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BackgroundFew studies have investigated tobacco industry interference in the tobacco control policies of Arab nations. This paper explores the tactics used by the industry to subvert tobacco control policies in Oman and offers lessons on how to prevent such interference in the future.MethodsWe searched the Truth Tobacco Industry Documents Archive using the word ‘Oman’, names of government institutions, policymakers and local tobacco distributors. Extracted data were noted chronologically by key elements of tobacco control measures. Gulf Cooperation Council (GCC) Health Ministers’ Council resolutions on tobacco control were also reviewed.ResultsOut of 1020 tobacco documents located, 327 were closely related to policy interference. Documents revealed that the industry met key government officials, offered in-kind services, used local diplomatic missions to influence Omani policymakers, opposed smoking bans, delayed regulations to lower tar and nicotine content of cigarettes, and to require effective health warnings, circumvented a tobacco advertising, promotion and sponsorship ban and provided voluntary codes as an alternative to effective regulations. Additionally, industry representatives lobbied individual countries in the GCC to veto tax increments and defeat consensus on agreed resolutions of the Health Ministers’ Council.ConclusionThe tobacco industry interfered in all key public health policies aimed to reduce tobacco use in Oman. There is an urgent need for the Omani government to enforce the Civil Code of Conduct and develop guidelines for all policymakers through implementing Article 5.3 of the WHO Framework Convention on Tobacco Control to curb the tobacco epidemic.

BackgroundThe economic cost of smoking has been determined in many high-income countries as well as at a global level. This paper estimates the economic cost of smoking and secondhand smoke (SHS) exposure in the six Gulf Cooperation Council (GCC) countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and the United Arab Emirates), for which no detailed study exists.MethodsWe used data from the Global Burden of Diseases Study 2016 and the cost-of-illness approach to estimate direct costs (healthcare expenditures) and indirect costs (productivity losses due to morbidity and mortality). Indirect cost was estimated with and without the inclusion of musculoskeletal disorders, using the human capital approach.ResultsTotal cost of smoking and SHS was estimated to be purchasing power parity (PPP)$ 34.5 billion in 2016, equivalent to 1.04% of the combined gross domestic product (GDP). SHS accounted for 20.4% of total cost. The highest proportion of indirect cost resulted from smoking in men and middle-aged people. The main causes of morbidity cost from smoking and SHS were chronic respiratory diseases and type 2 diabetes mellitus, respectively. Cardiovascular diseases were the main contributor to mortality cost for both smoking and exposure to SHS. Including musculoskeletal disorders increased total cost to PPP$ 41.3 billion (1.25% of the combined GDP).ConclusionThe economic cost of smoking and SHS in the GCC states is relatively low compared with other high-income countries. Scaling-up implementation of evidence-based policies will prevent the evolution of a tobacco epidemic with its negative consequences for health and public finances.

Background The Gulf Cooperation Council (GCC) countries relied, until recently, solely on import duties for tobacco products. The agreement for the introduction of an excise and value added tax (VAT) in 2016 and 2017, respectively, in most GCC countries, was a major breakthrough for public health. There is, however, ample room for improvement. Methods The study examines the outcomes of tax reforms, for both public health and public finances, based on the World Health Organization (WHO) recommendations and best practices worldwide. Tax simulations were performed using the WHO TaXSiM model. The study is based on data from Saudi Arabia, the only GCC country for which sufficient data existed. Results We recommend a stepwise tax reform, which involves increasing the current ad valorem excise tax rate, phasing out import duties keeping total tax share constant and introducing a minimum excise, and finally switching to a revenue-neutral specific excise. Specific excises must be adjusted for inflation and income increases. If implemented, cigarette tax reform simulations show that the recommended reforms would lead to a higher than 50% increase in cigarette prices, 16% reduction in cigarette sales and almost 50% increase in total cigarette tax revenue. A significant number of cigarette-related deaths would be averted. Conclusions The recommended tax reforms are expected to lead to significant improvements in both public health and tobacco tax revenues. Our results provide useful insights that are of relevance to the whole GGC region. The effectiveness of the reforms, however, requires a strong tax and customs administration, including the establishment of a good database to monitor and advance public health.

