In the pink health mag 2017

28

Man

34

More cases of prostate cancer in Oman today

Woman

PCOS risks higher if you are obese

•Vol.1 •Issue 1 •2017

38

58

Child

High prevalence of childhood overweight and obesity in children

Good Health

Oman rises to challenges of genetic disorders

health

wellness

AMBITIOUS HEALTH VISION 50 percent of medicines to be produced locally by 2050: Dr Ahmed Al Sa’eedi, Health Minister

Oman’s first FREE Annual Health Magazine

CONTENTS

INSIDE PAGE STYLES { EXCLUSIVE } { MAN }

{ WOMAN } { CHILD }

{ GOOD HEALTH } End of an article { EXCLUSIVE }

Pg 12 - 26 Interview with Dr Ahmed bin Mohammed bin Obaid Al Sa’eedi, health minister

{ MAN }

Pg 28 - 33 Pg 29

More cases of prostate cancer in Oman today – Dr Mahesh Krishnaswamy Pg 32

Oman’s medical centres well equipped to treat prostate-related problems – Dr Janan Esmail Al Najjar

{ WOMAN }

Pg 34 - 37 Pg 35

PCOS risks higher if you are obese – Dr Batoul Dalati { CHILD }

Pg 38 - 50 Pg 39

High prevalence of childhood overweight and obesity in children – Dr Siham Al Sinani Pg 46

Childhood obesity is a global problem – Dr Annamma Zacharia Pg 47

Onus is on parents to tackle childhood obesity, overweight – Dr Paul Joseph Pg 48

Incorrect eating habits, physical inactivity make a child overweight – Sumaira Fatima Pg 50

Embrace a family-oriented food culture – Dr C. N. Mohan

CONTENTS { GOOD HEALTH }

Pg 52 - 109

Pg 52

Writing on the LABEL – Dr Mazin Al Khabori Pg 80

Homoeopathy: an effective answer to depression – Dr Deepak Sharma and Dr Anupam Sharma Pg 84

Sitting too much is harmful to your health – POSTER Pg 58

Oman rises to challenges of genetic disorders – Dr Anna Rajab Pg 86

Health begins with a step – Dr Huda Khalfan Al Siyabi Dr Amal Al Siyabi Pg 92

National nutrition survey results by this September or October – Dr Samia Shtayet Al Ghannami Pg 96 Pg 68

Health Coach – Julia Stehlin

Diseases of affluence: a global challenge!!

– Dr Adhra Al-Mawali Pg 102

Comparative analysis of health insurance products in Oman – Dr J Retnakumar Pg 72

Stigma is the biggest hurdle in battling depression – Dr Amira Al Ra’aidan Pg 74

Shortage of mental health professionals – Dr Hamed Al Sinawi Pg 77

A depressed person is neither crazy nor mad – Dr Gerald D’ Costa Pg 107

CREDITS

Too much weight can damage knees – Dr Krishnakumar

Chairman: Mohamed Issa Al Zadjali

Pg 110

Obesity and Arthritis: Two sides of the same coin – Dr Dayanand Kaliaperumal

Editor-in-chief: Mohamed Al Balushi Managing editor: Priya Arunkumar

Supported by: A

Work editor: Adarsh Madhavan Design & production: Beneek Sirajudeen Advt. & marketing: Shallu Matharu Printed at Oriental Printing Press

Acknowledgements: Department of Public Relations, Ministry of Health

presentation

Published by: Muscat Media Group P O Box 86, PC 115, Madinat Sultan Qaboos Office: Hatat Complex A, 2nd Floor, Suite No: 212, Ph: +968 24565697 Fax: +968 24565496 e-mail: editor@blackandwhiteoman.com

DISCLAIMER: THIS MAGAZINE DOES NOT PROVIDE MEDICAL ADVICE. It is intended for general informational purposes only and does not address individual circumstances. It is not a substitute for professional medical advice, diagnosis or treatment and should not be relied on to make decisions about your health. Never ignore professional medical advice in seeking treatment because of something you have read on the PINK health magazine.

Be in the pink of life!

In this fast-paced age, one of the most important aspect of ensuring that we have good health is to have the right information.

I

F you have the right information on what is good living and healthy lifestyle, your day-today life and living gets better.

And we really don’t have to worry about getting information, because all we need to do is dip into the vast ocean of technology out there and with the help of the latest gadgets, smart phones or what have you, we can keep ourselves abreast of all that we require to better our health!

Always remember that absence of a disease does not mean you are healthy. So the first step towards good health is to be properly educated about your health and also to become self aware.

Every disease starts with your lifestyle. The food you eat, the water you drink, the shoes you wear, the day-to-day life you live, the posture you maintain when you are sitting in office, the physical activity schedule, the mental attitude, your cheerfulness‌ your basic good health depends on your living, your lifestyle and also on the food you consume.

Mohamed Issa Al Zadjali Chairman

Avoid making hasty health-related decisions Imagine your knee is giving you trouble and what is the first thing you do? Fix up an appointment and meet your doctor who will give you tests and prescriptions, which could itself be more traumatic than the pain you are in. Doctors are also human beings loaded with their own schedules. Your symptoms of the trouble is better known to you than the doctor you consult, because it is your lifestyle that brought in the pain/ailment in the first place. So help your doctor understand what could have caused the pain you are in.

With internet and search engines at your fingertips, equip yourself with the basics of all tests and symptoms. This will save you from falling in to the general category of undergoing a multitude of tests and diagnostic procedures.

Here is to good living!

It is better that we understand that good health is in our own hands. We can become more healthy if we adopt a natural way of life, and this means having fresh, organic, homegrown vegetables in our diet and also to include walking as a part and parcel of our daily exercise and make sure that we keep a positive frame of mind always.

So try to be in good cheer as far as possible. In short, be in the pink of life!

2017 IN THE PINK 11

{ EXCLUSIVE }

“Prevention, prevention, prevention!”

In his exclusive interview with In-the-PINK, health minister, Dr Ahmed bin Mohammed bin Obaid Al Sa’aeedi, said that this was his most important message to the public.

Stressing that healthcare was not the responsibility of the health sector or the health ministry alone, the minister exhorted the public to improve their lifestyle, to eat healthy and exercise without fail on a daily basis.

Currently, the three main challenges facing the health sector in Oman was the changing patterns of the diseases, health finance and shortage of human resources, he noted.

12 IN THE PINK 2017

2017 IN THE PINK 13

{ EXCLUSIVE }

Highlighting the aspects of Oman’s unique Health Vision 2050, Dr Ahmed bin Mohammed Al Sa’eedi said: “We are probably the first health ministry in the region, if not globally, to have a long-term vision:

Health Vision 2050!”

By 2050, Oman’s aim was to have at least

50 percent of the medicines and medical appliances to be produced locally. While the cost of medicines of 121 of 200 most widely used medicines are currently cheaper than any GCC countries, there will be a further drop in prices from June, he said.

Dr Ahmed Al Sa’eedi also noted that announcements would be made before this year end on the different stages of implementation of the prestigious

$1.5bn Sultan Qaboos Medical City.

“We will soon have a clear road map and with the SQMC, Oman would be a centre of excellence for tertiary medical care!”

14 IN THE PINK 2017

Excerpts: Oman has witnessed historic changes on the health front: the health scene is a far cry today from what it was prior to 1970. As we look back in 2017, what aspect of the health strides, which Oman has made in the last many decades, brings great pride in your heart?

Where we were and where we are now: Before 1970, the health care in Oman was on a very basic level. In 1970, after His Majesty Sultan Qaboos bin Said took over as our ruler, developments in all sectors, including health and human resources, happened beyond our imagination. I will give you some figures as to where we were in 1970 and where we are today: In 1970, we had only 13 physicians with each of them serving more than 50,000 people on an average; there were only two hospitals with 12 beds and less than 20 health clinics spanning the whole nation. At that time, a single hospital bed served about 50,000 of the population and a clinic served about 35,000 people! Morbidity and

Today, the life expectancy is 77.6 years.

The infant/child mortality is 9.6 deaths per 1000 births. mortality rates were very high. The life expectancy in Oman was around 49 years only. In the 1970’s the mortality rate in infants and children were very high; the figures reveal that around 180/1000 children used to die before their fifth birthday and malaria was widespread in the country.

I remember in the mid 80s there were around 33,000 cases of malaria. I was born here before 1970 and at that time, there were hardly any doctors or hospitals and there was no medication.

Health indicators Today, instead of 13 hospital beds, we have more than 6600 hospital beds, more

than 9000 physicians, more than 20000 nurses and of course, various other health care providers!

Today, the life expectancy is 77.6 years. The infant/child mortality is 9.6 deaths per 1000 births. All these improvements came through because of the rapid developments not just in health care, but other sectors too.

Success story in malaria eradication Oman has witnessed a success story in malaria eradication. In 1975, almost every third individual in the population was infected with malaria (241,431 malaria cases were reported at that time). I was also infected with malaria on two occasions!

The malaria eradication programme, which was initiated in 1991, resulted

Today, we have hardly 800 cases of malaria and even these are mainly imported; very few are local transmitted. We can safely say that malaria is eradicated! in a dramatic reduction in the number of cases. Today, we have hardly 800 cases of malaria and even these are mainly imported; very few are local transmitted. We can safely say that malaria is eradicated! Also, the childhood diseases that were the main causes for deaths are eliminated because of the excellent vaccination programmes.

Our vaccination programmes, for children between 10 to 15 years, was rated as number one amongst 127 countries worldwide by the World Health Organisation (WHO). International organisations have recognised and praised such

achievements. Oman was among the fastest to achieve high immunisation coverage for serious childhood diseases such as poliomyelitis, diphtheria, tetanus neonatorum, pertussis and measles. This has contributed significantly to the control of communicable diseases and the reduction in childhood mortality.

Oman was able to manage around two-thirds reduction in under-five mortality rate (U5MR) in only 10 years, between 1981 and 1991 and was ranked as the fastest country to record such a reduction.

Achievements continued during the last decade. The health sector successfully reduced infant mortality rate (IMR) by about 7.6 percent compared with 2005. The high childhood coverage was maintained with the introduction of the most recent vaccines developed worldwide as Penta vaccine (diphtheria, pertussis, tetanus, hepatitis B and haemophilus influenza B) and pneumococcal vaccine.

The health sector continued vaccinating all contacts of hepatitis B patients or carriers and all schoolchildren who did not receive hepatitis B vaccine before, thus resulting in all the population born since 1985 to date being immunised against hepatitis B. These strategies were successful in controlling communicable diseases, especially in children. The last case of poliomyelitis was reported in 1993. Since 1987, only two cases of diphtheria were reported in 1991 and 1992, respectively.

Since 1991, only one case of tetanus neonatorum was reported in 1995 and no cases of measles were reported during the last three years.

Whom should we give credit for all this? But of course: His Majesty Sultan Qaboos bin Said! The leadership and vision of His Majesty the Sultan for Oman has transformed this country to what it is today. We should be very proud of the achievements and thankful that the door of opportunities 2017 IN THE PINK 15

{ EXCLUSIVE }

The challenges of healthcare are similar worldwide and Oman is no different. In the 1970s, the main concern and the pattern of diseases were infectious diseases, which are less costly to manage and short lasting too.

The outcome was either the patient got cured or succumbed to the disease.

Now the pattern of disease in Oman has changed, and is similar to the other European countries and other nations. Our main burden is the noncommunicable diseases (NCDs). of modern Oman is thrown open to all of us!

What is the cause of the biggest worry on the health front? What are the main challenges that Oman face on the health front and how are they being tackled?

The challenges of healthcare are similar worldwide and Oman is no different. In the 1970s, the main concern and the pattern of diseases were infectious diseases, which are less costly to manage and short lasting too. The outcome was either the patient got cured or succumbed to the disease. Now the pattern of disease in Oman has changed, and is similar to the other European countries and other nations. Our main burden is the non-communicable diseases (NCDs).

The major ones among these are diabetes, cancer and cardiovascular diseases. I will add mental illness and of course kidney diseases to that list.

So the first challenge is the changing pattern of diseases and they are more expensive to manage since 16 IN THE PINK 2017

these NCD’s are going to remain for a lifetime! The other challenge is healthcare finance, which is an issue worldwide and the reasons for that are new technology, new medication and burgeoning population.

The third challenge is human resources, which constitute an important pillar of the health system, not only because they constitute more than 80 percent of health expenditure but also since the quality of healthcare is dependent on the quality of workers. The recruitment of sufficient numbers of qualified workers and their continuous development are major challenges. We are focussing on the training of Omanis, but up to now the percentage of Omani doctors do not exceed 35. And with the requirement for extended services today, though we have more doctors and nurses available, we still need to recruit from outside. The number of physicians serving 10000 population was decreased from 21.4 in 2015 to 19.6 in 2016. Similarly, the number of nurses serving 10000 population was

decreased from 46.3 in 2015 to 44.8 in 2016.

I will summarise the three main challenges as: changes in the disease patterns, health finance and shortage of HR. What is your vision on the future of health in Oman? What changes would you like to see in the next few decades?

We have a very ambitious health vision. We are probably the first health ministry in the region, if not globally, with a long-term vision and we call it the Health Vision 2050. It is made in Oman by Omanis and expatriates who work in Oman. We formed task forces across the country and these have met together and analysed various health criteria for the country.

When I say analyse, I mean everything, resources, leadership, building, medications and finance. The outcome of all those analysis and workshops were sent to experts in the healthcare industry worldwide, for example the US, the UK, India, Singapore, New

2017 IN THE PINK 17

{ EXCLUSIVE } Zealand and various other countries.

Finally, we had an international congress in 2012, attended by the Director General of WHO and many other international experts. Basically, this vision is a road map for Oman: for where we want to be in 2050, how we would like the future healthcare system in Oman to be. And why did we choose 2050? The year 2010 was the year of 40 years of the rule of our beloved ruler, His Majesty the Sultan.

And we are witness to the first – since 1970 – 40 years of rapid development.

Also, it is part of the whole nation’s vision of 2040. We are just 10 years ahead of all! And whatever is required for 2040 has already been included. The plan for 2040 is already documented.

A healthy population We aim to have a healthy public!

A healthy population! Healthy population is productive population.

Health and economic prosperity cannot be separated. If a child is healthy, he or she will study well, grow up healthy. If an individual is healthy, the work and productivity will be higher and the economy will progress.

I want to see the public participating in the making of healthy individuals in Oman.

Local manufacture of medicines and medical appliances By 2050 we aim to have at least 50 percent of our medicines and some medical appliances to be produced locally. We also aim to increase the Omanis working in the healthcare industry. We have a dedicated team to ensure the success of these visions.

We are encouraging private sectors from abroad to come and invest in the manufacture/production industry.

Some companies have already shown interest and have come in to do feasibility studies.

How would you rate the cost of medicines in Oman? Are there chances for a further drop?

With regards to the cost of medication, Oman was one of the expensive countries (to buy medication in the private sector) in the GCC region, though we were still much cheaper than Europe. In 2012, during the GCC ministerial meeting in Muscat, I personally insisted that we unify the 18 IN THE PINK 2017

price of medication delivered to the GCC countries and it was directed by the leaders of the GCC. We worked very hard on this. Today, 121 of the 200 widely used medications are cheaper in Oman than many GCC countries. And there is a further drop expected by the first of next month (June*). We will reduce the profit

By 2050 we aim to have at least 50 percent of our medicines and some medical appliances to be produced locally.

We also aim to increase the Omanis working in the healthcare industry. We have a dedicated team to ensure the success of these visions. We are encouraging private sectors from abroad to come and invest in the manufacture/ production industry.

Some companies have already shown interest and have come in to do feasibility studies. margin in Oman to be in line with the other GCC countries. So medication in Oman now is more than competitive with our neighbours!

How would you consider bridging the gap between the government and private sector hospitals?

Currently, there is a predominance of public healthcare facilities over the private facilities as regards to both the numbers and quality of care. There are only 19 private hospitals with 667 hospital beds out of 74 hospitals and

6589 hospital beds in the country.

The policy of the government and the MoH is to encourage investment by the private sector, both local and international, in the health sector. The health vision 2050 proposed a 50 – 50 percent partnership between the public and private health sector.

The private sector is our partner and we want them to grow quantitatively and qualitatively as well. We are actually doing everything to encourage them. We are buying some of our clinical services, logistics, etc from the private sector. Wherever there is quality, we encourage and buy services from them. Unfortunately, it is still not competitive with government hospitals. They need to get better, but there is a significant improvement.

How is the Patient Safety Friendly Hospital Initiative progressing?

Oman was one of the pioneers in the region for ‘Patient Safety Friendly Hospital’ Initiative (PSFI), which is supported by the WHO. We started in four hospitals – Nizwa and Rustaq in the government hospitals, Starcare and Al Raffa hospitals in the private sector. Recently, we had the WHO team who came and inspected these four. The news was much better than what we expected. I am giving you the exact figures: • Nizwa Hospital achieved level 3 out of 4 – Nizwa Hospital is the first hospital in the Eastern Mediterranean region to achieve level 3!

• Rustaq Hospital, Starcare and Al Raffa achieved Level 2 out of 4 and we are hoping before the end of 2018 that all major hospitals in Oman would be included in this initiative.

Private sector is definitely improving and we have very strict rules and regulations, because one of our main concerns is patient safety and protection of the public. We have closed several clinics and we stopped licenses of individuals violating the laws. And this is done mainly because we feel that the non-Omani population in the private sector, whose main source of healthcare is from the private sector, also deserves the same quality of healthcare as the Omani citizens.

What stages of completion are the two mega health projects: the $1.5bn Sultan Qaboos Medical City (SQMC) and $1bn International

2017 IN THE PINK 19

Regarding the SQMC project in Barka, a significant amount of work has been done by the ministry and it is moving forward.

With the SQMC, Oman should be a centre of excellence for tertiary medical care.

The Medical City will have multidisciplinary services in one place.

Strengthening tertiary healthcare will ensure the availability of such care to patients close to their families and it will not only have financial but also social implications.

The Medical City will also facilitate the training and education of healthcare professionals, reduce the cost of training abroad and achieve self reliance in higher-level training and continuing education of healthcare professionals. It will also enhance clinical research in national priority areas.

20 IN THE PINK 2017

{ EXCLUSIVE } Medical City (IMC)?

There is only one medical city project in Oman currently. The one in Salalah for the private sector did not go through due to various reasons. Regarding the SQMC project in Barka, a significant amount of work has been done by the ministry and it is moving forward. The feasibility study is completed, and we are in the process of formulating the master plan. There will be tremendous opportunity for the private sector there for health facilities, logistics, recreation and accommodation.

We have a five kilometres plot there and we are hoping that there will be announcements before the end of this year on the different stages of implementation. We will soon have a clear road map and it is a reality. I was nurturing this dream from the time I was appointed. With the SQMC, Oman should be a centre of excellence for tertiary medical care.

The Medical City will have multidisciplinary services in one place.

Strengthening tertiary healthcare will ensure the availability of such care to patients close to their families and it will not only have financial but also social implications. The Medical City will also facilitate the training and education of healthcare professionals, reduce the cost of training abroad and achieve self reliance in higher-level training and continuing education of healthcare professionals. It will also enhance clinical research in national priority areas.

What are the main targets in the current five-year health plan? What are the exciting new developments on the health front in the current plan?

All information and analysis in the Health Vision 2050, the working papers, the strategic studies and the Health Atlas will be used as guides and will be the basis for developing the coming Five-Year Health Development plans. The coming successive Five-Year Health Development plans will document the detailed expected results to be achieved as well as the activities to be implemented to meet the visions in the Health Vision 2050. The ninth Five-Year Health Development Plan (2016 to 2020) is the first (out of seven) health development plans to adopt and implement visions and strategic

actions of the Health Vision 2050. Its development, implementation and follow up have been institutionalised such that each directorate general with its directorates and departments bear the full responsibility for achieving its objective. The ninth plan has adopted the result-based management

In 2000, Oman healthcare was rated as one of the most efficient for the amount spent in the industry. In 2008, the Oman primary healthcare was rated as number 8 worldwide.

Last year, there was an index of prosperity, which is published by an organisation in the United Kingdom (UK) and Oman was placed overall 46 out of 149 countries, but in the health care index we were number two (2) in the Arab world after Qatar and 26 worldwide amongst 149 countries. techniques to specify achievable results that could be achieved through a number of products and activities. The results of the ninth plan were developed with reference to the following: a) Health Vision 2050 b) features of the long-term national strategy 2040 c) sustainable development goals (SDG) after 2015 d) international strategies for example for non-communicable diseases and others.

The main objective of the ninth FiveYear Health Development plan and examples of some proposed strategic actions are: 1) Implementation of the new organisation of the MoH with its functions that respond to policy and

population needs.

2) Sustaining and further developing achievements in primary healthcare.

3) Developing specialised and tertiary healthcare with emphasis on building medical cities and highly specialised hospitals with highly technical sub-specialities and ensuring the availability of highly specialised and well-trained human resources for health.

4) Promoting the investments in human resources for health, both quantity and quality, in an attempt to provide quality healthcare.

5) Re-visiting the health professions’ education strategies and adopting them according to future needs and expected future technological advancements.

6) Gradually increase health expenditure parallel to technological advances and to meet the expected escalating costs of healthcare technology and supplies with the emphasis on rational spending to ensure the provision of quality health services.

7) Studying the alternatives for health system financing to reduce the burden on the government.

8) Building sustainable and effective partnership with health related sectors, both public and private, based on roles and accountability.

Are there many more dreams of yours (on the health front) that are yet to be achieved?

To be very realistic, what Oman has already achieved is more than what we all could have aspired for. Various organisations have rated Oman positively. In 2000, Oman healthcare was rated as one of the most efficient for the amount spent in the industry.

In 2008, the Oman primary healthcare was rated as number 8 worldwide.

Last year, there was an index of prosperity, which is published by an organisation in the United Kingdom (UK) and Oman was placed overall 46 out of 149 countries, but in the health care index we were number two (2) in the Arab world after Qatar and 26 worldwide amongst 149 countries.

Our vaccination programme was rated number one worldwide out of 137 countries by the WHO last year.

So, let us say that some of my dreams have been achieved! There are still more. I would also like to see Oman 2017 IN THE PINK 21

{ EXCLUSIVE }

The infant and children mortality in Oman dropped significantly, but it has been static for the last seven years.

become one of the hubs of medical tourism. I would love to see at least 30 to 40 per cent production locally and thereby serve the medical industry needs here.

I would love to see more Omanis take up healthcare as career and to do good quality work. Omanisation cannot be successful unless quality healthcare professionals are present.

I will not Omanise a post unless the quality is evident.

We are grateful to the expatriate healthcare professionals who came to Oman in the early 70s and worked in harsh conditions and contributed their mite to establishing the healthcare system in Oman.

Your views on the long queues and the waiting list at government hospitals here?

Let me speak about the waiting list story internationally. Healthcare is roughly on three levels: primary, secondary and tertiary (healthcare).

22 IN THE PINK 2017

Primary health care is well developed in Oman. There is no appointment system there and it is almost open for extended hours for patient comfort and open sometimes all 24 hours.

This is the first stop for the patients.

Most cases are sorted out there. Those with complications are referred to hospitals. Here at the hospital referrals, cases differ according to the patients.

There are some who will be attended to on the same day, some in weeks and others in months, depending on the nature of the waiting list/cases/ complications.

In 2010 when I was appointed, the waiting list for knee and hip replacement was over two and a half years at the Khoula Hospital. That was unacceptable! And there were many factors. Today the waiting list for the same operations is three weeks in the regions and not later than three months in the Muscat region!

Now, if you look at other countries for example, the waiting period in one

of the European countries, when I was working there, was over two and a half years. In Oman we can walk in to see a GP (general physician) in the primary health care centre without any waiting time, while there are countries where you will have to wait 10 days to two weeks to get services at a primary healthcare centre.

We have to differentiate. For example, take the case of angiography, a very important procedure. Emergency cases are seen then and there, while the routine was 14 months in 2010.

In the Dhofar region the waiting list is zero. In Muscat centres, the waiting list was zero until three months back (from the date of this interview).

