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1.  The Pattern of Road Traffic Crashes in South East Iran 
Global Journal of Health Science  2015;8(9):149-158.
Background:
In the present study, the epidemiologic aspects of road traffic crashes in South East of Iran are described.
Methods:
This cross-sectional study included the profile of 2398 motor vehicle crashes recorded in the police office in one Year in South East of Iran. Data collected included: demographics, the type of crash, type of involved vehicle, location of crash and factors contributing to the crash. Descriptive statistics were used for data analysis.
Results:
Collisions with other vehicles or objects contributed the highest proportion (62.4%) of motor vehicle crashes. Human factors including careless driving, violating traffic laws, speeding, and sleep deprivation/fatigue were the most important causal factors accounting for 90% of road crashes. Data shows that 41% of drivers were not using a seat belt at the time of crash. One- third of the crashes resulted in injury (25%) or death (5%).
Conclusions:
Reckless driving such as speeding and violation of traffic laws are major risk factors for crashes in the South East of Iran. This highlights the need for education along with traffic law enforcement to reduce motor vehicle crashes in future.
doi:10.5539/gjhs.v8n9p149
PMCID: PMC5064071  PMID: 27157159
causal factors; human factors; injury; road traffic crash; South-East of Iran
2.  Status of Hearing Loss and Its Related Factors among Drivers in Zahedan, South-Eastern Iran 
Objective:
This study aims to investigate loss of hearing among drivers in Zahedan, southeastern Iran.
Patients and Methods:
This study carried out on a total of 1836 drivers in Zahedan in 2013. Loss of hearing in both ears was measured at 250, 1000, 2000, 3000, 4000, 6000, and 8000 Hertz. The demographic variables, blood parameter and anthropometric data were recorded through interview and examinations. Data were analyzed in Stata.12 software using paired t-tests, McNemar test and Multiple Logistic Regression.
Results:
The mean age was 38.2±9.8 years. The highest mean hearing thresholds in the right and left ears were 25.7±9.1 and 27.7±9.1, respectively at 250 Hz. There was significant difference between left and right ears hearing threshold at all frequencies (P<0.001), and the highest difference occurred at 250 Hz. Hearing threshold in the left ear was greater than in the right ear at all frequencies. Hearing threshold was correlated to marital status, type of license, and vehicle, smoking, age, and driving history at all frequencies (P<0.01), and also significantly correlated to blood sugar and cholesterol levels at 250 and 500 Hz in both left and right ears (P<0.01).
Conclusion:
In conclusion, high levels of noise increase hearing threshold with greatest damage to the left ear. Therefore, drivers should be periodically examined for ear damage in accordance to variables affecting loss of hearing. Moreover, drivers must be educated about usage of appropriate ear-plugs during driving, especially for the left ear.
doi:10.5539/gjhs.v8n8p66
PMCID: PMC5016339  PMID: 27045399
automobile driving; hearing loss; noise
3.  Prevalence of Addiction and Smoking and Their Relationship With Blood Parameters Among Drivers in Zahedan 
Background
Although smoking and drug use are the major causes of accidents and death of drivers, few studies have been conducted on the prevalence of smoking and its associated factors in this occupational group.
Objectives
The current study aimed to investigate the prevalence of smoking and its relationship with blood parameters among drivers in Zahedan city, Iran.
Patients and Methods
In this study, 1836 inner and intercity drivers were investigated in 2013 in terms of smoking and drug use and blood parameters. Data were obtained through in-depth interviews and necessary examinations and tests, and were analyzed by Stata.12 software using Chi-square, independent t-test, and multiple regression analysis at significance level of 0.05.
Results
Generally, four drivers were addicted to drugs and smoked as well. Two-hundred and eighty eight drivers (15.8%) reported daily smoking. Variables of age, education, and type of vehicle showed a significant relationship with smoking. No significant difference was found in blood parameters between the smokers and non-smokers.
