately to reduce flood deaths. These include planning, training, promotion of awareness and culture of prevention, promotion of risk perception, protection of vulnerable groups, flood risk assessment and flood risk reduction, observance of urban and construction safety principles, improving urban flood management by responsible organizations, and involvement of people in all stage s of death-flood risk management.

Purpose Famines and food shortages are one of the most common long time histories of Ethiopia. Hence, malnutrition has been persisted at alarming raters in the country. Moreover, it is a major cause of morbidity and mortality in Afar National Regional State of Ethiopia. Specifically, in Amibara and Awash Fentale districts. The anthropometric data were presented on height, weight, MUAC, weight/height/Age and Body Mass Index (BMI) of under-five children. Methods A cross-sectional descriptive survey was conducted from March 01, 2017 to June 15, 2018. The data was collected by using anthropometric measurement. A multi stage random sampling procedure was applied in order to recruit the required sample size. The data collections were conducted at two selected districts in Afar region by trained interviewers and health care providers. The data were analyzed by using SPSS Version 23. Bivariate analysis between dependent and independent variables was employed. Multivariate analysis was also done to control for possible confounding variable by selecting variable which show statistically significant association (P Results Out of 410 under five children's anthropometric finding, the majorities (62.7%) of those registered under five children were male and (33.3%) were female. The majority (46.8%) of under five children were less than or equal to 50 cm by their height. Most (54.1%) of under five children were less than or equal to 12.5 cm by their MUAC. It indicated that they were diagnosed with severe malnutrition based on anthropometric measurements. Meanwhile, majority (64%) of under five children were less than 60% their weight/age. Regression analysis result indicated that all of the variables were not significant predictors of BMI for under five children (P> 0.05). Based on ANOVA result, there was significant difference between sex and other predictors (P= 0.031). This finding implies that improvement in food aid and poverty alleviation programs are very important. Based on the finding, it is important to provide high quality and quantity of food. Moreover, less access to assets and health services commonly contributed for malnutrition. Highlighting under five children's malnutrition will help to develop and design future policies and programs in Ethiopia.

Background: Dust storms and their impacts on health are becoming a major public health issue. The current study examines the health impacts of dust storms around the world to provide an overview of this issue. Method: In this systematic review, 140 relevant and authoritative English articles on the impacts of dust storms on health (up to September 2019) were identified and extracted from 28 968 articles using valid keywords from various databases (PubMed, WOS, EMBASE, and Scopus) and multiple screening steps. Selected papers were then qualitatively examined and evaluated. Evaluation results were summarized using an Extraction Table. Results: The results of the study are divided into two parts: short and long-term impacts of dust storms. Short-term impacts include mortality, visitation, emergency medical dispatch, hospitalization, increased symptoms, and decreased pulmonary function. Long-term impacts include pregnancy, cognitive difficulties, and birth problems. Additionally, this study shows that dust storms have devastating impacts on health, affecting cardiovascular and respiratory health in particular. Conclusion: The findings of this study show that dust storms have significant public health impacts. More attention should be paid to these natural hazards to prepare for, respond to, and mitigate these hazardous events to reduce their negative health impacts. Registration: PROSPERO registration number CRD42018093325

Dezful is the capital of Dezful County, a city in Khuzestan Province, Iran. On August 12, 2017, after a chlorine gas leakage in Dezful, more than 475 people were affected by chlorine gas, and they all suffered from respiratory complications. A lot of problems were encountered in the preparation of the relief forces and organization of the blueprint on how to respond to the incident, such as lack of knowledge on establishment of danger zone, lack of warning system, lack of proper triage and absence of decontamination plans, lack of special chemical safety outfit and respiratory equipment for rescuers, lack of instructions for proper handling, lack of knowledge in dealing with this type of disaster, and inappropriate evacuation skills and failure to cordon off and insure the location of the incident. Although the initial measures to arrest this crisis was performed based on the health system’s instructions of the country with regard to all the possible risks, lack of a comprehensive inter-organizational program and prevention plans, lack of control plans, lack of adequate preparation and response to chemical poisoning, lack of foresight, lack of a risk plan, and lack of an intervention plan for these incidents were the reasons for the damages and problems encountered after the crisis.

