The impact of socio-economic, lifestyle habits, and obesity in developing of pregnancy-induced hypertension in fast-growing country: global comparisons

OBJECTIVE

The aim of the study was to determine the prevalence and associated risk factors of pregnancy-induced hypertension (PIH) in the third trimester of Arab women and their neonatal outcome.

DESIGN

A prospective study.

SETTING

Women's Hospital and Maternity Clinics.

SUBJECTS AND METHODS

The study was based on pregnant women in third trimester from the first week of January 2010 to April 2011. A total of 2,056 pregnant women, who had any kind of maternal complications, were approached and 1,608 women (78.2%) expressed their consent to participate in the study. A questionnaire covered variables related to socio-demographic factors, family history, medical history, maternal complications, and neonatal outcome. Multiple logistic regressions were used to describe the relationship between socio-demographic factors and PIH.

RESULTS

Pregnant women with Qatari nationality were 30% more likely to have PIH (Adj. OR 0.7; 95% CI 0.5-0.9, p = 0.03). Those living in villas were 50% more likely than those living in apartments (Adj. OR 0.5; 95% CI 0.3-0.9) and 40% more likely than those living in traditional houses (Adj. OR 0.6; 95% CI 0.4-0.8) to have PIH. The odds of PIH linearly increases with each decrease of 5,000 QAR in monthly income from > 20,000 to 10-15,000 (Adj. OR 1.2; 95% CI 0.7-2.1, Adj. OR 1.9; 95% CI 1.1-3.2, respectively) and then it starts decreasing from 10,000 to < 5,000 monthly income (Adj. OR 1.8;95% CI 1.1-3.1 and Adj. OR 1.3; 95% CI 0.7-2.7 respectively). The odds of PIH linearly increase with each five years increase in age among pregnant women from 30 to 45 years of age. A 10-fold increase in PIH odds was observed when body mass index (BMI) increased above > or = 30 (obese) (Adj. OR 10.0; 95% CI 6.4-15.6). Pregnant women who had no history of previous abortion were 60% less likely than those who had positive history of previous abortion (Adj. OR 1.6; 95% CI 1.1-1.2; p = 0.007) to have PIH. The odds of PIH increases by 50% when women do not receive antenatal care (Adj. OR 1.5; 95% CI 1.1-2.1; p = 0.040).

CONCLUSION

Qatar has a high prevalence of PIH compared to both regional and global rates. Maternal age > 30, increased BMI, previous abortion, lack of antenatal care, and physical activity were found to be significantly associated with increased risk of PIH in Arab women and could be potentially modifiable risk factors.

Have neonatal mortality rates in the state of Qatar become static? A PEARL study analysis

To ascertain the national neonatal mortality rate in Qatar during the first quarter of 2011 (1 January-31 March), we carried out a prospective pilot national epidemiologic study. Nationwide birth and neonatal mortality data were collected using predesigned, structured questionnaires. To analyse trends over the previous 4 years (2008-2011) we used neonatal mortality data for 2008-2010 from the database of the neonatal unit at the Women's Hospital, annual reports of Hamad Medical Corporation, and published neonatal mortality data for 2010 for comparative analysis. A total of 4909 live births and 21 neonatal deaths were recorded during the study period. The neonatal mortality rate was 4.28/1000 live births (corrected neonatal mortality rate 2.85/1000). The early neonatal mortality rate was 1.84/1000 and the late neonatal mortality rate was 2.44/1000 live births. Fifteen of the 21 neonatal deaths were in non-Qatari babies, reflecting the ethnic distribution in the population. Neonatal mortality rates in Qatar declined very little between 2008 and the first quarter of 2011.

Prevalence and associated risk factors of ante-partum hemorrhage among Arab women in an economically fast growing society

OBJECTIVE

The aim of this study was to determine the prevalence and associated risk factors of antepartum hemorrhage (APH) in the third trimester of Arab women residing in Qatar and their neonatal outcome.

DESIGN AND SETTING

A prospective hospital-based study was conducted in the Women's Hospital and Maternity Clinics.

MATERIALS AND METHODS

The study was based on pregnant women in the third trimester from the first week of January 2010 to April 2011. A total of 2,056 pregnant women, who had any kind of maternal complications, were approached and 1,608 women (78.2%) expressed their consent to participate in the study. The questionnaire covered variables related to socio-demographic factors, family history, medical history, maternal complications and neonatal outcome. Multiple logistic regressions were used to describe the association between socio-demographic factors and APH.

