School mental health screening: a model for developing countries.

Using the experience derived from a screening programme of all school-going children in the Al Ain District, United Arab Emirates, this article reports on a cost-effective model that can be used in other developing countries. The need for training child health and school professionals in identifying mental and developmental disorders is discussed.

Mental health problems among schoolchildren in United Arab Emirates: prevalence and risk factors.

OBJECTIVE: To examine child psychiatric morbidity in an Arab culture. METHOD: Emotional and behavioral problems were investigated in 3,278 schoolchildren aged 6 to 15 years using a two-stage epidemiological study in Al Ain District, United Arab Emirates. Children were screened using standardized questionnaires completed by parents and school physicians in the first stage, and a stratified random sample were interviewed by a child psychiatrist in the second stage. RESULTS: 23.9% of children were reported to have a mental health problem by either the parent or the school health physician. Boys were more often reported to be having problems than girls (1.8:1). Using the Rutter A2 scale for parents, the prevalence estimate for behavioral disorders was 16.5%. The weighted prevalence for DSM-IV disorders was 10.4% for the entire population. The presence of certain culture-specific risk factors such as male gender, number of children in the household, polygamy, and low socioeconomic status were identified for psychiatric disorders. A positive family history and consanguinity were the most significant factors associated with learning disorders. CONCLUSIONS: The prevalence rates of child psychiatric disorders and the symptomatology observed in this Middle East community are similar to those reported in Western studies.

Learning disorders in school-going children--detection and diagnosis.

A screening programme was carried out among school-going children in Al-Ain, United Arab Emirates (UAE), to identify children with learning disorders. During the course of one academic year, 34 such children were identified. The cause was considered preventable in around half of the cases. In a third of cases with a genetic cause, prevention was possible with existing knowledge and practice.

Factors associated with asthma in school children.

To investigate the factors associated with asthma in school children, a case-control study of 203 asthmatic and 203 non-asthmatic children (103 males and 100 females in each group) aged 6 to 18 years, was organized during the period September 1992 to May 1993 in Al Ain city, United Arab Emirates. Cases comprised known asthmatic children who were regularly receiving medication for asthma and were confirmed as asthmatics by a physician. Cases and controls were matched by age and sex. A questionnaire was used to obtain information about respiratory illnesses (pneumonia, bronchitis, bronchiolitis, sinusitis and croup); atopy (allergic rhinitis and atopic dermatitis) and familial allergic diseases (parental asthma and atopy). Information about socioeconomic status and limitations to children as a result of asthma were also obtained. Logistic regression analysis showed that bronchitis, atopy (allergic rhinitis and atopic dermatitis), croup, parental asthma and parental atopic dermatitis were significant risk factors for childhood asthma after adjusting for other confounding covariates. The model also showed that parental asthma (p < 0.0001) is much more influential than parental atopic dermatitis (p = 0.01) as a risk factor for asthma. Although pneumonia and sinusitis were significant risk factors when analyzed univariately, they were not significant after adjusting for other covariates. Bronchiolitis, smoking and socioeconomic status were beyond the reach of statistical significance as risk factors to asthma in our sample.

Neonatal BCG vaccination and tuberculin skin sensitivity among schoolchildren of the United Arab Emirates.

A cross-sectional survey of 785 schoolchildren living in the Al Ain region was undertaken between January and June 1994 to assess the effect of neonatal BCG vaccination on tuberculin sensitivity and to study the risk of exposure to tuberculosis in the same population. A documented history of BCG vaccination was obtained in 547 (69.7%) schoolchildren. The prevalence of a 10 mm or greater induration of tuberculin skin reactivity varied from 8% in unvaccinated to 11.5% among vaccinated children. This was not statistically significant. Children living in urban areas irrespective of vaccination status had a higher rate of tuberculin reactivity than those living in rural areas (relative risk 5.77; 95% confidence interval 1.85-18.00; p < 0.0004). The pattern and rate of tuberculin sensitivity were similar among the other socio-demographic standards investigated. Earlier BCG vaccination had no effect on subsequent tuberculin sensitivity of either negative (0.4 mm), intermediate (5-9 mm) or positive (> or = 10 mm) type skin reactions. It is concluded that the risk of exposure to tuberculous infection is several times higher among children living in urban areas than among those living in a rural environment. Earlier BCG vaccination should not interfere with diagnostic tuberculin skin sensitivity and is still a useful tool in assessing the risk of tuberculous infection in such populations.

The prevalence of group A streptococcal throat carriage in Al Ain, United Arab Emirates.

The aim of this study was to establish the carrier rate of group A beta haemolytic streptococci in school children in Al Ain, United Arab Emirates. One thousand and two randomly selected school children aged 5-7 years had their throats swabbed twice for both culture and direct antigen detection of group A streptococci. One hundred and fourteen children (11.3%) had both a positive antigen and culture test, while 216 (21.6%) had antigen-positive tests only and 16 (1.5%) had a positive culture only. Thus, the combination of culture and antigen detection revealed a carrier rate of 35.4% in the children examined. We conclude that in an affluent but isolated desert area on the Tropic of Cancer, group A streptococcal carriage rate is high. Antigen detection is superior to culture techniques in asymptomatic carrier studies.

Factors associated with tuberculin reactivity among children in United Arab Emirates.

