Tehran University of Medical Sciences Journal of Biostatistics and Epidemiology 2383-4196 7 4 2021 12 15 321 343 Saber Soltani Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. AND Research Center for Clinical Virology, Tehran University of Medical Sciences, Tehran, Iran Armin Zakeri Department of Hematology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran. Iraj Pakzad Department of Microbiology, School of Allied Medical Sciences, Ilam University Medical Sciences, Ilam, Iran. Alireza Tabibzadeh Department of VirologyDepartment of Virology, Iran University of Medical Sciences, Tehran, Iran., Iran University of Medical Sciences, Tehran, Iran. Amir Mohammad Zakeri Pediatric Surgery Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Milad Zandi Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. AND Research Center for Clinical Virology, Tehran University of Medical Sciences, Tehran, Iran Sara Akhavan Rezayat Department of Health Care Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Mehrzad Jafarzadeh Endocrine research center, institute of Endocrinology and Metabolism, Iran University of Medical Science, Tehran, Iran. Parinaz Khalkhali Asl Department of Microbiology, School of Medicine, Golestan University of Medical Sciences, Golestan, Iran. Arghavan Zebardast Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Yousef Erfani Department of Medical Laboratory Sciences, School of Allied Medical Sciences, Tehran University Medical Sciences, Tehran, Iran. Ramin Shahbahrami Research Center for Clinical Virology, Tehran University of Medical Sciences, Tehran, Iran Reza Pakzad Department of Epidemiology, Faculty of Health, Ilam University Medical Sciences, Ilam, Iran. AND Health and Environment Research Center, Ilam University of Medical Sciences, Ilam, Iran. Pooneh Malekifar Department of Epidemiology, School of Public Health, Tehran University Medical Sciences, Tehran, Iran. 2021 05 08 2021 10 23 Introduction/aims: Since the start of a pandemic from Wuhan, China in 2019, there is tremendous attention in the COVID-19 manifestation. One of the most important COVID-19 clinical presentations is gastrointestinal symptoms. The current systematic review study aims to focus on the implication of the gastrointestinal tract in patients infected with SARS-CoV-2. Methods: For that we searched literature in MEDLINE, Scopus, Web of Science, and Embase. Also, the medRxiv was searched for preprints. The search was performed by using the following keywords "Covid-19", "Coronavirus", "SARS-CoV-2 infection", "SARS-CoV-2", "Gastrointestinal", "Gastrointestinal Tract", "digestive system". All the studies were conducted based on the PRISMA criteria. Results: Of 3028 retrieved documents, 111 studies with 21126 COVID-19 cases were included. The prevalence of any Gastrointestinal symptoms was 17.22% (14.48 to 20.13). The prevalence of diarrhea was 13.75% (12.07 to 15.44), anorexia 27.41% (21.53 to 33.29) and Nausea/vomiting 8.11% (6.87 to 9.35). Furthermore, the prevalence of other symptoms in our current study was fever 76.70% (73.42 to 79.83), cough 58.07% (54.59 to 61.52) and dyspnea/shortness of breath 24.63% (20.06 to 29.48). According to meta-regression results, age (p: 0.027) and fever (p<0.001) did have significant effect on prevalence of any Gastrointestinal symptoms. Conclusion: The anorexia, diarrhea, nausea, and vomiting are the most common Gastrointestinal presentations. The majorities of studies are in the Case series setting and conducted in China. https://jbe.tums.ac.ir/index.php/jbe/article/view/513

Tehran University of Medical Sciences Journal of Biostatistics and Epidemiology 2383-4196 7 4 2021 12 15 344 359 Dinka Gamtesa Ethiopian Public Health Institute, TB/HIV Directorate Habteyes Tola Ethiopian Public Health Institute,TB/HIV Directorate Gadissa Gutema Ethiopian Public Health Institute, TB/HIV Directorate Biniyam Dagne Ethiopian Public Health Institute, TB/HIV Directorate Bira Bedassa Ethiopian Public Health Institute, TB/HIV Directorate 2021 05 22 2021 10 13 Background: Level of knowledge, attitude and practice (KAP) of the community towards corona virus disease 2019 (COVID-19) is important to prevent and control the disease . In Ethiopia there are some studies that assess the KAP’s of different segments of the community and reported different results. However, there is limited review evidence that pooled the proportion of KAP of the community to wards COVID-19 prevention and control of the disease in Ethiopia. The aim of this systematic review and meta-analysis was to summarize and pool the proportion of KAP towards COVID-19 prevention and control in general community. Methods: A systematic review and meta-analysis study was conducted to estimate the pooled proportion of Knowledge, Attitude and Practice towards COVID-19 prevention and control in general community. Electronic databases such as PubMed, Google Scholar and Science Direct were searched for studies reported in English language without restricting publication year. The search strategy was used by combining the keywords: “Knowledge”, “Attitude”, “Practice”, “COVID-19”, and “Ethiopia” both in Medical Subject Heading (MeSH) and free text terms. Data was analyzed using STATA version 14. Random effect model meta-analysis was employed to estimate pooled proportion of KAP’s towards COVID-19 in  general community Result: Data on 12391 participants which retrived from 26 studies included into this review .The study was pooled  to estimate the pooled proportion of knowledge, attitude and practice towards COVID-19 prevention and control in the community. Our meta-analysis reveal that the pooled proportion of good knowledge was 62% (95% CI: 54%-71%), while favorable attitude 64 %( 95% CI: 58%-71%) and prevention practice 44% (95% CI: 32%-56%). https://jbe.tums.ac.ir/index.php/jbe/article/view/532

