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Objective (s): The pandemic of the COVID-19 caused a wave of mental health problems in people. Resilience and social support can act as psychological factors to protect individuals from the devastating effects of the COVID-19 crisis and enable individuals to make positive changes in times of crisis. Based on this, the present study was designed and implemented with the aim of investigating the effect of protective factors such as social support on mental health and its mediating role on resilience in health workers of Tabriz before and during the Covid-19 pandemic Methods: This cross-sectional descriptive study is conducted on 350 health workers working in health centers in Tabriz, Iran. Health workers were selected by random cluster sampling. The data were collected using the Mental Health Continuum Short Form (MHC-SF), the Multidimensional Perceived Social Support (MPSS) and Connor-Davidson resilience questionnaire. Data were analyzed by Amos 22 software. Results: The results of the structural model showed that in coronavirus conditions, the direct effect of social support on resilience and the direct effect of social support on mental health were greater than in the situation before the outbreak of COVID-19. Also, the direct effect of mental health on resilience in the corona situation was higher than before the corona. The indirect effect of social support through mental health on resilience was also higher in the corona situation. Conclusion: The findings of the present study showed that in difficult conditions, such as the prevailing Corona pandemic, impressive social support, can improve mental health and resilience.

Introduction and purpose: Indicators of social accountability in medical education institutions are necessary for the improvement of community health needs. In this regard, the present research aimed to investigate the social accountability at Ilam University of Medical Sciences in the period before and during the COVID-19 pandemic. Methods: The present survey research was carried out in 2022 on students and professors of medicine and dentistry (n=788). The data were collected by standard questionnaire of Social Accountability of Medical Education. This questionnaire included 0 components and 85 items. Results: The results showed that the mean scores of the components of medical school standards range (24.9) (P=0.0002), amount of quality improvement in education and research (34.4) (P=0.0003), amount of mandatory mechanism for accreditation (23.2) (P=0.003), and amount of global principles with the characteristics of the context (33.8) (P=0.002) were in an unfavorable situation during the COVID-19 pandemic from the point of view of both professors and students. These values had a statistically significant difference (P

Background: The available information denotes the increased annual occurrence of breast cancer in Iranian women and the decreased age of developing this disease. Objectives: The present study aimed to assess risk factors for breast cancer in Iranian women. Methods: The present research was conducted in a hospital-based case-control study on 46 cases and 43 controls from March 2019 to March 2020 in Damghan. The interview was conducted to collect data by a predesigned questionnaire consisting of socio-demographic variables, nutrition and physical activity, and a checklist for fertility, and care items. Descriptive and analytical statistics, including the chi-square and logistic regression models, were used to analyze data by SPSS- ver16. Results: The findings showed that out of 46 cases, only 6 (6.7%) were detected by self-examination and two cases by health workers. The average age of breast cancer in the case group was 53.28 ± 10.4 years. The results showed significant association in many terms of education level, employment status, physical activity, nutrition and fertility factors (OR≤1, P-value≤0.05). Based on the determination coefficient obtained considering the mentioned variables, at minimum, 68.2%, and at maximum, 91% of the changes in the likelihood of developing the risk of breast cancer can be explained. Conclusion: Consistent with most studies, the findings of the current research showed a significant association with the developing risk of breast cancer. Considering that most factors identified in the present study are preventable, there should be effective interventions to control the disease and its complications in society.

Abstract Background In Iran, community health workers (CHWs) are selected and employed according to the instructions of the Ministry of Health (MOH). The present study aimed to investigate the views of different stakeholders regarding the selection criteria, as well as the competency of CHWs. Methods This study was conducted using a qualitative thematic analysis in Golestan Province, Iran. Data were collected using semi-structured interviews with managers, supervisors, CHWs, and common people in 2021. The interviews were recorded and then transcribed. To extract key themes, the six-step Brown model was used, which involved becoming acquainted with the data, meaningful organization of transcripts, extracting primary open codes, searching for themes in an iterative approach, theme extraction, defining themes, and preparing a report. The relationships between codes and sub-themes and themes were represented using ATLAS.ti version 8. Results Data saturation was achieved after interviewing 22 people. The extracted data included 340 open codes, two main sub-themes of “CHW effectiveness” and “CHW sustainability”, and three main themes of “criteria for employing competent people”, “barriers to employing competent people”, and “identifying the barriers to employing competent people”, according to the MOH instructions. Conclusion In the present study, local hiring was one of the major challenges in the competency-based selection of CHWs. One of the most repeated codes was expanding the local hiring concept and its requirements. Since different regions of Iran have different climatic, economic, cultural, and social conditions, the selection and hiring criteria for CHWs should be tailored to the needs of the community.

