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Article ; Online: The impact of the Iranian health transformation plan policy on equitable access to medical imaging services in West Iran

Maryam Saran / Banafsheh Darvishi Teli / Aziz Rezapour / Soraya Nouraei Motlagh / Meysam Behzadifar / Payam Haghighatfard / Nicola Luigi Bragazzi / Masoud Behzadifar

BMC Research Notes, Vol 16, Iss 1, Pp 1-

2023 Volume 6

Abstract: Abstract Objective Equity in the delivery of health services, including diagnostic imaging, is crucial to achieving universal health coverage. The Health Transformation Plan (HTP), launched in 2014, represents a major healthcare policy to improve the ... ...

Abstract	Abstract Objective Equity in the delivery of health services, including diagnostic imaging, is crucial to achieving universal health coverage. The Health Transformation Plan (HTP), launched in 2014, represents a major healthcare policy to improve the quality and accessibility of healthcare services. This study aimed to explore the impact of the HTP on equity in the access to medical imaging in Lorestan province, located in west Iran, from 2014 to 2023. Annual growth rates (AGR) of imaging devices were calculated, whilst equity assessment of medical imaging distribution was carried out by means of the Gini coefficient and the Lorenz curve per 100,000 population. The latter was generated using the cumulative distribution of imaging devices, as well as the cumulative population ratio. Results Between 2014 and 2023, the number of imaging devices has increased threefold. The AGR of installing CT and MRI scanners in Lorestan province increased between 2014 and 2023. The Gini coefficients increased from 0.12 for CT and 0.16 for MRI in 2014 to 0.33 in 2023 for both devices. This indicates a decrease in equity in access to these fundamental health technologies despite the increase in their figures. Policymakers should better allocate medical equipment based on the specific health needs of different regions throughout Iran.
Keywords	Diagnostic imaging ; Equity in Healthcare ; Gini Coefficient ; Health Economics ; Health Policy ; Health Transformation Plan ; Medicine ; R ; Biology (General) ; QH301-705.5 ; Science (General) ; Q1-390
Subject code	360
Language	English
Publishing date	2023-11-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Socio-economic inequalities in utilization of dental services in households of Lorestan province and comparing it with neighboring provinces

Sajad GHorbanizadeh / Fatemeh Tajar / Zahra Asadi Piri / Satar Rezaei / Yaser Mokhayeri / Soraya Nouraei Motlagh

بیمارستان, Vol 20, Iss 3, Pp 12-

2021 Volume 23

Abstract: Introduction: Socio-economic inequalities in the use of dental services are a major challenge to health policies in many countries. This cross-sectional study was conducted to investigate socio-economic inequalities in utilization of dental services in ... ...

Abstract	Introduction: Socio-economic inequalities in the use of dental services are a major challenge to health policies in many countries. This cross-sectional study was conducted to investigate socio-economic inequalities in utilization of dental services in households of Lorestan province and comparing it with neighboring provinces. Methods: Data required for the study were collected from the household expenditure and income survey (HIES). The study population included 5547 households in the western provinces of the country. Logistic regression method was used to determine the most important factors affecting the use of dental services, and the focus index was used to measure inequality between income groups. Data analysis was performed using Stata software version 14. Results: The highest and lowest percentages of dental services among households were related to Hamedan (7.02%) and Lorestan (3.19%) provinces, respectively. The results of the focus index showed that the benefits and costs of dental services were concentrated among households with higher socio-economic status. In other words, inequality benefits the rich. Being a female head of household and increased size of the household leads to a decrease in the use of these services. The higher education level of the head of the household and the increase in the number of employed and literate household members showed a positive relationship with the utilization of dental services. Conclusion: Benefiting from dental services was significantly higher among higher socio-economic groups. These inequalities can be avoided by introducing and implementing targeted policies. Low-income households, lower education levels, and the unemployed should be the focus of health policies to address unmet dental care needs.
Keywords	dentistry ; inequality ; western provinces ; socio-economic ; Public aspects of medicine ; RA1-1270
Subject code	338
Language	Persian
Publishing date	2021-12-01T00:00:00Z
Publisher	Tehran University of Medical Sciences
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Estimation of Iran’s Life Insurance Demand Function using Panel Data Method from 2006 to 2014

Naseh Lotfi / Soraya Nouraei Motlagh / Mohammad Hadian / Saman Ghasempour

Journal of Evidence Based Health Policy, Management & Economics, Vol 1, Iss 4, Pp 222-

2017 Volume 230

Abstract: Background: Insurance industry is recognized as a major economic entity. Development of insurance, and particularly life insurance, is among the necessities of industrial societies as this plays a substantial role in reinforcement of the society’s ... ...

