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Objectives This study aims to estimate the prevalence of coronavirus disease 2019 (COVID-19) in the general population of Iran. Methods The target population was all Iranian people aged 6 years and older in the country. A stratified random sampling design was used to select 28 314 people from among the individuals registered in the electronic health record systems used in primary health care in Iran. Venous blood was taken from each participant and tested for the IgG antibody against COVID-19. The prevalence of COVID-19 was estimated at provincial and national levels after adjusting for the measurement error of the laboratory test, non-response bias and sampling design. Results Of the 28 314 Iranians selected, 11 256 (39.75%) participated in the study. Of these, 5406 (48.0%) were male and 6851 (60.9%) lived in urban areas. The mean (standard deviation) participant age was 35.89 (18.61) years. The adjusted prevalence of COVID-19 until 20 August 2020 was estimated as 14.2% (95% uncertainty interval 13.3%–15.2%), which was equal to 11 958 346 (95% CI 11 211 011–12 746 776) individuals. The adjusted prevalences of infection were 14.6%, 13.8%, 16.6%, 11.7% and 19.4% among men, women, urban population, rural population and individuals aged 60 years or more, respectively. Ardabil, Golestan and Khuzestan provinces had the highest prevalence and Alborz, Hormozgan and Kerman provinces had the lowest. Conclusions Based on the study results, a large proportion of the Iranian population had not yet been infected by COVID-19. The observance of hygienic principles and social restrictions should therefore continue until the majority of the population has been vaccinated.

The role of hydroxychloroquine (HCQ) in early outpatient management of mild coronavirus disease 2019 (COVID-19) needs further investigation. This study was a multicenter, population-based national retrospective-cohort investigation of 28,759 adults with mild COVID-19 seen at the network of Comprehensive Healthcare Centers (CHC) between March and September 2020 throughout Iran. The baseline characteristics and outcome variables were extracted from the national integrated health system database. A total of 7,295 (25.37%) patients who presented with mild COVID-19 within 3 to 7 days of symptoms onset received HCQ (400 mg twice daily on day 1 followed by 200 mg twice daily for the next four days and were then followed for 14 days). The main outcome measures were hospitalization or death for six months follow-up. COVID-19-related hospitalizations or deaths occurred in 523 (7.17%) and 27 (0.37%) respectively, in HCQ recipients and 2,382 (11.10%) and 287 (1.34%) respectively, in non-recipients. The odds of hospitalization or death was reduced by 38% (odds ratio [OR] = 0.62; 95% confidence interval [CI]: 0.56–0.68, p = < 0.001) and 73% (OR = 0.27; 95% CI: 0.18–0.41, p = < 0.001) in HCQ recipients and non-recipients. These effects were maintained after adjusting for age, comorbidities, and diagnostic modality. No serious HCQ-related adverse drug reactions were reported. In our large outpatient national cohort of adults with mild COVID-19 disease who were given HCQ early in the course of the disease, the odds of hospitalization or death was reduced significantly regardless of age or comorbidities.

BackgroundThis study aims to estimate the prevalence of COVID-19 in the general population of Iran.MethodsThe target population was all Iranian people aged six years and older in the country. A stratified random sampling design was used to select 28,314 subjects from among the individuals registered in the electronic health record systems used in primary health care in Iran. Venous blood was taken from each participant and tested for the IgG antibody against COVID-19. The prevalence of COVID-19 was estimated at provincial and national levels after adjusting for the measurement error of the laboratory test, non-response bias, and sampling design.ResultsOf the 28,314 Iranians selected, 11,256 (39.75%) participated in the study. Of these, 5406 (48.0%) were male, and 6851 (60.9%) lived in urban areas. The mean (standard deviation) participant age was 35.89 (18.61) years. The adjusted prevalence of COVID-19 until August 20, 2020 was estimated as 14.2% (95% uncertainty interval: 13.3%, 15.2%), which was equal to 11,958,346 (95% confidence interval: 11,211,011–12,746,776) individuals. The prevalence of infection was 14.6%, 13.8%, 16.6%, 11.7%, and 19.4% among men, women, urban population, rural population, and individuals ≥60 years of age, respectively. Ardabil, Golestan, and Khuzestan provinces had the highest prevalence, and Alborz, Hormozgan, and Kerman provinces had the lowest.ConclusionsBased on the study results, a large proportion of the Iranian population had not yet been infected by COVID-19. The observance of hygienic principles and social restrictions should therefore continue until the majority of the population has been vaccinated.

