Assessing Health Inequalities in Iran: A Focus on the Distribution of Health Care Facilities

Abolhallaje, Masoud; Mousavi, Seyyed Meysam; Anjomshoa, Mina; Nasiri, Ali Beigi; Seyedin, Hesam; Sadeghifar, Jamil; Aryankhesal, Aidin; Vasokolaei, Ghasem Rajabi; Nasiri, Mahshid

doi:10.5539/gjhs.v6n4p285

Cited by 30 publications

(28 citation statements)

References 13 publications

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“…The results showed that the prevalence of each type of malnutrition, in terms of wasting, stunting and underweight were 7.8, 12.4 and 10.5 percent, respectively. One reason for the rather high overall prevalence of all three indicators in this review is that the majority of studies were conducted in the cities or provinces in which socioeconomic status was middle or low and we know that health and economic differences across Iranian provinces are very wide (22,23). The household socioeconomic status has been reported as one of the main factors of children malnutrition.…”

Section: Discussionmentioning

confidence: 98%

Prevalence of Malnutrition Among Iran’s Under Five-Year-Old Children and the Related Factors: A Systematic Review and Meta-Analysis

2018

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Context: Children's health is one of the priorities in most societies. Nevertheless, the highest prevalence rate of malnutrition occurs among under five-year-old children worldwide. Objectives: The aim of this study was to estimate the rate of malnutrition in Iranian children through a systematic review and meta-analysis. Also we tried to identify the most prevalent factors causing malnutrition. Data Sources: The required data were collected by searching the keywords of nutrition, malnutrition, under-nutrition, prevalence, epidemiology, etiology, occurrence and Iran in PubMed, Google Scholar, Scopus, Index Copernicus, DOAJ, EBSCO-CINAHL, SID, Magiran and Iranmedex. Results: Twenty studies were selected for the final analysis stage, dating from 1999 to 2014. Number of children investigated for wasting, stunting and underweight was 53612, 54312 and 55012 respectively. The results showed that the prevalence of each type of malnutrition, in terms of wasting, stunting and underweight were 7.8% (95% CI: 4.8%-12.6%), 12.4% (95% CI: 8.3%-18.5%) and 10.5% (95% CI: 7.1%-15.4%), respectively. Parents' educational level, in particular mothers', gender, birth weight, the place of residence, and mother's occupation were mentioned as important factors causing malnutrition. Conclusion: The rate of malnutrition in Iran's under five-year-old children is lower than the average of that in world and the Eastern Mediterranean region. Breastfeeding, the proper use of complementary feeding, and the principled spacing between births and improving the quality of maternal care have important role in prevention of malnutrition.

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Section: Discussionmentioning

confidence: 98%

Prevalence of Malnutrition Among Iran’s Under Five-Year-Old Children and the Related Factors: A Systematic Review and Meta-Analysis

2018

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“…Thus, people living in areas with an abundant supply of healthcare services are more prone to utilise those services (supplierinduced demand); by contrast, zones where healthcare provision is low may be subject to so-called supplier-suppressed demand (Rice and Smith, 2001). Spatial inequalities in healthcare provision occur in both developing countries (Kumar, 2004;Abolhallaje et al, 2014) and industrialised ones (Houghton, 2005;Perez and Decoupigny, 2009). Limited geographical access not only reduces the availability of pharmaceuticals but also limits recommendations regarding their use (Norris et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

Assessing spatial inequalities in accessing community pharmacies: a mixed geographically weighted approach

Domnich¹,

Arata²,

Amicizia³

et al. 2016

Geospat Health

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Geographical accessibility is an important determinant for the utilisation of community pharmacies. The present study explored patterns of spatial accessibility with respect to pharmacies in Liguria, Italy, a region with particular geographical and demographic features. Municipal density of pharmacies was proxied as the number of pharmacies per capita and per km 2 , and spatial autocorrelation analysis was performed to identify spatial clusters. Both non-spatial and spatial models were constructed to predict the study outcome. Spatial autocorrelation analysis showed a highly significant clustered pattern in the density of pharmacies per capita (I=0.082) and per km 2 (I=0.295). Potentially under-supplied areas were mostly located in the mountainous hinterland. Ordinary least-squares (OLS) regressions established a significant positive relationship between the density of pharmacies and income among municipalities located at high altitudes, while no such association was observed in lower-lying areas. However, residuals of the OLS models were spatially auto-correlated. The best-fitting mixed geographically weighted regression (GWR) models outperformed the corresponding OLS models. Pharmacies per capita were best predicted by two local predictors (altitude and proportion of immigrants) and two global ones (proportion of elderly residents and income), while the local terms population, mean altitude and rural status and the global term income functioned as independent variables predicting pharmacies per km 2 . The density of pharmacies in Liguria was found to be associated with both socio-economic and landscape factors. Mapping of mixed GWR results would be helpful to policy-makers.

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“…Yet in the health district of Sélingué, close to the national capital, with moderate geographic access to health services, there are clear disparities within the district. As noted in existing studies, the unequal distribution of healthcare facilities according his geographical accessibility in West African regions is rarely discussed [23][24][25][26]. The internal disparities identi ed in this paper provide insight into why some women still experience poor maternal healthcare utilization and access, despite living in moderate geographic access regions of Mali.…”

Section: Discussionmentioning

confidence: 81%

Geographic access and maternal health services utilization in Sélingué Health District, Mali.

Tounkara

Sangho

Beebe

et al. 2020

Preprint

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Introduction. Maternal mortality is one of the main causes of death for women of childbearing age in Mali, and improving this outcome is slow, even in high geographic-access regions. Disparities in maternal health services utilization can constitute a major obstacle in the reduction of maternal mortality and denotes a lack of equity in the Malian health system.Literature on maternal health inequity has explored structural and individual factors influencing outcomes but has not examined inequities in health facility distribution within moderate geographic access districts in Mali. The purpose of this article is to examine disparities in education and geographic distance and how they affect utilization of maternal care within the Sélingué health district, a district with moderate geographic access to care, near Bamako, Mali.Methods. We conducted a cross sectional survey with cluster sampling in the Sélingué health district. Maternal health services characteristics and indicators were described. Association between dependent and independent variables was verified using Kendall’s tau-b correlation, Chi square, logistic regression with odds ratio and 95% confidence interval. Gini index and concentration curve were used to measure inequity.Results. The majority of the participants were 20 to 24 years old. Over 68% of our sample had some education, 65% completed at least four ANC visits, and 60.8% delivered at a health facility. Despite this evidence of healthcare access in Sélingué, disparities within the health district impede the other roughly 40% of our sample from utilizing maternal healthcare. The concentration index demonstrated the impact of inequity in geographic access comparing women residing near and far from the referral care facility.Conclusion. Maternal health services underutilization, within a district with moderate geographic access, indicates that deliberate attention should be paid to addressing geographic access even in such a district.

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Assessing Health Inequalities in Iran: A Focus on the Distribution of Health Care Facilities

Cited by 30 publications

References 13 publications

Prevalence of Malnutrition Among Iran’s Under Five-Year-Old Children and the Related Factors: A Systematic Review and Meta-Analysis

Prevalence of Malnutrition Among Iran’s Under Five-Year-Old Children and the Related Factors: A Systematic Review and Meta-Analysis

Assessing spatial inequalities in accessing community pharmacies: a mixed geographically weighted approach

Geographic access and maternal health services utilization in Sélingué Health District, Mali.

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