Abstract	Background: Insurance industry is recognized as a major economic entity. Development of insurance, and particularly life insurance, is among the necessities of industrial societies as this plays a substantial role in reinforcement of the society’s economic power and, thus, establishes security and confidence. Aimed at analyzing the economic-social factors affecting insurance demand, the present study deals with estimation of life insurance demand function using panel data from 2006 up to 2014 in Iran. Methods: The present research is a descriptive-analytical study of the retrospective cohort applied type. Information registered in Iran’s Statistics Center encompassing the interval from 2006 to 2014 was analyzed. Benefitting from economic evaluation mechanism and macro-scale economic and social variables affecting life insurance demand were investigated in 30 provinces of Iran. Finally, the country’s demand function of life insurance was estimated using Stata12 and Eviewes8 software packages with panel data method. Results: Life expectancy rate has the largest impact on life insurance demand among the variables analyzed. In addition, urban settlement rate leaves the smallest effect on life insurance demand. Conclusion: Results of the study indicate that increase and rise of variables such as life expectancy rate, dependency rate, urban settlement rate, literacy rate, likelihood of family head’s death, population, and average net annual expenditures of urban family lead to increased tendency of individuals to life insurance. Furthermore, increase of other parameters like inflation rate and interest rate result in reduction of people’s tendency toward life insurance.
Keywords	Life Insurance ; Demand ; Inflation Rate ; Interest Rate ; Life Expectancy Rate ; Medicine ; R ; Public aspects of medicine ; RA1-1270
Subject code	336
Language	English
Publishing date	2017-12-01T00:00:00Z
Publisher	Shahid Sadoughi University of Medical Sciences
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Fairness of Health Financing before and after Introduction of Iranian Health Sector Evolution Plan

Soraya Nouraei Motlagh / Banafsheh Darvishi / Payam Haghighatfard / Mohammad-Hasan Imani-Nasab

Journal of Clinical and Diagnostic Research, Vol 12, Iss 6, Pp IC10-IC

A Case Study

2018 Volume 15

Abstract: Introduction: Since out-of-pocket payments of household are a serious obstacle to the equitable utilization of health services, paying attention to the direct payment of households and, consequently, incidence of catastrophic health expenditures should ... ...

Abstract	Introduction: Since out-of-pocket payments of household are a serious obstacle to the equitable utilization of health services, paying attention to the direct payment of households and, consequently, incidence of catastrophic health expenditures should always be considered in the planning and policy-making of health services. Iranian Health Sector Evolution Plan (HSEP) has been implemented since 2014, aiming at achieving universal coverage of health services and reducing the amount of out-ofpocket payments as a percentage of total health expenditures. Aim: To measure the fairness of health care financing and to identify incidence rate of catastrophic health expenditures and it's most important determinants before and after implementing the HSEP among households in one province of Iran (Lorestan). Materials and Methods: The study population of present crosssectional research was Lorestan households whose information was collected by a three-stage randomized cluster sampling method by the Statistics Center of Iran during 4/2012-3/2015. For data analysis, Logit’s regression model using Stata14 software was performed. Results: Based on the findings between 4/2012 and 3/2015, the incidence rate of Catastrophic Health Expenditure (CHE) reduced from 6.7 to 4.34; Fairness Financial Contribution Index (FFCI) varied from 0.66 to 0.74 and percentage of poverty due to health expenditure varied from 1.96% to 0.28%. The most important determinants of facing catastrophic health expenditure are economic status of households, location of households (urban or rural), and number of people over the age of 65 and under the age of 5 in the household, age and sex of household head and insurance status of households. The use of health care also showed a significant relationship with the incidence of catastrophic health expenditure. Conclusion: After implementing Iranian HSEP, the incidence of CHE and the percentage of poverty caused by health expenditure at the level of households were reduced to some degree, and fairness financial ...
Keywords	catastrophic health expenditure ; fairness financial contribution index ; equity ; health sector evolution plan ; Medicine ; R
Subject code	360
Language	English
Publishing date	2018-06-01T00:00:00Z
Publisher	JCDR Research and Publications Private Limited
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Attitude of public health students towards their field of study and future professions in Lorestan University of Medical Sciences

