2013-1-Karami-letter

JRHS 2013; 13(1): 102-103

Copyright © Journal of Research in Health Sciences

Comment on:

Epidemiologic, Clinical and Laboratory Findings of Patients with Brucellosis in Hamadan, West of Iran

Received: 16 December 2012, Revised: 26 December 2012, Accepted: 26 December 2012, Available online: 30 December 2012

Dear Editor-in-Chief

In an interesting study recently published by your journal, Eini et al1 addressed the epidemiological, clinical and laboratory findings among patients with brucellosis. They used hospital data in Hamadan. Accordingly, hospital admissions are selective and may lead to bias. Authors reported majority of patients (72.2%) were from rural areas in Hamadan City. This key finding has been supported by frequency of history of contact with infected animals, while, authors have cited the results of Haj Abdolbaghi et al.2 with 15.67% and Haddadi et al3 with 40.5% in contrast to their findings regarding proportion of patients from rural areas. But they have given their explanation as follows. “In Hamadan the percentage of population who live in rural areas is more than urban areas” 1. Moreover, they have justified the above mentioned finding by citing a similar study4 which included 245 patients with brucellosis who referred to Sina Hospital in Hamadan Province from January 2004 to December 2005.

It seems that better explanation is lack of geographical representativeness in case of application of hospital data. In another word, patients who were from rural areas have had a greater probability to admission to Farshchian Hospital in comparison to other patients with brucellosis from urban areas in Hamadan City. On the other hand, patients who live in urban areas of the city of Hamadan probably tend to visit private clinics rather than general hospital/referral hospitals.

In conclusion, the limitation of Eini et als study regarding the generalizability of its own findings should be considered by interested readers and policy makers. Moreover, interested readers are advised to compare such probably biased results with a valid data source, although the surveillance data of brucellosis in the city of Hamadan may not complete and representative of all cases of brucellosis. By the way, such data sources help readers and policy makers to interpret the above mentioned findings.

Manoochehr Karami (PhD)a*

a Department of Biostatistics and Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran

E-mail: ma.karami@umsha.ac.ir

References

  1. Eini P, Keramat F, Hasanzadehhoseinabadi M. Epidemiologic, Clinical and Laboratory Findings of Patients with Brucellosis in Hamadan, West of Iran. J Res Health Sci. 2012;12(2):105-108.
  2. Haj Abdolbaghi M, Rasooli Nejad M, Yaghoob Zadeh M, Looti Shahrokhi B. Epidemiological, clinical, diagnostic and therapeutic survey in 505 cases with Brucellosis. Tehran University Medical Journal. 2001;59:34-46 [Persian].
  3. Haddadi A, Rasoolinejad M, Afhami SH, Mohraz M. Epidemiological, clinical, para clinical aspects of brucellosis in Imam Khomeini and Sina Hospital of Tehran (1998-2005). Behbood Journal. 2006;10:242-251 [Persian].
  4. Hashemi SH, Keramat F, Ranjbar M, Mamani M, Farzam A, Jamal-Omidi S. Osteoarticular complications of brucellosis in Hamadan, an endemic area in the west of Iran. Int J Infect Dis. 2007;11:496-500.

Reply

The authors of the article would like to thank the reader for his constructive comments, and we would like to explain more regarding to why the prevalence of brucellosis in the rural patients was higher than the urban patients in this study. As we know, Hamadan is the capital city of Hamadan Province of Iran. At the 2011 census, the population of Hamadan Province was 1,758,268 which of 59.2% of them were living in urban areas; however, the censuses of people who have lived in rural areas were more than 40 % before 20111.

In addition, the Department of Infectious Diseases in Farshchian (Sina) Hospital is the sole center of infectious disease ward in the city of Hamadan and also in the province. Therefore, the most of patients with brucellosis who need to admit at the hospital referred to this hospital. Moreover, people who live in rural areas higher than people living in urban areas are in contact with infected animals and consumption of unpasteurized dairy products and also the rural patients do not access to physicians or laboratory facilities easily because of long distance of their villages from the city. Furthermore, sometimes delay in their diagnosis of the disease lead to severe or complicated brucellosis in these patients, so they may need to admit at the hospital for more evaluation and treatment than patients who referred from urban areas. Of course, in urban areas, more patients would like to go to private clinics because of easy access to these centers.

In addition, we should state among patients who live in rural areas, the risk of recurrent contact with infected animals and consumption of unpasteurized dairy products which leads to reinfection in these subjects is more than urban patients.

In the national guideline for brucellosis in 2009, Zeinali et al2 reported that the rate of brucellosis in rural areas (80%) was more than urban areas (20%) in Iran; therefore, these results support our study which was done in Farshchian (Sina) Hospital in Hamadan.

Eventually, we agree that this is an important issue that requires further research in the entire population especially in areas with high prevalence of brucellosis like Hamadan. Fariba Keramat (MD)a*

a Department of Infectious Diseases, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran

E-mail: faribakeramat@yahoo.com

References

  1. Census of Hamadan Province, Statistical Center of Iran Web Site, Census 2011; [updated 26 December, 2012]: Available from:

http://www.amar.org.ir/Default.aspx?tabid=115&agentType=View&PropertyID=872

  1. Zeinali M, Shirzadi MR. National Guideline for Brucellosis Control. Tehran: Ministry of Health and Medical Education; 2009 [Persian].


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