Interrupted Time Series Analysis About Impact of Presence of Midwives and Physicians on Maternal – Child Health Indicators in Iran

Objectives The establishment of the Family Physician (FP) program 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 program (intervention) on these indicators in Iran.Material and Method :Methods; 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. MCH indicators were grouped into three Categories: structure (mother’s age, education, occupation and gravidity), process (number of antenatal care visits (ACVs), laboratory tests, ultrasounds and natural vaginal deliveries (NVDs)) and outcomes (maternal mortality ratio (MMR), neonatal mortality rate (NMR), birth weight (BW), history of abortion and/or stillbirth, and hemoglobin level (Hb)).Result: The adjusted slope of the ACV trend decreased sharply after the intervention (b=−0.36, p<0.01), whereas it Increased for the frequency of ultrasounds (b=0.2, p<0.01) and did not change for number of laboratory tests (b=−0.09,p=0.95). The intensification of the descending slope observed for NVD (b=−1.91, 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<0.01). The decreasing trend of BW turned into a constant mode after the intervention (b=33.2, p<0.01), but no change was observed for Hb (b=−0.02, p=0.78).Conclusion: Although the FP program had a positive effect on the process and proximal outcome indicators (BW), no dramatic effect on mortality outcome indicators was distinguished. It shows that there should be determinants or mediators of mortality outcomes in this setting, other than accessibility and affordability of MCH services.