Time trends in diabetes mellitus in Jordan between 1994 and 2017.

AIM: The prevalence of diabetes has been increasing over the past few decades. The objective of this study is to assess the time trends in diabetes between 1994 and 2017 in Jordan. METHODS: Surveys were conducted in 1994, 2004, 2009 and 2017 by the same investigators using generally similar methods. Fasting blood glucose was measured in all surveys. Variables were obtained using structured questionnaires designed specifically for the surveys. Crude and age-specific diabetes prevalence rates were derived for each sex, together with overall, crude and age-standardized prevalence rates. RESULTS: The prevalence of diabetes in men aged ≥ 25 years increased from 14.2% in 1994 to 18.3% in 2004, 26.8% in 2009 and 32.4% in 2017. The corresponding prevalence rates in women were 12.3%, 16.9%, 18.8%, and 18.1%, respectively. The overall age-standardized prevalence rate increased from 13.0% in 1994 to 17.1% in 2004, 22.2% in 2009 and 23.7% in 2017. Known diabetes in the 2017 survey accounted for 82.6% of people with diabetes. A HbA1c of < 59 mmol/mol (7.5%) was observed in 41.4% of participants with known diabetes. CONCLUSION: The results showed a high prevalence of diabetes in Jordan among people aged ≥ 25 years. Prevalence increased from 1994 to 2009, but slowed thereafter. The increase was greater in men than in women. Previously diagnosed diabetes accounted for a high percentage of people with diabetes in all surveys and was highest in 2017 survey, suggesting that the national strategy against diabetes has brought some benefits. Efforts should be made to improve glycaemic control in people with diabetes.

Are insulin analogues an unavoidable necessity for the treatment of type 2 diabetes in developing countries? The case of Jordan.

Despite their reported benefits in terms of glycaemic control, insulin analogues are expensive for patients in developing countries. This study in Jordan aimed to compare the effectiveness and adverse events of premixed human insulin (BHI30) versus premixed insulin analogue (BIAsp30) in patients with type 2 diabetes. In a retrospective cohort study from October 2012 to March 2013, outcomes (HbA1c, weight, hypoglycaemia and lipohypertrophy) were compared at baseline and 6 months after treatment in 628 patients. BHI30 produced a significantly greater reduction in HbA1c than did BIAsp30. This difference in HbA1c remained significant after controlling for the effects of age, sex, duration of diabetes, body mass index and hypoglycaemia (ß-coefficient was -0.18 in favour of BHI30). Weight gain and mild hypoglycaemia was significantly higher with BHI30 than with BIAsp30. BHI30 achieved better reduction in HbA1c compared with BIAsp30, with less cost, slightly more weight gain and greater reported mild hypoglycaemia.

Maternal mortality in Jordan: role of substandard care and delays.

Understanding the factors that operate during pregnancy, delivery and postpartum is the key to success in the prevention of maternal mortality. This cross-sectional survey in Jordan for the years 2007-2008 aimed to identify the role of substandard care and delays in maternal deaths. All maternal deaths among women aged 15-49 years over this period (n = 76) were investigated retrospectively through file review and household interviews in all hospitals (n = 102) and forensic medicine departments in Jordan; elements of substandard care and delays at hospital, home and transport levels were evaluated. Substandard care accounted for 52.6% of deaths, delay in seeking care 55.3%, delay in transport 15.8% and delay in hospital care 17.1%. Women who did not recognize the danger signs of pregnancy (OR 6.32), refused medical advice to terminate the pregnancy (OR 1.78) or at a gestational age > 37 weeks (OR 1.85) were significantly more likely to delay seeking care, as were those with larger mean family size.

Depression is associated with low levels of 25-hydroxyvitamin D among Jordanian adults: results from a national population survey.

