Iranian Journal of Public Health
Volume:48 Issue: 1, Jan 2019

This study aimed at estimating the incidence, mortality, burden, and geographical distribution of HIV/AIDS in Iran at national and provincial level during 2008-2016. We applied the Disability Adjusted Life Years (DALYs) index to assess the burden of HIV/AIDS on the basis of Years of Life Lost (YLLs) and Years Lived with Disability (YLDs). We used the Iranian life table of 2016 for treated and a fixed figure of 8 years as remaining length of life in untreated patients, 0.03 as discount rate, and 0.504 as disability weigh in both treated and untreated cases. The primary data was obtained from HIV/AIDS surveillance system. The incidence of HIV/AIDS increased from 4440 cases in 2008 to 4928 cases in 2016. The mortality rate was 259 and 288 cases in 2008 and 2016, respectively, which was always higher among males than females. The burden of HIV/AIDS increased from 26231 DALYs in 2008 to 29114 DALYs in 2016. In addition, the population-adjusted burden of HIV/AIDS was not equally distributed among different provinces of Iran, and it was more concentrated in western regions of the country during the studied period. Although the trend of the national burden of HIV/AIDS did not change significantly over the past decade, it was alarming especially among males and among people living in some provinces such as Ker-manshah, Lorestan, Hormozgan, and Tehran.

This study aimed at estimating the incidence, mortality, and burden of Hepatitis B (HBV) and Hepatitis C (HCV) viruses and their trends from 2008 to 2015. The Disability Adjusted Life Year (DALYs) index was applied to calculate the burden of the diseases by age, sex, time, and locations. The incidence and demographic data were obtained from HBV and HCV sur-veillance system, and the data on natural history was extracted from the cohort studies; moreover, the data on the standard life expectancy was obtained from the Iranian life table 2016. The two values of 0.03 and 21.5 yr were set as the discount rate and mean standard duration of the disease for both types of hepatitis. The burden of HBV decreased from 13735 to 78277.6 yr, but there was an increase in the burden of HCV from 5174 to 14395 yr over the studied period. The burden of both types of hepatitis was higher among males than females. The incidence of HBV increased from 46611 to 22996 cases, and the incidence of HCV increased from 1210 to 3939 cases. The HBV decreased from 1925 to 1394 cases; however, the number of deaths caused by HCV increased from 197 to 583 cases over the studied period. The share of YLLs raised from 5% to 10% for HBV whereas it changed from 23% to 62% for HCV over the studied years. Tehran, Khorasan Razavi, and Golestan had the highest and Chaharmahal and Bakhtiari, Kurdistan, and Kermanshah had the lowest adjusted burden of HBV per 1000 population. Although the incidence, mortality, and burden of HBV declined over the eight studied years, these values increased dramatically for HCV.

Human brucellosis is the most common zoonotic disease worldwide. This study aimed at esti-mating the incidence, mortality, and burden of human brucellosis as well as its distribution in Iran from 2009 to 2015. Disability Adjusted Life Years (DALYs) index was used to estimate the burden of human brucello-sis. To calculate DALYs, years lost due to disability (YLDs) was added to years of life lost due to premature death (YLLs); they were calculated based on the Global Burden of Disease (GBD) formula recommended by the WHO. The data on incidence and mortality were collected from the national surveillance system of brucel-losis disease in the Center for Communicable Diseases Control (CCDC), Ministry of Health and Medical Edu-cation (MOHME), expert panels, and related literature. There is an increasing trend in human brucellosis-related DALYs (34.6 per 100,000 in 2009, and 71.4 per 100,000 in 2015), incidence (88450 in 2009, and 198030 in 2015), and mortality (244 in 2009, and 578 in 2015) from 2009 to 2015. Human brucellosis-related DALYs, incidence, and mortality were higher among males than females. About 51% of DALYs was attributed to YLLs. The burden of human brucellosis disease was not equally distributed among all provinces of Iran and it was largely concentrated in a number of provinces. Burden of human brucellosis is significantly high in Iran, and it has also increased during the re-cent years. It is alarming for health system managers and policymakers, and they are recommended to pay more attention to this issue.

Iran is among the first six countries in the world with the highest annual incidence of cutaneous leishmaniasis. This study aimed at estimating the incidence, burden, and trend of cutaneous leishmaniasis at the national level in Iran from 1977 to 2015. This study was conducted in 2017, used Disability Adjusted Life Years (DALYs) index, recom-mended by the WHO for assessing the Global Burden of Diseases, to estimate the burden of cutaneous leish-maniasis. The data on the incidence of the disease and the number of cases was obtained from the communi-cable diseases surveillance system (Center for Communicable Diseases Control (CCDC), Ministry of Health and Medical Education (MOHME) of Iran) that routinely collects data from all over the country; in addition, some data was extracted by reviewing the texts. Considering the views expressed in a panel of experts, to calcu-late the actual incidence of the disease, the number of registered cases was multiplied by 5. The incidence of cutaneous leishmaniasis varied from approximately 50 to 250 cases per 100,000 population during the studied period. During these years, the incidence of the disease was higher in males than females. Moreover, the burden of cutaneous leishmaniasis varied between 1.18 and 5.7 DALYs per 100000 population during the studied period. The incidence and burden of cutaneous leishmaniasis have not signifi-cantly decreased in recent years. Despite the implementation of a program for controlling cutaneous leishmaniasis in Iran since 1977, the incidence and burden of the disease are still high in the country; it is seriously alarming for policy makers and managers of the health system in Iran, indicating the presence of some problems in controlling the disease.

