Review of National Healthcare Systems in the Gulf Cooperation Council Countries for Noncommunicable Diseases Management

Economics of primary healthcare: cost estimation of clinical services at primary care facilities in the six countries of the Gulf Cooperation Council

OBJECTIVE

While the Gulf Cooperation Council (GCC) countries have demonstrated a strong commitment to strengthening primary healthcare (PHC), the costs of delivering these services in this region remain relatively unexplored. Understanding the costs of PHC delivery is essential for effective resource allocation and health system efficiency.

DESIGN

We used an ingredient-based method to estimate the cost of delivering a selection of services at PHC facilities in the six GCC countries in 2019. Services were categorised into eight programmes: immunisation; non-communicable diseases (NCDs); oral and dental care; child health; nutrition; mental health; reproductive, maternal, neonatal and child health and general practice. The cost estimation focused on two key ingredients: the costs of drugs and supplies and the healthcare workforce cost. The coverage rates of specific types of health services, including screening and mental health services, were also estimated. Data for the analysis were obtained from ministries of health, health statistics reports, online databases, national surveys and scientific literature.

RESULTS

The estimated costs of delivering the selected services at public PHC facilities in the six GCC countries totalled US$5.7 billion in 2019, representing 0.34% of the combined 2019 GDP. The per capita costs varied from US$69 to US$272. General practice and NCD programmes constituted 79% of the total costs modelled while mental health ranged between 0.0% and 0.3%. Over 8 million individuals did not receive NCD screening services, and over 30 million did not receive needed mental health services in public PHC facilities across the region.

CONCLUSIONS

To our knowledge, this is the first study to estimate the costs of services delivered at PHC facilities in the GCC countries. Identifying the main cost drivers and the services which individuals did not receive can be used to help strengthen PHC to improve efficiency and scale up needed services for better health outcomes.

The role of dietitian follow-ups on nutritional outcomes post-bariatric surgery

BACKGROUND

Current evidence recommends dietary counselling with a registered dietitian (RD) for successful weight loss after metabolic bariatric surgery; however, there are limited data on the effect of RD follow-ups on micronutrient deficiencies. This study evaluated the effects of the number of postoperative RD visits on nutritional outcomes, including weight loss and micronutrient deficiencies.

OBJECTIVES

The aim of this study was to evaluate the effects of the number of postoperative registered dietitian visits on nutritional outcomes, including weight loss and micronutrient deficiencies after metabolic and bariatric surgery.

SETTING

Cleveland Clinic Abu Dhabi, United Arab Emirates METHODS: This retrospective study included patients who underwent bariatric surgery between September 2015 and June 2020. Demographics, weight loss, micronutrients, and the number of postoperative RD visits were evaluated. Baseline and 12-month postsurgery outcomes were compared based on the number of RD follow-ups.

RESULTS

A total of 174 primary and 46 revisions were included. Patients were 73.6% female, with a mean age of 40 years. The initial mean body mass index was 42.8 kg/m2. Number of RD visits were as follows: 0-1 (39 patients), 2 (59 patients), 3 (55 patients), and 4 or more (67 patients). Baseline (pre-operative) micronutrient values were within normal range. In comparison with the reference group (REF = 0-1 post-op RD visits), patients with 3 RD visits had 7% higher total body weight loss (P < .001) and maintained micronutrients within the normal range at 12 months postoperative. Mean differences in postoperative values were statistically significant (P < .05) for weight, vitamin B12, and vitamin D but not for hemoglobin, ferritin, calcium, folate, vitamin B1, copper, and zinc.

CONCLUSION

Our study suggests that three or more RD visits during the first 12 months after bariatric surgery are associated with improved outcomes, including significant percent total body weight loss and lower rates of micronutrient deficiencies.

Burden of Ischemic Heart Disease and Its Attributable Risk Factors in North Africa and the Middle East, 1990 to 2019: Results From the GBD Study 2019

BACKGROUND

The North Africa and Middle East (NAME) region has one of the highest burdens of ischemic heart disease (IHD) worldwide. This study reports the contemporary epidemiology of IHD in NAME.

METHODS AND RESULTS

We estimated the incidence, prevalence, deaths, years of life lost, years lived with disability, disability-adjusted life years (DALYs), and premature mortality of IHD, and its attributable risk factors in NAME from 1990 to 2019 using the results of the GBD (Global Burden of Disease study 2019). In 2019, 0.8 million lives and 18.0 million DALYs were lost due to IHD in NAME. From 1990 to 2019, the age-standardized DALY rate of IHD significantly decreased by 33.3%, mostly due to the reduction of years of life lost rather than years lived with disability. In 2019, the proportion of premature death attributable to IHD was higher in NAME compared with global measures: 26.8% versus 16.9% for women and 18.4% versus 14.8% for men, respectively. The age-standardized DALY rate of IHD attributed to metabolic risks, behavioral risks, and environmental/occupational risks significantly decreased by 28.7%, 37.8%, and 36.4%, respectively. Dietary risk factors, high systolic blood pressure, and high low-density lipoprotein cholesterol were the top 3 risks contributing to the IHD burden in most countries of NAME in 2019.

CONCLUSIONS

In 2019, IHD was the leading cause of death and lost DALYs in NAME, where premature death due to IHD was greater than the global average. Despite the great reduction in the age-standardized DALYs of IHD in NAME from 1990 to 2019, this region still had the second-highest burden of IHD in 2019 globally.

