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Background: Building resilient communities has emerged as a dominant schema in the policy arena and in academia in the wake of recent disasters. Food insecurity is a complex and multidimensional phenomenon that is not appropriately captured by conventional proxy indicators currently used to assess the problem in developing countries. Ethiopia like many countries in sub-Saharan Africa, continues to experience high levels of drought driven food insecurity despite decades of implementing poverty alleviation and prevention programmes. These persistent droughts, combined with the devastating impact of climate change continue to threaten the livelihoods of thousands of men, women and children, who depend on agriculture for their livelihoods., Objective: The overall objective of this study was to assess and analyze the drought driven food insecurity situation, malnutrition and derive policy implications in the Afar National Regional State of Ethiopia., Methods: Mixed methods designs which include both qualitative and quantitative were used. The subjects of the study were men and women dwellers, government officials and other stakeholders in Afar Regional State of Ethiopia. Four Hundred Twenty Two (422) eligible households were enrolled consecutively from randomly selected two Districts in Afar National Regional State of Ethiopia which were selected by stratified Randomized method. The Districts were randomly allocated into 3 Keble's from Amibara and 2 Keble's from Awash Fentale. Two FGD (total of 10 FGDs participants that mean each Districts = 5 FGD) and 10 KIIs from Amibara and Awash Fentale were conducted. Standard questionnaires were used for data collection after validating the instruments. The data was analyzed by using SPSS version 23. Associated factors and multiple logistic regressions were employed. The study significance was conducted by using α 5% level., Results: In this research (58.1%) of the participants agreed that lower crop yield occurred due to heavy rains/floods were not shocks among households. While (41.9%) were shocks on households who travel further loyal for grazing was the highest level of shocks among all those listed. On top of that majority (56.8%) of under five children were < 60% by their weight/age and (33.9%) between 61 and 70%. There was significant difference among MUAC (P= 0.007), BMI (P= 0.003) and height, weight, MUAC, BMI and weight/age among under five children.

Objective: To find a proper search strategy to do a systematic review related to preparedness for disasters., Methods: MeSH and Emtree terms were searched to detect synonyms for two main search terms "disaster" and "preparedness". Expert opinion on the synonyms was examined applying a Google form. The adopted syntax was searched in PubMed and results were sifted. Hand searching in two top key journals was done and sensitivity was calculated., Results: Out of 1120 articles, 122 were included. In PDM journal, 10 articles were included by hand searching, out of which 5 were not spotted in PubMed search with the proposed syntax. In DMPHP journal, 13 publications were included, with 5 not found in PubMed search. Because of human error in hand searching 2 articles were added., Conclusion: The proposed syntax in this study achieves a sensitivity of search of 0.6 in PubMed which could be quite applicable for researchers. Moreover, in case only MeSH or Emtree terms were applied in search strategy or where hand searching was not performed, there were a number of articles missed., Competing Interests: No conflict of interest.

Background: Occupational chemical accidents have increased in recent years in the Islamic Republic of Iran. In June and August 2015, three large explosions occurred at chemical warehouses in Rey, Tehran Province, and toxic vapours were released., Aims: This study reviewed the three chemical accidents and assessed the extent to which the requirements for chemical safety and preparedness for chemical incidents under the International Health Regulations (IHR) are in place, and implemented at local and national levels in the Islamic Republic of Iran., Methods: Data were obtained from secondary data and field visits to selected chemical plants. The secondary data were used to complete a 33-item checklist based on the IHR and the Ministry of Health and Medical Education checklist. A sample of 15 warehouses in Kahrizak district, Rey County, were visited to assess their capacity in relation to the IHR using a 15-item checklist., Results: Some weaknesses were seen in the IHR capacity in the study area. The main weaknesses were lack of an effective surveillance system for chemical accidents and low levels of safety in chemical plants and warehouses. Other weaknesses included the lack of awareness of residents about chemical hazards and poorly equipped health centres for the management of victims of chemical accidents. The study area was not prepared for chemical accidents both within industrial plants and residential areas., Conclusions: Action is needed to improve the areas of weakness so as to achieve the necessary capacities for chemical safety, and preparedness and response to chemical incidents in line with the IHR., (Copyright © World Health Organization (WHO) 2019. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license (https://creativecommons.org/licenses/by-nc-sa/3.0/igo).)