Conclusions
Despite relatively high prevalence of smoking than drug use in Zahedan drivers, there are few reports of these behaviors. Laboratory tests cannot suitably measure substance use due to their interference with other substances. Considering adverse effects of smoking on health and driving, it is necessary to train drivers to reduce or stop smoking during driving.
doi:10.5812/ijhrba.27554
PMCID: PMC5086404  PMID: 27818963
Smoking; Beaviors-Addictive; Drivers
4.  The Prevalence and Risk Factors of Gallstone Among Adults in South-East of Iran: A Population-Based Study 
Objective:
The present study aimed to evaluate the prevalence and possible risk factors of gallstone disease in the general population.
Patients and Methods:
This cross sectional study was carried out on a total of 1522 males and females aged ≥30 years in Zahedan district, South-East of Iran. Data were collected by a validated questionnaire and gallstone diagnosis was assessed by an experienced radiologist using ultrasonography. Logistic regression model was used to identify the association between selected variables and gallstone disease.
Results:
The overall prevalence of gallstone in participants was 2.4%. The risk of gallstone was 2.60 times higher in people age 45 and older than those aged 30 - 44 years (Odds Ratio = 2.60, 95% CI; 1.22 - 5.55). Females were 2.73 (95% CI; 1.34 - 5.56) times more likely to have disease compared to males as well. The risk in unmarried individuals was also three times higher than married ones (OR = 2.99: 95% CI 1.02 - 9.16). Additionally, daily physical activity reduced the risk of gallstone disease by 66% (95% CI; 0.18 - 0.86).
Conclusion:
In conclusion, increasing age and female gender were risk factors, whereas daily physical activity and marriage identified as protective factors in aetiology of gallstone disease.
doi:10.5539/gjhs.v8n4p60
PMCID: PMC4873599  PMID: 26573029
gallstones; prevalence; risk factors
5.  The Prevalence of Hepatitis B Virus Among Municipal Solid Waste Workers: Necessity for Immunization of At-Risk Groups 
Hepatitis Monthly  2016;16(3):e30887.
Background
Hepatitis B virus (HBV) is likely to be more prevalent in certain populations and occupational groups, such as municipal solid waste workers (MSWWs).
Objectives
The current study aimed to estimate the prevalence of HBV and its risk factors among MSWWs compared to other municipal employees not exposed to waste.
Patients and Methods
The current cross-sectional study included 654 municipal employees in Zahedan (south-eastern Iran). A sample of blood was taken from each participant and tested for HBsAg through the enzyme-linked immunosorbent assay (ELISA). Demographic and other data on high risk behaviors were also collected through in-depth interviews. Data were analyzed using chi-square test and multiple regression analysis by STATA.
Results
The overall prevalence of HBV among municipal employees was 3.06% (95% CI: 1.70 - 4.30); however, it varied among the different employee subgroups as follows: 6.20% (95% CI: 2.70 - 9.70) in MSWWs, 3.3% (95% CI: 0.08 - 5.80) in drivers and 1% among staff who were not exposed to waste. Multiple regression analysis showed that exposure to waste [OR = 9.36; 95% CI = 2.01 - 43.7], lack of vaccination against HBV [OR = 3.83; 95% CI = 1.86 - 25.2], jaundice [OR = 6.91; 95% CI = 1.51 - 31.5], history of endoscopy [OR = 2.86; 95% CI = 1.08 - 7.62], and high risk behaviors [OR = 4.80; 95% CI = 1.96 - 27.2] were independently associated with HBV.
Conclusions
Greater encouragement for immunization against HBV as well as better education on HBV transmission routes and work safety precautions should be implemented to reduce the prevalence of HBV in MSWWs.
doi:10.5812/hepatmon.30887
PMCID: PMC4875503  PMID: 27226797
Hepatitis B; Municipality; Zahedan
6.  Predicting factors for malaria re-introduction: an applied model in an elimination setting to prevent malaria outbreaks 
Malaria Journal  2016;15:138.
Background
Malaria re-introduction is a challenge in elimination settings. To prevent re-introduction, receptivity, vulnerability, and health system capacity of foci should be monitored using appropriate tools. This study aimed to design an applicable model to monitor predicting factors of re-introduction of malaria in highly prone areas.