Atefeh Mokhtari Kia / Zahra Asadi Piri / Saman Ghasempour / Razieh Alaei / Soraya Nouraei Motlagh / Katayoun Bakhtiar

مجله ایرانی آموزش در علوم پزشکی, Vol 19, Pp 519-

2019 Volume 529

Abstract: Introduction: Field of study and future profession has always been an important subject of education. The purpose of this study was identifying the attitude of public health students at Lorestan University of Medical Sciences toward field of study and ... ...

Abstract	Introduction: Field of study and future profession has always been an important subject of education. The purpose of this study was identifying the attitude of public health students at Lorestan University of Medical Sciences toward field of study and future profession. Methods: This study is a cross-sectional. 78 students of public health from third to eighth semester in the academic year 2018 the population were selected by census method. The questionnaire used in this study is derived from the American University of Minnesota Attitude Questionnaire. It was developed in two sections (demographic characteristics & 17 questions about students̕ attitudes & perspectives toward field of study and future career). To analyze the data T-test, One-way ANOVA, Pearson correlation were used. Results: The mean score±standard deviation of students’ attitude toward the field of study and future career was 27.14±5.1 (theoretical mean score=27) and 22.79±5.25 (theoretical mean score =24) respectively. There was a significant correlation between their attitude towards field of study and their attitude towards future career (r = 0.472, P<0.0001). Important factors that gave rise to a negative attitude towards the future professions were inconsistencies between the curriculum of Public Health program and needs of society, anxiety about future profession, inadequate salary and employment benefits. Main negative factors related to students' attitudes about field of study were the negative attitude of society and other disciplines towards this field of study Conclusion: Regarding the results, attitudes of student about their future career and field of study were negative (close to average). Reforming and strengthening educational program, improvement of students’ internship, student admission according to society needs and establishing desirable conditions for graduates’ employment in this field lead to increase students' positive attitudes towards their field of study and consequently improve their attitude towards their ...
Keywords	attitude ; field of study ; future professions ; public health ; students ; Medicine ; R ; Medicine (General) ; R5-920
Subject code	300
Language	Persian
Publishing date	2019-04-01T00:00:00Z
Publisher	Isfahan University of Medical Sciences, Medical Education Development Center
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: The impact of disease characteristics on multiple sclerosis patients’ quality of life

Aziz Rezapour / Abdollah Almasian Kia / Sahar Goodarzi / Mojtaba Hasoumi / Soraya Nouraei Motlagh / Sajad Vahedi

Epidemiology and Health, Vol

2017 Volume 39

Abstract: OBJECTIVES The aim of this study was to assess the quality of life (QoL) of patients with multiple sclerosis (MS), and to investigate the effects of characteristics of MS such as disease course, severity, and relapses on patients’ QoL. METHODS This was a ...

Abstract	OBJECTIVES The aim of this study was to assess the quality of life (QoL) of patients with multiple sclerosis (MS), and to investigate the effects of characteristics of MS such as disease course, severity, and relapses on patients’ QoL. METHODS This was a cross-sectional study, in which 171 patients were enrolled. Health-related QoL was assessed using the Persian version of the Multiple Sclerosis Quality of Life-54 questionnaire. To measure patients’ disability status, we used the Expanded Disability Status Scale. Other variables included in the study were disease course and relapses of the disease. RESULTS The average scores for patients’ physical and mental QoL were 60.9±22.3 and 59.5±21.4, respectively. In a bivariate analysis, disease course, severity of the disease, and relapses were significantly associated with the physical and mental health composite scores. In a hierarchal regression analysis, disease course, severity of the disease, and relapses were responsible for 38 and 16% of the variance in physical and mental QoL, respectively. It was also observed that relapses were a strong predictor of both physical and mental QoL. CONCLUSIONS Our results showed that disease characteristics significantly affected both dimensions of QoL. It is therefore suggested that health care providers should be aware of these characteristics of MS to more successfully improve MS patients’ QoL.
Keywords	Quality of life ; Multiple sclerosis ; Iran ; Disease attributes ; Medicine ; R
Subject code	360
Language	English
Publishing date	2017-02-01T00:00:00Z
Publisher	Korean Society of Epidemiology
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Investigating the Relationship between Socioeconomic Factors and Incidence of Leukemia

