Abdulbari Bener

CONSANGUINEOUS MARRIAGES IN THE UNITED ARAB EMIRATES

This study examines the frequency of consanguineous marriage and the coefficient of inbreeding in the United Arab Emirates (UAE). The study was conducted in Al Ain and Dubai cities between October 1994 and March 1995. A sample of 2033 married UAE females aged 15 years and over participated. The degree of consanguinity between each female and her spouse, and the degree of consanguinity between their parents were recorded. The rate of consanguinity in the present generation was high (50.5%) with a coefficient of inbreeding of 0.0222. The commonest type of consanguineous marriage was between first cousins (26.2%). Double first cousin marriages were common (3.5%) compared to other populations. The consanguinity rate in the UAE has increased from 39% to 50.5% in one generation. The level of consanguinity was higher in Al Ain (54.2%) than in Dubai (40%).

A study of possible deleterious effects of consanguinity

The aim of the study was to determine whether consanguineous marriages result in reproductive wastage and an increased incidence of illness in the offspring in a community with a long history of inbreeding and an expected high rate of consanguineous marriage. A representative sample of 2200 women aged > 15 years from Dubai and Al Ain, two cities in the United Arab Emirates, representing on the one hand a modern metropolis and on the other a traditional society, were studied. A questionnaire, which included questions on age, parity, gravidity, number of stillbirths, number of abortions, number of children alive, neonatal deaths and specific illnesses in children, was administered by nurses in antenatal and gynaecological clinics in the two cities. The rate of consanguineous marriage was 50.5% and parity, gravidity, ages and number of children were similar in consanguineous and non‐consanguineous groups. There was no significant difference in rates of abortion, stillbirth and neonatal death between the two groups. Overall, there was statistically significant higher reproductive wastage in consanguineous couples, but when the category of less than second cousins was excluded from the consanguineous group no difference was found in reproductive wastage between consanguineous and non‐consanguineous marriages. Children born to consanguineous unions also had significantly higher incidences of illnesses (37.1%) than those of non‐consanguineous unions (29%). The occurrence of malignancies, congenital abnormalities, mental retardation and physical handicap was significantly higher in offspring of consanguineous than non‐consanguineous marriages. In conclusion, consanguinity did not result in reproductive wastage, but was found to be an important factor in the causation of specific illnesses in offspring.

Genetic and environmental factors associated with migraine in schoolchildren

Objective.–The aim of this study was to find the prevalence of migraine and headache in schoolchildren in the United Arab Emirates and to determine the genetic and environmental factors associated with these conditions.

Public awareness and attitudes towards epilepsy in the United Arab Emirates

The aim of this paper is to obtain an initial estimate of people awareness, attitudes and understanding towards epilepsy and to provide a basis for international comparisons. A cross-sectional study conducted during 1995 in Al-Ain City, Dubai and Sharjah Emirates, United Arab Emirates (UAE). We used a simple questionnaire following a two-stage sampling technique. A total of 1050 subjects aged 15 years and above were selected randomly. Of these a total of 892 individuals (86.4%) responded to the study. Seventy-five percent of respondents (665 people) had heard or read about epilepsy. Males and females were similarly familiar with the concept of epilepsy. The age group and education had a positive significant effect on awareness of epilepsy (p < 0.001). Thirty-four percent had occasionally seen a seizure. Nineteen suggested that there is not treatment. Those acquainted with a person with epilepsy were more likely to know that there is treatment. Among those familiar with epilepsy 18.5% believed in cautery and 40% believed in faith healing. A small percentage (7%) of respondents had objections to allowing their children associating with a person with epilepsy at school or in the playground; 68% objected to their children marrying an epileptic person; 10% believed that epileptic people should not be employed in jobs as other people are. In conclusion, unfortunately, knowledge, awareness and attitudes towards epilepsy in the UAE were less compared with surveys conducted in Western countries. The majority lacked information about the causes, nature and treatment of the disease.

The age and symptomatology of natural menopause among United Arab Emirates women.