Background: Serological surveillance of COVID-19 through conducting repetitive population-based surveys can be useful in estimating and monitoring changes in the prevalence of infection across the country. This paper presents the protocol of nationwide population-based surveys of the Iranian COVID-19 Serological Surveillance (ICS) program. Methods: The target population of the surveys is all individuals ≥6 years in Iran. Stratified random sampling will be used to select participants from those registered in the primary health care electronic record systems in Iran. The strata are the 31 provinces of the country, in which sampling will be done through simple random sampling. The sample size is estimated 858 individuals for each province (except for Tehran province, which is 2574) at the first survey. It will be recalculated for the next surveys based on the findings of the first survey. The participants will be invited by the community health workers to the safe blood sampling centers at the district level. After obtaining written informed consent, 10 mL of venous blood will be taken from the participants. The blood samples will be transferred to selected reference laboratories in order to test IgG and IgM antibodies against COVID-19 using an Iranian SARS-CoV-2 ELISA Kit (Pishtaz Teb). A serologically positive test is defined as a positive IgG, IgM, or both. After adjusting for the measurement error of the laboratory test, nonresponse bias, and sampling design, the prevalence of COVID-19 will be estimated at the provincial and national levels. Also, the approximate incidence rate of infection will be calculated based on the data of both consecutive surveys. Conclusion: The implementation of these surveys will provide a comprehensive and clear picture of the magnitude of COVID-19 infection and its trend over time for health policymakers at the national and subnational levels.

Background: Health information systems offer many potential benefits for healthcare, including financial benefits and for improving the quality of patient care. The purpose of District Health Information Systems (DHIS) is to document data that are routinely collected in all public health facilities in a country using the system. Objective: The aim of this study was to examine the strengths and operational challenges of DHIS2, with a goal to enable decision makers in different counties to more accurately evaluate the outcomes of introducing DHIS2 into their particular country. Method: A review of the literature combined with the method of meta-synthesis was used to source information and interpret results relating to the strengths and operational challenges of DHIS2. Databases (Embase, PubMed, Scopus and Google Scholar) were searched for documents related to strengths and operational challenges of DHIS2, with no time limit up to 8 April 2017. The review and evaluation of selected studies was conducted in three stages: title, abstract and full text. Each of the selected studies was reviewed carefully and key concepts extracted. These key concepts were divided into two categories of strengths and operational challenges of DHIS2. Then, each category was grouped based on conceptual similarity to achieve the main themes and sub-themes. Content analysis was used to analyse extracted data. Results: Of 766 identified citations, 20 studies from 11 countries were included and analysed in this study. Identified strengths in the DHIS were represented in seven themes (with 21 categories): technical features of software, proper management of data, application flexibility, networking and increasing the satisfaction of stakeholders, development of data management, increasing access to information and economic benefits. Operational challenges were identified and captured in 11 themes (with 18 categories): funds; appropriate communication infrastructure; the need for the existence of appropriate data; political, cultural, social and structural infrastructure; manpower; senior managers; training; using academic potentials; definition and standardising the deployment processes; neglect to application of criteria and clinical guidelines in the use of system; data security; stakeholder communications challenges and the necessity to establish a pilot system. Conclusion: This study highlighted specific strengths in the technical and functional aspects of DHIS2 and also drew attention to particular challenges and concerns. These results provide a sound evidence base for decision makers and policymakers to enable them to make more accurate decisions about whether or not to use the DHIS2 in the health system of their country.

