Impact of COVID-19 Pandemic on Utilization of Healthcare Services and Spending Patterns in Dubai, United Arab Emirates: A Cross-Sectional Study.

BACKGROUND: The COVID-19 pandemic affected the utilization of healthcare services in many parts of the world. The response to the healthcare burden imposed by the COVID-19 pandemic was associated with ensuring the provision of optimum healthcare services. This study aimed to estimate the effect of the COVID-19 pandemic on health services utilization and spending patterns in Dubai, the UAE. METHODS: This cross-sectional study used secondary data on healthcare utilization and spending to compare between 2019 and 2020. The data was extracted from the health insurance claims on the eClaimLink platform. Descriptive and inferential statistics were used to calculate the percent change of service utilization and spending and percentages of total claims by each encounter type across major diagnostic categories (MDCs). RESULTS: In 2020, there was an overall reduction in outpatient visits and inpatient admissions of 27% and 21%, respectively, compared to 2019. Outpatient visits and prescriptions decreased across all the MDCs except mental and behavioral disorders, which showed an increase of 8% in outpatient visits and 29% in prescriptions. The admissions to the healthcare facilities were also reduced significantly across various MDCs, ranging from 10% to 44%. Similarly, a downward trend was seen in diagnostics for different MDCs. An increase in expenditure on diagnostics and drugs for neoplasm was reported, despite a corresponding decrease in outpatient and inpatient admissions for the same. CONCLUSION: A significant decrease in overall healthcare utilization and corresponding healthcare spending, resulting from a decline in outpatient and inpatient volume in healthcare facilities at all the levels (hospitals, clinics, speciality centres), was reported during the pandemic. The impact of the pandemic on mental health was reported by this study, as it showed an upward trend in utilization and spending. For the neoplasms, although the utilization declined, the expenditure on diagnostics and drugs during each encounter increased significantly.

Doctor for Every Citizen: Telehealth Visits at Dubai Health Authority during COVID-19 Pandemic in Dubai, United Arab Emirates.

BACKGROUND: Digital health significantly affects healthcare delivery. Moreover, empirical studies on the utilization of telehealth in Dubai are limited. Accordingly, this study examines the utilization of telehealth services in Dubai Health Authority (DHA) facilities and the factors associated with telehealth appointment completion and turnaround time. METHODS: This cross-sectional study examines patients who used telehealth services in DHA from 2020 through 2021 using 241,822 records. A binary logistic regression model was constructed to investigate the association between appointment turnaround time as a dependent variable and patient and visit characteristics as independent variables. RESULTS: Of the total scheduled telehealth visits, more than three-quarter (78.55%) were completed. Older patients, non-Emiratis, patients who had their visits in 2020, patients who had video visits, and those who sought family medicine as a specialty had a shorter turnaround time to receive their appointment. CONCLUSIONS: This study identifies several characteristics associated with the turnaround time. Moreover, technological improvements focusing on specialties that can readily be addressed through telehealth and further research in this domain will improve service provision and support building an evidence-base in the government sector of the emirate of Dubai.

Prevalence and associated risk factors of overweight and obesity among adult population in Dubai: a population-based cross-sectional survey in Dubai, the United Arab Emirates.

