Iain Blair

Communicable disease control handbook

Section 1 - introduction section 2 - common topics section 3 - diseases section 4 - services and organization section 5 - communicable disease control in individual countries appendices - resources for the CCDC.

An analysis of the health status of the United Arab Emirates: the ‘Big 4’ public health issues

Background : The United Arab Emirates (UAE) is a rapidly developing country composed of a multinational population with varying educational backgrounds, religious beliefs, and cultural practices, which pose a challenge for population-based public health strategies. A number of public health issues significantly contribute to morbidity and mortality in the UAE. This article summarises the findings of a panel of medical and public health specialists from UAE University and various government health agencies commissioned to report on the health status of the UAE population. Methods : A systematic literature search was conducted to retrieve peer-reviewed articles on health in the UAE, and unpublished data were provided by government health authorities and local hospitals. Results : The panel reviewed and evaluated all available evidence to list and rank (1=highest priority) the top four main public health issues: 1) Cardiovascular disease accounted for more than 25% of deaths in 2010; 2) Injury caused 17% of mortality for all age groups in 2010; 3) Cancer accounted for 10% of all deaths in 2010, and the incidence of all cancers is projected to double by 2020; and 4) Respiratory disorders were the second most common non-fatal condition in 2010. Conclusion : The major public health challenges posed by certain personal (e.g. ethnicity, family history), lifestyle, occupational, and environmental factors associated with the development of chronic disease are not isolated to the UAE; rather, they form part of a global health problem, which requires international collaboration and action. Future research should focus on population-based public health interventions that target the factors associated with the development of various chronic diseases. To access the supplementary material to this article please see Supplementary files under Article Tools online.BACKGROUND The United Arab Emirates (UAE) is a rapidly developing country composed of a multinational population with varying educational backgrounds, religious beliefs, and cultural practices, which pose a challenge for population-based public health strategies. A number of public health issues significantly contribute to morbidity and mortality in the UAE. This article summarises the findings of a panel of medical and public health specialists from UAE University and various government health agencies commissioned to report on the health status of the UAE population. METHODS A systematic literature search was conducted to retrieve peer-reviewed articles on health in the UAE, and unpublished data were provided by government health authorities and local hospitals. RESULTS The panel reviewed and evaluated all available evidence to list and rank (1=highest priority) the top four main public health issues: 1) Cardiovascular disease accounted for more than 25% of deaths in 2010; 2) Injury caused 17% of mortality for all age groups in 2010; 3) Cancer accounted for 10% of all deaths in 2010, and the incidence of all cancers is projected to double by 2020; and 4) Respiratory disorders were the second most common non-fatal condition in 2010. CONCLUSION The major public health challenges posed by certain personal (e.g. ethnicity, family history), lifestyle, occupational, and environmental factors associated with the development of chronic disease are not isolated to the UAE; rather, they form part of a global health problem, which requires international collaboration and action. Future research should focus on population-based public health interventions that target the factors associated with the development of various chronic diseases. To access the supplementary material to this article please see Supplementary files under Article Tools online.

Decrease in effectiveness of routine surveillance of Haemophilus influenzae disease after introduction of conjugate vaccine: comparison of routine reporting with active surveillance system

In October 1992 routine immunisation with Haemophilus influenzae type b conjugate vaccine was introduced in the United Kingdom, and the incidence of disease was subsequently reported to have decreased 15-fold.1 The surveillance systems in place were primarily routine and were known to underestimate the burden of invasive H influenzae disease.2 This study aimed to determine whether underreporting continued after introduction of the conjugate vaccine, and how this might affect the reported success of the vaccine. Results of routine surveillance were compared with active surveillance for invasive H influenzae disease in the West Midlands health region of England. View this table: Comparison of cases of invasive Haemophilus influenzae disease in children <5 years identified by active surveillance and reports to the Communicable Disease Surveillance Centre (routine system) before and after introduction of the vaccine: West Midlands Health Region 1990-4 Invasive H influenzae disease was defined as an illness in which the organism was isolated from a sterile site in children aged …

Population structure and the burden of disease in the United Arab Emirates.