RESULTS

The overall prevalence of APH among Arab women residing in Qatar was 15.3% with 6.7% among Qatari's and 8.6% among non-Qatari Arab women; the difference in ethnicities was not significant. Among maternal socio-demographic characteristics, lower education (primary or below AOR 1.72; 95%CI 1.22-2.43, and intermediate education AOR 1.41; 95%CI 0.88-2.26; P=0.005) compared to university education was significantly associated with APH. As for maternal biological characteristics, family history of G6PD (AOR 1.87; 95% CI 1.18-2.95; P=0.007) and family history of Down's Syndrome (AOR 1.88; 95%CI 1.35-2.62; P=<0.001) were significantly associated with APH at the multivariable level; family history of hypertension (OR 1.78; 95%CI 1.30-2.44; P<0.001) was significant at the univariate level. Neonatal outcomes as a result of APH included increased risk of Apgar score at 1 minutes <7 (AOR 1.44; 95%CI 1.12-2.02; P=0.04) and minor congenital anomaly (AOR 2.82; 95%CI 1.39-5.71; P=0.004).

CONCLUSION

Qatar has a high prevalence of APH. Poor education, family history of hypertension, G6PD and Down's syndrome were found to be significantly associated with increased risk of APH in Qatar. Neonates of APH are at significantly increased risk of adverse outcome. Thus it is essential that obstetricians are alerted to these risk factors for early detection and to decrease the negative effects of APH.

Outcome of Occlusion Treatment for Strabismic Amblyopia in Children Below 12 Years Old Age

AbstractObjective:The aim of our study was to determine the related clinical factors affecting the outcome of occlusion treatment for Strabismic Amblyopia in Qatari children.

Design:This is a retrospective descriptive study.

Subjects and Methods: The study included 38 Qatari children with strabismic amblyopia who were treated with occlusion therapy. The survey was conducted among the Qatari children below 12 years of age during a 10 year period from 1992-2002. During this study period, 23 girls and 15 boys were treated for strabismic amblyopia.

Results:A total of 38 Qatari children were treated during the 10 year period. Of these children, 39.5% were males and 60.5% females. After the treatment, it is found that their final visual acuity improved. 73.7% achieved 6/9 or more and 26.3% achieved less than 6/9. The initial visual acuity, the presence of anisometropia and compliance were found to be related to the outcome of amblyopia treatment. The age at the start of treatment was found unrelated to the outcome. It was further discovered that most vision loss from amblyopia can be reversed with the correct intervention.

Conclusion:The results of the present study indicated that the main factors affecting the treatment of strabismic amblyopia are initial visual acuity, presence of anisometropia and compliance.

Is high prevalence of vitamin D deficiency evidence for asthma and allergy risks?

BACKGROUND

Studies suggest a link between vitamin D deficiency and development of asthma and allergic diseases.

AIM

To determine a) the association between vitamin D and asthma among children, b) difference in level of vitamin D in asthmatic children and control, and c) effect of vitamin D on atopy markers.

SETTING

Case-control study done, between October 2009 to July 2010, on asthmatics and controls (< 15 years) at Pediatric Allergy-Immunology Clinics and Primary Health care Clinics (PHC), Qatar. METHODS & SUBJECTS: A total of 483 cases and 483 controls matched by age, gender and ethnicity. Sociodemographic & clinical data was collected through physician diagnosis and questionnaire. Their health status was assessed by past or present clinical manifestations, family history, physical examination, BMI, and serum 25(OH) vitamin D, calcium, and phosphorus.

RESULTS

44.8% of asthmatic and 50.0% of controls were males, and 55.2% of asthmatic and 50% of controls were females. The mean age (+/- SD, in years)for asthmatic versus controls was 7.0 +/- 3.8 vs. 8.4 +/- 3.6. Vitamin D deficiency was more prevalent in asthmatics than controls. The mean value of Vitamin D in asthmatics was much lower than the normal value, and there was a significant difference found in the mean values of vitamin D between asthmatics (17.5 +/- 11.0) and the controls (20.8 +/- 10.0). Furthermore, there were statistically significant differences between asthmatic subjects and controls with respect to serum level of vitamin D (p < 0.001). Lower Vitamin D levels were associated with more allergic disease and elevated serum IgE.

CONCLUSION

Serum vitamin D levels were lower in asthmatic than control. Vitamin D deficiency was higher among children with asthma, allergic rhinitis, atopic dermatitis, acute urticaria, and food allergy. In addition, vitamin D deficiency was associated with IgE atopy markers in asthmatic children more than controls.

