Trend and geographical inequality pattern of main health indicators in rural population of Iran

Despite the valuable information contained in the Vital Horoscope in regard with monitoring and evaluation of Iranian health system performance, few in-depth analyses of this information are available. We carried out this study to assess the time trend as well as the inequality pattern of health indicators in rural population of Iran applying the information derived from the Vital Horoscope in an in-depth analysis. Values of nine main health indicators were extracted from the official annual reports of Deputy for Health from 1993 to 2005. We predicted their values for 2006 and 2007 using linear regression and fractional polynomial regression models, and then analyzed the time trends of indicators’ changes. In addition, indicators were standardized with z score method, geographical map of indicators’ distributions were developed for two time bands of 1996-2000 and 2001-2005, and pattern of inequality was analyzed. Under-5 Mortality Rate (U5MR), Infant Mortality Rate (IMR), and Neonatal Mortality Rate (NMR) have had a decreasing trend during the recent 13 years. However, NMR reduction gradient (b =-0.26) was less than that for U5MR (b =-1.60) and IMR (b =-1.16). Percentage of deliveries attended by unskilled persons has decreased by 3.5 times and Maternal Mortality Rate (MMR) has reduced from 47 to 32 deaths per 100,000 live births. Inequality pattern of the former indicator has tended to more homogeneity among the provinces in the latter time band. Proportion of newborns with birth weight less than 2500 grams has increased from 2.9% to 4.6% and has been the only indicator whose average national values has had undesirable increase. Total Fertility Rate (TFR) and family planning coverage have had an appropriate improvement during 1990’s but had a relative plateau thereafter and will have no significant changes by 2007 according to the prediction. Inequality pattern of fertility indicators has had a very negligible change among the provinces, but TFR has somehow tended to more homogeneity among the provinces. Our findings indicate an acceptable improvement in many of the health indicators in rural areas of Iran during the recent 1-2 decades. On the other hand, despite the inequality decrease in some of the indicators in recent years, still inequality remains as the chronic and main problem of rural health system in Iran.