Introduction: Triage is a dynamic and complex decision-making process in order to determine priority of access to medical care in a disaster situation. The elements which should govern an ethical decision-making in prioritizing of victims have been debated for a long time. This paper aims to identify ethical principles guiding patient prioritization during disaster triage., Method: Electronic databases were searched via structured search strategy from 1990 until July 2017. The studies investigating patients' prioritization in disaster situation were eligible for inclusion. All types of articles and guidelines were included., Result: Of 7167 titles identified in the search, 35 studies were included. The important factors identified in patient prioritization were grouped into two categories: medical measures (medical need, likelihood of benefit and survivability) and Nonmedical measures (saving the most lives, youngest first, preserving function of society, protecting vulnerable groups, required resources and unbiased selection). Demographic characteristics, health status of patients, social value of patient, and unbiased selection are discriminatory factors in disaster triage., Conclusion: Various factors have been introduced to consider ethical patient prioritization in disaster triage. Providers' engagement, public education, and ongoing training are required to reach a fair decision., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: Drought is a serious issue which might be caused by climate change that could create famine and health problems. Drought reduces air quality, increases fungal infestation, reduces people hand washing, affects mental health, leads to malnutrition by decreasing agricultural production, and increases diseases transmitted by insects. This study aimed to determine and describe community health status through building drought resilience in Ethiopia., Methods: This review was conducted based on the available peer-reviewed articles that were published from January 2004 to December 2018 Online databases from PubMed, MEDLINE, Scopus, EMBASE and Google Scholar were searched for studies related to the building drought and community health resilience at different regions of Ethiopia that were published in English language. The search was made by using "Emergency disaster", "prevention", "preparedness", "response", "recovery", "drought", "food insecurity", "coping strategies" and "drought health policy" as keywords., Results: Most of the reviewed articles deal with the impact of climate change on the human health in relation to food security. The associated factors of the impact of drought on food security is basically due to lack of irrigation and farmland, the scarcity of water due to the direct effect of drought, flood, severe soil erosion, livestock dispossession, family size of the household and literacy of the households. Various coping strategies were employed by the households to alleviate the high and continued food insecurity problem such as reducing the number and amount of meal, scrounging cash and grain, searching for off-farm and non-farm jobs, getting food aid, vending of livestock, and partake in food for work programs., Conclusion: The findings explored components of the coping strategies to the building resilience create fruitful health conditions for the food insecure household. The effect of agricultural support services as reliance's on drought and community health situation was regarded as a positive outcome. Moreover, the means to get adequate food security strategies in all regions of Ethiopia should be designed. Furthermore, future researches are recommended for finding the best building strategies for each region of Ethiopia.

The relationship between apparent temperature and cardiovascular disease (CVD) mortality was studied in Rasht, Iran, from 2005 to 2014. The effects of apparent temperature on CVD mortality were investigated using the distributed lag nonlinear model. Data on all types of cardiovascular mortality cases according to the International Classification of Diseases were collected from the only cardiovascular hospital in Rasht, and the meteorological variables were obtained from Rasht Meteorological Center during the period of study. Our findings showed that low temperatures had significant impacts on CVD mortality, and a reverse J-shaped temperature-mortality relationship was found. Moreover, immediate effects of hot temperatures on CVD mortality with the strongest effects on the same day but delayed effects of cold temperature was observed. This study showed that exposure to both hot and cold apparent temperatures was associated with increased cardiovascular mortality in Rasht.

