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Recent nuptiality trends and patterns in Kuwait.

"Comparison of marriage data from the five-yearly censuses in Kuwait from 1970 to 1985, and vital statistics, show trends in marriage. Age at first marriage increased for women, but there was little change in men, so there was a narrowing of the age difference between spouses. There is a new tendency emerging for Kuwaiti males to marry non-Kuwaiti females. These changes are attributed to increasing education and employment of women, urbanisation and modernisation, and appear to be leading to a decline in fertility."

Asia↗

Factors affecting birth weight in Kuwait. Part II: Pregnancy characteristics and health factors.

The aim of this was to determine the mean birth weight of Kuwaiti infants, the incidence of low birth weight and the impact of maternal age, smoking, health status, parents' consanguinity and pregnancy characteristics on infants' birth weight. The study was conducted in the major maternity hospital in Kuwait where the body weight of 1995 newborn infants was recorded shortly after birth. Data describing maternal age, duration of pregnancy, sex of the infant and maternal illness during pregnancy were recorded. Mothers were interviewed to collect data on duration between present and last pregnancy, birth order of the infant, parents' consanguinity and frequency of smoking. The results show that the mean birth weight was 3.5 Kg and the incidence of low birth weight was 3.4%. The results illustrate that young mothers were more liable to have small infants while old mothers were more liable to deliver a very heavy or low birth weight infant. The weight of the newborn infant was positively correlated with duration of pregnancy, duration between present and last pregnancy and birth order. The mean birth weight of male infants (3.51 Kg) was higher than females (3.47 Kg). Parents' consanguinity and maternal smoking had a slight effect on infants' birth weight. The results show that diabetic mothers delivered large babies. On the contrary, the incidence of low birth weight was highest (7.0%) among infants of hypertensive mothers.

Birth Order↗

Patient satisfaction with hospital services: determinants and level in a hospital in Kuwait.

The present study used a well-tested patient satisfaction measuring instrument to identify the determinants of the level of overall satisfaction with hospital services, and to examine the level of satisfaction with attributes of 7 specific dimensions of hospital services. Using multiple regression analysis, it was found that out of 12 patient characteristics, age was the most important determinant of overall satisfaction, followed by gender. Perceived health status, clinical department, and expectations about the quality of services before admission were also significant but less important determinants of overall satisfaction. Marital status, level of education, nationality, and previous hospitalization in the study hospital, in Kuwait, or in a western country hospital, all had no significant effect on overall satisfaction. Concerning the effect of satisfaction with specific dimensions of hospital services on overall satisfaction, it was found that satisfaction with physicians was the most important determinant of overall satisfaction, followed by satisfaction with housekeeping and with nurses. Satisfaction with hospital environment and facilities and with admission process were also significant but less important determinants of overall satisfaction, while satisfaction with food and radiology services did not affect overall satisfaction. The level of overall satisfaction as well as satisfaction with specific dimensions of hospital services were quite high. Physicians' care was the most favorably rated dimension, followed by admission process and housekeeping, while nursing care was the least favorably rated dimension. Among the attributes of physicians' and nurses' care, technical care and courtesy were the most favorably rated items; while communication, particularly imparting of information, was the least favorably rated aspect. Several attributes of the hospital environment and facilities and of the food services were found to be dissatisfying to patients.

Adult↗

Emotional distress in infertile women in Kuwait.

OBJECTIVES: Although previous studies conducted in the Western countries have reported that psychological factors are implicated in the experience of infertility, no study has assessed this relationship in Arab women. We postulate that with all important causal "confounders" such as age, gender, education and general health status controlled, any significant difference in psychological profile can be attributed to infertility. METHODS: An Arabic version of the Hospital Anxiety and Depression Scale (HADS) was used to examine the psychological status of 120 Kuwaiti infertile women and an age-matched sample of 125 healthy pregnant women as a control group. RESULTS: Compared with an age-matched pregnant control sample, the infertile women exhibited significantly higher psychopathology in all HADS parameters in the form of tension, hostility, anxiety, depression, self-blame and suicidal ideation. The illiterate group attributed the causes of their infertility to supernatural causes, such as evil spirits, witchcraft and God's retribution, while the educated group blamed nutritional, marital and psychosexual factors for their infertility. Faith and traditional healers were the first treatment choice among illiterate women, while the educated women opted for an infertility clinic for treatment. Childlessness resulted in social stigmatization for infertile women and placed them at risk of serious social and emotional consequences. CONCLUSIONS: The prevalence and severity of psychological distress in this sample of infertile Kuwaiti women indicate the appropriateness of referring these patients for psychological evaluation. Programs successful in dealing with infertility in Kuwait need to include establishment of a community-based intervention strategy to educate people about infertility and to give guidelines for treatment.