Methods
This exploratory, descriptive study was conducted in a pre-elimination setting with a high-risk of malaria transmission re-introduction. By using nominal group technique and literature review, a list of predicting indicators for malaria re-introduction and outbreak was defined. Accordingly, a checklist was developed and completed in the field for foci affected by re-introduction and for cleared-up foci as a control group, for a period of 12 weeks before re-introduction and for the same period in the previous year. Using field data and analytic hierarchical process (AHP), each variable and its sub-categories were weighted, and by calculating geometric means for each sub-category, score of corresponding cells of interaction matrices, lower and upper threshold of different risks strata, including low and mild risk of re-introduction and moderate and high risk of malaria outbreaks, were determined. The developed predictive model was calibrated through resampling with different sets of explanatory variables using R software. Sensitivity and specificity of the model were calculated based on new samples.
Results
Twenty explanatory predictive variables of malaria re-introduction were identified and a predictive model was developed. Unpermitted immigrants from endemic neighbouring countries were determined as a pivotal factor (AHP score: 0.181). Moreover, quality of population movement (0.114), following malaria transmission season (0.088), average daily minimum temperature in the previous 8 weeks (0.062), an outdoor resting shelter for vectors (0.045), and rainfall (0.042) were determined. Positive and negative predictive values of the model were 81.8 and 100 %, respectively.
Conclusions
This study introduced a new, simple, yet reliable model to forecast malaria re-introduction and outbreaks eight weeks in advance in pre-elimination and elimination settings. The model incorporates comprehensive deterministic factors that can easily be measured in the field, thereby facilitating preventive measures.
Electronic supplementary material
The online version of this article (doi:10.1186/s12936-016-1192-y) contains supplementary material, which is available to authorized users.
doi:10.1186/s12936-016-1192-y
PMCID: PMC4776358  PMID: 26935846
Malaria; Re-introduction; Elimination; Outbreak; Forecast; MEWS; Transmission; Meteorological; Population movement
7.  Data mining EEG signals in depression for their diagnostic value 
Background
Quantitative electroencephalogram (EEG) is one neuroimaging technique that has been shown to differentiate patients with major depressive disorder (MDD) and non-depressed healthy volunteers (HV) at the group-level, but its diagnostic potential for detecting differences at the individual level has yet to be realized. Quantitative EEGs produce complex data sets derived from digitally analyzed electrical activity at different frequency bands, at multiple electrode locations, and under different vigilance (eyes open vs. closed) states, resulting in potential feature patterns which may be diagnostically useful, but detectable only with advanced mathematical models.
Methods
This paper uses a data mining methodology for classifying EEGs of 53 MDD patients and 43 HVs. This included: (a) pre-processing the data, including cleaning and normalization, applying Linear Discriminant Analysis (LDA) to map the features into a new feature space; and applying Genetic Algorithm (GA) to identify the most significant features; (b) building predictive models using the Decision Tree (DT) algorithm to discover rules and hidden patterns based on the reduced and mapped features; and (c) evaluating the models based on the accuracy and false positive values on the EEG data of MDD and HV participants. Two categories of experiments were performed. The first experiment analyzed each frequency band individually, while the second experiment analyzed the bands together.
Results
Application of LDA and GA markedly reduced the total number of utilized features by ≥ 50 % and, with all frequency bands analyzed together, the model showed average classification accuracy (MDD vs. HV) of 80 %. The best results from model testing with additional test EEG recordings from 9 MDD patients and 35 HV individuals demonstrated an accuracy of 80 % and showed an average sensitivity of 70 %, a specificity of 76 %, and a positive (PPV) and negative predictive value (NPV) of 74 and 75 %, respectively.
Conclusions
These initial findings suggest that the proposed automated EEG analytical approach could be a useful adjunctive diagnostic approach in clinical practice.