Diarrhea is a major cause of public health burden, especially in children under 5 yr of age. This study aimed at estimating the incidence, mortality, burden, and geographical distribution of Acute Watery Diar-rhea (AWD) in Iran from 2009 to 2016. This study was conducted in 2018. The data on the incidence and mortality from 2009 to 2016 was obtained from AWD surveillance system of the Centre for Communicable Diseases Control (CCDC), Ministry of Health and Medical Education (MOHME) of Iran. Disability Adjusted Life Years (DALYs) was used to estimate the burden of AWD. The DALYs-related AWD was calculated using a method developed by WHO. The average duration of the disease and its disability weight, respectively, were set at 5 d (0.0137 years) and 0.093 for all age groups. The incidence of AWD had an ascending trend over the studied period. Forty cases of deaths from AWD were reported. The lowest and highest burdens of AWD, respectively, were 436.1 DALYs in 2010 and 975.9 DALYs in 2015. The incidence and burden of AWD did not have an equal distribution across the coun-try, between the provinces. The incidence of AWD had an ascending trend over the studied period that can be attributed to the improvements in the disease surveillance system. Moreover, the incidence, mortality, and burden of AWD did not have an equal distribution in Iran. Hence, it is recommended to strengthen AWD surveillance system. In addition, it is suggested to adopt proper interventions for controlling the disease in areas with a high burden of AWD.

This study aimed at estimating the incidence, mortality, burden, and geographical distribution of Crimean Congo Hemorrhagic Fever (CCHF) using Disability Adjusted Life Years (DALYs) in Iran 2009-2015. CCHF-related DALYs was calculated using a method developed by WHO for the investigation of Global Burden of Diseases (GBD). DALYs was calculated through adding years of life lost due to premature death (YLLs) to years lived with disability (YLDs). To calculate YLD, the average duration of the disease and its disability weight were set at 25 d and 0.613, respectively. The data on the incidence and mortality were col-lected from the CCHF surveillance system from the governmental section. The highest and the lowest incidence rates of CCHF were observed in 2009 (122 cases) and 2010 (254 cases), respectively. Moreover, the lowest and highest mortality rates were reported in 2009 (20 cases) and 2012 (52 cases), respectively. The mean rate of fatality from CCHF observed between 2009 and 2015 was about 21.1%. In addition, the lowest and highest DALYs were observed in 2009 (483 cases) and 2010 (1156 cases), respectively. CCHF incidence, DALYs, and mortality rate over the studied period were higher among males than females. CCHF-related DALYs did not have an equal distribution in all provinces of Iran; some provinces were suffering from a higher burden of the disease. It is recommended to improve the CCHF surveillance system, identify high-risk areas, practice early diagnosis and intervention, develop vaccines, control, and fight tick, and screen livestock to control and prevent the spread of this disease.

This study aimed at estimating the incidence, mortality, burden, and geographical distribution of malaria between 2002 and 2015 in Iran. DALYs index was used to estimate the burden of malaria. DALYs-related malaria was calculated using a method developed by (WHO) for investigating the Global Burden of Disease (GBD); it was calculated through adding Years of Life Lost (YLLs) due to premature death to Years Lived with Disability (YLDs).The data on the incidence and mortality were collected from the malaria surveillance system in the Center for Com-municable Diseases Control (CCDC), Ministry of Health and Medical Education (MOHME). The incidence of malaria had a decreasing trend over the studied period and it reduced from 15378 cases in 2002 to 777 cases in 2015. Overall, 28 cases of mortality were observed between 2002 and 2015. In addition, disease burden decreased from 90.78 DALYs in 2002 to 22.38 DALYs in 2015.Overall, there were 949.2 DALYs due to malaria from 2002 to 2015. The incidence and burden of malaria were not equally distrib-uted among all the provinces in Iran and some areas were suffering from the highest burden of the disease. The incidence and burden of malaria have had a decreasing trend over the years of the study and Iran has little to do in order to eradicate malaria. Since the disease is not equally distributed among various provinces of Iran, health policymakers must direct health resources towards specific areas of the country (Sistan and Baluchistan, Kerman, and Hormozgan) with high concentration of cases of malaria.

Severe Acute Respiratory Infection (SARI) is responsible for mortality and hospital admissions in millions of people across the world. The present study, for the first time, aimed at estimating the incidence, mortality, and burden of SARI in Iran in 2015. Disability Adjusted Life Years (DALYs) was used as an index to estimate the burden of SARI. The SARI-related DALYs was calculated using a method developed by the WHO for assessing the Global Burden of Diseases. DALYs are calculated as the sum of the Years Lost due to Disability (YLDs) and the Years of Life Lost (YLLs) due to premature mortality. The data on the incidence and mortality were obtained from the SA-RI surveillance system of Iran's Ministry of Health and Medical Education. The average duration until remis-sion or death and the disease disability weight were set at four weeks and 0.373, respectively. In 2015, the incidence of SARI was 21309 and 20885 among males and females, respectively. Moreo-ver, 773 males and 737 females died from this disease (Case fatality rate was about 0.035). Total SARI-related DALYs in males and females was 17264 and 16720, respectively. Furthermore, YLLs was responsible for more than 96% of SARI-related DALYs in 2015. There was no significant difference between males and females in terms of the incidence, mortal-ity, and burden of SARI in 2015. Epidemiological data are required to adopt appropriate policies and responses to prevent and control SARI. The incidence, mortality, fatality, and burden of SARI are significant in Iran. It is necessary to develop appropriate strategies, such as vaccination against major pathogens of the disease at least in high-risk groups, strengthening the disease surveillance system, and attracting the attention of policy makers and health authorities of the country.