مجله اپیدمیولوژی ایران
سال چهارم شماره 1 (پیاپی 9، بهار 1387)

Disability-Adjusted Life Years (DALY) summarizes the fatal and nonfatal outcomes of diseases and injuries in one number and gives a quantitative assessment of the health of a population. Estimating the burden of diseases and injuries in Iran in terms of DALY both nationwide and in 6 provinces. We used slightly modified versions of the methods developed by the World Health Organization for estimating the burden of premature mortality, disability, and the DALY. The DALY rate per 100,000 was 21572 and 62% of this was life lost due to premature mortality; the remaining 38% was due to disability from diseases and injuries. Fifty-eight percent of the total DALYs had been lost due to non-communicable diseases, 28% due to external causes (injuries), and 14% due to communicable, maternal/ perinatal and nutritional illnesses. The group of diseases and injuries with the highest burden in males waz intentional and unintentional injuries (2.789 million DALYs), while in the female population this position was held by mental disorders with 1.191 million DALYs. The single most important cause of burden was traffic accidents in males and ischemic heart disease in females. Disease burden showed considerable variability between different provinces. The profile of health and disease in Iran has generally shifted from the predominance of communicable, maternal/perinatal, and nutritional illnesses towards predominance of non-communicable diseases and injuries at the national level. These figures on disease burden at population level are the most objective evidence that can be used in policy making and management of health programs, health research, and resource development within the health sector.

Malnutrition is one of the main nutritional problems among children under 5 years especially in developing countries. The effects of malnutrition in this range of age group includes; disorder of mental and physical growth and development, increase in the morbidity and mortality, decrease of the learning capacity. A detailed epidemiological picture of the prevalent malnutrition status among children under 5 years in different regions of Iran enables health policy makers to identify priorities, establish political commitment and design appropriate interventional programs to prevent and control malnutrition and improve nutritional status of children. To determine the prevalence rate of malnutrition among children under 5 years. Demographic data, weight and height of 34200 Iranian children between 0-72 months old in 28 provinces of the country in 2005 year based on a cluster sampling were gathered. The subject's weight and height were measured by trained staff. Prevalence of underweight, stunting, and wasting indicators was determined by measuring the weight and height of subjects in urban and rural areas. EPI6 statistical software, version b6/04, was used for all statistical analyses. 4.7% of the children aged less than five years suffered from stunting (95% CI: 4.5- 4.9%) The prevalence of this type of malnutrition among urban children is significantly less than rural children (95% CI: 3.1- 3.5% and 6.5-7.1% respectively). Meanwhile the prevalence of underweight was 5.2% in the country (95% CI: 5.1-5.4% while the prevalence of this type of malnutrition was significantly less among urban children than those in rural ones. Moreover, the prevalence of wasting was 3.7% (95%CI: 3.5-3.9%) and there was a significant difference in this regard between the urban and rural children. Thus this indicator was significantly higher among urban children than those in rural areas (95%CI: 3.8-4.3% and 3.0-3.5% respectively). The results of the study show that the prevalence of protein-energy malnutrition was low among Iranian children under five years old. In comparison with previous studies, it is felt that there has been a prudent decrease in all malnutrition in all levels. However, there were significant differences in the prevalence of malnutrition in different provinces, which has resulted in the differences in their developmental stages as well. It appears that subjective strategies are required to improve the nutritional and health status among children under five in all provinces.

Children are highly vulnerable to TB and childhood tuberculosis is a sign of TB transmission in community. This study aimed to determine the epidemiologic trend of this disease in Iranian children. A Trend Study was conducted to evaluate all Iranian patients aged below 14 who had been diagnosed with pulmonary or extrapulmonary TB from 1992 to 2005. Statistical relationships were tested using chi square tests (c²) and the software package SPSS (version 11.5). Out of the 6168 cases studied, 2528 (40.1%) were boys. Patients were assigned to three groups based on disease type: there were 1812 (29.4%) sputum- positive, 1920 (31.1%) sputum-negative, and 2449(39.7%) extrapulmonary cases.The incidence of sputum-positive TB declined from 0.8 per 100000 in 1992 to 0.2 per 100000 in 2005. A similar declining trend was observed for the overall TB incidence and in the incidence of sputum-negative and extrapulmonary cases. There was significant difference in TB incidence between girls and boys in the 10-14 year age group (P<0.001), but no sex difference was observed in 0-4y and 5-9y age groups. The incidence of sputum-positive TB decreased by 75 percent over the study period. This could be partly due to improvements in health status, better disease knowledge and the effects of Iran's National TB Control Program. In children aged below 10 years, there was no significant difference in the incidence of tuberculosis between girls and boys. At puberty, the incidence of all types of TB was higher in girls. Based on these findings, further studies are needed to elucidate the gender distribution of childhood tuberculosis in Iran.

