Javaid Sheikh

A Study of Postpartum Depression in a Fast Developing Country: Prevalence and Related Factors

Background: Depression is a common and disabling complication of post-partum women. There is a paucity of research on postpartum depressive disorders and their predictors in women from Arab countries. Aim: The aim of this study was to determine the prevalence and identify risk factors of postpartum depression among Arab women in Qatar using Edinburgh Postnatal Depression Scale Score (EPDS). Design: This is a prospective cross-sectional study conducted during the period from January 2010 to May 2011. Setting: Primary healthcare centers of the Supreme Council of Health, State of Qatar. Subjects: A representative sample of 1669 mothers within 6 months after delivery were approached and 1379 (82.6%) mothers participated in this study. Methods: The study was based on a face-to-face interview with a designed diagnostic screening questionnaire. Occurrence of postpartum depressive symptoms was assessed by the EPDS. Also, socio-demographic characteristics, medical and family history, and obstetric variables of patients were collected through a designed questionnaire. The diagnostic screening questionnaire was reviewed and calculated the final score which identified the risk cases. Results: The prevalence of postpartum depression among the study sample was 17.6%. Mothers of age above 35 years (49.9% vs. 39.2%; p < 0.001), low education below intermediate level (51% vs. 35.8%; p < 0.001), housewives (38.7% vs. 29%; p = 0.03), with low monthly income (QR 5000–9999) (43.2% vs. 32.2%; p < 0.001) were significantly at high risk for postpartum depression. Maternal complications (38.7% vs. 26.1%; p < 0.001) and caesarean section (36.2% vs. 28.8%; p = 0.022) were significantly higher among depressed mothers compared to non-depressed women. Financial difficulties (OR=2.04; p < 0.001), prematurity (OR=1.64; p = 0.025), poor family support (OR=1.52; p = 0.016), dissatisfaction in marital life (OR=1.26; p = 0.005), poor marital relationship (OR=1.13; p = 0.05) were the main predictors of postpartum depression. Conclusion: This prevalence of postpartum depression in women living in Qatar was comparable to previous epidemiological research done in developing countries. Financial difficulties, prematurity, lack of family support, and poor marital relationships have been identified as main risk factors for developing postpartum depression.

Medical education and research environment in Qatar: a new epoch for translational research in the Middle East.

Recent advances in medical technology and key discoveries in biomedical research have the potential to improve human health in an unprecedented fashion. As a result, many of the Arab Gulf countries, particularly Qatar are devoting increasing resources toward establishing centers of excellence in biomedical research. However, there are challenges that must be overcome. The low profile of private medical institutions and their negligible endowments in the region are examples of such challenges. Business-type government controlled universities are not the solution for overcoming the challenges facing higher education and research programs in the Middle East.During the last decade, Qatar Foundation for Education, Science and Community Development has attracted six branch campuses of American Institutions of higher learning to the Education City in Qatar, a 2500-acre area, which is rapidly becoming a model of integrating higher education and research in the region. Not-for profit, time-tested education institutions from abroad in public-private partnership with local organizations offer favorable conditions to build robust research programs in the region. Weill Cornell Medical College in Qatar (WCMC-Q) of Cornell University is an example such an institution. It is the first and only medical school in Qatar.WCMC-Qs interwoven education, research and public health based framework lays a sturdy foundation for developing and implementing translational medicine research programs of importance to the State of Qatar and Middle Eastern nations. This approach is yielding positive results. Discoveries from this program should influence public policy in a positive fashion toward reducing premature mortality and morbidity due to diabetes, obesity, heart disease and cancer, examples of health conditions commonly encountered in Qatar.

