Health services utilization by school going Omani adolescents and youths with DSM IV mental disorders and barriers to service use.

BACKGROUND: Recent corpus of research suggests that psychiatric disorders amongst adolescents and youths are an emerging global challenge, but there is paucity of studies exploring health services utilization by this age group in Arab region. AIM: This study focus on the health services utilization and the barriers among school going adolescents and youths with DSM IV disorders in the country Oman, whose population is predominantly youthful. METHODS: Representative sample of secondary school Omani adolescents and youths were concurrently interviewed for the (i) presence of DSM IV mental disorders using the face-to-face interview, World Mental Health-Composite International Diagnostic Interview (WMH-CIDI), (ii) tendency for health care utilization and (iii) predictors of utilization with clinical and demographic background. RESULTS: The proportions of lifetime cases having ever made treatment contact are low, being 5.2% for any anxiety disorder and 13.2% for any mood disorder category. None of these anxiety cases made treatment contact in the year of onset of the disorder, and the median delay when they eventually made treatment contact is about 14 years. In any mood disorders category only 3.6% made contact within the 1st year of onset with the median delay in initial treatment contact is two years for the Bipolar disorder (broad), four years for Any Mood disorder and nine years for the Major Depressive Disorder group. Male gender is significantly associated with less likelihood of making treatment contact when suffering from Social phobia (p = 0.000), Major Depressive Disorder (p = 0.000) and Bipolar Disorder (p = 0.000). The younger cohorts of 14-16 years and 17-18 years of Social phobic made significantly less lifetime any treatment contact (p = 0.000). The 14-16 year olds were significantly less likely to make lifetime any treatment contact for Bipolar Mood disorder (p = 0.000), while the 17-18 group were 1.5 times more likely to do so. Over past 12 months only between 6 to 12% of those having some form of mental disorder avail of any treatment facility with utilization pattern nearly equal between the any healthcare and any non healthcare facilities. In the any healthcare services, more of those with anxiety disorders seek help from general medical doctors while those with Major Depressive Disorder and any Mood disorders are comparatively treated more by non allopathic services. Females were 13.5 times more likely to avail treatment(chi sq 7.1) as also those cases with increased severity of illness were 7 times more likely(chi sq 9.6). In the any treatment category for any 12 month disorder in general, the younger cohort of 14-16 years is 2.2 times more likely to receive any treatment over past 12 months (p = 0.042) while the situation shows marked reversal in the 17-18 age groups. Having any mood disorder is a significant predictor for the same (p = 0.040). DISCUSSION: Present findings confer with other studies from elsewhere suggesting under utilization of health care services for those with mental illness. Since cultural teaching and traditional coping with mental illness are contributing significantly in furnishing mental health need for many in Oman, the findings are discussed within social-cultural context that forms the basis of the complex health care utilization in Oman. This could foster policies that help bridge the gap between allopathic and non-allopathic care services.

Trends in asthma prevalence and severity in Omani schoolchildren: comparison between ISAAC phases I and III.

BACKGROUND AND OBJECTIVE: This study evaluated changes in the prevalence of asthma symptoms and asthma severity in Omani school children over time. METHODS: Two cross-sectional surveys, in 1995 and 2001, were conducted as part of the International Study of Asthma and Allergies in Children on Omani schoolchildren in two different age groups (6-7 and 13-14 years). RESULTS: There were 7067 children surveyed in 1995 (3893 in the younger and 3174 in the older group) and 7879 in 2001 (4126 in the younger and 3753 in the older group). Over the 6 years there was a significant increase in the prevalence of current wheeze 'any wheeze during the past 12 months' (from 7.1% to 8.4%; P = 0.035) in the younger group with no significant change in asthma diagnosis (10.5% vs 10.6%) or any other asthma symptoms. In the older group, all asthma symptoms remained unchanged except speech-limiting wheeze which declined from 4.0% to 2.8% (P = 0.007). In both surveys, more than 60% of current wheezers reported severe asthma symptoms, while only 60% of these reported a diagnosis of asthma. CONCLUSION: The prevalence of both asthma and severe asthma remains high among Omani children. There is significant 'under-diagnosis' and/or 'under-treatment' of asthmatic children which requires urgent evaluation and intervention.

Regional Variation in the Prevalence of Asthma Symptoms among Omani School Children: Comparisons from Two Nationwide Cross-sectional Surveys Six Years Apart.