Adaptation, Psychological↗

Headache and blood pressure in primary health care setting in Kuwait.

OBJECTIVE: To identify the types of headache among patients, presenting at a primary health care setting, and to determine the correlation between headache and high blood pressure (BP). METHODS: This was a cross-sectional study administered in 2 primary health care centers (Fintas and AbuHalifa) of a regional health district in Kuwait from March 2003 to June 2003. Our study included 290 patients with different types of headache, and requested for BP measurement. RESULTS: The sample included patients, in the age group 15-80 years with an overall mean age of 41 (+13 SD) years. The male to female ratio was 1:2.7 and the majority (85%) of patients were Kuwaitis. Tension headache was the most frequent diagnosis (61.7%) among patients presenting with headache, followed by migraine (11.7%). The normal systolic BP was <140 mm Hg (52.8%), while 59% had normal diastolic BP, below 90 mm Hg. Increasing age was found to be associated with high BP levels (p<0.001). Diastolic BP was found significantly higher among males (p<0.01) Tension headache had higher levels of BP while migraine was found to have low levels. None of the sinusitis headache patients had high BP. Positive history of hypertension was found associated with high systolic and diastolic BP in tension and other type of headache (p<0.001). CONCLUSION: Headache is a very common symptom among patients presenting at the general practice health care setting, with most cases diagnosed with tension-type headache, and females out numbering males. There was no positive correlation between headache and high BP. Physicians should discourage their patients from considering headache as a measure of their BP status.

Adolescent↗

Fragile X syndrome: a clinico-genetic study of mentally retarded patients in Kuwait.

In a prospective study in Kuwait, 182 mentally retarded male patients who fulfilled 5 or more clinical criteria of fragile X syndrome were screened using polymerase chain reaction (PCR) testing. Twenty patients (11%) were highly suspected of having fragile X syndrome due to mutation at the FRAXA locus; none had mutation at the FRAXE locus. Of these, 11 (55%) were confirmed fragile-X-positive by both cytogenetic and PCR techniques. The most frequent clinical features were: prominent forehead, high arched palate, hyperextensible joints, long ears, prominent jaw, height > 10th centile and attention-deficit hyperactivity. Less common were avoidance of eye contact (45%), autism (45%) and seizures (30%). Large testes were found in 55% of cases. Pre-pubertal and post-pubertal clinical criteria were different.

Age Factors↗

Profile of major congenital malformations in neonates in Al-Jahra region of Kuwait.

We investigated major congenital abnormalities in babies born in Al Jahra Hospital, Kuwait from January 2000 to December 2001. Of 7739 live and still births born over this period, 97 babies had major congenital malformations (12.5/1000 births): 49 (50.6%) babies had multiple system malformations, while 48 (49.4%) had single system anomalies. Of the 49 babies with multiple malformations, 21 (42.8%) had recognized syndromes, most of which were autosomal recessive and 17 had chromosomal aberrations. Isolated systems anomalies included central nervous system (12 cases), cardiovascular system (9 cases), skeletal system (7 cases) and gastrointestinal system (6 cases). Of the parents, 68% were consanguineous. Genetic factors were implicated in 79% of cases. Genetic services need to be provided as an effective means for the prevention of these disorders.

Arabs↗

Pharmaceutical care services in hospitals of Kuwait.

PURPOSE: To describe the current pharmacy practice in the general public hospitals based on self-reported practice by pharmacists, explore the awareness of the pharmacists of pharmaceutical care concept, identify their willingness to implement pharmaceutical care practice, and identify the barriers that may limit its implementation. METHODS: Eighty hospital pharmacists working in four general public hospitals were approached to be included in the study. Data were colleted via face-to-face structured interview of the respondents using a pre-tested questionnaire. RESULTS: The response rate was 76.3%. Thirty five (57.4%) of the respondents had frequently performed interventions on prescriptions through interaction with physicians. Thirty two (52.5%) had frequently provided patient counselling. The knowledge of the respondents about the counseling points for salbutamol inhaler was assessed using a total score of 10, 35 (57.4%) scored = 5. The frequent provision of counseling was non-significantly least common among the > 40 years group compared to youngest age group (OR: 0.7, 0.3-1.9), male gender (0.6, 0.2-1.4) and those with a practice experience of > 20 years (0.4, 0.1-1.2). Forty six (75.4%) of the respondents reported that they were aware of pharmaceutical care concept. Thirty five (76.1%) and 39.1% of those who reported awareness of pharmaceutical care concept indicated that its main focus is the patient and the appropriate objectives of the concept, respectively. The awareness about the patient as the main focus of pharmaceutical care was non-significantly least among the respondents aged 41-60 years (OR: 0.6, 0.2-2.4) and those with a practice experience of 21-40 years (0.3, 0.1-1.0). The main barriers perceived by the participants were lack of time (78%) and lack of staff (71.2%). CONCLUSION: The current practice of hospital pharmacists in Kuwait needs further improvement in relation to interaction with physicians and patient counselling. The lack of uniformity in the responses regarding the focus and objectives of pharmaceutical care indicates a lack of appropriate understanding in this matter. All respondents have shown high willingness towards the implementation of pharmaceutical care services in their practice.

