Usage of Control Charts in Monitoring Primary Health Care Performance

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Scientific Journal of School of Public Health and Institute of Public Health Research
Vol. 8, No. 1, Spring 2010

Usage of control charts in monitoring primary health care
performance

Farahbakhsh M., MD. Department of Health Data Management, East Azerbaijan province
health center, Tabriz University of Medical Sciences, Tabriz, Iran- Corresponding author:
mfarahbakhsh@gmail.com

Received: Nov 2, 2009 Accept: Jun 15, 2010

ABSTRACT

Background and Aim: Monitoring and evaluation are basic components of any health
program. Control charts show clearly the process performance trend longitudinally and help
managers and staff to detect general and specific variations and evaluate the process
performance correctly. This study was conducted to design and utilize control charts in the
primary health care (PHC) system.
Materials and Methods: This study was conducted in two stages. In the first stage, the
average weekly, monthly and seasonal delays in receiving health services were compared
retrospectively. In the second stage, appropriate control charts were introduced with due
consideration of the PHC system.
Results: More than 95% of the weekly average delays were below the upper control limit,
while in 100% of the cases the monthly and seasonal averages were under the upper control
limit.
Conclusion: Desirable health outcomes result from appropriate services. It is necessary to
monitor health processes coverage and performance with simple and specific indicators. With
regard to the health process outputs in the PHC system, it is suggested that the R-X, np and C
charts be used in monitoring processes.
The control charts help the service providers to determine and manage process performance
by gathering simple, applicable data. Some of the advantages of using these charts are the
possibility of longitudinal surveys, simplicity of the calculation methods, and their high
applicability.

Key words: Control chart, Primary health care, Process performance

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Central obesity among Islamshahr women, their perception of
obesity, and their husbands' views on the subject

Sotoudeh, G., Ph.D. Associated Professor, Department of Nutrition and Biochemistry, School
of Public Health and Institute of Public Health Research, Tehran University of Medical Sciences,
Tehran, Iran- Corresponding author:gsotodeh@tums.ac.ir
Khosravi, S., MSc. Instructor, Department of Social Medicine, School of Medicine, Tehran
University of Medical Sciences, Tehran, Iran
Khajehnasiri, F., MSc. Instructor, Department of Social Medicine, School of Medicine,
Tehran University of Medical Sciences, Tehran, Iran
Koohdani, F., Ph.D. Assistant Professor, Department of Nutrition and Biochemistry, School
of Public Health and Institute of Public Health Research, Tehran University of Medical Sciences,
Tehran, Iran

Received: Nov 25, 2009 Accept: Jun 15, 2010

ABSTRACT

Background and Aim: Weight status perception is an important factor in nutritional
behavior. The aim of this study was to determine Islamshahr women's self-perception of their
obesity status and perception of their husbands' opinions regarding women's obesity status, as
compared with the actual central obesity status of the women.
Materials and Methods: This was a cross-sectional (descriptive-analytical) study carried out
in 2003 on a cluster sample of Islamshahr women aged 20-65 years (n = 704). Data were
collected by interviews and weight, height, and waist and hip circumferences were measured.
A waist-to-hip ratio (WHR) greater than 0.849 was considered as central obesity. Based on
the body mass index [BMI=weight/height
2
(kg/m
2
)], underweight, normal, overweight, and
obese were defined as a BMI <18.5, 18.5-24.9 , 25-29.9, and 30, respectively.
Results: About 35% of the women with central obesity considered themselves underweight
or normal. Married women's perception of husbands' opinions regarding their obesity status
showed about 45% misclassification. Women with central obesity who thought their husbands
would assess them as underweight or normal were more likely [OR=18.6, 95% CI: 9.1 to
38.2] to underestimate their obesity status as well.
Conclusion: Misperception of obesity status is common among Islamshahr women.
Considering the role of central obesity in metabolic diseases, menstrual disorders and
increasing serum androgens, conducting nutrition education programs is essential for
prevention and control of central obesity in the region studied.

Key words: Women, Husbands, Perception, Obesity, Islamshahr

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Community assessment for identification of problems in Chahestani
Region of Bandar-Abbas city

