| 1. |
- Ahmad Kiadaliri, Aliasghar, et al.
(författare)
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Geographic distribution of need and access to health care in rural population: an ecological study in Iran
- 2011
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Ingår i: International Journal for Equity in Health. - : Springer Science and Business Media LLC. - 1475-9276. ; 10:39
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Equity in access to and utilization of health services is a common goal of policy-makers in most countries. The current study aimed to evaluate the distribution of need and access to health care services among Iran's rural population between 2006 and 2009. Methods: Census data on population's characteristics in each province were obtained from the Statistical Centre of Iran and National Organization for civil registration. Data about the Rural Health Houses (RHHs) were obtained from the Ministry of Health. The Health Houses-to-rural population ratio (RHP), crude birth rate (CBR) and crude mortality rate (CMR) in rural population were calculated in order to compare their distribution among the provinces. Lorenz curves of RHHs, CMR and CBR were plotted and their decile ratio, Gini Index and Index of Dissimilarity were calculated. Moreover, Spearman rank-order correlation was used to examine the relation between RHHs and CMR and CBR. Results: There were substantial differences in RHHs, CMR and CBR across the provinces. CMR and CBR experienced changes toward more equal distributions between 2006 and 2009, while inverse trend was seen for RHHs. Excluding three provinces with markedly changes in data between 2006 and 2009 as outliers, did not change observed trends. Moreover; there was a significant positive relationship between CMR and RHP in 2009 and a significant negative association between CBR and RHP in 2006 and 2009. When three provinces with outliers were excluded, these significant associations were disappeared. Conclusion: Results showed that there were significant variations in the distribution of RHHs, CMR and CBR across the country. Moreover, the distribution of RHHs did not reflect the needs for health care in terms of CMR and CBR in the study period.
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| 2. |
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| 3. |
- Ahmad Kiadaliri, Aliasghar, et al.
(författare)
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Overall, gender and social inequalities in suicide mortality in Iran, 2006-2010: a time trend province-level study.
- 2014
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 4:8, s. 005227-005227
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Tidskriftsartikel (refereegranskat)abstract
- Suicide is a major global health problem imposing a considerable burden on populations in terms of disability-adjusted life years. There has been an increasing trend in fatal and attempted suicide in Iran over the past few decades. The aim of the current study was to assess overall, gender and social inequalities across Iran's provinces during 2006-2010.
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| 4. |
- Ahmad Kiadaliri, Aliasghar, et al.
(författare)
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Pure and social disparities in distribution of dentists: a cross-sectional province-based study in iran.
- 2013
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1660-4601. ; 10:5, s. 1882-1894
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Tidskriftsartikel (refereegranskat)abstract
- During past decades, the number of dentists has continuously increased in Iran. Beside the quantity, the distribution of dentists affects the oral health status of population. The current study aimed to assess the pure and social disparities in distribution of dentists across the provinces in Iran in 2009. Data on provinces' characteristics, including population and social situation, were obtained from multiple sources. The disparity measures (including Gini coefficient, index of dissimilarity, Gaswirth index of disparity and relative index of inequality (RII)) and pairwise correlations were used to evaluate the pure and social disparities in the number of dentists in Iran. On average, there were 28 dentists per 100,000 population in the country. There were substantial pure disparities in the distribution of dentists across the provinces in Iran. The unadjusted and adjusted RII values were 3.82 and 2.13, respectively; indicating area social disparity in favor of people in better-off provinces. There were strong positive correlations between density of dentists and better social rank. It is suggested that the results of this study should be considered in conducting plans for redistribution of dentists in the country. In addition, further analyses are needed to explain these disparities.
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| 5. |
- Batura, Neha, et al.
