Social Determinants of Health

  Background: The present study was conducted to assess the trend of geographical disparities in child and maternal mortality rates in 20 districts of East Azerbaijan, in the Northwest of Iran, between 1999 and 2013.

  Methods: Data on to health indicators between 1999 and 2013, extracted from population registry panels (ZIJ), was made available for the study by the East Azerbaijan Health Center. Disparities were measured by calculating the Index of Disparities (ID_isp) and the trend was assessed using the general linear model test.

  Results: All the four indicators revealed decreasing trends between 1999 and 2013 (P<0.001), while there were no significant differences among the districts studied (P>0.05). The ranges of the ID_isp between 1999 and 2013 were 19-32% for Neonatal Mortality Rate (NMR), 16-22% for Infantile Morality Rate (IMR), 14-20% for Under 5 Mortality Rate (U5MR), and 120-143% for Maternal Mortality Rate (MMR), which revealed an increasing trend for all the indices. The trend of health indicators before and after implementation of the family physician program showed no significant difference for MMR (P= 0.228), while significant declining trends were observed for NMR, IMR, and U5MR (P<0.001).

  Conclusion: The results showed that despite the downtrend in NMR, IMR, U5MR, and MMR indicators, there are still geographical disparities in these indicators among districts of the East Azerbaijan province, in the Northwest of Iran.

Keywords: Geography; Infant mortality; Maternal mortality; Registry

Background: Accountability refers to a set of concepts and social actions by which individuals or organizations have a sense of commitment to explain and to justify their behavior towards the others. Since it is one of the overall objectives of each university, the present study conducted to evaluate the effect of interdisciplinary education of social accountability in short-term workshops on medical student’s knowledge.

  Methods: The present study followed a qualitative-quantitative method with the qualitative stage conducted as group interview. In the first phase, eight faculty members were selected in order to determine the scope and the main topics of social accountability. The second phase was training workshops of social accountability using intervention method. Before and after the course, the knowledge of concepts was assessed using a valid and reliable questionnaire.

  Results: The main scope and criteria of the social accountability were extracted based on the results of the experts’ group discussion in eight items. The results of investigating the quality of the workshops revealed the student’s satisfaction of the quality of presentations (88%), the appropriate time management (86%), and the new information (85%). Also, the results of the second phase demonstrated the educational effectiveness of social responsibility in the student’s comments (pretest Mean±SD=13.86 and posttest Mean±SD=14.80, P=0.002). The results of the workshop showed a significant effect of social accountability education on the participants.

  Conclusion: The students comprehended the purposes of the application. So, the probability of changing the behavior in medical students is possible with the clinical perspective. However, the stability of this achievement needs sufficient enforcement. 

Background: The study of the mortality patterns in each country helps to improve proper programming to reduce the number of deaths. Our effort was to study the frequency of unnatural deaths from 2006 to 2010.   

Methods: In the present cross-sectional research carried out to study the cases of unnatural deaths in Fars province between 2006 and 2010, all documents related to unnatural deaths in Fars Forensic Medicine Registry (FFMR) were investigated. Information about the deceased, including age, gender, education, and type of accident, was extracted and analyzed using IBM SPSS Statistics for Windows, Version 21.0.   

Results: The findings indicated that during the five-year period studied a total number of 10079 unnatural deaths occured. During the study period, unnatural deaths had a decrease. The most recurring cause of death was traffic accidents (38%), with the death caused by substance abuse (19.2%) and burns (9.5%) the second and the third leading causes of death. Of all deaths, 81% of the deceased were male. The highest frequency of deaths occurred in the age group of 20 to 29 years. Also, the highest number of deaths belonged to individuals with primary and middle school education (52%).   

Conclusion: The number of unnatural deaths decreased as the time went by. Unnatural deaths were more frequent in males and in young people and happened more in people with lower education. Implementation of correct policies and appropriate programs focusing on these high risk groups could lead to considerable prevention of unnatural deaths.