Soraya Nouraei Motlagh / Parvaneh Heidari Orojlo / Farhad Lotfi / Marita Mohammadshahi / Nasrin Shaarbafchi Zadeh

پیاورد سلامت, Vol 10, Iss 2, Pp 205-

2016 Volume 219

Abstract: Background and Aim: Cancer disease is one of the main problems of Iranian health system. It is after Cardiovascular diseases and accidents, the third leading cause of death in Iran. In many countries, differences in socio-economic status have been linked ...

Abstract	Background and Aim: Cancer disease is one of the main problems of Iranian health system. It is after Cardiovascular diseases and accidents, the third leading cause of death in Iran. In many countries, differences in socio-economic status have been linked with the incidence of disease, death and in general, health inequalities. The aim of this study is to determine the socioeconomic factors associated with the incidence of leukemia in Iran. Materials and Methods: The present descriptive-analytical study was done with panel data modeling, including information related to 30 provinces of Iran from 2004 to 2009. Socioeconomic data were collected from provincial statistical yearbooks and data on age-standardized incidence rate (ASIR) of leukemia cancer per 100,000 populations were obtained from published reports by Iran Cancer Registry. Results: The results showed that the leukemia incidence in men and in women during the period under review has been upward. The highest and lowest incidence of leukemia was in Yazd and Sistan provinces, respectively. Direct relationship between unemployment rate, urbanization ratio, and human development index with cancer incidence rate was evident in this study. Conclusion: The increase of leukemia cancer in Iran has been confirmed by the current study. Leukemia cancer was significantly higher among provinces with higher socioeconomic status. This should be considered for planning support.
Keywords	socio-economic factors ; leukemia incidence ; iran ; Public aspects of medicine ; RA1-1270
Subject code	610
Language	Persian
Publishing date	2016-05-01T00:00:00Z
Publisher	Tehran University of Medical Sciences
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Health Needs Assessment among Female Adolescents

Nahid Khoshnoudfar / Mohammad-hasan Imani-Nasab / Mehdi Birjandi / Maryam Khoshnoudfar / Shadi Abdi / Soraya Nouraei Motlagh

Journal of Clinical and Diagnostic Research, Vol 11, Iss 11, Pp IC07-IC

A Case Study from Iran

2017 Volume 11

Abstract: Introduction: Identification of health needs of female adolescents is a necessity due to their double roles in the health status of current and future generations. Aim: To assess various types of health needs in physical, mental-emotional, social, ... ...

Abstract	Introduction: Identification of health needs of female adolescents is a necessity due to their double roles in the health status of current and future generations. Aim: To assess various types of health needs in physical, mental-emotional, social, spiritual, and educational aspects among Iranian female adolescents. Materials and Methods: A total of 400 girls studying in high schools of Khorramabad city of Iran, were selected using the stratified sampling and multistage cluster sampling. The tool used for data collection was Female Adolescents' Health Needs questionnaire. SPSS Version 20 Software was used to analyse the obtained data via Pearson correlation coefficient, ANOVA, and t-test. Results: The mean score and the Standard Deviation (SD) of the girls' health needs were 89.79±11.47. The highest and lowest health needs were spiritual and educational needs with the average scores of 94.79±11.70 and 87.37±14.13, respectively. The correlation coefficient test indicated that there is a strong and significant correlation between different dimensions of female adolescents' health needs. Social (75%) and spiritual (65%) dimensions had the highest and the lowest correlations with other dimensions, respectively. Conclusion: The study results show that the girls had varied health needs. To be prioritized are spiritual health, physical health, social health, mental-emotional health, and educational health, as found in this study.
Keywords	Health care ; Health planning ; Health services research ; Medicine ; R
Language	English
Publishing date	2017-11-01T00:00:00Z
Publisher	JCDR Research and Publications Private Limited
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Mapping geographical inequalities in oral rehydration therapy coverage in low-income and middle-income countries, 2000–17