Introduction and purpose: Evidence shows that a high level of emotional intelligence in health care workers leads to better communication with patients and, ultimately, the pateints’ satisfaction. Considering the undeniable and complex relationship between emotional intelligence and communication skills, the present research was designed and implemented. Methods: The current research is a descriptive-analytical study. The participants included 121 community health workers from Kurdistan Province, Iran. The required data was collected through a communication skills checklist by observation, Queen Dam's communication skills questionnaire, and Shering's Emotional Intelligence Questionnaire. Descriptive statistics, analysis of variance (ANOVA), and linear regression were performed using SPSS (version 21) software. Results: The results of self-declaration of emotional intelligence and communication skills showed that only 28% of the participants had high emotional intelligence, and 32.2% had high communication skills. The evaluation of communication skills through the observation method showed that the staff obtained a low score with respect to introducing themselves to patients, explaining the treatment process, and keeping the patients calm. Moreover, 40.7% of participants had active listening skills. The r-squared (the coefficient of determination) showed that 86% of the variance of emotional intelligence is related to the variable of communication skills. Conclusion: Overall, the findings of the present study revealed an average level of emotional intelligence and communication skills among health care workers. Concerning the communication weaknesses observed in the emotional dimensions, it is recommended to intervene appropriately.

Background: Socioeconomic status (SES) is a criterion consisting of several components that encompass socioeconomic and cultural dimensions. This study aimed to design and develop a methodological guideline for calculating a single summary index (SSI) using the contributing variables of SES in a family unit.Methods: The data consisted of 18 700 urban and 19 200 rural households. Effective components of SES were extracted using two-step factor analysis and the structural equational modeling (SEM) method for both populations separately with AMOS software. Then, in order to customize and validate the weight of each component, the analytic hierarchy process (AHP) method was performed by a panel of experts. Finally, the SES index computational tool was developed as an SSI using all effective components by Excel software. Statistical analysis was done with SPSS software version 21.Results: In rural areas, the four wealth components of education, job, income, and family size were recognized as effective socioeconomic factors. Yet, in urban areas, family size was disregarded as an effective factor. In both rural and urban communities the three welfare components of appropriate nutrition, appropriate home appliance, and appropriate housing were similarly effective. The SES of rural population had a homogeneous distribution, while urban population did not follow a particular trend.Conclusion: The SES index impacts all aspects of life, especially health status. The introduced method is comprehensive and applicable to both rural and urban populations. Due to ever-changing lifestyles, constant technological advances, and socio-political changes in each society, the tool requires modification in a specific time intervals.

Background and Objective: Periodontal disease has high prevalence in diabetic patients and the knowledge of them about the relationship between diabetes and periodontal disease is effective in the control of the blood glucose and progression of periodontitis. This study was done to evaluate the knowledge, attitude and practice of diabetic patients about periodontal disease in Gorgan north of Iran. Methods: This descriptive-analytical study was done on 300 type 1 and 2 diabetic patients (136 males & 164 females) whom referred to governmental health centers in Gorgan, northern Iran during 2019. Demographic information, knowledge, attitude and practice were recorded using a questionnaire. Results: The level of good knowledge, attitude and practice were evaluated 51.7%, 44.3% and 25%, respectively. There was significant association between oral hygiene practice and gender and education (P

