Estimation of Mean Intelligence Quotient with Wechsler Scale in Iran: Systematic Review and Meta‑Analysis

International Journal of Preventive Medicine (Int J Prev Med)2008-780210320190318Estimation of Mean Intelligence Quotient with Wechsler Scale in Iran: Systematic Review and Meta‑Analysis20087802ENSocial Determinants of Health Research Center, Yasuj University of Medical Sciences, YasujPsychosocial Injuries Research Center, Ilam University of Medical Sciences, IlamPsychosocial Injuries Research Center, Ilam University of Medical Sciences, IlamSocial Determinants of Health Research Center, Yasuj University of Medical Sciences, YasujNursing Research Center, Golestan University of Medical Sciences, GorganSocial Determinants of Health Research Center, Shahrekord University of Medical Sciences, Shahrekord20190318The low intelligence quotient (IQ) level is one of the most common and important medical, social, and familial problems in all countries. The current study aimed to estimate mean IQ with the Wechsler scale in Iran by performing a systematic review and meta-analysis. In the current meta-analysis, all articles related to IQ conducted in Iran using the Wechsler scale were deeply searched by reviewing citation databases including Science Direct, PubMed, Scopus, Web of Science, Springer, SID, Magiran, Iranmedex, Medlib, and Google Scholar motor search and using valid keywords without time limits. Due to heterogeneity between studies, a random effects model was used to combine the results of studies. To investigate the heterogeneity of the studies, the I2 index was used. All statistical analyses were performed using STATA software version 11.1. The number of participants in the 51 studies was 5352. The mean total IQ score in Iran was estimated 97.12 (95% conf dence interval [CI]: 88.71–105.52), the practical intelligence was 92.84 (95% CI: 79.14–106.55), and the verbal intelligence was 94.50 (95% CI: 83.90–105.10). The total IQ score in the northern, southern, central, eastern, and western regions of Iran was 97.08, 108.90, 92.31, 101.76, and 96.45, respectively. The mean IQ score in Iran in subjects under 20 years of age is 97.73 and in subjects over 20 years of age is 105.61. There is also no signif cant relationship between the mean total IQ in Iran and two parameters of the year of research and number of research samples. For prevention of decrease IQ and given that proper nutrition and breastfeeding directly contribute to increase IQ, nutrition should be provided free of charge in poorer areas during pregnancy until baby born. Moreover, the media should provide adequate education for breastfeeding and nutrition, because IQ affects people’s academic, occupational, personal, and social performance, and also prevents elite immigration with suitable planning and provides conditions for elites to return to the country. Keywords: Iran, intelligence quotient, meta‑analysis, practical intelligence, verbal intelligence, Wechslerhttp://ijpm.mui.ac.ir/index.php/ijpm/article/view/2022http://ijpm.mui.ac.ir/index.php/ijpm/article/download/2022/717717842

International Journal of Preventive Medicine (Int J Prev Med)2008-780210320190318Bivariate Spatio-Temporal Shared Component Modeling: Mapping of Relative Death Risk due to Colorectal and Stomach Cancers in Iran Provinces20262026ENDepartment of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, IsfahanDepartment of Biostatistics, School of Health, Isfahan University of Medical Sciences, IsfahanDepartment of Biostatistics, School of Public Health, Kermanshah University of Medical Sciences, Isfahan20190318Background: Gastrointestinal cancers make for nearly half fatal cancers with colorectal and stomach cancers’ being listed among the ten most common in Iran. This research aims to determine the spatial pattern and temporal trend of death risk due to colorectal and stomach cancers among provinces of Iran and estimate the effect of shared and specifc components as surrogates of risk factors for the aforementioned cancers on changes of death due to the cancers over time and place. Methods: In this ecological study, the data regarding death causes in colorectal and stomach cancers during 2006–2011 were obtained from the death registration system of the Iranian Ministry of Health. The estimation of relative risk (RR) of death due to the target cancers was performed applying Bayesian spatiotemporal shared component (SC) model in OpenBUGS software. Results: North‑Western provinces ranked frst regarding stomach cancer RR of death (RR >1.75). Furthermore, some North‑Western and central provinces had the highest RR of death due to colorectal cancer (RR >1.5). The SC surrogating the risk factor shared between both cancers had the most effect in Northern, North‑Western and western provinces, and the least effect in Southern and South‑Eastern ones. Conclusions: North and North‑West of Iran found to be the high‑risk area for death due to both stomach and colorectal cancers and South‑East and South provinces shown to have the lowest RR. The obtained results can be illuminating to health resource allocation to the health policymakers. Keywords: Bayesian model, colorectal cancer, disease mapping, model, shared component, stomach cancerhttp://ijpm.mui.ac.ir/index.php/ijpm/article/view/2026http://ijpm.mui.ac.ir/index.php/ijpm/article/download/2026/717717846