Although low serum 25-hydroxyvitamin D (25(OH)D) and elevated serum parathyroid hormone (PTH) have been associated with depression in clinical settings, this link in community-dwelling individuals is inconclusive. The present study aimed at examining the association between serum 25(OH)D and PTH levels and the presence of depression in a national population-based household sample of 4,002 Jordanian participants aged ≥25 years. The DASS21 depression scale was used to screen for depression, and serum concentrations of 25(OH)D and PTH were measured by radioimmunoassay. Multiple logistic regression models were used to explore the association between serum 25(OH)D and PTH levels and depression. The unadjusted odds ratio (OR) decreased linearly with increasing quartiles of serum 25(OH)D (P(trend) = 0.00). The OR for having depression was significantly higher among individuals in the first and second quartiles (OR = 1.4, 1.23, respectively) than among those in the fourth quartile (P values = 0.00 and 0.03, respectively). This relationship remained significant after adjusting for age, sex, marital status, education, BMI, serum creatinine, number of chronic diseases (OR = 1.39 and 1.21 and P values = 0.00 and 0.05, respectively) and after further adjustment for exercise, altitude, and smoking (OR = 1.48 and 1.24, respectively, and P values = 0.00 and 0.03, respectively). No significant association was found between serum PTH levels and depression. The decrease in risk of depression among participants started to be significant with serum 25(OH) D levels higher than 42.3 ng/ml (lower limit of the range of the third quartile). This value may help pinpoint the desirable level of serum 25(OH)D to be attained to help aid the prevention and treatment of depression.

Maternal mortality in Jordan: role of substandard care and delays

Understanding the factors that operate during pregnancy, delivery and postpartum is the key to success in the prevention of maternal mortality. This cross-sectional survey in Jordan for the years 2007-2008 aimed to identify the role of substandard care and delays in maternal deaths. All maternal deaths among women aged 15-49 years over this period [n = 76] were investigated retrospectively through file review and household interviews in all hospitals [n =102] and forensic medicine departments in Jordan; elements of substandard care and delays at hospital, home and transport levels were evaluated. Substandard care accounted for 52.6% of deaths, delay in seeking care 55.3%, delay in transport 15,8% and delay in hospital care 17.1%. Women who did not recognize the danger signs of pregnancy [OR 6.32], refused medical advice to terminate the pregnancy [OR 1.78] or at a gestational age > 37 weeks [OR 1.85] were significantly more likely to delay seeking care, as were those with larger mean family size

Hypertension prevalence, awareness, treatment and control, and associated factors: results from a national survey, jordan.

The study examined prevalence, awareness, treatment and control of hypertension (HTN), and associated factors and to evaluate the trend in hypertension between 2009 (period 2) and 1994-1998 (period 1). A national sample of 4117 adults aged 25 years and older was selected. Prevalence rate of HTN (SBP ≥ 140 or DBP ≥ 90 or on antihypertensive therapy) was 32.3% and was higher than the 29.4% prevalence rate reported in period 1. Prevalence rate was significantly higher among males, older age groups, least educated, obese, and diabetics than their counterparts. The rate of awareness among hypertensives was 56.1% and was higher than the 38.8% rate reported form period 1 data. Awareness was positively associated with age, smoking, and diabetes for both men and women, and with level of education and body mass index for men. Rate of treatment for HTN among aware patients was 63.3% and was significantly higher than the 52.8% rate reported in period1. Control rate of HTN among treated hypertensives was 39.6%; significantly higher than the 27.9% control rate in period 1. Control of HTN was positively associated with age but only for women. In conclusion, HTN is still on the rise in Jordan, and levels of awareness and control are below the optimal levels.

Vitamin D status in Jordan: dress style and gender discrepancies.

