{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T17:43:15Z","timestamp":1789062195013,"version":"build-2803163510"},"reference-count":50,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2018,11,28]]},"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The establishment of the Family Physician (FP) programme in the rural areas of Iran in 2005 has made health services accessible and affordable. This paper aims to assess the overall trends of maternal and child health (MCH) indicators in a 20-year period and possible effects of the FP programme (intervention) on these indicators in Iran.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design and setting<\/jats:title>\n                    <jats:p>An interrupted time series analysis was conducted on 20 annual MCH-related data points from 1994 to 2013. The intervention time was at the 12th data point in 2005.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcomes<\/jats:title>\n                    <jats:p>\n                      MCH indicators were grouped into three categories:\n                      <jats:italic>structure<\/jats:italic>\n                      (mother\u2019s age, education, occupation and gravidity),\n                      <jats:italic>process<\/jats:italic>\n                      (number of antenatal care visits (ACVs), laboratory tests, ultrasounds and natural vaginal deliveries (NVDs)) and\n                      <jats:italic>outcomes<\/jats:italic>\n                      (maternal mortality ratio (MMR), neonatal mortality rate (NMR), birth weight (BW), history of abortion and\/or stillbirth, and haemoglobin level (Hb)).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The adjusted slope of the ACV trend decreased sharply after the intervention (b=\u22120.36, p&lt;0.01), whereas it increased for the frequency of ultrasounds (b=0.2, p&lt;0.01) and did not change for number of laboratory tests (b=\u22120.09, p=0.95). The intensification of the descending slope observed for NVD (b=\u22121.91, p=0.03) disappeared after the adjustment for structural confounders (b=1.33, p=0.26). There was no significant slope change for MMR (b=1.12, p=0.28) and NMR (b=0.67, p=0.07) after the intervention. The slope for the history of abortion trend was constant before and after the intervention, but it considerably intensified for the history of stillbirths after the intervention (b=1.72, p&lt;0.01). The decreasing trend of BW turned into a constant mode after the intervention (b=33.2, p&lt;0.01), but no change was observed for Hb (b=\u22120.02, p=0.78).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Although the FP programme had a positive effect on the\n                      <jats:italic>process<\/jats:italic>\n                      and proximal\n                      <jats:italic>outcome<\/jats:italic>\n                      indicators (BW), no dramatic effect on mortality outcome indicators was distinguished. It shows that there should be determinants or mediators of mortality\n                      <jats:italic>outcomes<\/jats:italic>\n                      in this setting, other than accessibility and affordability of MCH services.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2018-021761","type":"journal-article","created":{"date-parts":[[2019,1,15]],"date-time":"2019-01-15T09:50:17Z","timestamp":1547545817000},"page":"e021761","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":22,"title":["Impact of rural Family Physician programme on maternal and child health indicators in Iran: an interrupted time series analysis"],"prefix":"10.1136","volume":"9","author":[{"given":"Hossein","family":"Jabbari Beyrami","sequence":"first","affiliation":[{"name":"Department of Community Medicine, School of Medicine, Iranian Center of Excellence in Health Management, Tabriz University of Medical Sciences, Tabriz, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leila","family":"Doshmangir","sequence":"additional","affiliation":[{"name":"Health Services Management Research Center, Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran"},{"name":"Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayat","family":"Ahmadi","sequence":"additional","affiliation":[{"name":"Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Asghari Jafarabadi","sequence":"additional","affiliation":[{"name":"Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran"},{"name":"Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esmaeil","family":"Khedmati Morasae","sequence":"additional","affiliation":[{"name":"National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care, North West Coast (NIHR CLAHRC NWC), Institute of Psychology, Health and Society, Health Services Research Department, University of Liverpool, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vladimir S","family":"Gordeev","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,1,15]]},"reference":[{"key":"2025121407083490000_9.1.e021761.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(04)16987-0"},{"key":"2025121407083490000_9.1.e021761.2","unstructured":"World Health Organization. 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Analysis of trends in birth outcomes and fertility measurs in the rural population of East Azerbaijan province, Iran: 2001\u20132013, 2015."},{"key":"2025121407083490000_9.1.e021761.42","unstructured":"Saltman R , Bankauskaite V , Vrangbaek K . Primary care in the driver\u2019s seat?: Organizational reform in European primary care: McGraw-Hill Education (UK), 2005."},{"key":"2025121407083490000_9.1.e021761.43","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2296-11-81"},{"key":"2025121407083490000_9.1.e021761.44","doi-asserted-by":"crossref","first-page":"277","DOI":"10.5455\/msm.2014.26.277-286","article-title":"Public health aspects of the family medicine concepts in South eastern europe","volume":"26","author":"Masic","year":"2014","journal-title":"Mater Sociomed"},{"key":"2025121407083490000_9.1.e021761.45","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2393-8-12"},{"key":"2025121407083490000_9.1.e021761.46","first-page":"152","article-title":"The relationship between social determinants of health and pregnancy outcomes: a retrospective cohort study in Tabriz","volume":"3","author":"Alizadeh","year":"2014","journal-title":"Journal of Clinical Research & Governance"},{"key":"2025121407083490000_9.1.e021761.47","unstructured":"Mc Donagh M , Goodburn E . Maternal health and health sector reform: opportunities and challenges. Safe motherhood strategies: a review of the evidence 2001."},{"key":"2025121407083490000_9.1.e021761.48","unstructured":"Statistical Centre of Iran. Iranian national census of population and housing. 2016. Available in http:\/\/irandataportal.syr.edu\/census\/census-2016."},{"key":"2025121407083490000_9.1.e021761.49","first-page":"632","article-title":"Islamic Republic of Iran\u2019s Multiple Indicator Demographic and Healh Survey","volume":"5","author":"Rashidian","year":"2014","journal-title":"Int J Prev Med"},{"key":"2025121407083490000_9.1.e021761.50","unstructured":"Distric Health Profile. Health data center. 2018. 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