Electronic supplementary material
The online version of this article (doi:10.1186/s12911-015-0227-6) contains supplementary material, which is available to authorized users.
doi:10.1186/s12911-015-0227-6
PMCID: PMC4690290  PMID: 26699540
Depression; EEG; Genetic algorithm; Linear discriminant analysis; Decision tree; Sensitivity; Specificity
8.  Cigarette Smoking and Skin Prick Test in Patients With Allergic Rhinitis 
Background:
Allergic Rhinitis (AR) is the most common allergic disease, affecting 30% of population around the world. The disease is predominantly associated with exposure to some aeroallergens like cigarette smoking. Skin Prick Test (SPT) is a method of detecting immediate allergic reactions and is applied for controlling disease and therapeutic modality.
Objectives:
This study was designed to investigate the effect of cigarette smoking on SPT results among male and female individuals with AR disease.
Patients and Methods:
A total of 478 patients with AR admitted to the 2 main hospitals of Zahedan City from 2005 to 2012, were recruited in this analytic-descriptive study. Categories of smokers and never smokers were used based on patient’s statements and their history of smoking. SPT was performed with panel of some allergens and results were recorded and analyzed statistically. Odds ratio and confidence interval method were calculated using univariate logistic regression.
Results:
The results of this study indicated that 41.4% of patients with allergic rhinitis was smoker with ages ranged from 15 to 70 years. The result of this study also showed that smoking has no effect on SPT results of pollen and weeds aeroallergens conducted on male and female AR patients. However, male were significantly more sensitive than female in terms of sensitivity to the aspergillus, cladosporium, house dust mite, grasses, wheat, cockroach, and feather allergens.
Conclusions:
Our findings did not support the effect of cigarette smoking on SPT reactivity to pollen and weeds aeroallergens. However, male were significantly more sensitive than female in terms of sensitivity to some allergens.
doi:10.5812/ijhrba.23483v2
PMCID: PMC4609504  PMID: 26495257
Cigarette Smoking; Hydrothermal Vents; Rhinitis; Allergic
9.  Evaluation of ergonomic factors and postures that cause muscle pains in dentistry students’ bodies 
Background
Work-related musculoskeletal disorders commonly experienced by dental professionals are one of the main occupational health problem affecting their health and well-being.This study was conducted to evaluate ergonomic factors and profession-related postures and also investigate relationship between demographic factors and work condition with pain in dental students.
Material and Methods
60 freshman and sophomore dentistry students were randomly chosen as the subjects of control group, and 60 of 5th and 6th-year students were selected as the members of exposure group. Data related to the subjects such as sex, doing exercise, severity of musculoskeletal pain were obtained through questionnaire. Students’ postures were directly observed while treating patients and they were scored by REBA method. Data were analyzed by SPSS software using Man-Whitney, Kruskal-Wallis, Spearman and Kendall correlation tests.
Results
80.8% of the subjects were not aware of the correct ergonomic postures for dental procedures. Severity of musculoskeletal pain in the exposure group (15.9± 4.2) was significantly higher than the control group (10.5 ±3.2), (p <0.001). Risk of the most subjects (84%) was at the medium level. Students who were more involved in clinical activities experienced more muscular pains.
Conclusions
The musculoskeletal disorders are probable prolonged in working hours in static positions, incorrect work postures, implying more force and even tools and instruments. Therefore, students who are aware of ergonomic principals of their own profession would be able to maintain their health through activities and lifelong.
Key words:Posture, dentistry, students, musculoskeletal pain.
doi:10.4317/jced.51909
PMCID: PMC4554244  PMID: 26330941
10.  Quantitative and Qualitative Evaluation of Bio-Aerosols in Surgery Rooms and Emergency Department of an Educational Hospital 
Background:
Bio-aerosols are a potential hazard in hospitals and are mostly produced by hospital staff, patients and visitors. Bio-aerosols are solid or liquid particles pending in the air and they consist of aerosols accompanying micro-organisms or organic compounds of micro-organisms such as endotoxin, metabolite, toxin and other parts of organism. Those are a potential hazard in hospitals and are mostly produced by hospital staff, patients and visitors.
Objectives:
This study aimed to determine the types and amount of bacterial contamination in operating rooms and emergency department of an educational hospital in Zahedan, South-East of Iran.