Community Pharmacy Services↗

Clinical presentation of enteric fever: its changing pattern in Kuwait.

The clinical experience with enteric fever (1985-89) at a general hospital in Kuwait is presented. There were 90 cases of typhoid and 10 cases of paratyphoid fever, with a mortality rate of 2%. Typhoid complications of bowel perforation, haemorrhage or septic shock were present in 5% and abortion in 2%. Neurological or psychiatric manifestations were a feature in 15%. Most infections were imported (78%). Despite rapid economic development, enteric fever may still be acquired locally but less frequently with time. This contributed to initial diagnostic uncertainty in 18% of cases, and especially in children. Another changing pattern emerged with the recent finding of five drug-resistant Salmonella typhi isolates, two in 1988 and three in 1989. Efforts are clearly needed to diagnose enteric fever more rapidly and to utilize new antibiotics for drug-resistant cases.

Adolescent↗

Attitude of the medical staff towards medical record departments of general hospitals in Kuwait.

The present study was undertaken with the aim of revealing the attitude of the medical staff towards the medical record departments in the six general hospitals of Kuwait. Results showed that only 39.1% of physicians who completed the study questionnaire had ever visited the MRD. In addition, only 19.4% perceived the MRD as a health information centre, while the greater proportion of physicians regarded the department as a file room. The attitude of the medical staff towards three aspects of the MRD, namely its staff, physical conditions and performance, was elicited by requesting the physicians to indicate whether they agreed or disagreed about positive descriptions of these three aspects. Attitude was most favourable towards the MRD staff. Unavailability of a satisfactory place for visitors appeared to be the main problem related to physical conditions, such a place being regarded as satisfactory by only 15.6% of physicians. Performance of the MRD was perceived as its weakest aspect, five of its six items being accorded negative responses by over 50% of physicians. The least favourable component of performance was availability of records, only 22.2% of physicians agreeing that requested records were always available. Regarding the overall opinion about the MRD, only 10.4% of physicians rated the department as good. Statistical analysis revealed a significant difference between hospitals regarding the extent of physicians' agreement about positive descriptions of the three aspects of the department studied. It also showed that a direct correlation exists between the attitude towards performance of the department and the overall opinion about the department.

Attitude of Health Personnel↗

Cryptosporidium gastroenteritis in immunocompetent children from Kuwait.

During an 18 months' survey of children admitted to hospital with gastroenteritis, oocysts of the protozoan Cryptosporidium were detected in 35 cases (1.6% of the total 2205 surveyed). The affected children (age range 5 months to 8 years; mean 34.2 months) were immunocompetent, and had green and offensive watery diarrhoea. Vomiting (94%) with dehydration (80%), fever (66%) and abdominal pain (26%) were major clinical features of the diarrhoeal illness which lasted a mean 8.2 (range 3-14) days. Five children were infected with other enteropathogens. The illness was self-limiting in all cases and none were excreting oocysts 2 weeks after cessation of diarrhoea. Peak incidence occurred during the months of March and April, with no cases during the hottest months of July and August. There was no known contact with animals or pets; 4 children had other siblings affected and 2 conformed to cases of travellers' diarrhoea. The significance of cryptosporidiosis in Kuwait and the need for epidemiological studies are discussed.

Animals↗

Cause and prognosis of acute renal failure in Kuwait: a 2-year prospective study.

At the Mubarak Al-Kabeer University Hospital of Kuwait (Arabian Gulf), 77 episodes of acute renal failure were collected prospectively over 2 years, yielding a mean annual incidence rate of 9.5/100,000 population. Forty-four episodes occurred in hospital, a rate of 1.3 per 1000 admissions. In this group, acute tubular necrosis was the commonest cause (27 episodes). Thirty-three episodes occurred in the community, acute tubular necrosis accounting for 11 episodes. In contrast to hospital-acquired renal failure there was a tendency for increased incidence of community-acquired renal failure in the summer months. A more striking observation was the lower mortality in the community-acquired form. The mortality was not related to severity of renal failure even within the group with acute tubular necrosis.

Acute Kidney Injury↗

Hepatitis B core and surface antigens and delta agent in chronic liver disease in Kuwait.