Introduction: Emergency physicians should secure Endotracheal tubes (ETT) properly in order to prevent unplanned extubation (UE) and its complications. Despite various available endotracheal tube holders, using bandages or tape are still the most common methods used in this regards., Objective: This study aimed to compare adhesive tape (AT) versus fixing bandage (FB) method in terms of properly securing ETT., Methods: This was an observational longitudinal trial. All patients older than 15-years-old admitted to the ED who had indication for ETT insertion were eligible. Patients were randomly assigned to one of the two groups in which AT or FB was applied. All patients were observed thoroughly in the first 24 hours after intubation. Using a pre-prepared checklist, encountered UE rate and other data were recorded., Results: Seventy-two patients with the mean age of 55.98 18.39 years were finally evaluated of which 38 cases (52.8%) were male. In total, 12% of patients in our study experienced unplanned extubation. Less than 12% of the patients experienced complete UE; there was no statistically significant difference between the two groups (p = 0.24). Comparison of UE with age showed no significant difference (p = 0.89). Male patients experienced more UE, but this was not statistically significant (p = 0.44)., Conclusion: It is likely that whether the AT method or FB was applied for securing the ETT in emergency departments, there was no significant difference in rates of unplanned extubation., Competing Interests: None declared.

Background: Over the years, Uganda has been one of the low and middle-income countries bearing the heaviest burden of road traffic incidents (RTI). Since the proclamation of the United Nations Decade of Action for Road Safety 2011 - 2020, a number of measures have been taken to reduce the burden. However, they ought to be premised on existing evidence-based research; therefore, the present review ventures to report the most recent five-year trend of RTI in Uganda., Methods: Based on Preferred Reporting Items for Systematic Reviews and Meta-Data Analysis (PRISMA) guidelines, a systematic review was employed. Using a thematic analysis, the articles were grouped into: trauma etiology, trauma care, mortality, cost, trauma registry and communication, intervention and treatment for final analysis., Results: Of the nineteen articles that were identified to be relevant to the study, the etiology of RTI was inevitably observed to be an important cause of injuries in Uganda. The risk factors cut across: the crash type, injury physiology, cause, victims, setting, age, economic status, and gender. All studies that were reviewed have advanced varying recommendations aimed at responding to the trend of RTIs in Uganda, of which some are in tandem with the five pillars of the United Nations Decade of Action for Road Safety 2011 - 2020., Conclusions: Peripheral measures of the burden of RTIs in Uganda were undertaken within afive-year timeframe (2011-2015) of implementing the United Nations Decade of Action for Road Safety. The measures however, ought to be scaled-up on robust evidence based research available from all the concerned stakeholders beyond Kampala or central region to other parts of Uganda., (© 2017 KUMS, All rights reserved.)

Introduction: In emergencies and disasters, hospitals are among the first and most vital organizations involved. To determine preparedness of a hospital to deal with crisis, health system requires tools compatible with the type of crisis. The present study aimed to evaluate the accuracy of tools used for assessment of hospitals preparedness for major emergencies and disasters in Iran., Method: In this review study, all studies conducted on hospital preparedness to deal with disasters in Iran in the interim 2000-2015 were examined. The World Health Organization (WHO) criteria were used to assess focus of studies for entry in this study., Results: Of the 36 articles obtained, 28 articles that met inclusion criteria were analyzed. In accordance with the WHO standards, focus of tools used was examined in three areas (structural, nonstructural, and functional). In nonstructural area, the most focus of preparation tools was on medical gases, and the least focus on office and storeroom furnishings and equipment. In the functional area, the most focus was on operational plan, and the least on business continuity. Half of the tools in domestic studies considered structural safety as indicator of hospital preparedness., Conclusion: The present study showed that tools used contain a few indicators approved by the WHO, especially in the functional area. Moreover, a lack of a standard indigenous tool was evident, especially in the functional area. Thus, to assess hospital disaster preparedness, the national health system requires new tools compatible with scientific tool design principles, to enable a more accurate prediction of hospital preparedness in disasters before they occur.