OBJECTIVE: To study the prevalence of overweight and obesity and determine the associated risk factors among adults in Dubai. DESIGN AND SETTING: A cross-sectional survey with a multistage, stratified random sampling design was conducted in the Emirate of Dubai in 2019. PARTICIPANTS: The study included 2142 adults aged 18+ years in the Emirate of Dubai. RESULTS: The overall prevalence of obesity, which was defined as body mass index (BMI) ≥30 kg/m2, was 17.8%. The highest obesity rates were reported among women (21.6%) and the United Arab Emirates (UAE)-nationals (39.6%). Moreover, 39.8% of the population was overweight (BMI ≥25-29.9 kg/m2). Multivariate logistic regression showed associations between obesity and age, sex, nationality, hypertension and occupation. Obesity increases with age, with the highest risk at age group 50-59 years (OR 4.30; 95% CI 1.57 to 11.78) compared with the reference group (18-24 years). Females had a higher risk of obesity than males (OR 1.62; 95% CI 1.10 to 2.38). Compared with those in the reference group (Western and others), UAE nationals, other Arabs and Asians were more likely to be obese ((OR 2.08; 95% CI 1.18 to 3.67), (OR 3.61; 95% CI 2.41 to 5.44) and (OR 1.98; 95% CI 1.12 to 3.50), respectively). Clerical and service workers (OR 4.50; 95% CI 2.54 to 8.00) and elementary and unskilled occupation categories (OR 2.57; 95% CI 1.56 to 4.25) had higher risks of obesity than the reference group (professionals), p<0.01). Hypertensive individuals had a higher risk of obesity than normotensive individuals (OR=3.96; p<0.01). CONCLUSIONS: Obesity and overweight are highly prevalent among adults in Dubai and are remarkably associated with sociodemographic and behavioural risk factors. Comprehensive strategic initiatives are urgently needed to control obesity in the high-risk populations in the Emirate of Dubai.

Impact of COVID-19 pandemic on the mental health of university students in the United Arab Emirates: a cross-sectional study.

BACKGROUND: The COVID-19 pandemic had a significant impact on the mental well-being of students worldwide. There is a scarcity of information on the mental health impact of the COVID-19 pandemic on university students in the United Arab Emirates (UAE). This study aimed to investigate the mental health impact of the COVID-19, including depression, anxiety and resilience among a sample of university students in the UAE. METHODS: A cross-sectional study using an online survey was conducted from September to November 2021. The patient health questionnaire (PHQ-9), generalized anxiety disorder-7 (GAD-7) and Connor-Davidson Resilience Scale (CD-RISC-10) were used to assess depression, anxiety, and resilience. The COVID-19 impact was assessed using a list of questions. RESULTS: Only, 798 students completed the survey and were analyzed for this study. Overall, 74.8% of the students were females, 91.2% were never married, and 66.3% were UAE-nationals. Based on PHQ-9 and GAD-7 cut-off scores (≥ 10), four out of ten of the students self-reported moderate to severe depression (40.9%) and anxiety (39.1%). Significantly higher mean PHQ-9 and GAD-7 scores were found among students who were impacted by COVID-19 than those non-impacted (mean PHQ-9 = 9.51 ± 6.39 and 6.80 ± 6.34; p = 0.001, respectively) and (mean GAD-7 = 9.03 ± 6.00 and 8.54 ± 6.02; respectively, p < 0.001). Female students who were impacted by COVID-19 had statistically significant higher depression and anxiety scores (mean PHQ-9 of 9.14 ± 5.86 vs. 6.83 ± 6.25, respectively; p < 0.001) than the non-impacted females (mean GAD-7 of 9.57 ± 6.32 vs. 5.15 ± 3.88, respectively; p = 0.005). Never married students had significantly higher PHQ-9 and GAD-7 scores than ever-married (9.31 ± 6.37 vs. 6.93 ± 5.47, P = 0.003) and (8.89 ± 6.11 vs. 7.13 ± 5.49, respectively; p = 0.017). CONCLUSIONS: The results of this study demonstrate that the COVID-19 pandemic has negatively impacted the mental health of this sample of university students in terms of depression and anxiety. The results highlight the need to adopt culturally appropriate interventions for university students and focus on vulnerable groups.

Adult Vaccine Hesitancy Scale in Arabic and French: Protocol for Translation and Validation in the World Health Organization Eastern Mediterranean Region.

