Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Community Based Participatory Research Center, Iranian Institute for Reduction of High-Risk Behaviors, Tehran, Iran.
Malar J. 2019 Jan 3;18(1):1. doi: 10.1186/s12936-018-2635-4.
There has been significant progress in eliminating malaria in Iran. The aim of this study is to investigate the structure of inter-organizational collaboration networks in the field of unauthorized immigrants and refugees access to services in order to eliminate malaria.
This study employed social network analysis, in which nodes represented stakeholders associated with providing access of immigrants and refugees to services in the field of malaria elimination, and ties indicated the level of collaboration. This study adopted socio-centric analysis and the whole network was studied. In this regard, 12 districts of the malaria-endemic area in Iran were selected. Participants included 360 individuals (30 representatives of the organization/group in each district). The data were gathered by interview, using the levels of collaboration scale. UCINET 6 was used for data analysis. The indices of density, centralization, reciprocity, and clustering were investigated for each twelve network and at each level of collaboration.
The average density of the networks was 0.22 (SD: 0.04). In districts with a high incidence of imported malaria, the values of network density and centralization were high and the networks comprised of a larger connected component (less isolated clusters). There were significant correlations between density of network (r = 0.66, P = 0.02), degree centralization (r = 0.65, P = 0.02), betweenness centralization (r = 0.76, P = 0.004), and imported malaria cases. In general, the degree centrality and betweenness centrality of the organizations of health, district governor, and foreign immigrants' affairs were higher. In all networks, 60% of the relationships were bilateral. At a higher level of collaboration, the centralization declined and reciprocity increased. The average of betweenness centralization index was 22.76 (SD = 3.88).
Higher values of network indices in border districts and districts with more cases of imported malaria, in terms of density and centralization measures, can propose the hypothesis that higher preparedness against the issue and centralization of power can enable a better top-down outbreak management, which needs further investigations. Higher centrality of governmental organizations indicates the need for involving private, non-governmental organizations and representatives of immigrant and refugee groups. Recognition of the existing network structure can help the authorities increase access to malaria prevention, diagnosis, and treatment services among immigrants and refugees.
伊朗在消除疟疾方面取得了重大进展。本研究旨在调查非法移民和难民获得服务领域的组织间协作网络结构，以消除疟疾。
本研究采用社会网络分析，其中节点代表与消除疟疾领域移民和难民获得服务相关的利益相关者，关系表示协作水平。本研究采用了以社会为中心的分析方法，并研究了整个网络。为此，选择了伊朗疟疾流行地区的 12 个区。参与者包括 360 名（每个区 30 名组织/团体代表）。数据通过访谈收集，使用协作水平量表。使用 UCINET 6 进行数据分析。研究了每个网络和每个协作水平的密度、集中化、互惠性和聚类指数。
网络的平均密度为 0.22（SD：0.04）。在输入性疟疾发病率较高的地区，网络密度和集中化程度较高，网络由更大的连通分量组成（较少孤立的聚类）。网络密度（r=0.66，P=0.02）、程度集中化（r=0.65，P=0.02）和中介中心度（r=0.76，P=0.004）与输入性疟疾病例之间存在显著相关性。一般来说，卫生组织、地区长官和外国移民事务组织的程度中心度和中介中心度较高。在所有网络中，60%的关系是双边的。在更高的协作水平下，集中化程度下降，互惠性增加。中介中心度指数的平均值为 22.76（SD=3.88）。
在边境地区和输入性疟疾病例较多的地区，网络指数的更高值（就密度和集中化措施而言）可以提出这样的假设，即更高的准备度和权力集中可以实现更好的自上而下的疫情管理，这需要进一步调查。政府组织的中心度较高表明需要让私人非政府组织和移民和难民群体的代表参与进来。认识到现有的网络结构可以帮助当局增加移民和难民获得疟疾预防、诊断和治疗服务的机会。