To carry out their duties more effectively, health care professionals in the UAE often ask about the population structure and the main causes of mortality and morbidity in the country. This paper summarizes what is known about these topics drawing on secondary data sources that are available in the public domain, including census data, population estimates, births and deaths, proportionate mortality, age-standardized mortality rates and disability adjusted life-years. There are inconsistencies and flaws in some of this data which this paper will highlight and attempt to explain. Since 2005, the UAE population has grown substantially owing to high natural growth and high net inward migration and is currently estimated to be about 8.2 million. In 2008, injuries, heart disease, neoplasms and cerebrovascular disease accounted for 57% of deaths, and this is well known. Less is reported about the risk of death, disease, injury and disability. The population of the UAE is diverse, and there are variations in mortality and morbidity risk by age-group, sex and nationality. The authors recommend improvements in the timeliness, completeness and consistency of data. They conclude that better data will encourage more analysis which will generate health intelligence leading to health improvement for the UAE population.

Invasive Haemophilus influenzae disease: An ecological study of sociodemographic risk factors before and after the introduction of Hib conjugate vaccine

This study examines the impact of H. influenzae type b (Hib) conjugate vaccine on sociodemographic risk factors for invasive H. influenzae disease in the 2 years before and immediately after the introduction of Hib conjugate vaccine. An ecological study design was used and cases were identified using active surveillance employing several surveillance systems. The study population comprised all children aged <5 years resident in the West Midlands, an English health region, with laboratory confirmed invasive disease 2 years before (1990–1992) and 2 years after (1992–1994) the introduction of Hib conjugate vaccine. Selected sociodemographic variables derived from the UK census were obtained for all census enumeration districts in the region. Each variable was then ranked and divided into six categories. Linear associations between disease rates and sociodemographic variables were examined. Overall, there was a significant reduction in the incidence of invasive H. influenzae disease. In the pre-conjugate vaccine era there were trends of decreasing disease incidence with increasing child population density (p = 0.012) and total population density (p = 0.0023). In the post-conjugate vaccine period, total population density (p = 0.0275) remained significant and a trend of increasing disease incidence with increasing population mobility (p = 0.0012) was seen. Although Hib conjugate vaccine has resulted in a dramatic reduction in disease incidence changes in sociodemographic risk factors were identified in the post-conjugate vaccine period, particularly population mobility. Our results may have implications for current and future vaccine strategies.

An Investigation of the Feasibility and Cultural Appropriateness of Stated Preference Methods to Generate Health State Values in the United Arab Emirates

BACKGROUND No five-level EuroQol five-dimensional questionnaire (EQ-5D-5L) value sets are currently available in the Middle East to inform decision making in the regions health care systems. OBJECTIVES To test the feasibility of eliciting EQ-5D-5L values from a general public sample in the United Arab Emirates (UAE) using the EuroQol Groups standardized valuation protocol. METHODS Values were elicited in face-to-face computer-assisted personal interviews. Adult Emiratis were recruited in public places. Respondents completed 10 time trade-off tasks and 7 discrete choice experiment tasks, followed by debriefing questions about their experience of completing the valuation tasks. Descriptive analyses were used to assess the face validity of the data. RESULTS Two hundred respondents were interviewed in December 2013. The face validity of the data appears to be reasonably high. Mean time trade-off values ranged from 0.81 for the mildest health state (21111) to 0.19 for the worst health state in the EQ-5D-5L descriptive system (55555). Health states were rarely valued as being worse than dead (6.2% of all observations; 10% of all valuations of 55555). In a rationality check discrete choice experiment task whereby a health state (55554) was compared with another that logically dominated it (55211), 99.5% of the respondents chose the dominant option. Most of the respondents stated that their religious beliefs influenced their responses to the valuation tasks. CONCLUSIONS Our results suggest that it is feasible to generate meaningful health-state values in the UAE, though some adaptation of the methods may be required to improve their acceptability in the UAE (and other countries with predominantly Arab and/or Muslim populations).

The “Arab World” is Not a Useful Concept When Addressing Challenges to Public Health, Public Health Education, and Research in the Middle East

Interest in public health in the “Arab World” has intensified following the political and social changes that have affected the Middle East since 2010. A new text-book has been published (1), an international meeting has been held (2), a network of experts has been formed, and a special edition of major medical journal has been published (3). But how useful is the “Arab World” as a way of defining a geographical region in order to focus attention on the health challenges that it faces and in particular the challenges relating to public health research and education. In this brief essay, the authors argue that its usefulness is limited because the countries of the Arab World, however defined, are too heterogeneous to allow meaningful communal debate of their problems and solutions. As an alternative it is recommended that countries in the region form smaller more homogenous issue-specific groupings to discuss common challenges and action.