Objectives: Stroke is a significant public health problem and one of the most important preventable non-communicable diseases. Preventive stroke programmes with a better focus on increasing awareness among those who are currently at risk are yet to be properly established in Oman. This study was conducted to describe the characteristics of stroke patients presenting to a tertiary care hospital in Oman. Methods: This cross-sectional hospital-based study included 193 stroke cases which were prospectively recruited from the Emergency Department of Khoula Hospital, Muscat, Oman. Data were collected from November 2017 to April 2018. Results: The total number of patients was 193 with 82.9% of strokes being ischaemic strokes. Of this, 58% were male. The mean age of stroke patients was 61.05 years. Risk factors included hypertension (72.5%) and diabetes mellitus (54.4%). Dyslipidaemia, atrial fibrillation and ischaemic heart diseases were not particularly prevalent in the studied population and 24.4% of ischaemic strokes had large artery atherosclerosis while 21.9% had small vessel occlusion. Significantly more patients had lower Glasgow Coma Scale scores, required intensive care unit admission and experienced in-hospital deaths due to haemorrhagic stroke compared to ischaemic stroke. Conclusion: This study provides essential data regarding stroke characteristics specific to Oman’s population. Most of the information obtained appears to be in-line with what has been described internationally and, hence, preventive strategies similar to those indicated in extant literature can be implemented. This information can be utilised by health administrators in planning resource allocation. Further research is needed to explore rehabilitation aspects and long-term outcomes. Keywords: Stroke; Ischemic Stroke; Haemorrhagic Stroke; Risk Factors; Thrombolytic Therapy; Epidemiology; Oman.

Objectives: This study aimed to describe the epidemiology of diabetes mellitus over the past two decades in Oman, particularly in terms of its prevalence and incidence. In addition, the study sought to estimate the future incidence of diabetes in Oman. Methods: Three national and three regional surveys conducted between 1991 and 2010 were analysed to obtain the age-adjusted prevalence and undiagnosed proportion of type 2 diabetes mellitus (T2DM) among Omani subjects aged ≥20 years. Diabetes mellitus registers and published studies were used to determine incidence rates of both type 1 diabetes mellitus (T1DM) and T2DM in Oman. Linear regression was used to determine trends and projections for diabetes in 2050. Results: The age-adjusted prevalence of T2DM in Oman varied from 10.4% to 21.1%, while the highest prevalence of impaired fasting glucose was found in males (35.1%). In comparison to men, higher incidence rates of T2DM were found in women (2.7 cases compared to 2.3 cases per 1,000 person-years, respectively). No significant trends were observed for the prevalence or incidence of T2DM in both genders. Undiagnosed T2DM was more common in men (range: 33–68%) than women (range: 27–53%). The results of this study show that by 2050, there will be an estimated 350,000 people with T2DM living in Oman (a 174% increase compared to estimates for 2015). Conclusion: Health authorities need to prioritise diabetes prevention and control in order to prevent or delay long-term complications and avert a potential epidemic of diabetes in Oman.

Objectives: This study aimed to measure exposure to secondhand smoke (SHS) and assess venue compliance with the municipal Law against smoking indoors in public places in Muscat, Oman. Methods: Following the selection of 30 public indoor venues within the Muscat governorate, the concentration of suspended SHS particulate matter (PM2.5) in the venues’ indoor air was measured throughout July and August 2010. Results: Almost all of the venues were found to be compliant with the smoke-free municipal, with the exception of a café that served waterpipes for smoking indoors. The concentration of PM2.5 in this venue showed an average level of 256 μg/m3 which was 64 times the level of that found in the non-smoking venues. Conclusion: Aside from one café, the majority of the assessed indoor public venues abided by the smoke-free municipal law. However, the enforcement of policies banning smoking in indoor public recreational venues should be re-examined in order to protect member of the public in Oman from exposure to SHS.

