Underlying factors behind the low prevalence of autism spectrum disorders in Oman sociocultural perspective

Epidemiological surveys from various countries indicate an increased prevalence of autism spectrum disorders [ASD], leading researchers to debate whether there are now 'more affected' or 'more detected'. The epidemiology of ASD in developing countries, such as Oman, has generally indicated a lower prevalence compared to developed countries in the West. In Oman, the prevalence is low; however, this article highlights some of the factors that could contribute to the appearance of a low ASD rate: cross-cultural variations in the presentation of distress; a lack of reliable biological markers for diagnosing ASD, and a lack of health services for children with ASD, thus limiting the number of participants in epidemiological surveys. While the defining features of ASD have yet to be established, pilot studies in Oman indicate a substantial number of children with these disorders. Therefore, it is important that these discrepancies be addressed and the need for appropriate services for this patient population in Oman be highlighted

Quality of diabetes care at outpatient clinic, Sultan Qaboos University Hospital

To assess the clinical care of type 2 diabetes mellitus [T2D] patients at Sultan Qaboos University Hospital [SQUH], a countrywide tertiary referral center in Muscat, Oman. We performed a retrospective, observational, cross-sectional study using a total of 673 Omani T2D patients from the Diabetes and Family Medicine Clinics at SQUH. We collected patient data from June 2010 to February 2012 from the Hospital Information System [HIS]. Patients had to be Omani, aged more than 18 years old, and have T2D with active follow-up and at least three visits within one year to be included in the study. Ninety-three percent of the patients [n=622] were on oral hypoglycemic drugs and/or insulin, and 70% were on statins. Patients' anthropometric data, biochemical investigations, blood pressure, and duration of diabetes were recorded from the HIS. Using the recommended standards and guidelines of medical care in diabetes [American Diabetes Association and the American National Cholesterol Education Program III NCDP NIII standards], we observed that 22% of the patients achieved a HbA1C goal of <7%, 47% achieved blood pressure goal of <140/80 mm Hg, 48% achieved serum low density lipoprotein cholesterol goal of <2.6 mmol/L, 67% achieved serum triglycerides goal of <1.7 mmol/L, 59% of males and 43% of females achieved high density lipoprotein cholesterol goals [males>1.0; females >1.3 mmol/L]. Almost 60% of the patients had urinary microalbumin/creatinine ratio within the normal range. The clinical outcomes of the care that T2D patients get at SQUH were lower than those reported in Europe and North America. However, it is similar to those reported in other countries in the Arabian Gulf

Familial clustering of type 2 diabetes among Omanis

The aim of this study was to screen Omani individuals for the familial aggregation of type 2 diabetes mellitus. A random cohort of 1182 Omani individuals visiting the Family Medicine Clinic at Sultan Qaboos University Hospital [SQUH], Muscat, Oman, for regular medical checkup, aged >/= 40 years, were sampled. Patients were categorized into three groups: [1] individuals who claim not to have diabetes and had no family history of diabetes; [2] individuals who claim not to have diabetes but had family history of diabetes; [3] individuals with diabetes. Only 16% of these Omani individuals had no diabetes and no family history of diabetes. Another separate random cohort of 234 Omani type 2 diabetes mellitus patients, from the Diabetes Clinic at SQUH, were interviewed and questioned about their family history of type 2 diabetes mellitus. Ninety five percent of the patients had a family history of diabetes. Eighty percent had first degree relatives with diabetes and 46% had second degree relatives with diabetes. At least one parent with diabetes was reported among 55% of these diabetics, while maternal diabetes [55%] was found to be higher than paternal diabetes [47%]. However, only 15% had both parents with diabetes. Furthermore, almost half of the 234 diabetics were having at least one of the following relatives with diabetes: brother, sister, aunt or an uncle. The findings of this study confirm familial aggregation of diabetes among the Omani population. Compared to other populations, familial aggregation of type 2 diabetes mellitus among Omanis is relatively very high, and is perhaps due to the very high degree of consanguinity among Omanis. Since almost everyone seems to have a genetic predisposition to diabetes, the dramatic lifestyle changes over the past 25 years, could tip the population into an epidemic of type 2 diabetes mellitus

Impaired fasting glucose in Omani adults with no family history of type 2 diabetes