The burden of noncommunicable diseases (NCDs) is a major challenge facing the whole world. Around 15 million premature deaths due to NCDs occur in people aged 30-70 years annually.Mortality data based on death registration systems and population data were used to estimate proposed mortality statistics in the Islamic Republic of Iran.Various criteria and methods were used to assess the quality of mortality data. The probability of dying among those aged 30-70 years for all causes and for NCDs was calculated using the life table method.The mortality rate in the population aged 30-69 years was 343.12 (per 100 000 persons) in 2006 and decreased to 240.62 in 2016 in both sexes. The probability of dying due to NCDs was 21.36% in 2006 and declined to 14.95% in 2016 for both sexes.The number of premature deaths due to NCDs have decreased over the last decade. We predict that this reduction will continue and the country will meet the targets of the WHO NCD action plan by 2025 and also the targets of the Sustainable Development Goals for reducing premature deaths by 2030. However, the morbidity and burden of NCDs are still public health concerns in the country. Due to advancements in health care technologies and also the aging population, these concerns will impose greater costs on the health system. Hence, prevention programmes for NCDs should be an urgent priority for Iranian health policy.اتجاهات الوفيات المبكرة في جمهورية إيران الإسلامية: احتمال الوفاة بين 30 و70 عاماً.الهه کاظمی، اردشیر خسروی، سعیده آغا محمدي، محمد شریعتی، حسين كاظميني.يمثل عبء الأمراض غير السارية تحدياً كبيراً يواجه العالم بأسره. وتحدث نحو 15 مليون وفاة مبكرة جرّاء الإصابة بالأمراض غير السارية في صفوف الأشخاص الذين تتراوح أعمارهم بين 30 و70 عاماً سنوياً.هدفت هذه الدراسة إلى استخدام بيانات الوفيات المستمدة من نُظُم تسجيل الوفيات والبيانات السكانية لتقدير الإحصاءات المُقترحة للوفيات في جمهورية إيران الإسلامية.استُخدمت معا يري وأساليب مختلفة لتقييم جودة بيانات الوفيات. وتم حساب احتمال الوفاة الناجمة عن جميع الأسباب وعن الامراض غير السارية في صفوف من تتراوح أعمارهم بين 30 و70 عاماً باستخدام طريقة جدول الحياة.كان معدل الوفيات في صفوف السكان الذين تتراوح أعمارهم بين 30 – 69 سنة 343.12 (لكل 100000 شخص) في عام 2006، وانخفض إلى 240.62 في عام 2016 لكلا الجنسين. وبلغ احتمال الوفاة الناجمة عن الأمراض غير السارية ٪21.36 في عام 2006، وانخفض إلى ٪14.95 في عام 2016 لكلا الجنسين.انخفض عدد الوفيات المبكرة الناجمة عن الأمراض غير السارية على مدار العقد الماضي. ونتنبأ باستمرار هذا الانخفاض، وسيفي البلد بالغايات الواردة في خطة عمل منظمة الصحة العالمية بشأن الأمراض غير السارية بحلول عام 2025، وكذلك أهداف التنمية المستدامة للحد من الوفيات المبكرة بحلول عام 2030. ومع ذلك، فلا تزال الأمراض غير السارية وعبؤها من الشواغل الصحية العامة السائدة في البلد. وبسبب التقدم في تكنولوجيات الرعاية الصحية وكذلك شيخوخة السكان، ستفرض تلك الشواغل تكاليف أكبر على النظام الصحي. ومن ثم، ينبغي أن تكون برامج الوقاية من الأمراض غير السارية أولوية عاجلة للسياسة الصحية الإيرانية.Tendances en matière de mortalité prématurée en République islamique d’Iran : probabilité de décès entre 30 et 70 ans.La charge des maladies non transmissibles (MNT) constitue un défi majeur pour le monde entier. Chaque année, près de 15 millions de décès prématurés dus à des maladies non transmissibles se produisent chez des personnes âgées entre 30 et 70 ans.Des données sur la mortalité fondées sur les systèmes d’enregistrement des décès et des données obtenues en population ont été utilisées pour estimer les statistiques de mortalité proposées en République islamique d’Iran.Divers critères et méthodes ont été utilisés pour évaluer la qualité des données sur la mortalité. La probabilité de décès parmi les 30-70 ans , toutes causes confondues et pour les maladies non transmissibles, a été calculée à l’aide de la méthode de la courbe de survie.Le taux de mortalité dans la population âgée de 30 à 69 ans était de 343,12 (pour 100 000 personnes) en 2006 et a régressé à 240,62 en 2016 pour les deux sexes. La probabilité de décéder des suites de maladies non transmissibles était de 21,36 % en 2006 et a diminué pour atteindre 14,95 % en 2016 pour les deux sexes.Le nombre de décès prématurés dus aux MNT a diminué au cours de la dernière décennie. Nous prévoyons que cette baisse se poursuivra et que le pays atteindra les cibles du plan d'action de l'OMS pour la lutte contre les maladies non transmissibles à l’horizon 2025 ainsi que les cibles des objectifs de développement durable visant à réduire les décès prématurés d'ici 2030. Toutefois, la morbidité et le fardeau des MNT continuent à être une source de préoccupation pour la santé publique dans le pays. En raison des progrès des technologies en matière de soins de santé et de vieillissement de la population, ces préoccupations entraîneront des coûts plus élevés pour le système de santé. Les programmes de prévention des maladies non transmissibles devraient donc constituer une priorité urgente de la politique de santé iranienne.