Tehran University of Medical Sciences Journal of Biostatistics and Epidemiology 2383-4196 7 4 2021 12 15 360 370 Elham Eazari Department of Medical Informatics, Faculty of medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Somayr Nazari Ph.D Student of Neuroscience, School of Advanced Technologies in Medical Science, Mazandaran University of Medical Science, Mazandaran,Iran. Zahra Ebnehosseini Ph.D. of Medical Informatics, Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. Reza Akhavan Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Hamed Tabesh Department of Medical Informatics, Faculty of medicine, Mashhad University of Medical Sciences, Mashhad, Iran 2021 04 05 2021 09 06 Introduction:Poisoning is one of the most common causes of hospital admission. This study aims at 1- to determine the characteristics of poisoning, 2-to discover the relationship of the patients’ characteristics, and 3- to suggest a pattern of characteristics of poisoning.  MethodS: In this descriptive cross-sectional study, characteristics’ of patients with poisoning were extracted from the hospital information system (HIS) in a large teaching hospital. Gender, type of admission, the priority of admission, type of referral, cause of referral, insurance organization, age, and month of referral were the variables extracted. Data were analyzed using descriptive and analytical statistical methods in SPSS software version 21. Results Of the 15204 patients included in this analysis, 55.2% of the patients were men. Also, 68.5% had non-urgent triage level, and the cause of the 60.7% of the poisoning was medication overdose. Most of the patients (86.2%) aged from 30 to 20 years with the most frequent referral in May, June, July, and August. According to logistic regression results, gender, type of admission, type of referral, cause of referral, insurance organization, age, and referral month has a statistically significant effect on triage level. Conclusion: The use of preventive measures from the occurrence of poisoning is necessary for the country because this problem occurs due to the lack of awareness about its causative factors. Regarding the more prevalence of intentional poisoning, the necessary steps are needed to be taken to identify the Psychological causes and prevent suicide in at-risk groups. https://jbe.tums.ac.ir/index.php/jbe/article/view/466

Tehran University of Medical Sciences Journal of Biostatistics and Epidemiology 2383-4196 7 4 2021 12 15 371 381 Sevda Riahifar Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran Mahboobe Rasouli School of Public Health, Iran University of Medical Sciences, Tehran, Iran . Jamileh Abolghasemi School of Public Health, Iran University of Medical Sciences,Tehran, Iran. Moein Yoosefi Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Azita Azarkeivan Pediatric Hematology Oncology, Iranian Blood Transfusion Organization (IBTO), & High Institute for Research and Education in Transfusion Medicine, Thalassemia Clinic, Tehran, Iran. Asieh Ashouri School of public Health, Guilan University of Medical Sciences, Rasht, Iran. 2021 04 25 2021 09 12 Background: Thalassemia major is an important health problem in Mediterranean countries, placing a tremendous emotional, psychological, and economic burden. This study aimed to evaluate the effective factors on long- and short-term survival of thalassemia major patients using mixture and non-mixture cure survival models based on generalized-Gompertz distribution. The generalized-Gompertz distribution has flexible curve of failure rate that may be appropriate for different situation of survival analysis. Methods: In this retrospective cohort study, medical records of 300 thalassemia major patients referring to Zafar's thalassemia clinic during 1994-2017 in Tehran, Iran were reviewed. Mixture and non-mixture cure survival models based on Gompertz and generalized-Gompertz distributions were performed to investigate the survival of thalassemia major patients and the influential factors in their survival and longevity. The Akaike Information Criteria was used to compare the models. Analysis was performed using SAS software version 9.4. Results: The mean survival time was 32.21 ± 7.47years. The censorship rate was 78.3%. In both of the mixture and non-mixture cure models, generalized Gompertz distribution, as compared to the standard Gompertz had the lower Akaike (AIC) criteria that was 200.8. Based on this model, iron deposition in liver at mild and moderate levels had a significant effect on the long-term survival of these patients. Conclusion: Based on Akaike Information criteria, considering the generalized Gompertz mixture cure model has the best fit for the data of thalassemia major disease in which patients are long-term survivors. In order to analyze the survival of patients with thalassemia major, since iron deposition in liver at mild and moderate levels had a significant effect on the long-term survival of these patients; it is recommended to regular iron chelation therapy for extra iron extraction. https://jbe.tums.ac.ir/index.php/jbe/article/view/489