The aim of this study was to estimate the prevalence of impaired fasting glucose [IFG] among Omani adults with no family history [FH] of diabetes and to investigate the factors behind the risk of developing type 2 diabetes [T2D], while excluding a FH of diabetes. A total of 1,182 Omani adults, aged >40 years, visited the Family Medicine and Community Health Clinic at Sultan Qaboos University Hospital, Oman, on days other than the Diabetes Clinic days, from July 2010 to July 2011. The subjects were interviewed and asked if they had T2D or a FH of T2D. Only 191 [16%] reported no personal history of T2D or FH of the disease. Of these, anthropometric and biochemical data was complete in 159 subjects. Of these a total of 42 [26%] had IFG according to the American Diabetes Association criteria. Body mass index, fasting insulin, haemoglobin A[1c] and blood pressure [BP], were significantly higher among individuals with IFG [P <0.01, P <0.05, P <0.01 and P <0.01, respectively]. In addition, fasting insulin, BP and serum lipid profile were correlated with obesity indices [P <0.05]. Obesity indices were strongly associated with the risk of IFG among Omanis, with waist circumference being the strongest predictor. Despite claiming no FH of diabetes, a large number of Omani adults in this study had a high risk of developing diabetes. This is possibly due to environmental factors and endogamy. The high prevalence of obesity combined with genetically susceptible individuals is a warning that diabetes could be a future epidemic in Oman

Reasons for consultation among patients attending primary healthcare centres in Oman

Pathways to care or care-seeking, which translate into healthcare utilization, have been investigated in many parts of the world, but there is a dearth of studies in the Arabian Gulf. The aim of this study was to examine the characteristics of attendees at primary healthcare centres in northern Oman and their reasons for visiting. Face-to-face interviews were conducted with 676 participants attending 12 primary healthcare centres between June and July 2006. The catchment area was selected to represent the population structure in Oman. The 12-item questionnaire was read to every fifth eligible patient entering each healthcare centre for a routine appointment. Analyses were conducted using univariate statistics. About a third [n = 200; 29.6%] of the participants had a history of chronic illness; 231 [34%] were on regular medications; 211 [31%] were taking part in health education programmes; 130 [19%] were open to complementary medicine. The majority of the participants mentioned physician's advice [n = 570; 84%] as the strongest reason for seeking consultation. Conversely, physician's advice was strongly related to particular demographic factors. This observational study identified some characteristics and reasons for visiting healthcare facilities in northern Oman. These are discussed within the context of prevailing sociocultural factors. The implications for the prevention and detection of ill health in Oman are also discussed

Emerging burden of frail young and elderly persons in Oman for whom the bell tolls?

Recent improvements in health and an increased standard of living in Oman have led to a reduction in environment-related and infectious diseases. Now the country is experiencing an epidemiological transition characterised by a baby boom, youth bulge and increasing longevity. Common wisdom would therefore suggest that Omanis will suffer less ill health. However, a survey of literature suggests that chronic non-communicable diseases are unexpectedly becoming common. This is possibly fuelled by some socio-cultural patterns specific to Oman, as well as the shortcomings of the 'miracle' of health and rapid modernisation. Unfortunately, such new diseases do not spare younger people; a proportion of them will need the type of care usually reserved for the elderly. In addition, due to their pervasive and refractory nature, these chronic non-communicable diseases seem impervious to the prevailing 'cure-oriented' health care system. This situation therefore calls for a paradigm shift: a health care system that goes beyond a traditional cure-orientation to provide care services for the chronically sick of all ages

diagnostic yield of thyroid function tests and their cost-effectiveness in the student clinic at Sultan Qaboos University: retrospective chart review