BACKGROUND: The world as we know it changed during the COVID-19 pandemic. Hope has emerged with the development of new vaccines against the disease. However, many factors hinder vaccine uptake and lead to vaccine hesitancy. Understanding the factors affecting vaccine hesitancy and how to assess its prevalence have become imperative amid the COVID-19 pandemic. The vaccine hesitancy scale (VHS), developed by the World Health Organization (WHO) Strategic Advisory Group of Experts on Immunization, has been modified to the adult VHS (aVHS) and validated in English and Chinese. To our knowledge, no available aVHS has been designed or validated in Arabic or French. OBJECTIVE: The aim of this research is to translate the aVHS from its original English language to Arabic and French and validate the translations in the WHO Eastern Mediterranean region. METHODS: The study will follow a cross-sectional design divided into 5 phases. In phase 1, the original aVHS will be forward-translated to Arabic and French, followed by backward translation to English. An expert committee will review and rate all versions of the translations. Expert agreement will then be measured using the Cohen kappa coefficient (k). In phase 2, the translated aVHS will be pilot-tested with 2 samples of participants (n=100): a group that speaks both Arabic and English and another that speaks French and English. Participants' responses to the English version will also be collected. In phase 3, responses will then be compared. Descriptive statistics and paired t tests or one-way analyses of variance (ANOVA) and Pearson correlation coefficient will be used in the preliminary validation. In phase 4, prefinal versions (Arabic and French) will be tested with larger sample sizes of Arabic speakers (n=1000) and French speakers (n=1000). Sociodemographic information and vaccination status will be collected and used for further analysis. In phase 5, the scale's statistical reliability and internal consistency will be measured using Cronbach alpha. An exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) will be used to examine the model fit resulting from the EFA. ANOVA and regression models will be constructed to control for confounders. All data will be electronically collected. RESULTS: As of January 2022, the scale had been translated to Arabic and French and was undergoing the process of back translation. All data collection tools have been prepared (ie, sociodemographics, vaccination status, and open-ended questions) and are ready to go into their electronic formats. We expect to reach the desired sample size in this phase by June 2022. CONCLUSIONS: This study will provide researchers with a validated tool to assess adult vaccine hesitancy within populations that speak Arabic and/or French and provide a road map to scale translation and ensure cross-cultural adaptation. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/36928.

Prevalence and associated risk factors of hypertension and pre-hypertension among the adult population: findings from the Dubai Household Survey, 2019.

BACKGROUND: Minimal data is available on the prevalence and correlates of hypertension and prehypertension in Dubai. The study aims to measure the prevalence of hypertension and pre-hypertension and the associated socio-demographic characteristics, behavioral risk factors and comorbidities among the adult population of Dubai. METHODS: This study used data from the Dubai Household Health Survey, 2019. A cross-sectional population survey based on a complex stratified cluster random design. The total eligible sample included 2530 adults (18+). Sociodemographic and behavioral factors were considered as independent covariates. The main study outcome variables, pre-hypertension and hypertension, were ordinal, with normotension as the reference group. RESULTS: The overall prevalence of hypertension in adults was 32.5% (38.37% in males and 16.66% in females). Prehypertension was prevalent in 29.8% of adults in Dubai (28.85% in males and 32.31% in females). The multivariate logistic regression analysis revealed that age groups, gender, occupation, and high Body Mass Index were significantly associated with a higher risk of hypertension at the level of P < 0.05. No clear trend toward a higher correlation of hypertension was noted with the increase in age, except after the age of 50 years. Males were five- times more likely to be hypertensive than females. Participants enrolled in skilled and service works had a five times higher risk of hypertension, compared with the reference group (professionals). Obese subjects had a 5.47-times greater correlation of hypertension compared with normal-weight subjects. Physically active individuals were less likely to develop hypertension. For the correlates with prehypertension in the present analysis, skilled and service workers and those working in elementary jobs had a higher risk of prehypertension, compared with the reference group (professionals) Individuals with a status of overweight were associated with a higher prevalence of prehypertension compared with people of normal weight. CONCLUSIONS: This study showed a high prevalence of prehypertension and hypertension among adults in Dubai. Some socio-demographic and behavioral risk factors were correlated with prehypertension and hypertension among the studied population. Interventions aiming at increasing public awareness about such risk factors are essential.