Background: In the past three decades, Tehran has experienced warmer summer so we need to determine heat-related mortality to establish appropriate public health activities during hot summers. The aim of the present study was to detect heat waves during the last decades and then determine excess mortality in immediate and lagged times., Methods: An ecological study based on time-series model was conducted in Tehran for recent decade using generalized linear lagged model (GLLM) with Poisson regression. Maximum daily temperature was heat exposure for death outcome on the same day (lag 0), 3 (lag01) and also 7 (lag02) day moving average. Relative risk with 95% confidence was reported to quantify for increasing of daily mortalities for 1°C risen exposure. Air pollutants considered as confounders in final model., Results: Total excess mortality during 17 heat waves was 1069 (8.9 deaths/Heat wave days). All non-external cause of death increased significantly during heat waves (3-9%) and after adjusting for ozone and PM10, raised. Cause-specific deaths (especially circulatory disease) and death among elderly increased during heat waves (especially in the hottest wave). The largest positive lagged effect of hot temperature although seen during hottest waves for all mortalities. Three waves had the most harvest effect for all categories of mortalities., Conclusion: Study showed excess mortalities resulted from hot temperatures and exacerbated with air pollutants in Tehran in the context of climate change. Forward displacement mortality and lagged mortalities as well as were seen, but our results were not conclusive about the displacement pattern of mortalities.

Introduction: It is estimated that during the Iraq-Iran war of the 1980s, over 100,000 Iranians (military or civilian) were exposed to sulfur mustard (SM), and a considerable proportion of them are still suffering with long-term consequences of exposure. The aim of the present article is to address carcinogenesis of SM following these acute exposures., Methods: Using a cohort study, we estimated and compared the incidence rates of malignant disorders in 7,570 veterans exposed to SM and 7,595 unexposed comrades in a 25-year follow-up period. We also determined the hazard ratio of cancer occurrence for SM exposure during the follow-up period., Results: Cancer incidence was significantly increased with exposure to SM. The incidence rate ratio of cancer for SM exposure was 1.81 (95 % CI 1.27-2.56), and the age-adjusted incidence rate ratio was 1.64 (95 % CI 1.15-2.34).The hazard ratio of cancer was 2.02 (95 % CI 1.41-2.88)., Conclusion: Present study suggests carcinogenesis of SM following acute exposure during war. With respect to this finding, it is reasonable to improve care programs such as routine screening schemes for exposed veterans.

Objective: To evaluate effectiveness of a community-based preparedness program for flash floods., Design: A controlled community intervention trial with preassessment and postassessment., Setting: Fifteen intervention villages and 16 control villages in Golestan province of Iran., Participants: People more than six years of age., Intervention: Intervention program consisted assembling Village Disaster Taskforces (VDTs), training of VDTs and community, evacuation drill, and program monitoring., Main Outcome Measures: Individual participation in household preparedness actions including, preparedness meeting, risk mapping, preparation of emergency supplies, assisting vulnerable people, and evacuation drill., Results: Our intervention improved preparedness of local community for flash floods in term of all interested outcome measures. For instance, adjusted odds ratio for participation in an evacuation drill in intervention area in postassessment compared with preassessment was 29.05 (95% confidence interval [CI]: 21.77-38.76), whereas in control area it was 2.69 (95% CI: 1.96-3.70). Difference in these odds ratios was statistically significant (p < 0.001). Participation in a family preparedness meeting and risk mapping were helpful in motivating individuals to take other preparedness actions. Women were found prepared as much as the men. Younger people showed lower participation in preparation of family emergency supplies but higher attendance in evacuation drills. Participation in evacuation drills decreased with increasing age. It was a positive association between risk perception and taking all preparedness actions., Conclusion: Flood preparedness programs should focus on participatory risk assessment and preparedness techniques, strive to improve risk perception and female capabilities, and ensure providing assistance to the older people during evacuation.