Introduction and purpose: Emotional intelligence has a crucial role in organizational performance, especially in the health domains facing high levels of emotions and challenges. Given that emotional intelligence is a skill based on competency that can be learned, it provides training in specific competencies causing the expansion and improvement of quality performance. In this regard, the present study aimed to investigate the effect of emotional intelligence on the quality of service delivery of health care providers. Methods: The present descriptive-analytical study was conducted in regions supported by Tehran University of Medical Sciences, Tehran, Iran, in 2019. A total of 500 individuals (including 250 health care providers and 250 clients of the health centers) were selected using random cluster sampling. Two valid questionnaires were used for data gathering, namely Schering’s Emotional Intelligence and SERVQUAL. The data were analyzed using descriptive statistics, two-way analysis of variance (ANOVA), and correlation and regression analyses in SPSS software (version 21). Results: The results of the present study showed a significant positive relationship between emotional intelligence and quality of services (r=0.45; P=0.001). The dimensions determined the relationships respectively between self-awareness with responsiveness, assurance, reliability, empathy, and tangibles. Regression results also showed that 20% of the changes in the service quality variable based on the emotional intelligence of health care providers can be explained. Two-way ANOVA demonstrated that the interactive effect of age and experience on emotional intelligence was significant (P

Abstract Introduction: Today, improvement of a labor inspectorate is an indicator of a country's economic and social growth development. So, inspectors need to perform a level of competence, professional knowledge, and skills. Training should meet these particular needs. Methods: This cross-sectional study was conducted to assess the educational priorities over 80 occupational health inspectors in Tehran province. The study tools included an attitude questionnaire and a knowledge test in occupational health based on the instructions provided by Ministry of Health inspection. The reliability and validity of these tools were evaluated and confirmed by quantitative and qualitative (Delphi) methods by experts in each field. Results: The attitude of inspectors was in the desirable range (total score of 4.669). Knowledge status was low in all fields (in the 70% threshold) and very low in some cases. Regarding the educational priorities, chemical agents with an average of 4.121 and the lowest percentage of correct response were placed at the first priority of education. The sound and vibration with an average of 1.325 were laced at the seventh priority of education. Moreover, ergonomics, thermal stress, biological, and radiation were placed from the second to sixth levels of priority. Conclusion: Due to the low knowledge level of the studied participants and their abilities, these workers should be trained as inspectors in the realm of sound. To this end, continuous educational planning is required based on needs assessment studies. Keywords: Needs Assessment, Education, Occupational Health, Inspectors

Introduction and purpose: Colorectal cancer is the third and fourth common type of cancer among Iranian males and females, respectively. According to previous studies, awareness and belief regarding the risk factors of this disease have a significant association with screening behaviors. The present study aimed to investigate the behavior of colorectal cancer prevention based on the health belief model. Methods: The present descriptive cross-sectional study was performed on 382 people in rural and urban areas of Behshahar City, Iran during 2019-20. The participants were selected using the random cluster sampling and the required data were collected using Standard Champion Questionnaire, consisting of 36 phrases and 6 dimensions, including perceived sensitivity, perceived intensity, perceived benefits, perceived barriers, awareness, and self-efficacy. The collected data were analyzed in SPSS software (version 17) using frequency, mean, standard deviation, correlation coefficient, and regression coefficient. Results: The majority of the research population (65.8%) were not aware of the implementation of the program and only 2.6% of them participated in it. The perceived intensity with a regression coefficient of 0.422 was the most predictive factor, while self-efficacy with the lowest value (b=0.226) was the least effective factor in the prediction of preventive behaviors. Conclusion: Awareness seems to be an effective factor in the practice of screening for colorectal cancer. Interventions at various levels are necessary to increase public awareness and access to prevention programs. It is recommended to use theories and models of health promotion to promote health behaviors in society.

Background: Despite a lot of efforts made in the rabies health-care system, Iran is still in an endemic region and millions are spent annually to prevent rabies. Materials and Methods: Searching in national and international databases has been performed. The preferred reporting items for systematic reviews and meta-analyses protocol were followed. To assess heterogeneity, the I-index was calculated. In addition, sensitivity analysis was performed by the remove-one method. The publication bias was also investigated by Egger's regression test, and the trim and fill method. To perform a meta-analysis, CMA version 2 software was used. Results: Totally, 33 studies with 250,980 animal-bite cases were meta-analyzed. A summary estimate of the incidence of 1200 per 100,000 population (95% CI 1000, 1500) with a mean age of 29.97±15.13years (95%CI: 29.33, 30.61) was estimated. The rate in men was higher 76.7% (95%CI 74.7%, 78.8%) than in women and in the rural 49.7% (95%CI: 42.8%, 58.6%) was equal in the urban. Most bites occurred in the spring and summer 20.5% (95%CI: 16.1%, 25.9%). The highest of job-related bites was in students 20.1% (95%CI: 19%, 23%). The highest rate of bite location and the animal type were estimated in the order of lower limbs and by dogs respectively. The rate of complete vaccination 61% (95%CI: 43%, 76%) and immunoglobulin injection 39% (95%CI: 22%, 59%), were estimated respectively. Conclusion: Estimates reveal that there has been little change in the animal bites over the years. It is necessary to take special actions to control the disease at the national and international levels.