Maybe it would have increased to two weeks currently, but that’s about it.

The centres work around the clock.

Patients admitted on emergency are attended to immediately everywhere.

The problem with the health industry and waiting list issues are mainly generated out of bad publicity, not reality. People talk about medical errors, waiting list etc., but don’t see the global picture or compare it with any other healthcare system.

They don’t look at it as services that are free and most feel anything free is not worth appreciating. The waiting list is not an issue here in Oman -- it certainly does not exceed any global list/standards.

What would you like to say about the hereditary and genetic diseases in Oman?

The infant and children mortality in Oman dropped significantly, but it has been static for the last seven years. Why is that? It isn’t because the healthcare system is not improving or progressing; it is because most of the infant deaths are due to hereditary, congenital and hematological diseases, one of the main reasons being consanguineous marriages. Genetic diseases are a worldwide phenomenon. And, we have an excellent centre – National Genetic Centre – in Oman. If we implement, as we have the resources and cooperation of the people, the premarital test, we can have the same success that happened in Cyprus, where they almost eliminated Thalassemia and sickle cell disease.

This is also one of my dreams. The Kingdom of Bahrain, which is same

2017 IN THE PINK 23

{ EXCLUSIVE } Yet, people talk as if cancer cases have increased. In Oman, the cancer rate is 82 cases per 100,000 population.

The global average is more than 150 cases per 100,000 population and one of the Scandinavian countries have 350 per 100,000 population.

Why are more cancer cases seen now? First reason being longevity: we live longer. Second reason is having better detection and diagnosis.

Cancer, diabetes, BP, cholesterol, cardiovascular etc. are diseases of lifestyle and we need to modify and change our lifestyles for the better.

That is the only way!

Why are more cancer cases seen now? First reason being longevity: we live longer. Second reason is having better detection and diagnosis. Cancer, diabetes, BP, cholesterol, cardiovascular etc. are diseases of lifestyle. as Oman (in the diseases profile), has reduced similar diseases by 97 percent within a span of 20 years.

So, it is doable with some efforts and cooperation and participation from 24 IN THE PINK 2017

the public.

Are cancer cases on the increase?

Like the global figures, Oman too has its share, but cancer rate in Oman is less than the international standards.

What is your message to the public with regards to their health and well being?

Prevention, prevention and prevention! It is safer and easier!

Healthcare or health of the nation is not the responsibility of the health sector alone! The responsibility of the health sector is to provide health care.

Good health starts with a healthy diet, exercises and physical activity and a responsible media to create awareness on good living and what is harmful and what is good.

The responsibility starts from home, school, work places and then the MoH. Our role is to provide the appropriate information, to provide screening and to provide the treatments required. But the main role for all of us is to ensure that we find the best way to good health and living, which is prevention, prevention and prevention! It is safer and easier.

We would like to appeal to the community to help us by increasing their efforts to change their bad behaviours and lifestyle. Eating healthy food and walking at least 30 minutes are essential to protect against chronic diseases.

Road injuries have the highest rank with regards to its impact on health loss. Many families lose members of their family, friends and others.

The society has a high responsibility to educate and encourage people, especially the youth to change their behaviours in driving. Social relationships, for example, caring for the elderly as well as other vulnerable groups, are also essential to improve the public health in Oman and could help to decrease the mental disorders.

2017 IN THE PINK 25

{ EXCLUSIVE }

The most salient points of Oman’s

Health Vision 2050

(as noted by the health minister, Dr Ahmed bin Mohammed bin Obaid Al Sa’eedi)

D

URING the past three years, the Ministry of Health (MoH) developed Health Vision 2050 to visualise how we would like our health system to be in future and until the year 2050. It was a challenge as predicting the future of health care delivery can be fraught with uncertainty and risk, especially with the number of determinants that affect healthcare for eg, demographic, political, economic, social, technological, environmental and legal determinants. It was thus necessary to analyse extensively the status of the Omani health system and the expected future development and

changes in the population including macro-social and macro-economic changes. The development process of the ‘Health Vision 2050’ included the development of a number of working papers and 24 strategic studies in important areas of health and health system.

Health Vision 2050, the working papers, and the strategic studies include enormous information and analysis of the health status in Oman and of the health system as well as actions for future improvements in health status and enhancing performance of the health system.

The development of the Health

Vision 2050 also included the development of the Health Atlas, which contains information about population projections, the expected future requirements of health services in addition to the expected requirements of human resources for health. All information and analysis in the Health Vision 2050, the working papers, the strategic studies and the Health Atlas are being used as guides and as basis for developing our health development plans.

The Health Vision 2050 has identified 28 visions and a number of strategic actions for each vision for the seven building blocks of the health system.

THESE ARE THE DEFINED VISIONS FOR DEVELOPING THE HEALTH SYSTEM: Leadership and governance 1. Updated policies and strategies based on need and priorities 2. An accountable and transparent health system 3. A structured and accountable decentralised health system 4. Health system responsive to health and non-health needs of the people

Human resources for health 15. Human resources for health (HRH) numbers and mix fit-for-purpose and equitably distributed 16. Human resources for health developed to sustain health system 17. Human resources for health qualification fit-for-purpose 18. Motivated human resources for health management system

Health system finance 5. Total health expenditure 8 – 10 percent of GDP by year 2030 6. Sustained health system financing for universal health coverage 7. Rationalised expenditure of the health system 8. Established and well functioning system of health account ‘National Health Account (NHA)’ 9. Healthcare facilities budgeted based on outcome 10. Enhanced private health sector

Medical products and technologies 19. Pharmaceutical and medical products availability for health service delivery sustained 20. Procurement, replacement and maintenance of biomedical equipment sustained 21. Evidence-based policies for procurement of emerging technologies established 22. Effective connectivity among all healthcare facilities established

Health services 11. A strong, responsive and sustainable primary healthcare (PHC) system as the main entry point and backbone of health care 12. Establishment of a state-of-the-art tertiary care services provided through medical cities 13. Types and construction plans for health services redefined according to new roles for health facilities 14. Umbrella of health facilities expanded and renovated to achieve universal coverage and parallel to population growth 26 IN THE PINK 2017

Health information and health research 23. The availability and accessibility of reliable, relevant, up-to-date and timely health and health –related information ensured 24. Sustainable funding for health research and development ensured 25. Health research directed to identified priorities Inter-sectoral partnership 26. Inter-sectoral partnerships is a vehicle for health development 27. Inter-sectoral and population health approach institutionalised 28. Health is the responsibility of everyone

{ MAN }

Are there more cases of prostate cancer in Oman today? Some doctors note that they are seeing more cases of prostate cancer. Cases of stomach cancer, which was the leading cancer among men in Oman since a long time, has decreased, thereby lowering itself to the second spot.

28 IN THE PINK 2017

More cases of prostate cancer in Oman today Worldwide it has been found that prostate cancer is the most common type of cancer found in males.

Doctors often perform a test to measure the level of the PSA produced only by the prostate gland

Treating a prostate enlargement problem is easy if it is identified in the early stages. Most patients respond well to medical management in the early stages and disease progression can be prevented to some extent in most of the cases, says Dr Mahesh Krishnaswamy, specialist – urology.

Widespread screening The reason for the increase in prostate cancer would be mostly due to widespread screening of patients with PSA (prostate-specific antigen) testing by doctors during routine health checkups resulting in increase in incidentally detected cases, according to a urology specialist. But, worldwide, it has been found that prostate cancer is the most common type of cancer found in males.

Doctors often perform a test that measures the level of the PSA that is produced only by the prostate gland.

In-the-PINK spoke to Dr Mahesh Krishnaswamy, specialist – urology, Burjeel Hospital, Muscat.

Excerpts: Prostate-related problems are common in men over 50 years. Is this true of Omani and expatriate men here? Are there a lot of cases in Oman?

Prostate related problems like benign (non-cancerous) enlargement of prostate gland are more common in men above 50 years throughout the world, irrespective of the fact that they are expatriates or Omanis.

But the numbers in Omanis are not high enough to raise an alarm due to the low population base compared to countries like India and also since it is a problem that can be easily managed if diagnosed early.

What are the main symptoms to induce a self-check in men? Should only men over 50 be concerned about this, or should young men also need to be concerned?

Common urinary symptoms caused by prostate enlargement like poor flow or interruption of stream of urine, hesitancy in starting flow of urine, frequency, urgency, sense of incomplete voiding, burning sensation etc. are easily identified by patients.

In younger men the problems are more due to infections of the prostate (prostatitis) while in older men they are due to enlargement of the gland.

Men, irrespective of age, having these symptoms should consult a doctor for basic evaluation of the problem by simple tests like digital rectal examination, urine examination, blood test for PSA (prostate specific antigen), uroflowmetry and ultrasound scan.

Is it difficult to treat a prostate enlargement problem? Is it a costly process? Are the best treatments for prostate problems available in Oman? Are there any new developments in the treatment of prostate related problems and are they also available in Oman?

Treating a prostate enlargement problem is easy if it is identified early. Most patients respond well to medical management in the early stages and disease progression can be prevented to some extent in most of the cases. Those who do not respond or progress in spite of medical management can be treated easily by surgery in the early stages.

The lesser the size of the gland, lesser the surgical complications like bleeding and better the outcome.

Complications of surgery are more in larger glands and in long standing obstruction due to inadequate removal of the gland by surgery or weakness of bladder muscles.

Endoscopic removal of prostate (TURP) is commonly available in most major hospitals in Oman, while more recent developments like laser enucleation or ablation of prostate are not available in the private health sector.

2017 IN THE PINK 29

{ MAN }

What about prostatitis problems among men in Oman? Are there too many cases?

Prostatitis (infection of prostate) is common among young Omanis. Even though treatment of acute prostatitis gives good results, chronic prostatitis is a frustrating condition to treat both for the patient as well as the doctor due to poor response to treatment and high chance of recurrence.

30 IN THE PINK 2017

Recent reports note that prostate cancer is now the number one cancer among Omani men (as opposed to stomach cancer, which was earlier considered to be the number one). Why has prostate cancer become so common now?

The apparent rise in incidence may be more due to widespread screening of patients with PSA testing by doctors during routine health checkups resulting in increase in

incidentally detected cases, which previously went undetected as most of them were asymptomatic. For this reason routine screening of public and asymptomatic individuals is not recommended. Treating these incidentally detected cases is a great financial burden on the country, without any corresponding significant benefit in improving the health of the general population.

Prostate gland - the basics The prostate is a small gland found only in men. It surrounds the urethra (the tube that carries urine out of the body). It sits just below the bladder and the opening of the vas deferens (tube that carries sperm up from the testicles to the urethra). The prostate gland produces a thick, white fluid that’s mixed with sperm to create semen. The prostate gland is about the size and shape of a walnut, but tends to get bigger as you get older. It can sometimes become swollen or enlarged because of some medical conditions.

PROSTATE ENLARGEMENT Prostate enlargement is a very common condition associated with ageing. Over a third of all men over 50 years will have some symptoms of prostate enlargement. It’s not known why the prostate gets bigger as you get older, but it isn’t caused by cancer and it doesn’t increase your risk of developing prostate cancer. An enlarged prostate can put pressure on the urethra, which can affect how you urinate.

Signs of an enlarged prostate can include: • difficulty starting or stopping urinating • a weak flow of urine • straining when peeing • feeling like you’re not able to fully empty your bladder • prolonged dribbling after you’ve finished peeing • needing to pee more frequently or more suddenly • waking up frequently during the night to pee

PROSTATITIS Prostatitis is where the prostate gland becomes inflamed (swollen). It’s sometimes caused by a bacterial infection, although more often no infection can be found and it’s not clear why it happened.

Unlike prostate enlargement or prostate cancer – which usually affect older men – prostatitis can develop in men of all ages. However, it’s generally more common in men between 30 and 50 years of age.

PROSTATE CANCER Prostate cancer is the most common type of cancer in men today. It’s not clear why it occurs, but chances of developing prostate cancer increase as men get older.

The condition mainly affects men over 65, although men over 50 are also at risk. The symptoms can be difficult to distinguish from those of prostate enlargement.

Symptoms of prostatitis can include: • pain in the pelvis, genitals, lower back and buttocks • pain when urinating • a frequent need to urinate • difficulty urinating, such as problems starting to urinate • pain when ejaculating • pain in the perineum (the area between the anus and scrotum), which is often made worse by prolonged sitting

They may include: • needing to urinate more frequently (often during the night) • needing to rush to the toilet • difficulty starting to urinate • straining or taking a long time while urinating • weak flow • a feeling that your bladder hasn’t emptied fully

2017 IN THE PINK 31

{ MAN }

Oman’s medical centres well equipped to treat prostate-related problems Prostate-related problems (prostatitis) are common in men over 30 years and not necessarily only over 50 years

Prostate enlargement treatments are available in Oman and varies from medical to minimally invasive endoscopic (vaporisation of the prostate) to conventional open surgical procedures and they are relatively not costly procedures, explains Dr Janan Esmail Al Najjar, specialist urologic surgeon.

Recent reports cite that an Omani chemical pathologist, Dr Safana Al Saidi, from the ministry of health (MoH), has succeeded in validating a new marker in early prostate-cancer diagnosis. The new prostate specific marker is called -2 pro PSA succeeded

by Dr Safana Salim Al Saidi.

Unlike the conventional one, the new marker is more specific in diagnosing prostate cancer in its early stage. By introducing this new test, the patient could be diagnosed early and hence could get the proper management at a very early stage of the cancer.

In addition, the development could lead to a reduction in unnecessary prostate biopsies if the result of the new test is not suggestive of prostate cancer.

The waiting list for the prostate biopsy procedure will therefore be shortened to include only patients who really need it based on the result of the new marker.

Dr Janan Esmail Al Najjar, specialist urologic surgeon, Gulf Specialised Hospital, was commenting on the benefits of this new marker when he made the above observations.

32 IN THE PINK 2017

Prostatitis common in men over 30 To a query, Dr Janan Al Najjar, noted that prostate-related problems (prostatitis) are common in men over 30 years and not necessarily only over 50 years. “Actually prostate related problems (prostatitis) are common in men over 30 years considering inflammatory cases in men between 30 to 50 years and benign prostatic enlargement plus prostate cancer in men over 50 years in Oman,” he said, adding that there were lot of cases in Oman as well as other countries.

Main symptoms “The main symptoms are: lower urinary symptoms like frequency, urgency, straining, weak stream, intermittency, nocturia and sensation of incomplete voiding,” Dr Janan said. He also noted that it should not be only men over 50 who should be concerned about this -- young men also need to be concerned. “Every patient experiences symptoms and therefore should be examined regardless of age,” he opined.

Referring to the prime reasons for prostate-related problems, Dr Janan said: “There are a variety of causes for

prostate-related problems, including age and increase of age ranges, low exposure to sunlight and vitamin D deficiency, low fiber fast food diet, less exercise and increased smoking.”

These were some of the wrong things that a man did, which resulted in an enlargement of his prostate.

Good treatments available here Good treatments are available for prostate-related problems in Oman.

“Prostate enlargement treatments are available in Oman and varies from medical to minimally invasive endoscopic (vaporisation of the prostate) to conventional open surgical procedures and they are relatively not costly procedures, explained Dr Janan, noting that laser enucleation (*) was still not available in Oman. “And it is a costly procedure.”

Referring to prostatitis problems here, Dr Janan said: “Prostatitis is a very common prostatic problem in young ages as I mentioned before. It is a completely different issue, which can be bacterial or nonbacterial inflammatory process, affecting the quality of life because of its irritative nature and chronicity.”

Well equipped centres Dr Janan explained why cases of prostate cancer has increased in Oman. “Why? I think because of many reasons: longevity, modification in lifestyle, more awareness and

thereby concern about prostaticrelated problems, leading to more medical checks, and also due to the availability of accurate diagnostic tools,� he said, adding that medical centres in Oman were well equipped

to provide both medical and surgical treatments to stop prostate cancers. (*)Holmium laser enucleation of the prostate (HoLEP) is a minimally invasive treatment for BPH (benign prostatic hyperplasia).

MARCH 2017 IN THE PINK 33

{ WOMAN }

Women of all races and ethnicities are at risk for PCOS, but your risk for PCOS may be higher if you are obese or if you have a mother, sister, or aunt with PCOS, say doctors.

34 IN THE PINK 2017

PCOS risks higher if you are obese It is found generally that between five and 10 percent of women of childbearing age (between 15 and 44) have PCOS

There are many ways in which PCOS symptoms can be decreased says Dr Batoul Dalati, specialist gynaecologist. The treatment will vary from woman to woman, depending on specific symptoms. A healthy diet and regular exercise is recommended for all women with PCOS, particularly those who are overweight.

Polycystic ovarian syndrome, or PCOS, is a condition in which a woman’s levels of the sex hormones estrogen and progesterone are out of balance.

This leads to the growth of ovarian cysts (benign masses on the ovaries).

The PCOS can cause problems with a women’s menstrual cycle, fertility, cardiac function, and appearance.

It is found generally that between five and 10 percent of women of childbearing age (between 15 and 44) have PCOS. Most often, women find out they have PCOS in their 20s and 30s, when they have problems getting pregnant and see their doctor. But PCOS can happen at any age after puberty.

Women of all races and ethnicities are at risk for PCOS, but your risk for PCOS may be higher if you are obese or if you have a mother, sister, or aunt with PCOS, say doctors.

Symptoms of PCOS While the symptoms of PCOS may start soon after a woman begins to menstruate, the type and severity of symptoms could vary from person to person. “The most common characteristic of PCOS is irregular menstrual periods,” experts say.

As you are aware, PCOS would mean a decrease in female sex hormones, therefore, it could trigger some male characteristics in women, such as: • excess hair on the face, chest, stomach, thumbs, or toes • decrease in breast size • deeper voice

• thin hair • Other symptoms include: • acne • weight gain • pelvic pain • anxiety or depression • infertility It is also noted many women with PCOS have other concurrent health problems, such as diabetes, hypertension, and high cholesterol.

These are linked to the weight gain typical in PCOS patients.

Not curative Now, it is clear that treatment for PCOS

What causes PCOS? No one knows what causes PCOS. Hormonal imbalances and genetics play a role, say doctors. Apparently, women are more likely to develop PCOS if their mother or sister has the same condition.

2017 IN THE PINK 35

{ WOMAN }

UNDERSTANDING PCOS SIGNS & SYMPTOMS HEAD • Dandruff • Male pattern baldness • Depression

CAUSES + CnRH (hypothalamus)

+ LH:FSH (pituitary)

FACE • Excessive hair growth • Coarse hair growth • Masculine features

SKIN • Dark patches • Cystic acne

Follicles do not mature = 0 ovulation = 0 menstruation

Insulin • Weight gain • Skin changes • Fungal infections (ovaries)

ABDOMEN • Weight gain

PELVIS • Thickening of the uterus walls • Polycystic ovaries • Multiple cysts can be seen on ultrasound of ovaries • May cause pelvic pain if large enough • Irregular menses • Infertility

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(adrenals)

+ estrogen (fat)

testosterone

• Acne • Facial hair • Male pattern baldness • Masculine features

5 FACTORS THAT CAUSE YOUR PCOS A healthy diet and regular exercise is recommended for all women with PCOS, particularly those who are overweight.

This can help to regulate your menstrual cycle and lower your blood glucose levels

Unknowningly you are creating a perfect environment for PCOs But the good news is that you can reverse by appropriate lifestyle changes Weakened Immune System Nutritious diet and supplements boost immunity

Bad Dietary Choices Switch to natural & organic foods

Accumulation of Toxins Stop eating junk foods

Genetic Tendency Find ways to alter it

Insulin Resistance and Obesity Enjoy meditation and exercise

is not curative. So, the treatment has to focus on “controlling symptoms and managing the condition to prevent complications. The treatment will vary from woman to woman, depending on specific symptoms,” experts note.

“A healthy diet and regular exercise is recommended for all women with PCOS, particularly those who are overweight. This can help to regulate your menstrual cycle and lower your blood glucose levels.

Women who don’t want to become pregnant may be prescribed birth control pills. These can help treat acne, regulate the menstrual cycle, and lower levels of male hormones,

such as testosterone, in the body.

If a woman with PCOS is suffering from infertility, fertility drugs may be administered to aid in ovulation,” reports on PCOS note.

Diabetes medications may be prescribed to lower blood glucose and testosterone levels, it said, adding that surgery may be recommended for some women with PCOS. What are the potential complications of PCOS? Women with PCOS have a higher risk of developing: • hypertension (high blood pressure) • high colesterol

• anxiety and depression • sleep apnea (when a person stops breathing periodically during sleep) • endometrial cancer (cancer caused by thickening of the lining of the uterus) • heart attack • diabetes • breast cancer “If you become pregnant, your doctor may refer you to a doctor who specialises in high-risk pregnancies.

Women with PCOS have a higher rate of miscarriage, gestational diabetes, and premature delivery. They may need extra monitoring during pregnancy,” experts further add.

PCOS SYMPTOMS CAN BE DECREASED

In-the-PINK spoke to Dr Batoul Dalati, specialist gynaecologist of Burjeel Hospital to garner more details: Excerpts: Is PCOS a major problem for women in Oman? Are these mostly for women of childbearing age?

The PCOS is considered to be one of the most common endocrine disorders among women of reproductive age.

What is the rough estimate of women with PCOS in Oman?

In Oman, the prevalence of PCOS is still unknown. In one study it was estimated that seven percent of Omani women have PCOS.

What are the main symptoms of PCOS in women?

• irregular period or no period at all.

• difficulty getting pregnant.

• excessive hair growth.

• weight gain.

• oily skin or acne.

• hair loss from the head.

Is it true that women are more likely to develop PCOS if their mother or sister have this condition? What are the main complications posed by PCOS? The causes of PCOS are not fully understood, but genetics may be a factor, so that women are more likely

to develop PCOS if their mother or sister have this condition.

Can PCOS be cured? What are the treatment methods?

There is no cure for PCOS , but there are many ways we can decrease or eliminate PCOS symptoms like lifestyle modification, weight reduction, ovulation induction, combined oral contraceptive pills, metformin and progestins.

(Dr Batoul MD, MRCOG is a specialist gynaecologist with more than 12 years’ experience in her clinical field.)

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{ CHILD }

Overweight and obesity result from long-term positive energy balance. The rising childhood overweight and obesity trend has been attributed to many factors such as the rapid economy and social transformation as well as the nutrition transition in a short period of time that occurred in Oman. In addition, increases in calorie intake (eating out too frequent), changes in the composition of diet (eating foods that are high in fat and calories-fast food), declining levels of physical indoor and outdoor activities and increasing video/TV/computer time and and electronic gaming in this age group and eating while watching TV encourages excessive eating are definitely major contributing factors to rising obesity and overweight trends in Oman and worldwide.

38 IN THE PINK 2017

High prevalence of childhood overweight and obesity in children The prevalence of overweight and obesity is rising among children and adolescents, increasing from 8.1 percent in 1980 to 12.9 percent in 2013 for boys and from 8.4 percent in 1980 to 13.4 percent in 2013 in girls.

The rising childhood overweight and obesity trend has been attributed to many factors such as the rapid economy and social transformation as well as the nutrition transition in a short period of time that occurred in Oman, says Dr Siham Al Sinani, senior consultant, paediatric gastroenterology.

Globally, the prevalence of overweight and obesity in children shows an increase of 47.1 percent between 1980 and 2013. Evidence also points out to the high prevalence of childhood overweight and obesity in children and adolescents of the Arabian Gulf.

High rates of overweight and obesity In the Lancet 2014 data on the prevalence of obesity and overweight found it to be rising significantly over the past three decades. The Middle East have already reached particularly high rates of overweight and obesity

which have been substantial and widespread. The prevalence of overweight and obesity is rising among children and adolescents, increasing from 8.1 percent in 1980 to 12.9 percent in 2013 for boys and from 8.4 percent in 1980 to 13.4 percent in 2013 in girls. This trend is expected to reach 9.1 percent or 60 million, in 2020.