International Journal of Preventive Medicine (Int J Prev Med)2008-780210320190318The Relationship between Depression or Anxiety Symptoms and Objective and Subjective Symptoms of Patients with Frozen Shoulder20087802ENOrthopedic Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, MashhadOrthopedic Research Center, Mashhad University of Medical Sciences, Mashhad & Hand and Upper Extremity Division, Department of Orthopedic Surgery, Mass General Hospital, Harvard Medical School, Boston, MA, USAOrthopedic Research Center, Mashhad University of Medical Sciences, MashhadSchool of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan20190318Background: the aim of this study is to evaluate the prevalence and effect of depression and anxiety on the shoulder range of motion, as well as the objective and subjective symptoms in patients suffering from frozen shoulder. Methods: Between 2013 and 2014, in a cross‑sectional study, we evaluated 120 patients with idiopathic frozen shoulder. We collected the demographic data for each patient and measured shoulder range of motion in four directions in both limbs. All patients flled out visual analog scale (VAS) for pain and the disabilities of the arm, shoulder, and hand (DASH) questionnaires. Both Hamilton anxiety and depression questionnaires were flled out for each patient. Results: A total of 92 patients (77%) with idiopathic frozen shoulder showed symptoms of depression, while only 32 (27%) of them experienced anxiety. Thirty‑two patients (27%) showed symptoms of both depression and anxiety. Although elevation and abduction were not affected by depression, internal and external rotations were more restricted among patients who had symptoms of depression. DASH and VAS scores were higher in patients with symptoms of depression. In terms of anxiety, only VAS and DASH were different between two groups. In multivariable analysis, DASH score was correlated with severity of both anxiety and depression symptoms.Conclusion: While there is no defnitive relationship between symptoms of depression or anxiety and shoulder range of motion in patients suffering from frozen shoulder, patients who suffer from depression or anxiety experienced increased pain and limb disability. Keywords: Adhesive capsulitis, anxiety, DASH, depression, frozen shoulderhttp://ijpm.mui.ac.ir/index.php/ijpm/article/view/2025http://ijpm.mui.ac.ir/index.php/ijpm/article/download/2025/717717845

International Journal of Preventive Medicine (Int J Prev Med)2008-780210320190318Lead Poisoning in Opium‑Addicted Subjects, Its Correlation with Pyrimidine 5′‑Nucleotidase Activity and Liver Function Tests20087802ENDepartment of Toxicology and Pharmacology, Faculty of Pharmacy, Pharmaceutical Sciences Branch, Islamic Azad University (IAUPS), TehranDepartment of Forensic Toxicology, Legal Medicine Research Center, Legal Medicine Organization, TehranTehran University of Medical Sciences (TUMS), Tehran20190318Background: Lead may be added to the opium by drug smugglers. It can cause elevated blood lead level (BLL) in opium‑addicted patients. Erythrocyte pyrimidine 5′‑nucleotidase (P5N) activity is susceptible to high BLL. The aim of this study was to fnd out whether opium‑addicted patients show erythropathy and elevated liver enzymes explainable by high BLL and decreased P5N activity. Methods: Forty orally opium‑addicted subjects and 40 normal healthy volunteers were enrolled in this study. BLL was measured in whole blood specimens using atomic absorption spectrometry instrumentation. Enzymatic activity, protein amount of P5N, and erythrocyte purine/pyrimidine ratio were determined. Blood flms were analyzed for the presence of basophilic stippling of red cells and hemolytic anemia. The level of liver function enzymes was measured. Results: The mean BLL for opium‑addicted patients was signifcantly higher than control group (P < 0.001). On the contrary, P5N activity showed a valid decrease in opium‑addicted patients when compared with control group (P < 0.001). In line with repressed P5N activity, erythrocyte purine/pyrimidine ratio in patients was lower than control group (P < 0.001). A statistically signifcant reverse correlation was found between BLL and P5N activity (P < 0.05, r = -0.85). The prevalence of both basophilic stippling (P < 0.001, z = 6.62) and hemolytic anemia (P < 0.001, z = 6.52) in study population was signifcantly associated with elevated BLL. We could not fnd any signifcant correlation between serum level of liver enzymes and BLL. Conclusions: Opium‑addicted patients in Tehran, Iran, are at high risk of lead poisoning which may result in hematologic problems and possibly hepatic damage. Keywords: Anemia, lead poisoning, liver function tests, opium, pyrimidine 5′‑nucleotidasehttp://ijpm.mui.ac.ir/index.php/ijpm/article/view/2024http://ijpm.mui.ac.ir/index.php/ijpm/article/download/2024/717717844

