Movahedi Mohammad, Hajarizadeh Behzad, Rahimi Azamdokht, Arshinchi Masoumeh, Amirhosseini Khadijeh, Haghdoost Ali Akbar
Ministry of Health & Medical Education, and Epidemiology Department, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Health Policy Plan. 2009 May;24(3):229-37. doi: 10.1093/heapol/czp007. Epub 2009 Mar 20.
For more than three decades, the main health indicators of the rural population of Iran have been gathered using a 'vital horoscope'. In this study, we use information derived from the vital horoscope to assess trends over time and geographic patterns of inequality in these health indicators.
Nine main health indicators were derived from official annual reports of the Ministry of Health & Medical Education from 1993 to 2005. Having plotted their temporal variations, we modelled their patterns and predicted their values for 2006 and 2007 using linear regression and fractional polynomial regression models. In order to illustrate spatial variations, we normalized the provincial indicators and mapped their geographical variations in two time bands: 1996-2000 and 2001-05.
Neonatal mortality rate (NMR), infant mortality rate (IMR) and under-5 mortality rate (U5MR) had a decreasing trend between 1993 and 2005. However, the slop for NMR (beta = -0.26) was much smaller than the slopes for IMR (beta = -1.16) and U5MR (beta = -1.60), thus the rate of decline for NMR was less. The percentage of births attended by unskilled personnel declined from 27.2 to 7.5%, and the maternal mortality rate (MMR) declined from 47 to 34 deaths per 100 000 live births. At a provincial level, the heterogeneity in some indicators decreased (e.g. unskilled attendance at birth, IMR and total fertility rate), while we found no substantial changes in others.
Our findings indicate a remarkable improvement in most of the health indicators in rural areas. On the other hand, there is still considerable inequality among the rural population at a provincial level.
三十多年来，伊朗农村人口的主要健康指标一直通过“生命占星图”来收集。在本研究中，我们利用从生命占星图中获得的信息来评估这些健康指标随时间的变化趋势以及不平等的地理模式。
九个主要健康指标来自1993年至2005年卫生与医学教育部的官方年度报告。在绘制了它们的时间变化图后，我们对其模式进行建模，并使用线性回归和分数多项式回归模型预测了2006年和2007年的值。为了说明空间变化，我们对省级指标进行了标准化，并绘制了它们在1996 - 2000年和2001 - 2005年两个时间段的地理变化图。
1993年至2005年期间，新生儿死亡率（NMR）、婴儿死亡率（IMR）和5岁以下儿童死亡率（U5MR）呈下降趋势。然而，NMR的斜率（β = -0.26）远小于IMR（β = -1.16）和U5MR（β = -1.60）的斜率，因此NMR的下降速度较慢。由非专业人员接生的比例从27.2%降至7.5%，孕产妇死亡率（MMR）从每10万例活产47例死亡降至34例死亡。在省级层面，一些指标的异质性有所下降（例如非专业人员接生、IMR和总生育率），而我们发现其他指标没有实质性变化。
我们的研究结果表明农村地区大多数健康指标有显著改善。另一方面，省级农村人口之间仍存在相当大的不平等。