OBJECTIVES: The International Study of Asthma and Allergies in Children (ISAAC) highlighted the presence of wide variations in asthma prevalence between and within countries. The aim of this study was to determine the changes in the prevalence of asthma and its symptoms across the different regions of Oman. METHODS: Two cross-sectional surveys were conducted as part of ISAAC phases I (1995) and III (2001) in two age groups (6-7 and 13-14 years) from nation-wide samples of Omani school children, with 7,067 participants in 1995 (3,893 young and 3,174 older group) and 7,879 participants in 2001 (4,126 young and 3,753 older group). RESULTS: Over the period of six years, the Sharqiya (Eastern) region continued to have the highest prevalence of self-reported asthma diagnosis and all asthma symptoms in both age groups, with a significant increase in the prevalence of wheeze in the past 12 months (from 8.7% to 13.8%; p=0.002) and asthma diagnosis (from 13.8% to 17.8 %; p=0.046) in the young group, and a significant increase in night cough (from 21.6% to 27.8%; p=0.039) in the older group. All other regions had lower prevalence rates in 1995 in both age groups, and showed either no significant change or a decline in one or two of the self-reported asthma symptoms. The prevalence of asthma diagnosis among wheezy children remained unchanged across all regions. In addition, asthma under-diagnosis remains a problem with only 60% of children with severe wheeze reporting asthma diagnosis in both surveys. CONCLUSION: The geographic variation in the prevalence of self-reported of asthma symptoms among Omani school children persists with further increase in the Sharqiya region. The findings also suggest under-diagnosis and/or poor recognition of asthma which had not improved over time.

The relation of smoking to body mass index and central obesity among Omani male adults.

OBJECTIVE: Despite the prevalence that smoking has declined in many countries, there is a large increase in the number of young adults starting to smoke and in per capita cigarette consumption. In some studies smoking was associated with a lower body mass index (BMI) and increased waist hip ratio (WHR). Our aim is to study the association of smoking with BMI and WHR among male adults aged 20 years and above in a community based survey as a part of the National Health Survey, 2000. METHODS: A cross sectional survey representing all parts of Oman was designed in the year 2000. A part of the survey was door to door interviews including demographic data and inquiry regarding current and former smoking for male adults aged 20 years and above. In addition, taking the weight, hip and waist measurements, blood pressure and fasting blood glucose for them. RESULTS: The crude prevalence of current smoking was 13.3% among adult males and 4.6% of them were former smokers. The mean BMI was non significantly lower among smokers than never or former smokers. There was no significant difference also regarding WHR. Adjusting BMI by 10 different multiple linear regression models for other co-variates; age, educational level, marital status, having hypertension and total fasting glucose intolerance revealed significant association in 3 of them of BMI with smoking status. Non-significant association was revealed for WHR. CONCLUSION: Current smokers were of low BMI compared to non smokers and ex smokers, and currently light smokers were also of low BMI compared to ex smokers. There was no association of central obesity to smoking status. The association between smoking status and relative weight is modified by social factors as education.

Determinants of women's fertility in Oman.

OBJECTIVE: International studies have the inverse relationship of women education and empowerment on fertility. Our aim is to study the association of women education, and empowerment with some of the fertility determinants in a community based survey. METHODS: A cross sectional survey of the health status of the Omani community was designed. Face to face interviews with 2037 women, who were or had been married including demographic data, fertility patterns, family planning, 2 women empowerment indices (decision making and freedom of movement), and other modules reproductive health, were carried out during the year 2000. RESULTS: About 31% of the sample was considered highly empowered in decision making and the mean number of decisions taken in the household was 4.46 for the overall sample. For freedom of movement, 29% of the sample was highly empowered with a mean number of 3.88 for the overall sample. The mean values of both indices varied significantly according to age, residence, level of education and work status. Higher freedom of movement score women were more likely to have less number of children in the first 20 years of marriage. Women of higher score of decision making index were more likely to have longer closed birth interval Those scored low in the decision making index were more likely to get a child at an earlier age. CONCLUSION: There is inverse relationship between both education and empowerment and fertility. However, the 2 indices of women empowerment; decision making and freedom of movement were not always predicting the same fertility indicator, as women's empowerment is multidimensional in nature.

Prevalence and correlates of obesity and central obesity among Omani adults.

