Catastrophic health expenditure among ex-Gazan families in Jerash camp, Jordan.

OBJECTIVES: This study investigated the magnitude of catastrophic health expenditure (CHE) among ex-Gazan households in Jerash camp in Jordan. STUDY DESIGN: This retrospective survey used a systematic sample. METHODS: A systematic sample was used wherein every fifth house in Jerash camp was invited to participate in the study. The camp represents the largest community of ex-Gazan refugees in Jerash camp. Of the 1038 households who were invited, 976 households agreed to participate (response rate = 94%) and filled the pilot-structured questionnaire with information related to their socio-economic characteristics, health status, and their healthcare and total household expenditures. van Doorslaer's method was used to calculate the frequency of CHE, wherein the expenditure on health care was considered catastrophic if it exceeded 10% of a household's total expenditure. RESULTS: Of the sample, 41.8% suffered from CHE. Moreover, we calculated the frequency of CHE using 15%, 20%, 30%, and 40% as threshold values, and the total rates were 14.7, 6.3, 1, and 0.3%, respectively. In addition, the statistical analysis of the results showed higher frequencies of CHE in households with larger number of dependents, those headed by widowed women, and those with history of hospitalizations. CONCLUSIONS: The study shows that the rate of CHE in Jerash camp is very high and mainly due to the cost of hospitalization. Special attention should be paid for the residents of that area.

Time trends in diabetes mellitus in Jordan between 1994 and 2017.

AIM: The prevalence of diabetes has been increasing over the past few decades. The objective of this study is to assess the time trends in diabetes between 1994 and 2017 in Jordan. METHODS: Surveys were conducted in 1994, 2004, 2009 and 2017 by the same investigators using generally similar methods. Fasting blood glucose was measured in all surveys. Variables were obtained using structured questionnaires designed specifically for the surveys. Crude and age-specific diabetes prevalence rates were derived for each sex, together with overall, crude and age-standardized prevalence rates. RESULTS: The prevalence of diabetes in men aged ≥ 25 years increased from 14.2% in 1994 to 18.3% in 2004, 26.8% in 2009 and 32.4% in 2017. The corresponding prevalence rates in women were 12.3%, 16.9%, 18.8%, and 18.1%, respectively. The overall age-standardized prevalence rate increased from 13.0% in 1994 to 17.1% in 2004, 22.2% in 2009 and 23.7% in 2017. Known diabetes in the 2017 survey accounted for 82.6% of people with diabetes. A HbA1c of < 59 mmol/mol (7.5%) was observed in 41.4% of participants with known diabetes. CONCLUSION: The results showed a high prevalence of diabetes in Jordan among people aged ≥ 25 years. Prevalence increased from 1994 to 2009, but slowed thereafter. The increase was greater in men than in women. Previously diagnosed diabetes accounted for a high percentage of people with diabetes in all surveys and was highest in 2017 survey, suggesting that the national strategy against diabetes has brought some benefits. Efforts should be made to improve glycaemic control in people with diabetes.

Prevalence of coeliac disease among adult patients with autoimmune hypothyroidism in Jordan.

The prevalence of coeliac disease among patients with autoimmune hypothyroidism has not been studied before in Jordan and other Arab countries. A cross-sectional record-based review was made of all adult autoimmune hypothyroidism patients who attended a referral centre in Jordan, during an 8-month period. Coeliac disease in these patients was diagnosed by the attending physician based on positive serological tests for anti-endomysial antibodies IgA and IgG followed by duodenal biopsy to confirm the diagnosis of coeliac disease. Of 914 patients recruited, 117 (12.8%) were seropositive for coeliac disease. Of 87 seropositive patients who underwent duodenal biopsy, 39 had positive histological findings of coeliac disease (44.8%). Extrapolating from these findings the overall rate of coeliac disease among autoimmune hypothyroidism patients was estimated to be 5.7%. In multivariate logistic regression coeliac disease was significantly associated with older age (> 40 years), presence of other autoimmune diseases, vitamin B12 deficiency and anaemia.

Depression is associated with low levels of 25-hydroxyvitamin D among Jordanian adults: results from a national population survey.