OBJECTIVES To determine the median age of natural menopause in United Arab Emirates women, the factors affecting that age and the prevalence of climacteric symptoms amongst those women. METHODS A population-based survey was conducted on a community sample of United Arab Emirates women who had had natural menopause defined as cessation of menstruation for at least 6 months at the end of reproductive years. A total of 742 women aged 40 years and above were recruited from both urban and rural areas of the country using the multi-stage stratified cluster sampling technique. Data were collected using a structured questionnaire and face to face interviews and included a number of familial, reproductive and life-style variables. RESULTS The median age of the menopause in the United Arab Emirates is 48 years (mean = 47.3 +/- 3.29, range 40-59). This is significantly lower than the median age reported from the West (50.3 years). The subject median age of the menopause was significantly related to that of the mother (P < 0.001), older sister (P < 0.001), parity (P < 0.0001) and the previous use of oral contraceptive pills for more than 1 year (P < 0.001). Hot flushes were the commonest feature of the menopause occurring in 45% of women. CONCLUSION The age of natural menopause in United Arab Emirates women, as in other developing countries, is less than in Western women and may be influenced by genetic factors, parity and previous use of oral contraceptives. Climacteric symptomatology, however, is similar in the different patient groups.

The determinants of breast cancer screening behavior: a focus group study of women in the United Arab Emirates.

PURPOSE/OBJECTIVES To explore perceptions, knowledge, attitudes, and beliefs about breast cancer and its screening among Emirati national women in Al Ain, United Arab Emirates. DESIGN A qualitative study using focus group methods. SETTING Primary healthcare centers and a community-based womens association in the United Arab Emirates. SAMPLE 41 women, aged 25-45 years. METHODS Four 90-minute focus group discussions exploring perceptions, knowledge, attitudes, beliefs, and practices regarding breast cancer were audiotaped, transcribed, translated, and analyzed. MAIN RESEARCH VARIABLES Social and cultural themes related to breast cancer and its screening. FINDINGS Focus group methodology worked well in this setting. The womens perceptions, knowledge, attitudes, and beliefs regarding cancer and screening, together with aspects of the healthcare system and social milieu, appeared to strongly influence the womens preventive practices. Some of these factors had an encouraging effect on the womens practices, and others had a deterring effect. The encouraging factors included feelings of susceptibility, high levels of knowledge in some women, attitudes and beliefs about personal responsibility for health, and a supportive social milieu. Deterring factors included anxiety and fear leading to denial; lack of knowledge about cancer and the screening program; fear, embarrassment, and mistrust of health care; and belief in predestination. CONCLUSIONS Health planners and healthcare providers must capitalize on encouraging factors and minimize deterring factors to optimize breast cancer screening practices among these women. IMPLICATIONS FOR NURSING Identifying and accounting for the factors that encourage or deter women in their breast cancer screening practices will help to optimize screening programs.

Epilepsy in children with cerebral palsy

OBJECTIVES To study the occurrence, associated factors, nature and prognosis of seizures in children with cerebral palsy (CP). DESIGN A prospective, descriptive, hospital-based, case-control study. SETTING Tertiary level University Teaching Hospitals in the Al Ain Medical District, United Arab Emirates. PATIENTS Fifty-six children with CP and seizures seen in the neurodevelopmental clinics at Al Ain and Tawam University Hospitals during the period of 1997-1999 were studied (group 1). Two control groups of 35 children with CP without seizures (group 2) and 50 children with seizures but no CP (group 3) were also studied. RESULTS Spastic tetraplegia was the commonest type of CP associated with seizures whereas spastic diplegia was the commonest variety of CP in group 2. Most children with CP had an early onset of seizures within the first year of life as against those without CP. The children in group 1 had a higher incidence of neonatal seizures (42.9% vs. 29.4% in group 2 and 0% in group 3), presence of significant developmental delay (98.2% vs. 20.0% in group 3), occurrence of significant abnormalities on brain imaging (94.6% vs. 19.6% in group 3) and a need for use of more than 1 antiepileptic drug (66.1% vs. 30.0% in group 3). Over half of children in the study group presented with generalized tonic clonic seizures; the electroencephalogram (EEG) showed focal epileptic discharges with or without secondary generalization in 39.3%. The overall outcome of seizures in children with CP was poor needing prolonged course of anticonvulsant medications, polytherapy and higher incidence of refractory seizures and admissions for status epilepticus compared to the control group. CONCLUSIONS Cerebral palsy is associated with a higher incidence of seizure disorders, which, in a majority, has its onset in the neonatal period; brain imaging showed abnormal pathology in most affected children, which possibly accounts for the tendency to more refractory seizures in these children.

Folic acid awareness and intake survey in the United Arab Emirates.