Materials and Methods:
In this study, 72 samples were collected from three operating rooms and three rooms in the emergency department of an educational hospital during 2012. On the first day of every month, a sample was taken from each room during the morning shift; active sampling was done on plates consisting of blood agar and brain-heart infusion agar (BHI) for 10 minutes in the axis of a one-story Anderson impactor (flow rate 28.1 litter per minutes) and SIBATA air pump SIP 32-L and samples were then placed in a 35°C Incubator. Bacterial colonies were counted; warm coloring and differential tests were done and the data were analyzed using Mann-Whitney U and Kruskal-Wallis tests.
Results:
Seventeen types of bacteria were detected including Staphylococcus, Micrococcus, Viridians, Pneumococcus, Escherichia coli, Streptococcus, Bacillus cereus, B. subtilis, Klebsiella, Pseudomonas, Diphtheroid, Citrobacter and Enterobacter. Quantitative bacterial results showed that the number of observed bacteria in the emergency department with an average of 103.88 ± 33.84 cfu/m³ was more than that of the surgery rooms with an average of 63.32 ± 32.94 cfu/m³. Furthermore, the highest average number of all counted colonies (106 ± 28.45 cfu/m³) was determined in autumn. In all samples, S. aureus and Micrococcus were the most detected bacteria.
Conclusions:
The World Health Organization (WHO) has suggested relatively relaxed limits of 100 cfu/m3 for bacteria and 50 cfu/m3 for fungi in the hospital air. Therefore, quantitative and qualitative outcomes of this study demonstrate that contamination level and bacterial variety in surgery rooms and emergency departments is high and effective measures must be taken to control the possible health risks.
doi:10.5812/jjm.11688
PMCID: PMC4295311  PMID: 25632321
Operating Room; Hospital; Bioaerosol, Bacteria, Fungi, Indoor
11.  Muscular adaptations to depth jump plyometric training: Comparison of sand vs. land surface 
The purpose of this study was to compare the effects of plyometric training on sand vs. land surface on muscular performance adaptations in men. Fourteen healthy men were randomly assigned to two training groups: a) Sand Depth Jump (SDJ; N = 7) and b) Land Depth Jump (LDJ; N = 7). Training was performed for 6 weeks and consisted of 5 × 20 repetitions of DJ training on 20-cm dry sand or 3-cm hard court surface twice weekly. Vertical Jump Test (VJT), Standing Long Jump Test (SLJT), 20-m and 40-m sprint, T-test (TT) and one repetition maximum leg press (1RMLP) were performed before and after training. Significant improvements in VJT [4 (ES = 0.63) vs. 5.4 (ES = 0.85) cm], SLJT [8.3 (ES = 0.3) vs. 12.7 (ES = 0.57) cm], and 1RMLP [23.5 (ES = 0.56) vs. 15.3 (ES = 0.49) kg] were seen for both the groups. Likewise, significant decreases were observed for both SDJ and LDJ groups in 20-m [0.3 (ES = 0.72) vs. 0.4 (ES = 1.98) s] and 40-m sprint times [0.2 (ES = 0.4) vs. 0.5 (ES = 0.71) s], and TT [0.5 (ES = 0.62) vs. 0.9 (ES = 0.57) s]. With regard to ES, it can be recommended that athletes used LDJ training for enhancing sprint and jump and SDJ training for improving agility and strength.
doi:10.1556/IMAS.6.2014.3.5
PMCID: PMC4168734  PMID: 25243078
jumping ability; performance; sand; stretch-shortening cycle
12.  Imatinib Therapy in Chronic Myelogenous Leukemia and Thyroid Function Tests 
Introduction
Imatinib, a tyrosine kinase inhibitor which resulted in much improvement in the treatment of chronic myelogenous leukemia (CML), may adversely affect thyroid gland function. To date, assessment of thyroid function during imatinib therapy has limited to retrospective studies. The aim of this study was to evaluate the effects of imatinib on thyroid function in a prospective manner.