Although low serum 25-hydroxyvitamin D (25(OH)D) and elevated serum parathyroid hormone (PTH) have been associated with depression in clinical settings, this link in community-dwelling individuals is inconclusive. The present study aimed at examining the association between serum 25(OH)D and PTH levels and the presence of depression in a national population-based household sample of 4,002 Jordanian participants aged ≥25 years. The DASS21 depression scale was used to screen for depression, and serum concentrations of 25(OH)D and PTH were measured by radioimmunoassay. Multiple logistic regression models were used to explore the association between serum 25(OH)D and PTH levels and depression. The unadjusted odds ratio (OR) decreased linearly with increasing quartiles of serum 25(OH)D (P(trend) = 0.00). The OR for having depression was significantly higher among individuals in the first and second quartiles (OR = 1.4, 1.23, respectively) than among those in the fourth quartile (P values = 0.00 and 0.03, respectively). This relationship remained significant after adjusting for age, sex, marital status, education, BMI, serum creatinine, number of chronic diseases (OR = 1.39 and 1.21 and P values = 0.00 and 0.05, respectively) and after further adjustment for exercise, altitude, and smoking (OR = 1.48 and 1.24, respectively, and P values = 0.00 and 0.03, respectively). No significant association was found between serum PTH levels and depression. The decrease in risk of depression among participants started to be significant with serum 25(OH) D levels higher than 42.3 ng/ml (lower limit of the range of the third quartile). This value may help pinpoint the desirable level of serum 25(OH)D to be attained to help aid the prevention and treatment of depression.

Vitamin D status in Jordan: dress style and gender discrepancies.

BACKGROUND/AIMS: Vitamin D deficiency is highly prevalent worldwide and has been linked to many diseases. The aims of the present study were to assess the vitamin D status of Jordanians at the national level and to identify groups of the population at high risk for vitamin D deficiency. METHODS: Vitamin D status was assessed in a national sample of 5,640 subjects aged ≥7 years. The study involved interviews, laboratory measurements of 25(OH)D and others, and physical measurements. The present report deals, exclusively, with subjects aged >18 years. RESULTS: The prevalence of low vitamin D status [25(OH)D <30 ng/ml] was 37.3% in females compared to 5.1% in males. Dress style in females was independently related to low vitamin D status; women wearing 'Hijab' (adjusted OR = 1.7, p = 0.004) or 'Niqab' (adjusted OR = 1.5, p = 0.061) were at a higher risk for low vitamin D status than were western-dressed women. CONCLUSION: The high prevalence of low vitamin D status in females in contrast with a low prevalence in males, together with a higher prevalence in women wearing Hijab or Neqab, calls for action to increase the population's awareness and to develop strategies to reduce this risk among women, particularly those wearing dress styles that cover most or all of their skin.

Glycaemic control and its associated factors in type 2 diabetic patients in Amman, Jordan.

A study of 1000 patients attending a diabetes referral centre in Amman, Jordan, identified factors associated with good glycaemic control, as measured by glycosylated haemoglobin (HbA1c) levels. Glycaemic control improved significantly between the first clinic visit and at 12-months follow-up. The proportion of patients with extreme HbA1c (> or = 10%) decreased from 15.3% to 6.0% after 12 months. The percentage of patients with optimal control (HbA1c < 7%) increased from 25.4% at the first visit to 27.5% at 12-month follow-up. Multivariate regression showed that low body mass index, shorter duration of diabetes and higher baseline HbA1c were related to reductions in HbA1c between the first and 12-month visits.

Diabetes mellitus: the leading cause of haemodialysis in Jordan.

This study aimed to define the role of diabetes mellitus as a cause of end-stage renal disease requiring haemodialysis in Jordan, and to compare diabetic and nondiabetic patients. All patients on haemodialysis in Jordan at the time of the survey in 2003 (n = 1711) were personally interviewed and additional data were obtained from medical records. Diabetes mellitus was the most common cause of end-stage renal disease (29.2% of cases). The mean age of patients was higher in diabetics [57.5 years, standard deviation (SD) 12.3] than nondiabetics (45.4 years, SD 17.1). Duration on haemodialysis was significantly shorter in diabetics compared to nondiabetic patients.

Epidemiology and cost of haemodialysis in Jordan.