Background: Known as a health and medical problem in the community, osteoporosis (OP) is the most prevalent metabolic bone disease. The most facile approach to dealing with osteoporosis is prevention and lifestyle modification. In adolescents, in particular, lifestyle plays the most important role in preventing from osteoporosis in the adulthood. This study was conducted to determine the level of osteoporosis preventive lifestyle and awareness among 13-15-year-old students in Garmsar city in 2018. Methods: This descriptive cross-sectional study was conducted on 400 high school students selected by two-stage cluster sampling method in Garmsar city in 2018. The data were collected with a three-part questionnaire containing 38 questions related to personal data and measurement of the awareness and lifestyle dimensions associated with osteoporosis prevention, including habits (smoking cigarettes and hookah and exposure to the sun to mention a few), nutrition, and physical activity. Cronbach’s alpha of awareness (0.84), habits (72. 5), and nutrition (0.72) was calculated to specify the reliability of the tool and the content validity was calculated with Lawshe method containing CVR (0.9) and CVT (0.86). For data analysis, use made of descriptive statistics and multiple linear regression by SPSS software version 24. Results: The results of awareness dimension with merely 42.77% correct answers indicated the low awareness of students. The dimension of habits in the preventive lifestyle was in optimal condition with a score of 61.1%. With scores of 33.4 and 25.2%, physical activity and activity without mobility were optimum (score: 70%). There was a direct and significant correlation between students’ awareness and their performance regarding osteoporosis (P Conclusions: The studied population had inadequate awareness and poor lifestyle. Given the existing risk factors, it is necessary to pay close attention to education and lifestyle changes in adolescents and their families.

Introduction and purpose: Self-care and patients education is the core of diabetes care and control. Family as the most fundamental pillar of society is responsible for the provision of proper and appropriate health care. The current study aimed to investigate the family-oriented empowerment model on self-care behaviors of patients with Type 2 diabetes in Neka. Methods: This quasi-experimental study was conducted on patients with diabetes mellitus referring to comprehensive rural health centers in Naka. They were randomly assigned into two groups of intervention and control. The intervention group received training for three months. Data collection instrument included Summary of Diabetes Self Care Activities(SCSCA) questionnaire consisting of two parts, namely demographic characteristics and dimensions of self-care activities(including diet, random blood glucose, physical activity, foot care, fasting blood sugar). The obtained data were analyzed in SPSS software( version 24). Results: Based on the results of the study, there was a significant difference in the mean scores before and after the intervention in terms of blood sugar, dietary control, and self-care behaviors (P 0.05). Conclusion: The results were indicative of the impact of family-Oriented empowerment education on most self-care behaviors of patients with type 2 diabetes.

Background: According to the World Health Organization, the high prevalence of breast cancer mortality in the least developed countries is because breast cancer is diagnosed at late stages. Accordingly, cost-effective breast cancer screening plans are the most effective methods to control this cancer and also increase women's survival. Methods: This retrospective cross-sectional study was conducted to evaluate the performance of the breast cancer screening program based on the guidelines of the Ministry of Health on 14,493 eligible women in rural areas of the Rudsar city in 2018-19. Providing target coverage, identification of the at-risk population, early diagnosis, referral index, and other statistical indices were calculated, analyzed and quantified using the relevant scales and SPSS 22 software. Results: The target population coverage was estimated at 48%. The results showed that 0.4% of the cases (27 cases) were identified as high-risk group according to national guidelines with referral to a specialist of 100%. All cases identified at the first stage of screening were found with BIRADS (Breast Imaging Reporting and Data System)4 and 5 based on biopsy specimens. Conclusion: The low target population coverage, as well as the cases with advanced breast cancer, indicated the need for more attention and consideration in implementing programs and policies for preventable cancer by all organizations. In this regard, there is a need for relevant interventions and follow-up by health authorities.