Cardiovascular disease is the leading cause of death worldwide and is predicted to retain this position until 2020. The aim of the present study was to map cardiovascular mortality rates in Kerman Province counties during 2004-2005. In this descriptive study we collected all mortality data registered in various counties of Kerman Province. We calculated mortality rates and drew maps showing the geographical distribution of the dead cases. Total cardiovascular mortality was higher in the northern counties. The pattern is the same in males and females The reasons for higher mortality in the northern regions of the province may include a greater prevalence of major cardiovascular risk factors such as physical inactivity, unhealthy diets, and smoking.

Anemia is one of the most common disorders affecting all age groups. This cross-sectional study aimed to determine the prevalence of anemia and microcytic anemia in the population served by Asadabadi Health Center in Tabriz. We used a systematic sampling method to select 1623 subjects out of a total of 233000 persons aged above 12 years. Measurements of hemoglobin, MCV (Mean Cell Volume) and in the case of anemia, serum iron, ferritin, TIBC (Total Iron Binding Capacity), together with hemoglobin electrophoresis and reticulocyte count were performed in reference laboratories. Data were analyzed using T tests and the Epi6 software package. The prevalence rate of anemia was 9.7%; more than 75% of the cases were due to iron deficiency, while 11.4% were caused by minor thalassemia. Prevalence rates for iron deficiency anemia and minor thalassemia in studied population were 7.3% and 1.1% respectively. Findings show that the degree of anemia- as defined in the WHO classification- is mild in this region. The most common cause of anemia is iron deficiency.

Rabies is one of the oldest and most lethal zoonoses in the world. Cases have been reported from most provinces of Iran, involving both domestic and wild animals. This study aimed to define the epidemiology of rabies in human and animal populations in the western province of Ilam and was conducted in all of the 7 cities of the province. In this descriptive study we recorded data on the number of the persons bitten by animals, geographical location, age category, occupation and professional relationships, pre-exposure prophylaxis, treatment for rabies, conditions of the injured organs, and the mortality rate. Data were analyzed using the SPSS software package. There were 4 human deaths from rabies in this province (2 men and 2 women); three of these cases had been bitten by dogs and the remaining one by a cat. The mean age of these people was 25.2 years (SD=15.3y). A total of 2431 people had been bitten by animals over the preceding 10 years. Most such injuries happened in the 10-29y age group and the frequency was greater for males (P<0.01). About 64% of all cases had been reported from rural areas, and the greatest number of injuries occurred in winter and spring. The most common sites of injury were hands and feet (88.5%), trunk and the cervical region (9.3%) and head/ face (2.2%). The increasing number of stray dogs and the movement of dogs and wild animals into cities and villages are important factors in the transmission of rabies. More research needs to be done on the eco-epidemiology of the disease in different cities of Ilam.

In Iran, cutaneous leishmaniasis (CL) as a health problem is increasing and presenting two epidemiological forms; Zoonotic CL (ZCL) and anthroponotic CL (ACL). The objective of the present study was to introduce the CL epidemic in Baft district, Kerman province. This study was conducted in 3 villages; Soltanabad, Vakilabad and Shahmaran as a census between spring and autumn of 1998 in Orzoeihe region, Baft district. Various epidemiological aspects of this epidemic including prevalence and related demographic factors, diagnosis by direct smears, identification of the causative species by immunological and biological methods were determined. Population of the 3 villages was 13721; mean 21.8±13.9 years, 50.7% males and 49.3% females.. The prevalence rate of 12.3% with mean age of 16.3±12.1 years were infected. Most of the cases were in 10-20 years of age and in Soltanabad (30.6%). The mean number of lesions was 2.58, majority with ≥2 lesions, frequently located on the legs and hands. No previous history of CL scar were observed. All 100 IFAT, 30 ELISA tests and 18 inoculated mice showed L.major as the overall causative agent. This is the first epidemic of CL occurred in the southern villages of Baft district with high severity in all age and sex groups in a new agricultural region. Probably the source of infection was the new comers who arrived the region from endemic areas for agricultural purposes and infecting the gerbils. Thus, this new agricultural development has created an extraordinary suitable condition for propagation of rodents and sand fly populations, then the occurrence of the new epidemic in rural residence, consequently.

The case-crossover design was developed in the early 1990s to study the effects of transient, short-term exposures on the risk of acute events such as myocardial infarction. To estimate relative risk, the exposure frequency during a period just before outcome onset (hazard period) is compared with exposure frequency during control time(s) in that person rather than in a control. One or more "control times" are supplied by each of the cases themselves to control for confounding by constant characteristics and self-confounding between the trigger's acute and chronic effects. In the analysis of case-crossover studies, exposure frequency in the hazard period is compared with the control period or the individual's usual frequency of exposure. The design has been used frequently for heart diseases, injuries and air pollution epidemiology. This review article looks at published case-crossover studies and is intended to help the reader gain a better understanding of the strengths and limitations of the case-crossover design in studying the epidemiology of injuries and air pollution.