Road traffic injuries in Iran, a fast look on a disappointing report

Each year 50 million road traffic injuries (RTI) take place around the globe. As a consequence 1.2 million people lose their life.Ninety percent of all RTI deaths happen in developing or middle income countries (Koptis 2003, Murray1996). While pedestrians, bikers ,motorcyclists, and bus and minibus occupants are reported as the main victims of RTI in developing countries, car occupants constitute the major subgroup of RTI death in developed countries. In some Asian countries motorcyclists comprise over 50% of RTI death. Estimated number of hospitalized cases after road traffic injuries and outpatient cases per one RTI death is 15, and 70 respectively(Gururaj, 2000, Varghese 2003,Mohan 2002, Martinez 1996,Mock 1999and 2003, Evans 1991, London 2002). It is believed that by the year 2020 RTI death will be considerably decreased in developed countries and increased among developing nations (Murray1996).
In 2003, RTI death rate in Iran was estimated to be 34.2 in 100,000 population while the world average was 28.8. RTI death seems to be higher in provinces with high travelling rate but low ratio of highway roads to non-highway roads. In some provinces RTI death in rual areas were higher than that of urban areas. RTI Death rate was consistently 3-5 times more in men than in women. 46.8% of RTI deaths happend on streets inside villages and cities. Rural roads oustside villages was the place of 19.5% of RTI deaths while 21.5% of death happened on intercity roads. Only 8.5% of RTI deaths took place on highways (inside or outside the cities). Motorcyclists constituted 51.7 % of RTI deaths. Pedestrains, four-wheeler occupants, and occupants of vehicles with more than four wheels comprised 17.5%, 14.9% and 11.3% of total RTI deaths. 49.1% of all RTI deaths happened immidiately after accident and on the accident scene, while 13.9% and 28.3% of them happened during transferring to hospitals and after hosptalization respectively. 95% of RTI deaths happened within 2 hours after accidents. Only 14% of RTI victims were transferred to hospitals by ambulance and just 40% of RTI victims were transferred to hospitals within 20 minutes after accident. In 2001, Iranian experts guesstimated that RTI causes 600 million US dollars loss in one year.

Source: Naghavi M, Ja'fari N, Alaeddini F, Akbari ME, Epidemiology of external causes of injuries in I.R. Iran. 2004, Ministry of Health and Medical Education, Tehran-Iran

My comment: I think the numbers in the report are self-expressing. Only 12 provinces were included in this study and all major provinces plus Tehran and its suburbs were excluded. If added, Tehran in itself with 13 million population and millions of motorcyclist can make major changes to the presented rates and propotions .
Code:3A

Health in the news: 50,000 annual mortality due to congestive heart failure in Iran

Dr Hassan Radmehr, chief of the cardiovascular surgery department of Imam Hospital in Tehran, announced that 50,000 people die each year because of heart failure in Iran.
Source: www.pezeshkan.ir, December,28 2006

My comment: It shows that the health transition (from infectious disease to western disease pattern plus population aging) has already happend. You can find tabulate data on burden of disease in Iran from the book published by the Ministry of Health titled "Simaye Marg dar 18 Ostan) by Dr. Naghavi and his colleagues.
Code:5N

Health in the news: Who is responsible for patients with chronic mental disorders?

In 2001, provinding healthcare for patients with mental disorders became a responsibility of the Sazemane Behzisti (Welfare Organization)* . According to the Article 97 of the Fourth Development Plan 75% of the target population should be covered during a five-year peiod beginnig from 2005.
Mr. Barati, chair of the committee for reorganizing chronic mental disorders of Sazemane Behzisiti says: over the last 4 decades the absolute number of hospital beds for mental patients has been increasing while the ratio of mental beds to total beds has been on the steady decrease. This ratio has been 10%, 8%, 7%, and 5% for the years 1968, 1973, 1984, and the current year respectively. Now, Sazemane Behzisti with 4200 beds is provinding standard care with patients affecting mental disorders. Barati claims that the MOH through focusing on preventive mental care has been deviated from investment for therapeutic mental care. He reiterates that in order for the people in the MOH to find a solution for problems with mental illnesses in the country they should see and analyze the facts instead of investing time in trasnlating foreign books and articles!
More statistics repoted by Barati:
1-21,100 mental patients are being serviced by Behzisti.
2-Cost per mental bed for Behzisti : 125,000 Tomans
3-Total hostpital beds in the coutnry: 109,000
* Welfare Organization is completely different from Vezarate Refah (formerly Sazemane Tamine Ejtemaei). Now, Iran has different bodies for providing welfare for the people, all acting at national level but are totally independent.

