فهرست مطالب

Health Scope - Volume:7 Issue: 3, 2018
  • Volume:7 Issue: 3, 2018
  • تاریخ انتشار: 1397/05/22
  • تعداد عناوین: 16
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  • Sakineh Dadipoor, Ali Ramezankhani, Teamur Aghamolaei, Fatemeh Rakhshani, Ali Safari, Moradabadi * Page 1
    Objective
    This systematic review and meta-analysis was conducted to assess the level of health literacy (HL) in the Iranian population. Data Sources: Persian and English-language articles were identified through Embase, MEDLINE, CINAHL, PsycINFO, SID, Web of Science, and hand-searching (search dates for articles on health literacy, 1990 to February 2016). Study Selection: Two reviewers independently selected studies that directly measured health literacy levels. Data Extraction: Abstracted article information were categorized into evidence tables by one reviewer; information accuracy was checked by a second reviewer. Two reviewers independently evaluated the study quality by using predefined inclusion criteria, and jointly the overall strength of evidence evaluated by the research team.
    Results
    Twenty-eight relevant good- or fair-quality studies amongst 102 articles were identified, and 44 publications were assessed in full text. The researchers excluded 16 studies: Nine were reports with inadequate results and seven had low quality. Results of meta-analysis showed that better level of HL existed among 66 adults (62.47 to 69.53), 61.62 patients (53.40 to 69.84), 58.88 female (51.68 to 66.07), and 40.98 elderly (17.71 to 64.26).
    Conclusions
    Health Literacy of the Iranian population was inadequate and borderline. Therefore, the need to increase awareness and intervention to reduce poor HL in the Iranian population is crucial.
    Keywords: Health Literacy, Health Literacy Questionnaire, Iranian Population, Systematic Review
  • Majid Nozari, Mansooreh Dehghani, Ali Asghar Ebrahimi, Mohammad Reza Samaei * Page 2
    Background
    Contamination of soil with organic pollutants is one of the most important environmental challenges. Bioremediation is a simple and economical method for treatment of hydrocarbon-contaminated soil.
    Objectives
    The purpose of this study was to investigate the simultaneous bioremediation of n-hexadecane and n-dodecane from soil in an S-SBR using two types of bacterial consortium isolated from oil contaminated soils and compost.
    Methods
    In this study, S-SBR reactor was used at a pilot scale. For polluting the soil, agricultural soil was used. The n-hexadecane and n-dodecane were analyzed with GC-FID. Two microbial consortiums type A (Acinetobacter radioresistence, Bacillus subtilis and Pseudomonas aeruginosa) and type B (Ochrobactrum oryzae, Bacillus sp. and Sphingomonas yanoikuyae) were used. Type A and B were isolated from soil and compost, respectively.
    Results
    Maximum simultaneous bioremediation of n-hexadecane (17.61%) and n-dodecane (28.55%) was done by consortium type A. The maximum simultaneous bioremediation of n-hexadecane and n-dodecane by consortium type B was 13.22% and 19.24%, respectively.
    Conclusions
    The findings of this study showed the simultaneous bioremediation of n-hexadecane and n-dodecane in an S-SBR using two types of the bacterial consortium (type A and B) during a three-day period was relatively satisfactory. Hydrocarbon removal by bacteria isolated from polluted soils was more than bacteria that had been isolated from compost.
    Keywords: Petroleum Pollution, Soil Pollutants, Microbial Consortia, Hydrocarbons
  • Mohammad Javad Jafari, Gholam Abbas Shirali, Soheila Khodakarim, Hassan Khademi Zare, Reza Jafari Nodoushan * Page 3
    Background
    Resilience engineering is a new approach for safety management. The purpose of this paper was to determine indicators constructing organizational resilience as an important part of overall resilience.
    Methods
    This was a qualitative study. The data collection method was semi-structured interviews as well as the discussion group method. The data were analyzed with conventional qualitative content analysis.
    Results
    Overall, 232 primary codes were classified in 81 sub-indicators and 11 indicators. Eleven indicators were as follows: management commitment, performance management system, flow of information/communication, involvement culture, error management system, education, preparedness, flexibility, innovation culture, change management, and human resource management.
    Conclusions
    Refineries and other firms are recommended to evaluate the situation of any identified indicators, therefore, they can promote the level of resilience by improving any indicator.