Higher in developing countries In 2010, 43 million children (35 million in developing countries) were estimated to be overweight and obese; 92 million were at risk of overweight. The vast majority of

children affected by overweight or obesity (35 million) live in developing countries. In addition, the relative increase in the past two decades has been higher in developing countries than in developed countries particularly in the Arabian Gulf states in the last two decades. In short, Oman is hardly exempt from this situation.

In-the-PINK spoke to Dr Siham Al Sinani, senior consultant, paediatric gastroenterology, hepatology and nutrition and visiting consultant, department of child health, Sultan Qaboos University Hospital, regarding the issue of overweight and obesity in Omani children.

Global prevalence and trends of overweight and obesity among preschool children.

Reference: De Onis et al. The American journal of clinical nutrition. 2010

2017 IN THE PINK 39

{ CHILD }

One of the reports is by Ministry of Health of a study done in 2007 based on annual school health examination indicated obesity prevalence of 1.0 percent, 3.0 percent and 3.9 percent among school children aged 6, 12, and 15 years respectively with 30 percent increase between 2006 and 2007.

Obesity trend owing to many factors The rising childhood overweight and obesity trend has been attributed to many factors such as the rapid economy and social transformation as well as the nutrition transition in a short period of time that occurred in Oman, Dr Siham noted. In addition, increases in calorie intake (eating out too frequently), changes in the composition of diet (eating foods that are high in fat and calories-fast food), declining levels of physical indoor and outdoor activities and increasing video/TV/computer time and electronic gaming in this age group and eating while watching TV, which encourages excessive eating are definitely major contributing factors to rising obesity and overweight trends in Oman and worldwide. There are possible genetic, endocrine and syndromic factors in a minority of cases. In addition, studies showed that changes in the gut microbiome could also attribute to the rising trends in obesity worldwide.�

Urgent need for surveillance Dr Siham, who is also the director of training affairs at the Oman Medical Specialty Board (OMSB), stressed on the urgent need for an Omani prospective national surveillance to study the prevalence of childhood overweight and obesity in Omani population, including children. She said the findings of such a surveillance could lead to effective interventions 40 IN THE PINK 2017

Prevalence of children at risk of overweight or classified as overweight or obese.

Reference: De Onis et al. The American journal of clinical nutrition. 2010

starting as early as infancy to reverse anticipated trends.

Excerpts: Has Oman seen the increase in the occurrence of overweight children?

Has it doubled or tripled? Could an estimate be given?

Accurate and comprehensive data on the extent of the problem of childhood obesity is lacking in countries of the Middle East, Gulf States and specifically in Oman.

Globally, prevalence of overweight and obesity in children has risen by 47.1percent between 1980 and 2013.

Evidence suggests high prevalence of childhood overweight and obesity among children and adolescents of Arabian Gulf.

In the Lancet 2014, data on the prevalence of obesity and overweight, found it to be rising significantly over the past three decades. The Middle East has already reached particularly high rates of overweight and obesity which has been substantial and widespread. The prevalence of overweight and obesity is rising among children and adolescents, increasing from 8.1percent in 1980 to 12.9 percent in 2013 for boys and from 8.4 percent in 1980 to 13.4 percent in 2013 in girls. This trend is expected to reach 9.1 percent or 60 million, in 2020. In 2010, 43 million children (35 million in developing countries) were estimated to be overweight and obese; 92 million were at risk

of overweight. The vast majority of children affected by overweight or obesity (35 million) live in developing countries. In addition, the relative increase in the past two decades has been higher in developing countries than in developed countries particularly in the Arabian Gulf states in the last two decades.

The Lancet study, however, showed that in Omani boys aged between 2 to 19 years, the prevalence of obesity is between 7.5 to 10 percent and Omani girls aged 2 to 19 years the prevalence of obesity is between 15 to 20 percent. However, there appears to be a lack of recent national data that have investigated the prevalence of childhood overweight and obesity in Oman. Additionally, results of reports should be interpreted with caution as the likelihood of non-standardised measurements and equipment used is possible. One of the reports is from the Ministry of Health of a study done in 2007 based on annual school health examination. This study indicated obesity prevalence of 1.0 percent, 3.0 percent and 3.9 percent among school children aged 6, 12, and 15 years respectively with 30 percent increase between 2006 and 2007.

Another study published in 2004 in 550 school children aged 6, 12 to 13 and 15 to 16 years showed that the prevalence of obesity among this group to be 7.3 percent, 16percent and 23.3percent respectively.

A more recent study of 3,657 children between the ages of 0 to15 years at

2017 IN THE PINK 41

{ CHILD }

Paediatricians have a major role in counseling children and families on methods to overcome such disorders and prevent future possible complications related to overweight and obesity. the SQUH between 2007 and 2012, using WHO references, reported that the overall prevalence of childhood overweight was 11.3 percent and obesity 9.4 percent in all age groups with no significant difference between boys and girls. A significant increase of overweight (8.0 percent vs 12.4 percent) and obesity (4.2 percent vs 12.9 percent) was found between younger age group 3 to 5 years and the older 10 to 15 years age group.

An increasing annual trend of obesity (6.2 percent, 7.8 percent, 9.3 percent, 10.5 percent and 11.5 percent) was evident between the years 2007 and 2011 respectively. The study found lower prevalence of overweight and obesity among studied Omani children compared with non-Omani children.

How worrying is this problem and is it a recent trend? Is childhood obesity or overweight the most prevalent nutritional disorder of Omani and expatriate children and adolescents?

Compared to the previous data of MOH from 1999 suggesting a prevalence of 1.9 percent overweight and 0.5 percent obesity among (0 to 5 years) old Omani infants and pre-school children, the recent study from the SQUH shows a prevalence of 10.0 percent overweight and 5.3 percent obesity among the same age group. Findings may suggest a gradual increase in the prevalence of overweight and obesity over years. However, the recent study was a hospital-based study and might have methodological differences in 42 IN THE PINK 2017

Prevalence of obesity and overweight among children seen at SQUH between 2007 and 2012 done by Shadyia Al Harthi, SQUH

measurements. The graph below shows the trend of increasing obesity and overweight among children studied at the SQUH between 2007 and 2012. In regard to the age, there appear to be a general agreement that older children are more likely to be overweight or obese compared with the younger children. The majority of studies examining the prevalence of childhood overweight and obesity between younger children to adolescents. Of note, the prevalence of childhood overweight and obesity among studied children at the SQUH is lower than the reported in other Arabian Gulf countries. The difference may be genuine or may be due to differences in the sample characteristics and measurements.

Is it the most common problem seen by paediatricians?

No. Paediatricians still see more common childhood disorders such as acute infections and injuries related to accidental trauma.

However, paediatricians and general practitioners at health care facilities in Oman should draw special attention to the fact that overweight and obesity are both increasing in prevalence.

Paediatricians have a major role in counseling children and families on methods to overcome such disorders and prevent future possible complications related to overweight and obesity.

What is the prime reason (or reasons) for this rise in overweight and heavy children? Should we blame it on the rise in the junk

food culture in Oman or is there something more? Could we look at some of the main contributors to childhood obesity/overweight?

Overweight and obesity result from long-term positive energy balance.

The rising childhood overweight and obesity trend has been attributed to many factors such as the rapid economy and social transformation as well as the nutrition transition in a short period of time that occurred in Oman. In addition, increases in calorie intake (eating out too frequently), changes in the composition of diet (eating foods that are high in fat and calories -fast food), declining levels of physical indoor and outdoor activities and increasing video/TV/computer time and electronic gaming in this age group and eating while watching TV which encourages excessive eating are definitely major contributing factors to rising obesity and overweight trends in Oman and worldwide. There are possible genetic, endocrine and syndromic factors in a minority of cases. In addition, studies showed that changes in the gut microbiome could also attribute to the rising trends in obesity worldwide.

While prevention is the key, what do we do to help children who might suffer from obese/overweight lose their unwanted weight?

Families should be seeking experts in the field to manage their children in such cases. Assistance definitely starts with prevention. However, assistance to children who suffer from overweight and obesity and their families starts addressing the causes of excessive

2017 IN THE PINK 43

{ CHILD } weight (mentioned above) with careful observation to their diet and physical activity with minimisation of screen time according to the international standards, which is less than two hours per day and increasing physical activity to one hour to one and a half hours of vigorous exercise per day.

Children should eat a healthy balanced and varied diet and increase their water intake and minimise fast food, soft drinks and flavoured water intake. Options could be limiting milk/dairy intake to maximum three cups each day, preferably reduced fat milk and dairy products after the age of two years. Children should be encouraged to avoid gazing between meals and snacks. Juice intake should also be limited to 120 ml per day.

Children should be eating a variety of whole fruit instead of juice and replace at least half of their grain intake with whole grain. Parents should be selecting lean meat for their family meals and remove skin from poultry and avoid frying as much as possible.

Cake, candy, potato and corn chips, cookies, honey, jam, jelly, pastries, pies, sweet toppings, syrup, fruitflavoured drinks should be avoided.

There is a lot more to this deity advice.

Parents and children are encouraged to seek a professional dietary advisor.

Studies have shown that diet alone is not successful emphasising on increasing exercise together with healthy diet. This is very hard to most of us. It can be very difficult for parents (and children). However, it is done gradually and if the whole family choses this option of lifestyle, it won’t be as hard. It will be a family choice to live healthier. Studies found that family support and contribution to diet and physical activities options is essential in assisting these children losing weight and maintaining healthy weight. Parents should set a good example and pass good habits to their children. Parents might be considered that losing weight might affect their children’s growth. It is important to know that growth requires calories not excessive calories. Growth requires good nutrition not a diet high in fats and calories. However, diet should not be severely restricted. Growth of the child who is on diet to lose weight should be monitored while dieting.

It is essential that paediatricians and nutrition specialists work together 44 IN THE PINK 2017

Kids and adolescents might suffer from poor self-esteem, low social acceptance leading to loneliness and depression. In the long term, obesity is associated with increased risk of cancer.

Furthermore, strong evidence suggests that obese children grow to be obese adults. Obesity can decrease life expectancy by 22 percent. to prevent unwanted consequences of dieting in children. Diet pills are harmful and do not result in long-term weight loss. Parents must not seek the use of pills of weight reduction for their children. They must always ask physicians before medications are used for weight reduction in children.

Parents (and children) should have reasonable expectation for weight reduction. They should be aware that it could sometimes take a year for children to lose the unwanted weight.

This understanding is very important in maintaining weight loss and physical activity. Nevertheless, in severe cases or when dietary intervention fails, medical and/or surgical intervention might be necessary in rare cases when obesity is associated with complicated medical problems.

What are the consequences of childhood obesity/overweight?

Could you highlight both the short and long-term effects of overweight on the health of children as well as look at the negative psychological and health consequences in childhood?

Overweight and obesity are both recognised as a risk factor for many medical and psychological conditions

among children and adolescents such as high blood pressure, metabolic disorders, heart and vascular disorders and stroke, type 2 diabetes, fatty liver and gallstones, heartburn and gastroesophageal reflux disease, bone and orthopaedic disorders, skin infections and poor wound healing, breathing problems and sleep apneas and increased risk of complications with anaesthesia and surgery, blood clots, gynaecological disorders especially in adolescents such as abnormal menses and others.

In addition, kids and adolescents might suffer from poor self-esteem, low social acceptance leading to loneliness and depression. In the long term, obesity is associated with increased risk of cancer.

Furthermore, strong evidence suggests that obese children grow to be obese adults. Obesity can decrease life expectancy by 22 percent. Therefore, there is an urgent need for Omani prospective national surveillance to study the prevalence of childhood overweight and obesity in Omani population including children.

The findings of which might lead to effective interventions starting as early as infancy to reverse anticipated trends.

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{ CHILD }

Childhood obesity is a global problem In Oman, the figures have been slowly growing and can be considered as doubled over the years.

There are various reasons for the problem, and most of it pertains to lifestyle and living habits, says Dr Annamma Zacharia, paediatrician and neonatologist. She has been in Oman since the last 27 years and is therefore an authority on the rising childhood obesity rates and the problems it pose among the affected children.

Childhood obesity is not just a problem in Oman or the GCC countries alone, in fact it is one of the most serious public health challenges globally. In 2015 the number of overweight children under the age of five is estimated to be over 42 million, according to global statistics.

Obese child, obese adult Every parent thinks that a chubby child is cute, without realising that the same child is going to grow up into an adult and before they know it, would be caught in a losing battle to shed the fat. And unless and until a disciplined lifestyle, which involves lot of physical activity and a healthy balanced diet, is followed, there is very little chance to lose all that ‘chubby’ weight.

“Overweight and obese children are likely to stay obese into adulthood and more likely to develop noncommunicable diseases like diabetes and cardiovascular diseases at a younger age, within 16 to18 years. Where would that leave our community? The society will have many young obese teenagers,” Dr Annamma tells In-the-PINK health magazine.

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Prevention better than cure Though today’s lifestyle largely depends on inactivity, with computers, internet, mobile phones and televisions, it is the duty of parents and school authorities to ensure that a healthy and active lifestyle is followed by every child, she says. It should start at home at a young age through a balanced diet and proper physical activity, she added. “Overweight and obesity, as well as their related diseases, are largely preventable.

Prevention of childhood obesity therefore needs high priority,” notes Dr Annamma.

There is no ideal weight It is difficult to develop one simple index for the measurement of overweight and obesity in children and adolescents because their bodies undergo a number of physiological changes as they grow.

“So a paediatrician would ideally see the birth weight and prescribe a diet or can advise the parents accordingly.

Ideally a five-year old should weigh 20 kilograms and a 10 year 35 to 38 kgs of weight.

But again, the right weight of a child depends on his/her birth weight.

Whenever a child is born, we check

the thyroid values to rule out any complications. Once that is cleared, a child can grow up healthy and well,” Dr Annamma explained.

Ill effects of child obesity It is not just about the physical discomfort of the obese child. The stigma of growing up as an obese child can be very long lasting and detrimental. The growing years can be harsh to these children, especially at the schools and neighbourhood that would hurt their emotional state of mind, either making them withdrawn and depressed or make them grow up as bullies. “Either way they are emotionally affected,” Dr Annamma said.

Let them play more Think twice before overfeeding a child or buying a small kid a mobile or a tablet, Dr Annamma warned. “The priority should be to see that they are physically active and play every day.

An active child will grow up with an active mind and will be a responsible and healthy adult in future. So the solution is simple, let the child run and play, every day at home and at school.

He/she will be socially, physically and mentally healthy!”

Onus is on parents to tackle childhood obesity, overweight Childhood obesity and overweight in children can be tackled if parents take control of the situation.

Calling on parents to follow a healthy lifestyle for them as well as their children, Dr Paul Joseph, paediatrician, says, the onus is on the parents to tackle the childhood obesity problems – not just in Oman, but worldwide.

Focus on a healthy lifestyle Parents need to focus on their children’s health in a big way, says Dr Paul Joseph, paediatrician, Badr Al Samaa hospitals.

“Prevention is better than cure. So to nip this issue in the bud, the parents should be made aware of how to promote a healthy lifestyle. There are three factors to be considered here with utmost diligence: healthy meal and snacks, Daily physical activity and nutrition education.”

Inculcate positive attitudes Parents should focus on good health, not on a certain weight gain, Dr Paul maintained. “They should teach and inculcate healthy and positive attitudes.

The main focus should be on the type of food the kids eat, and the physical activity required without focus on the weight factor. The focus should not be on weight gain or reduction. The goal should be on maintaining the weight, because when a child grows, the height also increases. Obesity is related to the height also, it is about the right BMI (body mass index). So weight loss should not be a criteria at all,” Dr Paul advised.

Don’t focus on your obese child “The focus of the family should not be on the overweight child. It could cause emotional trauma in the child.

All members of the family should participate in the daily life in a normal manner and jointly work out, exercise etc. Every parent should be a role model.

The child learns from their parents.

Family meals make a difference too. A home-cooked meal, when consumed

at a family dinner or lunch makes all the difference. Please avoid takeaways and meals from outside. When you have time to sit together, the lifestyle becomes more natural and healthy,” Dr Paul said.

Not an overnight phenomenon There isn’t any sudden surge in obesity or overweight related issues, Dr Paul noted. “More health awareness and similar campaigns have brought obesity and overweight issues into the focus now. If you look at the statistics published globally since 1995 onwards, it will reveal that obesity in adults have doubled. Most adults would have been obese or overweight when they were kids. There is no sudden rise in obese kids or individuals. The increase over the last few decades is part of a slow and gradual process, which we can safely attribute to lifestyle reasons and physical inactivity,” Dr Paul said.

He referred to a survey published by the NCSI (National Centre for Statistics and Information), which states that about 30 per cent of the Omani population is overweight. And out of this 20 percent is obese. “So when you consider the fact that Oman is a young nation with a good 50 percent below 20 years, we can say that obesity is quite prevalent in children. Yes child obesity is definitely a problem, which has to be looked at from all angles and attended to,” Dr Paul noted. Obesity is a precursor to many medical conditions, mainly all NCDs (non communicable diseases) from metabolic to cancer to muscular skeletal problems and cardiovascular problems, he added.

Lack of physical activity There are multiple factors for this growing issue. The most critical one is food and eating habits, mainly snacking, fast foods, easy meals. “Look at the availability of a variety of snacks in the market; the dispensers at various public outlets including schools, mails even in hospitals,” pointed out Dr Paul. “The next is the physical inactivity. With the advent of all the modern gadgets and technological innovations, youth and young kids are on a high, addicted to computer games and sitting activities.

They need to put in a minimum hours of games and sports.”

Emphasis on physical education The effects of obesity could be damaging and negative to the growing child. “The stigma of being overweight and obese plays heavily too on the mind of the child. Just like the right meal, physical activity plays a major role. “A child spends quite a lot of growing years in the school. There should be lot of emphasis on physical education in the schools.

According to the WHO, a minimum of 60 minutes of exercise and physical activity is recommended for a child every day, along with weekly three times mild to vigorous exercises, especially muscle strengthening exercises are recommended, for children of five to 17 years,” Dr Paul advocated.

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Incorrect eating habits, physical inactivity make a child overweight In Oman, the figures have been slowly growing and can be considered as doubled over the years.

“Encourage them to indulge in physical activities that are fun and entertaining,” advices Sumaira Fatima, dietician.

You don’t need to enroll your overweight or obese child to a gym to make him/her lose weight, says a dietician.

In fact, dieticians world over have also pointed out that overweight children need not do more exercise than slimmer children.

“Their extra body weight means they will naturally burn more calories for the same activity,” they note.

“Encourage them to indulge in physical activities that are fun and entertaining,” adds Sumaira Fatima, dietician, Apollo Sugar IMC (International Medical Centre).

Excerpts What is the prime reason (or reasons) for this rise in overweight and heavy children? Should we pinpoint the blame on the rise in junk food culture in Oman or is there something more?

The increase in childhood obesity in majority of the cases is mainly due to incorrect eating habits and lack of physical activity. As a dietician, I find 48 IN THE PINK 2017

kids skip their healthy breakfast at home and prefer fast food or processed food at school canteens, which are low in nutrients, high in calories and fat. Neglecting fruits, vegetables and dairy products and giving preference to biscuits, cookies and fried foods as their snacking options adds up to lot of calories. Another reason is the big portions being served by mothers and the liberal use of simple sugars in the form of packed juices.

Watching cartoons for long hours, play stations and videogames makes the condition worse.

While prevention is the key, how do we help obese/overweight children lose their unwanted fat?

As prevention, teach the right eating habits at home. Start the day with breakfast at home serving healthy cooked meals adding cereal and proteins. Use fruits and vegetables for snacks in the school break. Serve them salads, cook different variety of coloured vegetables for lunch, which looks attractive and appetising too. Don’t encourage the use of

bakery and junk foods other than on weekends. Kids don’t need a gym for knocking calories! Instead, encourage them to indulge in physical activities and make them fun and entertaining.

What are the consequences of childhood obesity/overweight?

Obese children have increased risk of impaired glucose tolerance, insulin resistance, high blood pressure, high cholesterol, anxiety and depression.

They face social problems, including feeling inferior and lacking confidence.

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Embrace a family-oriented food culture More efforts should be put in to help obese and overweight children lose their unwanted fat or weight

Parents need to play a bigger and responsible role in bringing child obesity levels down and the best way is to start right from home.

“Firstly, we should encourage home-cooked food advises Dr C. N. Mohan, senior consultant paediatrics and neonatology.

A singular way to overcome the childhood obesity problems would be to embrace a food culture, which is totally family oriented, feels a top doctor of a well-known hospital here.

“I believe that the food culture should be completely family oriented,” Dr C. N. Mohan, senior consultant paediatrics and neonatology, Al Hayat International Hospital, tells the In-thePINK. Noting how childhood obesity has become something of an epidemic worldover, he stressed that more efforts should be put in to help obese and overweight children lose their unwanted fat or weight.

Parents hold the key Here again, parents held the key to charting a successful path to reduce child obesity levels in Oman, Dr Mohan said. “Parents should be the role models,” he emphasised. Parents need to play a bigger and responsible role in bringing child obesity levels down and the best way is to start right from home. “Firstly, we should encourage home-cooked food,” Dr Mohan said.

While it is understood that children somehow fall in love with fast food, even then, certain judicious restrictions could be set in place. “We should make an effort to reduce the frequent visits to fast-food joints,” he said.

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Constant motivation In a country like Oman, the great outdoors was omnipresent. So, it is not going to be difficult to persuade youngsters to get on the physical activities’ bandwagon.

“There should be a constant motivation and encouragement to make the children get into doing outdoor physical activities.” While, the importance of electronic gadgets cannot be undermined, it is important that children are not allowed to freely use electronic gadgets all the time.”It is high time that we, as parents, play a part in bringing safety and happiness to our children.

And one of the first steps would be to reduce the rampant use of electronic gadgets.

While it is important for the parents concerned to take good care of their children, it is equally important that the school also take good care of their students.

The school is quite often the witness and the guide and the support to the student, right from his formative years.

“There is no doubt about this, I feel that schools should take a prominent role in guiding healthy lifestyle and good physical activities etc.,” Dr Mohan noted.

Rise in junk food culture Asked what was the prime reason for the rise in overweight and obese children, Dr Mohan squarely blamed the rise in the junk food culture to be one of the reasons. “Junk food is one of the reasons.” But, he also noted that there were others: Lack of exercise; inadequate outdoor activities.

Children today are totally caught in the whirl of their electronic gadgets like playstations, their tablets, or glued to the TV sets, or stuck with video games.

However, Dr Mohan noted that a small minority of children may have genetic and/or endocrine diseases.

Most common problem Dr Mohan admitted that childhood obesity and oveweight was one of the most common problems encountered in their daily practice. But it was difficult to support any such statements with facts and figures because of the lack of studies on this front. “I do not think there is any (recent) study about obesity in children in Oman!

“But, sadly, obesity has become an epidemic worldwide with an increase in the incidence of overweight children in Oman too. I think it could be in the range of 10 percent and above. Also, this trend is common in cities than in the rural areas,” he concluded.

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Take a walk down any aisle in your local supermarket and there will be low fat, high fibre, caloriecounted packaged food screaming for your attention. If we are making healthy choices by picking these guiltfree foods, then, why are our waist-lines getting bigger?

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Writing on the LABEL Go read the fine print, exhorts a health expert

“How many of us bother to look at the nutrition content of a food label? Unless you are aware you are not going to look for it; unless you know what you are buying to eat, you will not know what you are consuming,” Dr Mazin Al Khabori, director general of private healthcare establishment, ministry of health tells In-thePINK. His fears are not unfounded. Diseases are born out of such ignorance, he believes.

Deciphering food labels Advanced apologies if any of our (PINK health magazine’s) comments below are deemed unpalatable.

But, the truth is that the vast majority of us consumers are blind. We may pat ourselves on our backs on being very health conscious and the like, but unless we are health-educated consumers, or experts, which may include to a certain extent, those in the medical profession, dieticians, nutritionists etc., a large majority of us, consumers, are often ignorant of the dangers that lurk in supermarket foods.

Why? Because we hardly read the labels on the packaged foods. We scrutiny the front of the product but

skip the writing on the label. Also, most of us think that foods, which are labelled ‘low fat’ or have ‘no added sugar’ are better, but the truth is otherwise, health officials in town claim.