To determine clinical characteristics, management, and in-hospital outcomes of diabetic and non-diabetic patients admitted with acute coronary syndrome (ACS) in Oman.Data were analyzed from 1583 consecutive patients admitted to various hospitals in Oman with ACS from May 8 to June 6, 2006, and from January 29 to June 29, 2007, as part of the Gulf RACE (Registry of Acute Coronary Events). The ACS patients were stratified into those with and without diabetes mellitus.In this study, 588 (37%) patients were diabetic with a mean age of 59 years and included more female than male diabetics (43% versus 33%; p0.001). Diabetic patients were more likely to present with unstable angina (55% versus 44%; p0.001) and less likely to present with ST elevation myocardial infarction (20% versus 27%; p=0.001). Both groups received ACS treatment equally; however, diabetic patients were more likely to be treated with glycoprotein IIb/IIIa antagonists and angiotensin-converting enzyme inhibitors or receptor blockers. Diabetic patients experienced more recurrent ischemia (12% versus 8%; p=0.043), heart failure (29% versus 23%; p=0.009), cardiogenic shock (7.5% versus 4.6%; p=0.018), and ventilator requirement (7.3% versus 4.1%; p=0.006). When adjusted for age and gender, diabetes status was an independent risk factor of in-hospital mortality in ACS patients (adjusted odd ratio, 1.68; 95% confidence interval, 1.022.77; p=0.042).Diabetic ACS patients have different clinical characteristics and poorer outcomes. Present treatment strategies are not sufficient to counter the adverse impact of diabetes. More effective and evidence-based therapeutic strategies should be identified and used in diabetic ACS patients.

The Arab world, stretching from Lebanon and Syria in the north, through to Morocco in the west, Yemen in the south and Iraq in the east, is the home of more than 300 million people. Cancer is already a major problem and the lifestyle changes underlying the markedly increasing rates for diabetes mean that the burden of neoplasia will only become heavier over time, especially with increasing obesity and aging of what are now still youthful populations. The age-distributions of the affected patients in fact might also indicate cohort effects in many cases. There are a number of active registries in the region and population-based data are now available for a considerable number of countries. A body of Arab scientists is also contributing to epidemiological research into the causes of cancer and how to develop effective control programs. The present review covers the relevant PubMed literature and cancer incidence data from various sources, highlighting similarities and variation in the different cancer types, with attempts to explain disparities with reference to possible environmental factors. In males, the most prevalent cancers vary, with lung, urinary bladder or liver in first place, while for females throughout the region breast cancer is the greatest problem. In both sexes, non-Hodgkins lymphomas and leukemias are relatively frequent, along with thyroid cancer in certain female populations. Adenocarcinomas of the breast, prostate and colorectum appear to be increasing. Coordination of activities within the Arab world could bring major benefits to cancer control in the eastern Mediterranean region.

Introduction The overall health status of the Omani population has evolved over the past 4 decades from one dominated by infectious disease to one in which chronic disease poses the main challenge. Along with a marked reduction in the incidence of infectious diseases, improvements in health care and socioeconomic status have resulted in sharp declines in infant and early childhood mortality and dramatic increases in life expectancy. Methods Focusing on the time period from 1990 through 2005, we reviewed relevant epidemiological studies and reports and examined socioeconomic indicators to assess the impact of the changing disease profile on Oman's economy and its health care infrastructure. Results Over the next 25 years, the elderly population of Oman will increase 6-fold, and the urbanization rate is expected to reach 86%. Currently, more than 75% of the disease burden in Oman is attributable to noncommunicable diseases, with cardiovascular disease as the leading cause of death. The distribution of chronic diseases and related risk factors among the general population is similar to that of industrialized nations: 12% of the population has diabetes, 30% is overweight, 20% is obese, 41% has high cholesterol, and 21% has the metabolic syndrome. Conclusion Unless reforms are introduced to the current health care system, chronic diseases will constitute a major drain on Oman's human and financial resources, threatening the advances in health and longevity achieved over the past 4 decades.