A study of postpartum depression and maternal risk factors in Qatar

Abstract Objective: The objective of this study was to investigate the association between maternal complications and postpartum depression (PPD) among postpartum women in Qatar by using the Edinburgh Postnatal Depression Scale (EPDS) as well as a structured questionnaire. Methods: This is a cross-sectional study of PPD of 1379 postpartum women within 6 months of delivery attending the primary healthcare centers of the State of Qatar. Results: The prevalence of PPD was 17.6% in the studied mothers. The results of the logistic regression analysis showed that the risk factors for PPD included various socio-demographic risk factors such as education, occupation, consanguinity and access to transportation. Amongst the maternal factors studied, history of unplanned pregnancy and infertility and other medical complications such as gestational diabetes, heart disease, threatened abortion and cesarean section were found to be risk factors for PPD. Amongst the postpartum women with maternal complications, items related to feeling scared and panicky and feeling sad and miserable were the most frequently reported symptoms of depression. These women were also more likely to be experiencing sleep difficulty (p = 0.029) compared to women without maternal complications. Conclusion: While socio-demographic risk factors are well studied in the PPD literature, there is much less information on the impact of maternal complications on the psychological status of postpartum women. Postpartum women, especially those with maternal complications, need close screening and have quick access to mental healthcare within integrated reproductive health services.

Motor vehicle injuries in Qatar: time trends in a rapidly developing Middle Eastern nation

Despite their wealth and modern road systems, traffic injury rates in Middle Eastern countries are generally higher than those in Western countries. The authors examined traffic injuries in Qatar during 2000–2010, a period of rapid population growth, focusing on the impact of speed control cameras installed in 2007 on overall injury rates and mortality. During the period 2000–2006, prior to camera installation, the mean (SD) vehicular injury death rate per 100 000 was 19.9±4.1. From 2007 to 2010, the mean (SD) vehicular death rates were significantly lower: 14.7±1.5 (p=0.028). Non-fatal severe injury rates also declined, but mild injury rates increased, perhaps because of increased traffic congestion and improved notification. It is possible that speed cameras decreased speeding enough to affect the death rate, without affecting overall injury rates. These data suggest that in a rapidly growing Middle Eastern country, photo enforcement (speed) cameras can be an important component of traffic control, but other measures will be required for maximum impact.

A road map to Translational Medicine in Qatar and a model for the world

Translational Medicine (TM) in Qatar is part of a concerted effort of the Qatari medical and scientific leadership supported by a strong political will by Qatari authorities to deliver world-class health care to Qatari residents while participating in the worldwide quest to bridge the gap between bench-to-bedside-to-community. TM programs should embrace the Qatar National vision for research to become an international hub of excellence in research and development, based on intellectual merit, contributing to global knowledge and adhering to international standards, to innovate by translating new and original ideas into useful applications, to be inclusive at the national and international level, to build and maintain a competitive and diversified economy and ultimately improve the health and well-being of the Qatar’s population. Although this writing focuses on Qatar, we hope that the thoughts expressed here may be of broader use for the development of any TM program particularly in regions where an established academic community surrounded by a rich research infrastructure and/or a vibrant biotechnology enterprise is not already present.

Prevalence and determinants of metabolic syndrome in Qatar: results from a National Health Survey