Introduction: Education and research are two thinking based processes. Nowadays, the main function of educational institutions is evaluated by thinking. This study aimed to determine the dominant thinking styles among medical and dental students of Ilam University of Medical Sciences (IUMS). Materials and methods: This cross-sectional study was conducted on all medical and dental students of IUMS in the academic year of 2016-2017. Data was collected by Sternberg’s standard thinking style inventory and a demographic data questionnaire. Data analysis was carried out with the software SPSS 20 using descriptive statistical analysis methods and t-test. Results: In total, 497 students of IUMS participated in the study. Among whom 395 (79.5%) were medicals students and 102 (20.5%) were dental students. The findings showed significant differences between the legislative and executive thinking styles of medical and dental students (P=0.042 and P=0.024 respectively), more specifically, the mean score of legislative thinking style was found to be higher among dental students than that of medical students, and the opposite relation was found in the mean scores of executive thinking style. Comparison of mean scores of thinking style dimensions between medical and dental students showed significant differences in some but not all dimensions. Conclusion: Considering the differences found in thinking styles of medical and dental students and their effects in emergence of unique behavioral and decision-making characteristics in medical and dental students, educational planners and professors should attempt to adjust their teaching methods and professional approach according to students individual features in terms of thinking style and preferences so as to foster the growth and flourish of their thinking, academic, and clinical capabilities. The results of the study showed significant differences between the legislative and executive thinking styles of medical and dental students, also regarding the different dimensions of thinking styles of medical and dental students, some significant differences in some but not all dimensions were reported.

Background and objectives: Tuberculosis is a global health problem and one of the top ten causes of mortality in the world. Therefore, the purpose of this study was to assess the educational needs of general practitioners working in health centers of Shahid Beheshti University of Medical Sciences in Tehran about tuberculosis. Material and Methods: This descriptive cross-sectional study was performed with the participation of all general practitioners working in health centers of Shahid Beheshti University of Medical Sciences in Tehran. Sampling method was census and 83 of the 97 doctors participated in the study. A needs assessment was performed using selfassessment and knowledge assessment questionnaires that were classifid into fie areas of general information about tuberculosis, detection, diagnosis, treatment and prevention. Data were entered into the SPSS-21 software and analyzed using one-way ANOVA. Results: In this study, 35 (42.2%) of the participants were from the Shargh Health Center, 31 (37.3%) from the Shomal Health Center and 17 (20.5%) of them were from the Shemiranet Health Network. Among the participants, 50 (60.2%) had participated in TB training course, and 79 (95.2%) had followed the DOTS strategy for treating patients. About 58 (69.9%) of them declared that workshop is the most effective method for learning. The mean (SD) level of general knowledge of physicians in the Shomal Health Center was 8.22 (6.4), the Shargh Health Center was 22.8 (6.5) and the Shemiranat Health. Network was 22.1 (7.5) out of 40. One-way analysis of variance didnot show a signifiant difference between mean scores of groups, but weakness of knowledge in the fild of treatment was observed according to the knowledge test and self-assessment. Conclusion: The study showed that the physicians’ knowledge was weak in all areas and was more signifiant in the fild of treatment than other areas.