Tehran University of Medical Sciences Journal of Biostatistics and Epidemiology 2383-4196 7 4 2021 12 15 382 391 Hossein Zamani Department of Statistics, Faculty of Science, University of Hormozgan, Bandar Abbas, Iran 2021 06 23 2021 09 12 Background and Aim:  The growth curve are time dependece regression models  which commonly are useful in describing the rapid growth of total cases or deaths in a pandemic situation Methods & Materials: The Gompertz and logistic functions are useful to describe the growth curve of a population or any time dependence variable such as metabolic rate, growth of tumors and total number of cases or death in a pervasive disease. The logistics family of growth curve including logistic, SSlogistic, generalized logistic and power logistic and Gompertz models were considered to describe the growth curve of total_cases_per_million (t_c_p_m) of COVID-19 in Iran during the 19-Feb-2020 to 20-May-2021. The models were fitted to data using nls function in R and the fitting accuracy was evaluated using the numerical and graphical approaches.  Results: The logistic family and Gompertz growth curve were applied to fit the total_cases_per_million of COVID-19 in Iran as the response versus the time in days as predictor variable. The RMSE criterion was used as the numerical criterion to assess the model accuracy. The growth curve of fitted models was compared with the growth curve of observed data. Results indicated that the logistic and Gompertz models provided a better description of target variable than the alternatives. Conclusion: This paper considered the logistic family of growth curve including logistic, SSlogistic, generalized logistic and power logistic and Gompertz models to describe the total_cases_per_million of COVID-19 in Iran during the 19-Feb-2020 to 20-May-2021. As results shown, the logistic and Gompertz models provided a better description of response variable than the alternatives. Therefore, the logistic and Gompertz models are able to describe and forecast the COVID-19 variables (including total cases, death, recovered and so on) very well. https://jbe.tums.ac.ir/index.php/jbe/article/view/596

Tehran University of Medical Sciences Journal of Biostatistics and Epidemiology 2383-4196 7 4 2021 12 15 392 402 Melkamu Zeru Department of Statistics, College of Sciences, Bahir Dar University, Bahir Dar, Ethiopia 2021 07 09 2021 08 21 Introduction: Unplanned pregnancy is a public health problem that affects maternal and child health, including maternal death, abortion, and low birth weight. Consequently, the government established family planning for action to prevent and reduce the health problems for most disadvantaged women. Objective: This study was to investigate the determinant factors of unplanned pregnancy among pregnant women in Ethiopia. Methods: A Population based cross-sectional study was conducted from Ethiopian 2016 demographic healthsurvey data. A total of 3894 pregnant womenwereincludedinthestudyandthesampleswereselectedtroughmultistagestratifiedclustersampling.Uni-variate and multiple logistic regression analysis was used toidentify factors associated with an unplanned pregnancy. Variables with p-value < 0.05 were identified assignificantfactors. Result: Among 3894 study pregnant, 31.05% of pregnancies was unplanned. The analysis result revealed that women whose age ≤ 30 years [AOR = 5.42, 95 % CI=2.38 - 12.34], women in rural [AOR=1.11, 95% CI=1.03 - 2.39], illiterate women [AOR=2.3,95% CI=2.02 - 4.09], women drinks alcohol [AOR=1.45,95% CI=1.31- 1.67], smoker women [AOR= 1.52, 95% CI 1.49 - 2.65 ],women chewing chat[AOR=1.66, 95% CI=1.66 1.18 - 2.33], unemployed women[AOR = 4.97, 95%CI=1.31-12.38] , poor economic level [AOR=8.42,95%CI=5.87- 14.39] and none-user contraceptive methods [AOR=1.7, 95% CI=1.14 – 3.87] were found to be associated with unplanned pregnancy(p < 0.05). Conclusion: The prevalence of unplanned pregnancy in the study area was 32.05%. The findings suggest that certain groups of women are at increased risk of unplanned pregnancy and would benefit from targeted family planning interventions https://jbe.tums.ac.ir/index.php/jbe/article/view/627