The Socio-Demographic Characteristics Associated with Non-Communicable Diseases among the Adult Population of Dubai: Results from Dubai Household Survey 2019.

BACKGROUND: Non-communicable diseases (NCDs) are the leading causes of death worldwide. In the UAE, NCDs account for nearly 77% of all deaths. There is limited empirical research on this topic in the UAE. We aimed to examine the association of non-communicable diseases and the sociodemographic characteristics among the adult population of Dubai. METHODS: The study used secondary data from the Dubai Household Health Survey (DHHS), 2019. DHHS is a cross-sectional complex design, stratified by geographic area, and uses multistage probability sampling. In this survey, 2247 families were interviewed and only adults aged 18+ were included for the analysis. The quasi-binomial distribution was used to identify the socio-demographic characteristics association with NCDs. RESULTS: The prevalence of NCDs among the adult population of Dubai was 15.01%. Individuals aged 60+, local Arabs (Emirati), divorced and widowed individuals, and individuals who were not currently working reported NCDs more than the other groups. In the regression analysis, the association with NCDs were reported among elderly people, males, unmarried individuals, older individuals who are unmarried, and Emiratis. CONCLUSION: The study identified several socio-demographic characteristics associated with reporting NCDs. This is one of the few studies related to NCDs in Dubai. Allocating appropriate resources to the population groups identified is crucial to reduce the incidence of NCDs in the Emirate.

A hypertension risk score for adults: a population-based cross-sectional study from the Dubai Household Survey 2019.

OBJECTIVES: The aim of this study was to develop a risk score model for predicting hypertension specific to the population of Dubai in the United Arab Emirates (UAE) to facilitate prevention and early intervention. METHODS: A retrospective analysis of data from the Dubai Household Health Survey 2019 was conducted. Demographic and physical parameters, as well as blood glucose levels, were included in the data. The risk factors for hypertension were identified using bivariate analysis. A risk score model was developed using the enter method, where all significant predictors of hypertension in bivariate analyses were entered in a single step with the primary outcome of hypertension status (yes/no). The model was validated internally by splitting the data into Emirati and non-Emirati populations. RESULTS: A total of 2,533 subjects were studied. The significant risk factors for hypertension identified were male sex, older age (≥40 years), education level, body mass index, diabetes mellitus, and dyslipidaemia. The model showed a high discrimination ability between individuals with and without hypertension, with an area under the curve of 0.77 (95% confidence interval [CI], 0.75 to 0.79), excellent sensitivity (81.0%; 95% CI, 71.9 to 88.2) and moderate specificity (56.0%; 95% CI, 45.7 to 65.9). CONCLUSIONS: The model developed by this study is simple, convenient, and based on readily available demographic and medical characteristics. This risk score model could support initial hypertension screening and provide an effective tool for targeted lifestyle counselling and prevention programs.

Intimate partner violence among Arab women before and during the COVID-19 lockdown.

INTRODUCTION: Intimate partner violence (IPV) remains a serious human rights violation and an important health concern during the ongoing COVID-19 pandemic. The study aims to estimate the proportion of IPV among adult Arab women before and during the COVID-19 lockdown and to identify its possible predictors during the lockdown. METHODS: A cross-sectional study was conducted between April and June 2020 using an online questionnaire. The sample included 490 adult Arab women aged 18 years and above, who live with their husbands. Data was collected using a Google forms designed questionnaire that included the socio-demographic characteristics, nature of lockdown, and exposure to different types of IPV before and during COVID-19 lockdown and the frequency of their occurrence. McNemar's test was used to determine differences in the exposure to IPV before and during the lockdown, while logistic regression analysis was performed to identify the predictors of exposure to IPV during the lockdown. RESULTS: Half of women reported that they were ever exposed to IPV with psychological violence ranking 1st. Exposure to any type of IPV and exposure to psychological, physical, and sexual violence have significantly increased during the lockdown compared to before the lockdown. The frequency of exposure to the different types of IPV ranged from 1-3 times per month to almost every day, but the most commonly reported was 1-3 times per month. Predictors of exposure to IPV during the COVID-19 lockdown included country of residence, family income, and whether the husband lost his job during lockdown. CONCLUSIONS: IPV has increased during the COVID-19 pandemic lockdown in the Arab countries, and it was associated with the socioeconomic consequences of the pandemic on families. Actions towards raising awareness about the problem among professionals and the community, early detection, and provision of appropriate services are mandatory.

