factors, diseases and Sociodemographic background distribution
among attendants of Health Promotion Clinic at Capital
Health Region, Kuwait
Ibrahim S Al-Eisa
Head of Primary Health Care at Capital Health Region
Adel M Al-Terkit
Head of Preventive Health Department, Primary Care, Capital
Manal S Al-Mutar
Sawaber Health Center
Mohamed S Azab
Preventive Health Department Capital Health Region, Ministry
of Health, Kuwait
Maged M Radwan
Preventive Health Department Capital Health Region, Ministry
of Health, Kuwait
Address for correspondence
Ibrahim Al-Eisa, (R.C.G.P.)
P.O. Box : 13061 Kaifan Postal Code:71951
Objective: To evaluate the health condition
of people attending Health Promotion Clinic (HPC) at Capital
Subjects and methods: This is a medical
records based study of 700 subjects attending Health promotion
clinic between May 2002 and June 2003 .
Results: The study group consisted of
608(86.9%) Kuwaitis, 447(63.9%) females, 329(47.0%) aged between
20 and 39 years old, 549(79.0%) married and 257(36.7%) clerks.
64(9.1%) of subjects were smokers, 345(49.3%) were practicing
exercise and 243(34.7%) were obese. Out of the subjects 79(11.3%)
had hypertension, 70(10.0%)had diabetes, 149 (21.3%) had hyper-cholestrolaemia
and 21(3.0%)had CVD.
Conclusion: Health Promotion Clinic is
important for early detection of diseases and risk factors
in order to prevent diseases and complication and decrease
rate of death.
KEY WORDS: health promotion, hyper-cholestrolaemia,
hypertension, diabetes, obesity.
The World Health Organization
declaration of Alma Ata  stated that primary health care
(PHC) was the key to achieving 'Health for all by the year
2000' and that it should be an integral part of a country's
health care scheme. Primary health care is essential health
care based on delivering integrated health services (curative
and preventive). Prevention can be primary (i.e. to postpone
the disease, event or symptom), secondary (i.e. to prevent
recurrence or progression to disease) and tertiary (i.e. prevent
the complication of the clinical disease). Primary care can
be individually oriented involving screening for risk factors
and treatment of these risk factors by pharmacological means
-the so-called high-risk approach. On the other hand, primary
prevention can be directed towards a whole population group.
Secondary prevention is always directed towards individuals
. Although, health promotion is an area that has been relatively
neglected by health economist . An abundance of evidence
has accumulated pointing to the possibility of preventing
new events in subjects who have already experienced an event,
using specific pharmacological tools such as anti-hypertensive
and lipid-lowering drugs , and or by multifactorial prevention
including such drugs and advice to stop smoking. This high-
risk approach has also been shown to prevent/postpone events
in subjects previously free of disease, i.e. primary prevention
Obesity is a risk factor for several chronic
diseases including coronary vascular disease (CVD), hypertension,
diabetes, arteriosclerosis, hyperlipidemias and some types
of cancer . Smoking is the risk factor for CVD which theoretically
should be the most effective to treat, and is very well proven
risk factor for many disorders in long-term observational
studies . A lot of researchers confirm that exercise has
some benefit in preventing CVD .
The prevalence of diabetes is increasing globally.
By the end of the 20th century, the worldwide diabetes pandemic
had affected an estimated 151 million persons . This figure
is expected to double over the next 25 years . A WHO study
group on the prevention of diabetes predicts that the majority
of the increase will occur in developing countries. This could
be due to the most dramatic changes in living conditions as
a result of urbanization and demographic changes [11,12].
In Kuwait 1997, the prevalence of diabetes was 15% [13,14].
Early identification of people who have diabetes will reduce
the cost, giving a better chance of proper management and
reduce the number of lost workdays, hospitalization and emergency
A large proportion of the adult population in
many parts of the world have blood pressure ranges associated
with an excess morbidity and mortality [16,17,18], which can
be reduced by appropriate treatment [19,20]. In Kuwait 1999,
the prevalence of hypertension was 26.3% .
CVD and cancer are the leading causes of death
and disability in industrialized nations today, and are becoming
an increasing problem in developing countries as well [22,23].