OBJECTIVE: Overweight, particularly obesity is a major risk factor for several important diseases, especially hypertension, coronary heart diseases and diabetes mellitus. Our aim is to determine the prevalence of obesity and central obesity among Omani adults aged > or =20 years, and to identify the socio-demographic and health variables that correlate to obesity and central obesity in a community based survey (National Health Survey, 2000). METHODS: A community based cross-sectional survey representing all parts of Oman was designed in the year 2000. A part of the survey was a door to door interviews including demographic data, weight, height, hip and waist measurements, blood pressure and fasting blood glucose and serum cholesterol for adults aged > or =20 years. RESULTS: The crude prevalence of overweight and obesity (body mass index >25 kg/m2) was 47.9% for the whole sample, and 46.2% for males, 49.5% for females. The crude prevalence of central obesity (abnormal weight hips ratio) was 49.3% for the whole sample, 31.5% for males, and 64.6% for females. Obesity and central obesity were less prevalent among younger age groups and highly educated subjects. Both obesity and central obesity increased the odds of having diabetes, hypertension and hyperchlostremia. CONCLUSION: The prevalence of obesity and central obesity is quietly high in Oman. Launching nutritional programs and promotional life style modification programs are recommended.

Hypertension in Oman: distribution and correlates.

BACKGROUND: International studies have reported increased prevalence of hypertension and other cardiovascular risk factors, Our aim was to study the distribution and the correlates of hypertension (HTN - systolic or diastolic) in a community based survey (National Health Survey, 2000). METHODS: A cross-sectional survey of the health status of Omani community was designed. Face to face interview including demographic data, blood pressure measurement, fasting blood glucose and serum cholesterol, weight, height, waist and hip measurement for 7011 Omani subjects with a response rate ranging between about 83% (for fasting blood glucose) to about 91% (for blood pressure measurement). RESULTS: The crude prevalence of HTN was 33.1%, while the age-adjusted prevalence was 38.3%. Older age groups, male gender, lower level of education, non- working, hypercholestremia, being married, obese, smoker, or having abnormal Waist Hip Ratio (WHR), or Total Impaired fasting glucose (TIFG) were found to be associated with hypertension in bivariate analysis. Logistic models were run to identify the adjusted Odds Ratio for the overall sample, for separate genders and age groups. For the overall sample, subjects aged 60 and above were 5.4 times more likely to be hypertensive than those below forty. Female gender was a protective factor in the overall sample, while it increased the risk by 1.4 times among those aged 60+. Obese or centrally obese subjects were also more likely to be hypertensive. Subjects with impaired fasting glucose, diabetes, or hyperchlosteremia were more likely to have hypertension than others in the majority of the logistic regression models. CONCLUSION: Hypertension is considered a major public health problem in Oman. Increasing the awareness of both health care providers and the community is crucial.

Prevalence of asthma symptoms in Omani schoolchildren.

OBJECTIVES: To determine the prevalence of asthma in Omani schoolchildren using the International Study of Asthma and Allergies in Children (ISAAC) protocols. METHOD: The ISAAC-written questionnaire was completed by a total of 7,067 Omani schoolchildren (3,893 children aged 6-7 years of which 56% were boys and 3,174 aged 13-14 years of which 51% were boys) from the 10 health regions in the country. RESULTS: The estimated mean national 12-month prevalence of any wheeze, night waking with wheeze, speech limiting wheeze and exercise wheeze were respectively 7.8%, 3.5%, 3.2% and 6.9% for the 6-7 year age group and 8.9%, 2.9%, 4.0% and 19.2% for the 13-14 year age group. Both age groups reported high prevalence of night cough (19.6% and 20.9% in the younger and the older children respectively). The prevalence of self-reported asthma diagnosis was higher in the older age group (20.7% vs. 10.5%, p<0.001). In the younger age group, the diagnosis of asthma was more common in boys (12.5% vs. 8.0%, p>0.001), but there was no significant difference between the two sexes in the older age group (22.0% of boys vs. 20.5% of girls). There was nearly three-fold difference in the prevalence of self-reported diagnosis of asthma between the regions with the highest and the lowest prevalence of asthma for both young and older children (from 5.3% and 9.5% in Musandam to 14.2% and 30.6% in South Sharqiya, respectively). CONCLUSION: The results of this first epidemiological survey of asthma in Oman indicate that asthma is common in Omani children and adolescents. Night cough is the most frequent symptom. There is also significant regional variation in prevalence of asthma symptoms and diagnosis within the country and this requires further investigation.