Objectives To determine optimum measurements for abdominal obesity and to assess the prevalence and determinants of metabolic syndrome in Qatar. Design National health survey. Setting Qatar National STEPwise Survey conducted by the Supreme Council of Health during 2012. Participants 2496 Qatari citizens aged 18–64 representative of the general population. Primary and secondary outcome measures Measure of obesity (body mass index, waist circumference or waist-to-height ratio) that best identified the presence of at least 2 other factors of metabolic syndrome; cut-off values of waist circumference; frequency of metabolic syndrome. Results Waist circumference ≥102 for men and ≥94 cm for women was the best predictor of the presence of other determinants of metabolic syndrome (raised blood pressure, fasting blood glucose, triglycerides and reduced high-density lipoprotein cholesterol). Using these values, we identified 28% of Qataris with metabolic syndrome, which is considerably lower than the estimate of 37% calculated using the International Diabetes Federation (IDF) criteria. Restricting the analysis to participants without known elevated blood pressure, elevated blood sugar or diabetes 16.5% would be classified as having metabolic syndrome. In a multivariable logistic regression analysis, the prevalence of metabolic syndrome increased steadily with age (OR=3.40 (95% CI 2.02 to 5.74), OR=5.66 (3.65 to 8.78), OR=10.2 (5.98 to 17.6) and OR=18.2 (7.01 to 47.5) for those in the age group ‘30–39’, ‘40–49’, ‘50–59’, ‘60–64’ vs ‘18–29’; p<0.0001), decreased with increasing educational attainment (OR=0.61 (0.39 to 0.96) for those who attained ‘secondary school or more’ compared with ‘less than primary school’; p=0.03) and exercise (OR=0.60 (0.42 to 0.86) for those exercising ≥3000 vs <600 MET-min/week; p=0.006) but was not associated with smoking or diet. Conclusions Waist circumference was the best measure of obesity to combine with other variables to construct a country-specific definition of metabolic syndrome in Qatar. Approximately 28% of adult Qatari citizens satisfy the criteria for metabolic syndrome, which increased significantly with age. Education and physical activity were inversely associated with this syndrome.

Adolescent prediabetes in a high-risk Middle East country: a cross-sectional study

Objective To estimate the prevalence of prediabetes in adolescents living in a high-risk country and to detect risk factors associated with this disorder. Design Survey questionnaire combined with physical measurements and blood sugar determination. Setting Doha, capital city of Qatar. Participants A total of 1694 male and female students aged 11–18 years without previously diagnosed diabetes enrolled in four schools. Main outcome measure Blood sugar measurements. Other measured variables included gender, height, weight, abdominal circumference, country of origin, family history of diabetes and frequency of exercise. Results Using a random blood sugar ≥7.8 mmol/L or a fasting blood sugar ≥5.5 mmol/L as cutpoints, we identified 4.2% of students (56 boys, 15 girls) as probable prediabetics. In a multivariate model, being boys (OR 3.2, 95% CI 1.7–6.2), having a diabetic parent (OR 1.9, 95% CI 1.1–3.2) or having a waist-to-height ratio >0.5 (OR 1.8, 95% CI 1.1–3.0) were significantly associated with being a prediabetic. The parental origin of diabetes had a differential effect upon blood sugar. The mean random blood sugar in students with a maternal inheritance pattern of diabetes was 5.61 mmol/L ± 1.0, compared to 5.39 mmol/L ± 0.89 in students with a paternal inheritance pattern (p = 0.02). Conclusions In a country with a high risk of adult diabetes, we identified 4.2% of students aged 11–18 as being prediabetic. Risk factors associated with prediabetes included male gender, family history of diabetes and waist-to-height ratio >0.5.

Establishment of a model academic health system in Qatar.

