International Journal of Preventive Medicine (Int J Prev Med)2008-78024320130217265270ENSocial Health Determinants Research Center and Department of Epidemiology and Biostatistics, School of Health, Shahrekord University of Medical Sciences, Shahrekord, IranChild Mortality Surveillance office, Ministry of Health and Medical Education, Tehran, IranChild Health Office,Ministry of Health and Medical Education, Tehran, Iran3Department of Pediatrics, Jondishapour University of Medical Sciences, Ahwaz, Iran, and Community, Family and Schools Health Office, Ministry of Health and Medical Education, Tehran, IranChild Growth and Development Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, IranChild Health Promotion Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran20130217<p><strong>Background: </strong>To determine inequality in mortality in 1‑59 months children across Iranian provinces focusing on referring system and determinants of death.</p><p><strong>Methods: </strong>After designing and examining a national questionnaire for mortality data collection of children 1‑59 months, 40 medical universities have been asked to fill in the questionnaires and return to the main researcher in the health ministry in 2009.</p><p><strong>Results: </strong>Mortality in 1-59 months children was unequally distributed across provinces (universities). The recommended refer was 3466 but only 1620 patients were referred. The first five important determinants of death were congenital (671 children or 20.9%), accident (547 children or 17.1%), pulmonary diseases (370 children or 11.5%), cardiovascular (266 children or less than 8.3%), central nervous system (263 children or 8.2%), and infectious and parasitic diseases (245 children or 7.6%), respectively.</p><p><strong>Conclusions: </strong>Our results suggest that inequality in 1‑59 months mortality based on the hospital records, and specially referring system, needs more attention in Iran. In addition, it is advisable to conduct provincially representative surveys to provide recent estimates of hospital access inequalities and to allow monitoring over time.</p><strong>Keywords: </strong>Children mortality, hospital records, Iran, national mortality registration system, referring systemhttp://ijpm.mui.ac.ir/index.php/ijpm/article/view/1066http://ijpm.mui.ac.ir/index.php/ijpm/article/download/1066/821