To assess the epidemiology and burden of haemodialysis in Jordan, all patients on haemodialysis (1711 patients) were surveyed during September/October 2003. Mean age was 48.9 years, 56% were male, 86.8% were unemployed and 92% were poor. Mean distance to the haemodialysis service was 13.6 km. Annual hepatitis B and C seroconversion for patients negative before dialysis was 0.34% and 2.6% respectively. Prevalence of haemodialysis was 312 per million population; the incidence in 2002 was 111 per million population. Fatality rate at 1 year was 20%. Diabetes mellitus was the leading cause of haemodialysis, 29.2% of cases. Total estimated cost of haemodialysis in 2003 was US$ 29.7 million.

Serum micronutrients and the subsequent risk of cervical cancer in a population-based nested case-control study.

A nested case-control study was conducted in Washington County, MD, to determine whether low serum micronutrients are related to the subsequent risk of cervical cancer. Among the 15,161 women who donated blood for future cancer research during a serum collection campaign in 1974, 18 developed invasive cervical cancer and 32 developed carcinoma in situ during the period January 1975 through May 1990. For each of these 50 cases, two matched controls were selected from the same cohort. The frozen sera of the cases and their matched controls were analyzed for a number of nutrients. The mean serum levels of total carotenoids, alpha-carotene, beta-carotene, cryptoxanthin, and lycopene were lower among cases than they were among controls. When examined by tertiles, the risk of cervical cancer was significantly higher among women in the lower tertiles of total carotenoids (odds ratio 2.7; 95% confidence limit, 1.1-6.4), alpha-carotene (odds ratio, 3.1; 95% confidence limit, 1.3-7.6), and beta-carotene (odds ratio, 3.1; 95% confidence limit, 1.2-8.1) as compared to women in the upper tertiles and the trends were statistically significant. Cryptoxanthin was significantly associated with a lower risk of cervical cancer when examined as a continuous variable. Retinol, lutein, alpha- and gamma-tocopherol, and selenium were not related to cervical cancer risk. Smoking was also strongly associated with cervical cancer. These findings are suggestive of a protective role for total carotenoids, alpha-carotene and beta-carotene in cervical carcinogenesis and possibly for cryptoxanthin and lycopene as well.

Clinical sinusitis in children attending primary care centers.

OBJECTIVES: To determine the proportion of children who meet the clinical criteria for the diagnosis of sinusitis among all children attending primary care pediatric practices, to explore the relationship between passive smoking and the occurrence of sinusitis and to study the role of antibiotics in the management of sinusitis. DESIGN: A prospective observational cohort study. SETTING: Outpatient Pediatric Clinics of Jordan University of Science and Technology and Princess Rahma Teaching Hospital. Patients. All children ages 1 to 10 years presenting for any reason to participating practices. METHODS: Physicians participating in this study completed a questionnaire on all children attending the primary care centers, detailing the presence of nasal congestion or discharge, the duration of symptoms, daytime cough and whether symptoms were improving. The presence or absence of smokers in the family was also recorded. Children meeting our clinical criteria for sinusitis were further evaluated for other signs and symptoms including the type of medication prescribed. The severity of symptoms was reassessed at 10-day follow-up after the first visit. RESULTS: The study population was composed of 3001 children, of whom 249 met our clinical criteria for diagnosis of sinusitis (8.3%; 95% confidence interval, 7.3 to 9.3%). The prevalence rate of clinical sinusitis was greater among children age 5 years and older than among those younger (9.3% vs. 7.2%, P = 0.04). Children exposed to passive smoking in the household had clinical sinusitis significantly more than those not exposed (68.8% vs. 1.2%, P = 0.00). Antibiotics were prescribed for 80% of children who fulfilled the clinical criteria for diagnosis of sinusitis. Marked improvement of symptoms at the 10-day follow-up visit was reported among those who received antibiotics compared with those who did not (91% vs. 21.4%, P = 0.00). CONCLUSIONS: Sinusitis is not an uncommon problem in children, passive smoking might be a contributing factor and a course of antibiotic therapy is beneficial.

Growth status of Jordanian schoolchildren in military-funded schools.