Objective: To predict the accident mortality trend in next two decades in Iran. Methods: The study population comprised all deaths recorded in the system of registration and classification of causes of death of Ministry of Health and Medical Education of Iran during the years 2006 to 2015. The information was collected via death certificate, burial permit, and reporting forms. To forecast the trends of causes-of-death, Lee Carter model was employed in a demographic package 18.1 of R software version 3.3.1. Results: Based on the results, the highest percentage of all causes of death from accidents (in unintentional accidents) goes to transport accidents, and most top intentional accidents belonged to intentional self-harm. The trends of unintentional accidents in the whole population and both sexes have reduced from 2006 to 2035, such that the rate has reduced from 62.2 in 2006 to 12.1 per 100 thousand populations in 2035. It is anticipated that the causes of death due to intentional accidents with the rate of 8.86 in 2006, will be 1.89 (per 100,000 population) in the year 2035. Conclusion: Accident mortalities have a significant role in the deaths of Iranian population; therefore, to reduce the impact of accident mortality on society, a precise approach is needed to monitor the trends as well as preventing measures and increasing the safety standards.

The Islamic Republic of Iran has encountered demographic and epidemiological changes as a result of the transformation of health measures.This study aimed to calculate the population and mortality in the Islamic Republic of Iran during the years 2006 to 2035.We carried out a cross-sectional analytical-descriptive account. We calculated the age and sex structure of the Iranian population using census data as well as mathematical methods. The crude and causal death rates were calculated and their 20-year trend was predicted using the Lee-Carter model.In 2035, the age group 60 years and over will reach 17.6% of the total population. Endocrine, nutritional and metabolic diseases will be the biggest causes of an increase in the rate of death in the general population. The largest decline in cause of death is for unintentional injuries.Noncommunicable diseases will increase as the aging population grows. Identification of their primary causal and risk factors can, therefore, contribute to prevention and control.مرتسم تعداد السكان ومعدل الوفيات في جمهورية إيران الإسلامية في الفترة من 2006 إلى 2035.سعيدة أقا محمدي، كامران حاجي نبي، كتايون جهانگيري، إيروان مسعودي اصل، رضا دهنوية.تشهد جمهورية إيران الإسلامية في الوقت الحالي تغيرات سكانية ووبائية ناجمة عن تغير التدابير الصحية.هدفت هذه الدراسة إلى حساب تعداد السكان ومعدل الوفيات في جمهورية إيران الإسلامية في الفترة من 2006 إلى 2035.أجرينا دراسة وصفية تحليلية مقطعية لحساب بنية العمر والنوع للسكان الإيرانيين باستخدام بيانات مستمدة من إحصاء السكان. وقمنا بحساب معدلي الوفيات الخام والسببي والتنبؤ باتجاههما على مدى 20 عاما باستخدام نموذج لي-كارتر.من المتوقع أن تصل نسبة السكان في عام 2035 في الفئة العمرية 60 عاما وأكثر إلى 17.6 % من مجموع السكان. ومن المتوقع أن تشكل أمراض الغدد الصماء والتغذية والاستقلاب أكبر أسباب الزيادة في معدل الوفيات بين عموم السكان، ومن المتوقع أن تسجل الإصابات غير المتعمدة أكبر انخفاض في العوامل المسببة للوفاة.من المتوقع أن تزداد الأمراض غير السارية مع زيادة السكان المسنين في جمهورية إيران الإسلامية. وبالتالي، فإن تحديد عواملها الأساسية وعوامل خطرها من شأنه أن يسهم في الوقاية والحد منها.Profil démographique et de la mortalité en République islamique d’Iran entre 2006 et 2035.La République islamique d’Iran connaît des changements démographiques et épidémiologiques qui découlent d’une modification des mesures sanitaires.La présente étude avait pour objectif d’estimer la population et la mortalité en République islamique d’Iran entre 2006 et 2035.Il s’agissait d’un compte-rendu analytique et descriptif transversal. Nous avons calculé la structure par âge et par sexe de la population iranienne en utilisant les données de recensement et à l'aide de méthodes mathématiques. Le taux brut de mortalité et les taux de mortalité par cause ont été calculés et leur tendance sur 20 ans a été prédite à selon le modèle de Lee-Carter.En 2035, le groupe d’âge des 60 ans et plus comptera pour 17,6 % de la population totale. Les maladies endocriniennes, nutritionnelles et métaboliques seront les causes principales à l’origine d’une augmentation du taux de décès dans la population générale, et la baisse de décès la plus importante concernera les traumatismes non intentionnels.Les maladies non transmissibles connaîtront une augmentation dans la population vieillissante dont le nombre croît en République islamique d’Iran. L’identification de leurs principaux facteurs de risque et causes peut donc contribuer à la prévention et la maîtrise de ces maladies.

