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WHO Collaborating Centers In Iran meeting with WHO Colleagues June 4,2014

WHO Collaborating Centers In Iran meeting with WHO Colleagues June 4,2014 . Reza Malekzadeh M.D Professor of Medicine Deputy for Research and Technology MOHE IR Iran. WHO Collaborating Centres. Digestive Disease Research Institute, TUMS

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WHO Collaborating Centers In Iran meeting with WHO Colleagues June 4,2014

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  1. WHO Collaborating Centers In Iranmeeting with WHO ColleaguesJune 4,2014 Reza Malekzadeh M.D Professor of Medicine Deputy for Research and Technology MOHE IR Iran

  2. WHO Collaborating Centres • Digestive Disease Research Institute, TUMS • Endocrinology & Metabolism Research Institute, TUMS • Research Centre for Diseases of Ear, Nose Throat, IUMS • Mental Health Research Centre, IUMS • Centre for Nursing Care Research, IUMS • National Research Institute of Tuberculosis and Lung Disease, SBMU • Community Oral Health Department, School of Dentistry, SBMU • Ophthalmic Research Centre, SBMU • Tobacco Prevention and Control Research Centre, SBMU • Educational Development Centre, SBMU • Isfahan Cardiovascular Research Centre, MUI • Regional Knowledge Hub for HIV/AIDS Surveillance, KMU • National Public Health Management Centre, TBZMED • Rabies Research Department, Pasteur Institute of Iran, MOHME • Reference Health Laboratories, MOHME • Iranian Blood Transfusion Organization (IBTO)

  3. WHO Collaborating CentresPending Status • National Nutrition and Food Technology Research Institute, SBMU • Research Institute for Endocrine Sciences, SBMU • Scientific Publication and Information Development Center, MOHME

  4. Proposal for designation as WHOCC • National Institute of Health Research, TUMS • Institute for Environmental Research, TUMS • Safety Promotion and Injury Prevention Research Centre, SBMU • Toxicological research Centre, SBMU • Health Policy Research Centre, SUMS • Occupational Health Research Centre,IUMS • Institute for Futures Studies in Health, KMU • Malarial and Vector Research Group, Biotechnology Research Centre, Pasteur Institute of Iran • Reference Food and Drug Laboratories, FDO • Noor Ophthalmology Research Centre

  5. WHO Collaborating CentresPotential Centres Candidates • Centre for Research and Training in Skin Disease and Leprosy, TUMS • Sina Trauma and Surgery Research Centre, TUMS • Growth and Development Research Centre, TUMS • Psychiatry and Psychology Research Centre, TUMS • Food Security Research Center, MUI • ZahedanHealth Promotion Research Centre, ZAUMS • Liver and Gastrointestinal Diseases Research Centre, TBZMED

  6. Health in the Islamic Republic of Iran May 2014

  7. Global Burden of Disease (GBD) Study Iran, 2010 Archives of Iranian Medicine May 2014 special ISSUE

  8. History of GBD • GBD is the largest study on health at global, regional, and national levels • GBD has been started since 1990 with collaboration of 486 researchers from 302 research center in 50 countries • Methodologically, GBD is a systematic review of all published and unpublished data at national levels in 188 countries from 1990 to 2010 • In GBD, novel statistical methods have been used to estimate prevalence of diseases and risk factors in places and times where no data is available

  9. Main Features of GBD • Innovation of indicators that make possible the comparison of burden of diseases between different countries, in different regions, and different time frames • Innovation of indicators that measure not only diseases (289 diseases) and risk factors (67 risk factors), but also health, quality of life, and disability

  10. Epidemiological Transition • In developing countries, a trend from communicable diseases to non-communicable chronic diseases has been observed • The epidemiological transition is an evident sign of development in a developing country

  11. GBD 2010 Iran • Burden of 67 risk factors and 291 diseases for three time points (1990, 2005, and 2010) during the last 20 years in Iran* • The obvious finding is a shift away from premature death to years lived with disability and from infectious and communicable etiologies to chronic non-communicable diseases (NCDs) *AIM 2014 May

  12. Two Decades increase in Life expectancy • Despite post revolution conflicts, an 8-year war, tight economic sanctions by Western countries, and multiple earthquakes over the last three decades: • Life expectancy increased by 22 years for women and 21 years for men

  13. Results 2010GBD • Total number of deaths in 2010 in Iran: 351,814 • Deaths in men in 2010: 223,768 • Deaths in women in 2010: 128,045 • Transport accidents have been the main causes of YLL

  14. NCDs in global scale Causes of death, 1990 Causes of death, 2010 GBD 2010

  15. NCDs in Iran Causes of death, 1990 Causes of death, 2010 GBD 2010

  16. Main NCDs in Iran Fatal Diseases Ischemic Heart Disease Stroke Hypertension Diabetes Transport accidents Cancers Non-fatal disabling Diseases Mental Diseases Musculoskeletal Diseases Diabetes Transport accidents Chronic Respiratory Diseases Unintentional Injuries GBD 2010