    Keywords: Organizational Resilience, Indicator, Sociotechnical Systems, Refinery, Qualitative Study
  • Fatemeh Setoodehzadeh, Arash Rashidian *, Sara Emamgholipour Sefiddashti Page 4
       
    Background
    Before the revolution, the gap between rural and urban areas of Iran was enormous and the socio-economic condition in rural areas was substantially different from the condition of their urban counterparts. Over the past 35 years, the Islamic Republic of Iran has made a considerable investment in infrastructures to reduce inequalities between rural and urban areas. Therefore, we evaluated the regional status of health infrastructure development between 1976 and 2011 in rural and urban areas.
    Methods
    We selected piped water, electricity, piped gas, bathrooms, and health houses as the investigated variables. We used the national population and housing data in Iran obtained in 1976, 1986, 1996, 2006, and 2011, as well as the health house census data. We constructed variables for consistent geographic areas in STATA software. The share of the variables was calculated at the county level and the mean and standard deviation was calculated at the provincial level.
    Results
    The gap between rural and urban areas and between different regions of the country was great in access to piped water and electricity in 1976 before the Islamic revolution. In addition, the speed of health houses construction was very slow and households of urban and rural areas did not have piped gas, at all. Between the 1986 and 1996 census, infrastructure variables, except piped gas, experienced a good improvement, especially in rural areas. After the war, the ascending trend continued with a higher speed so that the gap between rural and urban areas decreased sharply.
    Conclusions
    Although involved in a war with Iraq between 1980 and 1988, Iran had a great development in infrastructure variables. In that period, simultaneously several voluntary organizations began their activities in the rural areas; therefore, the sharp progress could be a result of these activities. Although the gap between rural and urban areas has decreased over time, inequity between provinces still is high and this issue calls for more attention.
    Keywords: Infrastructure, Development, Revolution
  • Ali Zafarzadeh *, Hadi Rahimzadeh, Amir Hossein Mahvi Page 5
    Background
    Nowadays, the heavy metals pollution is increasing and the accumulation of these metals in food has posed adverse effects on humans such as inducing various kinds of cancer and non-cancer diseases. The Northeast of Iran, especially Torkman Sahra, has the maximum number of patients with esophageal cancer.
    Objectives
    We investigated the levels of four heavy metals (Zn, Cd, Pb, and Cu) in cucumber and tomato samples in Golestan province, an endemic esophageal cancer region. We evaluated the levels and potential health risks of heavy metals in vegetable samples of Northeastern Iran.
    Methods
    The heavy metal content of the samples was determined by polarography methods. All sample preparation and digestion procedures were carried out according to the Standard Methods for the Examination of Water and Wastewater, 20th Edition.
    Results
    The results showed that Cd and Pb concentrations in cucumber and tomato were estimated to be respectively 2.4 to 14.4 and 1.6 to 7 folds higher whereas Zn and Cu levels were lower than the maximum permissible limit for vegetables. The amounts of Pb intake through the consumption of these vegetables were determined more than the provisional tolerable daily intake. The total non-cancer and cancer risk results indicated that the investigated region was relatively unsuitable for growing the vegetables in the view of the risk of the elevated intakes of heavy metals adversely affecting food safety for consumers. Pb was the heavy metal posing non-cancer risks while Cd caused the greatest cancer risk.
    Conclusions
    It was concluded that due to the toxic effects of cadmium and lead, we should be more serious to reduce pollution levels in this region.
    Keywords: Risk Assessment, Heavy Metals, Cancer, Vegetables, Iran
  • Husam Al Najar *, Ayah Ghourab, Reham Eid, Hanady Farhouda Page 6
    Al-Shifa medical complex is one of the most famous medical complex in the Gaza Strip. Since 1946 it was expanded many times, nowadays, the total clinical capacity has 564 beds on an area of 42,000 m2. The main aim of the current research is to characterize the medical wastewater in the Gaza Strip. Currently, wastewater from hospitals is discharged to the public network then to overloaded central wastewater treatment plants, where partially treated effluent is infiltrate to the groundwater and the majority discharged to the sea. Composite samples from different sectors of the complex are collected every two hours for 24 hours and analyzed for physical and chemical characteristics. The pH from different medical sectors showed an acceptable range for disposal to the public network, while the salinity was extremely high and differs from sector to another. The Surgery department recorded the highest wastewater pollution i.e. TSS, BOD, and COD accounted for 3008, 1150, and 5350 mg/L, respectively, while the highest TKN (117 mg/L) was from the surgery operation room. Heavy metals such as Cd, Zn, and Pb in the medical wastewater from Al-Shifa medical complex do not constitute a threat to public wastewater sewerage system, mostly below the detection limits. It is highly recommended to further investigate the causes of strong pollution from both the surgery department and surgery room to propose pretreatment before disposal to the public network. Microbiology and infectious diseases and radioactive pollution should be considered in future planned research to gain comprehensive medical waste characteristics in the Gaza Strip.