Look before you buy or eat “How many of us bother to look at the nutrition content of a food label?

Unless you are aware you are not going to look for it; unless you know what you are buying to eat, you will not know what you are consuming,” Dr Mazin Al Khabori, director general of private healthcare establishment, ministry of health tells PINK. His fears are not unfounded. Diseases are born out of such ignorance, he believes.

“The high percentage of prevalence of non communicable diseases (NCD) today is because the food market is filled with brands and products, predominantly high in sugar and substituted carbohydrate and processed foods and the majority of us are gullible enough to consume them without checking.

“If you are consuming a high level of sugar or salt, how will you escape the onslaught of NCD?” he asks sadly.

90 percent of food parents’ buy is junk Know what you are eating. Read the labels, create awareness on nutrition eating, Dr Mazin exhorts. “That is one of the most critical awareness we need 2017 IN THE PINK 53

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If you are on an unhealthy diet of high sugar or salt, then you are basically inviting diseases from diabetes to cardiovascular problems and the like

to create today. The hypermarkets and shops are loaded with numerous local and international brands of food items. But, how many among the public know what they are buying?

Do they know or understand what the food label says; what it means? What are the nutrition contents mentioned there?

We need to create awareness of what people are buying and eating. We need to encourage people to learn and know what they are choosing to eat!” Dr Mazin stressed.

Food brands manipulate taste “You get hooked on to food brands by habit. And most food brands manipulate your taste. We buy things based on taste without knowing the nutritional content. Take brown bread for example: most of the brown bread is caramel-coloured white bread and it is mentioned in the label! It is white bread, coloured brown! Caramel is used to mimic the brown colour.

Unless it is wholemeal bread, it is just plain-coloured white bread! Legally,

the manufacturers are not misleading, it is brown ‘looking’ bread! Sometimes the label would say ‘no artificial preservatives’, but that does not mean no sugar! It only means no chemicals.”

all soya, protein, starch and other ingredients. Have you read the label on chicken nuggets? If you did, you will be asking yourself where is the chicken (in the nuggets)?

Halo effect Labelling and health claims on packaging need to be deciphered properly. For example, the packet could say that the product is high in fibre or contains whole grains or has added vitamins and minerals. What we fail to understand is that this could probably mean nothing, because the product might also contain high levels of salt or sugar or saturated fat. These terms create a halo effect around products to make them appear healthy when they might not be, other officials note.

Say ‘NO’ cheese?

“Look at cheese. People buy cream cheese, but, have they checked whether it is cheese? No! it is fat, with cheese flavour made into a paste!

“So educate yourself; become aware and then choose wisely. Some cheese have 60 percent fat! It is all written there! So go read the fine print. It is of utmost importance,” exhorts Dr Mazin.

Sugary fruit juices “Look at the fruit juices. All have sugar! But, sugar is also natural. So it is safe. If it says freshly squeezed, or made from concentrate, then look at the ingredients and it would say 10 percent fruit pulp, sugar plus 60 percent flavour – this is not healthy,” Dr Mazin said.

Truth about sausages Dr Mazin also highlighted a salient point about sausages bought from the market. “Look at children eating sausages. Have the parents read the labels? Most sausage brands contain only 10 percent meat! The rest is

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Fruit in jam How can you get a jar of good fruit jam at 300 baisas, asks Dr Mazin. “Let’s be realistic! Fruit is expensive, so healthy food is expensive. A good fruit jam would ideally have 40 to 50 percent fruit in it. It cannot come cheap!

“Now, look at jam, how much sugar is in it? There will be around 65 percent sugar in a good jam, but most of the jam products have 80 percent sugar. The good, healthy brands are expensive too. So if you actually look at the shopping trend today, without reading nutrition labels, 90 percent of food purchased by parents are junk!

Fruit juices, sausages, cheese, bread, chips, jams!

Sugary drinks There is this myth that apple juice is

{ GOOD HEALTH }

Utilise health centres As the director general of private healthcare establishments, Dr Mazin Al Khabori was instrumental in creating national committees.

“A key point that I would like to raise is that it is not that easy for women here to join a health club owing to cultural issues.

“It would be easy for those who are exposed to international lifestyles, but for most of the local citizens, getting to a health club or gym may not necessarily be part and parcel of their lives! Therefore, one of my suggestions to the

Ministry of Health was that the ministry should utilise the many health centers spread across the nation. In the UK, every community has a sports’ complex. His Majesty Sultan Qaboos bin Said has built many sports complexes, replete with all the necessary facilities. So, if we can enter into some sort of public-private partnership with health clubs or the municipality concerned to built a small health facility, for example a swimming facility within the health centres, this would be ideal. It would be

of great help for women and children and it would enable families to come forward and use such facilities. It would also be close to their residences. It will not cost the MoH much for maintenance etc and some sort of private sector sponsorship could be solicited too!”

Dr Mazin noted.

healthy! But, it is filled with sugar. A can of cola and a can of apple juice is of the same nutrition value. Both contain high sugar!”

Dr Mazin further urged consumers to read nutrition labels carefully. “Not just the front of packets!”

For instance, as consumers, we are wont to believe the health claim on a package. Or if the images in a packet denote health, we tend to believe that it’s going to be good for us.

The idea was to look beyond the front of the packet and check out what’s actually in the ingredients list before making the final decision to buy or not, Dr Mazin stressed.

Open invitation to NCDs People are totally unaware of healthy eating and that was paving the way to NCDs, Dr Mazin pointed out.

“If you are on an unhealthy diet of high sugar or salt, then you are basically inviting diseases from diabetes to

Obesity is malnutrition Dr Mazin recalled an interesting anecdote: “Many years back when I attended a primary health care meeting held in Abu Dhabi, they were talking about malnutrition in children in the Gulf countries.

“When we say malnutrition, our minds automatically visualise thin children. But, on the contrary, they were talking about obese children. Obesity is malnutrition too.”

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cardiovascular problems and the like!” Dr Mazin warned, adding that today, “over a good 20 percent are becoming diabetic in our society”.

The problem was that people trusted brands and even medical practitioners were often blind to labels, he noted.

Manufacturers are not cheating “But remember that no food manufacturer is cheating the public.

They are all labelling their food brands. But, the problem lies with us, as we sadly lack the ability to decipher food facts. “Basically, I would just say, you are what you eat!

You eat healthy, you remain healthy!”

Dr Mazin said, advising people to also try to cultivate basic vegetables at home. On an aside, he noted that there was not much of a difference between organic and non-organic vegetables and fruits. “Because many of the pesticides go away if you wash the vegetables properly!”

Almost all human disorders have direct relation to a function of either one, or a group of genes, with some impact from our environment, and the life style. All humans are equal in a way that all have few (10-20) genetic imperfections.

The term “genetic disorders� in Oman is usually referred to Autosomal Recessive Disorders. These occur in all communities around the world but are more frequent in countries with high level of consanguinity

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Oman rises to challenges of genetic disorders Efforts on to construct modern gene chip for Omani population

Omani families who have been exposed to genetic diseases are helping the trend to bring down consanguineous marriages. Others are resorting to genetic testing before marriage and also seeking consul on how to avoid the next affected birth, says Dr Anna Rajab, one of the topmost names in the realm of genetic diseases and its prevention in Oman.

On one hand, there is the alarming trend in the rise of newborns in Oman affected by birth defects and genetic conditions, high mortality in childhood, etc., but on the other hand, Oman has risen up to all of these challenges and are making great efforts in combating them.

Efforts are on to construct a modern gene chip for Omani population, which will help in controlling genetic disorders. Omani families who have been exposed to genetic diseases are helping the trend to bring down consanguineous marriages.

Others are resorting to genetic testing before marriage and also seeking consul on how to avoid the next affected birth.

Dr Anna Rajab (*), one of the topmost names in the realm of genetic diseases and its prevention in Oman and currently a senior consultant at the Muscat Private Hospital (MPH), also notes in this interview with Inthe-PINK that the development of the National Genetic Centre in Baushar, was a major achievement that offered services and preventive measures to Omani citizens.

Excerpts:

What exactly are genetic disorders and how do they manifest in a child or an adult and what problems do they bring about in the lives of those affected? Does it make their lives a living hell?

Almost all human disorders have direct relation to a function of either one, or a group of genes, with some impact from our environment, and the life style. All humans are equal in a way that all have few (10 to 20) genetic imperfections.

The term “genetic disorders� in Oman is usually referred to Autosomal Recessive Disorders. These occur in all communities around the world but are more frequent in countries with high level of consanguinity. In Western communities, three percent children are born with birth defects and genetic conditions, and in consanguineous families around the world the risk of having affected child is around seven percent.

This is due to the fact that every eighth gene in a first cousin couple is the same gene inherited from their common grandparent. An unrelated couple may have the same number of genetic imperfections but such imperfection are less likely to surface as unrelated parents share smaller

number of similar genes. Familiar genetic disorders associated with mental or physical disability are known to have adverse affect on family and community life and cause psychological, social and financial difficulties. If parents have few children affected by handicapping genetic condition, their entire life is devoted to their care. Mothers suffer the most.

Genetic disorders are of great concern in all countries around the world with large implication for social and health-care services.

Prevention is the key, everyone would advise, so, in this case, are genetic disorders preventable and if so, how?

Prevention is the key. Emerging new technologies, like pre-implantation genetic diagnosis, maternal serum screening and diagnostic chip technology have been introduced in many countries, These offer new solutions for effective prevention of the genetic diseases.

Prevention have to be compatible with the cultural and social make up and religious beliefs of the population, and the legal system of the country.

The joint effort from the governmental 2017 IN THE PINK 59

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Success story Here is a success story of an Omani family with five children affected by severe handicapping genetic condition that has been investigated for a number of years. All children have severe intellectual disability with absent speech, autistic behaviour and totally dependent on parents for feeding and toileting. It is only in recent years with the help of advancing genetic technology that it was possible to find genetic mutation. At present the family knows who of their unaffected have to opt for premarital testing and how the disease avoidance can be achieved with certainty.

No more ill children are expected in this family!

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a great variety of rare disorders are put together.

bodies supported by medical, social and education professionals, the industry and Omani community would be required to develop comprehensive prevention facilities.

What is the scene in Oman as far as genetic disorders are concerned?

Are there too many Omanis suffering from genetic disorders?

How does Oman fare as compared to other countries in the region and in the world?

In the Western countries the birth rate of genetic diseases is smaller compared with Middle East, and preventive measures are well established. Genetic disorders in Oman occur with the same frequency as in other countries in the Middle East where the rate of consanguineous unions is similar. The difference is in the amount of the information available from Oman. Through comprehensive centralised healthcare facilities and genetic services, a large amount of information regarding genetic disorders is available in Oman.

Rare disorders Various groups of “rare” disorders have been observed such as

blood disorders; inborn errors of metabolism; neurodevelopmental and neurodegenerative conditions; congenital malformations syndromes; skeletal dysplasias; disorders affecting liver, kidneys, gut and skin; congenital blindness and deafness.

Numerous novel disorders have been described in Oman and many are confined to certain population groups and geographic locations.

The complexity of dealing with autosomal recessive disorders is that they constitute a large number when

A recent report quoted the Ministry of Health suggested that “more than 300 types of diseases are inherited by citizens from their parents in the country – it included different diseases related to blood disorders, chromosomal abnormalities and metabolic disorders”. What are your comments on this?

There are more than 7000 genetic variants known to date causing genetic disorders across the world.

In Germany a single genetic test for 4000 genetic diseases is available.

In a recent publication 300 genetic variants in Omani citizens were compiled for the storage as a valuable information used to avoid unnecessary repeated investigations and to create a base for the development of the national genetic chip.

The report also spoke about how “genetic diseases had no cure and that the treatment was very cumbersome and costly”. Your comments.

To date there is no definite cure for most of the genetic disorders, but 2017 IN THE PINK 61

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Modern genetic chip technology is very promising: it can be constructed for thousands of diseases in one single test and serve nationals at any age: pre- marital, pre-school, newborn and in adults.

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Autosomal Recessive Inheritance

there are comprehensive preventive measures available, and well suited for Muslim communities. Preventive genetic facility cost is estimated internationally as six percent from the 100 percent cost of care for those affected by genetic diseases if no prevention is available.

Will the numbers (of those afflicted with genetic disorders in Oman) increase – what is the current percentage of people with genetic disorders in Oman?

In the past 40 years, Oman has witnessed remarkable social and economic growth, which is best reflected in the well organised and efficient healthcare system. With these achievements, the country has had a shift in the pattern of disease. There has been a significant decrease in the incidence of communicable diseases and in the mortality and morbidity rates of infants and children.

‘In the past, the scale of the problem of congenital/genetic disorders were hidden in the high infant mortality rate because most affected infants died without being diagnosed. At present, the majority are diagnosed and provided with the best possible

treatment. As a result, the number of surviving affected children increases every year causing a considerable burden on the health care services.’

(Alwan and Modell 1997; Rajab et al.

2013).

Modern genetic chip technology is very promising: it can be constructed for thousands of diseases in one single test and serve nationals at any age: pre- marital, pre-school, newborn and in adults.

A study funded by the Oman Research Consul 2010 to 2012 indicated that 10 percent of Omani families reported children surviving with birth defects and genetic conditions. Conditions with intellectual disability cause the greatest burden to families and communities.

It is noted that 60 percent of the 2.5million population carries at least one type of genetic blood disorder – is this true? Your comments.

Genetic blood (hemoglobin) disorders are very important, and are among the best studied in Oman. Carrier status of the hemoglobin disorders offer advantage for survival in malarial areas, and due to such an advantage, 60 percent could survive before malaria eradication was achieved in Oman in 1975. Most frequent forms of genetic blood disorders like Alfa -Thalassaemia and G6PD Deficiency do not cause adverse effect on health and are innocent traits and characteristics of a nation surviving in tropical desert conditions. About 10 percent of Omani citizens are healthy carriers of the Sickle Cell disease and Beta-thalassaemia. If both parents are carriers of Sickle Cell disease, or Beta-Thalassaemia, there is a 25 percent chance to have an affected child. Precision genetic tests for haemoglobin disorders are available at the Sultan Qaboos University and at the laboratory -- donated by Oman LNG -- at the National Genetic Center.

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Orphan disease A rare disease, also referred to as an orphan disease, is any disease that affects a small percentage of the population.

Most rare diseases are genetic, and thus are present throughout the person’s entire life, even if symptoms do not immediately appear. Many rare diseases appear early in life, and about 30 percent of children with rare diseases will die before reaching their fifth birthday. No single cutoff number has been agreed upon for which a disease is considered rare, notes Dr Anna Rajab. “A disease may be considered rare in one part of the world, or in a particular group of people, but still be common in another. Different types of rare diseases are examined and many people are living with a rare disease, helping hands for rare diseases and life stories of existing lives are helpful for boosting new research and development.”

350m are fighting rare diseases globally Dr Rajab also outlined some facts: 350 million people globally are fighting rare diseases. Rare diseases impact more people than aids and cancer combined. One in 10 people have a rare disease, 30 percent of children with rare and genetic diseases will not live to see their fifth birthday.

Here are a few statistics and facts to illustrate the breadth

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of the rare disease problem worldwide: There are approximately 7,000 different types of rare diseases and disorders, with more being discovered each day. 30 million people in the United States are living with rare diseases.

This equates to 1 in 10 Americans or 10 percent of the U.S. population. Similar to the United States, Europe has approximately 30 million people living with rare diseases. It is estimated that 350 million people worldwide suffer from rare diseases. If all of the people with rare diseases lived in one country, it would be the world’s third most populous country. In the United States, a condition is considered ‘rare’ if it affects fewer than 200,000 persons combined in a particular rare disease group. International definitions on rare diseases vary. For example in the UK, a disease is considered rare if it affects fewer than 50,000 citizens per disease. Eighty percent of rare diseases are genetic in origin, and thus are present throughout a person’s life, even if symptoms do not immediately appear. Approximately 50 percent of the people affected by rare diseases are children. Rare diseases are responsible for 35 percent of deaths in the first year of life. The prevalence distribution of rare diseases is skewed – 80 percent of all rare disease patients are affected by approximately 350 rare diseases and many more.

Should pre-marital tests be made obligatory to save the future generation from carrying genetic disorders? What are the other precautions to be taken?

International experience of obligatory instructions for premarital tests did not prove to be the most efficient.

Using knowledge for prevention demonstrated much better results.

Strengthening genetic literacy among the population about genetic health and genetic disease avoidance holds the key.

Modern genetic chip technology is very promising: it can be constructed for thousands of diseases in one single test and serve nationals at any age: pre- marital, pre-school, newborn and in adults.

What is the most alarming trend in the issue of genetic disorders in Oman?

The most alarming trends are the high number of newborns affected by birth defects and genetic conditions, high mortality in childhood and high number of those disadvantaged by the handicapping genetic disorders in the community.

Is Oman on the right track in combating the rise of such diseases and disorders and what more should be done to prevent the rise?

The development of the National Genetic Center in Baushar was a major achievement to offer services and preventive measures to Omani citizens.

It is a center of excellence in the GCC providing comprehensive

genetic services to the Omani population. Many talented Omani genetic scientists have demonstrated excellent performance in advancing genetic testing technologies under international quality control. The study of genetic causes of intellectual disability from His Majesty the Sultan’s grant, and numerous other genetic studies are underway at the SQU. Efforts to construct modern gene chip, which is specific to the Omani population can be a major step in controlling genetic disorders.

Numerous Omani families having been exposed or experienced handicapping genetic diseases are trying to avoid marriages between relatives. Many families request genetic testing before marriage and seek advice on how to avoid next affected birth. Such families should not be criticised, judged or ridiculed but need to be supported in any possible way.

The application of new genetic technology needs to be explained to the population and medical professionals. Strengthening genetic literacy among the population about genetic health and genetic disease avoidance. The main drivers for the development of medical genetic services are the increasing recognition of community needs for genetic services, the availability of new genetic information developing from the advancement of the science of genetics and the improved understanding of genetic predisposition to adult-onset disorders.

• Various groups of rare disorders have been observed such as genetic blood disorders; inborn errors of metabolism; neurodevelopmental and neurodegenerative conditions; congenital malformations syndromes; skeletal dysplasias; disorders involving the liver, kidneys, gut and skin; congenital blindness and deafness.

• Numerous novel rare disorders have been described in Oman, and many are confined to certain population groups and geographic locations.

• Available mutation data of Omani population include many groups of rare disorders and

Profile: Dr Anna Rajab has vast experience in clinical genetics, syndromology, community genetics and paediatrics.

Dr Anna graduated from Ukraine.

Her postgraduate studies in the United Kingdom included Diploma in Child Health, Membership of Royal College of Physicians, and Doctorate Degree in Genetics from London University. Dr Anna initiated genetic services in Oman in 1992 in order to give better care to the many sufferers of genetic diseases and their families. The ambition of the provision of the state-ofthe-art genetic services in Oman materialised. She is a founder of the National Genetic Center with clinical genetic facility, genetic diagnostic laboratories, national programme for prevention of genetic blood disorders, premarital counseling services and health education.

Dr Anna has been involved in a number of national and international research projects in the field and has more than 80 publications to her credit. Dr Anna has also been involved in raising public awareness of genetic disease and it’s prevention, and in developing strategies which are ethically compatible with the cultural and religious beliefs of Oman.

Dr Anna is a member of the ASHG, ESHG, HUGO, executive member of CAGS; served as consultant for the WHO and the EU Research Commission; received award from WHO and Sheikh Hamdan Bin Rashid AI Maktoum award for Medical Sciences.

reflect the interest of individual physicians in genetic research.

• Recent population-based study revealed the prevalence of survivors with rare disorders and birth defects in 10 percent of Omani families. High mortality in newborns, infants and children was also recorded.

The prevalence distribution of rare diseases is skewed towards high percent of survivors with intellectual disability of unknown cause.

• The complexity of dealing with rare disorders, conducting research, collecting the data is discussed in view of improving care.

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A new lease of life

Salem Zubaidi with Mussab and Abdullah

Some years ago we had the opportunity to be up close and personal with a successful medical story; a tale of a family that watched two of their young members battle with a terrible disease that nearly took their lives and yet triumphed over it thanks to the wonders of medicine.

We revist the past to briefly spend time with the Omani family of Salem Zubaidi, who resides in Dhofar. Many years ago, Salem Zubaidi was one unfortunate father who had to undergo the singular trauma of being a mute witness to both his sons fight an uphill battle with a major blood disorder.

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Suffering from thalassaemia Salem Zubaidi faced one of the worst periods of his life when he found out that both of his sons, Mussab and Abdullah, who were three years apart, were suffering from thalassaemia major. First, he found out that Mussab had thalassaemia major and then to his horror, his worst fears were realised when his second son, Abdullah, was also found to be suffering from the same disease.

Blood transfusions and injections When Mussab was born, the parents noted that in the initial few months itself he was turning pale and yellow.

So, they took him to a private clinic from where they were referred to the Sultan Qaboos Hospital in Salalah.

Mussab was diagnosed with the genetic blood disorder, thalassaemia major. Thus began a life of blood transfusions and daily injections in their lives. In 1999, Salem’s second son, Abdullah was born, but very soon, the latter was also diagnosed with thalassaemia major. But, their third child, Afnan, thankfully, was normal.

Meeting with Dr Dennison All this while, the two sons were undergoing blood tranfusions and

a steady intake of drugs. But, very soon, they were entrusted into the care of Dr David Dennison, senior consultant haematologist and bone marrow transplant (BMT) physician at the Sultan Qaboos University Hospital (SQUH).

BMT option Meeting up with Dr Dennison was quite providential as his suggestion of bone marrow transplantation (BMT), was quickly taken up by Salem and the rest was history. Of course, the procedure was indeed “physically, emotionally, psychologically taxing” for them, yet, it was a major success story. The idea was to take the bone marrow of Afnan and transplant it into Mussab and Abdullah.

United for a cause Both Mussab and Abdullah were too young to understand the process and the isolation required for the BMT to happen. Abdullah, who was the younger one, and was then requiring the attention of his mother found it quite hard to be separated from her.

Both were very weak too: walking, sitting up in bed for long periods of time, or even talking was quite a task, recalls Salem Zubaidi. Besides that there were the long periods of

waiting for the transplanted marrow to engraft; for the blood counts to return to safe levels and for side effects to disappear. Somehow, the family stood united for this cause and the hope that success was awaiting them at the end of this long, dark tunnel, made them cope.

Red-letter day And, as Salem happily noted then and now, August 26, 2006 was a red-letter day in their lives as that was the day a new lease of life was finally granted to his beloved sons. That was the new birth date of both their sons. A new lease of life that the duo squarely owed to their darling sister, Afnan.

Leading normal lives Back to the present and we can happily say that both, rather, all three, are leading pretty normal lives: and studying quite well too! Mussab, 20, is in his second year at the Caledonian College. Abdullah, 18, is studying at a secondary school in Salalah, while the little blessing, as Salem notes of his youngest child, Afnan, is in her 11th grade, also at a secondary school in Salalah. “All are quite well. Of course, they have their regular check ups, but other than that they are healthy and well!” noted Salem.

In conversation with: Dr David Dennison Dr David Dennison, senior consultant haematologist and BMT physician, Sultan Qaboos University Hospital gives PINK health magazine an update on Mussab and Abdullah and also the BMT programme in Oman:

How many have been successful in leading lives free from blood transfusions (what percentage)?

Total of 52 patients (91 percent) are well and free from transfusions. Some are working while others are in school.

Mussab and Abdullah How are these two boys doing, health wise? Was any treatment provided after the BMT from Afnan?

Did they come back to the SQUH for any treatment other than regular check ups?

Both the boys are well. They are off all medications and only come for annual check ups to the hospital.

No treatment was provided to Afnan other than a short course of oral iron supplementation for a few months after she donated her marrow.

Simultaneous transplants How many pairs of siblings have undergone BMTs each from one common matched sibling?

Including Mussab and Abdulah, there have been three pairs of siblings who have had transplants from a common-matched sibling.

BMT facility How many patients have undergone treatment at the BMT facility so far (since 1996)?

