|The Relationship Between The Social Determinants of Health With Preterm Birth in Iran Based on The WHO Model: A Systematic Review and Meta-analysis|
|Nasibeh Sharifi1, Mahrokh Dolatian2, Azita Fath Nezhad kazemi3, Reza Pakzad4|
|1School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2Department of midwifery & Reproductive Health, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3Department of Midwifery, School of Nursing and Midwifery, Islamic Azad University of Tabriz, Tabriz, Iran
4Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
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Keywords : Preterm birth, social determinants of health, Iran, systematic review
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Objectives: Despite the medical advances in the diagnosis and treatment of diseases, preterm birth is still a global problem. The aim of this study was to investigate the relationship between the social determinants of health with preterm birth in Iran based on the WHO model.
Materials and Methods: This systematic review and meta-analysis was performed based on studies conducted in Iran. An advanced search was carried out in seven databases( Iranmedex, Magiran, SID, Irandoc, PubMed, Google Scholar and Scopus) for relevant articles published in 2000-2016 using the keywords‘ social determinants of health’, ‘preterm birth’ and their equivalent Persian and MeSH terms. All the articles were screened by two of the researchers in three steps. After looking for relevant articles based on the reference list, quality assessment was performed using a STROBE checklist. After extracting the required data, they were combined using a random model and the heterogeneity of the studies was evaluated using the I2 index and the data were analyzed in STATA-11.
Results: A total of 16 studies were included in the analysis of the relationship between the intermediate determinants of health and preterm birth; however, only six truly investigated the relationship between structural determinants and preterm birth. The overall odds ratio for the relationship between the structural and intermediate social determinants of health with preterm birth was estimated as1.43 (0.84%-2.41: %95 CI) and 2.17 (1.75%-2.68: %95 CI). The results showed that preterm birth was more common in women with anxiety, depression, unwanted pregnancies, poor health behaviors (smoking, the use of alcohol and drugs),inadequate prenatal care, and who were abused and exposed to secondhand tobacco smoke (p<0.05).
Conclusion: The results of the reviewed studies suggest that preterm birth is a common problem associated with several social determinants of health. Life skills and self-care training and increased prenatal care are therefore recommended to reduce preterm birth, especially in high-risk pregnant women.
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