    Keywords: Wastewater, Heavy Metals, Hospital, Effluent
  • Samin Arbabi, Farzad Firouzi Jahantigh *, Somayeh Ansari Moghadam Page 7
    Background
    Artificial neural networks (ANNs) can be used in various medical cases due to their high performance in learning the relationship between variables. Periodontal diseases are common oral infectious diseases that can cause tooth loss, if not treated.
    Objectives
    The current study aimed at evaluating the role of ANNs in periodontal disease diagnosis.
    Methods
    The data were collected from 190 periodontal disease cases in Zahedan dentistry school from 2015 to 2016. Five variables including age, gender, plaque index, probing pocket depth, and clinical attachment loss index were evaluated. The patients were divided into two groups of training (n = 160), and testing (n = 30). In the current study model, two Levenberg-Marquardet (LM) and scaled conjugate gradient (SCG) algorithms were used, and the results were compared in terms of the number of iterations and the mean square error (MSE).
    Results
    The obtained results showed that the LM algorithm with fewer iterations and a minimum MSE, had a better performance than the SCG algorithm.
    Conclusions
    ANNs can be used with low error as an effective tool to diagnose periodontal diseases.
    Keywords: Periodontal Disease, Clinical Attachment Loss, Diagnosis, Artificial Neural Network, Levenberg-Marquardet Algorithm, Scaled Conjugate Gradient Algorithm
  • Alireza Rahmani, Mojtaba Davoudi, Fatemeh Nazemi, Fateme Barjasteh, Askari * Page 8
    This study evaluated silica aerogel as an adsorbent for phenol removal from aqueous solutions. Silica aerogel was prepared through the sol-gel process and characterized by different analyses. Then, it was used for phenol removal under various conditions of operational parameters. Also, twelve isotherm parameters were employed to describe the behavior of phenol-silica aerogel adsorption system. The chemical structural analysis confirmed -OH functional groups in amorphous SiO2 and proved the adsorption of phenol onto the surface of silica aerogel. The findings of the adsorptive behavior of silica aerogel toward phenol showed increasing pH, up to 8.5, and contact time, and adsorbent dose increased the phenol removal. The removal efficiency reached over 90% when phenol concentration was below 50 mg L-1. The reaction kinetics followed the pseudo-first order model. The isotherm study showed that equilibrium adsorption data were well-described by Freundlich and Halsey equations, among two-parameter isotherms, and Hill, Sips, and Koble-Corrigan, among three-parameter isotherms. Jovanovic and BET were the worst isotherm models for prediction of experimental equilibrium data. The maximum adsorption capacity of 75.23 mg.g-1 was calculated in phenol-silica aerogel adsorption system. The study showed silica aerogel as an efficient adsorbent to remove phenol from phenol-containing solutions.
    Keywords: Adsorption, Kinetics, Phenol, Silica Aerogel, Aqueous Solution
  • Santosh Kr. Karn *, Sharadhanshu Raj, Neha Khatkar Page 9
    Background
    The threat of heavy metals such as Cr and Pb is already known; they have serious negative effects on animal and human health and also persist for a long time in the environment, which is the reason they are frequently detected in soil and water and efforts are made to convert them to nontoxic forms and stabilize them.
    Objectives
    The current study aimed at finding an efficient organism with high transforming capability of Cr and Pb and well surviving ability to get back into the soil further, and adding biochar to stabilize the transformed metals.
    Methods
    The current study first dealt with Cr and Pb transformation by Aspergillus sp. in different concentrations and further applied to contaminated soil to treat contaminant, next untransformed metal from the soil was stabilized by bio-charcol amendment provided from Pistia stratiotes leaves.