Materials and Methods
In this prospective study, 16 newly diagnosed adult subjects with positive Philadelphia chromosome in chronic phase of CML without any other apparent underlying diseases were enrolled. Free T3, Free T4, TSH, Anti TPO and Anti thyroglobulin antibodies were measured before and after 4 and 12 weeks of treatment.
Results
Of the 16 patients, 9 were male (57.1%) and 7(42.9%) were female with a mean age of 29±5 years. There were statistically significant changes within reference ranges in serum concentrations of TSH (P=0.753 and 0.002), Free T3 (P=0.012 and 0.007) and Anti Thyroglobulin (P=0.221 and 0.041) 1 month before and 3 months after imatinib initiation, respectively. At the same time, there were no significant changes in serum Free T4 (P=0.196 and 0.650) and Anti TPO (P=0.807 and 0.600) concentrations.
Conclusion
This study showed some significant changes on thyroid function tests during imatinib therapy. However, all of them were within the normal range without any clinical abnormalities in the course of treatment. We recommend other studies with larger sample size and longer duration of follow-up.
PMCID: PMC4305377  PMID: 25642304
Imatinib mesylate; Chronic myelogenous leukemia; Thyroid function tests
13.  Community Perceptions and Practices about Malaria Prevention and Control in Iran 
Abstract
Background
General knowledge of at risk people regarding malaria is key element to facilitate appropriate treatment and prevention behaviours. The aim of this study was to assess the family heads' understanding of malaria transmission, signs and symptoms, and preventive measures in malaria-affected districts of Iran.
Method
In 2009 in a cluster randomized cross-sectional survey data were collected from the heads of 5,466 randomly selected households by trained interviewers and a validated questionnaire. Only one adult person was interviewed per household Once all the information collected and entered to the SPSS Ver. 18 analysis was done and descriptive statistics were used to summarize results. Point estimates and 95% confidence intervals were also estimated for indicators.
Results
63.8% [95% CI: 62.2 - 65.4] of the participants recognized fever as a sign of malaria, 56.4% [95% CI: 54.6 - 58.2] reported that mosquito bites cause malaria and about 35% [95% CI: 32.7 - 37.1] of participants mentioned that the use of mosquito nets could prevent malaria. Furthermore, about one-third of selected samples in target districts did not know symptoms, transmission route and appropriate prevention method of malaria. Data also suggests a slight variation by residency, but substantial discrepancy according to the region.
Conclusions
General knowledge of respondents concerning malaria is too far from the levels required to be constructive for malaria elimination. Therefore, the survey suggests developing, and implementing effective health promotion policies to increase the awareness of households about the symptoms, transmission route and control measures of malaria.
PMCID: PMC4454025  PMID: 26060681
Malaria; Prevention; Knowledge; Iran
14.  Mortality Risk Prediction by Application of Pediatric Risk of Mortality Scoring System in Pediatric Intensive Care Unit 
Iranian Journal of Pediatrics  2013;23(5):546-550.
Objective
The Pediatric Risk of Mortality (PRISM) score is one of the scores used by many pediatricians for prediction of the mortality risk in the pediatric intensive care unit (PICU). Herein, we intend to evaluate the efficacy of PRISM score in prediction of mortality rate in PICU.
Methods
In this cohort study, 221 children admitted during an 18-month period to PICU, were enrolled. PRISM score and mortality risk were calculated. Follow up was noted as death or discharge. Results were analyzed by Kaplan-Meier curve, ROC curve, Log Rank (Mantel-Cox), Logistic regression model using SPSS 15.
Findings
Totally, 57% of the patients were males. Forty seven patients died during the study period. The PRISM score was 0-10 in 71%, 11-20 in 20.4% and 21-30 in 8.6%. PRISM score showed an increase of mortality from 10.2% in 0-10 score patients to 73.8% in 21-30 score ones. The survival time significantly decreased as PRISM score increased (P≤0.001). A 7.2 fold mortality risk was present in patients with score 21-30 compared with score 0-10. ROC curve analysis for mortality according to PRISM score showed an under curve area of 80.3%.
Conclusion
PRISM score is a good predictor for evaluation of mortality risk in PICU.
