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Basics in Public Health and Epidemiology
Short paper task
Diabetes in the Arab world.
Submitted by: Mohammed A. M. Herzallah .
Stefaan De Henauw
Description and introduction:
Arab populations have many similarities and differences. They share culture, language, and religion, but they are also subject to economic, political, and social differences (1). Diabetes is a global problem with devastating human, social and economic impact. The impact of diabetes is considerable since at least 171 million people worldwide have diabetes. This figure is likely to be more than double by 2030. The case is even worse in the developing countries since the number of people with diabetes will increase by 150% in the next 25 years. It is also expected that the global increase in diabetes will continue because of an increase in the life span of the general population, rising trends towards overweight/obesity, unhealthy diet practices and sedentary lifestyles. In Developed Countries most people with diabetes are above the age of retirement, while in developing countries they are between 35 and 64 (2).
According to United Nations Educational, Scientific, and Cultural Organization (UNESCO), there are a total of 22 Arab nations. Arab countries are mainly classified into three groups according to the diabetes comparative prevalence (high, medium and low) but other differences are seen in terms of diabetes-related mortality and diabetes related expenditure per person. We also investigate the correlation between the human development index (HDI) and diabetes comparative prevalence
(R = 0.81).
Conclusion: The alarming rising trend of diabetes prevalence in the Arab region constitutes a real challenge for heath decision makers. In order to alleviate the burden of diabetes, preventive strategies are needed, based essentially on sensitization for a more healthy diet with regular exercise but health authorities are also asked to provide populations with health- care and early diagnosis to avoid the high burden caused by complications of diabetes(1).
Data, database and indicators:
In reviewing the available evidence on the epidemiology of diabetes in the Arab world, it is clear that there is limited information. In 2007, four out of the top five countries with the highest prevalence of diabetes were high income countries from the Arab world. The five countries with the highest diabetes prevalence in the adult population are Nauru (30.7%), United Arab Emirates (19.5%), Saudi Arabia (16.7%), Bahrain (15.2%) and Kuwait (14.4%) (40). Table 1 depicts the estimated prevalence of diabetes in 2000 and the expected number in 2030 in the Arab countries. Most individuals with diabetes in low and middle income countries are middle-aged (45-64), and elderly (>65years). In Jordan, Libya, Morocco and Oman, data shows that the prevalence of diabetes has increased from approximately 3% prior to 1980 to a current prevalence of 5% to 16%, (prevalence exceeding 10% of the adult population) In Jordan, the leading cause of end-stage renal disease (ESRD) was reported to be diabetes (29.2%). In the United Arab Emirates, 23.3% of patients with ESRD had diabetes as the cause. Therefore, collectively, since 30% of individuals with diabetes develop kidney disease, it is likely that diabetic kidney disease is also a significant burden in the Arab world (2).
The general health scale is an indication of patients' perception of their health status, in general and in comparison with others. The vitality scale provides insight into how energetic patients feel. The role physical scale is a reflection of the impact of physical health on work or other daily activities. These scales are expected to show improvement of patients undergoing a program that emphasises exercise and positive lifestyle changes (4) .
The risk factors for type 1 diabetes are still being researched. However, having a family member with type 1 diabetes slightly increases the risk of developing the disease. Environmental factors and exposure to some viral infections have also been linked to the risk of developing type 1 diabetes. Several risk factors have been associated with type 2 diabetes and include (3) :
1. Family history of diabetes
3. Unhealthy diet
4. Physical inactivity
5. Increasing age
6. High blood pressure
8. Impaired glucose tolerance (IGT)
9. History of gestational diabetes
10. Poor nutrition during pregnancy.
There are two types of diabetes: juvenile diabetes (or Type I or Insulin-dependent diabetes) and maturity onset diabetes (or Type II or non-insulin dependent diabetes mellitus): 1. Type I diabetes usually begins in childhood and individuals suffering from this type need insulin treatments because their bodies produce very little insulin by themselves. 2. Type II diabetes (non-insulin dependent diabetes mellitus or NIDDM) is commonly associated with obesity. Insulin treatment is usually unnecessary as dietary measures and sometimes oral medications are sufficient. NIDDM does not usually occur until after the age of 40 although 2 to 5% of those people affected do get diabetes before they are 25 years old. Both types of diabetes tend to run in families and genetic factors do contribute to the disease. But it must be recognized that environmental factors play a significant role. Interactions between generic and environmental factors are clearly important. A complex combination of many genes may increase a person's risk for developing diabetes as an adult. In the past few years, several groups of scientists provided evidence of genetic connections to NIDDM and a breakthrough was published very recently (5).