    Results
    The obtained results demonstrated that Aspergillus sp. could transform 96% of Cr and Pb at 40 mg/L. At 80 and 100 mg/L, transformation was up to 87.22% and 74.87% for Cr and 76.52% and 68.12% for Pb by forming well biomass in malt extract medium. Further application to soil containing 20 and 40 mg/kg of Cr and Pb respectively, Aspergillus sp. minimized significant quantities of both metals in the exchangeable fraction; at 20 mg/kg there was almost no available form of metals, but at 40 mg/kg there was about 5 mg/kg of Cr and about 3 mg/kg of Pb, but in the control, exchangeable form contained almost the same concentration about 17 mg/kg and 38.6 mg/kg of Cr and 18.6 mg/kg and 38.3 mg/kg of Pb were found. Further biochar was applied to Aspergillus sp. treated soil and great impact was observed on the stabilization of metals and it also reduced the exchangeable fraction of metals.
    Conclusions
    Based on the obtained results, it can be concluded that the strains used in the current study efficiently transformed the metals and biochar successfully stabilized metal at greater extent in the soil. Therefore, it is suggested as a considerably important factor to treat metal contaminated sites in the environment.
    Keywords: Environment, Metals, Biochar, Soil, Aspergillus sp., Contaminated Sites
  • Maryam Nasirian, Samira Hosseini Hooshyar, Arezoo Saeidifar, Leila Taravatmanesh, Aboubakr Jafarnezhad, Sina Kianersi, Ali Akbar Haghdoost * Page 10
    Background
    Crosswise, as an indirect questioning method, is not applied to the general population. The current study aimed at assessing the feasibility of crosswise among Iranian general population to estimate the frequency of sexually transmitted infection (STI) symptoms.
    Methods
    To estimate the frequency of STI-associated symptoms among the general population of Kerman, Iran, in 2014, participants were inquired to specify whether their “yes or no” answers to a set of paired questions (sensitive/non-sensitive) were the same (concordance) or different (discordance). Based on the frequency of concordance response and known prevalence of positive response to non-sensitive questions, the frequency of positive responses to the sensitive questions was estimated. The estimations were compared with the results of a population-based survey, conducted at the same time and setting, in which participants directly responded to the sensitive questions.
    Results
    The current study recruited 128 people aged 18 - 60 years (50% male). The estimated frequency for genital ulcer in crosswise method was 53.1% and 34.9% in males and females, respectively. The estimated frequency of urethral discharge in crosswise method was 72.3%. The crosswise method outcomes were significantly different from those of the survey (P > 0.05).
    Conclusions
    The estimated frequency of STI-associated symptoms in crosswise was unexpectedly higher than that of obtained by the population-based survey. Hence, experts in the field of STIs did not accept the crosswise estimations. This overestimation could be a result of differences in the ability of people, with various socioeconomic levels, to understand conceptually how to answer the questions along with the influence of study setting and administration method of questionnaires on the participants self-reports.
    Keywords: Sexually Transmitted Disease, Prevalence, Ulcer
  • Mohammad Hajaghazadeh *, Roya Emamgholizadeh Minaei, Teimour Allahyari, Hamidreza Khalkhali Page 11
    Background
    Foot anthropometry will enhance the fit and comfort of shoes. There are limited published data on the foot anthropometry of Iranians. Therefore, this study aimed to collect foot anthropometric data in northwest Iran to compare dimensions between the two genders and also with the corresponding data from other populations.
    Methods
    A total of 21 dimensions of the right foot were measured in 290 males and 290 females using a digital caliper and a tape. Digital patterning and different percentile values were calculated. Independent t-test was applied to test the effect of gender on foot dimensions. Cohen’s d was computed to express the magnitude of dimensional differences between the participants of the current study and others.
    Results
    The absolute foot dimensions of males were significantly larger than those of females. After normalization to the foot length, however, some foot dimensions of females were found to be larger. The relative proportion of digital patterning of I and II were 78% and 22% respectively. Digital patterning and the main dimensions such as foot length and width were different among the participants of the current study and those of other populations, especially the East Asian communities.
    Conclusions
    The data of this study could be utilized by local footwear designers. In accordance with the relative foot dimensions, the female foot was not a scale-down of the male foot. Therefore, women’s data should be used in designing their footwear. Compared with other populations, the participants of this study had individual foot morphology, which should be considered in the design and import of footwear.
