Publications by authors named "Hamidreza Farrokh-Eslamlou"

11 Publications

  • Page 1 of 1

Incidence of household catastrophic and impoverishing health expenditures among patients with Breast Cancer in Iran.

BMC Health Serv Res 2021 Apr 9;21(1):327. Epub 2021 Apr 9.

Department of Health Management and Economics, School of Public Health, Urmia University of Medical Sciences, Urmia, Iran.

Background: Breast cancer disease is the most common cancer among Iranian women and imposing a significant financial burden on the households. This study calculated out-of-pocket (OOP), catastrophic health expenditure (CHE), and impoverishing health spending attributed to breast cancer in Iran.

Methods: In this cross-sectional household study, clinical and financial information on breast cancer and also household information (expenditures and income) were obtained through face-to-face interviews and completing a questionnaire by 138 women with this disease in 2019. We applied three non-food expenditure thresholds of 40, 20, and 10% to defining the CHE. Disease costs included periodical visits, diagnostic services, hospitalization care, treatment and rehabilitation services, home, and informal care. Households were disaggregated into socioeconomic status quintiles based on their Adult Equivalent values standardized monthly consumption expenditures. To identify the factors affecting these indicators, we performed the two different multivariate logistic regression models.

Results: This study finds that each patient had a monthly average OOP payment of $US 97.87 for the requested services, leading to impoverished of 5.07% and exposed 13.77% of their households to CHE. These indicators have been mainly concentrated among the poor, as they have spent a large part of their meager income on buying the needed services, and for this purpose, most of them forced to sell their assets, borrow, or take a bank loan.

Conclusions: The patients in lower SES quintiles can be protected from impoverishing and catastrophic health spending by expanding insurance coverage, providing financial risk protection programs, and increasing access to quality and effective public sector services. Alongside, expanding inpatient coverage and adding drug benefits for the poor can significantly decrease their OOP payments.
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http://dx.doi.org/10.1186/s12913-021-06330-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8034109PMC
April 2021

Knowledge, attitude, and practice toward Zika virus among staff of comprehensive health services centers affiliated with Tehran University of Medical Sciences in 2020.

J Obstet Gynaecol Res 2021 Mar 15. Epub 2021 Mar 15.

Department of Public Health, School of Health, Reproductive Health Research Center, Urmia University of Medical Sciences, Urmia, Iran.

Aim: Assessment of knowledge, attitude, and practice of healthcare providers regarding Zika virus, provides information on their ability to prevent its transmission, and emphasizes the necessity of implementing educational programs if their knowledge, attitude, and practice are low. Therefore, the present study aimed to investigate the knowledge, attitude, and practice of the staff of comprehensive health services centers affiliated with Tehran University of Medical Sciences regarding Zika Virus.

Methods: This cross-sectional study was conducted on 354 staffs of comprehensive health service centers. The researcher-made questionnaire consisted of two sections. The first section of the questionnaire was about demographic and professional characteristics of the participants and the second section was assessment of knowledge, attitude, and practice regarding Zika virus. Data analysis was performed by SPSS 16 software using descriptive and analytical statistics.

Results: In this study, 70.9% of the participants had poor knowledge, 24.1% had moderate knowledge, and only 5% had good knowledge about Zika virus. Regarding attitude, 10.6% of the participants had negative attitude, 45.9% had neutral attitude, and 43.5% had positive attitude toward Zika virus. Moreover, 40.6% of the participants had poor practice, 24.7% had moderate practice, and 34.7% had good practice in Zika virus.

Conclusion: The knowledge level in participants about Zika virus was unacceptable and their attitude and practice level was relatively acceptable. Therefore, it is necessary to design and implement educational interventions aimed at promoting knowledge, attitude, and practice of the staff of comprehensive health services centers regarding Zika Virus.
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http://dx.doi.org/10.1111/jog.14745DOI Listing
March 2021

Identification and Validation of Requirements for a Registry System of Children's Developmental Motor Disorders in Iran.

Methods Inf Med 2019 Nov 13;58(4-05):124-130. Epub 2020 Mar 13.

Department of Health Information Technology, Khalkhal University of Medical Sciences, Khalkhal, Iran.

Background:  Despite recent advances in the field of medical sciences, children's developmental motor disorders (DMDs) are considered as one of the challenges in this area. Establishment of electronic systems for recording and monitoring children's DMDs can play an effective role in identifying patients and reducing the costs and consequences of the disease management. The aim of this study was to identify and validate the requirements for a registry system of children's DMDs in Iran.

Methods:  The present descriptive-analytical study was performed in three main stages. In the first step, the literature was reviewed to identify the requirements. In the second stage, the information obtained from the literature review was used to develop a questionnaire for validating and selecting the requirements for an electronic system of recording DMDs in infants. In the final stage, the requirements were validated by selected experts (22 specialists). Data were analyzed using SPSS 20 software (IBM Corporation, New York, United States).