My comment: Well, it's not that easy to comment on this article. Behzisti is a typical example of decentralization of healthcare in Iran at all possible levels (from policymaking to provinding direct care). Reviewing 50 years history of healthcare in Iran, I can say we have had few successful decentralization examples in healthcare. We all know that standard mental wards staffed by university psychiatrists are under the MOH. In order for Sazemane Behzisti to act successfully in providing therapeutic care for patients with mental illnesses it may need to have kind of policies for integration into these wards in one way or another.


Source: Jamejam online: December 27, 2006
Code:4N

Health in the news:Per capita therapeutic health care should be increased to 10,000 Tomans (approx 11 USD) by 2007

" To be in accord with the fourth National Development Plan the government should increase the therapeutic per capita health care to around 11 USD by the year 2007; as a result the out of pocket (OOP) payment will decrease from current 60% to 50%" Heidarpour Shahrezaei said to ISNA. He stressed that according to the fourth National Development Plan the share of out of pocket payment (people's share in health expenditure) is to be 30%.

Source: Aftabyazd online newspaper, www.aftabyazd.com, NO: 1973 , December 27, 2006

My comment: This may be considered an incredible jump. Now, the government pays 4.5 USD per person for therapuetic health care. I think 30% increase is what we can expect instead. I'd like to add that should the government accepts to pay this magic share, it will not guarantee the expected decrease in the share of out-of-pocket payments. Sudden increase in interest rate for expensive therapeutic services by private sector soon after the rise in the goverment's share might cause OOP to go up to some extent.
Code:3N

Health in the news: Differential scoring of provinces in Iran in terms of level of health

According to the latest scoring of provinces in Iran in tems of health level by Mr. Nejat Amini , Tehran, Markazi, and Isfahan provinces were scored as having appropriate level of health, Golestan, Ardabil, and Ghom provinces were classified into the middle grade, and finally Sistan & Baloochestan, Khoozestan, and Kohgilouyeh & Boyerahmad were given the worst score. Thirty-five different health indices were employed by Amini and his colleagues to make up a composite index for scoring health level of provinces.
From 1990 up to 2003 the inflation rate in health care costs in urban areas of the country was reported to be consistently more than general infation rate. The only exception was said to be the year 1992.
In a ten-year period from1991 to 2001 permanent hospital beds increased from 85,810 to 109,863. The corresponding figures for the number of hospitals during this period was an incresase from 639 to721. For each 100,000 population Iran has 5.14 medical specialist in average. The distribution of medical specialists are not even across provinces.

Source: Health level scoring in Iran. www.peikeiran.com, December 25, 2006. Code: 35935

My Comment: I wish I could publish the complete list of provinces along with their score in health level in English. I don't have access to it for the time being. Undoubtedly, Sistan & Baloochestan is the worst province in terms of poverty and consequently health indices. You can consider this province as a separate part of the whole picture. Portions of Sistan, especially areas close to Afghanistan-Iran border are extremely poor. Despite the fact that primary healthcare system with all its potential capacity is up and running in Sistan, other socio-economic factors prevent health indices to improve. Nowadays I hear that the government has particular plan for poverty reduction in poor areas of the coutnry but I am not optimistic about the short-term (and even long-term) results of these programs. According to many calculations the poverty gap has been getting bigger in the coutnry in recent decades.
Code:2N

Health in the news : 20,000 annual neonatal death in Iran

"Following accidents and cardiovascular diseases, perinatal mortality is the third cause of premature loss of death in Iran. Annually, 20,000 neonates lose their life at birth and 5000 additional neonates die of other pregancy related causes before and after birth " Mohammad Esmaeil Motlagh , the chair of the Office for Population and Family Health of the MOH, said. Most cases of neonatal death occur in ghettos of towns and cities close to borders. Preeclampsia/eclampsia, postpartum bleeding, and pregnancy related infections are among the top causes of neonatal death.

