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Roshanfekr P, Ahmadi S, Amirahmadi R, Karimijavan G, Yazarloo R, Hosseinabadi M, SoleimanvandiAzar N, Karimi SE. Sexual Behaviors in Iranian Working Children and the Correlated Risk Factors: Result of the Large-Scale Rapid Assessment and Response (RAR) Survey. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2024; 36:189-198. [PMID: 38616796 PMCID: PMC11008545 DOI: 10.1080/19317611.2024.2322978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 02/20/2024] [Indexed: 04/16/2024]
Abstract
This study aimed to investigate the sexual behaviors among working children and the associated factors. This cross-sectional study was conducted on a sample of 1937 working children in the 10-18 age range in 15 provincial capitals in 2019-20 (Feb-May); the Response rate was 94.9%. Univariate and multivariable logistic regression was used to examine the variable of sexual behaviors. Adjusted odds ratios (AOR) and 95% confidence intervals (CI) are reported. The prevalence of sexual behaviors in working children was 4.2%. The results showed a significant difference between those who reported sexual behaviors and those who did not in terms of age, identity document (ID), running away from home, alcohol use, and substance use. There was a statistically significant relationship between fathers' unemployment and sexual behaviors among working children. Furthermore, we found that having divorced parents could increase the odds of sexual behaviors by 3.74 times. The findings showed that related welfare and support organizations should design and implement effective and continuous training and interventions to raise awareness and reduce the prevalence of high-risk sexual behaviors in working children. They should also provide family counseling and promote parental supervision of children.
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Affiliation(s)
- Payam Roshanfekr
- Social Welfare Management Research Center, Social Health Research Institute, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Sina Ahmadi
- Social Development & Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Gelavizh Karimijavan
- Department of Speech Therapy, Rehabilitation Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Yazarloo
- Department of social science, Payam_e_noor University, Tehran, Iran
| | - Mahmoud Hosseinabadi
- Social Injured Affairs Office, Social Deputy, State Welfare Organization, Tehran, Iran
| | - Neda SoleimanvandiAzar
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Department of Community and Family Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Salah Eddin Karimi
- Social Determinants of Health Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
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Nasiri N, Kostoulas P, Roshanfekr P, Kheirkhah Vakilabad AA, Khezri M, Mirzaei H, Sharifi A, Sharifi H. Prevalence of HIV, hepatitis B virus, hepatitis C virus, drug use, and sexual behaviors among street children in Iran: A systematic review and meta-analysis. Health Sci Rep 2023; 6:e1674. [PMID: 37927540 PMCID: PMC10620850 DOI: 10.1002/hsr2.1674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 10/14/2023] [Accepted: 10/18/2023] [Indexed: 11/07/2023] Open
Abstract
Background and Aims Street children face a disproportionately higher risk of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) due to high-risk sexual and drug use practices. We aimed to estimate the prevalence of these infections and related risk behaviors among street children in Iran. Methods We searched PubMed, Web of Science (ISI), Embase, Scopus, and Google Scholar for the English-language records and Iranian databases, including SID, Magiran, and IRANDOC for the Farsi-language records up to September 18, 2022. Random effects analysis was used to obtain prevalence estimates for each condition. Homogeneity across included studies was assessed using I 2. Results We extracted data from 18 eligible studies, representing 5646 children (83.2% boys), with a mean age of 10.2 (range: 5-18). The prevalence of HIV, HBV, and HCV were 0.79% (95% confidence intervals [CIs]: 0.0-5.56), 1.97% (95% CI: 1.01-3.19), and 1.88% (95% CI: 0.74-3.46), respectively. The prevalence of lifetime drug use and sexual abuse was 8.32% (95% CI: 4.83-12.62) and 10.18% (95% CI: 3.02-20.67) among street children, respectively. Conclusion The estimated prevalence of HIV, HBV, and HCV among street children in Iran was higher than the estimates in the general population. Moreover, drug use and the experience of sexual abuse were prevalent among this population. These findings suggest the need for targeted prevention programs for street children in Iran.
