Makhdoom A. Shah

Over-the-counter use of oral contraceptives in Kuwait

Oral contraceptive pills (OCPs) are available over‐the‐counter (OTC) in Kuwait, and constitute a leading method for spacing and limiting children. Data from a nationally representative survey of Kuwaiti women are used to examine OTC use of OCPs. One‐fourth of the women initiated use without consulting a doctor, and 50% bought OCPs from the pharmacy. No socioeconomic or demographic differences were found between those who consulted a physician, implying that women of different background have similar accessibility to the physician. Using multivariate analysis, the odds of consulting a physician were found to be significantly lower for women who first bought OCPs directly from the commercial pharmacy. The duration of first time OCP use did not differ according to physician consultation. It is concluded that OTC availability of OCPs has many advantages and prevents unwanted pregnancy. However, there is a need for better packaging and instructions that would enable high‐risk women to identify themselves and to use OCPs under physician supervision.

Asian women workers in Kuwait.

As a percentage of the female expatriate labor force in Kuwait, Asians increased from 13 percent in 1965 to 68 percent in 1985. A major reason for this is the increase in domestic servants, especially in Kuwaiti households, 62 percent having at least one servant. Maids come mainly from Sri Lanka, India and the Philippines. A majority are married, aged 20–39 and earn KD 39 (US

Patterns of desired fertility and contraceptive use in Kuwait.

130) a month. Some are faced with horrific living conditions. In contrast, the professional and clerical females earn KD242 (US

Living arrangements of older women and men in Kuwait.

800). Regression analysis indicates the wage differentials between Asian and national women to be significant and indicative of discrimination.

The family planning program in Pakistan: what went wrong?

This study examined ideal family size its determinants and the impact of motivation on contraceptive use in Kuwait. Data were obtained from a household survey conducted in 1994 among 615 currently married nonpregnant women aged younger than 50 years in 5 major governorates in Kuwait. Six variables (number of living children marriage age wifes employment educational status of husbands and wives ethnic background and desired fertility) explained 15% of the variance in ideal family size. Women desired about 5.3 children. Women who married before the age of 18 years desired about 1 more child than women who married at over 21 years. Bedouin women desired 5.6 children and non-Bedouin women desired 4.8 children. Illiterate women desired 6.3 children. Women without formal schooling desired about 5.0 children. Working women desired 4.9 children. Number of living children and ethnicity were statistically significantly associated with ideal family size. 41% of women did not desire another child. The proportion of women wanting to stop childbearing increased with the number of living children. Non-Bedouin women were more likely to desire a stop to childbearing. 67% had ever used contraception; 50% were current users. Current use was associated with husbands level of education and wifes employment. With controls for the 6 variables women who had the same or more children than their ideal were twice as likely to be current users as women who had not reached their ideal. Number of living children may be the most important factor in determining a stop to childbearing and the use of contraceptives.

Foreign live-in domestic workers as caretakers of older Kuwaiti men and women: socio-demographic and health correlates

The main objectives of this article are toanalyze the correlates of living arrangementsof persons aged 60 or above in the oil-rich,Muslim country of Kuwait and to examine whetheror not patterns of co-residence differ bygender. Data were obtained from a nationallyrepresentative survey of households of Kuwaitinationals, and this paper is based on the 687older Kuwaiti residents of these households.Living arrangements were generally similar forwomen and men. Eighty nine percent of women and94 percent of men co-reside in households with atleast one son or daughter. Only 0.3 percent of menand 1.9 percent of women live alone.Socio-demographic characteristics of women andmen differed significantly; 58 percent of women werewidowed compared with 5 percent of men. Logisticregression analysis showed that women had twotimes higher odds than men of living withouttheir children. The odds of residing withoutchildren also increased with the respondentsage and education but decreased with increasingwealth. Continued rapid demographic,socioeconomic, and cultural change in Kuwaitforetells continued decline in co-residencewith children, and the implications of suchchange in a small city-state merits furtherresearch.

Searching for socioeconomic risk factors in perinatal mortality in Kuwait: a case control study

Pakistan was 1 of the 1st developing countries to adopt an official policy to reduce fertility. Its national family planning program begun in 1965 cost more than 165 million dollars over 15 years and was widely considered to be a model for other nations to follow. Yet by the end of the 1970s it became clear that the program had not worked. Only 5% of married women were using any contraceptive method; 2/3 did not know where they could obtain a method; 70% had never met a family planning program staff member. The crude birthrate (40 per 1000) was the same as in the early 1960s. According to the authors many program reforms which were supposed to have been introduced in the 1970s were never introduced partly a result of administrative problems and internal and external conflict but also partly due to low levels of effective demand. Administrators and donors accepted the figures garnered from service statistics about new acceptors and couple years of protection and assumed that program reforms would clear up problems indicated by the bad news about contraceptive use and continued high fertility which 1st broke in 1969. Observers thus continued to be surprised with the results of the 1975 fertility survey which showed no improvement. The schemes developed by program administrators are now seen to have been based on unrealistic targets and were hampered by inadequate supervision of fieldworkers political interference in staff recruitment inadequate evaluation procedures lack of commitment and motivation of key program staff and most importantly a preoccupation with a supply oriented approach. A considerable unmet need for family planning services remains which has not been converted into effective contraceptive usage partly because of the family dynamics of a male dominated society. Women who bear most of the costs of childbearing may want fewer children while men who receive most of the benefits want more. The cost of having more children may not be great enough to encourage women to face the problem of going against the wishes of husbands or mothers-in-law. The current family planning approach in Pakistan lays stress on changing the attitudes of potential clients about contraception apparently recognizing the lack of effective demand. (summary in FRE)