The coronavirus disease (COVID-19) spread rapidly worldwide and led to the death of thousands of people. To date, there isn’t any vaccine or specific antiviral medicine that can prevent or treat this virus. This caused panic among citizens who try their best to prevent being infected. In Iran, alcohol poisoning was reported and led to the death of hundreds of people in several provinces. The incident occurred after a rumor circulated in the country that drinking alcohol can cure or prevent being infected by COVID-19., Highlights • Currently Iran is not only suffering from the COVID-19 outbreak, but also alcohol poisoning incident was reported weeks ago in several provinces. • This report highlights the details of the incident, its causes and the results. Lessons learned from this incident is shared so that other countries will know what actions should be done to prevent the occurrence of such incident.

Background: Internationally, inclusion of physical rehabilitation services during early disaster response is relatively new. The aim of the study was to gain an understanding of disaster relief physical rehabilitation in Iran. Methods: A qualitative study design was employed and sixteen semi-structured interviews were conducted for data collection. Content analysis was used for data analysis. The participants in this study were purposively selected among people who experienced the Bam (2003) and Varzaghan (2012) earthquakes. Results: Three main themes were explored including: indispensable intervention, barriers to continuous intervention and opportunities for intervention. Almost all participants reiterated the importance of effective physical rehabilitation services during disasters. Some participants mentioned significant barriers for delivering such services in the context of Iran. The lack of an effective responsible body, weak disaster-related competencies and under-prioritization by government were among other barriers. On a more positive note, some interviewees talked about national programs that could facilitate service delivery. Conclusions: Providing disaster relief physical rehabilitation has faced many barriers in Iran. However, there are some facilitators in the country that could help provide these services. Finally, the feasibility of post-disaster physical rehabilitation services delivery completely depends on the current national rehabilitation system.

Background Hospitals play a vital role in disaster stricken regions. The resilient hospitals will be able to provide essential services to affected people and it can mitigate the risk of injuries during and after disasters. This study aimed to obtain the indicators required for the evaluation of hospital resilience. Methods This systematic review was conducted in 2018. Through this systematic review, international electronic databases were investigated for the research studies published in English. The exclusion and inclusion criteria were determined to extract the hospital resilience indicators. These indicators will be used in order to develop a model to keep the system performance at an acceptable level during disasters. Results Out of 1794 research studies published until September 2018, 89 articles and guidelines with full text were surveyed. Thirty-two articles and guidelines were then selected and analyzed to collect the indicators related to hospital disaster resilience (HDR). The domains and the indicators were extracted from these selected research studies. The authors collected and categorized them into three domains and twenty seven subdomains. The three domains included constructive, infrastructural, and administrative resilience. The relevant indicators were designed for each subdomain to assess HDR. Conclusion Since diverse indicators affect hospital resilience, other studies should be conducted to propose some models or tools to quantify the hospital resilience in different countries and scopes with an all hazards approach.

Background: In Spring 2018, due to intense rainfalls in Iran, plenty of mushrooms had grown, some of which were poisonous and their consumption had induced poisoning in people of different provinces; 1151 mushroom poisoning cases were reported within 25 days from 12 May to 9 July 2018. Objectives: This study aimed to address this issue from the public health perspective. The study further aimed at reporting the mortality and morbidity associated with mushroom poisoning and ascertaining the reasons behind the increase in the numbers of the affected persons. Methods: This report was based on the review of official reports and a field assessment in the areas affected by mushroom poisoning in the western part of Iran. Results: There were 1151 mushroom poisoning cases, out of which 1133 (98.4%) were hospitalized, and unfortunately, 18 (1.56%) died. Kermanshah province had the highest rate of mushroom poisoning casualties, out which seven people died. A total of 12 provinces were affected. Conclusions: Lack of knowledge of local people about the types of mushroom and their inability to differentiate between the toxic and non-toxic mushrooms, as well as lack of a swift and convenient immediate warning system has caused this incident of massive mushroom poisoning. However, planning and proper management can help to resolve these problems.

