Relatives’ Advice and Health Care-Seeking Behaviour in Oman (Orginal Study) Ahmed Al-Mandhari, Samir Al-Adawi, Ibrahim Al-Zakwani, Mohammed Al-Shafaee and Liyam Eloul

ABSTRACT: Objectives: It has been well established that pathways to care are considerably modified by local, social and psychological characteristics as well as the doctor-patient relationship. Scant attention has been paid to the role of family advice in care-seeking. In Omani society, traditional family values and a collective mindset are the norm rather than the exception. This paper examines how family advice affects the trajectory of care seeking. Methodology: During 2006-2007, data was collected through face-to-face interviews among a randomised sample of patients seeking medical consultation in various primary health care centres in the northern region of Oman. This study enrolled a total of 493 patients. The association between the advice of family members as a reason to seek health care and other predictors was analysed using multivariable logistic regression. Results: The data suggest that the advice of family members in care-seeking is strongly associated with gender, education, history of chronic illness, previous exposure to traditional medicine, and health education, as well as the history of immunisation. Conclusion: These findings suggest that the advice of family members remains a strong catalyst for care-seeking in Oman. The psychosocial factors affecting care-seeking leading to underutilisation of services or otherwise are discussed. Keywords: Care-seeking behavior; Relatives’ advice; Clinical population; Oman; Arab/Islamic.

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Impact of Geographical Proximity on Health Care Seeking Behaviour in Northern Oman (Orginal Study) Ahmed Al-Mandhari, Samir Al-Adawi, Ibrahim Al-Zakwani, Mohammed Al-Shafaee and Liyam Eloul

ABSTRACT: Objectives: Despite its impact on health policy, the relationship between geographical proximity and health care seeking has received scant attention in the medical literature. This paper aims to evaluate the relationship between geographic proximity and health care usage behaviour among patients seeking medical consultation in the northern region of Oman. Methods: During 2006- 2007, data was collected via face-to-face interviews among 428 randomized patients seeking medical consultation in various primary health care centres in the northern region of Oman. The association between geographical proximity as a reason to seek health care and other predictors was also analysed using multivariable logistic regression. Results: The data suggest that preference for geographical proximity as a reason for seeking health care is strongly associated with marital status, previous exposure to traditional medicine and health education, as well as history of immunisation. Conclusion: This finding supports the view from elsewhere that geographical proximity remains a strong catalyst for care seeking in Oman. The psychosocial factors affecting care seeking are discussed. Keywords: Geographic proximity; Health care utilization; Arab/Islamic; Clinical-based study; Oman.

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Clinical and Epidemiological Characteristics of Pituitary Tumours using a Web-based Pituitary Tumour Registry in Oman (Orginal Study) *Abdullah Al-Futaisi, Al-Yaarubi Saif1, Ibrahim Al-Zakwani, Salim Al-Qassabi, Shaden Al-Riyami and Yasser Wali

ABSTRACT: Objective: From a recently instituted web-based pituitary tumour registry at Sultan Qaboos University Hospital, Oman, this study explores the results of comprehensive clinical evaluation, hormonal levels, radiological evidence of pituitary mass lesion using magnetic resonance (MRI) and the different treatment modalities. Methods: All patients who were diagnosed with pituitary mass tumours in our tertiary care endocrinology clinic between January 998 and February 2006 were registered in the Oman pituitary tumour registry. Two physicians performed hospital chart review and data entry. Results: A total of 60 entries were made into the pituitary tumour registry. The overall mean age of the cohort was 32 ±12 years (age range 8-73 years). The majority of registrations were female (n=114; 7%). There were 81 patients with non-functioning adenomas (50.6%), 59 with prolactinoma (36.9%) eight with acromegaly (5%), seven with craniopharyngioma (4.4%), four with Cushing’s disease (2.5%) and one with sarcoidosis (0.6%). Sub-group analyses were done only for the subjects with the 3 most prevalent pituitary tumours (non-functioning adenomas, prolactinomas, and acromegaly). The most prevalent symptoms are amenorrhea-galactorrhea (n=55; 37%), headache (n=31; 21%) and fatigue (n=23; 16%). The most common treatment modality was medical (n=58; 39%), followed by observation (n=56; 38%), surgery (n=31; 21%) and surgery plus medical (n=3; 2%). None of the patients in this registry are recorded to have died. Conclusion: To our knowledge, this is the first pituitary tumour registry in the Arabian Gulf countries using a web-based programme. This tumour registry will enable us to characterize clinical and the epidemiological features of pituitary tumours in the Sultanate of Oman. Keywords: Pituitary adenomas, Registry, Oman, Clinical, Epidemiology.