International Journal of Preventive Medicine (Int J Prev Med)2008-780210320190318Simplifed Algorithm for Evaluation of Proteinuria in Clinical Practice: How should A Clinician Approach?20087802ENDepartments of Pediatrics, Section of Nephrology, Semnan University of Medical Sciences, SemnanDepartment of Pediatrics, Section of Nephrology, Rush University Medical Center, Chicago, Illinois20190318Background: Proteinuria is a common laboratory fnding among children and adolescents. It can be identifed as either a transient or a persistent fnding and can represent a benign condition or a serious disease. Methods: Pertinent medical literature for asymptomatic proteinuria in children and adolescents published in English was searched between January 1980 and May 2017 using PubMed, MEDLINE, EMBASE, and Google Scholar research databases. Of the 64 reviewed articles, 24 studies were eligible for inclusion.Results: Random spot urine protein‑to‑creatinine (PCR) ratio is widely used to reliably detect proteinuria. The normal value for the spot PCR in children aged 2 years or older is less than 0.3. In children aged below 2 years, the PCR can be as high as 0.5. Orthostatic proteinuria is defned as urine PCR greater than 0.3 detected in a urine specimen during the daytime activity but less than 0.3 on the frst morning void specimen. PCR above 3.0 signifes heavy proteinuria as seen in nephrotic syndrome. Orthostatic proteinuria is a frequent cause of proteinuria in asymptomatic children and adolescents, which require no specifc therapy except for health maintenance follow‑up. Pediatric nephrologist referral is indicated when the proteinuria is constant and persists over 6 months or is associated with hematuria, hypertension, or renal dysfunction. Conclusions: We provide a simplifed diagnostic algorithm for evaluation of proteinuria in primary care adolescents who appear well and in whom proteinuria is incidentally discovered during a routine examination. Keywords: Adolescents, algorithm, asymptomatic proteinuria, childrenhttp://ijpm.mui.ac.ir/index.php/ijpm/article/view/2023http://ijpm.mui.ac.ir/index.php/ijpm/article/download/2023/717717843

International Journal of Preventive Medicine (Int J Prev Med)2008-780210320190318Vitamin B12 and Folate Status in Patients with Epilepsy Under Levetiracetam Monotherapy20087802ENDepartment of Community Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, IsfahanDepartment of Community Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, IsfahanDepartment of Neurology, Faculty of Medicine, Isfahan University of Medical Sciences, IsfahanIsfahan Center of Health Research, National Institute of Health Research, IsfahanDepartment of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan20190318Background: Antiepileptic drugs (AEDs) may lead to an increase in the plasma concentration of homocysteine. There is limited information, especially from Iran, regarding the risk in patients who are treated with levetiracetam as a new type of AED. The aim of the present study was to investigate the effect of levetiracetam on plasma homocysteine, vitamin B12, and folate levels in adult patients with epilepsy. Methods: We conducted a case‑control study and enrolled adult patients with epilepsy who had received monotherapy with levetiracetam for at least 6 months at some time prior to the study. homocysteine serum, vitamin B12, and folate were measured, and folate and vitamin B12 intake was determined by the food frequency questionnaire (FFQ). Results:Thirty‑three patients on levetiracetam and 35 control subjects aged between 18 and 60 years were enrolled. No statistically signifcant differences in the means of the serum markers of vitamin B12, FA, and homocysteine levels were found between the two groups. In the frst model, i.e., the crude model, no signifcant differences were observed in the serum concentrations of homocysteine, vitamin B12, and folate. In the second model, education was considered, and body mass index and folate intake was controlled with no signifcant difference being observed in the mean homocysteine serum level. Conclusions:Treatment with levetiracetam in patients with epilepsy has no effect on the serum levels concentrations of homocysteine, vitamin B12, and folate. This medication is suggested for patients who use AEDs on a long‑term basis and at high dosages. Keywords: Folic acid, levetiracetam, monotherapy, patients with epilepsy, vitamin B12 http://ijpm.mui.ac.ir/index.php/ijpm/article/view/2020http://ijpm.mui.ac.ir/index.php/ijpm/article/download/2020/717717840

