Mohamud Sheek-Hussein

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 Methods : A systematic literature search was conducted to retrieve peer-reviewed articles on health in the UAE, and unpublished data were provided by government health authorities and local hospitals.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.

Seroprevalence of measles, mumps, rubella, varicella–zoster and hepatitis A–C in Emirati medical students

BackgroundThe aims of this study were to assess the seroprevalence of vaccine-preventable infections in Emirati medical students, and to provide scientific evidence for implementation of a cost-effective immunization guideline and policy for medical school admission.MethodsThis prospective cohort study involved 261 (61% female) Emirati medical students (preclinical and clinical) attending the College of Medicine and Health Sciences at UAE University. Data on vaccination and history of infectious diseases were collected from participants. Blood samples were collected between July 1, 2011 and May 30, 2012 for serological testing and QuantiFERON®-TB assay.ResultsAll students tested negative for infection with hepatitis C virus and human immunodeficiency virus. The prevalence of seropositivity to rubella virus was 97%, varicella–zoster virus 88%, mumps virus 84%, measles virus 54%, hepatitis B virus (HBV) 48%, and hepatitis A virus 21%. The QuantiFERON®-TB test was positive in 8% and indeterminate in 2%. Forty percent of students received HBV vaccine at birth; their HBV titers (mean ± SD) were 17.2 ± 62.9 mIU/mL (median = 1.64). The remaining 60% received it at school and their titers were 293.4 ± 371.0 mIU/mL (median = 107.7, p = 0.000).ConclusionAbout 50% of students were susceptible to HBV and measles virus; therefore, pre-matriculation screening for antibodies against these viruses is highly recommended. Moreover, tuberculosis screening is necessary because of the high influx of expatriates from endemic areas. Students with inadequate protection should be reimmunized prior to contact with patients.

The use of an interferon-gamma release assay to screen for pediatric latent tuberculosis infection in the eastern region of the Emirate of Abu Dhabi

OBJECTIVES Intense migration to the United Arab Emirates from tuberculosis (TB) high-endemic areas presents a particular risk to the population. Screening for latent tuberculosis infection (LTBI) usually involves risk assessment, the tuberculin skin test (TST), and interferon-gamma release assay (IGRA). This study investigated the use of an IGRA to screen for LTBI and compared its performance with a risk assessment questionnaire. METHODS This prospective cross-sectional study was conducted at seven Ambulatory Healthcare Services facilities in Abu Dhabi. Participants (88% Emiratis) were pediatric patients presenting for routine care. The QuantiFERON-TB Gold In-Tube test was performed and the parents completed a questionnaire assessing TB risk factors. RESULTS Six-hundred and ninety-nine subjects (median age 8.7 years, interquartile range 9.2 years) were enrolled; 669 (96%) agreed to testing. Four patients had a positive IGRA; one had previously been treated for TB, resulting in three patients with LTBI. The estimated LTBI prevalence was 0.45% (95% confidence interval 0.09-1.3). A household contact from a TB high-endemic area was reported in 44%, travel to a TB high-endemic area in 10%, and contact with someone with a chronic cough in 7%, a TB case in 3%, a TST-positive case in 2%, and an IGRA-positive case in 2%. Fifty percent of participants had at least one risk factor. The risk assessment did not predict a positive IGRA. CONCLUSIONS The questionnaire yielded a risk of TB exposure of 50%, however the LTBI prevalence, as defined by the IGRA, was low (0.45%).

Mycobacterium tuberculosis in the United Arab Emirates: evidence of local transmission with unique strains

A retrospective epidemiological analysis was performed of Mycobacterium tuberculosis infections in the Al Ain Medical District, Al Ain, United Arab Emirates (U.A.E.) during the period 1995-2000. The mean incidence for the study period was 7.1%, more than 3 times that reported for the period 1983-1992 (2.1%). For the years 1997 through 2000, the highest incidences (approximately 5-7% of tested) were from health care facilities that cater exclusively for citizens and long-term residents of the U.A.E. Corresponding rates for the immigrant visa applicants (non-citizens) were lower and showed a dramatic decrease from approximately 18% in 1995 to approximately 2% in 2000. Most importantly, the number of multidrug-resistant cases showed an increase from 1.4% during the period August 1997-December 1998 to 8.5% during the period January 1999-July 2000. Analysis of 7 different isolates by restriction fragment length polymorphism (RFLP) showed RFLP patterns that did not match > 4000 individual patterns from 32 countries, suggesting the possible presence of M. tuberculosis strains unique to the U.A.E. Our data demonstrate local transmission of M. tuberculosis in the Al Ain Medical Region of the U.A.E.

Pattern of varicella and associated complications in children in United Arab Emirates: 5-year descriptive study.

The objective of this study was to characterize the epidemiology of varicella and varicella-associated complications in Al-Ain, United Arab Emirates (UAE) during 2000-04. The annual number of reported cases varied from 373 to 790 per 100 000 population. Most (89%) occurred in children < 15 years old. Of 187 children requiring hospital admission, 50.3% had febrile illness due to secondary bacterial infection and 17.6% had neurological complications. The overall mortality rate among hospitalized children was 1.1%, all due to invasive group A Streptococcus. Varicella and associated complications in previously healthy children is becoming an important clinical and public health problem in the UAE.