Aims To present epidemiological data, probable causes and lessons learned from the outbreak of methanol poisoning in Iran in September 2018, and relate this to the increasing incidence of methanol poisoning worldwide over recent decades. Method Analysis of all available reliable field information, official news reports and reports from the country's forensic medicine organization and the Ministry of Health. Results Overall, 768 people in Iran were documented as poisoned from September 7 to October 7 2018 by consuming an informal alcohol containing methanol, of whom 76 died (10.1% fatality rate); 460 subjects attended state hospitals due to acute methanol poisoning of whom 42 (9.13%) died. Those who were hospitalized comprised 177 subjects (38.4%), with 241 subjects (52.3%) seen and discharged. Males comprised 93% of the deaths. About 41% of those poisoned were aged 25-36. Outbreaks were reported in 21 provinces. Conclusion These data indicate a high fatality rate of methanol poisoning in Iran, something seen also in some other countries. Considering that such outbreaks take place more in low-income and Islamic countries due to ignorance and legal constraints, it seems necessary to seek an effective educational model for raising public awareness and a fully native and early warning system in this regard to reduce the damage and enhance readiness to deal with the health effects of such outbreaks.

Background: In 2015, it was estimated that the burden of disease in Iran comprised of 19 million disability-adjusted life years (DALYs), 74% of which were due to non-communicable diseases (NCDs). The observed leading causes of death were cardiovascular diseases (41.9%), neoplasms (14.9%), and road traffic injuries (7.4%). Even so, the health research investment in Iran continues to remain limited. This study aims to identify national health research priorities in Iran for the next five years to assist the efficient use of resources towards achieving the long-term health targets.Methods: Adapting the Child Health and Nutrition Research Initiative (CHNRI) method, this study engaged 48 prominent Iranian academic leaders in the areas related to Iran's long-term health targets, a group of research funders and policy makers, and 68 stakeholders from the wider society. 128 proposed research questions were scored independently using a set of five criteria: feasibility, impact on health, impact on economy, capacity building, and equity.Findings: The top-10 priorities were focused on the research questions relating to: health insurance system reforms to improve equity; integration of NCDs prevention strategy into primary health care; cost-effective population-level interventions for NCDs and road traffic injury prevention; tailoring medical qualifications; epidemiological assessment of NCDs by geographic areas; equality in the distribution of health resources and services; current and future common health problems in Iran's elderly and strategies to reduce their economic burden; the status of antibiotic resistance in Iran and strategies to promote rational use of antibiotics; the health impacts of water crisis; and research to replace the physician-centered health system with a team-based one.Conclusions: These findings highlight consensus amongst various prominent Iranian researchers and stakeholders over the research priorities that require investment to generate information and knowledge relevant to the national health targets and policies. The exercise should assist in addressing the knowledge gaps to support both the National General Health Policies by 2025 and the health targets of the United Nations' Sustainable Development Goals by 2030.

Background: Physical rehabilitation, as one of the rehabilitation disciplines, can play a great role in humanitarian reliefs. The effectiveness of physical rehabilitation services is completely dependent on time of intervention, the importance of good timing in providing services during disasters is not well understood. The objective of this study was to systematically review the physical rehabilitation services provided in disasters and emergencies. Methods: An electronic search of PubMed, Scopus, Cochrane, and PEDro (Physiotherapy Evidence Database) was undertaken from Jan 2000 to Sep 2017. All English studies reporting physical rehabilitation services in natural and man-made disasters were selected regardless of study design. The included studies were analyzed by descriptive and analytical method. Results: Thirteen studies were included after reviewing by title, abstract and full text in this study. Most of the physical rehabilitation studies come back to recent years. Most of the disaster physical rehabilitation services were physiotherapy and occupational therapy. The physical rehabilitation experts have been attended in the affected area from the few first hours until several months after disasters in order to provide the required services to the affected population. Conclusion: There are few studies about physical rehabilitation services provided in the disaster-affected areas and this study showed that the services were limited and at different times. Physical rehabilitation services post disasters should have a comprehensive service model, like other health services. Therefore, it is necessary to conduct further studies to achieve this aim.