Nutritional status during pregnancy can have a significant impact on infant and maternal health outcomes. To maintain maternal homeostasis and support fetal growth, adequate macronutrient and energy ...intake during pregnancy is essential. Therefore, this study sought to systematically review and meta-analyze macronutrient and energy intakes during pregnancy.
A systematic review and meta-analysis was carried out based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The required data were collected from four databases including: Web of Sciences, ProQuest, Scopus, and PubMed, from 1 January 1980 to 30 May 2023, by using a combination of search terms (dietary pattern" OR "diet quality" OR "food habits" OR "nutrition surveys" OR "diet surveys" OR "food-frequency questionnaire" OR "diet record" OR "dietary recall") AND ( "pregnancy" OR "reproduction" OR "maternal health" OR "neonatal outcomes") among interventional and observational studies. Excel and STATA version 11 were used for data analysis.
Among 7081 published articles, 54 studies were included in the review. Most of the 33 (61%) studies were cohort studies and a total of 135,566 pregnant women were included. The overall average of energy, carbohydrate, fat, and protein intake was 2036.10 kcal/day, 262.17 gr/day, 74.17 gr/day, and 78.21 gr/day, respectively. Also, energy intake during pregnancy was higher in American (2228.31 kcal/day, CI95%: 2135.06-2325.63) and Eastern Mediterranean regions (2226.70 kcal/day, CI95%: 2077.23-2386.92) than other regions (P < 0.001). Energy intake was higher in the third trimester than others (2115.64 kcal/day, CI95%: 1974.15-2267.27). Furthermore, based on the findings, there was a significant difference between energy intake in different World Health Organization (WHO) regions (P < 0.05).
According to the results of meta-analysis, the average total energy was below than average total energy required during pregnancy. More efforts are needed to encourage women to adopt healthy eating habits during pregnancy to support healthy fetal and infant development.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract To adapt to the changing conditions and respond to the needs of society, health systems need continuous changes and reforms in their structure and performance, and subsequently, they need to ...evaluate their indicators. Therefore, this study aimed to investigate the impact of the health system transformation plan (HTP) on the functional indicators and efficiency of hospitals in a country in the Middle East region (Iran). A systematic literature review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using the online databases Medline, EMBASE, Scopus, Pubmed, SID, Magiran, and Medlib from 2013 to 2022 using a combination of medical subject heading terms (‘health system transformation plan Mesh OR ‘health reform Mesh OR implementation of the health transformation plan Mesh ‘’AND (‘performance indicators’ Mesh) ‘’AND (‘Iran’ Mesh). STATA version 11 were used for data analysis. A total of 20 reports (cross-sectional, cohort, and case-control) were identified for this study. The results showed that after the HTP, the indices of bed occupancy rate and bed turnover rate have increased and the index of bed turnover distance has decreased. On the other hand, after the implementation of this plan in hospitals, the average of patients’ length of stay has increased. The implementation of HTP has improved most of the performance indicators of hospitals and has generally led to an increase in the productivity of hospitals compared to that before the implementation of the plan. However, efforts to strengthen weak performance indicators and identify effective indicators along with adopting correct policies to increase the overall efficiency of hospitals can be effective in improving HTP.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Introduction: Tuberculosis is one of the oldest and best-known diseases that has been with mankind for many years. Despite the reduction of infectious diseases in Iran, tuberculosis still remains in ...some parts of the country, especially in the south of Iran. The aim of this study was the epidemiological investigation of tuberculosis in Sistan and Baluchistan Province. Methods: The current research was conducted cross-sectionally in 2022. The study population included all the patients with tuberculosis in Sistan and Baluchistan Province. Data were collected by census method and using standard checklist. Data analysis was done using SPSS v16 software and descriptive and analytical tests. Results: In this study, the files of 5382 patients with tuberculosis in Sistan and Baluchistan Province were examined. 2489 patients (42.6%) were men. The most affected group were 2309 elderly people (39.5%) and 20 patients (0.34%) with HIV. The number of 4309 patients (73.8%) were suffering from pulmonary tuberculosis. There was a significant relationship between the elderly age group (P=0.04), female gender (P=0.02), non-Iranian nationality (P=0.02), and urban residences (P=0.03) with tuberculosis. However, no significant relationship was observed between marital status (P=0.06) and prison history (P=0.07). Conclusion: The incidence of tuberculosis fluctuated during the five years, but the overall incidence has been decreasing. Considering that some factors such as age groups, gender and symptoms such as cough, weight loss and chest pain increase the chance of contracting the disease. Therefore, doctors of health centers can take an important step in reducing the incidence of tuberculosis with timely visits and regular monitoring of the treatment process of patients.