We have done a total of 57 transplants for thalassaemia since 1995 when we started the transplant programme.

First transplant for thalassaemia Was the Mussab-Abdullah-Afnan transplant the only one in which both siblings were transplanted simultaneously? (First such transplant for thalassemia in the reported medical literature?)

Yes, this was the only pair which was transplanted simultaneously. I have not been able to find a reference where similar simultaneous transplant has been done before.

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Health Coach With your Integrative Health Coach you’ll have the opportunity to talk about your life, what you’ve always dreamed of, and the goals you’d like to accomplish for your health, Julia Stehlin

I

NTEGRATIVE Health Coaching is a field that is fast growing. As an Integrative Health Coach, several areas of life are taken into consideration when working with a client: creativity, joy, spirituality, finances, relationships, physical fitness, environment, career, home life and social life. As you can see, it’s not just about the food you eat.

In fact, the food you eat is secondary to these areas of your life and overall health in many cases.

Having a coach is quite different from seeing a counselor/therapist or mentor. According to the International Coach Federation, coaching does not delve into the pain and emotions of the past but, instead, focuses on the present while working towards the future. Coaching supports selfinitiated personal growth.

The emphasis in coaching is action, accountability and follow through, all with a specific outcome determined by the client,

not the coach, yet with the support of the coach. Having a coach is quite different than seeing a doctor, as well, since your coach will not diagnose your health or prescribe.

Rather, your coach will work closely with you to carry out choices that you make based upon what you know your body to be saying, and perhaps your doctor, too!

Think of a health coach as the person who helps you to cross the finish line by supporting you to create a plan specific to your goals and needs.

In short, having a health coach is not about where you’ve been but helping to get you where you are trying to go.

With your Integrative Health Coach you’ll have the opportunity to talk about your life, what you’ve always dreamed of, and the goals you’d like to accomplish for your health. It’s an opportunity to be heard and to get a sense of what it feels like to have more support in your life. You’ll also learn how to reach those goals by working with your Integrative Health Coach in making food and lifestyle changes.

To get in touch with an Integrative Health Coach in Muscat, email ihcjulias@gmail.com for a free consultation which we can conduct by phone or in person. This confidential session may very well be a turning point in your life.

To learn more about the various types of coaches that are available, visit www.coachfederation.org.

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Essential Oils Over the last two decades, essential oils (EOs) have been gaining in popularity even though their use is thousands of years old. One of the larger companies selling EOs for the last 20 years has just announced that in one month their membership grew by 100,000!

“I get asked lots of questions about how to buy essential oils as I am an independent distributor for a large company. How to buy EOs is an excellent question that many really don’t know the answer to, but purchase oils anyway,” says Julia Stehlin.

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When a company labels their EOs as being ‘therapeutic grade’, remember, in the science of aromatherapy there’s no such grade. What the EO company is likely trying to convey is that their process of creating this EO has captured the most therapeutic benefits that they can possibly manage.

Essential oils are the life blood of the plant and as such, they work in harmony with our own blood.

Just how they work is a completely different subject and this information is everywhere on the internet. My favorite explanation to give is Quantum Physics!

Sounds fancy, doesn’t it? It is true that Quantum Physics is involved. (And to think we just thought it was a bottle of lavender oil. Who knew so much science could be packed up into something that smells so great!)

The efficacy of an EO is determined by the botanical family to which the seed belongs (example, not all frankincense is the same); the method of extraction (the methods do vary and have a huge impact on the end result); it’s chemical constituents once extracted (these determine its properties which aid and support our health). Other important determinants are the soil the plants are grown in; the water used; how they are harvested; and even the energy of the caregivers which surrounds them during growing season and harvest; this all has a huge impact on the quality of the EO once it reaches the bottle that you will eventually purchase.

As you can see, already, it really does matter which company you choose to buy from. Getting to know the company you are buying from is very important, not in terms of their range of products but in how they work with the plant matter long before it reaches the bottle.

Another consideration is how you intend to use the EO. These precious oils can be used aromatically, topically or through ingestion (the latter of which requires one to be very cautious when doing so and to know your product very, very well as most oils are not safe for ingestion.) Just a drop of peppermint oil in a glass of water, for example, can soothe an upset tummy. A drop of the same oil on the crown of the head can be very 70 IN THE PINK 2017

comforting and relieve headaches.

Inhaling peppermint oil can open up the nasal passage ways. However, the quality of the oil you buy will certainly have an impact on the efficacy of any of these uses. All the more reason to know how to choose an EO brand if you intend to oil up!

In the science of aromatherapy they believe there is no such thing as a ‘therapeutic grade’ of EO and yet we see this label on the bottles of many companies. (This is not to say that aromatherapists believe that essential oils are without therapeutic values, quite the contrary, hence, their work as aromatherapists is to prevent, treat and even cure using these precious oils.) An aromatherapist will tell you

to buy your EOs from several different companies, or to even learn to distill your own oils. All the more reason to know your seller.

In today’s market, price is often a clue, but not always. There are companies who sell 30 or more different essential oils, all in the same size bottle; plastic bottles instead of glass; very much the same colour of oil across the range of products; printed instructions with little variances from one EO to the next (no, not every oil is suitable for the hair and a skin massage); and the oils are roughly the same price. These are great clues that something isn’t quite right here. At the very least, they have been heavily diluted. I can honestly say, I would not buy these oils, for

any purpose other than to teach what not to buy. We find oils in health food stores, as well. Inexpensive, dark tinted, glass bottles. Seems like a bargain, after all, they’re in a health food store, they must be safe to use!

They probably are safe to use, in your homemade laundry detergent or as a spray to keep the cats off of your upholstered furniture. You could also freshen up the smell of a room in your home with such oils. After all, that 30ml bottle of jasmine oil smells just like a real jasmine so it must be the real thing. It is, kind of.

It literally takes thousands of jasmine flowers to create just 5ml of jasmine oil. When you smell a bottle of any oil and it smells identical to the plant, in its whole form, you should safely assume that the essential oil has been diluted; especially if you are buying a quantity as large as 30ml and it’s a very affordable price!

You should be asking yourself about now, why are essential oils sold in diluted form? There are a few good reasons for doing so. First, it makes it more affordable for you to purchase it. Second, most EOs, when used, do require some dilution if they aren’t already diluted. Few EOs can be used ‘neat’ meaning applied directly and without dilution.

Understand, however, that not all EOs require the same dilution ratio.

Dilution is for one of two reasons.

To either weaken the strength of the EO or to impact the vibration of the oil to get the most benefit by using it. (Yes, EOs are also measured in frequencies and used as such. Don’t let that scare you away from trying them.) A reputable company will have instructions on each bottle as to whether or not dilution is needed and, if so, provide the ratio. If such information is absent, again, you know you’re holding a diluted EO in your hand.

There are great variances in dilution from 1:1 up to 1:8 and higher in very

few cases. We don’t know, and the companies don’t tell us, that when we are buying these obviously diluted oils that they are diluted properly.

They also don’t tell us what they are diluted with. In fact, their labeling will often say “100% Pure Essential Oil” and that will be accurate. Yes, you read that correctly.

In the USA, for example, an EO company can label a diluted EO as being “100% Pure Essential Oil” because, by law, the company is not required to put in more than 5 percent of the EO named on the bottle. So while you may hold in your hand a 30ml size bottle of jasmine oil while standing in that health food store, only 1.5ml of the 30ml filling that bottle is the pure EO! Legally, the EO company can add up to 95 percent of another oil, normally called a carrier oil (a healthy vegetable oil commonly used on the skin), and still label the bottle as being “100% Pure Essential Oil”, as compared to being a synthetic fragrance giving you the impression that it is Jasmine oil in the bottle.

Having said that, consider this, if the dilution ratio is normally a range of 1:1 up to 1:8, rarely higher, by law the companies are able to sell EOs with a dilution ratio of 1:20! When you buy an EO that is diluted in this way, you are not really buying an EO. You are actually paying for a carrier oil that is scented with an EO. Hence, the price is usually much lower than undiluted EOs on the market, and rightfully so.

I buy such “EOs” and I use them to perk up the air and for my laundry needs. I simply make sure that it is labeled as being “100% Pure Essential Oil” because I don’t want the smell to be an artificial source as that would be harmful. After all, there can be a place in our lives for these grades of oils, if you so choose to make a place for them. When a company labels their EOs as being ‘therapeutic grade’, remember, in the science of

An EO company can label a diluted EO as being “100% Pure Essential Oil” because, by law, the company is not required to put in more than 5 percent of the EO named on the bottle. So while you may hold in your hand a 30ml size bottle of jasmine oil while standing in that health food store, only 1.5ml of the 30ml filling that bottle is the pure EO

aromatherapy there’s no such grade.

What the EO company is likely trying to convey is that their process of creating this EO has captured the most therapeutic benefits that they can possibly manage. As I previously said, seed selection, botanical family, soil, water, harvest, extraction – these all contribute to the collection of chemical constituents.

Depending on the combination of the chemical constituents and quantities present, the chemical constituents will, in fact, determine their efficacy on your health. I can’t emphasise enough, know the company you are dealing with. Know their methods.

Look for their test results to be posted on their website showing the presence of the chemical constituents. If not, ask for the results. If they won’t share them, you should be concerned. If they outsource their oil, you should be concerned. If they outsource the bottling of their oil, you should be concerned. If they make their own oil but don’t own any farms, you should be concerned. You should be concerned because these are just some of the important steps a company will take to be able to produce a high quality essential oil that will improve your life and the lives of those you love. I am not an aromatherapist but I would be happy to assist you in your journey of using essential oils safely. It is one of the best decisions I have made for me and my family and I would gladly support you to do the same.

Feel free to contact me by email at compassjulia@gmail.com with your questions. Meanwhile, I highly recommend one publication for you if you’re wanting to get comfortable with essential oils and learn how to safely use them. The title is “Reference Guide for Essential Oils” by Connie and Alan Higley.

Happy oiling!

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Depression in Oman is a growing problem, which needs proper assessment at the primary care level.

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Stigma is the biggest hurdle in battling depression Depression can be avoided and prevented if we are able to adopt a healthy, balanced and positive lifestyle

Extreme cases of depression can drive the victim to suicide, but the real killer is the stigma attached to this disease, notes Dr Amira Al Ra’aidan, director for health education and awareness programmes, and also head of the department of mental health, ministry of health (MoH) in Oman.

Extreme cases of depression can drive the victim to suicide, but the real killer is the stigma attached to this disease, notes Dr Amira Al Ra’aidan, director for health education and awareness programmes, and also head of the department of mental health, ministry of health (MoH) in Oman. “The biggest killing factor surrounding depression is the stigma attached to it – this makes any effort to cure the depressed state of a persion next to impossible!” says Dr Al Ra’aidan, who is also a senior medical officer, drug addiction unit.

Acceptance There was a great need to educate the ones who are dealing with a depressed person, she stressed.

And, it was important not to isolate the depressed person, she added.

“Most often a person suffering from depression is left alone to suffer, while the family, relatives, friends and the society at large, studiously avoid them.”

Instead of adding to the depressed person’s burden, it is imperative that they are embraced into society as someone suffering from yet another disease. “Why can’t people accept that depression is just like any other disease? And that it is completely curable if it is attended to in the right manner and at the right time.”

Dr Ra’aidan also said that it was necessary to attend to any sudden changes in behaviour of their family members, relatives and friends.

“If we come across our friends or relatives displaying sudden change in behaviour, like sadness, lack of interest in life, especially if this change in behaviour continues for more than two weeks, we should act immediately: we need to speak to them, get them help, it will save them from falling into depression.”

Infuse a sense of positivity In our own way, we can help those suspected of having depression to filter their thoughts. “It pays to know that most state of negativity is triggered by the nature of our thoughts. If we are able to cleanse and purify our thoughts or infuse a sense of positivity in ourselves, we will find our thoughts also changing automatically,” Dr Ra’aidan enthused.

Destroy the myths Making a fervent plea to destroy the various myths surrounding depression, Dr Ra’aidan said depression was nothing but being caught in the wrap of chemical imbalances.

“In simple terms depression is a state created by the imbalance of chemicals that causes good and bad

moods. There are many reasons that can cause the fluctuating state of emotions from external factors like environmental issues, work-related pressures, societal problems, induced traumas, and hormonal problems.

Whatever the reasons that induce depression, the symptoms include: sudden mood swings, fatigue, lack of interest, sadness, irritation and being easily provoked, plus having a sense of perpetual guilt, a feeling of worthlessness, hyper sensitivity, pre-occupied mind and a don’tcare attitude. An extreme case of depression could also lead to suicidal tendencies!”

Lead a healthy lifestyle Depression can be avoided and prevented if we are able to adopt a healthy, balanced and positive lifestyle, Dr Ra’aidan noted. “Always ensure some quality time for yourself along with a good diet, ample exercise and healthy social relationships.

Managing a balanced life between personal relationships and career is the most important criteria in having a life of positivity,” she said, will adding that it was very important to avoid and perhaps try to fully remove stress out of your life! “Remove stress and you fill find depression runing out of your lives too!”

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Shortage of mental health professionals

Although no studies have been conducted in Oman with regards to depression, it is believed that the number of depressed in the country would be similar to those in the countries in the region.

Oman has a shortage of mental health professionals. That is one problem. The other issue is that even the available ones are located in the capital area. Therefore, those afflicted with the all-consuming nightmare of depression or are suffering from related illnesses in the interior regions are unable to obtain timely help, says Dr Hamed Al Sinawi, senior consultant psychiatrist While mental health units in Oman are appropriately equipped as far as treatment and medications are concerned, the worry is that there is still shortage of psychological services like talking therapy, counselling etc.

Although no studies have been conducted in Oman with regards to depression, it is believed that the number of depressed in the country would be similar to those in the countries in the region.

Worldwide, it has been found that around 350 million people suffer from depression. Since it is an incredibly complex mental condition, it is important to identify and seek professional help to fight it. In-thePINK approached Dr Hamed Al Sinawi, senior consultant psychiatrist at the Sultan Qaboos University Hospital (SQUH) with some queries.

Dr Hamed Sinawi, who is the cofounder and chairman of the Oman Alzheimer’s Society (OAS), has also a first to his credit being the first Omani to win the Public Educator Award from the Royal College of Psychiatrists, UK for his work in the field of psychiatry.

He has also won the best staff award from the department of behavioural medicine during the SQU Day 2106.

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Excerpts: Oman specific Have any studies been done to find the percentage of the depressed population in Oman?

It is difficult to get the percentage of the depressed population as this requires a study that involves screening everyone, which is not practical. Also, the numbers recorded at health clinics will not serve to be a representative figure as many people do not seek help for depression due to both stigma and lack of awareness.

But, it is estimated that around 350 million people suffer from depression worldwide.

Children, women, men‌ who are more depressed in Oman?

Women are twice more likely to suffer from depression. This is mainly due to hormonal changes and psychosocial factors. All of this put women more at risk to develop depression.

How bad is the scene in Oman on the depression front?

As explained we do not have exact statistics, but it would be similar to other countries in the region.

We see cases on a daily basis from

different age groups and severities.

Some get to the point of losing hope and attempting suicide, others, unfortunately, have committed suicide.

Stigma and family support. Is there a problem of stigma for families suffering from depression in Oman?

When it comes to mental illness, stigma is a big issue, not only in Oman but also in other developed countries. The main misconception about depression is that it is a sign of weakness and lack of faith also contribute to stigma; it also stops people from asking for help even when they are very depressed, which then leads to a negative impact to their social and professional life.

How is the family support system in Oman with regards to those undergoing depression?

Most families are supportive and tend to sympathise with the person and accompany the patient to the clinics.

But, there are some who have negative beliefs, which include seeking advice from traditional healers who do not have the skills to handle such cases and thereby worsening the condition of the patients.

Are families of the depressed in Oman equipped to understand the nature of the problem (of their children, family members)?

Initially there was poor understanding but with more health education campaigns and awareness building programmes, families have become more knowledgeable on how to support the patient and help them through recovery.

Is there sufficient treatment and support system in Oman to assist the depressed in their battle?

Before we get to the treatment aspects, we need to first focus on identifying the symptoms and provide a diagnosis of the patients.

In Oman there is still a shortage of mental health professionals. Most are available in the capital area which means those outside Muscat are unable to receive timely help. When it comes to treatment, most mental health units have the appropriate medications, but there is still shortage in psychological services, which provides what is called ‘talking therapy’ and counseling to help

people learn new skills to cope with their stress and depression along with medication.

What is the general – common – view of depression in Oman?

Depression in Oman is a growing problem, which needs proper assessment at the primary care level.

Doctors and nurses working in health centers need to have regular courses and workshops on how to identify people with depression; trained counselors need to be appointed at these clinics so patients get the treatment without having to travel to the psychiatric hospitals. This will address the issue of stigma and encourage people to seek help at early stages.

Other than reasons, which lead to depression, are there any selfindulgent actions that may lead to depression?

Depression is a mental health problem that can arise due to many factors: some due to genetics, which means that children of the depressed are more at risk of developing

depression. Other risk factors for depression include stressful life events, such as losing a child or a spouse due to ailment, accidents etc; losing your status in the community, losing your job and/or getting into financial problems!

Also, medical conditions such as diabetes, cancer and heart diseases increase the risk of developing depression.

Are the introverts, the shy and the lonely ones more prone to depression?

There are studies that support the ideas that introverts are more likely to develop depression and have trouble reaching out to others, especially in times of stress.

Is depression a kind of illness tantamount to a mental problem?

Depression is a common mental health problem with different severities.

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Depression is a common mental health problem with different severities.

People with mild depression may suffer in silence without others noticing them; they may still be able to work and carry on their daily chores; those with moderate depression are more affected and may have other symptoms like poor sleep and constant feeling of sadness and low energy , people with severe depression have negative thoughts about themselves and the future depression are more affected and may have other symptoms like poor sleep and constant feeling of sadness and low energy , people with severe depression have negative thoughts about themselves and the future; some may have false beliefs and could harbour guilty feelings tantamount to believing that they have committed a sin and do not deserve to live. In severe cases, some of them may get to the point of ending their lives by attempting and/or committing suicide.

What are the main dos and don’ts to avoid getting into depression?

Best advice to avoid depression is: • Get regular sleep • Eat balanced diet • Get regular exercise • Have a hobby /passion in life • Have a friend who you can confide in • Learn how to relax

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Are we more depressed than, say, a decade ago; 20 years ago; 50 years ago; 100 years ago?

There are some international studies that support this view. A recent report from the United Kingdom showed that rates of depression and anxiety among teenagers have increased by 70 per cent in the past 25 years. The number of children and young people turning up at the A&E (accidents and emergency) with a psychiatric condition has more than doubled since 2009. In a 2016 survey for Parent Zone, 93 per cent of teachers reported seeing increased rates of mental illness among children and teenagers and 90 per cent thought the issues were getting more severe, with 62 per cent dealing with a pupil’s mental-health problem at least once a month and an additional 20 per cent doing so on a weekly or even daily basis.

In this modern world, aren’t we better prepared to fight against depression than before?

The modern world with its weak social connection and more reliance on social media means people are more likely to feel isolated even when physically surrounded by others.

The competitive lifestyles that exist today are also more likely to create stressful situation for people to prove themselves at work and at a personal level. On the positive side, the Internet can have a good impact on spreading awareness about depression and describing how to cope with it. It is also interesting to see the new virtual clinics that provide psychological help for people with depression and other mental health problems using website and video conferencing. Here, the patients do not have to leave their homes and/or wait for hours just to see a specialist.

A depressed person is neither crazy nor mad Depression is mostly prevalent in three categories of people, namely youth, mothers and the elderly

Depression is a common mental disorder, characterised by sadness, loss of interest or pleasure, feelings of guilt or low selfworth, disturbed sleep or appetite, feelings of tiredness, and poor concentration,” explains Dr Gerald D’ Costa, specialised psychiatrist.

Three years. Three years in a selfinflicted prison from which there seemed to be no escape.

That was what a poor, 30-year old woman inflicted on herself. She was the accused, the defendant, the lawyer and the judge for a crime she never committed. And the selfinflicted judgment was harsh: three years in solitary confinement!

Web of depression No, this is not a crime-thriller story.

This is simply the gist of a narrative

by Dr Gerald (Gerry) D’ Costa (*), specialised psychiatrist at Badr Al Sama’a hospital in Ruwi, who was telling In-the PINK about a young woman, whose depression pushed her to the edge , while at the same pushing everyone else out of her life.

Dr Gerry was explaining how this disease of the mind ate this poor woman inside out and how she disappeared from the world into the confines of her room, refusing to interact with anyone and cutting off ties with everyone for the best part of three years.

“Nobody in her family had a clue as to what was happening to her. Actually, she had everything going for her. In the sense, she had a good career,

good family, but unfortunately, she was caught in the web of depression,” Dr Gerry said.

“What she did was drastic – she cut off all ties with everyone. She just shut everyone out of her life. She stopped going to work; stopped interacting with her friends, relatives and even family members. She did not move out of her room and transformed from a sprightly career woman into a moody, sad, angry and highly distressed individual. She even stopped selfgrooming or caring for herself.

“For three very long years, she just sank into a sea of depression. So, it was quite a task for her family to convince her to meet me for a consultation.

Three years was quite a long time and the depression had set in quite deep.

But, although it was a challenge, we did not give up. Slowly, but surely, we broke into the hard-crusted shell of depression and managed to bring her back to normalcy! Today, she is perfectly normal!”

Difficult to detect Dr Gerry seemed to heave a sigh of relief as he narrated the above episode he had with a patient. We had asked him to give us a case of depression that he had come across

in his practise here and this was a ready example that he unveiled.

“Depression creeps onto you, slowly and silently and before you know it you are in its grasp. Unlike other diseases, it does not aggravate overnight or in a short span, making it at times a difficult disease to detect,” he noted.

Triggers to cause depression “There are many triggers for causing depression, and it differs from person to person, so we cannot put a patient with depression into one common bracket of mental illness. Depression is a common mental disorder, characterised by sadness, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, feelings of tiredness, and poor concentration,” he explained.

Double trouble Those undergoing depression has to undergo the dual pain of having to suffer from the disease as well as being weighed down by the terrible stigma attached to it. Depression is most often seen as a mental illness.

And a mental illness is something that is given a ‘crazy’ or ‘mad’ tag. “This is unfair and untrue as a depressed 2017 IN THE PINK 77

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The four main reasons that cause depression are: Genetic, bad early childhood experiences, hormonal reasons and stress.

person is neither crazy or mad. He/ she is just going through a medical condition, similar to diabetes or heart disease. Will you call someone with diabetes or a heart disease mad? So, why call a depressed person that?

Nothing to be ashamed about “Also, a person suffering from depression need not feel ashamed about it. It is just a medical condition and not a moral issue. Is a person with a heart ailment weak-willed or lazy?

Neither is a person who suffers from depression!” stressed Dr Gerry.

“Depression should be addressed in a normal manner, just like any other disease. And, it can be controlled and cured just like any other health issue.

It is a matter of non acceptance that aggravates the illness and leaves the depressed alone in their own dark world. They need understanding, help and support. If you see your friend or a family member running a high temperature or with a sore throat and running nose, will you not take him or her to a doctor? So why can’t you do the same with someone suffering from depression?” Dr Gerry asks.

“When you see your friend of family member sad, hopeless, withdrawn or silent over a period of two weeks, immediately take them for a medical 78 IN THE PINK 2017

consultation. If anyone is going through this stage for two weeks, then immediately take action. Not before.

Once they cross the two-weeks’ phase, take them to a doctor. In the meantime, speak to them, talk to them, listen to their fears, understand what they are going through. Just like any other physical ailment, they are going through a mental ailment that can be controlled and cured!” he said.

Three forms of depression Dr Gerry also noted that depression came in three forms – mild, moderate and severe. “The severe form can make a victim become suicidal too. So next time you see someone you know going through a bad mental phase, don’t avoid them or try to judge them, rather help them overcome the phase,” he advised.

Four main reasons There are many reasons we can attribute to a mental health condition, and it may differ from person to person. However the four main reasons that cause depression are: Genetic, bad early childhood experiences, hormonal reasons and stress.