OBJECTIVE: To study the growth status of Jordanian boys and girls in comparison with the Centers for Disease Control (CDC) growth charts. DESIGN: Cross-sectional study. SUBJECTS AND DATA COLLECTION: A total of 5826 boys and 1414 girls, aged 6.5-17.5 y, were included in the study. Height and weight were measured. Body mass index (BMI) was calculated as weight (kg) divided by the square of the height (m). Socioeconomic data were collected using a structured questionnaire. RESULTS: The height-for-age values fluctuated between the 5th and 10th percentiles of the CDC for both sexes, and then after the age of 8.5 and 14.5 y for boys and girls, respectively, values were just above the 10th percentile. The body weight-for-age values were just above the 25th percentile for boys and fluctuated between the 25th and 50th percentiles for girls; then after the age of 14.5 and 12.5 y for boy and girls, respectively, values fluctuated between the 25th and 50th percentiles for boys and just above the 50th percentile for girls of the CDC values. BMI values for boys were just above the 50th percentile of the CDC and for girls values fluctuated between the 50th and 75th percentiles until the age of 13.5, then values matched the 75th percentile of the CDC. CONCLUSION: The height of Jordanian children ranges from the 5th to the 10th percentile of the CDC reference values during schools years. Girls have a tendency toward obesity after puberty.

A clinical study of a large inbred kindred with pure familial spastic paraplegia.

BACKGROUND AND OBJECTIVES: Spastic paraplegia, an uncommon neurodegenerative disorder with phenotypic and genotypic heterogeneity, is mainly characterized by progressive weakness and spasticity of the lower limbs. We here present a large inbred family with pure familial spastic paraplegia outlining the clinical picture, the age at onset and the possible mode of inheritance. METHODS: This family was ascertained through two probands after which we structured an extended 10 generation pedigree. We examined 43 available family members to identify affected individuals based on fixed criteria. The clinical presentation and phenotypic specifics of this disease were studied in the affected members. We analyzed the possible mode of inheritance and the age at onset in this family. RESULTS: This 10 generation family reported about 50 affected individuals distributed over 5 consecutive generations. We identified 13 affected individuals out of the examined 43 and five individuals were classified as probably affected. We noticed the clinical specifics of this disorder in this family and identified some unique features not described in previous reports. DISCUSSION AND CONCLUSION: The mode of inheritance is either autosomal recessive or autosomal dominant with incomplete penetrance or variable expression of the age at onset. The age at onset seems to decrease with successive generations, either due to a true anticipatory phenomenon or to increased awareness. The unique features of this disorder in this family are discussed.

Risk factors for childhood epilepsy: a case-control study from Irbid, Jordan.

OBJECTIVE: The goal of this case-control study is to identify the significance of certain risk factors for epilepsy in a population of epileptic children in Northern Jordan. The risk factors examined are febrile convulsions, head trauma, central nervous system infections, abnormal perinatal history, family history and parental consanguinity. METHODOLOGY: We designed a case-control study for patients attending the outpatient neurology clinic of Princess Rahma Teaching Hospital in Irbid, Jordan during a 7-month period. Controls were selected, matched for age and sex, from a group of non-epileptic patients attending the general paediatrics outpatient clinic in the same hospital and during the same period. Data about the investigated risk factors were obtained by personal interview and review of the medical records and were analysed statistically for significance. RESULTS: The total number of participants was 200 patients and controls each. History of febrile convulsions, head trauma, abnormal perinatal history and family history showed a statistically significant increase risk for developing epilepsy. Central nervous system infections and parental consanguinity did not add to the risk of developing epilepsy. CONCLUSION: Positive family history for epilepsy, head trauma, febrile convulsions and abnormal perinatal history were shown to have a statistically significant association with epilepsy in patients attending Princess Rahma Teaching Hospital in Northern Jordan. Although consanguinity is widely practised in Jordan, it appears that it does not increase the risk of epilepsy probably due to the small contribution of monogenic recessive epilepsies to the population with epilepsy.

Evaluation of drug use in Jordan using WHO patient care and health facility indicators.

We prospectively studied current drug use in Jordan in 21 primary health care facilities in northern Jordan over a three-month period, using World Health Organization-recommended indicators. Both the mean time spent on physician-patient consultations (3.9 +/- 3.5 minutes) and mean pharmacy dispensing time (28.8 +/- 23.7 seconds) were short, resulting in a mean patient knowledge of prescribed drug dose of 77.7%. No centre had an essential drugs list and/or formulary available. An average of 80% of key drugs were available at centres. Baseline data gathered by this study can be used by researchers and policymakers to monitor and improve pharmaceutical prescribing and consumption practices in Jordan.