Hepatitis B surface antigen was detected immunohistochemically in 25 out of 85 liver biopsies (29.4%) of chronic liver disease. Core antigen was also demonstrated in 9 of the 25 Hepatitis HBs Ag positive biopsies (36%). Delta agent however, was found in only one case of HBs positive chronic active hepatitis. The number of hepatocytes staining positively for HBc antigen was greater in those biopsies with the strongest staining for HBs antigen. The only case of chronic active hepatitis positive for delta agent showed that the positive staining was confined to the nuclei of few hepatocytes. The routine histology showed chronic active hepatitis with a moderate degree of inflammation. The present results confirm our previous reports that almost one third of chronic liver disease in Kuwait is associated with hepatitis B infection. Previous serological studies suggest that delta agent infection is also common; however, the present study suggest that delta agent may be a transient, and not a major, contributing factor in the progression of liver disease.

Hepatitis B Core Antigens↗

Prospective serological and clinical studies on infants born in Kuwait with an elevated IgM in cord blood.

Little is known about congenital viral and toxoplasmal infections in the developing countries. This study attempts to provide preliminary data on such infections among Arab mothers and infants in Kuwait. Babies born with an elevated IgM in cord blood were selected at birth and then studied prospectively during the first year of life for serological and clinical evidence of viral and toxoplasmal infections. There appeared to be a significant association between the elevation of total cord blood IgM and the selection of cases with cytomegalovirus infection. Demonstration of specific IgM in cord sera was attempted, whenever possible, to provide further evidence of congenital infection and to exclude early postnatal infections. In 18.5% of cases there was an association between serological evidence of infection and certain clinical abnormalities. Apart from cytomegalovirus and rubella virus, no evidence was found for congenital infection by other viruses or toxoplasma in this study.

Congenital Abnormalities↗

Human brucellosis in Kuwait: a prospective study of 400 cases.

The clinical pattern of 400 cases of brucellosis in Kuwait is presented. The disease was acute in 77 per cent, sub-acute in 12.5 per cent and chronic in 10.5 per cent of cases. Raw milk was the major source of infection. The major features on presentation, irrespective of the course of the disease, were fever, sweating, headache, rigors, arthralgia, myalgia, and low back pain. Hepatosplenomegaly was present in 41 per cent of cases and in 32 per cent neither liver nor spleen were palpable. The haematologic findings were not specific and hepatic dysfunction (shown by liver enzyme abnormalities) was common. Skeletal (26 per cent) and genital (8.5 per cent) changes and neurobrucellosis (7 per cent) were the major complications. The ELISA was the most sensitive and reliable diagnostic test especially in relation to chronic brucellosis and neurobrucellosis. ELISA allowed the determination of brucella-specific immunoglobulins (Ig)G, IgM and IgA in the CSF, and provided profiles of Ig, in sera, which were different in patients with chronic (elevated IgG and IgA) from those with acute (elevated IgM alone or IgG, IgM and IgA) brucellosis. Treatment with tetracycline, doxycycline or rifampicin gave a cure rate of over 91 per cent in acute and subacute brucellosis. Co-trimoxazole was associated with a relapse rate of 50 per cent. Two drug combinations of streptomycin and tetracycline, streptomycin and rifampicin or streptomycin and doxycycline were effective, but one of five patients with chronic brucellosis relapsed. A combination of streptomycin, tetracycline and rifampicin with or without steroids was used successfully in neurobrucellosis, septicaemic shock and subacute bacterial endocarditis.

Acute Disease↗

Enumeration of pathogenic bacteria from sewage sludge in Kuwait.

Domestic sewage in Kuwait is mainly treated by an activated sludge process. Sewage sludges at different treatment stages and the digested sludge were studied for their content of pathogenic bacteria. Two Gram-positive cocci and eight Gram-negative bacilli were isolated and enumerated in the sewage sludges and in raw sewage. During March, Aeromonas hydrophila was the dominant bacterium isolated. Serratia liquefaciens in raw sewage and sludge-2, and Salmonella species in digested sludge were dominant during April. Enterobacter aerogenes was dominant in sewage samples in May. Various types of bacteria isolated were tested for their sensitivity to a wide range of antibiotics.

Aeromonas↗

Incidence of peritonitis, distribution of causative bacteria and outcome in continuous ambulatory peritoneal dialysis (CAPD) in Kuwait.

In 28 CAPD patients in Kuwait, 69 peritonitis episodes occurred in an observation period of 311 patient treatment months (1 episode per 4.5 PTM). Microorganisms were isolated 53 times (gram-positive 34, gram-negative 17, fungi 2). Peritonitis was the principal cause for stopping CAPD, i.e. on 9 occasions. Gram-negative and fungal peritonitis had particularly high failure rates.

Adult↗