The genetic reasons are more dependent on the family background and is beyond a person’s control.

However bad or traumatic childhood experiences can be attended to and brought under control. Children are very sensitive, emotionally and physically and it is the responsibility of the parents, teachers and elders of the family to protect them from scarring and traumatic childhood experiences, Dr Gerry said. “But today, thanks to smartphones and technology, our society has become so disconnected from each other.”

Hormonal reasons can be attributed to thyroid glands, post partum and menopausal reasons and they can be addressed too. Well, the most crucial reason today however remains something we have created ourselves with the modern lifestyle – stress!

“Clinically, depression can be addressed and cured or controlled with four to six weeks of medication.

The medication course varies upon individual cases and the effect can be noticed in four to six weeks, where the depressed person improves in sleeping, eating processes and starts showing interest in his or her life.”

Brain -- most sensitive part The brain is not just the most sensitive part of our body, and not just physically, but in an emotional sense, too. “Physically, it not only registers pain, but if it is hurt, it could kill you; a

The stigma of a mental disease, the lack of understanding, or rather the indifference towards a depressed person are major hurdles in the quick treatment of this illness. “Mental health is more important than physical health. If you are physically healthy and yet mentally depressed, life is still going to be very difficult. According to the World Health Organisation (WHO), the first and most important step is to talk. Talking, understanding, addressing depression is the first step in tackling the ailment head injury or brain injury leaves you half dead instantly. But the mental injury has long-term deleterious effects and can make you depressed too. Human beings can easily be hurt by words, and by how we register and respond to stimuli. It is the brain that triggers emotions that can lead us to kill and harm ourselves. This is only because of how we react to some electrons and chemicals in our body.

The neurotransmitters play a vital role in our good living and healthy state of mind,” Dr Gerry said.

Clinically speaking, the conditions of depression is the result of the imbalance of one of the neurotransmitters Serotonin.

The imbalance could cause changes in moods, sexual desire and function, appetite, sleep, memory and learning, temperature regulation, and many social behaviours. “In fact, serotonin can also affect the functioning of our cardiovascular system, muscles, and various elements in the endocrine system. Too little serotonin in the brain is thought to play a role in depression. Too much, however, can lead to excessive nerve cell activity, causing a potentially deadly collection of symptoms known as serotonin syndrome. So with correct medication, this imbalance can be controlled and the state of depression can be cured,” Dr Gerry enthused.

Youth, mothers and the elderly Depression is mostly prevalent in the three categories of people, namely youth, mothers and the elderly.

Why? Because the young ones are impressionable, sensitive and stressed out of the fear of the future, goals, aspirations and the pressure of proving themselves successful in the eyes of their parents and elders, Dr Gerry said. “The fear of failure looms

in front of them causing anxiety, trauma and stress, all reasons to cause or trigger depression.”

“Mothers, in fact women, are more prone to depression, be it a young mother who delivers or an older mother whose child is leaving home or the woman of the house who is stressed out trying to meet the ever-growing demands of the family members, her own fear of performance and meeting expectations and her hormonal deflections.

The elderly have the fear of retirement, of being deemed useless and old and therefore being a burden to their children and family. All their lives they have worked and provided for the family and then, they reach a stage when they start fearing their own existence. Diseases pertaining to old age and lifestyle add on their stress levels. These three groups are vulnerable in their own positions in the family and society and they are more prone to depression.”

Depression: Talking is the first step The stigma of a mental disease, the lack of understanding, or rather the indifference towards a depressed person are major hurdles in the quick treatment of this illness. “Mental health is more important than physical health. If you are physically healthy and yet mentally depressed, life is still going to be very difficult. According to the World Health Organisation (WHO), the first and most important step is to talk. Talking, understanding, addressing depression is the first step in tackling the ailment,” Dr Gerry noted.

“Clinical intervention or cure is secondary. In fact mild to moderate levels of depression can be mostly cured with just psychotherapy – plain talking and consultations. Even those

who are just on the brink of depression should talk about how they feel and try to step out of the withdrawal state at the beginning stage itself and seek help. By remaining silent or hiding under a cloak of silence and indifference could only push them into an abyss.”

Good health is not the absence of a disease Depression still remains a scary enigma for many, bracketed into the confines of mental illness or craziness. “But, it is not true. Just like a physical illness, mental illness need to addressed positively, openly and attended rightly with proper medical intervention. So it is very important that an awareness is required globally. That is where media and publicity can play effective roles. It is easy to address if the public are educated about the various facets of depression. Because good health is not the absence of a disease, it is the state of well being physically, mentally and spiritually!” noted Dr Gerry.

Create awareness For achieving that we need to create awareness and live a balanced life, in short a better quality of life, which gives stress free peace from self inflicted deadlines and goals, social support that bonds communities together, rather than keeping them disconnected, a healthy diet, balanced with physical activity and nutrition. Finally, whether it is physical emotional or mental, we humans move towards a state of happiness, Dr Gerry concluded. (*) Dr Gerry D’Costa has a MD in psychiatry and a special interest in the areas of anxiety, depression, addiction, and children’s psychiatry.

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Homoeopathy: an effective answer to depression

A well selected homoeopathic remedy can help cure depression and it is a very effective way as there are no side effects. It is non addictive and cost effective.

Homoeopathy works for depression, note two of the most wellknown homoeopathic consultants – Dr Deepak Sharma and Dr Anupam Sharma

Does homoeopathy make more sense for depression than antidepressant drugs?

Let us respond to this in a slightly different manner. When a depressed person presents himself/herself before a homoeopathic practitioner, the latter is known to ask one important question: “What happened in your life when you got depressed?”

This question is imperative as it traces the condition back to its origin and then addresses that particular state with a remedy. In this manner, homoeopathy can attempt to cure any depression. The best part of this is that “a cure in homoeopathy means not only relieving the symptoms but eradicating the predisposition to a particular condition”, homoeopaths note.

Now, what does pharmaceutical drugs for depression do? They artificially increase the effects of brain chemicals known as neurotransmitters. But again, it only reduces the symptoms of depression. It does not address the root cause of depression.

Addresses the root causes However, homoeopathy does that: it addresses the root causes. Which is why homoeopathy is often seen 80 IN THE PINK 2017

as both art and science as the practitioner extracts information from the patient as to how he/she is feeling “emotionally and physically and then matches the best homoeopathic remedy to that patient”. Now, we leave it to you as to whether we have answered the original query or not.

Homoeopathy works Homoeopathy works for depression, note two of the most well-known homoeopathic consultants – Dr Deepak Sharma and his wife, Dr Anupam Sharma who jointly run the Dar Al Huda (Homoeocare) Clinic – in town. The duo, who are pioneers in the field of homoeopathy here and have seen more than 30,000 patients in over two decades, out of which a good percentage (*)are patients with depression. Dr Deepak has been practicing homoeopathy for 25 years in total, out of which 21 in Oman, while Dr Anupam, who has been practicing for 23 years in total, has put in 20 years in Oman.

They not only explained how homoeopathy is able to cure depression, but also cited examples where they have successfully cured such patients, including a 10-year old boy.

Excerpts: Can homoeopathy cure depression?

Is it effective? Could you explain how? Is it because the therapy is tailored to the patient?

Yes, a well selected homoeopathic remedy can help cure depression and it is a very effective way as there are no side effects. It is non addictive and cost effective. The main points to be considered here are: Homoeopathic remedies stimulate the body’s own healing capabilities. In homoeopathy, the physician seeks to treat the patient as a whole, which is considering the physical, mental as well as emotional make up and alterations there in diseases.

A homoeopathic consultation traces the origin of any disease to its beginning and thus a homoeopath not only can help in a diagnosed depression but many a times pick up the signs of depression in its budding stage and thus help even to prevent it by timely help.

Definitely in homoeopathy every treatment is tailored to the individual patient and there are no specifics in any chronic or deep-seated diseases like depression.

Homoeopathic remedies stimulate the body’s own healing capabilities. In homoeopathy, the physician seeks to treat the patient as a whole, which is considering the physical, mental as well as emotional make up and alterations there in diseases.

If homoeopathy can cure depression, then, why is it mostly underrated?

It is not underrated, there are many patients who take help of homoeopathy for their diagnosed depression, both who are already on prescribed medicines and want to withdraw as well as those who are diagnosed but do not want to take conventional medicines. And also as we stated before we do not cure diseases but diseased individuals as a whole.

Is depression cured by homoeopathy in conjunction with nutritional and/or hormone therapy?

If a patient presents with signs of a nutritional deficiency then definitely a homoeopath, as any other physician, recommends supplements and dietary modifications and different additional helpful techniques like yoga and

meditation along with homoeopathic medicines. There is no hormonal therapy in homoeopathy rather a rightly selected medicine helps the patients with hormonal imbalance to correct itself. A large number of cases in this regard are documented for example in hypothyroidism or a peri-menopausal patient, there is a marked improvement in the levels of hormones along with the symptomatic relief the patient enjoys.

Do you have any successful stories that we could cite as examples (of homoeopathic cure)?

There are numerous cases of total cures. Let us give you a couple: A 10year old boy with progressive vitiligo was extremely depressed due to social stigma and talking about life being useless and with no focus in studies, improved not just in his depression and concentration issues but even got cured of his vitiligo, completely.

A practicing medical specialist of menopausal age, suffering from severe depression was not only cured in mind but also in her other symptoms including headaches and heat flushes, and on lab investigation it was noted that her female hormonal profile, which was altered, became perfectly normal without any use of replacement therapy. (*) (Dr Deepak and Dr Anupam, both graduates in homoeopathy from Delhi University and post graduates from Irish School of Homoeopathy, Ireland, note that it is very difficult to give the exact number of patients with depression that they have seen “as every chronic disease patient has depression to a certain extent, which gets cured along with the disease as we treat the patient as a whole and it is a cure at every front which a patient enjoys when treated in homoeopathy�.)

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Sitting too much

is harmful to your health

Sitting is harmful?

How ridiculous!

That would be your first reaction if someone told you that sitting is harmful for you.

Well, too much sitting IS harmful.

Of course, sitting is a default human body posture. You work, you study, you travel, you drive, you socialise etc in a seated position.

It’s second nature.

So, sitting is not harmful in that sense of the word.

But, so is food. Is food harmful? No! But too much food?

Yes! So there you are. Too much of anything – even sitting – is harmful.

And today, it is said that sitting is the new smoking!

INCORRECT: Sit-bones pointing forward.

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INCORRECT: Sit-bones lifted up in back.

CORRECT: Sit-bomes pointing straight down.

ARE YOU

sitting too much?

More prone to sedentary behaviour Today, thanks to modernity, thanks to technology, we are more prone to sedentary behaviour than ever before. We spent a good portion of our day sitting. Look at the typical office worker: He or she may sit for an average 15 hours (*) per day as opposed to the other workers, who may in stark contrast be sitting only somewhere between three to five hours per day.

Waistline linked Your waistline is interminably linked to sitting. The longer you sit, the fatter you get, say health experts. Therefore, sedentary behaviour, of which sitting is the best example, is linked to obesity. Research have found out that obese people sit for an average of two hours more than their leaner counterparts.

Dying early Research has also shown that the more sedentary you are, the more likely you are to die early. The early death risk is placed between 22 to 49 percent.

Enough evidence Bottom Line: There is sufficient evidence to suggest that “the most sedentary people have a much greater risk of dying early� as per studies. (*) On the higher side

In-the-PINK walks away from sitting With so much evidence against sitting, In-the-PINK decided to highlight this problem in very lucid terms. Take a peek at this special poster and try to imbibe its essence.

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Health begins with a

Health officials in Oman have stepped up their efforts to urgently address the issue of physical inactivity in Oman. Given the rise in the prevalence of the NCDs (non communicable diseases) in Oman and the country’s commitment to global targets, this was of paramount importance, officials told In-the-PINK.

A year-long strategy is in place since December last and a simple, but striking slogan, “health begins with one step” has set the wheels in motion to this full-fledged nationwide effort to promote physical activity.

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In Oman, physical inactivity rate stood at 37 percent. This is a challege that needs to be tackled, says Dr Huda Khalfan Al Siyabi, director of community based initiatives department

Physically inactive Physical inactivity is the fourth leading cause of death in the world, according to the World Health Organisation (WHO) report 2008.

Globally, 28 percent of men and 34 percent women do not engage in any kind of physical activity, officials note, citing the report.

In Oman, the physical inactivity rate stood at 37 percent, according to the report.

This is a challege that needs to be tackled, officials across Oman say in unison and this is endorsed by both Dr Huda Khalfan Al Siyabi, director of community based initiatives department and Dr Amal Al Siyabi, head of community participation section, community based initiatives department. Dr Amal is also the rapporteur of the physical activity taskforce.

Leading risk factor of global mortality “Physical inactivity (engaging in less than 150 minutes of moderateintensity activity in a week) is one of the leading risk factors for global mortality. And data shows physical inactivity is responsible for 25 percent of the incidence of colon cancer and 27 percent of cases of diabetes and about 30 percent of cases of heart disease and coronary artery disease.

Directly linked to the sedentary life style is the growing burden of the

four major diseases under NonCommunicable Diseases (NCD), namely: cardiovascular diseases, diabetes, cancers and chronic respiratory diseases. This is the current health challenge not just in Oman, but globally too. Oman being a young nation, the impact would be more hazardous with a young population of over 70 per cent,” Dr Huda Al Siyabi told In-the-PINK. Nine global targets There is an increasing burden of obesity and obesity-related noncommunicable diseases; physically inactive adults are at an increased risk of obesity, type 2 diabetes and other nutrition-related noncommunicable diseases. In early 2015, the World Health Organisation (WHO) launched the Global Status Report on noncommunicable diseases 2014 in which countries were urged to accelerate action on nine voluntary global targets, including a 10 per cent reduction of insufficient physical activity.

Various reasons, cultural and lifestyle habits “The physical and social environment of Oman – with its high dependency on cars, inadequate infrastructure, hot arid climate, employment of domestic workers and cultural norms placing a low value on physical activity – inhibits engagement in physical activity,

particularly for women and older adults,” Dr Huda said.

“The other risk factors included inappropriate nutrition and unhealthy food habits, tobacco and alcohol indulgence/consumption. Lack of motivation, time and awareness still remains the number one factor amongst many regions. Family pressures, cultural limitations, and even lack of public amenities added on to the risks.

Oman has a unique cultural society and the climatic and lifestyle set up brings about it owns limitations, but that can be cleared through nationwide proper and intelligent awareness campaigns.”

WHO’s seven best investment areas for promoting physical activity Physical activity campaigns cannot be single-routed initiatives. The complete society and various authorities involved in the overall planning of community-based developmental programmes should be pooled in to actively participate for the betterment of the society.

As per the WHO strategy, the seven (7) investments can be as adapted to trigger and activate the physical activity awareness campaigns: Public awareness campaign Physical activity cannot be measured by a standard ruler. Any movement is considered as physical activity.

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Given the rising prevalence of noncommunicable diseases in Oman and the country’s commitment to the global targets, addressing physical inactivity was urgently required, says Dr Amal Al Siyabi, head of community participation section, community based initiatives department.

However if a strong and well planned awareness campaign can be put in place, the ball can be set to roll.

Empowering the public with the knowledge of the advantages and disadvantages of physical activity/ inactivity can go a long way.

School-based campaigns According to the 2010 survey, 81.4 per cent of girls and 74 per cent of boys under 18 years of age (school going) was found to be physically inactive. According to the WHO, a physical activity plan of one hour a day can be incorporated in the school curriculum, giving the opportunity for the young students to be safely and physically active during the schoolgoing timings.

Sports for all Physical activity does not mean taking part in sports and games. Not everyone can be an athlete or a sports person. However, if the authorities and nationwide initiatives can be put in place where the community can join in a sports for all campaign, the physical inactivity can be addressed on a mass level.

Public transportation plans Oman has a high dependency on cars for transportation and low dependency on public transport systems. If a shift can be caused towards the publics transportations, a change can be expected.

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Urban design Parks, walkways, bicycles, sidewalks, public systems and amenities with appropriate zebra crossings, should be put in place as supportive environment that promotes physical activity and walking, which will allow and persuade families to come out in public for cycling, walking and other related participating lifestyles.

Community involvement initiatives A conducive environment to be set upto live, play and educate involving physical activity groups that would promote, encourage and motivate physical activity.

Marathons, awareness walks, open days and related programmes can be scheduled.

Healthcare providers Heathcare providers are very much trusted by every community, more than any awareness campaigns. If the care providers can be trained and set to advise and promote every single patient to embrace walking and physical activity, it would be more result oriented.

Physical inactivity team in place Given the rising prevalence of noncommunicable diseases in Oman and the country’s commitment to the global targets, addressing physical inactivity was urgently required, Dr Amal noted.

A ‘physical inactivity’ team was put in place with a planned strategy for a year’s duration with active collaboration of relevant different

sectors and a national media marketing plan in January 2017.

‘Health begins with one step’ is the slogan for the year-long campaign to promote physical activity, which was launched on December 27, last year. “The main aim of this national campaign is to communicate specific and innovative messages about physical activity to inform, persuade and motivate people to be more physically active,”Dr Huda said.

The other objectives include: to increase awareness of the importance of physical activity, the facilities available in the community for being physically active, encourage communities to actively participate in sports and to increase the number of practitioners of physical activity in Oman.

The physical inactivity task force will lead the campaign in collaboration with the different partners from governmental, non-governmental organisations and volunteers. The campaign was launched under the auspices of Dr Ali Talib Al Hinai, undersecretary of planning, ministry of health and chairperson of the NCD committee with wide participation of members of parliament, decision makers from different sectors and prominent sports and social figures.

Social media like facebook, twitter, Instagram, local websites, and YouTube, and mass media (newspaper, magazine, TV, radio) will be used to convey the campaign

messages informed Dr Huda, who is also the secretary for the national physical activity task force.

“In addition we will use educational materials like posters, leaflets, banners to transmit messages to school age children and patients in primary health care setting. Other activities will be implemented in schools, health centers, shopping malls, movie theaters, public parks, sport clubs and OWA,” Dr Huda said.

of a healthy society and its community members. Good health is not limited as the responsibility of the health ministry, it should be the responsibility of every living being of the society we all live in, starting at home, to schools and colleges to work place to public arenas. Come, let us all join hands to take that one vital STEP forward, stand up and walk away from physical inactivity, the officials said.

Change is inevitable Life is all about change and moving forward. With all arms in tune with each other, a positive change can be brought about in the community, discouraging the sedentary lifestyle and promoting more physical activity.

Good health is not the absence of a disease, it is all about the well being

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SIMPLE OFFICE WORKOUT Neck

Abs

Chest

Oblique

Lower, Upper & Back

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Legs Triceps

The WHO on Physical Inactivity Key facts • Insufficient physical activity is one of the leading risk factors for death worldwide.

• Insufficient physical activity is a key risk factor for noncommunicable diseases (NCDs) such as cardiovascular diseases, cancer and diabetes.

• Physical activity has significant health benefits and contributes to prevent NCDs. • Globally, 1 in 4 adults is not active enough.

• More than 80 percent of the world’s adolescent population is insufficiently physically active.

• Policies to address insufficient physical activity are operational in 56 percent of WHO member states.

• WHO member states have agreed to reduce insufficient physical activity by 10 percent by 2025.

HOW MUCH OF PHYSICAL ACTIVITY IS RECOMMENDED? WHO RECOMMENDS: Children and adolescents aged 5-17years: • Should do at least 60 minutes of moderate to vigorous-intensity physical activity daily.

• Physical activity of amounts greater than 60 minutes daily will provide additional health benefits.

• Should include activities that strengthen muscle and bone, at least three times per week.

Adults aged 18–64 years: • Should do at least 150 minutes of moderate-intensity physical activity throughout the week, or do at least 75 minutes of vigorous-intensity physical activity throughout the week, or an equivalent combination of moderate- and vigorous-intensity activity.

• For additional health benefits, adults should increase their moderate-intensity physical activity to 300 minutes per week, or equivalent.

• Muscle-strengthening activities should be done involving major muscle groups on two or more days a week.

Adults aged 65 years and above: • Should do at least 150 minutes of moderate-intensity physical activity throughout the week, or at least 75 minutes of vigorous-intensity physical activity throughout the week, or an equivalent combination of moderate- and vigorous-intensity activity.

• For additional health benefits, they should increase moderate-intensity physical activity to 300 minutes per week, or equivalent.

• Those with poor mobility should perform physical activity to enhance balance and prevent falls, three or more days per week.

• Muscle-strengthening activities should be done involving major muscle groups, two or more days a week.

• The intensity of different forms of physical activity varies between people. In order to be beneficial for cardio respiratory health, all activity should be performed in bouts of at least 10 minutes duration.

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Statistics reveal that 40 per cent children under five years and 27 per cent of pregnant women are found to be anemic. There is data on bad nutrition, including underweight, stunting, overweight and obesity.

The term under nutrition/bad nutrition is increasingly used to designate malnutrition that is due to a lack of food or nutrients. Another exhaustive survey was required to find out the causes of anaemia, deficiency of vitamins, prevalence of thalassaemia, food habits of pregnant woman, mothers and children and other anaemia-related disorders

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National nutrition survey results to be out by this September or October The general purpose of every health research is to generate knowledge that can be used to promote, restore, and maintain individual health, thereby ensuring a healthy community

The MoH, under the department of nutrition, has launched an exhaustive and strategic nationwide nutrition survey spanning 11 governorates and targeting 4000 Omani households with an aim to investigate and arrive at the latest causes of anemia in children and pregnant women, noted Dr Samia Shtayet Al Ghannami, director of nutrition department, MoH.

The Oman National Micronutrients Survey/Food Fortification Study in 2004 revealed, among other things, that 40 percent of children underfive years and 27 percent of pregnant women were anaemic.

That, as said, was in 2004.

This year, the Ministry of Health (MoH), under the department of nutrition, has launched a nationwide nutrition survey (ONNS), the results of which are scheduled to be out by September or October. What will the survey results reveal?

In-the-PINK speaks to Dr Samia Shtayet Al Ghannami, director of nutrition department, MoH to find out more details: Nutrition survey for awareness of nutritional deficiencies The MoH, under the department of nutrition, has launched an exhaustive and strategic nationwide nutrition survey spanning 11 governorates and targeting 4000 Omani households with an aim to investigate and arrive at the latest causes of anaemia in children and pregnant women.

The survey was launched on December 4, last year.

The general purpose of every health research is to generate knowledge that

can be used to promote, restore, and maintain individual health, thereby ensuring a healthy community, noted Dr Samia Ghannami.

Fully trained 11 survey teams The MoH organised 11 survey teams, comprising seven fully trained members in each team. Their duty was to conduct direct interviews, filling in an exhaustive questionnaire to collect data from basic details to anthropometric measurements (to assess the size, shape and composition of the human body),collecting blood samples etc pertaining to a successful data collection, concluding the basic survey in April 2017.

“The 11 teams were properly trained, plus we made various announcements to publicise the survey through various

public and social media platforms, informing the communities, the Wali offices, the Royal Oman Police (ROP) authorities of the region to make this survey purposeful and complete. The public were quite cooperative and hence our teams could complete the data collection. Currently we are at a stage of entering the data collected.

The 4000 households were selected and prefixed well in advance at the planning level, making it practical for the survey teams to approach them directly. It took the MOH departments over two years of planning and research to set the survey in motion,�

Dr Ghannami noted.

Rigorous training programmes The survey teams were put through a rigorous training process that 2017 IN THE PINK 93

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Data says a low 16 percent breast feeding over the last 10 year period and various other reasons could be attributed to under nutrition and anaemic tendencies.

included three days of classroom instruction and practice and two days of field testing of all survey procedures, including interviews, examination for edema, examination for signs of rickets, anthropometric measurement, and collection and processing of blood specimens. Team leaders were identified during the training and their names announced at the end of training. As a result, team leaders participated in the whole survey worker training and had an additional special session at the end of the training. Seventy MoH staff from the 11 governorates participated in the training and pretesting of the survey, Dr Ghannami noted.