    Keywords: Anthropometry, Foot, Female, Male, Shoes
  • Ebrahim Pirasteh, Mehdi Akbari *, Akram Pourbakht, Amir Hosseini, Mohsen Bahadorifar, Milad Saliminezhad, Mehdi Mohammadi Page 12
    Background
    Recent epidemiological evidence indicates that the fetal environment can influence susceptibility to later disease during the lifespan. Prenatal stress exposure alters the programming of the metabolic and endocrine balance of various organs, including the auditory system.
    Objectives
    The current study aimed at evaluating how prenatal stress influences Auditory Brainstem Responses.
    Methods
    Eighteen pregnant Wistar rats were stressed during a one-month gestation by chronic mild stress (CMS, a variable schedule of different stressors). After birth, the offspring’s hearing thresholds and latencies were evaluated and compared with the control group. The hearing thresholds were assessed by recording auditory evoked brainstem responses to 4, 8,12, and 16 kHz tone burst.
    Results
    The results showed that although CMS caused a significant increase in corticosterone in pregnant mothers, the offspring with CMS experience had significantly lower body weight than control animals (P < 0.00) yet there was no difference between hearing sensitivity of prenatally stressed offspring and the control group. However, ABRs showed a marked prolongation in wave II and IV latencies in prenatally stressed rats (P < 0.05).
    Conclusion
    The current data confirmed that prenatal exposure to mild stress is not detrimental to hearing sensitivity. However, these data suggest that prenatal stress can affect the temporal processing of auditory stimuli in the brainstem.
    Keywords: Prenatal Stress, Hearing System, Auditory Brainstem Response, Rat
  • Masoomeh Goodarzi, Khoigani, Mohammad Hossein Baghiani Moghadam, Azadeh Nadjarzadeh, Farahnaz Mardanian, Hossein Fallahzadeh, Seyed Saeed Mazloomy Mahmoodabad * Page 13
    Background

    A great proportion of pregnant women gain weight above the recommendations of the Institute of Medicine (IOM), which is associated with adverse maternal and child health outcomes. We did not find any nutrition education intervention in this field and the available significant results are related to lifestyle trials. Thus, we examined the effect of a nutrition education intervention on gestational weight gain and adherence to IOM limits as the first study in this field. We surveyed the impact of the intervention on the birth anthropometric indices, as well.

    Methods

    192 pregnant mothers were recruited to this prospective randomized clinical trial from 15 health centers, five hospitals, and 15 private obstetrical offices in Isfahan. They were randomly divided into an intervention (n = 96) or a control (n = 96) group. Each woman met the same nutritionist at the time of enrollment for nutrition assessment and an individualized nutrition intervention plan was developed. Then, the nutrition education intervention including three 45 - 60 min training sessions at 6 - 10, 18, and 26 weeks of pregnancy was performed.

    Results

    The proportion of excessive gestational weight gain (GWG) during pregnancy decreased in the interventional group (27.9% vs. 46.0%, P = 0.01). In addition, the mean of total GWG in the intervention group decreased significantly compared to the control group (13.11 ± 3.95 vs. 15.37 ± 5.16, P = 0.001). The nutrition education intervention did not decrease the mean of birth weight, length, and head circumference in the intervention group compared to the control group (P > 0.05).

    Conclusions

    Nutrition education considering the national comprehensive guidelines is effective to prevent excessive GWG and control GWG without adverse effects on the birth size.

    Keywords: Knowledge, Self-Efficacy, Weight Gain, Nutritional Status, Pregnancy
  • Masoud Maleki, Mahdi Yousefi, Sayyed Abolghassem Sajadi Tabassi, Hassan Rakhshandeh, Sayyed Mojtaba Mousavi Bazzaz, Gholamreza Haghighi *, Shokouh Sadat Hamedi, Sayyed Abdolrahim Rezaee, Fatemeh Haghighi Page 14
    Background
    Despite numerous studies aimed at finding a new treatment for cutaneous leishmaniasis (CL), glucantime remains the first-line approach. Side effects, drug resistance, and high cost are the challenges of glucantime treatment. A simple treatment method with the fewest side effects, minimum cost, and maximum efficacy is ideal. In Iranian traditional medicine (ITM), dry CL lesions are categorized as rashes, and for treatment, corrosive and keratolytic agents should be used, including garlic. The current study was conducted to assess the effects of an ITM treatment on CL. Methods and Results: In this experimental study, 10 patients with 20 dry CL lesions received treatment based on ITM. For this purpose, some garlic poultices were used. The mean age of the patients was 36.2 years, and the average bout was nearly four months. Based on the findings, garlic poultices could treat all dry skin lesions completely during 14 days. Also, after 40, 70, 100, and 190 days of follow-up, 95% of cases were completely treated. On the 70-day follow-up, a nodule with negative direct smear and PCR results recurred in one patient. Overall, the applied treatment was cost-effective with no systemic side effects.