BACKGROUND: In Iran, community health workers (CHWs) are native and are only employed in the health-care system. Therefore, the training and empowerment of these staff are essential. The present study was aimed to develop cooperative learning techniques in CHWs to improve both cognitive and noncognitive aspects such as accountability and other social skills in learners. METHODOLOGY: This study employed a quasi-experimental pre- and post-test design with a control group that was conducted in Kangavar City, Iran, in 2019. Forty-four CHWs were selected using a two-stage cluster sampling, of whom 22 were randomly assigned to the experimental group where the jigsaw technique was applied and the rest to the control group where the lecture method was applied. The aim was to identify job performance and motivation among the CHWs after instruction and compare the two groups. Pre- and posttests were applied to the groups before and after an in-service training course using valid questionnaires. Data analysis was performed on both descriptive and inferential statistics such as mean and standard deviation, paired t-test, and covariance analysis with the confidence level of 95%. RESULTS: The findings showed that the intervention significantly increased the mean score of motivation and performance in the experimental group. Covariance analysis with the removal of the pretest effect was also statistically significant (P = 0.01). Moreover, the MANCOVA test showed the jigsaw technique effect considering motivation and performance with a confidence level of 95%. CONCLUSION: Given the well-known effect of cooperative learning techniques and since CHWs have multi roles and tasks, it is necessary to use such techniques so that they can be accountable for developing health indicators in local areas.

BACKGROUND: Assessing the effectiveness of in-service training courses in order to achieve the desired goals and reduce the waste of costs and opportunities in the system is necessary. The purpose of this study was to determine the effectiveness of the “pharmacopeia home health” course considering its importance in different aspects using the Kirkpatrick model. MATERIALS AND METHODS: The present study was a quasi-experimental conducted at community health workers (CHWs) on three levels of reaction, learning, and behavior. In each phase, a valid questionnaire was used to measure the outcome according to the Ministry of Health guidelines with pretest and posttest measurements. The data were analyzed through SPSS 23, using descriptive statistics and repeated measures test and general linear model. RESULTS: The results of the study showed that at the level of reaction in terms of content and holding, conditions of implementation were favorable. Findings at the level of learning showed that the training course was only effective in enhancing the knowledge and awareness about drug maintenance and had no significant effect on other areas. In the third level, the results of the CHWs' performance showed that in some areas, the results were influenced by the demographic variables. CONCLUSION: The present study showed the effectiveness of education in different areas using on the Kirkpatrick model. Given the lack of impact of education in some areas in the present study and on the other, it is necessary to consider cooperative learning methods in order to develop the effectiveness of the courses.

مقدمه: عفونت روتاویروسی عامل بسیاری از گاستروانتریت‌های حاد در بین کودکان زیر 5 سال در کشورهایی است که برنامه‌ی معمول واکسیناسیون روتاویروس را اجرا نکردند. هدف این مطالعه، مرور سیستماتیک شواهد موجود در زمینه‌ی کارایی و ایمنی دو واکسن روتاتک و روتاریکس می‌باشد. روش‌ها: یک مرور نظام‌مند بین کارآزمایی‌های بالینی تصادفی شده و مطالعات تجربی بر روی کودکان زیر 5 سال جمعیت عمومی انجام شده است. پایگاه‌های اطلاعاتی پزشکی Medline، Ovid، Cochranel proquest، Scopus، DARE، HTA و NH SEED جستجو گردیدند. هتروژنیسیتی مطالعات با انجام متاآنالیز ارزیابی شد. به منظور برآورد تجمیعی کارایی واکسن روتاویروس (روتاریکس ®و روتاتک ®) از مدل تصادفی استفاده شده است و سوگرایی انتشار نیز با آزمون‌های Egger و Begg ارزیابی شد. یافته‌ها: 12 مطالعه مطابق با معیارهای ورود جهت تحلیل نهایی به دست آمد. برآورد ترکیبی کارایی برای تمام پیامدها برای روتاتک و روتاریکس به ترتیب 70/0 (85/0-65/0 :CI 95 درصد)، 80/0 (87/0-68/0 :CI 95 درصد) محاسبه گردید. نسبت خطر محاسبه شده‌ی عوارض در گروه مورد نسبت به گروه شاهد بین 20/1-83/0 قرار داشت. نتیجه‌گیری: واکسیناسیون روتاویروس سبب پیشگیری قابل توجهی از موارد حاد و غیر حاد اسهال روتاویروسی در کودکان می‌شود و می‌تواند بار قابل انتساب به بیماری را کاهش دهد. انجام مطالعات هزینه- اثربخشی برای اجرای برنامه‌ی معمول واکسیناسیون روتاویروس در ایران ضروری به نظر می‌رسد.