10 households per day Each interviewer was responsible for interviewing respondents for 10 households per day, and the phlebotomist for collecting blood specimens from the participants in 10 households per day. The field work in each governorate was completed in approximately three months. Data collection occurred simultaneously in all governorates.

Unicef technical support Dr Ghannami said that the MOH provided the resources for blood processing, including laboratory space and laboratory technicians and facilitated the daily shipment of whole blood specimens from the field to the governorate hospital laboratories.

“The MoH also appointed a principal investigator and co-principle investigator and a survey coordinator to manage the process.

The Unicef provided the technical support for methodology and 94 IN THE PINK 2017

questionnaire development, data analysis and report writing for the survey,” she said.

Survey results to be out in October 2017 “The survey report is scheduled to be distributed to professionals working in the field of nutrition, health, academia, and policy in Oman by September/ October this year. In addition to the printed version, an electronic PDF version will be published on the websites of the participating agencies,” Dr Ghannami informed.

2004 survey results Forty percent children under five years and 27 percent of pregnant women are anaemic! The last Oman National Micronutrients Survey/Food Fortification Study was conducted in 2004. After assessing the impact of that fortification programme, the MoH moved forward with its plan of the latest survey with the aim of providing data for improving

nutrition programmes,” Dr Ghannami explained.

“The 2004 statistics revealed that 40 per cent children under five years and 27 per cent of pregnant women were found to be anaemic and had data on bad nutrition, including underweight, stunting, overweight and obesity. The term under nutrition/bad nutrition is increasingly used to designate malnutrition that is due to a lack of food or nutrients.

Another exhaustive survey was required to find out the causes of anaemia, deficiency of vitamins, prevalence of thalassaemia, food habits of pregnant woman, mothers and children and other anaemiarelated disorders,” Dr Ghannami noted.

Potential reasons It is very challenging to analyse data without fully knowing the cultural aspect of the community, the daily schedules, food patterns and various other variants of the community, Dr Ghannami pointed out. “The earlier data stating the under nutrition and anaemic tendencies could be because of many reasons: From lack of awareness to bad food habits to working women etc. It could be also genetic in nature. Data says a low 16 percent breast feeding over the last 10 year period and various other reasons could be attributed to this trait, from new working women, education, availability of formula milk brands in market etc.

Hence the need for a comprehensive nutrition survey came up. Without right data and evidences, we cannot arrive at a more accurate nutrition figure,” she noted.

The ONNS Rationale and Alignment with National Priorities Although several surveys provided prior assessments, there is limited data available about a number of nutrition conditions on the national level and no data available at the governorate level. The last nutritional survey was carried out over eight years ago and only provided limited coverage and data.

Moreover, the contribution of various risk factors to both under nutrition and over nutrition have not been systematically assessed. This data is needed for programme planning for the Ninth (9th) five-year Health Development Plan (2016 – 2020) and will be used to evaluate the Eighth (8th ) five-year Health Development Plan (2011 – 2016) and will support Oman’s policy makers in identifying new priorities, formulating new nutrition interventions, and improving existing health programmes.

ONNS Goals The goal of the survey is to determine the type, prevalence, and severity of nutritional deficiencies and excesses in the population in order to formulate policy and design appropriate interventions. In specific the ONNS seeks to: 1. Assess the nutritional status of specific subgroups of the Omani population in i) children under 5 years of age, ii) non-pregnant women of child-bearing age, and iii) pregnant women 2. Estimate the frequency of intake of selected foods rich in specific micronutrients 3. Assess risk factors for obesity in pre-school children and adult women 4. Evaluate infant and young child feeding, including breastfeeding and complementary feeding 5. Assess the level of morbidity in children

6. Assess the relative importance of selected likely causes of anaemia 7. Evaluate the programmes fortifying wheat flour and edible oil in Oman 8. Assess other aspects of the health status of these population subgroups The measurement indicators will be adjusted per target group. Additional variables which may influence various types of malnutrition or play a contributory role will also be assessed. Such additional variables include assessment of socio-economic status, household food consumption patterns, infant feeding and breastfeeding practices, intake of micronutrient supplements, and household sanitation and hygiene.

Planned activities Implementation of the survey was launched in December 2016 and final results are expected to be disseminated in the last quarter of 2017.

Dissemination: The survey report will be printed and distributed to professionals working in the field of nutrition, health, academia, and policy in Oman. In addition to the printed version, an electronic PDF version will be published on the websites of the participating agencies. Following the completion of the survey report, ONNS results will be presented and discussed in a workshop for stakeholders, including representatives of the Government of Oman, donors, and the private sector. This workshop will serve to disseminate the survey results and create awareness of nutritional deficiencies and the programmes that can be employed to address these deficiencies.

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Diseases of affluence: a global challenge!

National Survey for Non-Communicable Diseases (NCDs) will help provide accurate data that will help in developing the burden of the disease and the risk factors

There is a great need to control NonCommunicable diseases to reduce complications and premature deaths, stresses Dr Adhra Al-Mawali, director, Centre of Studies and Research.

National Survey for NonCommunicable Diseases (NCDs) Oman, as in other parts of the world, is witnessing an epidemiological shift to Non-Communicable Diseases (NCDs), which are responsible for the increased number of disability and premature deaths, according to a top health official.

“The whole world is threatened by the fact that from 56.4 million deaths occurring globally in 2015, the NCDs were responsible for 39.5 million (70 percent of all deaths – according to the WHO, 2015).

“Especially in developing countries, the burden of NCDs is increasing rapidly and will have significant social, economic, and health consequences.

By 2030, these figures are expected to be around 52 million deaths.

Approximately 42 percent of all NCD deaths are premature, occurring before 70. The majority of premature deaths (82 percent) are in low and middle income countries,” Dr Adhra Al-Mawali, director, Centre of Studies and Research, directorate general of planning and studies at the Ministry of Health (MoH) explained with information made available to In-thePINK. “In Oman, these are mainly cardiovascular diseases, cancer, diabetes, chronic renal diseases and chronic obstructive pulmonary 96 IN THE PINK 2017

diseases (COPD), which were responsible for more than 68 percent of total deaths.”

Global epidemic Dr Adhra Al-Mawali notes that these diseases “are a result of a global epidemic of modifiable and preventable behavioural and biological risk factors among the Omani population such as smoking, unhealthy diet and physical inactivity.

“As a result, there is a steep increase in the rates of obesity (24 percent), diabetes (13 percent) and high blood pressure (40 percent)”.

In Oman, 84 percent of adolescents lack physical activity.

Great need to control the diseases There is a great need to control these diseases to reduce complications and premature deaths, Dr Adhra stressed.

“This can only be achieved through identification of the most important risk factors. In this regard, the WHO delegation monitoring the countries under the WHO Regional Office for the Eastern Mediterranean visited Oman in April last year (2016) to evaluate for NCDs and their risk factors.

“It (Oman) was chosen as one of the 12 countries in the world to be evaluated and monitored for reducing and preventing the spread of NCDs and their risk factors. So, there is a political

will to fight this epidemic,” Dr Adhra says in this message.

Aim to quantify burden of NCDs Thus, it was with this aim to quantify the burden of NCDs and their risk factors that the MoH had conducted a ‘NCDs and their risk factors’ survey in cooperation with the WHO. The survey will help provide accurate data that will help in developing the burden of the disease and the risk factors due to the NCDS, Dr Adhra said. “This will be useful in formulating new policies for timely intervention and management of NCD. “It will also be used to establish a national database and registry for these widespread diseases of affluence!”

NCD nationwide survey – main objective Dr Adhra, who is also the principal surveyor of the national survey of NCDs, further noted that the main objective of the survey is to establish a national baseline data for NCDs and community food patterns; to provide a platform for the establishment of a system to monitor NCDs and to make informed decisions based on evidence.

The study population The sample was designed

to

In Oman, cardiovascular diseases, cancer, diabetes, chronic renal diseases and chronic obstructive pulmonary diseases (COPD) were responsible for more than 68 percent of deaths. be multistage stratified random sampling (according to geographical distribution and nationality [Omani/ Non-Omani]) as a cluster sample (based on the 2010 census blocks) and systematic equal number of blocks chosen from each governorate.

Approximately, 9000 households were selected (Omani and nonOmani) and one adult was selected from each household randomly.

Study phases The Phase I consisted of updating of population settlements, and preparing a list of households in each block by nationality and language to choose the survey sample in each governorate.

The Phase II consisted of three steps - data collection and conducting individual interviews with a family member starting from 15 years, physical measurements (height, weight, waist, and blood pressure) and biochemical measurements (blood sugar, cholesterol and creatinine).

Information on the use of tobacco, including current and former, smoking of different types of tobacco, use of alcohol, duration and amount of use was sought.

The dietary practices and habits, including eating fruits and vegetables, the use of table salt, oils used in cooking and for other purposes at home and exercises was also enquired.

This survey, which had commenced in mid-February consisted of 11 teams – one in each governorate of Oman. A total of 9053 households of Omani’s and Non-Omani’s identified through advanced epidemiological methods were visited from all over Oman to collect medical information in three steps.

Step one comprised a demographic and lifestyle questionnaire whilst step two involved physical examinations such as height, weight, and blood pressure. The final step three included biochemical measurements such as blood glucose, total cholesterol, urine sodium and creatinine levels.

National database for NCDs The survey is designed to create a national database for noncommunicable diseases.

• It will provide a platform for the establishment of a surveillance system of the major non-communicable diseases, and the risk factors associated thereof in the Sultanate.

• It will estimate the tobacco use among adults in the Sultanate.

• It will develop a strong framework for monitoring, following-up

and evaluation to see the extent of implementing these policies in consistency with the WHO framework and provide regular reports to the ministries, and national health agencies, and international organisations on progress in nutrition interventions, and in the field of noncommunicable diseases.

The processing and preparation of the national survey of NCDs began two years ago after the issuance of the ministerial decree no. (176/2015) by the minister of health and the formation of a working group headed by the Centre of Studies and Research.

NCDs account for 68 percent of total deaths in Oman Non-communicable diseases (NCDs), the leading cause of death globally killing 38 million people every year, accounts for 68 percent of total deaths in Oman, according to Dr Adhra.

“Of these deaths, cardiovascular diseases (CVDs; predominantly heart attacks and stroke) account for 33 percent, diabetes and cancer account for 10 percent each, and chronic respiratory diseases account for two

Fieldwork completed by May By the end of this May, the CSR announced that it had completed the fieldwork component of this national survey.

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2000

RISK FACTORS

2008

24%

INACTIVITY

24-13%

8.7%

TOBACCO INTAKE

24-13%

33%

BLOOD PRESSURE

11.6%

BLOOD GLUCOSE

12.3%

40.6%

CHOLESTEROL

35%

EVERY YEAR percent, reveals Dr Adhra. “In total, 18 percent of 30 to 70 year olds in Oman have a high probability of dying from these four NCDs,” Dr Adhra said, quoting from her article, ‘NonCommunicable Diseases: Shining a light on cardiovascular disease, Oman’s biggest killer’, which she had published in the Oman Medical Journal (2015) (*).

Number one killer The CVDs are the number one cause of death globally: more people die annually from CVDs than from any other cause. “An estimated 17.5 million people died from CVDs in 2012, representing 31 percent of global deaths. Of these, an estimated 7.4 million were due to coronary heart diseases (CHD) and 6.7 million were due to stroke.

“Over 80 percent of CVD deaths take place in low and middle income countries. Of the 16 million deaths under the age of 70 were due to NCDs, 37 percent were caused by CVDs,” Dr Adhra said. “And, in Oman, CVDs are the leading cause of death – around 30 percent – of all MoH hospital deaths,” she noted.

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40% (30% don’t know they have BP)

1300 NEW CASES OF CANCER IS REPORTED.

CVDs dominate future mortality rates The World Health Organisation (WHO), had in its earlier report reiterated that CVDs will continue to dominate mortality rates in the future. “Mortality rates are usually linked to epidemiological transitions, which Oman has seen a considerable amount of in the past 25 years. There exists an uneven distribution of ageadjusted CVDs mortality around the world with the lowest rates in advanced industrialised countries and parts of Latin America.

“This could be attributed to a reduction in the burden of CVD and improvements in lifestyle-related risk factors associated with CVDs in these countries. Hence, age-adjusted mortality rates are higher in Oman and Saudi Arabia, compared to the countries like Japan, France and the United States. The highest mortality rates are in Eastern Europe and a number of low and middle income countries.”

Hypertensive heart diseases are the main form of all CVDs in Oman,

accounting for 71 percent, whilst ischemic heart disease is the foremost cause of CVDs death globally.

Acute coronary syndrome – highest “The incidence of acute coronary syndrome among Omanis is one of the highest in the world with a crude incidence rate of 338.9 per 100,000 person-years. This could be attributed to the changing lifestyles of Omanis and hence greater susceptibility to cardiovascular risk factors.

Individuals with hypertension, diabetes mellitus, a family history of CHD, dyslipidemia and those working with sedentary occupation were found to have a high risk of CHD, dyslipidemia, and those working in sedentary occupations were found to have a high risk of CHD. “ Congenital heart diseases, a range of birth defects that affect the normal functioning of the heart, also form an important component of heart disease in Oman. With an incidence of 7.1 per 1000 births, congenital heart disease accounts for around five percent of all congenital disorders.

Non-communicable diseases (NCDs), the leading cause of death globally killing 38 million people every year, accounts for 68 percent of total deaths in Oman. Of these deaths, cardiovascular diseases (CVDs; predominantly heart attacks and stroke) account for 33 percent, diabetes and cancer account for 10 percent each, and chronic respiratory diseases account for two percent

According to the WHO: NCD Of 56.4 million global deaths in 2015, 39.5 million, or 70 percent, were due to noncommunicable diseases (NCDs).

The four main NCDs are cardiovascular diseases, cancers, diabetes and chronic lung diseases.

The burden of these diseases is rising disproportionately among lower income countries and populations.

In 2015, over three quarters of NCD deaths -- 30.7 million -- occurred in low- and middle-income countries with about 48 percent of deaths occurring before the age of 70 in these countries.

The leading causes of NCD deaths in 2015 were cardiovascular diseases (17.7 million deaths, or 45 percent of all NCD deaths), cancers (8.8 million, or 22 percent of all NCD deaths), and respiratory diseases, including asthma and chronic obstructive pulmonary disease (3.9 million).

Diabetes caused another 1.6 million deaths.

LIFESTYLE

Minimise Risk of Cardiovascular Disease

Your lifestyle is the best defence against heart disease and stroke. A heart healthy lifestyle includes some of the ideas below

LIMIT Food with extra sugar added, canned fruit, refined white flour/grains, donuts, saturated fats & transfats, full-fat dairy, egg yolks, fried meats, nuts with oil, canned soups and salted foods

EAT Fresh fruits & vegetables, whole grains, low-fat dairy, egg whites, lean ground meat, raw nuts, reduced-salt snacks, salmon, ground flaxseed, oatmeal, almonds, broccoli and blueberries.

EXERCISE 30 to 60 minutes of routine daily activity for at least 150 minutes of moderate intensity physical activity per week.

• More than 10 percent of youth (13 – 15 years) use tobacco products (16 percent boys and 5 percent girls), while 12 percent have been affected by passive smoking.

• The annual per capita average consumption of pure alcohol in those aged over 15 is 0.9 litres (1.2L in males and 0.4L in females).

• The prevalence of insufficient physical activity in adolescents is 84 percent (77 percent in boys and 90 percent in girls).

• Raised blood pressure in adults is seen in 40 percent of the population (50 percent in males and 30 percent in females).

• Obesity is seen in 22 percent of the population (19 percent in males and 26 percent in females).

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Beyond that great Everyone thinks having a good oral hygiene is to have a great smile!

That is just the tip of the iceberg, so to speak.

Having a good oral hygiene means avoiding a variety of dental and medical problems.

And, these include gum diseases, infections, bone losses, heart diseases, strokes etc.

What you need to do prevent these problems is to ensure that you have regular check ups and cleanings.

And it all starts with the simplest of action: brushing your teeth properly!

And, well, if you do consider these few tips, it is going to take you a long way in maintaining good oral hygiene. And, you bet, you are going to have a great smile too!

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SMILE...

Good brushing habits The easiest thing in the world is to keep your pearlies clean. And for that, the first thing to do is to brush your teeth well. In other words, brush right.

How do you brush right? Simple: Take your brush, position it at an angle of 45 degrees and make sure that your bristles cover both the gum line and the tooth surface.

To floss or not to floss Okay, for the unitiated, flossing can REALLY help remove food particles and other substances that normal brushing cannot. It is recommended that flossing is done at least once a day. Possible?

Stub the habit No, this is NOT about anti-smoking in that sense of the word, or maybe, it is.

It is not a joke that so much of noise is made, even in this advertisement crazy world about why you should not smoke. You should not smoke because you will get oral cancer!

Now, if that does not scare you, we do not know what will.

Coffee, sodas etc in moderation The tried and tested advice is everything in moderation and the same goes for coffees, sodas and other such beverages. Most beverages have additives that can make your teeth look dull and discoloured. Of course, coffee and sodas do contain phosphorous, which is good for the mouth, but then, too much of it can also deplete the calcium level.

Visit your dentist Yes, at least twice a year and get the full works. It is a MUST. Mouthwash too Of course, we know that not all mouth washes are useful. But, go for those containing Listerine and/or chlorine dioxide. If you are burshing, flossing and making twice a year visits to your dentist, mouthwash would be the cherry on top. Got it?

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Comparative analysis of health insurance products in Oman A health insurance premium pool can be created out of the premium received from the entire population on a mandatory basis

Dr J Retnakumar, chief executive officer, Insurance Services Centre (ISC), gives his perspective on compulsory health insurance in Oman and has also done a comparative analysis of health insurance products here.

“Oman is having an estimated population of 4.3million, of which 60 percent are Omanis. As per the statistics from the Capital Market Authority (CMA), which is the controlling authority for insurance business in Oman, the medical premium for 2015 was OMR102.5 million.

“As per the products available in Oman, the concentrations are mainly on group policies taken by the employers to cover their employees and the minimum premium cost is OMR100 to OMR150 per person for an annual sum insured of OMR5000 and depending on the levels of coverage, deductibles and claims experience,” he says in the research report, ‘Comparative Analysis of Health Insurance Products of the Sultanate of Oman’.

Only one-third coverage “The proportion of the population versus total premium generated from this product leads to the fact that only one-third of the population is currently covered under medical insurance.

“Omanis are covered for treatment facilities in government hospitals and hence not provided with medical insurance by many of the private sector employers. But considering the waiting period and non availability of 102 IN THE PINK 2017

services in a satisfactory manner, the local population would also like to have better insurance benefits, which will enable them to utilise private healthcare services as well.

And, with the expatriates, the creamy layers can afford health insurance but the blue-collar workers are deprived of such benefits because of the cost involved and also because it is not mandatory as yet.

In Oman, the local population were mainly deprived of the benefits of medical insurance by many employers citing that they are eligible for free facilities in government health centres and hospitals.

Difficulties involved The local population are currently facing these difficulties: * Delayed treatment. Because of the lack of facilties, the waiting time has increased. * Those from Oman are availing of medical tourism in other countries. As per the Tourism Authority of Thailand (TAT) Dubai and Middle East office, last year, more than 80,000 Omanis travelled to Thailand, with 80 percent of these making the journey for treatment. * Oman imports more than 93 percent of its medical supplies, including essential laboratory and surgical equipment and pharmaceuticals. The

Sultanate’s dependence on imports threatens the sustainability of Oman’s healthcare system.

“Often the low-income expatriate population (whose employers have not provided medical insurance) in the country have not been able to meet the immediate emergency medical expenses itself. They are forced to depend upon social workers and the embassies concerned to help them to settle their bills and to facilitate their travel to their native country after availing immediate treatment,” Dr Retnakumar noted in his report.

Key findings Dr Retnakumar, in his review, also identified certain key findings, which he says necessitated the need for unified health insurance policy in Oman and additional coverage to the unified health insurance policy, which can be purchased by the buyers by paying additional premium.

“To ensure affordability of premium to all residents including local and expatriates, all should be covered under a mandatory health insurance at the time of entry to Oman or at the time of renewal of their work permists or resident cards.

The basic health cover should be sold by all insurance companies with the minimum sum insured for OMR1000/2000.

“Healthcare services can be delivered by private hospitals as well as government hospitals. For those members who require wider covers, increased sum insured, geographical extensions, etc., they can purchase the additional health insurance plans separately from the insurance companies by paying additional premium, subject to the acceptance norms of the insurance company.”

Create health insurance premium pool Dr Retnakumar noted that the unified health insurance policy should be recommended to the government as mandatory. “This is so to have the benefit of the law of large numbers (*) in insurance to have a viability portfolio for insurance companies and to ensure smooth running of the product.

“A health insurance premium pool can be created out of the premium received from the entire population on a mandatory basis and this premium and claims can be shared by all participating health insurers depending upon their portfolio percentage. These health insurers only can sell additional health insurance plans for additional covers as per purchasers’ needs.” (*) A principle of insurance.

Numerous benefits in implementing mandatory health insurance Dr Retnakumar explains in detail about the various benefits of mandatory health insurance to the PINK health magazine.

Excerpts: Could you please explain how beneficial it would be to have compulsory health insurance? Will it boost the quality of health among people here and will it also keep people from travelling abroad for treatment?

The healthcare costs are escalating everyday. With this increasing trend, it becomes very difficult for both Omanis and expatriates to avail quality healthcare at affordable prices in private hospitals. Omanis are covered for free treatment at government hospitals. However, the waiting period has increased due to the increase in number of patients and limited number of centres in Oman. Regarding expatriate bluecollar workers, many a time they are unable to meet the immediate emergency medical expenses and have to depend on philanthropist organisations or social workers or respective embassies to settle their hospital bills and to facilitate their travel to native countries. If medical

Oman to launch mandatory medical insurance in 2018 Oman is planning to implement mandatory medical insurance cover for private sector employees by next year (2018).

Currently, the government is carrying out a study for implementing medical insurance for both Omanis and expatriates in the private sector.

According to the Oman Chamber of Commerce and Industry (OCCI), this plan will be implemented in stages. The plan is expected to be implemented over several phases and the OCCI hopes it can be rolled out by early 2018. The first phase will involve consultation with companies that have more than 100 employees to ensure cover for all staff. This phase is expected to start in early 2018.

Under the plan, the second phase will include companies, which have between 50 and 100 employees.

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When the insurance scheme is compulsory, based on the law of large numbers, the per person premium will also be very low.

The insurers are also benefited as there is no adverse selection of risks, since all are covered.

insurance is made mandatory, the residents of Oman can avail better health facilities as the medical expenses will be met by the respective employers subject to the sum insured under the policy. More and more number of specialised centres (centre of excellence-tertiary care centres) will be established in Oman to cater to the medical needs of the entire insured population.

Innovative medical insurance products need to emerge out and more number of health insurance companies need to be introduced in Oman. With these developments, the population will slowly start depending on Oman for their secondary/tertiary healthcare in these specialist centres. Also, it will restrict people from travelling abroad if these specialist centres offer quality services at affordable prices to the population. There is also a need to have a regulatory authority comprising medical doctors and insurance professionals to ensure the quality of healthcare as well for redressing the grievances of the insured population.

How do you think compulsory health insurance – for both Omanis and expatriates - should be introduced to Oman?

A unified medical insurance for a simple coverage (say OMR2000) per annum for all residents of Oman need be designed and implemented 104 IN THE PINK 2017

on a mandatory basis, keeping the premiums as low as possible so as to be within the paying capacity of all residents.The low-income group can be given coverage on a reduced premium. The terms and conditions of such policy need to be simple and also the same for all. And, most importantly, it needs to be customer friendly. When the insurance scheme is compulsory, based on the law of large numbers, the per person premium will also be very low. The insurers are also benefited as there is no adverse selection of risks, since all are covered.

The CMA, which is the insurance regulator, can think of creating a health insurance pool, which can be shared by the participating insurers on a percentage for premium and claims.

The participating insurers only can also sell additional health insurance plans with more comprehensive coverage as well other need-based innovative covers.

A chain of family clinics need to be established throughout Oman to cater to the outpatient services at very simple medical care costs apart from the other clinics available.