OBJECTIVE The aim of this study was to determine the level of knowledge and use of periconceptional folic acid supplementation in a sample of postpartum women recruited from three hospitals. DESIGN Cross-sectional survey in which a structured questionnaire was used in a face-to-face encounter between the subject and a trained nurse. SETTINGS Two teaching hospitals associated with Faculty of Medicine and Health Sciences and one private hospital. SUBJECTS Postpartum women in the three hospitals were recruited during a 40-day period in November 1999. Women who did not agree to participate, had complicated labor, delivered babies with congenital malformations, or were too exhausted or difficult to examine, were excluded. RESULTS Univariate analyses showed that overall 46.4% of the respondents had heard about folic acid and only 8.7% knew that it prevented birth defects. 45.5% of respondents took folic acid in the first trimester. The percentage of women who had ever heard about folic acid was higher in those with higher education, and those who were not UAE nationals. Use of folic acid was associated with non-UAE nationality. CONCLUSION Awareness of the value of periconceptional folic acid was very low and use of folic acid was less prevalent among women of UAE nationality.

Road traffic accidents in the United Arab Emirates: trends of morbidity and mortality during 1977–1998

High rates of serious road traffic accidents (RTAs) have been reported for several Arabian Gulf countries, including the United Arab Emirates (UAE). in recent years. This study aims to describe quantitatively the morbidity and mortality from RTAs in the UAE, to identify their trends during the period 1977-1998, to compare the results with those of developed countries, and to evaluate the information available on possible causes with a view to identifying the most useful direction for future research. Data were obtained from UAEs police and health sources and, for international comparison, from WHO Statistics reports and the published literature. Overall and cause-specific fatality and injury rates of RTAs were calculated. Estimates of trends were achieved by using linear regression. The characteristics of road users injured or killed were also analysed. The results revealed that during the period 1977-1998, the rates of RTAs per 100,000 population and per 100,000 motor vehicles declined in the UAE by a trend component of -56.3 (P < 0.001: R2 = 0.69) and -521.8 (P<0.001; R2=0.92), respectively. RTA fatality and injury rates based on the same denominators also declined by -1.1 (P<0.001; R2 = 0.56) and -13.3 (P < 0.001; R2 = 0.47); and by -3.8 (P < 0.02; R2 = 0.23) and - 90.0 (P < 0.001; R2 = 0.59), respectively. Paradoxically, however, except for a short period (1977-1985), a steady increase in the risk of injury and death in each RTA accompanied these declines. Between 1985 and 1998 the severity rate (the ratio of fatalities and injuries per 1,000 RTAs) more than tripled in the UAE. The UAEs rates were high when compared with a number of selected countries. The cause for the increasing severity of RTAs is not clear but the most likely cause could lie in speeding, careless driving, the changing vehicle mix on the roads and the standard of immediate care available for victims. Further investigation is essential and will require close collaboration between police and health authorities.

Injury mortality and morbidity among children in the United Arab Emirates

The objective of this study was to identify the major causes of accident mortality and morbidity among children (0–14 years) in Al-Ain, United Arab Emirates (UAE). A retrospective descriptive study was set in the Al-Ain Hospital and Preventive Medicine Department, Ministry of Health, Al-Ain. Subjects were all patients aged 0–14 years who were seen at Al-Ain Hospital for injury during the 12-month period January to December 1995, and all recorded deaths aged 0–14 years in Preventive Medicine Department from 1980 to 1995. Results. Mortality: 301 children (69.4% males, 30.6% females) died after accidents from 1980 to 1995. UAE citizens and other Arabs represented the majority of deaths. Most mortality (28.6%) occurred in the 1–4 year age group. Head and neck injury was the major type of injury causing death (57.5%). The most common cause of accidental death was road traffic accidents (boys 67.1%, girls 60.4%), followed by drowning and burns (8%). Morbidity: Pediatric trauma cases seen during 1995 totaled 17,498, representing one third of all patients attending the Hospital Emergency Room. About 70% of encountered injuries occurred among boys; 44.6% of cases were UAE citizens. The most common trauma type was contusion (40.2% boys; 40.6% girls), the most common type of trauma in boys and girls (30.4% and 36%, respectively). In the age group <5 years, the most common causes of trauma were fall (41.1%), blunt trauma (38.7%) and burns or scalds (64%), while in 5–9 year olds, the most common cause was road traffic accidents (40%). Finally, in 10–14 year olds, the most frequent causes were traffic accidents (32.8%) sharp objects injuries (38.3%), and fights and sporting (28.9%). Conclusion: More boys than girls presented with injury and the majority were nationals. Road traffic accidents mainly occurred in children over 10 years.