Kirsten E Wiens / Paulina A Lindstedt / Brigette F Blacker / Kimberly B Johnson / Mathew M Baumann / Lauren E Schaeffer / Hedayat Abbastabar, Sr / Foad Abd-Allah / Ahmed Abdelalim / Ibrahim Abdollahpour / Kedir Hussein Abegaz / Ayenew Negesse Abejie / Lucas Guimarães Abreu / Michael R M Abrigo / Ahmed Abualhasan / Manfred Mario Kokou Accrombessi / Dilaram Acharya / Maryam Adabi / Abdu A Adamu /

Oladimeji M Adebayo / Rufus Adesoji Adedoyin, Sr / Victor Adekanmbi / Olatunji O Adetokunboh, Sr / Beyene Meressa Adhena / Mohsen Afarideh / Sohail Ahmad / Keivan Ahmadi / Anwar E Ahmed / Muktar Beshir Ahmed / Rushdia Ahmed / Temesgen Yihunie Akalu / Fares Alahdab / Ziyad Al-Aly / Noore Alam, Sr / Samiah Alam / Genet Melak Alamene / Turki M Alanzi / Jacqueline Elizabeth Alcalde-Rabanal / Beriwan Abdulqadir Ali / Mehran Alijanzadeh / Vahid Alipour / Syed Mohamed Aljunid / Ali Almasi, Sr / Amir Almasi-Hashiani / Hesham M Al-Mekhlafi / Khalid A Altirkawi / Nelson Alvis-Guzman / Nelson J Alvis-Zakzuk / Saeed Amini, Sr / Arianna Maever L Amit, Sr / Catalina Liliana Andrei, Sr / Mina Anjomshoa / Amir Anoushiravani, Sr / Fereshteh Ansari / Carl Abelardo T Antonio / Benny Antony / Ernoiz Antriyandarti / Jalal Arabloo / Hany Mohamed Amin Aref, Sr / Olatunde Aremu / Bahram Armoon / Amit Arora, Sr / Krishna K Aryal / Afsaneh Arzani / Mehran Asadi-Aliabadi / Hagos Tasew Atalay / Seyyed Shamsadin Athari, Sr / Seyyede Masoume Athari / Sachin R Atre / Marcel Ausloos / Nefsu Awoke / Beatriz Paulina Ayala Quintanilla / Getinet Ayano / Martin Amogre Ayanore, Sr / Yared Asmare Aynalem IV / Samad Azari / Peter S Azzopardi / Ebrahim Babaee / Tesleem Kayode Babalola / Alaa Badawi, Sr / Mohan Bairwa / Shankar M Bakkannavar / Senthilkumar Balakrishnan / Ayele Geleto Bali / Maciej Banach, Sr / Joseph Adel Mattar Banoub, Sr / Aleksandra Barac / Till Winfried Bärnighausen / Huda Basaleem / Sanjay Basu / Vo Dinh Bay / Mohsen Bayati / Estifanos Baye / Neeraj Bedi / Mahya Mahya Beheshti Beheshti / Masoud Behzadifar / Meysam Behzadifar / Bayu Begashaw Bekele / Yaschilal Muche Belayneh / Michellr L Bell, Sr / Derrick A Bennett, Sr / Dessalegn Ajema Berbada / Robert S Bernstein / Anusha Ganapati Bhat, Sr / Krittika Bhattacharyya, Sr / Suraj Bhattarai / Soumyadeep Bhaumik / Zulfiqar A Bhutta / Ali Bijani / Boris Bikbov / Binyam Minuye Birihane IV / Raaj Kishore Biswas / Somayeh Bohlouli / Hunduma Amensisa Amensisa Bojia I / Soufiane Boufous / Oliver J Brady / Nicola Luigi Bragazzi / Andrey Nikolaevich Briko / Nikolay Ivanovich Briko / Gabrielle B Britton / Sharath Burugina Nagaraja, Sr / Reinhard Busse, Sr / Zahid A Butt / Luis LA Alberto Cámera, Sr / Ismael R Campos-Nonato, Sr / Jorge Cano / Josip Car / Rosario Cárdenas / Felix Carvalho, Sr / Carlos A Castañeda-Orjuela, Sr / Franz Castro / Wagaye Fentahun Chanie, Sr / Pranab Chatterjee / Vijay Kumar Chattu / Tesfaye Yitna Yitna Chichiabellu, Jr / Ken Lee Chin, Sr / Devasahayam J Christopher / Dinh-Toi Chu / Natalie Maria Cormier / Vera Marisa Costa / Carlos Culquichicon / Matiwos Soboka Daba / Giovanni Damiani, Sr / Lalit Dandona / Rakhi Dandona / Anh Kim Dang / Aso Mohammad Darwesh / Amira Hamed Darwish / Ahmad Daryani, Sr / Jai K Das / Rajat Das Gupta / Aditya Prasad Dash / Gail Davey / Claudio Alberto Dávila-Cervantes / Adrian C Davis, Sr / Dragos Virgil Davitoiu / Fernando Pio De la Hoz / Asmamaw Bizuneh Demis / Dereje Bayissa Demissie / Getu Debalkie Demissie / Gebre Teklemariam Demoz, Sr / Edgar Denova-Gutiérrez, Sr / Kebede Deribe, Sr / Assefa Desalew / Aniruddha Deshpande / Samath Dhamminda Dharmaratne / Preeti Dhillon / Meghnath Dhimal / Govinda Prasad Dhungana / Daniel Diaz, Sr / Isaac Oluwafemi Dipeolu / Shirin Djalalinia / Kerrie E Doyle / Eleonora Dubljanin / Bereket Duko / Andre Rodrigues Duraes / Mohammad Ebrahimi Kalan / Hisham Atan Edinur, Sr / Andem Effiong, Sr / Aziz Eftekhari / Nevine El Nahas / Iman El Sayed / Maysaa El Sayed Zaki / Maha El Tantawi / Teshome Bekele Elema I / Hala Rashad Elhabashy, Sr / Shaimaa I El-Jaafary / Hajer Elkout / Aisha Elsharkawy / Iqbal RF Elyazar / Aklilu Endalamaw / Daniel Adane Endalew, Sr / Sharareh Eskandarieh / Alireza Esteghamati / Sadaf Esteghamati, Sr / Arash Etemadi / Oluchi Ezekannagha / Mohammad Fareed / Roghiyeh Faridnia / Farshad Farzadfar / Mehdi Fazlzadeh / Valery L Feigin, Sr / Seyed-Mohammad Fereshtehnejad / Eduarda Fernandes / Irina Filip / Florian Fischer / Nataliya A Foigt / Morenike Oluwatoyin Folayan, Sr / Masoud Foroutan / Richard Charles Franklin / Takeshi Fukumoto / Mohamed M Gad / Reta Tsegaye Gayesa / Teshome Gebre, Sr / Ketema Bizuwork Gebremedhin / Gebreamlak Gebremedhn Gebremeskel, Sr / Hailay Abrha Gesesew / Kebede Embaye Gezae / Keyghobad Ghadiri, Sr / Ahmad Ghashghaee / Pramesh Raj Ghimire, Sr / Paramjit Singh Gill, Sr / Tiffany K Gill / Themba G G Ginindza / Nelson G M Gomes / Sameer Vali Gopalani / Alessandra C Goulart / Bárbara Niegia Garcia Goulart / Ayman Grada / Mohammed Ibrahim Mohialdeen Gubari / Harish Chander Gugnani, Sr / Davide Guido / Rafael Alves Guimarães / Yuming Guo, Sr / Rajeev Gupta / Nima Hafezi-Nejad / Dessalegn H Haile, Sr / Gessessew Bugssa Hailu / Arvin Haj-Mirzaian / Arya Haj-Mirzaian / Randah R Hamadeh / Samer Hamidi / Demelash Woldeyohannes Handiso / Hamidreza Haririan, Sr / Ninuk Hariyani / Ahmed I Hasaballah / Md Mehedi Hasan / Edris Hasanpoor / Amir Hasanzadeh / Hadi Hassankhani / Hamid Yimam Hassen / Mohamed I Hegazy / Behzad Heibati / Behnam Heidari / Delia Hendrie, Sr / Nathaniel J Henry / Claudiu Herteliu / Fatemeh Heydarpour / Hagos Degefa de Hidru I / Thomas R Hird / Chi Linh Hoang / Enayatollah Homaie Rad / Praveen Hoogar / Mohammad Hoseini / Naznin Hossain / Mostafa Hosseini / Mehdi Hosseinzadeh / Mowafa Househ / Mohamed Hsairi, Sr / Guoqing Hu / Mohammedaman Mama Hussen / Segun Emmanuel Ibitoye / Ehimario U Igumbor, Sr / Olayinka Stephen Ilesanmi / Milena D Ilic / Mohammad Hasan Imani-Nasab / Usman Iqbal / Seyed Sina Naghibi Irvani / Sheikh Mohammed Shariful Islam / Chinwe Juliana Iwu / Neda Izadi, Sr / Anelisa Jaca / Nader Jahanmehr / Mihajlo Jakovljevic / Amir Jalali / Achala Upendra Jayatilleke / Ravi Prakash Jha / Vivekanand Jha / John S Ji, Sr / Jost B Jonas / Jacek Jerzy Jozwiak / Ali Kabir / Zubair Kabir, Sr / Amaha Kahsay / Hamed Kalani / Tanuj Kanchan / Behzad Karami Matin / André Karch / Mohd Anisul Karim / Hamidreza Karimi-Sari / Surendra Karki / Amir Kasaeian / Gebremicheal Gebreslassie Kasahun / Yawukal chane Kasahun / Habtamu Kebebe Kasaye / Gebrehiwot G Kassa / Getachew Mullu Kassa / Gbenga A Kayode / Ali Kazemi Karyani / Mihiretu M Kebede / Peter Njenga Keiyoro / Abraham Getachew Kelbore, Sr / Andre Pascal Kengne, Sr / Daniel Bekele Ketema / Yousef Saleh Khader / Morteza Abdullatif Khafaie / Nauman Khalid / Rovshan Khalilov / Ejaz Ahmad Khan, Sr / Junaid Khan / Md Nuruzzaman Khan I / Muhammad Shahzeb Khan / Khaled Khatab, Sr / Amir M Khater / Mona M Khater / Maryam Khayamzadeh / Mohammad Khazaei / Salman Khazaei / Mohammad Hossein Khosravi / Jagdish Khubchandani / Ali Kiadaliri / Yun Jin Kim / Ruth W Kimokoti / Adnan Kisa / Sezer Kisa / Niranjan Kissoon, Sr / Shivakumar KM Marulasiddaiah M KMShivakumar, Sr / Sonali Kochhar / Tufa Kolola, Sr / Hamidreza Komaki / Soewarta Kosen / Parvaiz A Koul / Ai Koyanagi / Moritz U G Kraemer / Kewal Krishan / Nuworza Kugbey / G Anil Kumar / Manasi Kumar, Sr / Pushpendra Kumar / Vivek Kumar / Dian Kusuma / Carlo La Vecchia / Ben Lacey / Sheetal D Lad / Dharmesh Kumar Lal / Felix Lam / Faris Hasan Lami, Sr / Prabhat Lamichhane / Van Charles Lansingh / Savita Lasrado / Avula Laxmaiah / Paul H Lee, Sr / Kate E LeGrand / Mostafa Leili / Tsegaye Lolaso Lenjebo / Cheru Tesema Leshargie, Sr / Aubrey J Levine / Shanshan Li, Sr / Shai Linn / Shiwei Liu / Simin Liu / Rakesh Lodha / Joshua Longbottom / Jaifred Christian F Lopez / Hassan Magdy Abd El Razek / Muhammed Magdy Abd El Razek / D R Mahadeshwara Prasad / Phetole Walter Mahasha, Sr / Narayan B Mahotra / Azeem Majeed / Reza Malekzadeh, Sr / Deborah Carvalho Malta / Abdullah A Mamun, Sr / Navid Manafi, Sr / Ana Laura Manda / Narendar Dawani Dawanu Manohar / Mohammad Ali Mansournia / Chabila Christopher Mapoma / Joemer C Maravilla / Gabriel Martinez, Sr / Santi Martini / Francisco Rogerlândio Martins-Melo / Anthony Masaka / Benjamin Ballard Massenburg / Manu Raj Mathur / Benjamin K Mayala / Mohsen 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The Lancet Global Health, Vol 8, Iss 8, Pp e1038-e