Results:  According to findings, the requirements of a registry system for children's DMDs were identified in three areas of demographic (24 data elements), clinical data (87 data elements), and technical (28 capabilities). In the demographic section, data elements of "family history of motor disorders" (mean = 1.18) and "drug allergy" (mean = 2.9) gained an average score of < 2.5 and therefore were not selected as data elements necessary for the registry system of data recording and monitoring children's DMDs.

Conclusion:  In such developing countries as Iran, standard information recording and management is not properly done due to a large amount of information and the lack of comprehensive information registry systems. The findings of this study can help to design and establish information registry systems in the field of children's DMDs. Based on the findings of this research, it is recommended that future research be done to explore infrastructures necessary for providing a suitable platform to design and implement information registry systems in the field of children's DMDs.
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http://dx.doi.org/10.1055/s-0040-1701482DOI Listing
November 2019

Determinants of Iran's in Pharmaceutical Industry.

Iran J Pharm Res 2018 ;17(2):822-828

Department of Public Heath, School of Health, Social Determinants of Health Research Center, Urmia Medical Sciences University, Urmia, Iran.

Among non-oil and in trade arena, drug has always been strategic importance and most government especially industrialized countries pay special attention to its production and trade issues. Thus, having a comprehensive view from economic perspective to this section is essential for suggesting intervention. This was a descriptive-analytical and panel study. In this study, gravity model is used to estimate Iran's bilateral intra-industry trade in pharmaceutical products in the 2001-2012 periods. To illustrate the extent of pharmaceutical's intra-industry trade between Iran and its major trading partners, the explanatory variables of market size, income, factor endowments, distance, cultural contributions, and similarities and also special trade arrangements have been applied. Analysis of factors affecting Iran's bilateral intra-industry trade in pharmaceutical industry showed that the average GDP and cultural similarities had a significant positive impact on Iran's bilateral IIT, while the difference in GDP has a negative and significant effect. Coefficients obtained for the geographical distance and the average ratio of total capital to the labor force is not consistent with theoretical expectations. Special trade arrangements did not have significant impact on the extent of bilateral intra-industry trade between Iran and its trading partners. The knowledge of the intra-industry trade between Iran and its trade partners make integration between the countries. Factors affecting this type of trade pattern underlie its development in trade relationship. Therefore, the findings of this study would be useful in helping to develop and implement policies for the expansion of the pharmaceutical trade.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5985198PMC
January 2018

Cause-specific mortality among women of reproductive age: Results from a population-based study in an Iranian community.

Sex Reprod Healthc 2017 Dec 18;14:7-12. Epub 2017 Aug 18.

Reproductive Health Research Center, School of Public Health, Urmia University of Medical Sciences, Urmia, Iran. Electronic address:

Purpose Of Study: This study was conducted to evaluate the levels, patterns, and causes of mortality among women of reproductive age in Northwestern Iran.

Methods: Deaths were determined for females resident in West Azerbaijan Province of Iran and who died between March 2013 to February 2014 using reproductive age mortality survey (RAMOS). Causes of death were ascertained by verbal autopsy (VA) and classified based on the International Classification of Diseases, tenth revision (ICD-10). Overall and cause-specific mortality rates (MRs) per 100,000 women with 95% confidence intervals were calculated.

Results: A total of 510 deaths were detected, and VA interviews were conducted with the relatives of the deceased Cases; overall MR was 56.59 per 100,000 women (95% CI: 56.49-56.69). The highest MR was observed in suicide cases (MR=10.21per 100,000women, 95% CI: 10.15-10.27), accounting for 18% of all deaths. The most common method of suicide was self-inflicted burns (45.6%), followed by deaths due to breast cancer (MR=4.22per 100,000women, 95% CI: 4.18-4.26), which accounted for the most cancer-related mortality. All-cause mortality was associated with age, area of residence, marital status, level of education, and ethnic (religious) status relationship (P<0.001).

Conclusion: Suicide, especially self-immolation, was the main cause of death among women of reproductive age, and both suicides and breast cancer are major public health problems for this group of women.
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http://dx.doi.org/10.1016/j.srhc.2017.08.003DOI Listing
December 2017

Comparing clinical outcomes for a twelve-month trial of zotarolimus- and everolimus-eluting stents in patients with coronary artery disease: data from the THCRIC registry.

Ther Adv Cardiovasc Dis 2016 Aug 7;10(4):206-13. Epub 2016 Feb 7.

Reproductive Health Research Center, Urmia University of Medical Sciences, Urmia, Iran.