694 www.thelancet.com Vol 379 February 25, 2012 As the winds of social and political change sweep across the Middle East, Qatar has become a beacon of stability and rational discourse. Qatar National Vision 2030— a long-term national leadership strategy—was launched in 2008 and provides the framework for transforming Qatar into an advanced society by achieving major milestones in human, social, economic, and environmental development. As part of this process, Qatar’s education system has undergone changes with the introduction of international universities and academic programmes by the Qatar Foundation for Education, Science, and Community Development. Similarly the Supreme Council for Health has introduced a national health strategy for Qatar by establishing a network of hospitals and health-care centres that provide high-quality primary, secondary, and tertiary health care. We have now embarked on an ambitious and transformational programme to establish a national academic health system that will provide a model for other small nations. This attempt is the fi rst to assemble all of a nation’s academic and health-care providers into one partnership working towards a shared vision and strategic plan. Qatar is a diverse and rapidly growing nation of 1·7 million inhabitants with 400 000 indigenous Qataris and a large multi-ethnic migrant population, mostly from the Indian subcontinent. The population is young and faces many health-care challenges, including an increasing prevalence of chronic diseases and diseases linked to lifestyle and behaviour, some of which are driven by economic, cultural, and social disparities that have a profound eff ect on health. These diseases include obesity, diabetes, cardiovascular disease, congenital disorders, trauma (particularly related to road-traffi c accidents), and certain types of cancer. The construction industry presents interesting health-care challenges, such as complex trauma and heat exhaustion. Although the government has implemented legislation to protect migrant workers, the academic health system could address these problems with collaborative research, education, community engage ment, and pursuit of innovative solutions. The health-care system in Qatar is state funded and available to all at little or no cost via a net work of hospitals and health-care centres delivering health care. Although most of the hospital system is integrated through Hamad Medical Corporation, primary care and the various academic institutions are rarely aligned. The Academic Health System Initiative is designed to correct this inconsistency and align the various strands with a single mission and vision. These health systems are a potential solution to integration problems because of their unique combination of teaching, research, and patient care. Their strength results from the seamless integration of these central activities to improve health and wellbeing, search for innovative health-care solutions, and ensure a modern, fl exible, and sustainable workforce. The Academic Health System Partnership will enable interprofessional teams to address key research questions and ensure rapid translation into clinical practice. To be leading organisations of the future, academic health systems should be focused directly on their communities and regions. This focus involves development of a social conscience and provision of tangible economic and personal health benefi ts to the community. These social determinants of health include an individual’s social circumstance, environment, and behavioural patterns. Qatar has a unique opportunity to embrace this concept and develop a distinctive academic health system, which will allow the diverse academic institutions Establishment of a model academic health system in Qatar 9 Soofi S, Ahmed S, Fox MP, et al. Eff ectiveness of community case management of severe pneumonia with oral amoxicillin in children aged 2–59 months in Matiari district, rural Pakistan: a cluster-randomised controlled trial. Lancet 2012; published online Jan 27. DOI:10.1016/S01406736(11)61714-5. 10 Bari A, Sadruddin S, Khan A, et al. Community case management of severe pneumonia with oral amoxicillin in children aged 2–59 months in Haripur district, Pakistan: a cluster randomised trial. Lancet 2011; 378: 1796–803. 11 WHO. Recommendations for management of common childhood conditions: evidence for technical update of pocket book recommendations: newborn conditions, dysentery, pneumonia, oxygen use and delivery, common causes of fever, severe acute malnutrition and supportive care. Geneva: World Health Organization, 2012 (in press). 12 Marsh DR, Gilroy KE, Van de Weerdt R, Wansi E, Qazi S. Community case management of pneumonia: at a tipping point? Bull World Health Organ 2008; 86: 381–89. 13 Straus WL, Qazi SA, Kundi Z, Nomani NK, Schwartz B, and the Pakistan Co-trimoxazole Study Group. Antimicrobial resistance and clinical eff ectiveness of co-trimoxazole versus amoxycillin for pneumonia among children in Pakistan: randomised controlled trial. Lancet 1998; 352: 270–74.