To assess the significance of requesting thyroid function tests [TFT] and their cost effectiveness for specific and non-specific symptoms of thyroid disease in a specific population in Oman. A retrospective chart review study was conducted in the student clinic at Sultan Qaboos University in Oman in the year 2007-2008. It included all patients [N=319] of both sexes for whom TFTs were requested. The patients' main complaints and the final diagnoses were collected from their medical records. The most common presentations for which TFTs were requested were irregular periods [n=82]; fatiguability [n=49], palpitations [n=39]; weight changes [n=22]; hair changes [n=20]; sensation of heat and cold [n=18]; diarrhoea and constipation [n=13], and neck swelling [n=13].The most common diagnoses reached in relation to these complaints were polycystic ovarian syndrome [n=51]; iron deficiency anaemia [n=42]; anxiety and depression [n=11]; thyroid disease [n=18], and no specific diagnosis [n=193]. The percentage of thyroid diseases among females [7.1%] compared to males [1.2%] was statistically significant [P <0.05]. Thyroid disease accounted for 61.5% of those patient with neck swelling, 7.7% of those with palpitations, 4.1% of those with fatigue, 3% of those with other complaints, and 1.2% of those with irregular periods. The cost of the tests was around 20,000 US dollars. TFT is necessary for those presenting with neck swelling, but restraint should be used in administering the test for those complaining of palpitations or fatigue. Additionally, irregular periods have little link with TFT abnormality

Quality of diabetes care: a cross-sectional observational study in Oman

The objective of this study was to evaluate the quality of diabetes care in Oman. This was a cross-sectional observational study. Fifty percent of all those attending six general health centers in June 2005 were systematically selected for the study. Descriptive statistics were used to describe the data. A total of 430 diabetic subjects were included. Just over 61% percent of the subjects were female [n = 263]. The overall mean age of the cohort was 52 +/- 12 years ranging from 6 to 84 years. Only 40% [n = 171] and 39% [n = 169] of the diabetics had their random blood sugar [RBS] and fasting blood sugar [FBS] documented, respectively. However, 79% [n = 339] had either RBS or FBS done according to the records. Documentation for the other measurements ranged from 74% [n = 317] for HbA1c and low density lipoproteins-cholesterol [LDL] to 95% [n = 409] for systolic and diastolic blood pressure [SBP/DBP] readings. A total of 58% [n = 249] of patients had non-missing values of HbA1c, SBP/DBP, total cholesterol, LDL-cholesterol, high density lipoproteins-cholesterol [HDL], and triglycerides. Only 2.4% [6 out of 249 diabetics] were simultaneously within goal for HbA1c [<7%], SBP/DBP [<=130/80 mmHg], total cholesterol [<5.2 mmol/L], LDL-cholesterol [<3.3 mmol/L], HDL-cholesterol [>1.1 - <1.68 mmol/L], and triglycerides [<1.8 mmol/L]. There was good documentation of values for the indicators used in the assessment of quality. However, the proportion [2.4%] of those meeting internationally recognised goals for the three diabetes-related factors was extremely low

Relatives' advice and health care-seeking behaviour in Oman

It has been well established that pathways to care are considerably modified by local, social and psychological characteristics as well as the doctor-patient relationship. Scant attention has been paid to the role of family advice in care-seeking. In Omani society, traditional family values and a collective mindset are the norm rather than the exception. This paper examines how family advice affects the trajectory of care seeking. Methodology: During 2006-2007, data was collected through face-to-face interviews among a randomised sample of patients seeking medical consultation in various primary health care centres in the northern region of Oman. This study enrolled a total of 493 patients. The association between the advice of family members as a reason to seek health care and other predictors was analysed using multivariable logistic regression. Results: The data suggest that the advice of family members in care-seeking is strongly associated with gender, education, history of chronic illness, previous exposure to traditional medicine, and health education, as well as the history of immunisation. These findings suggest that the advice of family members remains a strong catalyst for care-seeking in Oman. The psychosocial factors affecting care-seeking leading to underutilisation of services or otherwise are discussed

Impact of geographical proximity on health care seeking behaviour in northern Oman

Despite its impact on health policy, the relationship between geographical proximity and health care seeking has received scant attention in the medical literature. This paper aims to evaluate the relationship between geographic proximity and health care usage behaviour among patients seeking medical consultation in the northern region of Oman. During 2006- 2007, data was collected via face-to-face interviews among 428 randomized patients seeking medical consultation in various primary health care centres in the northern region of Oman. The association between geographical proximity as a reason to seek health care and other predictors was also analysed using multivariable logistic regression. The data suggest that preference for geographical proximity as a reason for seeking health care is strongly associated with marital status, previous exposure to traditional medicine and health education, as well as history of immunisation. This finding supports the view from elsewhere that geographical proximity remains a strong catalyst for care seeking in Oman. The psychosocial factors affecting care seeking are discussed