To assess the prevalence and determinants of waterpipe use among school-going adolescents in Oman.A cross-sectional, school-based study was conducted in 2003 involving 9 regions of Oman, as part of the Global Youth Tobacco Survey. Participants were requested to complete an anonymous questionnaire containing demographic characteristics, current and previous use of waterpipe tobacco, attitudes towards cigarette smoking, parents' and friends' cigarette smoking habits. Proportions were used to calculate prevalence rates and logistic regression analysis to obtain odds ratio (OR) and 95% confidence interval (CI).1,962 students participated of whom 1,005 (51.2%) were males. Eighty-eight percent were between 13 and 16 years of age. Five hundred and twenty-two (26.6%) reported ever smoking waterpipe tobacco while 189 (9.6%) were current users. Among males, 155 (15.5%) were current users while among females only 24 (2.6%) smoked currently. Study participants were more likely to use waterpipe if they had a parent or friend who smoked cigarettes. Adolescents were, however, less likely to use waterpipe tobacco if they believed that cigarette smoking was harmful to health. Students who were receiving 500 Baisas (US$ 1.3) or more per day pocket money were more likely to use waterpipe tobacco compared to those receiving less (OR 3.3, 95% CI 2.3 to 4.6). In multivariate analysis, the OR for males being a smoker of waterpipe tobacco compared to females was 4.46 (95% CI, 2.38 to 8.35); while the OR for most or all friends smoking cigarettes compared to non-smoking was OR 5.65 (95% CI 2.87 to 11.13). Study participants who perceived smoking as harmful to health were less likely to use waterpipe tobacco compared to those who did not believe smoking was harmful (OR 0.31, 95% CI 0.29 to 0.92) and those receiving 500 Baisas or more (OR 2.2, 95% CI 1.5 to 3.2).Waterpipe smoking among Omani adolescents is an emerging public health concern. Efforts to prevent adolescent smoking should be designed with knowledge of associated factors of such behaviour and should include all forms of tobacco.

DIABETES MELLITUS IS A PUBLIC HEALTH problem in both developing and developed countries with one of its complications being diabetic retinopathy (DR). As the life expectancy of people with diabetes has increased owing to improved health care, the prevalence of DR is rising. DR is therefore now included in the list of priority diseases of the WHO’s VISION 2020 strategy to eliminate all preventable cases of blindness by the year 2020. In Oman, a comprehensive programme approach to DR was adopted in 1998. Oman’s system of screening for and treating DR is considered to be a good model in the region. The programme approach for eye care of people with diabetes in Oman has strengths and weaknesses. This editorial describes these, along with future challenges and solutions to handle them, including the use in Oman of modern technology to manage the eye complications of diabetes. However, strategies for educating people about their role in primary prevention of DR and the development of rehabilitation services for visually impaired diabetics still need urgent implementation.

To determine the prevalence of overweight and obesity by age, gender and region and to assess the difference between rural and urban populations and determine the trends of the past decade.Analysis of nationally represented samples from 2 cross-sectional surveys conducted in 1991 and 2000, containing 5,086 and 6,400 Omani citizens agedor=20 years. Body mass index (BMI) (weight in kg) divided by height (in meters squared) was calculated using measured height and weight data. Overweight was defined as BMI 25-29.9 kg/m2 and obesity as BMIor= 30 kg/m2.In the year 2000, the age adjusted prevalence of obesity reached 16.7% in men, compared to 10.5% in 1991 (p0.001). In women, the prevalence was 23.8% in 2000, compared to 25.1% in 1991 (p=0.231). Similarly, the prevalence of overweight increased among men, from 28.8-32.1% (p=0.011) and decreased among women, from 29.5-27.3% (p=0.053). When obesity and overweight were combined, there was a significant increase in men (9.5%; p for the change0.001) and decrease in women (3.5%; p for the change0.003). Obesity and overweight combined was markedly more common in the Southern part of Oman (70%) compared to Northern areas (32-57%). People living in urban areas were more obese (21.1%) than those living in the rural communities (13.1%) (p0.001).The prevalence of obesity is high in Oman and has increased predominantly among men. Primary prevention programs are needed to counteract this condition and its cardiovascular and metabolic complications.