Objectives: New-generation coronary stents including zotarolimus- and everolimus-eluting stents (ZES and EES) have been shown to decrease the risk of restenosis. The purpose of this study was to compare the safety and efficacy of ZES and EES over a 12-month clinical follow up, in routine clinical practice.

Methods: This is an observational study in which 1029 consecutive patients treated with ZES (n = 669) or EES (n = 360) were enrolled. The study endpoint was major adverse cardiac events (MACE), defined as cardiac death, nonfatal myocardial infarction (MI), and target lesion or vessel revascularization at 12 months.

Results: Follow up was completed among 94.9% of the patients. The overall MACE occurred in 4 (0.6%) and 7 (2.0%) patients in the ZES and EES group, respectively. The occurrence of other cardiac events including nonfatal MI and target vessel or lesion revascularization was 1 (0.2%) versus 1 (0.3%) and 7 (1.1%) versus 5 (1.4%), respectively, in the ZES and EES groups of patients. Despite a slightly lower rate of MACE and cardiac death in the ZES group, the difference between these two groups was not significant (n = 0.064 for overall MACE, p = 0.129 for cardiac mortality, n = 0.999 for nonfatal MI, n = 0.468 for target vessel and n = 0.999 for target lesion revascularization).

Conclusions: According to our results, it could be concluded that the difference in the rate of MACE between the ZES and EES groups was not statistically significant at 12-month follow up.
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http://dx.doi.org/10.1177/1753944716629868DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5942625PMC
August 2016

Novel restricted access to vasectomy in Iran: addressing changing trends in vasectomy clients' characteristics over 16 years in northwestern Iran.

Contraception 2015 Nov 28;92(5):488-93. Epub 2015 Jul 28.

Reproductive Health Research Center, School of Public Health, Urmia University of Medical Sciences, Urmia, Iran. Electronic address:

Objectives: This study is designed to evaluate the popularity of vasectomy in Iran. The study was conducted to calculate the frequency of vasectomy over time, to compare vasectomy users' characteristics with the general population and whether these characteristics have changed over time.

Study Design: A cross-sectional study of 7864 men undergoing vasectomy in a 16-year period was conducted in Urmia, Iran. Comparative statistics described differences between vasectomy users and nonusers. The data were analyzed separately in two 8-year periods, 1996-2003 and 2004-2011. The time period did not involve 2012, the year which vasectomy became outlawed in the whole country.

Results: During the study period, the contraceptive prevalence rate of vasectomy increased from 0.1% to 3.35%. Vasectomy users were predominantly older, better educated, had more children and more urban residents than the general male population (p<0.001). Over time, men who underwent vasectomy tended to be younger, have well-educated wife and rural resident (p<0.05).

Conclusions: This study highlighted a dramatic rise in the use of vasectomy between 1996 and 2011 in Iran. While the characteristics of vasectomy users versus general population were different, especially in age, education, resident area, number and sex of their children, there were significant changes from two 8-year study time periods.
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http://dx.doi.org/10.1016/j.contraception.2015.07.010DOI Listing
November 2015

Persistence of Hemorrhage and Hypertensive Disorders of Pregnancy (HDP) as the Main Causes of Maternal Mortality: Emergence of Medical Errors in Iranian Healthcare System.

Iran J Public Health 2014 Oct;43(10):1395-404

1. Reproductive Health Research Center, School of Public Health, Urmia University of Medical Sciences , Urmia, Iran.

Background: This study aimed to assess factors affecting substandard care and probable medical errors associated with obstetric hemorrhage and HDP at a Northwestern Iranian health care system.

Methods: In a community-based descriptive cross-sectional study, data on all maternal deaths occurred at West Azerbaijan Province, Iran during a period of 10 years from March 21, 2002 to March 20, 2011 was analyzed. The principal cause of death, main contributory factors, nature of care, main responsible staff for sub-standard care and medical error were determined. The data on maternal deaths was obtained from the national Maternal Mortality Surveillance System (MMSS) which were covered all maternal deaths. The "Three delays model" was used to recognize contributing factors of maternal deaths due to obstetric hemorrhage and HDP.

Results: There were 183 maternal deaths, therefore the Mean Maternal Mortality Ratio (MMR) in the province was 32.8 per 100 000 live births (95% CI, 32.64-32.88). The most common causes of maternal deaths were obstetric hemorrhage in 36.6% of cases and HDP in 25.7%. The factors that most contributed to the deaths were all types of medical errors and substandard care with different proportions in management of obstetric hemorrhage and HDP.

Conclusion: A substandard care and medical error was the major contributing factor in both obstetric hemorrhage and HDP leading to maternal mortality, therefore, it is necessary to improve the quality of health care at all levels especially hospitals.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4441893PMC
October 2014

Premenstrual syndrome and quality of life in Iranian medical students.

Sex Reprod Healthc 2015 Mar 30;6(1):23-7. Epub 2014 Jun 30.