Mohammadi, Y., MSc. Student, Department of Epidemiology and Biostatistics, School of
Public Health and Institute of Public Health Research, Tehran University of Medical Sciences,
Tehran, Iran
Javaheri, M., MSc. Student, Department of Epidemiology and Biostatistics, School of Public
Health and Institute of Public Health Research, Tehran University of Medical Science, Tehran,
Iran
Mounesan, L., MSc. Student, Department of Epidemiology and Biostatistics, School of Public
Iran
Rahmani, Kh., MSc. Student, Department of Epidemiology and Biostatistics, School of Public
Iran
Holakouie Naeini, K., Ph.D. Professor, Department of Epidemiology and Biostatistics,
School of Public Health, Bandar Abbas Health Research Station- I. R. Iran National Institute of
Health Research (Formerly Institute of Public Health Research), Tehran University of Medical
Sciences, Tehran, Iran-Corresponding author: holakoik@hotmail.com
Madani, A., Ph.D. Assistant Professor, Department of Epidemiology, School of Public Health,
Hormozgan University of Medical Sciences, Bandarabbas, Iran
Ghasemi, F., BSc. Environmental health professional, Health deputy, Hormozgan University
of Medical Sciences, Bandarabbas, Iran

Received: Nov 9, 2009 Accept: May 18, 2010

ABSTRACT

Background and Aim: Community involvement is the most important strategy in
development. In health program planning, community assessment is a process in which
society members get a thorough understanding of all matters, problems, resources,
weaknesses, strengths, needs, and surveillance related to health by collecting, analyzing, and
publishing relevant data and information. This study was conducted to identify and prioritize
problems of the Chahestani region, a poor region in Bandar-Abbas city, Iran, with active
participation of the people.
Materials and Methods: The study was based on a model designed in North Carolina, US.
In this model, the assessment process is performed in eight steps. In the first seven steps
problems are identified and prioritized, and in step 8 a plan of action is developed to deal with
the problem selected.
Results: A total of 60 problems were identified, of which the following were considered to be
top priorities: lack of responsibility of the authorities, insecurity, unemployment, poverty,
sewerage disposal, insufficient water, insufficient electricity, unpaved roads, lack of green
space, and dirty streets and passages.
Conclusion: Most of the problems identified were non-health problems, including social,
cultural, and economic issues.

Key words: Community assessment, Problem identification, Prioritization, Bandar Abbas
city, Iran

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Treatment of synthetic wastewaters contaminated with formaldehyde
using an anaerobic sequencing batch biofilm reactor

Farzadkia, M., Ph.D. Associated Professor, Department of Environmental health
Engineering, Faculty of health, Iran University of Medical Sciences, Tehran, Iran
Jorfi, S., Ph.D. student, Department of Environment and occupational health, Faculty of
Medical Science, Tarbiat Moddares University, Tehran, Iran -Corresponding author:
sahand359@yahoo.com
Estebar, M., MSc. Department of Environmental Engineering, Science and Research Unit,
Azad university, Ahvaz, Iran

Received: Jul 26, 2009 Accept: Mar 9, 2010

ABSTRACT

Background and Aim: Formaldehyde is an organic chemical with widespread applications
as a raw material in many industries. Industrial effluents with high contents of formaldehyde
should be treated because of their carcinogenic and mutagenic effects. The objective of this
study was to determine the efficacy of the anaerobic sequence batch biofilm reactor (ASBBR)
for formaldehyde biodegradation.
Materials and Methods: A laboratory-scale ASBBR with a total volume of 6 liters was used.
The efficacy of the reactor was determined in 9 stages with organic loading rates of 0.54 to
7.09 Kg COD/m
3
.d.
Results: The best removal efficiency for COD and formaldehyde were 94% and 99%,
respectively, with an organic loading of 0.54 KgCOD/m
3
.d.The lowest efficiencies were 48%
and 63.1%, respectively, with an organic loading of 7.09 KgCOD/m
3
.d.
Conclusion: Based on the findings, it can be concluded that ASBBR is a viable, efficient and
reliable technology for treatment of industrial wastewaters containing formaldehyde.

Key words:Formaldehyde,Anaerobic sequencing batch biofilm reactor, Wastewater treatment

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Ergonomic assessment (identification, prediction and control) of
human error in a control room of the petrochemical industry using
the SHERPA Method

Ghasemi, M., MSPH. Student, Department of occupational Health, School of Public Health
and Institute of Public Health Research, Tehran University of Medical Sciences, Tehran, Iran
Nasl saraji, G., Ph.D. Professor, Department of occupational Health, School of Public Health
and Institute of Public Health Research, Tehran University of Medical Sciences, Tehran, Iran-
Corresponding author: jnsaraji@tums.ac.ir
Zakerian, A., Ph.D. Assistant Professor, Department of occupational Health, School of Public
Health and Institute of Public Health Research, Tehran University of Medical Sciences, Tehran,
Iran
Azhdari, M.R., BSc. Zagross Methanol Company, Asalouye, Iran