2020 Volume 1060

Abstract: Summary: Background: Oral rehydration solution (ORS) is a form of oral rehydration therapy (ORT) for diarrhoea that has the potential to drastically reduce child mortality; yet, according to UNICEF estimates, less than half of children younger than 5 ... ...

Abstract	Summary: Background: Oral rehydration solution (ORS) is a form of oral rehydration therapy (ORT) for diarrhoea that has the potential to drastically reduce child mortality; yet, according to UNICEF estimates, less than half of children younger than 5 years with diarrhoea in low-income and middle-income countries (LMICs) received ORS in 2016. A variety of recommended home fluids (RHF) exist as alternative forms of ORT; however, it is unclear whether RHF prevent child mortality. Previous studies have shown considerable variation between countries in ORS and RHF use, but subnational variation is unknown. This study aims to produce high-resolution geospatial estimates of relative and absolute coverage of ORS, RHF, and ORT (use of either ORS or RHF) in LMICs. Methods: We used a Bayesian geostatistical model including 15 spatial covariates and data from 385 household surveys across 94 LMICs to estimate annual proportions of children younger than 5 years of age with diarrhoea who received ORS or RHF (or both) on continuous continent-wide surfaces in 2000–17, and aggregated results to policy-relevant administrative units. Additionally, we analysed geographical inequality in coverage across administrative units and estimated the number of diarrhoeal deaths averted by increased coverage over the study period. Uncertainty in the mean coverage estimates was calculated by taking 250 draws from the posterior joint distribution of the model and creating uncertainty intervals (UIs) with the 2·5th and 97·5th percentiles of those 250 draws. Findings: While ORS use among children with diarrhoea increased in some countries from 2000 to 2017, coverage remained below 50% in the majority (62·6%; 12 417 of 19 823) of second administrative-level units and an estimated 6 519 000 children (95% UI 5 254 000–7 733 000) with diarrhoea were not treated with any form of ORT in 2017. Increases in ORS use corresponded with declines in RHF in many locations, resulting in relatively constant overall ORT coverage from 2000 to 2017. Although ORS was uniformly distributed subnationally in some countries, within-country geographical inequalities persisted in others; 11 countries had at least a 50% difference in one of their units compared with the country mean. Increases in ORS use over time were correlated with declines in RHF use and in diarrhoeal mortality in many locations, and an estimated 52 230 diarrhoeal deaths (36 910–68 860) were averted by scaling up of ORS coverage between 2000 and 2017. Finally, we identified key subnational areas in Colombia, Nigeria, and Sudan as examples of where diarrhoeal mortality remains higher than average, while ORS coverage remains lower than average. Interpretation: To our knowledge, this study is the first to produce and map subnational estimates of ORS, RHF, and ORT coverage and attributable child diarrhoeal deaths across LMICs from 2000 to 2017, allowing for tracking progress over time. Our novel results, combined with detailed subnational estimates of diarrhoeal morbidity and mortality, can support subnational needs assessments aimed at furthering policy makers' understanding of within-country disparities. Over 50 years after the discovery that led to this simple, cheap, and life-saving therapy, large gains in reducing mortality could still be made by reducing geographical inequalities in ORS coverage. Funding: Bill & Melinda Gates Foundation.
Keywords	Public aspects of medicine ; RA1-1270
Subject code	310
Language	English
Publishing date	2020-08-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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