Prevalence, awareness and determinants of contraceptive use in Qatari women

We determined the knowledge of, attitude to and practice of contraception and the associated sociodemographic factors among a representative sample 1130 Qatari married women aged 18-49 years. Data were collected by questionnaire. The mean age of the women was 32.5 (SD 7.6) years. The vast majority (94.6%) knew about contraception but of these 1070, only 694 (64.9%) were in favour of contraception. Knowledge of contraception increased with increasing level of education (P < 0.001), but decreased the lower the household income (P = 0.002). Only 511 (47.8%) women were currently using contraceptives, which was significantly associated with age, husband's age, years of marriage, education level, income level and attitude to family planning. The most commonly known and used contraceptives were intrauterine device and pills. Friends were the most common source of knowledge about family planning method (80.0%).

The Outcome of Severe Traumatic Brain Injury in Children in Qatar: Six year study

Traumatic brain injuries (TBI) are important public health problem resulting in short-term or permanent disability and death. To determine the extent and outcome of severe TBI amongst children in Qatar medical records were reviewed retrospectively of all cases of severe TBI in children aged 14 years or less who attended the Children Rehabilitation Unit, Hamad General Hospital, Qatar, between January 2002 to December 2008. The severity of TBI was assessed by the Glasgow Coma Scale (GCS). Of 65 children with severe TBI, most were male (73.8 %) and 91 % were older than five years of age. The leading causes of injury were road traffic accident (84.6%) and falls (10.8%). Other causes included trauma by ceiling fan blades (4.6%), sports and recreation injuries. Early sequelae included spasticity (43.1 %) and posttraumatic epilepsy (33.8%); both were significantly associated with the increased severity and need for intracranial surgery. Almost a quarter of the children had communication disorders, 17 (26.2 %) had poor cognition, 16 (24.6%) had hemiplegia and 12 (18.5 %) had abnormal behaviour. Twelve (18.5%) children died within the first month of admission to hospital. It is clear that severe TBI results in significant morbidity and mortality among children in Qatar and special efforts are needed to reduce the causes especially motor vehicle crashes and injuries. Rehabilitation programs are also needed to limit the extent of long-term complications associated with TBI.

Does Delay in Diagnosing Acute Appendicitis Affect the Outcome?

Acute appendicitis is the most common surgical case met in an emergency department. Immediate surgery results in the confirmation of diagnosis and control of sepsis. To determine whether the delay in operating upon patients with acute appendicitis will affect the outcome or the stage of the disease, and if the clinical parameters give an indication of the severity of the disease medical records were reviewed retrospectively of 373 appendectomized patients above 14 years of age who were diagnosed with appendicitis in the emergency department of Hamad General Hospital, State of Qatar, between June and September 2007; 341 were diagnosed as acute appendicitis. Patients were classified according to the pre-operative and histopathological findings into four grades; A1: inflamed appendix, A2: gangrenous appendix, A3: perforated appendix, A4: pus +/- mass formation. Complications increased with the duration of the pre-hospital delay. The length of stay in hospital correlated significantly with the grade of diagnosis. The presence of fever, no change in bowel habit, and rigidity correlated well with advanced pathology, the complications increasing with greater delay. We conclude that delayed appendectomy is unsafe since it is associated with an increase in pathological grading as well as increasing the morbidity and the length of stay in hospital.

Road traffic fatalities in Qatar, Jordan and the UAE: estimates using regression analysis and the relationship with economic growth

Smeed's equation is a widely used model for prediction of traffic fatalities but has been inadequate for use in developing countries. We applied regression analysis to time-series data on vehicles, exponential models for fatality prediction, producing an average absolute error of 20.9% for Qatar, 10.9% for population and traffic fatalities in the United Arab Emirates (UAE), Jordan and Qatar. The data were fitted to Jordan and 5.5% for the UAE. We found a strong linear relationship between gross domestic product and fatality rate.

Clinical and epidemiological characteristics of lung cancer cases in Qatar

This study documents for the first time the clinical and epidemiological characteristics of lung cancer cases in Qatar from 1998 to 2005. The age-standardized incidence rate was higher than that in many other Gulf countries: 8.95 per 100,000 (15.2 per 100,000 for males; 3.95 per 100,000 for females). Mean age at diagnosis was 57.5 years. Most patients were current smokers or ex-smokers at the time of diagnosis (82.5%). Unlike other Gulf countries, adenocarcinoma was the predominant type in both Qatari nationals and expatriates (43.9% of lung cancer types). Many cases were in an advanced stage at diagnosis (64.2% at stage IV). Incomplete information was available on mortality rate due to the migration of expatriates.