Reproductive Health Research Center, Urmia University of Medical Sciences, Urmia, Iran.

Purpose Of Study: The purpose of this research was to investigate the prevalence of premenstrual syndrome (PMS) in medical students and to evaluate the hypothesis that PMS may result in a decrease in quality of life.

Methods: In a cross-sectional study, 142 female medical students who study at Urmia University of Medical Sciences were included. The data were compiled using a PMS questionnaire based on the fourth version (DSM-IV) criteria, the questionnaire of "Premenstrual Syndrome Scale" as well as the "World Health Organization's Quality of Life (WHOQOL-BREF)" questionnaire.

Findings: In total, 56 out of 142 (39.4%) female medical students met the DSM-IV criteria for PMS. In the PMS group, more than half of the girls, i.e. 60.6% had mild, 25.1% had moderate and 14.2% had severe PMS. PMS was found to be significantly high in students who have positive history of PMS in their first degree relatives and who have used drugs to relieve PMS symptoms (P<0.05). Life quality score was low in more than half of the medical students, especially in psychological and social components (P>0.05). However, the quality of life score means in mental health (P=0.02) and environmental health (P=0.002) decreases as the PMS score average increases.

Conclusion: The results of premenstrual syndrome prevalence and their severity suggest that PMS is common in medical students and this adversely affects some domains of the quality of life. Improving the life quality of female medical students needs some interventions related to the PMS and also other interventions not related to PMS.
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http://dx.doi.org/10.1016/j.srhc.2014.06.009DOI Listing
March 2015

Intimate partner violence during pregnancy in Urmia, Iran in 2012.

J Forensic Leg Med 2014 May 28;24:28-32. Epub 2014 Mar 28.

Reproductive Health Research Centre, School of Public Health, Urmia University of Medical Sciences, Urmia, Islamic Republic of Iran.

Background: In spite of enough prevalence data on Intimate Partner Violence (IPV) during pregnancy from many countries, there are still some regions such as the Middle East with relatively limited data. The purpose of research was to investigate the magnitude of IPV during pregnancy in an Iranian community.

Methods: Thirty hundred fifty women during their postpartum period were invited to participate in a cross-sectional population-based study, but 10.6% of them refused participation. The data was compiled using the Abuse Assessment Screen questionnaire.

Results: Of the 313 women, 55.9% reported violence during pregnancy. All types of violence were detected in victims during pregnancy, including psychological violence (43.5%), physical violence (10.2%), and sexual violence (17.2%). Intimate partner violence during pregnancy was significantly associated with lower education of the husbands (PR 1.64; 95% CI 1.15-2.36), un-employment of the husbands (PR 1.36; 95% CI 1.12-1.64), marriage duration of 5-9 years (PR 0.95; 95% CI 0.74-1.20) and gravidity of two (PR 0.80; 95% CI 0.59-1.08).

Conclusion: The reported prevalence of IPV before and during pregnancy in this sample is substantially higher than estimates of exposure to violence in other parts of the globe, even the East Mediterranean region which has the highest prevalence estimation in the globe.
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http://dx.doi.org/10.1016/j.jflm.2014.03.007DOI Listing
May 2014

Impact of the World Health Organization's Decision-Making Tool for Family Planning Clients and Providers on the quality of family planning services in Iran.

J Fam Plann Reprod Health Care 2014 Apr 14;40(2):89-95. Epub 2013 Aug 14.

Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, New South Wales, Australia and Reproductive Health Research Center, School of Public Health, Urmia University of Medical Sciences, Urmia, Iran.

Objective: We investigated whether use of the World Health Organization's (WHO's) Decision-Making Tool (DMT) for Family Planning Clients and Providers would improve the process and outcome quality indicators of family planning (FP) services in Iran.

Methods: The DMT was adapted for the Iranian setting. The study evaluated 24 FP quality key indicators grouped into two main areas, namely process and outcome. The tool was implemented in 52 urban and rural public health facilities in four selected and representative provinces of Iran. A pre-post methodology was undertaken to examine whether use of the tool improved the quality of FP services and client satisfaction with the services. Quantitative data were collected through observations of counselling and exit interviews with clients using structured questionnaires.

Results: Different numbers of FP clients were recruited during the baseline and the post-intervention rounds (n=448 vs 547, respectively). The DMT improved many client-provider interaction indicators, including verbal and non-verbal communication (p<0.05). The tool also impacted positively on the client's choice of contraceptive method, providers' technical competence, and quality of information provided to clients (p<0.05). Use of the tool improved the clients' satisfaction with FP services (from 72% to 99%; p<0.05).

Conclusions: The adapted WHO's DMT has the potential to improve the quality of FP services.
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http://dx.doi.org/10.1136/jfprhc-2012-100290DOI Listing
April 2014