Iranian Journal of Epidemiology

Estimation of the Incidence of Abortion in Women of Reproductive Age 18-54 in Kerman City in 2022-2023

2025-10-26T11:16:51+00:00

Background and Objectives: Abortion is a significant health and social issue in Iran, which affects women's physical and mental health, as well as population growth rates. This study evaluated and compared direct and indirect estimates of abortion incidence and its associated factors among women of reproductive age in Kerman, Iran.

Methods: This cross-sectional study estimated the incidence of abortion using direct and indirect methods (Proxy network Scale-Up Method). In the direct method, 471 women aged 18-54 were interviewed about their personal experiences with abortion. In the indirect method, 450 women provided information about abortions within their close social networks. The number of abortions reported by each individual was divided by the corresponding person-time to estimate the incidence rate using the direct method. The number of abortions reported within the social network was divided by the size of each individual’s close network population for the indirect abortion incidence estimation.

Results: The annual abortion incidence is estimated indirectly at 62 per 1,000 women of reproductive age (95% CI = 52, 73), with 57% attributed to spontaneous abortion and 43% to induced abortion. Factors such as more children, higher socioeconomic status, and an educated spouse were associated with increased abortion rates.

Conclusion: The occurrence of abortion in Kerman, as in the rest of the country, was a serious health issue. The underlying and root causes should be addressed to manage it more effectively. And it should be noted, more than half of these abortions are spontaneous, meaning that there are inherent limitations in reducing the number of abortions even with optimal management.

Determinants of Dental Care Utilization for Children Under Six: A Study Based on Andersen’s Behavioral Model

2025-10-26T11:17:07+00:00

Background and Objectives: Timely use of dental services in early childhood plays an essential role in maintaining the health of primary teeth and preventing complications related to jaw development, nutrition, speech, and mental well-being. Regular dental visits help prevent early childhood caries and its consequences. This study aimed to evaluate factors influencing the use of dental services for primary teeth from parents’ perspectives, based on Andersen’s Behavioral Model.

Methods: This descriptive-analytical cross-sectional study was conducted in 2023 among 395 parents of children under six attending health centers in Semnan, Iran. Participants were selected using simple random sampling. Data were collected online via the Hackey questionnaire and analyzed using SPSS version 26 applying Chi-square tests and logistic regression.

Results: A minority of parents were aware of the appropriate timing for the first dental visit. Forty-five percent sought care only when problems occurred, while 36% attended regular check-ups. Overall, 62% reported moderate to good financial status, and 82% had basic insurance coverage. Key determinants of dental attendance included maternal education, service accessibility, insurance coverage, health information sources, and the characteristics of the healthcare providers as an educator. Larger family size and negative experiences with healthcare staff were associated with reduced utilization.

Conclusion: Interventions at individual and structural levels are needed to promote regular pediatric dental visits. Enhancing parental awareness, involving influential health personnel, expanding dental insurance, and fostering positive provider–parent interactions are recommended.

Investigating the Fertility Pattern of Married Women of Reproductive Age in Miyaneh and Their Tendency to Have Children in 2021

2025-10-26T11:17:22+00:00

Background and Objectives: The removal of the free family planning program was implemented in Iran following the decrease in the fertility rate. This study evaluated the impact of this decision on couples' willingness to have children, the use of contraceptives, the increase in unwanted pregnancies and illegal abortions, especially in rural areas.

Methods: This was a cross-sectional study with a descriptive-analytical approach, conducted in 2021 on 592 married women aged 10–54 in Miyaneh. Data were collected using a researcher-designed questionnaire through a multi-stage random sampling method and analyzed using logistic and Poisson regression models.

Results: The mean (± standard deviation) of number of children of couples was 2.15 ± 1.01. The level of education and age at marriage of women were identified as the variables affecting the number of live children born. The desire for children was significantly related to the number of live-born female children (OR = 0.23, CI 95%: 0.12, 0.44) and current male children (OR = 0.12, CI 95%: 0.05, 0.25). Unwanted pregnancies in the first half of 2021 were 2.3 times higher than in the same period in 2020.

Conclusion: The results showed that education and age at marriage significantly affect fertility patterns. Most couples consider two children ideal and do not wish to have any more. The removal of the family planning program led to increased unwanted pregnancies and unsafe abortions. Thus, revisiting population policies and improving access to family planning services is essential.

Assessment of Immunity Status against Hepatitis B and C among Staff in Different Sections of a Waste Processing and Disposal Facility

2025-10-26T11:17:40+00:00

Background and Objectives: The increased production of infectious and sharp waste in waste disposal centers has created significant health risks for staff in these facilities. This study aimed to evaluate the prevalence of serological markers of hepatitis B and C among staff of the Aradkuh Waste Processing and Disposal Complex in Tehran.

Methods: In this study, 89 staff from four different sections—administrative, pre-processing, post-processing (composting), and landfill were selected through convenience sampling, and their blood samples were tested for HBsAg, Anti-HBs, and Anti-HCV markers using the ELISA method. The anti-Hepatitis B antibody titer (Anti-HBs) was categorized into three levels: complete immunity (>100 IU/L), partial immunity (10-100 IU/L), and no immunity (<10 IU/L). The results were reported based on the staff in different sections.

