title: Mortality-related factors disparity among Iranian deceased children aged 1-59 months according to the medical activities in emergency units: National mortality surveillance system.
abstract: BACKGROUND
  To determine disparity in mortality-related factors in 1-59 months children across Iran using hospital records of emergency units.
  
  
  METHODS
  After designing and validating a national questionnaire for mortality data collection of children 1-59 months, all 40 medical universities has been asked to fill in the questionnaires and return to the main researcher in the Ministry of Health and Medical Education. Age and sex of deceased children, the type of health center, staying more than 2 h in emergency unit, the reason of prolonged stay in emergency, having emergency (risk) signs, vaccination, need to blood transfusion, need to electroshock and so on have also been collected across the country. There was also a comparison of children based on their BMI. Chi-square test has been applied for nominal and ordinal variables. ANOVA and t-student test have been used for measuring the difference of continuous variables among groups.
  
  
  RESULTS
  Mortality in 1-59 months children was unequally distributed across Iran. The average month of entrance to hospital was June, the average day was 16(th) of month, and the average hour of entrance to hospital was 14:00. The average of month, day and hour for discharge was July, 16, and 14:00, respectively. The hour of discharge was statistically significant between children with and without risk signs. More than half (54%) of patients had referred to educational hospital emergency units. There were no statistically significant differences between children with and without emergency signs. There were statistically significant differences between children with and without emergency signs in age less than 24 months (0.034), nutrition situation (P = 0.031), recommendation for referring (P = 0.013), access to electroshock facilities (P = 0.026), and having successful cardiopulmonary resuscitation (P = 0.01).
  
  
  CONCLUSIONS
  This study is one of the first to show the distribution of the disparity of early childhood mortality-related factors within a developing country. Our results suggest that disparity in 1-59 months mortality based on hospital records in emergency units needs more attention by policy-makers. It is advisable to conduct provincially representative surveys to provide recent estimates of hospital access disparities in emergency units and to allow monitoring over time.
authors.affiliation: Department of Pediatrics, School of Medicine, Child Growth and Development Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Roya
authors.initials: R
authors.lastname: Kelishadi
authors.forename: Sayyed-Hamed
authors.initials: SH
authors.lastname: Barakati
authors.forename: Hamid Reza
authors.initials: HR
authors.lastname: Lornejad
authors.forename: Masoud
authors.initials: M
authors.lastname: Amiri
authors.forename: Mohammad Esmaeil
authors.initials: ME
authors.lastname: Motlagh
keywords: Children mortality; Iran; emergency units; national mortality registration system