Summary Background Child mortality as one of the key Millennium Development Goals (MDG 4—to reduce child mortality by two-thirds from 1990 to 2015), is included in the Sustainable Development Goals (SDG 3, target 2—to reduce child mortality to fewer than 25 deaths per 1000 livebirths for all countries by 2030), and is a key indicator of the health system in every country. In this study, we aimed to estimate the level and trend of child mortality from 1990 to 2015 in Iran, to assess the progress of the country and its provinces toward these goals. Methods We used three different data sources: three censuses, a Demographic and Health Survey (DHS), and 5-year data from the death registration system. We used the summary birth history data from four data sources (the three censuses and DHS) and used maternal age cohort and maternal age period methods to estimate the trends in child mortality rates, combining the estimates of these two indirect methods using Loess regression. We also used the complete birth history method to estimate child mortality rate directly from DHS data. Finally, to synthesise different trends into a single trend and calculate uncertainty intervals (UI), we used Gaussian process regression. Findings Under-5 mortality rates (deaths per 1000 livebirths) at the national level in Iran in 1990, 2000, 2010, and 2015 were 63·6 (95% UI 63·1–64·0), 38·8 (38·5–39·2), 24·9 (24·3–25·4), and 19·4 (18·6–20·2), respectively. Between 1990 and 2015, the median annual reduction and total overall reduction in these rates were 4·9% and 70%, respectively. At the provincial level, the difference between the highest and lowest child mortality rates in 1990, 2000, and 2015 were 65·6, 40·4, and 38·1 per 1000 livebirths, respectively. Based on the MDG 4 goal, five provinces had not decreased child mortality by two-thirds by 2015. Furthermore, six provinces had not reached SDG 3 (target 2). Interpretation Iran and most of its provinces achieved MDG 4 and SDG 3 (target 2) goals by 2015. However, at the subnational level in some provinces, there is substantial inequity. Local policy makers should use effective strategies to accelerate the reduction of child mortality for these provinces by 2030. Possible recommendations for such strategies include enhancing the level of education and health literacy among women, tackling sex discrimination, and improving incomes for families. Funding Iran Ministry of Health and Education.

Background: Authoritative information and description of the causes of mortality trends is one of the most basic principles of evaluation of the health sector in all countries. Therefore, this study aims to predict the trend in main groups of causes of death in the Islamic Republic of Iran. Methods: The study population comprised all deaths recorded in the system of registration and classification of causes of death of Ministry of Health and Medical Education during the years 2006 to 2015. The information was collected via death certificate, burial permit, and information forms. In order to forecast the trends of causes-of-death, Lee Carter model was employed in a demographic package 18.1 of R software version 3.3.1. Results: Based on the results, the crude death rate in the total population has reduced from 435.86 in 2006 to 405.01 per 100000 population in 2035. It is anticipated that endocrine, nutritional and metabolic diseases with the rate of 197.71 per 100000 population will be responsible for the highest causes of death in the year 2035 and from 2021 onwards, the mental and behavioral disorders will be responsible for the lowest rate of mortality. Conclusion: Non-communicable diseases have a major role in the deaths of Iranian population; therefore, to reduce the impact of non-communicable diseases on individuals and society, a holistic approach is needed which requires all sectors to cooperate.