TY - JOUR
T1 - Impact of rural Family Physician programme on maternal and child health indicators in Iran
T2 - An interrupted time series analysis
AU - Jabbari Beyrami, Hossein
AU - Doshmangir, Leila
AU - Ahmadi, Ayat
AU - Asghari Jafarabadi, Mohammad
AU - Khedmati Morasae, Esmaeil
AU - Gordeev, Vladimir S.
N1 - Funding Information:
The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Esmaeil Khedmati Morasae is part-funded by the National Institute for Health Research Collaboration for Leadership in AppliedHealth Research and Care, North West Coast (NIHR CLAHRC NWC). The views expressed are those of the author and not necessary those of the NHS, NIHR or Department of Health.
Publisher Copyright:
© Author(s) (or their employer(s)) 2019.
PY - 2019/1/1
Y1 - 2019/1/1
N2 - Objectives: The establishment of the Family Physician (FP) programme in the rural areas of Iran in 2005 has made health services accessible and affordable. This paper aims to assess the overall trends of maternal and child health (MCH) indicators in a 20-year period and possible effects of the FP programme (intervention) on these indicators in Iran. Design and setting: An interrupted time series analysis was conducted on 20 annual MCH-related data points from 1994 to 2013. The intervention time was at the 12th data point in 2005. Outcomes: MCH indicators were grouped into three categories: structure (mother's age, education, occupation and gravidity), process (number of antenatal care visits (ACVs), laboratory tests, ultrasounds and natural vaginal deliveries (NVDs)) and outcomes (maternal mortality ratio (MMR), neonatal mortality rate (NMR), birth weight (BW), history of abortion and/or stillbirth, and haemoglobin level (Hb)). Results: The adjusted slope of the ACV trend decreased sharply after the intervention (b=-0.36, p<0.01), whereas it increased for the frequency of ultrasounds (b=0.2, p<0.01) and did not change for number of laboratory tests (b=-0.09, p=0.95). The intensification of the descending slope observed for NVD (b=-1.91, p=0.03) disappeared after the adjustment for structural confounders (b=1.33, p=0.26). There was no significant slope change for MMR (b=1.12, p=0.28) and NMR (b=0.67, p=0.07) after the intervention. The slope for the history of abortion trend was constant before and after the intervention, but it considerably intensified for the history of stillbirths after the intervention (b=1.72, p<0.01). The decreasing trend of BW turned into a constant mode after the intervention (b=33.2, p<0.01), but no change was observed for Hb (b=-0.02, p=0.78). Conclusion: Although the FP programme had a positive effect on the process and proximal outcome indicators (BW), no dramatic effect on mortality outcome indicators was distinguished. It shows that there should be determinants or mediators of mortality outcomes in this setting, other than accessibility and affordability of MCH services.
AB - Objectives: The establishment of the Family Physician (FP) programme in the rural areas of Iran in 2005 has made health services accessible and affordable. This paper aims to assess the overall trends of maternal and child health (MCH) indicators in a 20-year period and possible effects of the FP programme (intervention) on these indicators in Iran. Design and setting: An interrupted time series analysis was conducted on 20 annual MCH-related data points from 1994 to 2013. The intervention time was at the 12th data point in 2005. Outcomes: MCH indicators were grouped into three categories: structure (mother's age, education, occupation and gravidity), process (number of antenatal care visits (ACVs), laboratory tests, ultrasounds and natural vaginal deliveries (NVDs)) and outcomes (maternal mortality ratio (MMR), neonatal mortality rate (NMR), birth weight (BW), history of abortion and/or stillbirth, and haemoglobin level (Hb)). Results: The adjusted slope of the ACV trend decreased sharply after the intervention (b=-0.36, p<0.01), whereas it increased for the frequency of ultrasounds (b=0.2, p<0.01) and did not change for number of laboratory tests (b=-0.09, p=0.95). The intensification of the descending slope observed for NVD (b=-1.91, p=0.03) disappeared after the adjustment for structural confounders (b=1.33, p=0.26). There was no significant slope change for MMR (b=1.12, p=0.28) and NMR (b=0.67, p=0.07) after the intervention. The slope for the history of abortion trend was constant before and after the intervention, but it considerably intensified for the history of stillbirths after the intervention (b=1.72, p<0.01). The decreasing trend of BW turned into a constant mode after the intervention (b=33.2, p<0.01), but no change was observed for Hb (b=-0.02, p=0.78). Conclusion: Although the FP programme had a positive effect on the process and proximal outcome indicators (BW), no dramatic effect on mortality outcome indicators was distinguished. It shows that there should be determinants or mediators of mortality outcomes in this setting, other than accessibility and affordability of MCH services.
KW - family physician
KW - health reform
KW - interrupted time series analysis
KW - Iran
KW - maternal and child health indicators
UR - http://www.scopus.com/inward/record.url?scp=85060033681&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2018-021761
DO - 10.1136/bmjopen-2018-021761
M3 - Article
C2 - 30647030
AN - SCOPUS:85060033681
SN - 2044-6055
VL - 9
JO - BMJ Open
JF - BMJ Open
IS - 1
M1 - e021761
ER -