These clinics can be included in the service provider network of insurance companies for efficient implementation of the insurance scheme.

(Dr Retnakumar has around three decades of service in the insurance sector, as an insurer and insurance intermediary in India as well as well Oman. He served as the Ceo of the Oman operations of VPS Healthcare -- Lifeline hospitals in Oman -- and also as head of Oman operations of New India Assurance Co. Ltd. At the NIA, he was instrumental in taking the company to the top slot as the best brand among all foreign insurance companies in Oman in 2009.

As Ceo of Gargash & Tradelinks Insurance services in Oman, he was instrumental in organising a medical insurance workshop titled ‘Medical Insurance – Problems, Solutions and Challenges’ at the Oman Chamber of Commerce and Industry in 2011.

In 2014, as Ceo of VPS Healthcare, he was instrumental in organising another symposium titled ‘Universal Health Insurance – Oman Perspective’ with insurance specialists leading the symposium from India, Saudi Arabia, the UAE and Oman. This was done under the patronage of the Ministry of Health, Oman. This year – 2017 -Dr Retnakumar did the comparative analysis of health insurance products in Oman; it was done under the guidance of the College of Banking and Financial Studies.

Contact: ceo@isc-oman.com)

HAND GUIDE to PORTION CONTROL Look at your fingertip. That’s about a teaspoon or how much butter your toast needs.

Limit biriyani servings to 1/2 cup or about the front of your clinched fist.

The recommended serving size of meat is 3oz., roughly the size of your palm.

Your thumb from knuckle to tip, is about the size of a tablespoon. Double it for a single serving of peanut butter.

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Worldwide estimates suggest that demand for knee-replacement operations could rise by 600 per cent by 2030 in tandem with rising obesity levels

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Too much weight can damage knees People in Oman are considered the most common sufferers of degenerative knee problems in the world.

Obesity and overweight was a precursor to knee-related problems. Carrying too much body weight can do real damage to the knees, as well cause a lot of pain, Dr Krishnakumar, orthopaedic specialist, said.

Old and ailing individuals could do well to avoid kneeling, which would damage their knees, according to a senior orthopaedic specialist in town.

Noting that knee arthiritis problems were common in Oman, Dr C. V. Krishnakumar, orthopaedic specialist, Gulf Specialised Hospital, said: “Squatting is a major issue, as well as kneeling. These should be discontinued when a person gets older.” Obesity and overweight was a precursor to knee-related problems.

Carrying too much body weight can do real damage to the knees, as well cause a lot of pain, he added.

Exercise not part of culture Obesity and overweight in Oman was rearing its ugly head primarily due to the lifestyle. “Most Omanis have abandoned the physical labour of their forefathers for the western systems of earning, using machines and computers thus putting on fat.

Exercise is sadly not a part of the Omani culture, though football has great patrons in Oman,” Dr Krishnakumar said, adding that the football players are mainly “weekend warriors, with poor quads tone, therefore having more knee injuries”.

Lack of gym culture Dr Krishnakumar also lamented on the lack of a gym culture amongst

Omanis. “So, it is imperative that this is promoted in Oman!”

He also agreed that people in Oman are the most common sufferers of degenerative knee problems in the world.

Obesity and sedentary lifestyles are main culprits While the prime reason for this is obviously obesity, which is a welldocumented risk factor for the development of osteoarthritis, a sedentary lifestyle was also a culprit.

Dr Krishnakumar agreed to the reports that worldwide estimates suggest that demand for knee-replacement operations could rise by 600 per cent by 2030 in tandem with rising obesity levels. He also noted that “Omani women are suffering from obesityrelated knee problems”.

Mode of prevention Dr Krishnakumar said that there were ways and means to bring more awareness and bring about a mode of prevention with regards to kneerelated problems. “Ladies should have minimum sun exposure inside their own houses in order to get proper bone strength. The need for 2017 IN THE PINK 107

exercise should be incorporated into school text books. Football players should get adequate quads exercises to prevent knee damage,” he said.

Post-surgery success Dr Krishnakumar was positive about the post-surgery situation for those undergoing knee-replacement surgery.

He said that the recovery process

108 IN THE PINK 2017

could take upto three months depending on the patient. “If done successfully, it will last 15 years. But yes, some will fail and resurgery would be required.”

Knee-replacement getting popular Referring to media reports, which had noted that “at least 20 per cent of the Omani population between the ages of 40 and 70 will require compatible

knee joint replacement” and that “more than 50 percent of the elderly population in the country is suffering from arthritis, Dr Krishnakumar said that there were chances that this could be true. “Yes, it maybe correct. But, the fact is that only when certain services are popularised and affordable, people will come in search of it. Knee replacement is now gaining popularity, so more will ask for it.”

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Obesity and Arthritis: Two sides of the same coin Statistics reveal that obesity is increasing in Oman with females reaching about 35 to 40 percent and males around 27 to 30 percent.

“Obesity plays an important role in the wear and tear of articular cartilage of the knee joint. Studies note that a pound of overweight adds up to four pounds of pressure or exertion on the knee,” says Dr Dayanand Kaliaperumal, specialist orthopaedic surgeon.

Prevention of knee-related problems requires one to first leap over the obstacle of overweight and/or obesity, notes a specialist orthopaedic surgeon of a local private hospital.

And that is a major hurdle as obesity rates are soaring. Obesity plays an important role in the wear and tear of articular cartilage of the knee joint. Studies note that a pound of overweight adds up to four pounds of pressure or exertion on the knee (as knee is the major weight-bearing joint).

Statistics reveal that obesity is increasing in Oman with females reaching about 35 to 40 percent and males around 27 to 30 percent.

Therefore the role of obesity in kneerelated problems is well established.

Basically, arthritis of the knee is the wear and tear of the knee joint, which happens with age. “It usually happens in people above 65 years of age.

But it also can happen in younger individuals, say around 40 years,” Dr Dayanand Kaliaperumal, specialist orthopaedic surgeon, Al Hayat International Hospital said, in remarks made to In-the-PINK. Arthritis can be divided into primary and secondary arthritis. Primary arthritis occurs mainly due to the wear and tear of articular cartilage and secondary arthritis is 110 IN THE PINK 2017

due to trauma, gout and inflammatory conditions like rheumatoid arthritis.

“The quality of the cartilage also plays an important role in whether the degeneration occurs early or late,” explained Dr Dayanand.

Are knee arthritis problems very common in Oman; if so, why? Has it to do with obesity and/or kneeling lifestyle issues? What are the other contributing factors?

Yes. Arthritis of the knee is becoming a common problem in Oman. Obesity plays an important role in the wear and tear of articular cartilage of the knee joint. It has also been shown in studies that a pound of overweight adds up to four pounds of pressure or exertion on the knee (as knee is the major weight-bearing joint). The second cause can be excess fat, which can also cause inflammatory changes on the articular cartilage adding to its degeneration and damage.

Some are of the opinion that people in Oman are common sufferers of degenerative knee problems in the world – is this true? Also, are those in the Middle East the biggest sufferers; if so, what is the prime reason for this? Is it only obesity, which is a well-documented risk

factor for the development of osteoarthritis? And is sedentary lifestyle also a culprit?

I am not sure if Oman is one of the major sufferers in degenerative arthritis. Nor do I think that people in the Middle East are the major sufferers. But, seeing the statistics of obesity increasing in the Middle East, I assume that osteoarthritis could be a major problem in Oman. Of course, sedentary lifestyle could play a major role.

What percentage – roughly -- of knee replacement operations in Oman are weight-related?

Worldwide estimates suggest that demand for knee-replacement operations could rise by 600 per cent by 2030 in tandem with rising obesity levels. Is this true?

Statistics have shown that obesity is really increasing in Oman with females reaching about 35 to 40 percent and males around 27 to 30 percent.

Therefore, it is safe to conclude that obesity must be playing an important role in degenerative osteoarthritis.

But, I am not really sure as to how many knee replacements are weight related.

What are the ways and means to bring more awareness and bring

Normal Joint

Osteoarthritis Cartilage

bones rub together

Synovial membrane

about a mode of prevention with regards to this? What are your thoughts on finding solutions for the same?

We should increase people's awareness by explaining serious consequences of obesity and degeneration of the articular cartilage.

Once started, these changes will be progressive and cannot be reversed easily. Immediate diet planning, exercises as advised by physicians and especially the younger crowd and children in school-going age to avoid junk food.

Junk food and sedentary life style is the major cause for obesity, which has to be first corrected.

What about the post-surgery situation: is the recovery process complicated; what are the longterm success of knee-replacement surgery? Do patients come for second and third replacements?

Post surgery is never a major problem. We usually do a complete preoperative assessment of the patient and get the necessary clearance from the physician, cardiologist and anesthetist and proper investigation before taking the patient to surgery. The long-term

Rheumatoid Arthritis

Thinned cartilage

The main difference among the Asian, Arab and European knees is the size in the ascending order. The Asian knee is the smallest and the European knee is the largest amongst the nationalities mentioned.

Yes, there are various implants available, which can fit any knee: Asian, Arab or European. success rate for knee replacements can be from 15 to 25 years. But, it is imperative that the patient maintains his/her weight as obesity can also cause damage to the implant.

Swollen inflamed synovial membrane

Media reports note that “at least 20 per cent of the Omani population between the ages of 40 and 70 will require compatible knee joint replacement” and that “more than 50 percent of the elderly population in the country is suffering from arthritis”? Are these statistics correct? Your thoughts on the same.

Well, there is a report saying the obesity is rapidly increasing in Oman and the Middle East countries. Oman being 14th in the league table of the most obese nations in the world and Qatar, Kuwait and UAE being the second, third and fourth most obese nations in the world.

What are the main differences between the Arab, Asian and European knees? Are the kneereplacement systems available in Oman?

The main difference among the Asian, Arab and European knees is the size in the ascending order. The asian knee is the smallest and the European knee is the largest amongst the nationalities mentioned.

Yes, there are various implants available, which can fit any knee: Asian, Arab or European.

2017 IN THE PINK 111

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A new home deserves the new LG Mega-Capacity side-by-side REFRIGERATOR LG’s new Side-by-Side refrigerator offers elegant design, energy efficient technology and mega-capacity storage, making it a perfect piece for the perfect home.

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UILDING on the success of LG’s previously released Side-by-Side models, this refrigerator includes a redesigned Door-in-Door™ feature as well as new design enhancements like fine exterior metal finishing.

Furthermore, the company’s new Side-by-Side model is also energy efficient, thanks to the Inverter Linear Compressor. “Consumers in Oman have often demanded for stylish and space-saving designs when it comes to refrigerators. We have made strong efforts to ensure that our latest Sideby-Side refrigerator gives consumers ample room to keep their stored food items as fresh as possible,” said Yong Geun Choi, president, LG Electronics Gulf. “This kind of innovation and attention to detail is what has fueled LG’s rise to its prominent position as a leader in the home appliance industry.”

fresher for longer periods of time thanks to LG’s Nature FRESH system, which includes FRESH BalancerTM. FRESH BalancerTM maintains optimal humidity and temperature levels for specific food items, such as fruits and vegetables.

Enormous Food Storage Potential LG’s new Side-by-Side refrigerator withstands more than 600 liters of storage capacity, making it an industry leader in capacity for counter-depth refrigerators.

By utilising LG’s unique space-saving frame and slim insulation technology, the exterior of the refrigerator is the same dimensions as its predecessor.

Also, consumers can keep their foods

Improved Water and Ice Dispensing System LG’s non-plumbing water dispensing system allows the versatility to install the refrigerator anywhere in the home with an electrical socket.

The large capacity water tank has been streamlined and moved to the refrigerator’s main compartment, making it easier to refill and making available more storage space on the

112 IN THE PINK 2017

Redesigned Door-in-Door™ Compartment LG has trimmed down the width of the door frame to increase the Doorin-Door™ compartment size by 9 percent. Consumers now have a wider view of the contents stored inside the Door-in-Door™ compartment, which can be effortlessly opened using a sleekly designed Hidden Button placed on the underside of the refrigerator door. The Door-in-Door™ not only gives users quick access to frequently sought food items, it also reduces cold air loss by up to 46.5 percent.

door basket. Consumers can pour water directly into the tank without having to remove it.

Impeccable Exterior Design On the exterior of the Side-by-Side refrigerator models, LG is offering consumers two options, either a premium metal finish or a stunning black stainless steel that is both fingerprint and scratch resistant.

Meanwhile, LG’s trademark Square Pocket Handle, as well as the brilliantly illuminated dispenser display, flawlessly blends into the all-metal finishing.

Inverter Linear Compressor Ensures Maximum Energy Savings LG refrigerators are powered by the unique Inverter Linear Compressor, which employs a linear piston drive instead of a conventional reciprocating drive. This generates less internal friction, resulting in lower energy consumption, less noise while providing greater reliability and durability. LG’s Inverter Linear Compressor is backed by a 10year warranty. In a review, by the Verband der Elektrotechnik Elektronik Informationstechnik (VDE), a German scientific and technical association, noted that LG’s Inverter Linear Compressor-equipped refrigerator is estimated to last 20 years.

{ PRESS RELEASE }

Playing a positive role in the health care sector of the country Mazoon Pharmacy LLC traces its origin to W. J. Towell & Co., founded in 1866 by William Jack Towell, a British citizen working in Oman. In 1883, Late Mohamed Fadhel; grandfather of Mazoon Pharmacy’s Late Mohamed Habib started his business association with Towell, eventually buying it fully in 1914.

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ATE Mohamed Habib has been principally responsible for the pharmaceutical and healthcare business of W. J. Towell & Co., before, during and after the World War II. It was in 1973 that Late Mohamed Habib Mohamed Fadhel founded a new partnership firm with his sons under the name Mazoon Pharmacy LLC, & Mohamed Habib & Sons LLC and separated from W. J. Towell & Co., thereby, acquiring the total pharmaceutical business.

Reposing their trust and faith, all the principals and manufacturers consequently opted to continue their business with Mazoon Pharmacy on an exclusive basis.

Mazoon Pharmacy LLC Mazoon Pharmacy LLC is the first and oldest pharmaceutical trading house of Oman (Established 1942) and one of the largest importers and suppliers of pharmaceutical specialties, surgical and other healthcare products, laboratory and medical equipments and other general products in Oman.

It also has good influence over the market in capital as well as interior areas covering throughout Oman.

They have an experienced qualified field sales force who are regularly visiting retail pharmacies, poly-clinics and doctors’ for the promotion of their range of products throughout the country, and they are supplying to local government / ministerial institutions and private market.

Currently they own three pharmacy

retail outlets out of which two are situated in the heart of the Muscat city.

Mazoon Pharmacy LLC represents on an “Exclusive” basis the prestigious multinational pharmaceutical manufacturers for their very specialised and quality products in Oman: F. Hoffmann La-Roche, LEO Pharma, Advanced Pharmaceutical, Actavis hf, Concordia International, Haw Par Healthcare Ltd, Hisamitsu Pharmaceutical Co. Inc., Molnlycke Health Care Group, Meda Pharma GmbH, CHEPLAPHARM Arzneimittel GmbH, Tentan AG, OTC Pharma, Catalysis, S.L., Helago Pharma GmbH, Mazoon Pharmacy is firmly committed to play a positive role in the health care sector of the country.

Mohamed Habib & Sons LLC Mohamed Habib & Sons LLC is a sister concern company of Mazoon Pharmacy LLC taking the responsibility of distribution of pharmaceuticals and non pharmaceutical products across the Sultanate and other general trading and investments.

The company was established in 1973 by its founder Late Mohamed Habib Mohamed Fadhel. Being a family owned business, Mazoon Pharmacy & Mohamed Habib & Sons share the same board of directors and management.

To meet the ever-increasing demand of personal care products, Mohamed

Habib & Sons LLC brings some of the finest brands in medical equipments, surgicals, ortho and dentals, cosmetics and baby care products, personal hygiene and general healthcare items.

Quality and safety of the product are given utmost importance while identifying products for import and distribution. Besides offering the products through own retail outlets, these are supplied to all major hypermarkets, supermarkets and grocery stores through their widespread network of wholesalers and the sales team. Mohamed Habib & Sons represents on an “Exclusive” basis the prestigious multinational companies for their very specialised and quality products in Oman: Hoyu Co. Ltd., Prime Corporation, PT. Nutrifood, Kohinoor Chemicals, Manfred Pabst, 3A Health Care, Adwin Korea Corp., Purodent, Lunida, Fashy, Louis Cardin, IFI Perfumes, Parfums Loreste.

Under the able guidance and leadership of His Majesty Sultan Qaboos Bin Said, Oman has made remarkable development in various fields over the past 46 years, opening up unprecedented opportunities for increases businesses. Mazoon Pharmacy LLC and Mohamed Habib & Sons LLC took advantage of this opportunity and established itself as a local prominent distributor of pharmaceutical, healthcare products, other general trading and investments across the Sultanate.

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{ PRESS RELEASE }

A walk to Eighth edition of Beat Diabetes Walk all set to witness around 14000 participants this year

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VERY year, since 2010, Oman plays host to an awareness walk on a deadly disease, in which thousands actively participate.

Last year, over 10000 Oman residents came together to raise awareness about diabetes during the 7th annual walkathon organised by the Landmark Group, the region’s largest retail and hospitality conglomerate.

The walkathon was held under the patronage of the ministry of health (MoH) and Oman Diabetes Association (ODA).

Clive Freeman, COO Landmark Group, Oman along with the dignitaries from the MoH and ODA led the three kilometres walk sporting blue ‘Beat Diabetes’ T-shirts.

Dr Mohammad bin Saif Al Hosni, health affairs undersecretary at the 114 IN THE PINK 2017

MoH was also part of the walkathon last year.

“The aim of the Beat Diabetes initiative, is to remind people of the magnitude of the threat posed by diabetes. We also want to highlight the simplicity with which the condition can be managed by taking three simple steps – taking the blood glucose test, eating healthy and getting active.

Through the walk we encourage the community to take proactive steps about their own health as this is very essential for the long-term welfare of the family, community and nation,” Freeman noted.

Participants growing in numbers The first walk was launched in the UAE in 2009. And in 2010, it was launched in Bahrain, Saudi Arabia, Kuwait, Oman and India.

When it was launched in Oman in

2010, around 3000 participated. Last year, 10000 joined the walk and this year, anywhere between 13000 to 14000 participants are expected.

Figures to rise to 471 million by 2035 worldwide Figures from the last edition of the International Diabetes Federation’s (IDF) Diabetes Atlas indicate that the number of people living with diabetes around the world is expected to rise from 382 million in 2014 to 471 million by 2035.

It is a growing epidemic in the GCC region and India. “Today, one in 11 adults has diabetes and one in two adults with diabetes is unaware that they are living with the condition. In 2015, there were 35.4 million living with diabetes in the Mena region and this number is expected to cross 72 million by 2040,” officials say.

Key contributors A sedentary lifestyle, unhealthy eating habits and low levels of awareness are noted as key contributors to the rapid incidence of type 2 diabetes in the Middle East and North Africa.

Type 1 diabetes, which affects children and relatively younger people, is considered to be caused by hereditary factors. This condition has also been on the rise with over 79,000 children (0-14 years) across the region believed to be affected by the condition. Three countries from the MENA region - Kuwait, Qatar and the United Arab Emirates – feature in the list of top 10 countries with the greatest prevalence of diabetes with the UAE ranking third (16.6 per cent) in the top 10 countries with prevalence of Impaired Glucose Tolerance in 2013 with Bahrain coming fifth.

Grown since 2009 Since its launch in the UAE in 2009, the Beat Diabetes initiative has grown in reach and participation. It currently has a presence across seven countries, including Kuwait, Bahrain, Oman, Qatar, Saudi Arabia and India.

Beat Diabetes Walk – At A Glance What is the Beat Diabetes Walk all about?

Beat Diabetes is Landmark Group’s Corporate Social Responsibility initiative to increase awareness about diabetes and help more people lead healthy lives.

The walk is about raising awareness against the deadly disease. Diabetes

affects so many peoples lives. Its an annual event, conducted at the end of the year (November – December).

Everyone can participate, of all ages and race.

The walk is for three (3) kilometers and it will be held at the Qurum Natural Park.

How many such walks (editions) have been conducted so far in general (internationally) and when was the first one ever conducted (internationally); which year and where? How many such walks have been conducted in Oman alone?

The first walk was organised in 2009 in the UAE. Oman, Bahrain, Saudi, Kuwait and India joined with this awareness walk in 2010. This year it will be Oman’s 8th walk.

How many people have participated in the first Beat Diabetes Walk in Oman and how many have participated in the last walk in Oman; how many are expected in the next edition (in Oman)?

The first edition saw 3000 people participating. Last year (2016) more than 10000 people joined the walk.

This year we expect 13000 to 14000 participants.

How does one register and what are the fees?

Registration is free, and you can register online and in all Landmark stores. The registration drive starts across Muscat through online platforms, corporate registrations camps and in all Landmark Stores in

Muscat ie Centrepoint, Babyshop, Splash, Lifestyle, ShoeMart, Home Centre, Emax, Max, Shoexpress, Carpisa, Steve Madden, Koton, Newlook, Ecco and Funcity.

Are there any other related activities that are conducted during the walk or post walk? Any opportunities to check sugar levels at the event etc?

Pre-walk: We conduct a three-month campaign (free) prior to the walk in corporations, schools, universities and colleges, instore (Landmark group outlets). Our team visits there and do free blood sugar checking tests.

On the event day below are the activities: • The participants are provided free t-shirts and caps on the venue.

• Free blood sugar counter are on the venue • Warm up sessions.

• Engaging work outs • Selfie stands • Play area for children and other fun activities related to it • Free water kiosks Post Walk Since this a continuous activity we do regularly free blood sugar test camps in corporates and in Landmark Group stores.

Is the walk a competition too?

No it is not a competition, this is an awareness, where it is an initiative to break the usual routine in people’s daily lives.

2017 IN THE PINK 115

Rays of Hope

ESHRAQA – The Khimji Ramdas Social Development Arm As part of its Corporate Social Responsibility to empower the people of Oman and providing access to means that help them DFKLHYH WKHLU IXOOHVW SRWHQWLDO .KLPML 5DPGDV KDV EXLOW SDUWQHUVKLSV RQ D QRWêIRUêSURoW EDVLV ZLWK SXEOLF VRFLHWDO DQG HGXFDWLRQê DO LQVWLWXWLRQV 7KHVH LQLWLDWLYHV DLP WR KHOS GHYHORS WKH 2PDQL &RPPXQLW\ DW ODUJH QXUWXUH WKH 2PDQL FKLOG LQVSLUH WKH 2PDQL Youth and empower Omani Women in particular.

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Eshraqa installed Vital-Signs monitors for the 6DPDLO +RVSLWDO 3DHGLDWULF ,QWHQVLYH &DUH 8QLW 3,&8 ZKLFK KDV KHOSHG UDLVH WKH VWDQGDUGV RI medical care for children at the hospital.

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Dr. Samia Ghannami, Director of the Nutrition Department at the Ministry of Health said,

Dr. Yaqoub bin Nasser Al Nadhabi, Doctor In-charge said,

“I would like to thank Eshraqa– KR CSR arm - for their support in conducting the survey, which will contribute immensely to the future of the medical sector in Oman.�

“We thank Khimji Ramdas Eshraqa team for supporting us with the necessary medical equipment for the Paediatric ward. These monitors are critical for health of the children admitted to the PICU.

Basmat Kheir team of volunteers in Samail KDYH EHHQ ZRUNLQJ WR VXSSRUW 2PDQL ZRPHQ Eshraqa donated sewing machines to the women who could use these to become economically self-reliant and independent.

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Hamoud bin Ali Al Jabri, representative of the Sejah Majiles said

Fatima Bin Nasser Al Rouwahiya, Vice President of the Basmat Kheir,

�We are grateful to Eshraqa for their continues assistance and support towards the needs of the local community and for their valuable contribution in the construction of the council.�

“We thank Eshraqa for their contributions and recognizing the importance of our goals of supporting women on economic, social and educational levels on which our team works.�

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EDUCATION ESHRAQA LEARNS

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