    Conclusions
    Garlic poultices can be used as an alternative for glucantime. Topical use, shorter course of treatment, and lower number of applications, side effects, and treatment cost are the main advantages of this regimen. We suggest similar multi-centered clinical trials with a larger sample size to further evaluate this treatment regimen.
    Keywords: Dry Cutaneous Leishmaniasis, Treatment, Garlic, Iranian Traditional Medicine
  • Paria Amirian, Edris Bazrafshan *, Abolfazl Payandeh Page 15
    This study examines the efficiency of photodegradation process (color and COD removal) in textile wastewater treatment, using copper oxide nanoparticles (CuO-NPs) as photocatalyst to propose a suitable alternative for the available approaches. The experiments were developed, using a central composite design and response surface methodology (RSM). RSM was applied to evaluate the effects of different variables, including pH, CuO- NPs concentration, reaction time, and UV light intensity, as well as their interactions for achieving optimal conditions. The second-order model consisted of linear and quadratic terms, which seemed appropriate for color and COD removal. All the variables showed significant effects on color and COD degradation. The optimal conditions for maximum color degradation (83%) included pH of 6.9, contact time of 60 min, CuO- NPs concentration of 0.05 g/L, and UV light intensity of 30 W. In addition, the optimal conditions for maximum COD reduction (99%) were pH of 6.8, contact time of 60 min, CuO-NPs concentration of 0.02 g/L, and UV light intensity of 30 W. Based on the results of this study, CuO-NPs can be used for effective treatment of textile wastewater by high COD and color removal.
    Keywords: Textile Wastewater, Photocatalytic Degradation, Cuo Nanoparticles, Response Surface Methodology
  • Nasrin Derakhshanzadeh, Manoochehr Karami, Rashid Heidarimoghadam, Younes Mohammadi * Page 16
    Background
    Child mortality rate (CMR) is one of the most important health and socio-economic indicators and one of the targets for sustainable development goals to be achieved by 2030. However, due to incomplete registration of deaths in most of the developing countries there is limited knowledge on child mortality.
    Objectives
    The current study aimed at indirectly estimating the trend of CMR in Sistan and Baluchistan Province of Iran using summary birth history (SBH) method.
    Methods
    The SBH data were extracted from censuses 1986, 1996, 2006, and 2011 and demographic and health survey (DSH) 2000. The collected data were analyzed using maternal age cohort (MAC) and maternal period (MAC) methods. These two estimates were smoothed using Loess regression. Finally, the final trend of CRM (with an uncertainty level of 95%) was obtained using Gaussian process regression (GPR).
    Results
    Trend of CMR in Sistan and Baluchistan Province had a decreasing trend from 1962 to 2015; the rate of CRM was 336 per 1000 live births (95% confidence interval (CI): 306 - 366); it was 247 (95% CI: 264 - 279) and 182 (95% CI: 177 - 187) per 1000 live births in 1970 and 1980, respectively. Moreover, CRM in 1990 was 115 (95% CI: 114 - 118) per 1000 live births and in 2000 it reached 67 (95% CI: 66 - 70) per 1000 live births. In 2005, CMR in Sistan and Baluchistan Province was 50 (95% CI: 48 - 53), while it reached 35 (95% CI: 31 - 40) per 1000 live births in 2010 and 22 (95% CI: 17 - 29) per 1000 live births in 2015. Based on the results of analysis of annual reduction rate (ARR), the median ARR during 52 years was approximately 5%.
    Conclusions
    The results of the current study showed that the survival of children in Sistan and Baluchistan Province considerably improved during 53 recent years and achieved the MDG 4, as CMR reduced by over two-thirds. Nevertheless, according to sustainable development goals (SDG), CMR should be decreased further in the years to come in Sistan and Baluchistan Province to reach a favorable level.
    Keywords: Child Mortality Trends, Infant Mortality Trends, Iran