Evaluation of drug use in Jordan using WHO prescribing indicators.

Patterns of prescribing and use of pharmaceuticals by physicians and patients in Jordan have not previously been studied. We retrospectively evaluated pharmaceutical drug prescribing practices in 21 primary health care facilities in Irbid governorate, northern Jordan using World Health Organization-recommended core indicators. The mean number of drugs prescribed was 2.3 overall, ranging from 1.9 to 3.0. The percentage of drugs prescribed by generic name was very low, as was the percentage of prescriptions involving injections. The percentages of prescriptions involving antibiotics and drugs from the essential drugs list averaged 60.9% and 93% respectively. We conclude that the prescribing and use of drugs in Jordan requires rationalization, particularly the over-prescribing of antibiotics and the under-prescribing of generic drugs.

Craniofacial anthropometric measurements in a population of normal Jordanian newborns.

Anthropometric measurements provide quantitative values for qualitative descriptions, thus playing an important role in the evaluation of individuals with dysmorphic features for the identification of patterns of dysmorphism. Normative standard values and curves are needed for the meaningful interpretation of individual measurements. The available normative standards vary mainly due to differences in the populations studied. We obtained 13 different craniofacial anthropometric measurements on 158 newborns from Jordan within the first 24 hours of birth. We excluded few newborns for selected measurements based on preset exclusion criteria. We calculated means and standard deviations and constructed standard curves for each measurement. We here present the clinicians in our country, and the surrounding countries as well, with a set of reference values and curves and a guide to be used in the evaluation of newborns with dysmorphism.

Hypertension prevalence, awareness, treatment and control, and associated factors: results from a national survey, jordan.

The study examined prevalence, awareness, treatment and control of hypertension (HTN), and associated factors and to evaluate the trend in hypertension between 2009 (period 2) and 1994-1998 (period 1). A national sample of 4117 adults aged 25 years and older was selected. Prevalence rate of HTN (SBP ≥ 140 or DBP ≥ 90 or on antihypertensive therapy) was 32.3% and was higher than the 29.4% prevalence rate reported in period 1. Prevalence rate was significantly higher among males, older age groups, least educated, obese, and diabetics than their counterparts. The rate of awareness among hypertensives was 56.1% and was higher than the 38.8% rate reported form period 1 data. Awareness was positively associated with age, smoking, and diabetes for both men and women, and with level of education and body mass index for men. Rate of treatment for HTN among aware patients was 63.3% and was significantly higher than the 52.8% rate reported in period1. Control rate of HTN among treated hypertensives was 39.6%; significantly higher than the 27.9% control rate in period 1. Control of HTN was positively associated with age but only for women. In conclusion, HTN is still on the rise in Jordan, and levels of awareness and control are below the optimal levels.

Diabetes and impaired glucose tolerance in Jordan: prevalence and associated risk factors.

OBJECTIVES: To study the prevalence of diabetes mellitus (DM) and impaired glucose tolerance (IGT) and their risk factors in Jordan. DESIGN: A cross-sectional study in four Jordanian communities was conducted: Sarih in the north, Sikhra in the middle of the country, Mazar in the south and Subha-Subheih in the east. Within each community, a systematic sample of households was selected. All subjects > or =25 years of age within the selected households were invited to participate in the study. A total of 2836 subjects were actually included in the study with an overall response rate of 70.5%(45% in males and 86% in females). World Health Organization criteria were adopted for the diagnosis of DM (fasting plasma glucose > or =7.8 mmol L(-1) or plasma glucose of > or =11.1 mmol L(-1), 2 h after an oral anhydrous glucose load of 75 g) and IGT (fasting plasma glucose <7.8 mmol L(-1)and plasma glucose between 7.8 mmol L(-1) and 11.1 mmol L(-1), 2 h after an oral glucose load of 75 g). RESULTS: The overall prevalence of DM was 13.4%: 14.9% in males and 12.5% in females. IGT was found in 9.8% of the study population: 9.0% in males and 10.3%, in females. Factors independently related to DM using stepwise logistic regression analysis were sex, age, family history of DM, hypertension, hypercholesterolaemia (HC), and hypertriglyceridaemia (HTG). CONCLUSION: Diabetes mellitus and IGT are common among adult Jordanians. Considering the high prevalence of this sickness makes it imperative to formulate a national plan to face this disease and its complications.