Received: Nov 22, 2009 Accept: Feb 16, 2010

ABSTRACT

Background and Aim: Today in many work environments, such as nuclear, military and
chemical industries, human errors may result in disasters. Accidents in different parts of the
world bear evidence to this; examples are the Chernobyl disaster (1986), the Three Mile
Island accident (1974), and the Flixborough explosion (1974). Thus, identification of human
error, especially in complex and intricate systems, and devising control measures are
essential.
Materials and Methods: This project was a case study conducted in Zagross Methanol
Company in Asalouye (South Pars), Iran. The walking-talking-through method was used to
collect the required data and complete the Systematic Human Error Reductive and Predictive
Approach (SHERPA) worksheets. The process experts and control room operators were
interviewed and technical documents of the Company examined.
Results: Analysis of the SHERPA worksheets indicated that the majority (48.62%) of the
222 errors identified were action errors, followed by checking errors (31.97%), retrieval
errors (6.75%), selection errors (0.9%), and communication errors (11.7%).
Conclusion: The results of this study show that the method can be used effectively in
different industries, especially chemical industries, to identify human errors that may
potentially lead to dangerous situations and accidents.

Key words: Human factors engineering, Human error, SHERPA, Petrochemical industry,
Asalouye

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Assessment of Risk Factors and Prevalence of Musculoskeletal
Disorders in Raw Furniture Preparation Workshops of the Furniture
Industry

Rahimifard, H., MSc. Instructor, Department of occupational Health, School of Health, Qom
University of Medical Sciences, Qom, Iran
Hashemi Nejad, N., Ph.D. Assistant Professor, Department of occupational Health, School
of Health, Kerman University of Medical Sciences, Kerman, Iran
Choobineh, A., Ph.D. Associate Professor, Research Center for Health Sciences, Shiraz
University of Medical Sciences, Shiraz, Iran-Corresponding author:alrchoobin@sums.ac.ir
Haidari, H., MSc. Instructor, Department of occupational Health, School of Health, Qom
University of Medical Sciences, Qom, Iran
Tabatabaei, H., Ph.D. Assistant Professor, Department of Epidemioloy, School of Health and
Nutrition, Shiraz University of Medical Sciences, Shiraz, Iran

Received: Sep 26, 2009 Accept: Jun 15, 2010

ABSTRACT

Background and Aim: In the raw furniture preparation workshops, in which the workers
usually have an undesirable postures when at work, ergonomic assessment and the work
environment improvement seem essential. Developing checklists and calculating ergonomic
indices would be useful in this assessment. This study was conducted with the objectives of
assessing musculoskeletal disorders (MSDs) risk factors and determining types of corrective
measures in raw furniture preparation workshops.
Materials and methods: After conducting task analysis, 268 workers were assessed using an
ergonomic checklist developed for the purpose and ergonomic indices were calculated. The
Nordic musculoskeletal disorders questionnaire was used to determine the prevalence rate of
MSDs among the workers. Data were analyzed using the t-test and the test of proportions.
Results: The highest prevalence was in the lower back (38.4%) and the knees 36.2%).
Statistical analysis revealed that there were significant associations between MSDs and
calculated ergonomic indices (p<0.001). In addition, calculation of OR revealed that
ergonomic conditions were associated with MSDs in different body parts (OR=2.90-9.49,
p<0.001). On the whole, the working conditions of 32.46% of the workers studied were poor
from an ergonomic point of view.
Conclusion: The checklist developed was found to be an appropriate and low-cost tool for
ergonomic assessment. The most important problems in the workshops were due to
inappropriate general working conditions, inappropriate organization, and unsuitable work
stations.

Key words: Risk factors, Ergonomic checklist, Furniture industry, Raw furniture preparation
workshops, Qom

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Cadmium toxicity and spectrum of resistance/ tolerance to cadmium
by bacterial species isolated from water and sediments of the Kor
River, Fars province

Kafilzadeh, F., Ph.D. Assistant Professor, Department of Microbiology, Islamic Azad
University, Jahrom Branch, Jahrom, Iran

Abolahrar, S., MSc. Department of Microbiology, Islamic Azad University, Jahrom Branch,
Jahrom, Iran -Corresponding author: t_ahrar@yahoo.com

Kargar, M., Ph.D. Assistant Professor, Department of Microbiology, Islamic Azad University,
Jahrom Branch, Jahrom, Iran

Ghodsi, M. ,MSc. Instructor, Department of Statistics and Mathematics, Faculty of
Matematics, Islamic Azad University, Jahrom Branch, Department of Statistics and
Mathematics, Jahrom, Iran