Source: 20,000 annual neonatal death in Iran. JameJam online, December 25, 2006

My comment:
1- In a different source ( www.pezeshkan.ir, November 20, 2006) the perinatal mortality is reported to be 35,000/ year. In this report, the neonatal mortality rate is said to be 20,000 per year!
Having a look at trend of child mortality indices during the last decade, we can see that while under 5 mortality and infant mortality have been decreasing rapidly, neonatal death rate has been on slight increase. This is becuase the PHC network helped a lot in reducing mortality due to diarrhe and other infectious diseases via ORS therapy and immunization while neonatal deaths are being caused by multi-factorial causes in which interventions are to be expensive and multi-faceted. However, if maternal bleeding as a cause of neonatal death is reduced, we may expect a good decrease in neonatal death in poor areas of the coutnry as a result.
Code:1N

Overuse of injectable Diclofenc in Iran

Surfing the internet, I came across a very nice paper written by Dr. Cheraghali on a very unique issue in Iran's healthcare system which is overuse of injectable Diclofenac. I remember exactly the time I was serving as a GP in Zanjan, northwest Iran, where people had a huge demand for injectable Diclofenac, Vitamin B Complex and even Vitamin B6. Many of them believed that Vitamin B6 vials contained a powerful substance like blood that helped them stay in a better health. Talking to my friends from other parts of the country rolled out that this was a commonplace problem.It Most doctors cannot resist against individuals' request for injectables . I know that the problem of injectable drugs is not limited to Iran and many people in developing countries like India and Pakistan has a great demand for them.




Here is the abstract of the paper from PubMed:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16782253
code:2A

Summary of major healthcare challenges in Iran

HealthyIran is my first weblog created on December 25, 2006. I'd like to have your opinions on pros and cons of healthcare system in Iran. I try to write in brief but to the point.

I would like you to comment on the major challenges of healthcare in Iran, summarized as follows:


1- Healthcare delivery at primary (preventive) level is totally public and seems to be very efficient. Currently, more than 40,000 Behvarz (Community Health Workers) are working with the system. The system provides a number of basic level free of charge healthcare (mainly preventive) with rural people all over the country.

2- Higher level outpatient healthcare is in private sector and totally unregulated. This causes people to pay out of their pocket for healthcare. In fact, some 65% of healthcare expenditure is coming from people's pocket.

3-Inpatient care is mainly provided by governmental hospitals; however, 20-30% of hospitals are in private sector. Most of private hospitals are located in large cities like Tehran, Isfahan, Mashad, Shiraz, and Tabriz.

4-Ministry of Health and Medical Education supervises 40 Medical Universities. Medical university in each province is the core unit for local health policy making and supervising healthcare at provincial level.

5-Since the year 2005 the Ministry of Health has started a national program on referral healthcare delivery in outpatient care. Recruited General Practitioners are working as family physician and considered as gate keeper of the system.

6-The cost of healthcare is rapidly increasing.

7-Cardiovascular disease, Road traffic accidents, cancers, and addiction are conditions with the highest burden in the country . Other words, they are the main cause of mortality and morbidity. Like other (developing ) countries , and with increasing age, degenerative mental disorders (dementia) are increasing in Iran. Depression, and psychotic disorders are diseases with very high morbidity in the coutnry.

8-AIDS is increasing and is becoming a major challenge for the health system.

9- Micronutrient deficieny is commonplace while average weight of the population is on the increase.

10- Tuberculosis, malaria, brucellosis, and other infectious diseases have a patchy pattern and are endemic in parts of the country.


11-Health insurance policies are not efficient. More than 90 percent (and according to self-reported estimates at least 75%) of the population are covered by at least one type of health insurance plan. Less than one percent of the health insurance policies are private. Supplementory health insurance plans are only for a limited number of people working in high class formal sector.

code:1A