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Affiliation(s)
- Naser Nasiri
- School of HealthJiroft University of Medical SciencesJiroftIran
| | - Polychronis Kostoulas
- Laboratory of Epidemiology and Artificial Intelligence, Faculty of Public & One HealthUniversity of ThessalyThessalyGreece
| | - Payam Roshanfekr
- Social Welfare Management Research Center, Social Health Research InstituteUniversity of Social Welfare and Rehabilitation SciencesTehranIran
| | | | - Mehrdad Khezri
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV SurveillanceInstitute for Futures Studies in Health, Kerman University of Medical SciencesKermanIran
| | - Hossein Mirzaei
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV SurveillanceInstitute for Futures Studies in Health, Kerman University of Medical SciencesKermanIran
| | - Ali Sharifi
- Department of OphthalmologyShafa Hospital, Afzalipour School of Medicine, Kerman University of Medical SciencesKermanIran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV SurveillanceInstitute for Futures Studies in Health, Kerman University of Medical SciencesKermanIran
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Epidemiology of Hepatitis C Virus Infection Among High-risk Populations in Northeastern Iran. HEPATITIS MONTHLY 2022. [DOI: 10.5812/hepatmon-127166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Background: Chronic hepatitis C virus (HCV) infection affects 58 million people globally. The frequency of HCV infection in the general Iranian population is less than 0.5%; however, a concentrated epidemic was reported among people who use drugs, particularly those with a history of drug injection. Objectives: This cross-sectional study was performed to assess the prevalence of HCV infection among high-risk groups outside of prison in northeastern Iran. Methods: A total of 962 participants in Razavi Khorasan province were enrolled from 2018 to 2022. They included drug users referred to drug treatment and harm reduction centers and individuals with a history of crimes such as drug use or imprisonment who worked in a private industrial unit. Serum anti-HCV antibodies were assessed using a rapid or ELISA kit, and seroreactive samples were confirmed by single-step reverse transcriptase or qualitative real-time polymerase chain reactions. A P-value < 0.05 was considered statistically significant. Results: The mean age of 707 males and 255 females was 39.8 ± 10.2 years. Anti-HCV antibodies were detected from 129 samples (13.41%), of which 117 were available for polymerase chain reaction testing. HCV RNA was detected in 88 cases (75.2%); the total viremia rate was calculated as 9.26% (88/950). Logistic regression analysis revealed that HCV infection among drug users was significantly associated with older age (P = 0.002), being single (P = 0.009), and history of drug injection (P < 0.001) or incarceration (P = 0.04). Conclusions: The findings showed a considerably high prevalence of HCV infection among people who use drugs in northeastern Iran. To achieve the global goal of viral hepatitis elimination by 2030, we strongly recommend stricter screening and treatment of this infection among such hard-to-access populations in Iran.
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Fornaro M, Dragioti E, De Prisco M, Billeci M, Mondin AM, Calati R, Smith L, Hatcher S, Kaluzienski M, Fiedorowicz JG, Solmi M, de Bartolomeis A, Carvalho AF. Homelessness and health-related outcomes: an umbrella review of observational studies and randomized controlled trials. BMC Med 2022; 20:224. [PMID: 35818057 PMCID: PMC9273695 DOI: 10.1186/s12916-022-02423-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/30/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Homelessness has been associated with multiple detrimental health outcomes across observational studies. However, relatively few randomized controlled trials (RCTs) have been conducted on people who experience homelessness (PEH). Thus, this umbrella review ranked the credibility of evidence derived from systematic reviews (SRs) and meta-analyses (MAs) of observational studies investigating the associations between homelessness and any health outcome as well as RCTs targeting health needs in this population. METHODS Several databases were systematically searched from inception through April 28, 2021. Any SR and/or MA reporting quantitative data and providing a control group were eligible for inclusion. The credibility of the evidence derived from observational studies was appraised by considering the significance level of the association and the largest study, the degree of heterogeneity, the presence of small-study effects as well as excess significance bias. The credibility of evidence was then ranked in five classes. For SRs and/or MAs of RCTs, we considered the level of significance and whether the prediction interval crossed the null. The AMSTAR-2 and AMSTAR-plus instruments were adopted to further assess the methodological quality of SRs and/or MAs. The Newcastle-Ottawa Scale (NOS) was employed to further appraise the methodological quality of prospective cohort studies only; a sensitivity analysis limited to higher quality studies was conducted. RESULTS Out of 1549 references, 8 MAs and 2 SRs were included. Among those considering observational studies, 23 unique associations were appraised. Twelve of them were statistically significant at the p≤0.005 level. Included cases had worst health-related outcomes than controls, but only two associations reached a priori-defined criteria for convincing (class I) evidence namely hospitalization due to any cause among PEH diagnosed with HIV infection, and the occurrence of falls within the past year among PEH. According to the AMSTAR-2 instrument, the methodological quality of all included SRs and/or MAs was "critically low." Interventional studies were scant. CONCLUSION While homelessness has been repeatedly associated with detrimental health outcomes, only two associations met the criteria for convincing evidence. Furthermore, few RCTs were appraised by SRs and/or MAs. Our umbrella review also highlights the need to standardize definitions of homelessness to be incorporated by forthcoming studies to improve the external validity of the findings in this vulnerable population.