Demographic profile and pregnancy outcomes of adolescents and older mothers in Saudi Arabia: analysis from Riyadh Mother (RAHMA) and Baby cohort study.

OBJECTIVES: To investigate the impact of maternal age on pregnancy outcomes with special emphasis on adolescents and older mothers and to investigate the differences in demographic profile between adolescents and older mothers. METHODS: This study is a secondary analysis of pregnancy outcomes of women in Riyadh Mother and Baby cohort study according to maternal age. The study population was grouped according to maternal age into five subgroups; <20, 20-29, 30-34, 35-39 and 40+years. The age group 20-29 years was considered as a reference group. Investigation of maternal age impact on maternal and neonatal outcomes was conducted with adjustment of confounders using regression models. RESULTS: All mothers were married when conceived with the index pregnancy. Young mothers were less likely to be illiterate, more likely to achieve higher education and be employed compared with mothers ≥ 40 years. Compared with the reference group, adolescents were more likely to have vaginal delivery (and least likely to deliver by caesarean section (CS); OR=0.6, 95% CI 0.4 to 0.9, while women ≥40 years, were more likely to deliver by CS; OR 2.9, 95% CI 2.3 to 3.7. Maternal age was a risk factor for gestational diabetes in women ≥40 years; OR 1.7, 95% CI 1.3 to 2.1. Adolescents had increased risk of preterm delivery; OR 1.5, 95% CI 1.1 to 2.1 and women ≥40 years had similar risk; OR, 1.3, 95% CI 1.1 to 1.6. CONCLUSION: Adverse pregnancy outcomes show a continuum with the advancement of maternal age. Adolescents mother are more likely to have vaginal delivery; however, they are at increased risk of preterm delivery. Advanced maternal age is associated with increased risk of preterm delivery, gestational diabetes and CS.

Prevalence and Complications of Pregestational and Gestational Diabetes in Saudi Women: Analysis from Riyadh Mother and Baby Cohort Study (RAHMA).

The objectives of this study were to estimate the burden of diabetes and to explore the adverse pregnancy outcomes associated with pregestational diabetes mellitus (pre-GDM) and gestational diabetes mellitus (GDM) among the Saudi pregnant population. In this subcohort, we compared the maternal and the neonatal outcomes of diabetic women with pre-GDM and GDM to the outcomes of nondiabetic mothers who delivered during the same period. From the total cohort, 9723 women participated in this study. Of the participants, 24.2% had GDM, 4.3% had pre-GDM, and 6951 were nondiabetic. After adjustment for confounders, women with GDM had increased odds of delivering a macrosomic baby (OR: 1.6; 95% CI: 1.2-2.1). Women with pre-GDM were more likely to deliver by Cesarean section (OR: 1.65; CI: 1.32-2.07) and to have preterm delivery < 37 weeks (OR: 2.1; CI: 1.5-2.8). Neonates of mothers with pre-GDM were at increased risk of being stillbirth (OR: 3.66; CI: 1.98-6.72), at increased risk of admission to NICU (OR: 2.21; CI: 1.5-3.27), and at increased risk for being macrosomic (OR: 2.40; CI: 1.50-3.8). The prevalence of GDM and pre-GDM in the Saudi pregnant population is among the highest in the world. The conditions are associated with high maternal and neonatal morbidities and mortalities.

Barriers to breast cancer screening among a sample of Egyptian females.