Tehran University of Medical Sciences Journal of Biostatistics and Epidemiology 2383-4196 7 4 2021 12 15 403 412 Mohamad Nawi School of Dental Sciences, Universiti Sains Malaysia, Health Campus 16150 Kubang Kerian, Kelantan, Malaysia Wan Mohd Zainon School of Dental Sciences, Universiti Sains Malaysia, Health Campus 16150 Kubang Kerian, Kelantan, Malaysia Nor Farid Noor School of Dental Sciences, Universiti Sains Malaysia, Health Campus 16150 Kubang Kerian, Kelantan, Malaysia Mohd Khamis School of Dental Sciences, Universiti Sains Malaysia, Health Campus 16150 Kubang Kerian, Kelantan, Malaysia Ali Al-Rifai College of Dentistry, AhlBait University, Karbala, Iraq Muhamamd Mat Lazin School of Dental Sciences, Universiti Sains Malaysia, Health Campus 16150 Kubang Kerian, Kelantan, Malaysia Ibrahim Sulaiman School of Quantitative Sciences, College of Art and Sciences, Universiti Utara Malaysia, Sintok, Kedah, Malaysia 2021 07 17 2021 10 23 Introduction: Handling the COVID-19 outbreak is one of the most novelties modern work is facing by many countries today. Massive outbreak needs countries efficacy and talent in creating new approaches. These approaches need to prevent the spread of the outbreak and increase the citizens' belief as the outbreak will damage the countries' functional capacity. Technical efficiency is used maximally to gain total control of the conditions. This study aims to measure the relative efficiency level of Southeast Asian countries in dealing with COVID-19 pandemic over one year. Methods: The relative efficiency level of the most successful countries in Southeast Asia in managing COVID-19 infection was determined using Frontier 4.1 through Stochastic Frontier Analysis (SFA) and Excel software. The technical efficiency of the SFA model is defined as the ratio of observed output to maximum feasible production. If the country's technical efficiency (TE) is greater than 80%, it is the most effective in Southeast Asia at managing COVID-19 infection, but if it is less than 80% or close to 0, it is inefficient. Results: This research aims at the COVID-19 epidemic in a Southeast Asian country, where the country with the highest technical efficiency score is the most efficient and indicates the country's ability to deal with the COVID-19 outbreak without any complications. Laos was ranked first (TE = 0.99901), with a technical efficiency score that was higher than that of most other Southeast Asian countries. Singapore comes in second position with a technical efficiency score of 0.99882. Brunei is in third place for COVID-19, with a technical efficiency score of 0.99870. Cambodia is in last place, with a score of 0.84675 for technical efficiency. Conclusions: Laos is the highest technical efficiency score among the southeast Asian countries. Various things that can lead to inefficiency include lack of awareness about standard operating procedures (SOP) among the causes of COVID-19 case infection in the workplace, and the community continues to increase. This condition may also be due to the lack of medication or vaccines to cure COVID-19. All communities around the world are expected to adopt standard operating procedures (SOP) such as wearing face masks, hand sanitizers, and social distance to curb the increasingly violent spread of COVID-19. https://jbe.tums.ac.ir/index.php/jbe/article/view/649

Tehran University of Medical Sciences Journal of Biostatistics and Epidemiology 2383-4196 7 4 2021 12 15 413 426 Habibollah Esmaily Department of Epidemiology and Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran Rasoul Alimi Department of Public Health, School of Health, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran Zahra Meshkat Department of Microbiology and Virology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Ali Mohammad Hoseinpour General Practioner, Mashhad University of Medical Sciences, Mashhad, Iran Omid Kiani Clinical Research Development Unit of Imam Reza Hospital, Birjand University of Medical Sciences, Birjand, Iran. Fatemeh Khorashadizadeh Department of Epidemiology and Biostatistics, Neyshabur University of Medical Sciences, Neyshabur, Iran. 2021 08 11 2021 09 18 Objectives: Iran is facing a rapid change in the epidemiological pattern of HIV. We examine trends in disease incidence and factors associated with the development of HIV over the last two decades in Iran. Methods: We retrospectively collected data from patients who attended the Behavior Diseases Consultation Center of Mashhad University of Medical Sciences in Iran. Individuals were contributed if they were HIV-positive. We examined baseline factors including demographic, behavioral and clinical characteristics for all participants. Changes in population characteristics were assessed using chi-square test or the Fisher’s exact test. Results: From 1989 to 2014, 584 individuals were eligible for present analysis according to the inclusion criteria. Most patients were men (87%) with most being 36–52 years old, unemployed (58%), married (39.3%), less educated (47.7%) and had a history of imprisonment (83%). The most common modes of HIV transmission were injection drug use (IDU) (51.4%) and IDU along with the sexual relationship (26.5%). These transmission modes varied significantly according to gender (p-value<0.001). Similarly, IDU and sexual relationship were most important transmission modes in males and females, respectively. The incidence rate of HIV through sexual-related modes had a higher proportion than IDU in recent years. Conclusions: In Iran, the pattern of HIV transmission is shifting from unsafe injection drug to unsafe sexual contact for forthcoming years. Also, increasing trend of HIV incidence in women is remarkable. Accordingly, HIV-prevention strategies need to be changed. https://jbe.tums.ac.ir/index.php/jbe/article/view/696