Background: The recent studies show that Rotavirus is important cause of the acute gastroenteritis. The aim of this review is to estimate the number of Rotavirus infection among Iranian children by performing a systematic review and estimating a pooled data. Methods: We performed a systematic literature review in relevant databases including PUBMED, MEDLINE, OVID, SID, MAGIRAN, and IRANMEDEX. Search in databases was done in October 10, 2013. Meta-analysis was performed using the STATA statistical package version 11. We assessed heterogeneity by Q-test and used random model for pooling measures of proportion of Rotavirus infection among Iranian children with diarrhea (and 95% confidence intervals [CI]). Sub group analysis between in-patient and outpatient group were done and publication bias was assessed by Egger and Begg tests. Results: A total of 154 records were identified in our searching. There were 36 studies including a total of 15,368 children with diarrhea. Out of 15,368 children, 6,338 were positive for Rotavirus gastroenteritis. Overall pooled estimate of infection with Rotavirus among cases of gastroenteritis was 0.35 (95% CI, 0.28-0.41). Pooled estimates for hospitalized children and outpatient subgroups were 0.39 (95% CI, 0.30-0.48), and 0.31 (95% CI, 0.23-0.38), respectively. Conclusions: This study supports the importance of Rotavirus in the Iranian population such as common cause of diarrhea among children. Therefore, decision to adopt immunization programs to prevent Rotavirus infection might be helpful in Iran.

Background: Haemophilus Influenzae type b (Hib) is an important cause of morbidity and mortality in children. Although its burden is considerably preventable by vaccine, routine vaccination against Hib has not been defined in the National Immunization Program of Iran. This study was performed to assess the cost-benefit and cost-utility of running an Hib vaccination program in Iran. Methods: Based on a previous systematic review and meta-analysis for vaccine efficacy, we estimated the averted DALYs (Disability adjusted life years) and cost-benefit of vaccination. Different acute invasive forms of Hib infection and the permanent sequels were considered for estimating the attributed DALYs. We used a societal perspective for economic evaluation and included both direct and indirect costs of alternative options about vaccination. An annual discount rate of 3% and standard age-weighting were used for estimation. To assess the robustness of the results, a sensitivity analysis was performed. Results: The incidence of Hib infection was estimated 43.0 per 100000, which can be reduced to 6.7 by vaccination. Total costs of vaccination were estimated at US$ 15,538,129. Routine vaccination of the 2008 birth cohort would prevent 4079 DALYs at a cost per averted-DALY of US$ 4535. If we consider parents′ loss of income and future productivity loss of children, it would save US$ 8,991,141, with a benefit-cost ratio of 2.14 in the base-case analysis. Sensitivity analysis showed a range of 0.78 to 3.14 for benefit-to-cost ratios. Conclusion: Considering costs per averted DALY, vaccination against Hib is a cost-effective health intervention in Iran, and allocating resources for routine vaccination against Hib seems logical.

Background: Invasive Haemophilus Influenzae type b (Hib) disease is a major problem of the public health in the countries have not implemented Hib vaccine in their routine immunization. The aim this study was to summarize the best available evidences regarding vaccine efficacy of Hib in the children younger than 5 years of age. Methods: The study was a systematic review and meta-analysis of randomized controlled trials and quasi-experimental studies on children of general population with at-least two years of follow-up. We searched Medline, OVID, ISI, Cochrane (Central Register of controlled trials), Proquest, scopus, DARE, HTA, and NHSEED from first available time to the end of 2008. Types of acceptable interventions were conjugate Hib vaccines (PRP-T, HB-OC, PRP-OMP, PRP-D) compared with placebo, no treatment or not-relevant vaccines. The summary estimated effect was calculated with Random Effect model. The publication bias was assessed by Egger's and Begg's tests. Findings: We find nine article that met inclusion criteria. The pooled estimate for vaccine efficacy was 84% (95%CI: 69-92%) against invasive Hib diseases. The tolerability of vaccine was acceptable in all studies and the incidence rates of side effects were rare. Conclusion: The study shows that conjugated Hib vaccine could prevent about 84 percent of Hib aggressive diseases. In the case of approval in an economic evaluation, it is reasonable to implement such vaccine in the routine immunization system of Iran. Keywords: Haemophilus influenzae Type b, Vaccine, Meta-analysis.