This study aimed to determine the prevalence of lifetime and current primary infertility in Iran. The study was conducted in 2004-5 in all the 28 provinces of Iran. A cluster sampling method was used to select 10 783 women aged 19 to 49 years for the survey. Lifetime primary infertility was defined based on 1 of 2 contraception scenarios immediately after marriage to find experience of infertility despite 1 year of unprotected intercourse. The term "current primary infertility" designated a woman who, in addition to meeting the definition of lifetime infertility, had been unable to conceive up to the study time. A complex sampling design and SVY commands in the software package STATA 8.0 were used to derive 95% confidence intervals. A history of lifetime primary infertility was present in 24.9% of the subjects (95% CI: 23.5-26.2), and the prevalence of current primary infertility was 3.4% (95% CI: 3.0-3.8). As for age trends in lifetime primary infertility, the highest prevalence rates were observed in individuals with the lowest age at marriage. Minimum prevalence (17.2%) occurred with marriage age of 21 to 26 years, and the rates rose with higher age at marriage. About one fourth of the Iranian couples experience primary infertility at some point in their lives and 3.4% suffer from this problem at any time. For a correct interpretation of prevalence rates and the implications in terms of health care and service delivery, factors such as age at marriage and the couple's fertility potential must be taken into consideration.

Introduction: Breast cancer is the most common cancer among Iranian women. This study aimed to determine risk factors for breast cancer in the north of Iran., Method: A matched case-control study was conducted in Mazandaran province of Iran in 2004 of 250 biopsy proven cases of breast cancer and 500 neighbor controls that were matched by age within a 3 year period. Statistical analysis was carried out using conditional logistic regression with the backward elimination method and crude and adjusted odds ratios with related 95% CIs were estimated with Stata 8.0 software, Results: Multivariate analysis showed that higher education (OR=4.70, 95%CI: 1.71-12.88), late menopause (OR=4.18, 95%CI: 2.54-6.88), history of induced abortion (OR=1.62, 95%CI: 1.13-2.31), positive first-degree family history of breast cancer (OR=3.14, 95%CI: 1.37-7.20), and BMI (OR=1.02, 95%CI: 1.01-1.03) were risk factors for breast cancer. Furthermore, having more episodes of full term pregnancy (OR=0.87, 95%CI: 0.80-0.95), longer duration of breast feeding (OR=0.993, 95%CI: 0.989-0.997) and parity more than 2 were shown to be protective factors., Conclusions: Our study revealed the role of some modifiable determinants of breast cancer that can be focused by public health intervention in the northern community of Iran. Accordingly, the women who have one or more of the following risk factors should take the special attention to risk of breast cancer: obesity, being menopause, positive family history of breast cancer and history of induced abortion. The protective effect of longer duration of breast feeding should be encouraged too.

Objective: Although all newborns in Iran have been vaccinated against hepatitis B since March 1993, routine screening of pregnant women has not been conducted in prenatal care programs, yet transmission of hepatitis B via the maternal-fetal route is still a viable likelihood, which must be entertained., Methods: The subjects were divided into 2 groups. The exposed group comprised 97 vaccinated children whose mothers were seropositive for hepatitis B surface antigen (HBsAg) and had not received hepatitis immunoglobulin at birth. The unexposed group consisted of 87 vaccinated children whose mothers were seronegative for hepatitis B surface antigen. We compared these 2 groups to determine the efficacy of vaccine alone in high-risk children. This study was conducted in Tehran, Iran, from June 2002 to December 2002. All children were born after 1993., Results: Chronic infection (HBsAg positivity) was detected in 14.3% of children in the exposed group. There were no instances of chronic infection in the unexposed group (relative risk [RR]=13.48, 95% confidence intervals [CI] 1.8-100.02). Previous infection of hepatitis B (HBcAb positivity) was found in 29 (29.9%) children in the exposed group, but only one (1.2%) in the unexposed group (RR=26.01, 95% CI: 3.61-186.95). Immunity (HBsAb positivity) in the exposed group measured 48 (49.5%) and unexposed group measured 56 (64.4%) (R.R=0.76, 95% CI: 0.59-0.99)., Conclusion: Vaccination alone did not induce immunity against hepatitis B in high-risk children; it seems that routine screening of pregnant women is necessary for determining whether neonates need hepatitis B immunoglobulin after birth.