PMCID: PMC4006504  PMID: 24800015
PRISM Score; Mortality; Pediatric Intensive Care Unit; Children
15.  Efficacy of applying self-assessment of larviciding operation, Chabahar, Iran 
Malaria Journal  2012;11:329.
Background
Appropriate supervision, along with availability of an effective system for monitoring and evaluation, is a crucial requirement to guarantee sufficient coverage and quality of malaria vector control procedures. This study evaluated the efficacy of self-assessment practice as a possible innovative method towards achieving high coverage and excellent quality of larviciding operation in Iran.
Methods
The research was conducted on the randomly selected rural health centre of Kanmbel Soliman with 10 staff and 30 villages, in three main steps: (i) assessment of effectiveness of larviciding operations in the study areas before intervention through external assessment by a research team; (ii) self-assessment of larviciding operations (intervention) by staff every quarter for three rounds; and, (iii) determining the effectiveness of applying self-assessment of larviciding operations in the study areas. Two toolkits were used for self-assessment and external evaluation. The impact of self-assessment of larviciding operations was measured by two indicators: percentage of missed breeding habitats and cleaned breeding habitats among randomly selected breeding sites. Moreover, the correlation coefficients were measured between self-assessment measures and scores from external evaluation. The correlation coefficient and Mann Whitney test were used to analyse data.
Results
Following the utilization of self-assessment, the percentage of missed breeding habitats decreased significantly from 14.23% to 1.91% (P <0.001). Additionally, the percentage of cleaned breeding habitats among randomly selected breeding sites increased from 66.89% to 95.28% (P <0.001). The external evaluation also showed significant effects of self-assessment in performance of vector control; the maximum effect of intervention were seen in an action plan for monitoring and evaluation of larviciding operations at field level, geographical reconnaissance for the registration of breeding habitats and worker skills related to larviciding.
Before intervention, the results of self-assessment practice were compatible with external evaluation in 76.3% of 139 reviewed reports of self-assessment. After intervention, the findings of self-assessment and external evaluation were similar in the vast majority of reviewed reports (95%).
Conclusion
The self-assessment tool seems to be valid and reliable in improving effectiveness of larviciding operations. Furthermore, the result of self-assessment is more compatible with external evaluation results if it would be applied frequently. Therefore, it can be used as an alternative assessment technique in the evaluation of larviciding operations in addition to traditional assessment methods.
doi:10.1186/1475-2875-11-329
PMCID: PMC3507720  PMID: 22985394
Malaria; Larviciding; Self-assessment; Action research; Monitoring; Evaluation
16.  The pattern of injury and poisoning in South East Iran 
Background
Injury is a leading cause of morbidity and mortality worldwide, and even more so in low and middle-income countries (LMICs). Iran is a LMIC and lacks information regarding injury for program and policy purposes. This study aimed to describe the incidence and patterns of injury in one province in South Eastern Iran.
Methods
A hospital-based, retrospective case review using a routinely collected registry in all Emergency Departments in Sistan and Baluchistan province, Iran for 12 months in 2007–2008.
Results
In total 18,155 injuries were recorded during the study period. The majority of injuries in South Eastern Iran were due to road traffic crashes. Individuals living in urban areas sustained more injuries compared to individuals from rural areas. Males typically experienced more injuries than females. Males were most likely to be injured in a street/alley or village whereas females were most likely to be injured in or around the home. In urban areas, road traffic related injuries were observed to affect older age groups more than younger age groups. Poisoning was most common in the youngest age group, 0 to 4 years.
Conclusions
This study provides data on incidence and patterns of injury in South Eastern Iran. Knowledge of injury burden, such as this paper, is likely to help policy makers and planners with health service planning and injury prevention.
doi:10.1186/1472-698X-12-17
PMCID: PMC3492065  PMID: 22958398
Iran; Injury; Road traffic crash; Urban/rural; Sex
17.  Baseline results of the first malaria indicator survey in Iran at the health facility level 
Malaria Journal  2011;10:319.