BACKGROUND: Breast cancer (BC) is usually diagnosed in late stages in countries with limited resources. Early detection of BC is likely to improve the outcome of the disease for women in these areas. OBJECTIVE: The aim of this study was to understand the possible personal, economic, and systems barriers to BC screening in a sample of Egyptian women. MATERIALS AND METHODS: A cross-sectional study was conducted in family health centers representing the seven districts of Alexandria governorate, Egypt. A total of 612 women were randomly selected from the chosen centers. RESULTS: IN THIS SAMPLE OF EGYPTIAN WOMEN, THE MOST FREQUENTLY IDENTIFIED POTENTIAL BARRIERS TO BC SCREENING WERE THE FOLLOWING: 81.8% would not seek care until they were ill, 77% were unwilling to have a mammogram until it was recommended by the doctor, 71.4% blamed the, lack of privacy, 69.2% thought that medical checkups were not worthwhile, and 64.6% blamed the cost of services. The study further revealed that women of lower education, women in the lower income category, women who did not do paid work, those who had poor knowledge of the risks of BC, and women with no family history of BC were more likely to perceive different screening barriers compared with their counterparts. CONCLUSION: Many potential personal, economic, and health system barriers were identified. Addressing these barriers by increasing the awareness of BC and dealing with the misconceptions that the women have can help the policy makers to design more culturally relevant strategies to motivate women to utilize screening services.

Epidemiologic determinants of endometriosis among Egyptian women: a hospital-based case-control study.

BACKGROUND: Advances in understanding the epidemiology of endometriosis have lagged behind other diseases because of methodological problems related to disease definition and control selection. AIM: To identify possible risk factors associated with the development of endometriosis among a sample of Egyptian women. MATERIALS AND METHODS: A case-control study was conducted in the University Maternity Hospital and some private hospitals in Alexandria. The sample included 110 cases recently diagnosed with endometriosis and 220 hospital-based, age-matched controls. RESULTS: Using the logistic regression analysis, nulligravidae were four times more likely to develop endometriosis than gravid women [adjusted odds ratio (AOR)=4.0, 95% confidence interval (CI) (2.2-7.6)]. Short cycles were associated with approximately six times increase in risk of endometriosis [AOR=6.1, 95% CI (2.9-12.8)]. Women with irregular cycles were three times more likely to develop endometriosis than women with regular cycles [AOR=3.5, 95% CI (1.89-6.71)]. Similarly, women with a history of irritable bowel syndrome were twice as likely to develop endometriosis [AOR=1.9, 95% CI (1.03-3.87)]. Women who had one or more relatives with endometriosis were 1.2 times more likely to develop endometriosis [AOR=1.2, 95% CI (1.19-1.43)]. CONCLUSION AND RECOMMENDATIONS: Nulliparous and women reporting short and irregular cycles were at a significantly increased risk of developing endometriosis. A weak association between reported family history of endometriosis and history of irritable bowel syndrome and the development of endometriosis was also observed. Designing and implementing health education programs about endometriosis and its related risk factors should be a priority to ensure early diagnosis of the disease.

Raising the Breast Health Awareness amongst Women in an Urban Slum Area in Alexandria, Egypt.

BACKGROUND: Breast Cancer (BC) is the most frequently occurring cancer among Egyptian women. This study aimed to determine the effectiveness of a health education program on raising the knowledge related to BC, its risk factors, and some related preventive practices among women living in an urban slum area in Alexandria. PATIENTS AND METHODS: A pre-/post-test interventional study was conducted during 2009-2010 on a random sample of women aged 30-65 years (n = 486) living in a slum area in Alexandria, Egypt. 20 health education sessions were carried out to educate the women on BC risk factors and some preventive practices. Previously trained nurses educated the sampled women on breast self-examination (BSE). The women's knowledge and opinion about BC and their practice of BSE were evaluated before and 3 months after the intervention. RESULTS: The findings indicated a significant increase in the mean knowledge score regarding BC and the mean opinion score regarding some BC risk factors. A significant increase in the practice of BSE was observed post intervention. CONCLUSION: This study confirms the effectiveness of intervention programs in improving the knowledge about BC risk factors and practice of BSE even in a group of women with a low literacy rate living in a slum area.