(författare)
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Collecting and analysing cost data for complex public health trials : reflections on practice
- 2014
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Ingår i: Global Health Action. - : CoAction Publishing. - 1654-9716 .- 1654-9880. ; 7, s. 23257-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Current guidelines for the conduct of cost-effectiveness analysis (CEA) are mainly applicable to facility-based interventions in high-income settings. Differences in the unit of analysis and the high cost of data collection can make these guidelines challenging to follow within public health trials in low- and middle- income settings.OBJECTIVE: This paper reflects on the challenges experienced within our own work and proposes solutions that may be useful to others attempting to collect, analyse, and compare cost data between public health research sites in low- and middle- income countries.DESIGN: We describe the generally accepted methods (norms) for collecting and analysing cost data in a single-site trial from the provider perspective. We then describe our own experience applying these methods within eight comparable cluster randomised, controlled, trials. We describe the strategies used to maximise adherence to the norm, highlight ways in which we deviated from the norm, and reflect on the learning and limitations that resulted.RESULTS: When the expenses incurred by a number of small research sites are used to estimate the cost-effectiveness of delivering an intervention on a national scale, then deciding which expenses constitute 'start-up' costs will be a nontrivial decision that may differ among sites. Similarly, the decision to include or exclude research or monitoring and evaluation costs can have a significant impact on the findings. We separated out research costs and argued that monitoring and evaluation costs should be reported as part of the total trial cost. The human resource constraints that we experienced are also likely to be common to other trials. As we did not have an economist in each site, we collaborated with key personnel at each site who were trained to use a standardised cost collection tool. This approach both accommodated our resource constraints and served as a knowledge sharing and capacity building process within the research teams.CONCLUSIONS: Given the practical reality of conducting randomised, controlled trials of public health interventions in low- and middle- income countries, it is not always possible to adhere to prescribed guidelines for the analysis of cost effectiveness. Compromises are frequently required as researchers seek a pragmatic balance between rigor and feasibility. There is no single solution to this tension but researchers are encouraged to be mindful of the limitations that accompany compromise, whilst being reassured that meaningful analyses can still be conducted with the resulting data.
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| 6. |
- Bidgoli, Hassan Haghparast, et al.
(författare)
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Pre-hospital trauma care resources for road traffic injuries in a middle-income country-A province based study on need and access in Iran.
- 2011
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Ingår i: Injury. - : Elsevier BV. - 0020-1383 .- 1879-0267. ; 42:9, s. 879-884
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Access to pre-hospital trauma care can help minimize many of traffic related mortality and morbidity in low- and middle-income countries with high rate of traffic deaths such as Iran. The aim of this study was to assess if the distribution of pre-hospital trauma care facilities reflect the burden of road traffic injury and mortality in different provinces in Iran. METHODS: This national cross-sectional study is based on ecological data on road traffic mortality (RTM), road traffic injuries (RTIs) and pre-hospital trauma facilities for all 30 provinces in Iran in 2006. Lorenz curves and Gini coefficients were used to describe the distributions of RTM/RTIs and pre-hospital trauma care facilities across provinces. Spearman rank-order correlation was performed to assess the relationship between RTM/RTI and pre-hospital trauma care facilities. RESULTS: RTM and RTIs as well as pre-hospital trauma care facilities were distributed unequally between different provinces. There was no significant association between the rate of RTM and RTIs and the number of pre-hospital trauma care facilities across the country. CONCLUSIONS: The distribution of pre-hospital trauma care facilities does not reflect the needs in terms of RTM and RTIs for different provinces. These results suggest that traffic related mortality and morbidity could be reduced if the needs in terms of RTM and RTIs were taken into consideration when distributing pre-hospital trauma care facilities between the provinces.
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| 7. |
- Haghparast-Bidgoli, Hassan, et al.
(författare)
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Do economic evaluation studies inform effective healthcare resource allocation in Iran? A critical review of the literature.
- 2014
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Ingår i: Cost Effectiveness and Resource Allocation. - : Springer Science and Business Media LLC. - 1478-7547. ; 12:Jul 11
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Forskningsöversikt (refereegranskat)abstract
- To aid informed health sector decision-making, data from sufficient high quality economic evaluations must be available to policy makers. To date, no known study has analysed the quantity and quality of available Iranian economic evaluation studies. This study aimed to assess the quantity, quality and targeting of economic evaluation studies conducted in the Iranian context. The study systematically reviewed full economic evaluation studies (n = 30) published between 1999 and 2012 in international and local journals. The findings of the review indicate that although the literature on economic evaluation in Iran is growing, these evaluations were of poor quality and suffer from several major methodological flaws. Furthermore, the review reveals that economic evaluation studies have not addressed the major health problems in Iran. While the availability of evidence is no guarantee that it will be used to aid decision-making, the absence of evidence will certainly preclude its use. Considering the deficiencies in the data identified by this review, current economic evaluations cannot be a useful source of information for decision makers in Iran. To improve the quality and overall usefulness of economic evaluations we would recommend; 1) developing clear national guidelines for the conduct of economic evaluations, 2) highlighting priority areas where information from such studies would be most useful and 3) training researchers and policy makers in the calculation and use of economic evaluation data.
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| 8. |
- Haghparast-Bidgoli, Hassan, et al.