BACKGROUND/AIMS: Vitamin D deficiency is highly prevalent worldwide and has been linked to many diseases. The aims of the present study were to assess the vitamin D status of Jordanians at the national level and to identify groups of the population at high risk for vitamin D deficiency. METHODS: Vitamin D status was assessed in a national sample of 5,640 subjects aged ≥7 years. The study involved interviews, laboratory measurements of 25(OH)D and others, and physical measurements. The present report deals, exclusively, with subjects aged >18 years. RESULTS: The prevalence of low vitamin D status [25(OH)D <30 ng/ml] was 37.3% in females compared to 5.1% in males. Dress style in females was independently related to low vitamin D status; women wearing 'Hijab' (adjusted OR = 1.7, p = 0.004) or 'Niqab' (adjusted OR = 1.5, p = 0.061) were at a higher risk for low vitamin D status than were western-dressed women. CONCLUSION: The high prevalence of low vitamin D status in females in contrast with a low prevalence in males, together with a higher prevalence in women wearing Hijab or Neqab, calls for action to increase the population's awareness and to develop strategies to reduce this risk among women, particularly those wearing dress styles that cover most or all of their skin.

Psychiatric disorders among adolescent Jordanian returnees from Kuwait during the 1991 Gulf War.

Adolescent Jordanian returnees from Kuwait during the 1991 Gulf War were expected to have elevated rates of psychiatric disorders, therefore their mental health status was examined. We evaluated 1376 newly enrolled students in two public universities in northern Jordan using an Arabic translation of the self-administered General Health Questionnaire. The overall rate of psychiatric disorders among the study sample was 23.3%; the rate among adolescent returnees (30.8%) was significantly higher than among other adolescents (22.4%). Although psychiatric disorders were generally common among Jordanian adolescents, the exposure of Jordanian children in Kuwait to the Gulf War was still detrimental to their mental health status as adolescents.

Psychiatric disorders among adolescent Jordanian returnees from Kuwait during the 1991 Gulf War

Adolescent Jordanian returnees from Kuwait during the 1991 Gulf War were expected to have elevated rates of psychiatric disorders, therefore their mental health status was examined. We evaluated 1376 newly enrolled students in two public universities in northern Jordan using an Arabic translation of the self-administered General Health Questionnaire. The overall rate of psychiatric disorders among the study sample was 23.3%; the rate among adolescent returnees [30.8%] was significantly higher than among other adolescents [22.4%]. Although psychiatric disorders were generally common among Jordanian adolescents, the exposure of Jordanian children in Kuwait to the Gulf War was still detrimental to their mental health status as adolescents

Prevalence, awareness and management of hypertension in a recently urbanised community, eastern Jordan.

The objectives of this study were to: (1) estimate the magnitude of hypertension, and its levels of awareness and control of hypertension among a recently urbanised community of Jordanian aborigines; and (2) to compare the study findings with findings from other Jordanian communities. A sample was randomly selected from the roster of all inhabitants of the community aged 25 years or older. Data on 545 subjects included in the sample were collected during the months of January and February of 1995. A total of 89 (16.3%) subjects were suffering hypertension defined as systolic blood pressure > or =160 mm Hg and/or diastolic blood pressure > or =95 mm Hg or on antihypertensive medication. Prevalence rate of hypertension was comparable to that reported from other Jordanian communities who have experienced an urban lifestyle earlier than the reference community. Logistic regression analysis indicated that hypertension was positively associated with age, illiteracy, body mass index, family history of hypertension, and diabetes mellitus. No association was detected between hypertension and each of gender, smoking, and total serum cholesterol. This study showed that the vast majority of hypertensive patients (82.0%) were aware of their diagnosis. However, more than two-thirds (68.5%) of those aware of their diagnosis did not achieve control of their hypertension. In conclusion, hypertension is a common public health problem in this community and that the hypertension management programme is far below the optimal level.

Incidence of insulin-dependent diabetes mellitus in Jordanian children aged 0-14 y during 1992-1996.