International Journal of Preventive Medicine (Int J Prev Med)2008-780210320190318Development and Validation of “Caregiver Burden Scale‑Indian Population"20087802ENDepartment of Occupational Therapy, Swami Vivekananda National Institute of Rehabilitation Training and Research, Utkal University, Bhubaneswar, OdishaDepartment of Occupational Therapy, Swami Vivekananda National Institute of Rehabilitation Training and Research, Utkal University, Bhubaneswar, OdishaDepartment of Psychology, Center of Advanced Study in Psychology, Utkal University, Bhubaneswar, Odisha20190318Background: Caregiver burden is always a neglected domain, and assessment of burden with available instruments developed in one country is neither reliable nor valid because of different cultural, ethical, religious, and other personal values. This study is an attempt to develop an appropriate instrument which can assess the burden on caregivers from the Indian subcontinent and other Asian countries. This work is an attempt to develop and standardization of CBS-IP using content and construct validity. Methods: The study was conducted with a total of 125 (55 – initial interview + 25 – pilot study + 45 – construct validity) caregivers of individual with chronic neurologically ill patients. Content and construct validation was performed as follows: (1) search of relevant electronic databanks and use of experts and caregivers’ opinions to prepare appropriate content, review, and correction of the content through discussions with experts. (2) Content validity has been established by computing content validity index (CVI). (3) Construct validity has been established by correlating (Pearson’s-r) with another standardized instrument (Eysenck Personality Questionnaire-Revised) using multitrait procedure. Results: Using CVI procedure, scale‑level CVI (S-CVI) universal agreement is 0.889; S-CVI average is 0.898. The item-level CVI is 0.90. The Pearson product-moment correlation coeffcient (r) was obtained by comparing caregiver burden scale-Indian population (CBS-IP) total with extraversion, r = -0.440, n = 45, P = 0.002; CBS-IP total with neuroticism, r = 0.228, n = 45, P = 0.132; and CBS-IP total with psychoticism, r = -0.011, n = 45, P = 0.942. Conclusions: We believe that the new tool CBS-IP is a good empirical instrument for evaluating stressors on informal caregivers in India and possibly in some other countries in Asia. Keywords: Construct validity, content validity, neurologically illhttp://ijpm.mui.ac.ir/index.php/ijpm/article/view/2019http://ijpm.mui.ac.ir/index.php/ijpm/article/download/2019/717717839

