A study on the knowledge and practice of contraception among men in the United Arab Emirates

OBJECTIVE

To determine the knowledge and practice of contraception among United Arab Emirates (UAE) men.

DESIGN

Cross-sectional survey.

PARTICIPANTS

Four hundred UAE monogamously married men with children.

METHOD

The participants were randomly selected from the community and interviewed about knowledge and practice of contraception using a structured questionnaire.

RESULTS

A total of 348 men (87%) gave consent to participate in the study. Two hundred and ninety-four participants (84.5%) were aware of the availability of male contraceptive methods but only 94 (27%) were currently using these methods; 39 (41.5%) used condoms, 30 (31.9%) practised coitus interruptus, 24 (25.5%) practised the rhythm method and only one (1.1%) had been sterilised. Male contraception was accepted by 116 (33.3%) subjects of the total study population. The reasons for the objections were: religious 133 (57.3%), cultural barriers 47 (20.3%), personal beliefs 29 (12.5%), medical disorders 18 (7.8%) and economical factors five (2.2%). Of 54 users of condoms and coitus interruptus, 16 (29.6%) reported to have experienced adverse effects that included testicular pain in six (37.5%), decreased libido in six (37.5%) and diminished orgasm in four (25%). There were significant associations between using male contraception and levels of education of the partners (male p < 0.007, female p < 0.01), low family size (p = 0.0001) and family income (p < 0.05). Fifty-seven subjects (19.4%) thought that a 'male contraceptive pill' is available and 44 (15.0%) believed that a monthly injection is available for men.

CONCLUSIONS

The level of awareness of contraception among men attending primary care in UAE is moderate. Two-thirds of the study subjects objected to the use of contraception by their wives and less than 20% practise contraception themselves. This is partly due to sociocultural traditions, religious beliefs and poor knowledge.

Pattern of meningitis in Al-Ain medical district, United Arab Emirates--a decadal experience (1990-99)

OBJECTIVES

Haemophilus influenzae vaccine was introduced in the United Arab Emirates in 1999. Our objective was to describe the pattern of meningitis in a health district in the decade before the introduction of the vaccine and compare it with the data from elsewhere.

METHODS

For this retrospective study we included 128 meningitis cases reported from 1990 to 1999. Information on the cases was abstracted from the case notification forms and clinical and laboratory data from the hospital case notes.

RESULTS

H. influenzae was the most common cause of bacterial meningitis (n=59, 46.1%) followed by Streptococcus pneumoniae (n=20, 15.6%). Meningitis was a disease primarily of infants and children and the median age was 15 months. One fifth of the patients (n=27) had neurological sequelae of which 33.3% had seizures and 25.9% developed deafness. 18.9% (10 out of 53) of H. influenzae isolates were resistant to ampicillin compared with 5.9% (3 out of 51) to chloramphenicol. 78.9% (15 out of 19) of S. pneumoniae isolates were susceptible to penicillin.

CONCLUSIONS

The epidemiology of meningitis in our health district is similar to the epidemiology of meningitis during the pre-vaccine era in other countries.

Is the pleural fluid transudate or exudate? A revisit of the diagnostic criteria

BACKGROUND

Pleural effusions are classified into transudates and exudates based on criteria developed in the 1970s. However, their accuracy has not been evaluated. We compared the performance of the pleural fluid absolute lactic dehydrogenase level (FLDH), fluid to serum ratio of LDH (LDHR), and fluid to serum ratio of total protein (TPR). TPR has been used instead of the absolute value of fluid protein based on the observation that fluid protein is influenced by changes in the serum protein concentration. However, the rationale for using LDHR remains unexplored.

METHODS

Of 212 consecutive patients with pleural effusions, four with multiple causes and eight with an uncertain diagnosis were excluded. ROC curves were generated using sensitivity and 1-specificity values for TPR, FLDH, and LDHR and positive likelihood ratios (LR+ve) were computed using the optimum cut off values. The correlation between pleural fluid and serum concentrations of total protein and LDH was also estimated.

RESULTS

Of 200 effusions studied, 156 were exudates and 44 were transudates. The optimum cut off levels were: FLDH 163 IU/l, TPR 0.5, LDHR 0.6, and the FLDH-TPR combination 163 and 0.4, respectively. The area under the curve (AUC) with 95% confidence interval (CI) was: 0.89 (0.86 to 0.96) for FLDH, 0.86 (0.80 to 0.91) for TPR, 0.82 (0.77 to 0.89) for LDHR, and 0.90 (0.86 to 95) for FLDH-TPR. A significant correlation was observed between serum and pleural fluid protein levels in transudates and exudates (r=0.5 and 0.6, respectively), but the correlation between serum and pleural fluid LDH levels was insignificant.

CONCLUSION

FLDH is the most accurate marker for the diagnostic separation of transudates and exudates and LDHR has no role in this process. Combining TPR with FLDH appears to improve the diagnostic accuracy slightly.