An attempt was made by the Jordanian National Center for Diabetes, Endocrine and Genetic Diseases (NCDEGD) to identify all cases of type 1 diabetes among Jordanian children aged 0-14 y. Data were obtained retrospectively for the years 1992-1994 and prospectively for the years 1995 and 1996, including full name, national identifying number, date of birth, date of diagnosis and family history. The incidence was calculated as the number of cases per 100,000 population, according to the national census of 1994. The incidence rate for these years (1992 through 1996) was 2.8, 2.9, 3.2, 3.6 and 3.6 per 100,000 population, respectively. The male:female ratio was (1:1.03). Seasonal variation at clinical onset was noticed, with maximum incidence in the winter months and minimum incidence in the summer months. In conclusion, the incidence of type 1 diabetes mellitus in Jordanian children aged 0-14 y is among the lowest in the region, but is rising.

Diabetes and impaired glucose tolerance in Jordan: prevalence and associated risk factors.

OBJECTIVES: To study the prevalence of diabetes mellitus (DM) and impaired glucose tolerance (IGT) and their risk factors in Jordan. DESIGN: A cross-sectional study in four Jordanian communities was conducted: Sarih in the north, Sikhra in the middle of the country, Mazar in the south and Subha-Subheih in the east. Within each community, a systematic sample of households was selected. All subjects > or =25 years of age within the selected households were invited to participate in the study. A total of 2836 subjects were actually included in the study with an overall response rate of 70.5%(45% in males and 86% in females). World Health Organization criteria were adopted for the diagnosis of DM (fasting plasma glucose > or =7.8 mmol L(-1) or plasma glucose of > or =11.1 mmol L(-1), 2 h after an oral anhydrous glucose load of 75 g) and IGT (fasting plasma glucose <7.8 mmol L(-1)and plasma glucose between 7.8 mmol L(-1) and 11.1 mmol L(-1), 2 h after an oral glucose load of 75 g). RESULTS: The overall prevalence of DM was 13.4%: 14.9% in males and 12.5% in females. IGT was found in 9.8% of the study population: 9.0% in males and 10.3%, in females. Factors independently related to DM using stepwise logistic regression analysis were sex, age, family history of DM, hypertension, hypercholesterolaemia (HC), and hypertriglyceridaemia (HTG). CONCLUSION: Diabetes mellitus and IGT are common among adult Jordanians. Considering the high prevalence of this sickness makes it imperative to formulate a national plan to face this disease and its complications.

The effectiveness of BCG vaccination: the Jordanian experience.

The objective of the present study was to evaluate the effectiveness of BCG vaccination against tuberculosis (TB). TB cases occurring before 1 January 1995 among the birth cohorts 1980-1986 were identified from the Central TB Registry in Amman, Jordan and their BCG vaccination status determined. The proportion of vaccinated and unvaccinated children by age at vaccination and birth cohort was obtained from the Directorate of Chest Diseases based on the surveys conducted by the Directorate. A total of 429 cases of TB occurred among the above birth cohorts during the follow-up period. The overall BCG effectiveness against TB was 87 per cent (95 per cent CL 0.81-0.91). BCG was highly effective against pulmonary TB (85 per cent, 95 per cent CL 0.78-0.90) as well as extrapulmonary TB (95 per cent, 95 per cent CL 0.82-0.99). Our data suggest that BCG vaccination should continue to be considered as an important component of the strategy of TB prevention and call for improvement of coverage with this vaccine.

Obesity in Jordan.