Received: Jun 1, 2009 Accept: May 18, 2010
ABSTRACT
Background and Aim: Agricultural and industrial activities, as well as population growth,
have resulted in increases in the amounts of pollutants in the environment, the human body,
and other organisms. Cadmium is one of the common heavy metals entering the biological
cycles through different paths causing disease in humans, animals and plants. This study
aimed at determining cadmium levels and physicochemical and biological factors in water
and sediment samples, as well as determining relationships between culturable bacterial
counts and cadmium toxicity and assessing bacterial resistance/tolerance spectrum through
MIC and MBC.
Materials and Methods: Surface water and sediment samples were taken from five stations
in areas believed to be polluted along the Kor River. The stations included 1. Dorudzan Dam
outflow, 2. Petrochemistry Bridge, 3. Khan Bridge, 4. Doshakh Bridge, and 5. the mouth of
the Kor River to the Bakhtegan Lake. Two sets of samples were taken. Set 1was used for
measuring cadmium level, physicochemical and biological factors, while Set 2 was used for
the isolation and identification of cadmium resistant/tolerant bacteria and determination of
their resistance spectrum. Pure cultures of each bacterial species were prepared and the more
resistant bacteria were identified by exposure to media with different cadmium
concentrations.
Results: Stations 2 and 3 were found to be significantly more polluted with cadmium than the
other 3 stations (p<0.001). The cadmium level in sediments of all the stations was higher than
in water (p<0.001) and quite high as compared with the existing standards. The data also
showed a lower BOD/COD ratio in the last 2 stations and higher phosphate levels in the last 4
stations. As compared to control, the bacterial count decreased in the presence of 1 mM
cadmium chloride solution (p<0.001). Cadmium-resistant bacterial counts were higher in
stations 3 and 5 than in the others (p<0.001). The most cadmium-resistant/tolerant bacteria
were P. aeruginosa ETs and Bacillus ABs with MIC 6 and 4 and MBC 7 and 5 mM,
respectively. The most resistant bacteria were gram-negative, isolated from the sediments.
Conclusion: Cadmium pollution, especially in stations 2 and 3, are due to mans activities.
Although many bacterial types were found to be sensitive to cadmium in this study, some of
them showed resistance/tolerance to it to different extents. Our findings also show that unlike
water, which is an unstable environment, sediments are stable and provide a suitable
environment for bacteria to form biofilms as a way to reduce cadmium accumulation. The
most resistant bacteria were found in the stations with the highest cadmium concentrations.
This may be a result of cadmium-resistant gene expression in the presence of this heavy
metal. The use of these resistant strains in biofilters and wastewater bioremediation can
potentially help to reduce cadmium pollution, a problem in some rivers.

Key words: Tolerant/Resistant bacteria, Cadmium, Water and Sediments, Bioremediation,
The Kor River

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Review article:

Achievements of the family planning program in Iran

Simbar, M., Ph.D. Assistant Professor, Departement of reproductive health, Faculty of
Nursing and Midwifery, Shahid Beheshti Medical Science University, Tehran, Iran
Corresponding author: msimbar@sbmu.ac.ir

Received: Oct 24, 2009 Accept: Mar 9, 2010

ABSTRACT

Background and Aim: Rapid growth of Iran's population attracted attention of the authorities
after the 1986 national census. This led to population control and family planning programs to
be considered as a priority. Appropriate strategies of the family planning program led to a
very fast decrease in population growth and fertility indices:; and use of contraceptive
techniquies rate increased from 49% in 1989 to 73.8% in 2007. This study aimed at reviewing
family planning program in Iran (FPPI) during the last four decades and discussing the
reasons for its success, as it can be a guide for future efforts aimed at improving other aspects
of reproductive health.
Materials and Methods: The method used was systematic reviewing of articles indexed in
Medline and University Jihad Scientific Database, reports of the Demographic and Health
Project, the Iranian Statistical Center National Censuses, and the Ministry of Health and
Medical Education reports on knowledge, attitude and practice.
Results: FPPI initiated officially in 1966 faced with limited success. Following the 1986
national census, population control was announced as a public policy, supported by the
leaders. A supportive environment was created by mass media. Establishment of the
Departments of Population and FP in the Ministry of Health made possible reorganizing
family planning services: expanding coverage of PHC services, including FP services;
training skilled personnel; providing free contraceptives; and vasectomy and tubectomy
services. Involvement of volunteers and NGOs helped in strengthening community actions. In
order to develop personal skills, in addition to face-to-face FP counseling in the health
centers, FP education in schools, colleges, workplaces, army and pre-marriage classes was
also imparted. Promotion of mens participation in FPPI, by providing male methods of
contraception, such as vasectomy or condom use, was also considered. There was also
cooperation and support on the part of nongovernmental and international organizations.
Conclusion: Based on the findings, it may be concluded that the principles of health
promotion can explain the FPP achievements in Iran. This model can be used in expanding
other reproductive health programs in Iran.

Key words: Family planning, Health promotion, Fertility, Population, Iran

Usage of Control Charts in Monitoring Primary Health Care Performance

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