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Quality of Diabetes Care: A cross‑sectional observational study in Oman (Orginal Study) Ahmed Al-Mandhari, Ibrahim Al-Zakwani, Omayma El-Shafie, Mohammed Al-Shafaee and Nicholas Woodhouse

ABSTRACT: Objectives: The objective of this study was to evaluate the quality of diabetes care in Oman. Methods: This was a cross-sectional observational study. Fifty percent of all those attending six general health centres in June 2005 were systematically selected for the study. Descriptive statistics were used to describe the data. Results: A total of 430 diabetic subjects were included. Just over 61% percent of the subjects were female (n = 263). The overall mean age of the cohort was 52 ± 12 years ranging from 6 to 84 years. Only 40% (n = 171) and 39% (n = 169) of the diabetics had their random blood sugar (RBS) and fasting blood sugar (FBS) documented, respectively. However, 79% (n = 339) had either RBS or FBS done according to the records. Documentation for the other measurements ranged from 74% (n = 317) for HbA1c and low density lipoproteins-cholesterol (LDL) to 95% (n = 409) for systolic and diastolic blood pressure (SBP/DBP) readings. A total of 58% (n = 249) of patients had non-missing values of HbA1c, SBP/DBP, total cholesterol, LDL-cholesterol, high density lipoproteins-cholesterol (HDL), and triglycerides. Only 2.4% (6 out of 249 diabetics) were simultaneously within goal for HbA1c (<7%), SBP/DBP (<=130/80 mmHg), total cholesterol (<5.2 mmol/L), LDL-cholesterol (<3.3 mmol/L), HDL-cholesterol (>1.1 - <1.68 mmol/L), and triglycerides (<1.8 mmol/L). Conclusion: There was good documentation of values for the indicators used in the assessment of quality. However, the proportion (2.4%) of those meeting internationally recognised goals for the three diabetes-related factors was extremely low. Key Words: Quality; Diabetes; Indicators; Oman.

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Hypoparathyroidism in Adult Patients with Beta-Thalassemia Major (Orginal Study) Gihan Ali A M Sleem, Ibrahim S Al-Zakwani and Muhanna Almuslahi

ABSTRACT: Objective: To evaluate the prevalence of hypoparathyroidism in adult transfusion-dependent patients with beta-thalassemia major in a teaching referral hospital in Oman. Methods: All adult (>3 years) patients with beta-thalassemia major seen at Royal Hospital in Oman between 2004 and 2006 were studied. Demographic, pharmaceutical, clinical and biochemical data were collected for all the subjects. Analyses were performed using both descriptive and univariate statistics. Results: A total of 3 patients were included into the study with an overall mean age of 9±3 years ranging from 4 to 30 years. Just over half of the subjects were males (n=6; 52%). All the patients were on hypertransfusion and combined chelation therapy with desferrioxamine 40-60 mg/kg 5 days per week and deferiprone 75 mg/kg/day. Three of the patients had low levels of parathyroid hormone (<.6 pmol/l). A further three patients had normal levels of arathyroid hormone (.6 – 9.3 pmol/l) in the presence of low serum calcium levels (<2. mmol/l). These patients (with normal hypoparathyroid hormone levels, but lower calcium levels) were also defined to have hypoparathyroidism bringing the total prevalence of hypoparathyroidism in this cohort of adult patients with Beta-thalassemia major to 9% (6 out of 3). The patients with hypoparathyroidism had statistically significantly lower levels of parathyroid hormone (2.7 versus 5.3 pmol/l; p=0.03) and serum calcium (.7 versus 2.3 pmol/l; p=0.004) compared to those without hypoparathyroidism. Conclusion: The prevalence of hypoparathyroidism in adult beta-thalassemia major patients at this referral center was significantly higher (9%) than those reported elsewhere (2.5 and 0.7%). Keywords: Hypoparathyroidism; Thalassemia major; Beta-thalassemia; Oman.

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Control and Management of Hypertension at a University Health Centre in Oman (Orginal Study) Abdulaziz Almahrezi, Ibrahim Al-Zakwani, Ayman Al-Aamri, Samia Al-Khaldi, Nisrin Al-Zadjali, Mohammed Al-Hatali and Abdullah Al-Shukeili

ABSTRACT: Objectives: To evaluate the prevalence of hypertension, its control and management at Sultan Qaboos University (SQU) Health Centre, Oman. Methods: This was a retrospective cross-sectional study, in which were enrolled all the subjects (≥18 years), with the diagnosis of essential hypertension, who attended the SQU Health Centre between 1998 and 2002. The systolic and diastolic blood pressure (BP) values of the last three visits were used for analysis. BP control was defined using the Joint National Committee (JNC-7) criteria, <140 mmHg and <90 mmHg for systolic and diastolic BPs, respectively. Analyses were performed using univariate statistics. Results: Among the 7,702 medical records reviewed, the prevalence of hypertension was 2.4% (n = 187). The overall mean age of the cohort was 55±11 years, 54% (n = 101) were females, and majority of the subjects were Omanis (n = 123; 66%). The proportion of subjects who had their BP controlled was 41% (n = 77) with Omanis significantly less likely to have their BP controlled compared to non-Omanis (53% versus 35%; p = 0.017). The majority of the subjects were on mono (n = 131; 70%) followed by dual (n = 50; 27%) anti-hypertensive therapies. The most frequent mono anti-hypertensive therapies were B-blockers (n = 64; 34%) and angiotensin-converting enzyme (ACE) inhibitors (n = 47; 25%). Among the dual combination therapies, the most common prescribed regimens were ACE inhibitor plus B-blocker (n = 14; 28%) and B-blocker plus diuretic (n = 12; 24%). Conclusion: The prevalence of hypertension in this patient population was low compared to the national average. This study shows that control of hypertension is not optimal, but higher than those reported elsewhere. Key words: Hypertension; Prevention and control; Disease management; Oman.

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