OBJECTIVES: To study the prevalence of obesity among semi-urban communities in Jordan and its association with a number of factors. DESIGN: A sample of households was systematically selected from four Jordanian towns namely, Sarih, Sikhra, Southern Mazar and Subha-Subhieh. All subjects aged > or = 25 y within the selected households, were invited to participate in the study. A total of 2836 subjects were actually included in the study, with an overall response rate of 70.5%. Study procedures were carried out in the local health centres in each town over a one-month period. RESULTS: The overall prevalence of obesity (body mass index, BMI > or = 30 kg/m2) was 49.7%; 32.7% in males and 59.8% in females. Obesity was more prevalent in the older age groups, illiterate people, diabetic and hypertensive subjects, and those with hypercholesterolaemia (HC), hypertriglyceridaemia (HTG), high level of low density lipoprotein cholesterol (LDL), and low level of high density lipoprotein cholesterol (HDL). After adjusting for age and gender, obesity was associated with diabetes mellitus (DM) (odds ratio (OR) 1.4, 95% confidence limit (CL) 1.1, 1.8), hypertension (HT) (OR 2.2, 95% CL 1.7, 2.8), HC (OR 1.3, 95% CL 1.1, 1.5), HTG (OR 2.3, 95% CL 2.0, 2.8), elevated LDL (OR 1.5, 95% CL 1.2, 1.8) and low HDL (OR 2.3, 95% CL 1.8, 2.9). CONCLUSION: Obesity seems to be a common disorder among adult Jordanians. More attention should be paid to this problem at the national level.

Prevalence, recognition and management of mental disorders in primary health care in Northern Jordan.

This study examined the prevalence of psychiatric disorders and assessed factors that are assumed to be related to recognition of this morbidity among clinical patients. A total of 794 patients aged 18 years or older participated in the study. Using an Arabic-translated version of the General Health Questionnaire (GHQ-28), the prevalence of psychiatric morbidity was found to be 61%. The highest prevalence rates of psychiatric disorders were found in the 40 years and older age group, in female subjects, in uneducated and highly educated groups, in unemployed individuals, and in patients who were perceived to have 'fair' or 'poor' physical health. Multiple logistic regression analysis revealed that unemployment and perceived severity of physical illness were positively correlated with psychiatric disorders, but no significant correlation was found with sex, age or level of education. The physicians in the present study were able to detect morbidity in only 24% of the patients. Among patients with psychiatric disorders, recognition of this morbidity was significantly greater in women, in patients who had consulted with their family doctors, in patients previously known to their physicians, and in patients with mild physical illness than in their counterparts. The most common lines of psychiatric management used in this study were referral to psychiatrists (47%) and psychotropic medication (16%).

Prevalence and associated factors of hypertension: results from a three community-based survey, Jordan.

The aim of this study was to estimate the prevalence of hypertension, to determine its association with certain cardiovascular disease risk factors, and to evaluate level of hypertension awareness and control in an adult population in Jordan. The study used a cross-sectional population survey of a systematic sample of three communities. Data for the sample of 2299 adults, aged 25 years and older, were collected from September 1994 to September 1995. A total of 370 subjects or 16.1% were found to have hypertension. The prevalence rate was higher among women (17.1%) than men (14.4%). Logistic regression analysis indicated that hypertension was positively associated with gender, age, family history of hypertension, diabetes mellitus, and total serum cholesterol, but negatively associated with level of education. No association between hypertension and smoking was detected in this study. About one-half (48.6%) of hypertensives in this study were unaware of their diagnosis. Awareness of hypertension was positively associated with age and family history. More than one-third (36.5%) of those aware of their diagnosis did not achieve control of their hypertension. Hypertension appears to be a common public health problem in Jordan. Awareness and control of hypertension are far below optimal levels.

The silent gallstone: Follow-up of 33 cases.

This study reports the outcome of real-time ultrasonographic screening tests of a healthy population. The study group consisted of 33 female teachers who were found to have asymptomatic gallstone disease. All cases were followed up to determine the incidence of biliary colic or complications. After a 38-month period of follow-up, seven subjects (21.2%) developed either biliary colic or complication. Study results revealed that the 38-month cumulative probability of the development of biliary colic or complication was 36%. Data shown that development of biliary colic or complications was positively associated with obesity, but no assocition was found with age, number of activities, or duration of contraceptive pill-taking. Having such a high percentage of subjects who developed biliary colic or complications within a relatively short period of time suggests that the silent gallstone is not innocent.