Screening for cervical cancer - the experience of the United Arab Emirates

In most Arab countries, including Algeria, Lebanon, Libya, Morocco, Oman, Tunisia, Sudan and the United Arab Emirates [UAE], cervical cancer is the second most common malignancy seen in women. The objective of this study was to ascertain whether or not cervical cancer screening [CCS] is important in the detection of precancer and early cervical cancers, and if so, to understand how it can most effectively be implemented in the UAE. Before introducing any CCS programme, it is important to determine [1] the knowledge, attitude and practice [KAP] of physicians involved in the screening programme, [2] the actual prevalence of the precancer and cancer of the cervix, and [3] the choice of treatment modalities available. These factors will determine the likely effectiveness of screening. As in other Arab countries, women in the UAE have little awareness of Papanicolaou's stain test [also known as the Pap smear], and so many have never undergone this test. This is critical, as many patients present with advanced-stage disease in countries where awareness is low. Our observations indicate that there are significant gaps in the KAP of primary health care physicians with regard to CCS. Additionally, standards in colposcopy and cytology services are severely lacking, despite good treatment modalities. Based on this study, it is imperative that physicians receive training and that quality control measures be implemented prior to the introduction of CCS, to ensure that the programme can succeed in the UAE. In this way, the experience of the UAE should serve as a learning model for other countries in the Arab world, where CCS and prevention programmes have yet to be initiated

Babies as desired: Ethical arguments about gender selection

Gender selection for non-medical reasons raises serious moral, legal, social and ethical issues. The desire to preselect the gender of offspring dates from antiquity and is influenced by many factors including economics, culture, religion and personal circumstances. The gender ratio of children can be affected by using techniques such as prefertilization sperm sorting, preimplantation genetic diagnosis, and prenatal sex determination. The cheapest and the most widely used method is ultrasound scanning early in pregnancy, which may lead to abortion of the undesired sex. The distortion of the national sex ratio in countries where discrimination against women is common, such as India and China, has resulted in laws and policies to explicitly forbid sex selection. Laws and clinical practice guidelines should be enforced to eradicate sex selection especially in societies where gender selection is apparently sexist. The ethics of legal prohibition warrant urgent attention. The challenge to all societies is to improve womens social, economic, political and cultural status, in order to eliminate discrimination against women

External cephalic version for breech presentation at term: Tawam Hospital experience

In order to determine the impact of external cephalic version [ECV] at term on breech presentation in terms of success rate, factors affecting success, patient acceptance and mode of delivery with a view to improve the service were studied. A retrospective review of all women with singleton breech presentation at term seen in the obstetric clinic, Tawam Hospital, United Arab Emirates between Jan. 2003 to Dec. 2003 was carried out. One hundred and seven women were identified, but only 82 were suitable for ECV when they were seen in the labour and delivery after excluding patients with spontaneous reversion, delivery prior to the appointment for ECV and patients with exclusion criteria. F4fty five out of 82 [67%] eligible women agreed to have an attempt at ECV The overall success rate was 47%. There were no adverse outcomes. Successful version was related to maternal parity but did not depend on gestational age [37-42 wks] or foetal weight. Engagement of the breech and reduced amniotic fluid [amniotic fluid index<5 cm.] were associated with failure. When version failed, trial of vaginal breech was offered after appropriate counseling and strict evaluation. The caesarean section rate in the successful group was 4% with 96% of women having vaginal delivery. In marked contrast, caesarean section rate was 89% in the unsuccessful group of which two thirds were planned and in the group where ECV was not attempted the rate was 63%. The overall assisted vaginal breech rate was 14%. This review has assisted us in making important conclusions regarding future services. This has clearly shown the reduction in caesarean section due to breech presentation and this is especially important in our culture with multiparous population where operative delivery is generally unacceptable. As the trend for assisted vaginal breech delivery is generally decreasing, ECV is the only safe option to reduce the rising caesarean rate for breech presentation and the need for repeat caesarean

Cultural and ethnic barriers in conducting research. Factors influencing menarche in the United Arab Emirates

The objective of this cross sectional survey was to study the feasibility of conducting research on issues related to physical and sexual maturation in a predominantly Islamic society and to identify the factors influencing menarche in this multi ethnic community. This study was conducted in Al-Ain, United Arab Emirates [UAE] between January 1999 through to February 1999. Fifteen female secondary schools located in different geographical regions in Al-Ain were chosen in consultation with the District Education Department. All girls aged 12-16-years were selected. Information regarding whether they had attained menarche including month and the year, age at menarche and the factors influencing it such as height and weight, diet, physical activity were gathered. Univariate and multiple linear regressions were used in analysis. Of the 1500 questionnaires distributed, 1416 questionnaires were returned but only 890 had the required information and were used in the analysis. Ninety-three [10.4%] had not attained menarche and as expected these girls were younger [p<0.0001] than those who had attained menarche. Mean age at menarche was 12.68 [SD 1.27] years. In the univariate analysis UAE nationality, vegetarians [p=0.001], higher income group [p=0.008], low body weight [p=0.009] and a diagnosis of anemia [p<0.05] in the year before menarche were all positively associated with the age at menarche. Only anemia achieved borderline significance [p=0.056] in multivariate analysis and no other variables were significant. This study highlights the difficulties of conducting research on issues considered to be sensitive by the community and provide data on factors influencing menarche in a multi ethnic community