Diet, clothing, sunshine exposure and micronutrient status of Arab infants and young children

Vitamin C and D levels in Arab women and their newborn infants have been shown to be low. We investigated the prevalence of and risk factors for possible hypovitaminosis C and D in a convenience sample of 51 hospitalized children without clinical features of vitamin C or D deficiency. The mean age was 15.4 months. The serum vitamin C concentration was low in the mothers but normal in the children. Both mothers and children had low serum 25-hydroxyvitamin D (25-OHD) concentrations. Fifty per cent of the mothers and 22% of the infants and children had hypovitaminosis D (serum 25-OHD level < 25 nmol/l). Infants who received dietary vitamin D supplementation had a higher mean (SD) serum 25-OHD concentration than the unsupplemented group (62.5 (29.8) vs 38.5 (27.3), p = 001). Cutaneous light exposure in these children was poor. The children's serum 25-OHD concentration correlated with dietary vitamin D supplementation and maternal serum 25-OHD levels. The results suggest normal vitamin C status but a possible high prevalence of hypovitaminosis D in Arab children and their mothers in UAE. Health education to encourage greater sunshine exposure and improvement in maternal vitamin D stores and the availability of adequate vitamin D supplements would improve children's vitamin D status. The study indicates that hypovitaminosis D continues to be an important maternal and child health problem, despite the abundant sunshine.

Population-based survival trends for leukaemia in East Anglia, United Kingdom

BACKGROUND

Over the last 25 years clinical trials have reported improvement in the management of leukaemia leading to improved survival. In this paper we present the population-based survival patterns of leukaemia over the last two decades from East Anglia.

METHODS

Data on leukaemia from the East Anglian cancer registry were analysed to study survival based on age and time period at diagnosis. Kaplan-Meier survival was calculated for children (ages 0-14) and for adults (ages 15+) separately, for the main leukaemia sub-types.

RESULTS

A total of 2044 males and 1524 females with leukaemia were registered between 1971 and 1990, of whom 158 (7.7 per cent) and 123 (8.1 per cent) were aged less than 15 years at diagnosis. In children, five-year survival was significantly better for females for all leukaemias (p = 0.02) and for acute lymphoid leukaemia (ALL) (p < 0.01). Infants and older children had the worst prognosis as compared with children aged 2-9 years. Analysis by quinquennium of diagnosis showed a highly significant improvement in survival (p < 0.00001) for children with ALL in the later decade (1981-1990). In adults, patients with lymphoid leukaemia survived better as compared with the myeloid subtypes (p < 0.0001). Analysis by year of diagnosis in five-year calendar period showed a significant improvement in survival for acute myeloid leukaemia (p < 0.01), chronic myeloid leukaemia (p < 0.05), chronic lymphoid leukaemia (p < 0.05) and for the four types together (p < 0.001). Survival decreased with age for each subtype.

CONCLUSIONS

Age is an important predictor of survival. There was a significant improvement in survival with time for all subtypes except ALL in adults.

Seasonality in the diagnosis of acute lymphocytic leukaemia

Literature on seasonality of leukaemia shows conflicting results. We analysed the month of diagnosis of acute leukaemia in East Anglia, UK, for the period 1971-94, which showed a significant 40% summer excess (P < 0.001) for acute lymphocytic leukaemia both in children (P < 0.01) and adults (P = 0.01). Methodology, results and possible aetiological interpretations are presented.

Stopping drinking and risk of oesophageal cancer

OBJECTIVE

To examine the effect of stopping drinking on the risk of oesophageal cancer.

DESIGN

Hospital based case-control study.

SETTING

Surgical departments of four district general hospitals and general practices in Hong Kong.

SUBJECTS

Cases were 400 consecutive admissions of patients with histologically confirmed diagnosis of oesophageal cancer during a 21 month period in 1989-90 (87% response rate). Controls were 1598 patients selected from the same surgical departments as the cases and from the general practices from which the cases were originally referred (95% response rate).

MAIN OUTCOME MEASURE

Relative risk of developing oesophageal cancer after stopping drinking (adjusted for age, education, place of birth, smoking, and diet).

RESULTS

Current light drinking (< 200g ethanol/week) was not associated with significant increase in risk. Among former drinkers risk fell more quickly in moderate (200-599 g/week) than heavy (> or = 600 g/week) drinkers. Even among heavy drinkers, however, risk had dropped substantially after five to nine years of not drinking. The results suggest that the time taken for risk to return to that in subjects who never drink was 10-14 years for moderate drinkers and 15 years or more, if ever, for heavy drinkers.

CONCLUSION

Risk of oesophageal cancer decreases fairly rapidly with time after abstaining from drinking. This new finding could be used in health promotion to encourage behavioural changes, especially in heavy drinkers, who have a very high risk of developing oesophageal cancer. It also suggests that alcoholic beverages have a strong effect on the late stage of carcinogenesis.