Prevalence of Diabetes among Migrant Women and Duration of Residence in the United Arab Emirates: A Cross Sectional Study

Background The prevalence rate of type 2 diabetes mellitus (T2DM) is one of the highest in United Arab Emirates (UAE), however data for the expatriate population is limited. This study aimed to identify the prevalence of T2DM amongst migrant women and test the hypothesis that acculturation (measured by years of residency) is associated with an increased risk of T2DM. Methods This was a cross-sectional study and we recruited a representative sample (n = 599, 75% participation rate) of migrant women aged 18 years and over in Al Ain, UAE. The American Diabetes Association criteria were used to diagnose T2DM. An adapted WHO STEPS questionnaire was used to collect socio-demographic, lifestyle and clinical data. Logistic regression analysis was performed to identify correlates of T2DM including length of UAE residence. Results The mean age of participants was 34.1 (± 9.5) years. Of the study participants, based on HbA1C levels, 18.6% (95% CI: 13.9–24.4) had prediabetes and 10.7% (95% CI: 7.2–15.6) had T2DM. Prevalence of prediabetes was 8.5% for Filipinos, 16.7% for Arabs and 30.3% for South Asians. Similarly the prevalence of T2DM was 1.7% for Filipinos, 12.2% for Arabs and 16.7% for South Asians. Significant correlates of overall T2DM (measured and known diabetes) included length of UAE residence for more than 10 years (Adjusted Odds Ratio [AOR] 2.74, 95% CI: 1.21–6.20), age ≥40 years (AOR = 3.48, 95% CI: 1.53–7.87) and South Asian nationality (AOR 2.10, 95% CI: 0.94–4.70). Conclusion Diabetes is a significant public health problem among migrant women in the UAE, particularly for South Asians. Longer length of residence in the UAE is associated with a higher prevalence of diabetes.

The effect of religion on the perception of health states among adults in the United Arab Emirates: a qualitative study

Objectives Investigate how religion may affect the perception of health states among adults in the United Arab Emirates and the implications for research on self-reported health and quality of life and the use of values in cost-effectiveness analysis. Design Qualitative analysis of short-structured interviews with adult Emiratis carried out by a market research agency.The COREQ criteria have been used where appropriate to guide the reporting of our findings. Setting Participants were recruited from shopping malls and other public places in the cities of Al Ain and Abu Dhabi. Participants Two hundred adult Emiratis broadly representative of the Emirati population in terms of age and gender. Results Eighty one per cent of participants said that their perception of health states was influenced by their spiritual or religious beliefs. The two overarching themes that seemed to explain or classify these influences were ‘fatalism’ and ‘preservation of life’. Subthemes included powerlessness to change what is preordained by God, fear of disability (particularly diminished mobility) and appreciation of health and life and the requirement to look after one’s health. A final theme was that of acceptance, with respondents expressing a willingness to endure suffering and disability with patience in the expectation of rewards in the hereafter. Conclusions Our results emphasise the need for further work to establish locally relevant value sets for Muslim majority countries in the Middle East and elsewhere for use in health technology assessment decision-making, rather than relying on value sets from other regions.

Frailty in Community-Dwelling Older People in Abu Dhabi, United Arab Emirates: A Cross-Sectional Study

Background Frailty describes the aging-associated loss of physiological and psychological reserves, leading to an increased risk of adverse health outcomes. Many developed countries view frailty as a major priority for their health and social care systems. Less is known about frailty in less-developed countries. The purpose of this study was to determine the prevalence of frailty in a sample of community-dwelling older people in the United Arab Emirates (UAE). Methods This was a cross-sectional study of community-dwelling Emirati adults aged 55 years and older (n = 160) in Abu Dhabi, UAE. Data were collected at interview by questionnaire and physical measurements. Frailty was defined according to the criteria of the Fried Frailty Index. The prevalence of frailty and its association with selected independent variables were assessed. Results The overall prevalence of frailty (95% CI) was 47% (39–55). Higher levels of frailty were seen in older age groups, women, those who were non-married, those with recent hospital admission, those with comorbid conditions, those on more than five medications, and those with lower forced expiratory volume and mini-mental state examination score. After adjustment in a multiple logistic regression model, only age and gender were found to be independently associated with frailty. Conclusion A high prevalence of frailty was found among older Emiratis. Given that frailty is associated with adverse health outcomes and can be a means of identifying opportunities for intervention in clinical practice and health policy, further attention and consideration within professional and public health policy circles are needed.