Results: The results showed that 25% of the staff lacked protective immunity against hepatitis B, while 57% were completely immune, and 18% had partial immunity. The staff in the preprocessing unit were at the most significant risk, with 50% lacking protective immunity, whereas the administrative staff had the best immunity status, with 76% being fully immune. Regarding active hepatitis B infection (HBsAg positive), two individuals (11%) in the primary processing group and one individual (4%) in the post-processing (compost) group tested positive.

Conclusion: The results of the present study indicated that a significant percentage of staff lacked adequate immunity to hepatitis B. Additionally, positive cases of HBsAg and anti-HCV were identified. The staff involved in primary and final processing were at high risk of contracting hepatitis B and C due to frequent contact with urban waste containing used syringes, drug vials, sharp objects, and infectious waste. This highlights the importance of widespread vaccination, continuous monitoring of safety status, and implementation of occupational safety standards to reduce the risks of exposure to infectious waste and sharps. These findings can serve as a valuable basis for designing preventive interventions to promote occupational health among personnel in this field.

Survival Analysis Modeling of Colorectal Cancer Patients with Competing Risks in Golestan Province

2025-10-26T11:17:58+00:00

Background and Objectives: Colorectal cancer is the most common gastrointestinal malignancy worldwide, and its incidence is increasing in Iran. Competing risk analysis offers a refined approach to identify factors influencing Colorectal cancer-specific mortality. Therefore, This study was designed and conducted to determine the survival of patients with colorectal cancer and its associated factors.

Methods: The study was a historical cohort. Data of patients diagnosed with colorectal cancer between 2013 and 2019 at Golestan University of Medical Sciences were collected, and patients were followed up until May 4, 2024. Patient survival was estimated, and the cumulative incidence function, as well as competing risk models of cause-specific hazards and subdistribution hazards, were applied for competing risk analysis. Model adequacy was assessed using the Akaike Information Criterion. Analyses were performed in STATA version 17 (α = 0.05).

Results: Of the 811 patients, 366 (45.13%) were women and the rest were men. The mean age and standard deviation were calculated as 58.54 ± 13.87 years. In the multivariable analysis of factors associated with colorectal cancer mortality in the presence of competing risks, variables including gender, age, literacy, ethnicity, and metastasis were statistically significant in both models. Findings indicated that the cause-specific hazard model provided a better fit for analyzing survival outcomes in colorectal cancer.

Conclusion: Competing risk analysis based on cause-specific hazards is recommended in the multivariable analysis of factors associated with colorectal cancer mortality, particularly in the presence of competing risks of death from other causes.

Investigating the Desire for Childbearing and Its Related Factors in Jiroft in 2022

2025-10-26T11:18:14+00:00

Background and Objectives: Declining fertility rates have become a significant demographic challenge in Iran. This study aimed to evaluate the extent of desire for childbearing and its associated factors among women in Jiroft, Iran, in 2022.

Methods: This cross-sectional study included 600 married women under 49 years of age who attended comprehensive health centers in Jiroft. Data were collected using a questionnaire that covered demographic information and questions related to the study objectives. Statistical analysis, such as frequency, percentage, and logistic regression, was performed using SPSS version 20 software.

Results: The current desire for childbearing was found to be 32.7%, while the future desire was 59.7%. The primary reasons cited for desiring children were the wish to be a mother (94.4%) and the love for children (93.9%). Conversely, the main reasons for not desiring children included concerns about securing the future of children (57.2%) and the increased economic burden of having another child (50%). Factors significantly associated with the desire for childbearing were the number of children (one child vs. no child: OR=5.23,95% CI: 2.03–13.49; two children vs. no child: OR=2.21,95% CI: 0.98–5.001), the subscale “Child as a Pillar of Life” (OR=1.02,95% CI: 1.008–1.04), the subscale “Postponing Childbearing to the Future” (OR=1.06,95% CI: 1.05–1.08), and the subscale “Childbearing Requires Prerequisites” (OR=1.01,95% CI: 1.002–1.03).

Conclusion: Overall, one-third of the women who participated in this study currently desired childbearing, and nearly two-thirds expressed a desire for it in the future. A positive attitude towards childbearing emerged as the most essential factor associated with this desire.

Estimation of Underreporting in the COVID-19 Cases and Hospitalization Registry System Based on Data from a National Survey

2025-10-26T11:18:30+00:00

The COVID-19 pandemic has highly impacted health systems, and the limitations of the national reporting system have reduced the accuracy of estimating the burden of this disease. This study examined the underreporting of COVID-19 cases and hospitalizations using data from the National Survey on Risk Factors for Non-communicable Diseases (STEPS) in Iran in 2021. In this study, 25,425 individuals from the population aged 18 and above were randomly enrolled. In addition to information on non-communicable disease risk factors, participants were questioned about a history of COVID-19 infection, hospitalization, and intensive care unit admission. The frequency of these events was then compared with registry data at the time of data collection. According to the results, 9.3% (95% CI: 8.56 to 9.44) reported a history of COVID-19 infection. Furthermore, among those infected, 12.71% (11.25 to 14.20) reported a history of hospitalization due to COVID-19. Among those hospitalized, 13.74% (8.25 to 18.9) had been hospitalized in intensive care units. Based on this, it is estimated that the sensitivity of recording symptomatic cases was 61.7% (59% to 65%) and for hospitalized cases was 86% (77% to 97.1%).

As a conclusion, it can be stated that the registered incidence of symptomatic COVID-19 cases in Iran was underreported by nearly 40%, and hospitalizations due to COVID-19 were underreported by about 15%. Compared to data from many other countries, including developed nations, this situation can be considered as acceptable.