Nowadays, information and communications technology (ICT) has deeply influenced different aspects, especially healthcare sector.(1) Increasing public awareness and expectations has encouraged ...healthcare providers to use modern technologies to improve service quality.(2) Health technologies provide useful information for improving planning, implementing, monitoring, and policy making based on evidence (3). In fact, an electronic health record (EHR) is a digital version of a patient’s paper chart. EHRs are real-time, patient-centered records that make information available instantly and securely to authorized users. While an EHR contains the medical and therapeutic histories of patients, an EHR system is built to go beyond standard clinical data collected in a provider’s office and can be inclusive of a broader view of a patient’s care.(4) From the beginning of applying family physician and rural insurance program in Iran, different software packages have been developed for making EHR; however, due to technical and structural constraints and also different personal motivations, it is removed from the registration process and recording data in the early stages .(5) After implementing the health transformation plan (HTP) in 2014, the Ministry of Health and Medical Education (MoHME) launched the health integrated system (SIB) in 2016 with the aim of recording the EHR of households. SIB system follows valuable goals such as applying electronic health record, creating a national health information base, and providing referral systems in the family physician plan. Now, all health workers such as supervisor, general practitioners and dentists, health care providers, midwives, dietitians, mental health and social workers at the first level of service delivery record information on the SIB system. The information that is registered by users on SIB system are as follows: demographic information, disease reporting, physicians' visit, medical history, medications, vaccinations, and radiology and laboratory results. (6) After four years of SIB implementation at the comprehensive health centers, health centers, and health houses, the significant strengths of this system are:(5) • Possibility of supervision and direct and online evaluation by all managers in the health system • Establishment of a comprehensive EHR system for individuals from birth to end of life • Exclusion of the paper and bureaucratic system and quick extraction of health statistics • Application of new care guidelines and instant access of users On the other hand, constraints of the SIB systems are: • Extensive data recording and time-consuming nature of service registration in the system • Absence of proper internet infrastructure, especially in rural areas • Increase in the possibility of unrealistic data entry by compulsion of officials in order to increase service recordings • Incompatibility of certain system information with community needs and local preferences and specific diseases in each region of the country, and also lack of connection of SIB system information between specialized and sub-specialized centers after five years from the establishment of this system in Iran. Therefore, for successfully implementation of the system in the health field, it is recommended that we should provide hardware infrastructure, rationalize the number of required services in the system in the first years and then add other services in the long term, hold regular training courses, encourage family physicians as primary caregivers of services at the first level to accept this system, and record the information(7). E-health not only could increase the wellbeing of user, but also the pressure on the health care system could be somewhat relieved. By introducing the SIB, we have expanded the toolkit of user-centered design methods for e-health development. The method facilitates easy communication with novices about a future e-health technology, the identification of factors that can hinder or support end-user acceptance of a future e-health technology, and early and cheap possibility for testing functional design decisions (8).
Background and Aim: Children’s health is important as the future builders of society. Many children under 5 years of age around the world and in Iran have growth disorders. Due to the importance of ...growth disorder and its impact on the development, learning and future of the child, the present study was conducted with the aim of determining the frequency of deviations from the growth curves of children under 5 years of age and related factors in Zahedan city. Materials and Methods: This case-control study was conducted in 2020 in Zahedan. The study population included all children under 5 years old, born in Zahedan between 2013 and 2020 that 784 of whom were selected by random sampling method. To determine the factors related to growth disorder multiple logistic regression analysis was used and to check the significance level, chi-square test and Pearson correlation were used. In this research, the data were analyzed with SPSS software. Results: The results of this research showed that 54% of the boys and 51.20% of the girls had growth disorders. Between child growth disorder and maternal chronic disease (P<0.05), maternal body mass index (P<0.05), Maternal weight gain during pregnancy (P<0.05), distance between births (P<0.05) maternal urinary tract infection during pregnancy (P<0.05), mother’s age (P=0.006), mother’s education (P<0.05), birth weight (P<0.001), birth order (P<0.05), father’s occupation (P<0.05) and father’s education (P<0.05) a significant association was found. In the present study, the average birth weight in children with growth disorders was 2.75±0.58 and in healthy children was 2.95±0.57, and this difference was statistically significant (P=0.001). The average age of mothers of children with growth disorders was 29.19±6.07 and the average age of mothers of healthy children was 27.98±6.10, this difference was statistically significant (P=0.006). Conclusion: Growth disorder is a multi-causal complication. Risk factors can be corrected and prevented by developing health education and increasing mothers’ awareness and knowledge. Also, the father’s job and literacy are effective in the child’s growth disorder, so Increasing community health literacy and encouraging fathers’ learning and literacy can partially prevent growth disorders in children.