  17. Main causes of death in men in Iran, 2010 GBD 2010

  18. Main causes of death in women in Iran, 2010 GBD 2010

  19. Main causes of disability in men in Iran, 2010 GBD 2010

  20. Main causes of disability in women in Iran, 2010 GBD 2010

  21. Factors Influencing the Epidemiological Transition • Increased Literacy Rate • Modernization • Increased Urbanization • Increased Socio-Economical Status • Change in life style towards Western Style AND • The efficiency of the health system in prevention and control of communicable, maternal, and neonatal diseases and nutritional disorders

  22. Achievements of Health System in Iran • Increased life expectancy at birth by 22 years despite war, earthquakes, and economical sacntions • Decrease in mortality rates in all ages • Decrease in mortality rates among children under 5 years old • Decrease in maternal mortality rates • Decrease in fertility rates Ministry of Health and Medical Education

  23. Achievements of Health System in Iran • The percentage of iodinated salt surpasses 95% • The vaccination coverage of BCG, DPT, Polio, MMR, and hepatitis B surpassed 99% • Polio is eradicated • The prevalence and incidence of main communicable diseases including malaria, typhoid, and tuberculosis has decreased Ministry of Health and Medical Education

  24. Decreased Inequality in Under 5 Mortality Rate from 1981 to 2011 Farzadfar et al unpublished

  25. The Trend in Control of Malaria from 1994 to 2012 Ministry of Health and Medical Education

  26. Trend in Control of Typhoid from 1962 to 2010 Ministry of Health and Medical Education

  27. The Trend in Incidence of Tuberculosis Ministry of Health and Medical Education

  28. Trend in Detection and Control of HIV • Prevalence of HIV/AIDS in patients suffering from tuberculosis: in 2010: 3.8% in 2012: 2.5% Ministry of Health and Medical Education

  29. Improvement of Infrastructure • The achievement of campaigns for construction and literacy, increased GDP per capita, and the establishment of primary health care system in Iran: • Increased access to healthy drinking water • Increased access to healthy waste • Increased access to electricity and gas • Improved roads between cities

  30. The age structure in Iran 2013 Statistical Center of Iran

  31. Population of Iran from 1956 to 2011 Statistical Center of Iran

  32. Urbanization in Iran from 1956 to 2011 Statistical Center of Iran

  33. The literacy rate among people older than 5 from 1956 to 2011 Statistical Center of Iran

  34. Access to Drinking Water and Healthy Waste in Rural Areas from 2006 to 2010 Statistical Center of Iran

  35. The Number of HIV/AIDS Deaths Ministry of Health and Medical Education

  36. The Necessity of Change in the Health System • The necessity of changing policies based on new needs and priorities of the health system • The necessity of integrating service packages into the current health system to control NCDs and accidents • The necessity of inter-sectoral collaboration • The necessity of cost effective planning for optimal allocation of limited financial resources

  37. Non-Communicable Diseases • NCDs are main threats to economy • NCDs lead to inequality in income, decrease in household wealth, increase in health care cost, and decease in productivity Prevention is crucial

  38. The Trend of the fraction of YLLs caused by main NCDs, 1990 to 2010 GBD 2010

  39. Mental Diseases • Prevalence in different regions in Iran: 29% • Prevalence in Tehran: • In 1998: 21.5% • In 2007: 34.2% • Lifetime risk of incidence: 14.3% • Prevalence in women: 14.3% • Prevalence in men: 7.3%

  40. The Trend in Prevalence and Burden of Main NCDs • Necessity of national surveys to measure and monitor those diseases that impose most burden on Iranians • Necessity of improving the quality of routine data • The Golestan Cohort Study is the largest prospective study in Middle East has released comprehensive results

  41. * *Gastro-Esophageal Malignancies In Northern Iran Arch Iran Med. 2013 Jan;16(1):46-53. doi: 013161/AIM.0014. T

  42. Golestan Cohort Study (GCS) • This is a prospective study on 50,045 subjects 40 to 75 years old • Recruitment of subjects in 326 villages and Gonbad city, from 2004 to 2008 • Subjects consisted of 57% women, 8% rural dwellers, and 74% Turkmens • Data collected: • Demographic • Life style • Anthropometric • Biochemical samples • 10 year follow up

  43. Prevalence of Hypertension GCS 2007

  44. Treatment Coverage of Hypertension GCS 2007

  45. Prevalence of Diabetes GCS 2007

  46. Treatment Coverage of Diabetes GCS 2007

  47. Prevalence of Overweight and Obesity • Prevalence of overweight: 62.2% • Prevalence of obesity: 28% • Comparing to United States: • Iranian women are more obese than American women • Iranian men or thinner than American men GCS 2007

  48. The Prevalence of Overweight and Obesity in Iranian and American men and women in GCS Baharmih,Malekzadeh R BMC public health 2006 GCS 2007

  49. Epidemic of Overweight, Obesity, and Lack of Physical Activity • Prevalence of Overweight: 38% • Prevalence of Obesity: 22% • Significant decrease in physical activity especially among women • Prevalence of Diabetes: 10% • Prevalence of fatty liver: 30% GCS 2007

  50. Diet • Prevalence of excess consumption: 40% • Iranian diet: 40% excess carbohydrate, 30% excess oil • High consumption of white rice: Iran is the 13th country in the world in terms of excess consumption of rice (46 kg per person per year) Non-Communicable Diseases Surveillance Survey 2009

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