A cross-sectional survey of tuberculin skin reactivity was conducted in Al-Ain, United Arab Emirates (U.A.E.) between January and June 1994, to find out the prevalence rate of tuberculosis infection. A pre-designed questionnaire was used to collect details of BCG scar, age, sex, residence area, nationality, education, type of house, number of rooms, family size and household contact history of tuberculosis. A total of 785 students were screened, of whom 547 gave a history of BCG vaccination in the past and 238 were BCG-negative. Among BCG-negative children aged 5-11 years and 12-15 years, only 6.5% and 9.3%, respectively, had a positive Mantoux reaction--a rate lower than most Third World countries, but higher than developed countries where under 2% of children are tuberculin reactors. A general linear model with positive Mantoux reaction as the dependent variable was fitted to the data to examine the joint effect of age, sex, residential area, number of rooms at home, family size and BCG vaccine history. The Mantoux reaction was entered as positive and a number of statistically significant associations were found between positive Mantoux test > 10 mm and: age (P = 0.0018); sex (P = 0.0281); residential area (P < 0.0001); number of rooms (P = 0.0017); and BCG vaccine history (P < 0.0001). However, family size did not have any statistical effect on tuberculin testing (Mantoux test > 10 mm). The prevalence (8%) in the 5-14 years age group puts U.A.E. between low (2%) and middle (14%) prevalence countries, according to the classification of the International Union Against Tuberculosis. This calls for continuation of free treatment of active cases and increased efforts towards screening of contacts.

Seasonality and prevalence of rotavirus in Al-Ain, United Arab Emirates.

BACKGROUND: Rotaviruses are the single most important causative agent of acute neonatal enteritis in most avian and mammalian species including humans. Rotaviruses infections have also been shown to be associated with the elderly, immunocompromised individuals and more recently with epidemic diarrheal illness in adults. OBJECTIVES: To study the incidence and the effect of seasonality on the prevalence of rotaviruses in Al-Ain, United Arab Emirates. STUDY DESIGN: A total of 650 stool samples submitted to the laboratories of two University Teaching Hospitals (Al-Ain and Tawam) and a private hospital (Oasis) were examined for the presence of rotaviruses from January 1990-December, 1992, using a commercially available latex agglutination assay. The meteorological data (temperature, relative humidity and rainfall) recorded during the sampling period was analyzed statistically to examine the effect of seasonality on the prevalence of rotavirus cases in Al-Ain, United Arab Emirates. RESULTS: Rotavirus was detected in 21.4% of the samples examined. The predominant number of positive cases (35%) were in the 7-12 months age group. It was interesting to find rotavirus-positive cases in as low an age group as < 3 months (3.6%) and as high as 10 years (8.04%). There was no significant difference on infection rates between male and female groups in the study. However, there was a significant difference between the national (38.18%) and non-national children (61.28%). The higher rate of the latter may be due to import of infections. There appeared to be a seasonal pattern of rotavirus occurrence in the cases studied, with a marked increase in the number of positive cases during the months when the relative humidity was low (25-45%) and there was no rainfall. CONCLUSIONS: Rotavirus was detected in all age groups with a predominance in 7-12 month age groups, and a higher incidence in non-nationals. There was a marked increase in the number of positive cases during the months when the relative humidity was low (25-45%) and there was no rainfall. These findings are discussed in relation to the epidemiology and prophylaxis of rotavirus infections.

Contribution of body fat and fat pattern to blood pressure level in school children.

OBJECTIVE: The study aims are investigating the effect of body fat and fat localization on blood pressure. DESIGN: Case-control study. SETTING: The study was carried out in the school health primary care. SUBJECTS: The case-control study included 220 obese and 220 non-obese children aged 7-18 years from Al Ain city, United Arab Emirates between September 1992 to May 1993 inclusive. Each group consisted of 120 males and 100 females. Two schools were randomly selected from each of the three educational stages: primary, junior and secondary. The inclusion criterion for cases comprised children with body mass index (BMI; Quetelet index), > 90th percentile of age and sex-specific reference data of the French population. Non-obese healthy controls were randomly selected from the same classes from where obese children were identified in order to ascertain that cases and controls were matched by age and sex. MEASUREMENTS: Anthropometric measures (weight, height, waist and hip circumferences), systolic and diastolic blood pressure were measured. To minimize inter-observer error, blood pressure was measured by one physician. We also collected information about other confounding social variables (family history of obesity and mother's education) and behavioural variables (preferred diet and physical activity). RESULTS: There was significant difference of systolic and diastolic blood pressure means between obese and non-obese children (P < 0.001) in both males and females. Applying the multiple linear regression analysis to fix the confounding effect of age, sex, social and behavioural factors, the fatness index, BMI, was significantly related to systolic (P < 0.0004) and diastolic (P < 0.0001); while waist-to-hip circumference ratio (WHR) was not significant (P = 0.803 in systolic and P = 0.648 in diastolic blood pressure respectively). CONCLUSIONS: Systolic and diastolic blood pressure showed a positive relationship with the fatness index BMI, but not with WHR, in both boys and girls. This is an evidence that WHR may not be a reliable indicator of body fat distribution in children.

Factors associated with obesity in school children.

To investigate factors associated with the development of obesity in school children, the authors undertook a case-control study of 220 obese and 220 non-obese children aged 6 to 18 years from Al Ain, United Arab Emirates between September 1992 to May 1993 inclusive. The inclusion criterion for cases comprised children with body mass (Quetelet index) > 90th percentile of age-sex reference data of the French population. Questionnaires were used to obtain information about socioeconomic status (SES), family history of obesity, related diseases and behavioral factors (smoking, physical activity and preferred diet). Anthropometric measures (weight, height, waist and hip circumferences), systolic and diastolic blood pressure were measured. The waist/hip circumference ratio was used as an index for body fat distribution. The logistic regression analysis showed that family history of obesity, diet, physical activity and mother education were significant factors for development of obesity after adjusting for other confounding covariates. Neither smoking nor SES showed apparent relation to obesity. Both systolic and diastolic blood pressure showed stronger correlation with the fatness index, BMI, than with the fat distribution index, waist/hip ratio.