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Affiliation(s)
- Michele Fornaro
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, Federico Ii University of Naples, Naples, Italy
| | - Elena Dragioti
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, SE-581 85 Linköping, Sweden
| | - Michele De Prisco
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, Federico Ii University of Naples, Naples, Italy
| | - Martina Billeci
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, Federico Ii University of Naples, Naples, Italy
| | - Anna Maria Mondin
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, Federico Ii University of Naples, Naples, Italy
| | - Raffaella Calati
- Department of Psychology, University of Milan-Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126 Milan, Italy
- Department of Adult Psychiatry, Nimes University Hospital, 4 Rue du Professeur Robert Debré, 30029 Nimes, France
| | - Lee Smith
- Cambridge Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Simon Hatcher
- Department of Psychiatry, University of Ottawa, Ottawa, ON Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Mark Kaluzienski
- Department of Psychiatry, University of Ottawa, Ottawa, ON Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON Canada
| | - Jess G. Fiedorowicz
- Department of Psychiatry, University of Ottawa, Ottawa, ON Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, ON Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON Canada
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology, London, UK
- Faculty of Environmental and Life Sciences, Center for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, UK
| | - Andrea de Bartolomeis
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, Federico Ii University of Naples, Naples, Italy
- UNESCO staff, Chair - “Education for Health and Sustainable Development”, University of Naples, Federico II Naples, Naples, Italy
| | - André F. Carvalho
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
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BEHZADIFAR M, AZARI S, GORJI H, MARTINI M, BRAGAZZI N. The hepatitis C virus in Iran: health policy, historical, ethical issues and future challenges. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2020; 61:E109-E118. [PMID: 32490276 PMCID: PMC7225642 DOI: 10.15167/2421-4248/jpmh2020.61.1.1438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 12/24/2019] [Indexed: 01/20/2023]
Abstract
Background Hepatitis C infection (HCV) can have a harmful effect on the health of people and can impose relevant healthcare costs. The World Health Organization has identified the elimination of Hepatitis C by 2030 as an important goal for all countries. This study aimed to identify the HCV-related policies in Iran. Methods A qualitative approach was used for this study. Data was collected through a comprehensive search of documents and interviews with different stakeholders related to the HCV program. Data was analyzed and validated using content analysis based on the policy triangle framework. Results Our findings highlighted that certain social and cultural issues related to stigma can impact on awareness-raising processes. It is also necessary to consider HCV directly in the context of government policies. All relevant stakeholders should be included. Continued talks and interactions need to be made between them for the active participation of all actors. Conclusion The findings of this study can provide useful information for improving, supporting and developing policy processes. Healthcare providers should address all aspects of the disease by 2030 in order to achieve the goal of HCV elimination. Evidence-based planning, support for up-to-date policies and resource mobilization are needed to achieve this ambitious goal.
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Affiliation(s)
- M. BEHZADIFAR
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - S. AZARI
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - H.A. GORJI
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
- Correspondence: Hasan Abolghasem Gorji, Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Rashid Yasemi Street, Vali-e-asr Avenue Tehran, Iran -Tel. +2188883334 - E-mail:
| | - M. MARTINI
- Department of Health Sciences (DISSAL), University of Genoa, Italy
- UNESCO CHAIR “Anthropology of Health - Biosphere and Healing System”, University of Genoa, Italy
| | - N.L. BRAGAZZI
- Department of Health Sciences (DISSAL), University of Genoa, Italy
- UNESCO CHAIR “Anthropology of Health - Biosphere and Healing System”, University of Genoa, Italy
- York University, Toronto, Canada
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Behzadifar M, Behzadifar M, Bragazzi NL. A systematic review and meta-analysis of the prevalence of hepatitis C virus infection in people who inject drugs in Iran. BMC Public Health 2020; 20:62. [PMID: 31937278 PMCID: PMC6961327 DOI: 10.1186/s12889-020-8175-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 01/08/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) infection is one of the major public health challenges generating a relevant burden. High-risk groups, including people who inject drugs (PWID), are at serious risk for developing HCV. In recent years, several investigations have been conducted in Iran to assess the prevalence e of HCV among PWID. The aim of the present study was to synthesize the literature performing a comprehensive search and meta-analysis. METHODS A comprehensive literature search was carried out from January 2000 to September 2019. Several international databases, namely Scopus, PubMed/MEDLINE, Embase, ISI/Web of Science, PsycINFO, CINAHL, the Cochrane Library and the Directory of Open Access Journals (DOAJ), as well as Iranian databases (Barakathns, SID and MagIran), were consulted. Eligible studies were identified according to the following PECOS (population, exposure, comparison/comparator, outcome and study type) criteria: i) population: Iranian population; ii) exposure: injection drug users; iii) comparison/comparator: type of substance injected and level of substance use, iv) outcome: HCV prevalence; and v) study type: cross-sectional study. After finding potentially related studies, authors extracted relevant data and information based on an ad hoc Excel spreadsheet. Extracted data included the surname of the first author, the study journal, the year of publication, the number of participants examined, the type of diagnostic test performed, the number of positive HCV patients, the number of participants stratified by gender, the reported prevalence, the duration of drug injection practice and the history of using a shared syringe. RESULTS Forty-two studies were included. 15,072 PWID were assessed for determining the prevalence of HCV. The overall prevalence of HCV among PWID in Iran was computed to be 47% (CI 95: 39-56). The prevalence ranged between 7 and 96%. Men and subjects using a common/shared syringe were 1.46 and 3.95 times more likely to be at risk, respectively. CONCLUSION The findings of the present study showed that the prevalence of HCV among PWIDs in Iran is high. The support and implementation of ad hoc health-related policies and programs that reduce this should be put into action.
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Affiliation(s)
- Masoud Behzadifar
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Meysam Behzadifar
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Nicola Luigi Bragazzi
- School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
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Behzadifar M, Gorji HA, Rezapour A, Rezvanian A, Bragazzi NL, Vatankhah S. Hepatitis C virus-related policy-making in Iran: a stakeholder and social network analysis. Health Res Policy Syst 2019; 17:42. [PMID: 30992014 PMCID: PMC6469134 DOI: 10.1186/s12961-019-0442-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 03/27/2019] [Indexed: 01/17/2023] Open
Abstract
Background Hepatitis C virus (HCV) infection is a major public health challenge worldwide. Implementing policies to cope with this challenge requires commitment from all stakeholders at various levels, and all necessary resources should be mobilised. Support for various HCV-related stakeholders can reduce the challenges and obstacles that can be encountered during the programme implementation. The present study aims to identify all stakeholders involved with HCV-related policy-making in Iran at different steps (policy development, implementation and evaluation) and to characterise them in terms of interest, position, power and influence, in order to provide valuable information for appropriate decision-making and design. The present study can also serve as a case study for healthcare systems in other countries. Method An approach based on social network analysis was utilised. Data collected included relevant document searches and in-depth interviews to a sample of 18 key informants. Results Various stakeholders were found to be involved with HCV-related policies in Iran. The extent of their participation and support in policy-making varied. Specifically, international agencies had a high interest for HCV-related policy-making, whereas media and members of the private sector were characterised by a medium interest and governmental and non-governmental bodies by a highly variable interest, ranging from low to high, depending on the specific organism. Moreover, media and members of the private sector, non-governmental institutions and international agencies were rated low in terms of position, whereas governmental actors were rated low to high. Media were rated medium in terms of power, whereas international agencies and members of the private sector were respectively rated low to medium and low. Non-governmental actors were rated low, whilst governmental bodies were rated low to high. Finally, media, members of the private sector and international agencies were rated medium in terms of influence, whereas non-governmental and governmental actors were respectively rated low to medium and low to high. Conclusion Policy-making involves trust, negotiation and integration of the different views of all stakeholders. Social network analysis was critical for identifying stakeholders and showing that, in Iran, involvement in HCV-related policy-making is generally low. This information is of practical implication for policy- and decision-makers regarding the adoption of more favourable and effective strategies.
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Affiliation(s)
- Masoud Behzadifar
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hasan Abolghasem Gorji
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Aziz Rezapour
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Rezvanian
- School of Computer Science, Institute for Research in Fundamental Sciences (IPM), Tehran, Iran
| | - Nicola Luigi Bragazzi
- School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Soudabeh Vatankhah
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
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Prevalence of Hepatitis B, Hepatitis C, and HIV Infections in Working Children of Afghan Immigrants in Two Supporting Centers in Tehran and Alborz Provinces, Iran. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2019. [DOI: 10.5812/pedinfect.86118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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