International Journal of Preventive Medicine (Int J Prev Med)2008-780210320190318Health Services Management in Turkey: Failure or Success?20087802ENDepartment of Biostatistics and Medical Informatics, Cerrahpaşa Faculty of Medicine Istanbul University, Istanbul & Department of Evidence for Population Health Unit, School of Epidemiology and Health Sciences, University of Manchester, Manchester & Department of Public Health, Istanbul Medipol University, International School of Medicine, İstanbulDepartment of Public Health, Istanbul Medipol University, Faculty of Management and Administration, Kavacik, İstanbulDepartment of Biostatistics and Medical Informatics, Cerrahpaşa Faculty of Medicine Istanbul University, Istanbul & Department of Computer Education and Instructional Technologies, Faculty of Education, University of Kastamonu, KastamonuDepartment of Evidence for Population Health Unit, School of Epidemiology and Health Sciences, University of Manchester, Manchester & Department of Public Health, Faculty of Medicine, Bezmialem Vaqif University, İstanbulDepartment of Economic Evaluations and Drug Supply Management, Ministry of Public Health, Health Technology Assessment Directorate, Ankara20190318Background: The unfair distribution and delivery of health‑care resources have been recognized as a problem in the worldwide. In the past 18 years, Turkey has undergone rapid social, cultural, and economic changes. The lifestyle and dietary habits of its people have also been changing, and the rates of diabetes, obesity, cancer, and other chronic diseases have increased dramatically over the past two decades. The health transformation program (HTP) has improved the Turkish health‑care system since 2003. The main goal of HTP was to progress government, to provide equality between citizens, to give satisfaction to users and providers, and to subsidise the health‑care system in Turkey. Aim: The aim of this study is to assess health‑care services and health care quality delivery in the Republic of Turkey with special emphasis on governmental hospitals, university hospitals, primary healthcare centers (PHC) and to make comparison with low‑, medium‑ and high‑income countries. Methods: This is a retrospective, descriptive study. The ministry of health Annual Reports, websites of the Central Intelligence Agency (CIA), The World Fact Book, organization for economic cooperation and development report, Compendium of Health Statistics, the Google engine, and PubMed were searched for information about Turkey’s health‑care system and its history. Papers and websites in English were evaluated. There was no restriction on types of articles and sources. Results: Turkey has made outstanding reforms in health status in the last two decades, especially after the implementation of the HTP. The doctor’s perception has more inﬂuence regarding consultation length and visit than the patient’s. The results of consultations in volunteer practices in Istanbul showed that the mean and SD of the consultation length for the whole sample of 360 patients was 7.95 ± 4.38, (with range = 3–25 min). Consultation time has been affected by the patients’ diseases, genders that women got longer consultation time, medical practices at the urban or rural areas, and ages which older patients required longer consultation time. The current study revealed that increasing doctor’s workload leads to decrease the length of consultations. Moreover, average life expectancy reached 75.3 for men and 80.7 for women in 2015. The infant mortality rate decreased to 10.7/1000 live births in 2015, down from 117.5 in 1980. The leading causes of death are diseases of the circulatory system followed by cancer. Conclusions: The Turkish health system and health‑care delivery have been improved over the last decade. Still far from perfect, there is a particular planning to increase medical workforce in PHC including well‑trained staffs for a specifc area. An urgent need is to acquire more accurate and reliable data from hospital and PHC centers in Turkey. Additional some attempts should be made to assess quality of healthcare in relation to services and process. Keywords: Assessment, health care services, health performance, management, Ministry of Health, Turkeyhttp://ijpm.mui.ac.ir/index.php/ijpm/article/view/2018http://ijpm.mui.ac.ir/index.php/ijpm/article/download/2018/717717838

International Journal of Preventive Medicine (Int J Prev Med)2008-780210320190318Skeletal Muscle Hypertrophy, Insulin‑like Growth Factor 1, Myostatin and Follistatin in Healthy and Sarcopenic Elderly Men: The Effect of Whole‑body Resistance Training20087802ENDepartment of Sport Physiology, Shahid Chamran University of Ahvaz, Ahvaz & Department of Sport Physiology, Tarbiat Modares University, TehranDepartment of Sport Physiology, Shahid Chamran University of Ahvaz, AhvazSchool of Science and Sport, University of the West of Scotland, PaisleyDepartment of Sport Physiology, Shahid Chamran University of Ahvaz, AhvazDepartment of Sport Physiology, Shahid Chamran University of Ahvaz, Ahvaz & Department of Sport Physiology, Tarbiat Modares University, TehranDepartment of Radiology, Jundishapur University of Medical Sciences, AhvazInstitute of Sports Sciences and Innovation, Lithuanian Sports University, Kaunas20190318Background: Sarcopenia describes the inevitable deterioration in muscle mass and strength that accompanies biological aging. The purpose of this study was to investigate the effects of resistance training (RT) on quadriceps hypertrophy and related biochemistry in sarcopenic and healthy elderly men. Methods: A total of 31 elderly men (55–70 years old) were classifed as sarcopenic and nonsarcopenic and were divided into two groups. Both groups participated in a progressive RT program for 8 weeks. Results: Data indicated that the strength in the sarcopenic group increased more than the healthy group (P < 0.05). Quadriceps cross‑sectional area also increased more in the healthy group (P < 0.05). Myostatin concentration decreased in both groups after training (P < 0.05). Follistatin and testosterone increased in the healthy group; in contrast, only testosterone increased in the sarcopenic group after training (P < 0.05). Conclusions: The fndings from this study suggest that RT improves muscle cross‑sectional area and biomarker‑related muscle loss in both healthy and sarcopenic elderly men. The fndings also demonstrate that growth factor profles at baseline and changes in testosterone levels play an important role in muscle hypertrophy observed in both groups. Keywords: Aging, follistatin, hypertrophy, myostatin, resistance training, sarcopeniahttp://ijpm.mui.ac.ir/index.php/ijpm/article/view/2017http://ijpm.mui.ac.ir/index.php/ijpm/article/download/2017/717717837