Background: A common method used to examine the relationship between internal preferences and caring externalities is willingness to pay (WTP) approach. We aimed to estimate WTP for health status ...with different severity level and identify determinant factors on WTP. Methods: For determining main factors in WTP, a cross-sectional study was conducted in Shiraz in the southeast of Iran, in March to April 2015. The open-ended method was used to estimate monthly WTP in private and altruistic section. Multivariate regression analyses using ordinary least squares were applied to examine the effect of Scio-demographic factors on WTP using SPSS software 21. Results: Participants were willing to pay an average amount of $ 295 in health status 1 and an average amount of $ 596 in health status 6 (worst status) for internal preferences. Altruistic WTP for health status 1 was $ 294 and participants were willing to pay an average amount of $ 416 in health status 6. Multiple regression analysis identified monthly income as the key determinant of WTP for internal preferences and caring externalities (P < 0.01). With an increase of 1% in income, private WTP increase 1.38% in health status 1. Conclusions: The finding indicates that the mean of WTP increases at severe health status; therefore, health policy maker should allocate resources toward severe health status.
Introduction: Iran's Health Transformation Plan (HTP) was implemented in 2014 to decrease household expenditures. The present study seeks to measure the household financial contribution to healthcare ...expenditures in Sistan-Baluchistan Province after the implementation of HTP.
Methods: A household survey was conducted in 2017 in Sistan- Baluchistan Province. The province is the most remote and poorest in the country and this poverty has extended to most of its main health indicators as well. About 2400 households were selected as the study samples using multistage sampling. Data were collected using the World Health Survey questionnaire. The questionnaire was designed by WHO in 2003 for assessing health system performance. Two main indicators of equity in health were measured: the percentage of households facing catastrophic health expenditure (CHE) and the Fair Financial Contribution Index (FFCI). The multiple adjusted logistic regression model was used to study the likelihood of facing CHE and to calculate the adjusted odds ratios (OR) using the model coefficients. Data were then analyzed the Statistical Package for the Social Sciences.
Results: The results showed that 484 (20.2%) of the households faced CHE after implementation of the HTP. The FFCI was approximately 0.7 across the province. Statistically significant relationships were observed between the chances of facing CHE and variables including place of residence ('p'=0.010), having members aged more than 65 years ('p'=0.005) and having members with disabilities and in need of care ('p'=0.001). There were statistically significant relationships between the chance of facing CHE and variables related to the use of health services, including the use of dental (OR=5.212), rehabilitation (OR=2.471), diagnostic and laboratory (OR=3.637), and inpatient (OR=2.511) services.
Conclusion: Despite the implementation of HTP, a high percentage of the households faced CHE. The authorities should pay more attention to low-income and remote regions of the country; in addition, the HTP should financially cover outpatient healthcare services in an adequate manner.
One common challenge to social systems is achieving equity in financial contributions and preventing financial loss. Because of the large and unpredictable nature of some costs, achieving this goal ...in the health system presents important and unique problems. The present study investigated the Household Financial Contributions (HFCs) to the health system.
The study investigated 800 households in Shiraz. The study sample size was selected using stratified sampling and cluster sampling in the urban and rural regions, respectively. The data was collected using the household section of the World Health Survey (WHS) questionnaire. Catastrophic health expenditures were calculated based on the ability of the household to pay and the reasons for the catastrophic health expenditures by a household were specified using logistic regression.
The results showed that the fairness financial contribution index was 0.6 and that 14.2% of households were faced with catastrophic health expenditures. Logistic regression analysis revealed that household economic status, the basic and supplementary insurance status of the head of the household, existence of individuals in the household who require chronic medical care, use of dental and hospital care, rural location of residences, frequency of use of outpatient services, and Out-of-Pocket (OOP) payment for physician visits were effective factors for determining the likelihood of experiencing catastrophic health expenditure.
It appears that the current method of health financing in Iran does not adequately protect households against catastrophic health expenditure. Consequently, it is essential to reform healthcare financing.
Background: COVID-19 has become a global problem. In this case study, the experiences gained from disease control in rural areas are reported. Methods: An observational study was done in 2020 in ...Sistan and Balochestan, the largest province with most rural areas in the southeast of Iran. Results: After identification of the first patient of Covid-19 in a rural area, three measures were taken including: 1. Diagnosis, screening and treatment of the disease (Incident command post was established and the village was completely quarantined, etc.; 2. Intersectoral coordination for epidemiological management (limiting traffic for people and any gathering); and 3. Identification of any Covid-19 positive cases. The results of these measures showed that after quarantining the village and performing the mentioned actions, the number of patients decreased, and the disease was controlled. Conclusion: Quarantine of the contaminated rural area and people’s traffic routes is one of the most important measures in controlling Covid-19.
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