Epidemiological study Design:
Epidemiology is the study of the distribution and determinants of health in a population. In this study, I am interested in researching the correlation between Type II diabetes and wealth in Arab countries in the year 2009. The disease of interest in my study will be Type II Diabetes. The exposure of interest will be wealth. This study will use a Multiple-Group Ecological Study design to examine the incidence of diabetes in the year 2009. This study will examine whether there is an association
The Multiple-Group Ecological Study design was selected because of the benefits associated with such a study design as well as the scope of interest Ecological studies are beneficial for this type of study when examining diabetes in several different Arab countries with varying levels of wealth. An ecological study is quick and inexpensive to conduct. Surveillance programs and disease registries can be used to obtain data on diabetes in the Arab world.
The population of interest for this study will be 40-70 year olds that have lived in the country for at least 5 years. The unit of analysis is the country. Using proper formulas, the estimated sample size from each country will be calculated, while accounting for non-response Also, the power of the study will be calculated. Assuming that all 22 Arab countries have a disease registries system for Type II Diabetes, information will be taken from these systems in each country. Using the disease registries, a simple random sample of about 300 individuals from each country will be obtained (accounting for potential non-response in the sample size calculation). A mail-in survey will be conducted to determine financial income of each household as well as background information of the household. An incentive of a 2 Euros value will be provided to each survey that is completed and successfully returned within a month of beginning the survey. Once one month is complete, then the incidence of Type II Diabetes in association with financial level will be averaged within each country and then compared to the other Arab countries. The results will be entered using statistical software and graphed.
To control the diabetes in any place in the world not only in the Arabs states, we should control the food and add more awareness programs for the adults and old people from the governmatal associations and NGOs. This awareness programs should include the food style, life style and also the health control system. The majority of Arab countries are engaged in a multi- dimensional transition (demographic, economic, epide- miological and geographic). This 4-dimensional transi- tion engendered many direct and indirect factors ex- plaining the high prevalence of diabetes. The shift from rural to urban dominance lead to sedentary life and less physical exercise. The socioeconomic development al- lowed for higher income and more consumption espe- cially of fast-food and western diet. Socio-cultural habits and Arab generosity (Arab people enjoy inviting
guests to their homes for meals) encouraged gathering and high calorie intake. Finally, with epidemiological and demo- graphic transitions, ageing with a different history of early childhood conditions fostered the development of obesity and impaired glucose tolerance. The rising rates of obesity, IGT and diabetes constitute a real challenge in the Arab region.
Table 3 : from WHO Diabetes in these counties in 2000 and the expectations for the number of patients in 2030 .
Country 2000 2030 Algeria 426,000 1,203,000 Bahrain 37,000 99,000 Egypt 2,623,000 6,726,000 Islamic Republic of Iran 2,103,000 6,421,000 Iraq 668,000 2,009,000 Jordan 195,000 680,000 Kuwait 104,000 319,000 Lebanon 146,000 378,000 Libyan Arab Jamahiriya 88,000 245,000 Morocco 427,000 1,138,000 Oman 113,000 343,000 Qatar 38,000 88,000 Saudi Arabia 890,000 2,523,000 Somalia 97,000 331,000 Sudan 447,000 1,277,000 Syrian Arab Republic 627,000 2,313,000 Tunisia 166,000 388,000 United Arab Emirates 350,000 684,000 Yemen 327,000 1,286,000
(1) - The rise of diabetes prevalence in the Arab region for ,Abdesslam Boutayeb, Mohamed E. N. Lamlili, Wiam Boutayeb1, Abdellatif Maamri, Abderrahim Ziyyat, and Noureddine Ramdani , 26 April 2012 .
(2) - Diabetes in the Arab world An emerging silent epidemic , By Youssef MK Farag and Ajay K. Singh in middle east health magazine http://www.middleeasthealthmag.com/ ,30th Sep 2009 .
(3) - International Diabetes Federation website guide, http://www.idf.org/ .
(4) - Changes of some Health Indicators in Patients with Type 2 Diabetes: A Prospective Study in three Community Pharmacies in Sharjah, United Arab Emirates , AR Abduelkarem and MA Sackville , Mar 1, 2009 .
(5) - Genetic Disorders in the Arab World: United Arab Emirates , Diabetes in the United Arab Emirates and Other Arab , Article Countries: Need for Epidemiological and Genetic Studies , for Taher El-Sharkawy .