Background
Malaria continues to be a global public health challenge, particularly in developing countries. Delivery of prompt and effective diagnosis and treatment of malaria cases, detection of malaria epidemics within one week of onset and control them in less than a month, regular disease monitoring and operational classification of malaria are among the major responsibilities of the national malaria programme. The study was conducted to determine these indicators at the different level of primary health care facilities in malaria-affected provinces of Iran
Methods
In this survey, data was collected from 223 health facilities including health centres, malaria posts, health houses and hospitals as well as the profile of all 5, 836 recorded malaria cases in these facilities during the year preceding the survey. Descriptive statistics (i.e. frequencies, percentages) were used to summarize the results and Chi square test was used to analyse data.
Results
All but one percent of uncomplicated cases took appropriate and correctly-dosed of anti-malarial drugs in accordance to the national treatment guideline. A larger proportion of patients [85.8%; 95% CI: 84.8 - 86.8] were also given complete treatment including anti-relapse course, in line with national guidelines. About one third [35.0%; 95% CI: 33.6 - 36.4] of uncomplicated malaria cases were treated more than 48 hours after first symptoms onset. Correspondingly, half of severe malaria cases took recommended anti-malarial drugs for severe or complicated disease more than 48 hours of onset of first symptoms. The latter cases had given regular anti-malarial drugs promptly.
The majority of malaria epidemics [97%; 95% CI: 90.6 - 100] in study areas were detected within one week of onset, but only half of epidemics were controlled within four weeks of detection. Just half of target districts had at least one health facility/emergency site with adequate supply and equipment stocks. Nevertheless, only one-third of them [33% (95% CI: 0.00 - 67.8)] had updated inventory of malaria foci on quarterly basis.
Conclusion
To sum up, malaria case management still constitutes a public health problem in Iran. Additionally, data suggest scarcity in management and evaluation of malaria foci, detection and control of malaria epidemics as well as assignment of emergency sites across different regions of the country. Consequently, massive and substantial investments need to be made at the Ministry of Health to coordinate national malaria control programmes towards achieving determined goals and targets.
doi:10.1186/1475-2875-10-319
PMCID: PMC3213221  PMID: 22029447
18.  Baseline results of the first malaria indicator survey in Iran at household level 
Malaria Journal  2011;10:277.
Background
Malaria is one of the leading causes of sickness and death in the developing world, causing more than a million deaths and around 250 million new cases annually worldwide. The aim of this comprehensive survey was to provide information on malaria indicators at household level in high-risk malaria areas in Iran.
Methods
In a cluster randomized cross-sectional survey data were collected from 5,456 households in both rural and urban areas of 20 malaria-affected districts of Iran. All the fieldwork was done by trained interviewers and a validated questionnaire. The questionnaire comprised baseline characteristics of the study population, the knowledge of people about different aspects of malaria (such as clinical symptoms, transmission and prevention) and their practice to prevent illness (such as using mosquito nets, spraying houses). The data were analysed and descriptive statistics (i.e. frequencies, percentages) were used to summarize the results.
Results
The results of this survey showed that 20% (95% CI: 17.36 - 22.24) of households owned at least one mosquito net, whether treated or untreated. Consequently, the use of mosquito nets was considerably low among both children under age five [5.90% (95% CI: 5.14 - 6.66)] and pregnant women [5.70% (95% CI: 3.07 - 8.33)]. Moreover, less than 10% of households reported that the interior walls of their dwelling had been sprayed in the previous year [8.70% (95% CI: 6.09 - 11.31)]. Data also suggest that 63.8% of the participants recognized fever as a sign of malaria, 56.4% reported that mosquito bites cause malaria and about 35% of participants mentioned that the use of mosquito nets could prevent malaria.
Conclusion
Findings from this study indicate that low access to treated nets along with low understanding of the role of nets in malaria prevention are the main barriers to utilization of bed nets. Therefore, the use of insecticide-treated mosquito nets should be encouraged through health education on the importance of the use along with increasing access to it.
doi:10.1186/1475-2875-10-277
PMCID: PMC3184285  PMID: 21939505

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