Obesity Among Kuwaitis Aged 50 Years or Older: Prevalence, Correlates, and Comorbidities

ABSTRACT Ageing of the population is posing new challenges for caretakers. This paper aims to examine: (a) age and gender differences in care provided by a domestic worker versus a family member in the performance of activities of daily living (ADL); (b) socio-demographic correlates of care during illness; and (c) self-reported physical, functional, and psychological health status in relation to care-giver. A cross-sectional household survey was conducted among 2,487 Kuwaiti nationals aged 50 years or older. This paper focuses on persons aged 70 or more. We found that domestic workers provided care to 28 per cent of men and 58 per cent of women who needed assistance with ADL; and to 14 per cent men and 51 per cent women during illness. These respondents ranked poorer on several health indicators and reported higher depressive symptoms score than those looked after by a family member. Logistic regression indicated that care by a domestic worker was approximately seven times more likely for women than men, about 10.8 times more likely for those without co-resident children compared with those who had three or more co-resident children, and 44 per cent less likely for the poorest compared with the richest persons. It appears that reliance on domestic workers is increasing and such reliance will remain necessary in the absence of culturally acceptable alternative institutional arrangements.

Trends, Patterns and Correlates of Contraceptive Use among Kuwaitis, 1984-1999

The aim of this paper was to investigate whether socioeconomic factors such as parents education, occupation, and income constitute risk factors in perinatal mortality after controlling for biological variables such as birth weight and length of gestation, and maternal factors such as age, parity and reproductive history. A case-control study covering all perinatal deaths in Kuwait was conducted for one year from 1 October, 1997 to 30 September, 1998. Each case (perinatal death) was matched with a control (live birth). Matching criteria were: fathers nationality, place, and date of birth. Information was successfully collected on 463 matched pairs, 274 Kuwaitis and 189 non-Kuwaitis. Only singleton births were included in the analysis. Bivariate analysis showed that several of the socioeconomic variables (e.g. lower education, lower income) increased the risk of a perinatal death. However, none of these variables remained significant in the multivariate analysis in which birth weight and length of gestation emerged as the two major determinants of perinatal deaths among both nationality groups. Among the Kuwaitis, primiparity and high parity, and previous history of miscarriage were also significant risk factors. Among the non-Kuwaitis, none of the socioeconomic factors, or the maternal factors, were significant predictors of perinatal mortality. For Kuwaitis, it appears that the governments policies and programs aimed at reducing social inequalities in the society have been effective in eliminating perinatal mortality differences between socioeconomic groups. Among non-Kuwaitis, the lack of differences is reflective of the fact that this group is relatively homogenous and selective of the more affluent who can bring the family to Kuwait. Both nationality groups benefit from the governments free health services. However, charges for non-Kuwaitis are due to be levied soon which may increase disparities in access to health care.

Towards Defining Socioeconomic and Demographic Inequalities That May Affect Health in Kuwait

OBJECTIVES Obesity is a serious global health problem. Our objectives are to assess the prevalence of overweight and obesity among elderly Kuwaitis aged 50 or older, examine their sociodemographic correlates, and analyze the association between obesity and its comorbidities. METHODS A cross-sectional face-to-face interview survey using a structured questionnaire was conducted among 2,443 Kuwaiti men and women aged 50 or older. Height and weight were measured and body mass index (BMI) was calculated. RESULTS About 81% respondents were overweight of whom 46% were obese. Mean BMI was 30.0 (31.2 for women and 28.1 for men). Multinomial logistic regression analysis revealed that relatively young elderly Kuwaitis (50-59) were 1.7 and 2.2 times more likely to be overweight and obese, respectively, compared with those aged 70 or older. Married individuals had 2.3 times higher risk to be overweight or obese than non-married individuals. Women were 3.6 times more likely to suffer from obesity than men. Overweight and obesity were found to be independent risk factors for hypertension (OR = 1.3 and 1.9, respectively), diabetes (OR = 1.4), and osteoarthritis (OR = 1.8 and 1.6, respectively). CONCLUSIONS Prevalence of overweight and obesity is alarmingly high among elderly Kuwaitis. The associated disease burden is substantial. Stakeholders should address the problem and launch national extensive health-promoting campaigns targeting perceptible lifestyle changes.