Impact of migrant workers on the Human Development Index

IntroductIonIn 1990, to help public health officials, politicians and key leaders compare human wellbeing, the UN Development Programme created the Human Development Index (HDI).1 The aim was to create an index that was based on available country- specific data, whilst being transparent and suffi- ciently robust enough to withstand scientific scru- tiny. The index is now widely used to compare world countries, and government leaders pay close attention to the individual rank of each country.The HDI is based on the concept that people are the real wealth of a nation. The originators of the HDI recognised that there are three essential components required for humans to develop to their maximum ability: health, education and income. There is general agreement that if any one of these elements is absent, individual achievement will be severely limited. Currently, the composite index is obtained by first normalising each individual component to a maximum value of unity so that all are on a comparable scale. Then the overall HDI is computed by taking the geometric mean of the three individual index val- ues.2 The health component of the index is based solely on life expectancy at birth, and the wealth component is based upon the gross national income per capita. Since 2011, the education part of the HDI is calculated by combining two separate measures: mean schooling years for adults and expected school years for children entering the school system. The geometric mean of these two values comprises the education index.For countries with large numbers of guest workers, mean years of schooling is likely to be low, because the majority of guest workers are unskilled labourers with a lower educational level than the citizen population. In contrast, the expected number of school years component would be relatively unaffected by guest workers because it is based upon students currently enrolled in the educational system.The aim of this report is to determine the impact of guest worker status on the composite HDI ranking score. We focused on the 93 countries classified as high or very high human development because this group has the highest concentration of migrant guest workers.MethodWe used published HDI data from the UN Human Development Programme 2010 or the most recent year to examine country rankings for all the countries ranked in the high or very high HDI groups.2 As an estimate of the number of migrant guest workers, we used the percentage of migrant workers aged 40-45 in the total popula- tion from available data in the UN migration data- base or, if unavailable, data from the World Bank.3,4 To determine the impact of migrant sta- tus on HDI, we plotted the country-specific rank- ing of each of the three individual HDI compo- nents (education, health, income) against migrant status. We also plotted each of the three compo- nents against the overall HDI, using a marker to identify those countries with the highest propor- tion of migrant workers.We used linear least squares analyses to study the relationship between migrant status and HDI as well as the individual components of the HDI. For outcomes that appeared non- linear, we used locally weighted scatterplot smoothing (Lowess) to fit the data. For comparing continuous variables between groups of coun- tries, we used t-tests. All p-values are two-sided, with a predetermined significance level of .05.ResultsData for both HDI and migrant status were availa- ble for 89 of the 93 countries listed in the UN high or very high development group. When we plot- ted the educational component of the HD against the percentage of migrants in these countries, we noted a biphasic curve with an inflexion point when the percentage of migrant workers in the population reached 30%. After this level was reached, there was a robust negative correlation between the educational component of the HDI and percentage of migrant workers (R = 0. …

Gray literature in systematic reviews on population health in the Middle East and North Africa: protocol of an overview of systematic reviews and evidence mapping

BackgroundSystematic review (SR) guidelines recommend extending literature search to gray literature in order to identify all available data related to the review topic. We aim to conduct an overview of SRs on population health in the Middle East and North Africa (MENA), to assess the methodology of these SRs, to produce an evidence map highlighting methodological gaps in SRs regarding gray literature searching, and to aid in developing future SRs by listing gray literature sources related to population health in MENA.Methods/designWe will conduct an overview of SRs based on the Cochrane Handbook for Systematic Reviews of Interventions. This overview will be reported following PRISMA 2009 guidelines. Using comprehensive search criteria, we will search the PubMed database to identify relevant SRs published since 2008. Our primary outcomes are gray literature sources and study-level quality in the gray literature. We will include MENA countries with Arabic, English, French, and/or Urdu as primary official languages and/or media of instruction in universities. Two reviewers will independently conduct a multilevel screening on Rayyan software. Extraction of relevant data will be done on Statistical Package for the Social Sciences (SPSS) software. The methodological quality of included SRs will be assessed using the Assessment of Multiple Systematic Reviews (AMSTAR) tool. Any disagreements will be resolved by discussion and consensus.We will estimate the overall proportion of SRs that used gray literature as one of their data sources. Subgroup analyses will be conducted to identify characteristics of these gray literature sources. Chi-squared and t tests will be used to determine whether the differences between subgroups are statistically significant. Additionally, an evidence gap map will be constructed to highlight characteristics and quality of the gray literature used in SRs on population health in MENA and emphasize existing gaps in gray literature searching. We will also list gray literature sources identified in the included SRs stratified by country and research topic.DiscussionThis overview will comprehensively assess the overall quality of the SRs on population health issues in MENA. Our findings will contribute to the improvement of population health research practices in MENA.Systematic review registrationThe systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 26 October 2018 (registration number CRD42017076736 (Syst Rev 2:4, 2013).