(författare)
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Factors affecting hospital length of stay and hospital charges associated with road traffic-related injuries in Iran
- 2013
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Ingår i: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 13, s. Article Number: 281-
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Tidskriftsartikel (refereegranskat)abstract
- Background: Road traffic injuries (RTIs) are a substantial cause of mortality and disability globally. There is little published information regarding healthcare resource utilization following RTIs, especially in low and middle-income countries (LMICs). The aim of this study was to assess total hospital charges and length of stay (LOS) associated with RTIs in Iran and to explore the association with patients' socio-demographic characteristics, insurance status and injury-related factors (e. g. type of road users and safety equipment). Method: The study was based on the Iranian National Trauma Registry Database (INTRD), which includes data from 14 general hospitals in eight major cities in Iran, for the years 2000 to 2004. 8,356 patients with RTI admitted to the hospitals were included in the current study. The variables extracted for the analysis included total hospital charges and length of stay, age, gender, socio-economic and insurance status, injury characteristics, medical outcome and use of safety equipment among the patients. Univariable analysis using non-parametric methods and multivariable regression analysis were performed to identify the factors associated with total hospital charges and LOS. Results: The mean hospital charges for the patients were 1,115,819 IRR (SD=1,831,647 IRR, US$128 +/- US$210). The mean LOS for the patients was 6.8 (SD =8 days). Older age, being a bicycle rider, higher injury severity and longer LOS were associated with higher hospital charges. Longer LOS was associated with being male, having lower education level, having a medical insurance, being pedestrian or motorcyclist, being a blue-collar worker and having more severe injuries. The reported use of safety equipment was very low and did not have significant effect on the hospital charges and LOS. Conclusion: The study demonstrated that the hospital charges and LOS associated with RTI varied by age, gender, socio-economic status, insurance status, injury characteristics and health outcomes of the patients. The results of the study provide information that can be of importance in the planning and design of road traffic injury control strategies.
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| 9. |
- Haghparast-Bidgoli, Hassan
(författare)
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Road traffic injuries in the context of rapid motorization : studies on access, provision and utilization of trauma care in Iran
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Iran has one of the highest traffic-related mortality and morbidity rates in the world. Evidence shows that improvements in trauma care can prevent a substantial number of road traffic deaths and disabilities. Aim: The overall aim of this thesis is to explore factors influencing access, provision and utilization of trauma care for road traffic injuries (RTIs) in Iran. Methods: The thesis is based on four studies. Study I is a national ecological study in order to assess if the distribution of pre-hospital trauma care resources reflects the needs in terms of traffic-related mortality and morbidity in different provinces in Iran. Inequality measures and correlation analysis were used in the analysis. In Study II, qualitative interviews were conducted with 15 health professionals to explore factors influencing the provision of pre-hospital trauma care for RTI victims. In Study III, qualitative interviews were conducted with 15 health professionals and 20 RTI victims to explore factors influencing an effective trauma care delivery at emergency departments (EDs). The grounded theory approach was used in both Study II and III. Study IV utilized the Iranian National Trauma Registry Database to assess hospital resource utilization (hospital charges and length of stay (LOS)) associated with RTIs in Iran and also to evaluate the association with the patients’ socio-demographic characteristics, insurance status and injury-related factors. Univariable and multivariable analysis were used in this study. Findings: There was no significant association between traffic-related mortality and morbidity and pre-hospital trauma care resources (I). Seven main factors that could hinder or facilitate an effective pre-hospital trauma care process were identified: administration and organization; staff qualifications and competences; availability and distribution of resources; communication and transportation; involved organizations; laypeople; and infrastructure (II). Lack of a systematic approach to providing trauma care at EDs emerged as the core category in Study III. Unclear national policies and poor organization of care at the ED were perceived as the main factors contributed to non-systematic approach but the contextual factors in the hospitals and those specific to the context of Iran also played a role. The mean (SD) total hospital charges and LOS for the patients were US$ 165 (US$ 290) and 6.8 days (8), respectively. Older age, being female, lower level of education, higher injury severity and longer LOS were associated with higher hospital charges. Longer LOS was associated with being male, lower education, having a medical insurance, being a farmer or a blue-collar worker and having more severe injuries (IV). Conclusion: Pre-hospital trauma care resources across the country were not distributed based on needs in terms of traffic-related mortality and morbidity. For the provision of trauma care, the studies identified that there is a lack of interaction and common understanding among different actors involved in the pre-hospital trauma care and a non-systematic approach as the main barrier to managing trauma patients in the EDs. The findings indicated that the hospital resource utilization associated with RTI victims is substantial and varied based on the victims’ socio-demographic characteristics, insurance status and injury-related factors. Both the pre-hospital and hospital organization, and interaction between them, need to be considered in order to reduce the high burden of RTIs in Iran.
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