International Journal of Preventive Medicine (Int J Prev Med)2008-780210320190318Association between Dental Caries and Body Mass Index‑for‑Age among 10‑12‑Year‑Old Female Students in Tehran20087802ENDepartment of Health Education and Health Promotion, Faculty of Medical Sciences, Tarbiat Modares University, TehranDepartment of Health Education and Health Promotion, Faculty of Medical Sciences, Tarbiat Modares University, TehranDepartment of Health Education and Health Promotion, Faculty of Medical Sciences, Tarbiat Modares University, TehranDepartment of Population Health, Family and Schools Offce, Ministry of Health and Medical Education, Tehran20190318Introduction: Dental caries and obesity are multifactorial diseases with diet being a common contributory factor. Many studies have reported varied outcomes about the association between dental caries and body mass index. But, there is no published study that investigates this association among female students in Tehran. The main aim of this study was to examine the relationship between dental caries and body mass index (BMI) in a sample of female students in Tehran. Methods: In this cross‑sectional study, 416 students aged between 10 to 12 years was examined for dental caries using WHO standard diagnostic criteria. The Decayed, missing and flled of permanent teeth (DMFT) were recorded. The student’s weight and height were measured by two trained examiner and their BMI were calculated. BMI‑for‑age and dental caries categories were analyzed with Pearson correlation coeffcient, Chi‑square, and t‑tests using SPSS computer software. Results: The mean DMFT score and BMI of the study population was 1.03 ± 1.41 and 18.11 ± 3.33 respectively. The fndings showed that 58.9% of the children had a normal weight, 27.9% were overweight, 10.3% were obese, and only 2.9% of the students were thin when they were compared with WHO standard of BMI for children with the same age. The respective mean DMFT values for BMI groups (thin, normal, overweight and obese) were 1.25, 0.73, 1.42, and 1.65, respectively. There was a signifcant association (P < 0.05) between dental caries and high BMI. Conclusions: This study demonstrated a signifcant association between caries frequency with high body mass index. For these reasons, the evaluation of nutritional status in students should be implemented in control programs for dental caries both on the community, schools, and individual levels. Keywords: Body mass index, children, dental carieshttp://ijpm.mui.ac.ir/index.php/ijpm/article/view/2016http://ijpm.mui.ac.ir/index.php/ijpm/article/download/2016/717717836

International Journal of Preventive Medicine (Int J Prev Med)2008-780210320190318High Under‑fve Mortality Rate in Rural Madhya Pradesh, Time to Identify High‑Risk Districts Using National Family Health Survey‑4 Data with Comparison to Low Under‑fve Mortality Rate in Rural Tamil Nadu, India20087802ENDepartment of Community Medicine, LBRKM Government Medical College, Jagdalpur, Chhattisgarh20190318Background: India had highest number of under‑fve deaths, 1.2 million deaths out of 5.9 million (2015). As per the results from the frst phase of National Family Health Survey (NFHS‑4), 2015–2016, under‑fve mortality rate was highest in rural area of Madhya Pradesh (MP), 69/1000 live birth as compared to urban areas, 52/1000 live birth. The objective of the study was to identify potentially high‑risk districts (HRD). Methods: This study was carried out from the secondary data of 50 districts of MP State which was available from NFHS‑4 with information from 49,164 households. Scoring method was used to identify HRD by comparing variables related to maternal and child health care of rural MP with rural Tamil Nadu. Results: Eleven HRDs were identifed with poor maternal and child health care along with high women’s illiteracy and high percentage of child marriages in women. Indore division had 3 topmost HRD, Alirajpur, Jhabua, and Barwani followed by Rewa division with 2, Singrauli and Sidhi along with Sagar division. Conclusions: HRDs should be considered for targeted interventions using the strategies for reducing under‑fve mortality rate in rural MP. Keywords: Antenatal care, high‑risk districts, Madhya Pradesh, postnatal care, under‑fve mortality ratehttp://ijpm.mui.ac.ir/index.php/ijpm/article/view/2021http://ijpm.mui.ac.ir/index.php/ijpm/article/download/2021/717717841