Spectrum of genetic disorders and gene variants in the United Arab Emirates national population: insights from the CTGA database

Like many other Arab countries, the United Arab Emirates (UAE) has a relatively high prevalence of genetic disorders. Here we present the first review and analysis of all genetic disorders and gene variants reported in Emirati nationals and hosted on the Catalogue for Transmission Genetics in Arabs (CTGA), an open-access database hosting bibliographic data on human gene variants associated with inherited or heritable phenotypes in Arabs. To date, CTGA hosts 665 distinct genetic conditions that have been described in Emiratis, 621 of which follow a clear Mendelian inheritance. Strikingly, over half of these are extremely rare according to global prevalence rates, predominantly with an autosomal recessive mode of inheritance. This is likely due to the relatively high consanguinity rates within the Emirati population. The 665 conditions include disorders that are unique to the Emirati population, as well as clearly monogenic disorders that have not yet been mapped to a causal genetic locus. We also describe 1,365 gene variants reported in Emiratis, most of which are substitutions and over half are classified as likely pathogenic or pathogenic. Of these, 235 had not been reported on the international databases dbSNP and Clinvar, as of December 2022. Further analysis of this Emirati variant dataset allows a comparison of clinical significance as reported by Clinvar and CTGA, where the latter is derived from the study cited. A total of 307 pathogenic/likely pathogenic variants from CTGA's Emirati dataset, were classified as benign, variants of uncertain significance, or were missing a clinical significance or had not been reported by Clinvar. In conclusion, we present here the spectrum of genetic disorders and gene variants reported in Emiratis. This review emphasizes the importance of ethnic databases such as CTGA in addressing the underrepresentation of Arab variant data in international databases and documenting population-specific discrepancies in variant interpretation, reiterating the value of such repositories for clinicians and researchers, especially when dealing with rare disorders.

Assessing the Need for Pediatric Palliative Care in the Six Arab Gulf Cooperation Council Countries

Background

Palliative care is an essential element of universal health coverage. However, palliative care services, particularly pediatric palliative care (PPC) services, are still inadequately developed in many countries, not least members of the Gulf Cooperation Council (GCC) (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates). Advocating for palliative care services requires data-driven estimates of the number of patients needing these services.

Objective

To estimate the number of children living with life-threatening illnesses in the GCC countries requiring specialist and/or generalist palliative care service provision.

Method

Descriptive analysis of published cross-sectional epidemiological data. Subjects were from general and age-specific populations from individual GCC countries. The quantitative data on child population and mortality were collected from 2019 primary and secondary data sources. The need for PPC was estimated using mortality, incidence, and prevalence data from the Institute for Health Metrics and the Global Cancer Observatory.

Results

Our conservative analysis revealed that just under 22,000 children needed PPC in GCC countries in 2019, a minimum of 17.5 for every 10,000 children.

Discussion

There is a significant need for PPC services, suggesting that the medical needs of the pediatric population are currently not being fully met. Nationwide PPC services are essential to improve the quality of life of thousands of children in GCC countries by changing policies, professional education, and providing funding to palliative programs. To our best knowledge, this is the first study to highlight the clear and urgent need for the development of PPC services in the GCC countries.

Access to non-prescription medicines via vending machines: key considerations to help transfer the self-care concept to the next generation while managing safety risks

Objectives

Non-prescription vending machines are automated self-service systems that are increasingly used to dispense these medicines. Whilst regulatory health academics have devoted considerable attention to non-pharmacy medication outlets in Gulf Cooperation Council countries and others, the public health literature on these vending machines remains lacking. Whilst non-prescription vending machines undoubtedly provide a number of benefits, they are not without their risks, which include polypharmacy and medication interactions.

Methods

The purpose of this article is to provide a framework for further investigation of the function, advantages, and practical constraints of non-prescription vending machines.

Key findings

Overall, more research is required to determine the optimal balance between achieving the benefits of non-prescription vending machines whilst avoiding unnecessary constraints on regulatory bodies and vending machine providers but minimizing patient harm.

Conclusions

Further studies are also required to assess the consequences of these policy experiments. Specifically, there is a need to better understand the extent to which vending machines can provide beneficial and reasonable access to non-prescription medicines to enhance the quality of life of the population especially during pandemics.

Acceptability and Willingness of UAE Residents to Use OTC Vending Machines to Deliver Self-Testing Kits for COVID-19 and the Implications

PURPOSE

Self-testing kits for SARS-CoV-2 appear effective, practical, safe and reliable as well as helping patients with mild-to-moderate symptoms to be successfully managed at home without going to hospital. As a result, ease pressures on hospitals. OTC vending machines offer the potential for SARS-CoV-2 self-testing kits alongside making available OTC treatments to alleviate the symptoms of COVID-19. As a result, providing confidentiality alongside ease of use in case people do not want their status broad casted. Consequently, there was a need to assess the acceptability and willingness regarding the availability of OTC vending machines to dispense self-testing kits for SARS-CoV-2 among UAE residents to provide future direction.

PATIENTS AND METHODS

A cross-sectional survey using a designed questionnaire was based on previous research and expert input and pilot tested. All items in the final questionnaire were seen as acceptable with a satisfactory content validity. A purposive sampling strategy was used in the principal study by primarily sending a link to the questionnaire to UAE universities via Facebook and WhatsApp.

RESULTS

A total of 876 respondents participated in the study and completed the whole questionnaire. Most participants were female (63%), Arabic origin (42%) and holding a bachelor's degree (84.5%). There was high acceptability and willingness to use self-testing kits (87.2%), with 88.6% of respondents believing OTC vending machines would be beneficial for patients with actual or suspected SARS-CoV-2. Gender, nationality, educational level, employment status, having relatives infected with SARS-CoV-2 and being vaccinated were significantly associated with attitudes towards the self-testing kits. Recognised barriers include their potential costs, ease of access and help for those who cannot read the instructions.

CONCLUSION

Overall, there was high acceptability and willingness to use OTC vending machines to deliver self-testing kits for SARS-CoV-2 among the surveyed participants. Key barriers will need to be addressed to enhance their use.