Reducing CVD risk factors may decrease the mortality and morbidity
rates of these serious diseases . Risk factors for CVD
are related to lifestyle behaviors such as diets rich in cholesterol,
saturated fats, sugar, and salt; smoking and lack of physical
exercise . Therefore, Department of Public Health at Capital
Health Region initiated Health Promotion Clinic (HPC) on May
2002. Subjects were self-referred to the clinic by registering
their name to the administrative workers. HPC is staffed by
general practitioners, nurses, health educators and administrative
workers who are well trained about the subjects. HPC offered
health promotion and disease prevention by early detection
of risk factors and diseases and modifying personal behavior
through full history including lifestyle behaviors, full examination
and investigations, then health education, medication and
referral were done as necessary.
Given the increasing incidence of chronic diseases
across the world, the search for more effective strategies
to prevent and manage them is essential .
The rational for this study is to provide baseline
information for health providers at establishment of HPC at
Capital Health Region about sociodemographic background, risk
factors and diseases among attendants of HPC, including hypertension,
diabetes, CVD, hypercholesterolaemia and cancers, among subjects
attending HPC, and to determine the prevalence of diseases
among obese subjects.
SUBJECTS AND METHODS
A descriptive study involved reviewing
all records of people attending Health Promotion Clinic at
Capital Health Region between May 2002 and June 2003. History,
physical examination of weight, height and blood pressure,
and laboratory results of fasting blood sugar, and total blood
cholesterol was extracted from the records.
The subjects were considered as having diabetes,
hypertension and hypercholestrolaemia if they had been previously
diagnosed as having the disease, or if fasting plasma glucose
= 6.1 m mol/L, systolic blood pressure =140 mmHg, or diastolic
blood pressure =90 mmHg[28,29], and attaining level of total
cholesterol >5.2  respectively.
Body mass index (BMI) were calculated from weight
and height of subjects. BMI of less than 25 is considered
normal, 25-<30 as over weight and equal to 30 and above
as obese .
Data obtained from records were coded
and fed in to an IBM personal computer. The Statistical Package
for Social Sciences (SPSS) software Windows version 10.0 was
used for data analysis. The chi-square test was used to assess
the association between two variables.
A total of 710 records were
studied, 700 were completed. Out of all subjects 253(36.1%)
were males and 447 (63.9 %) were females. 608 (86.9%) of subjects
were Kuwaitis. 549 (79%) were married. The majority of subjects
329(47.0%) were aged between 20 and 39 years old, followed
by the age group between 40 and 60 years old. The mean age
(± SD) of all subjects was 41(± 12.0) years.
257 (36.7%) of subjects were clerks followed by housewives
124 (17.7%) and retired 108 (15.5%) (Table1).
Table 2 shows the distribution of diseases among
subjects attending HPC. More than half of subjects were healthy
381(54.4%) followed by having hypercholestrolaemia 149 (21.3%),
high blood pressure 79(11.3%), diabetes 70(10.0%), Bronchial
asthma 56(8.0%) and a combination of high blood pressure and
Most of our subjects 636 (90.9%) were non-smokers.
Significantly majority of smokers were males (X2 = 75.3, df=1,
P < 0.0001). Out of all subjects 345 (49.3%) were practicing
exercise with no significant difference for both sexes and
majority of them practicing exercise from three to six times
per week. About one-third of our subjects were obese. 75.3%
of obese subjects were females (X2 = 26.8, df = 4, p<0.0001)
Majority of subjects who have hypercholestrolaemia,
high blood pressure or diabetes were above than ideal body
weight 129 (86.6%), 70 (88.6%) and 55(78.6%) respectively
(Table4). In addition, more than two third of asthmatic as
well as CVD subjects were above than ideal body weight
40(71.5%) and 17(81%) respectively.
A survey of 700 subjects
showed that the majority of subjects were Kuwaitis and females.
Since most of the residents of the area around the clinic
were Kuwaiti nationals, and females were more anxious about
their health than males. The results of our study showed that
most of our subjects were aged between 20 and 39. This age
group corresponds with the age where building up their future
is important. The majority of the subjects were clerks and
housewives since they have more time.
Regarding exercise, approximately half of subjects
do exercise and that is encouraging regarding health education.
More than two-thirds of subjects had greater
than ideal body weight. This was consistent with the prevalence
of obesity in other countries. Latief  showed that 60%
of males and 75% of females in Saudi Arabia were above their
ideal body weights. The reasons for this are multi factorial.
Use of cars for even short distances, routine consumption
of high calorie foods including fast food, most of the physical
work inside the house and outdoors is being done by foreign
manpower, and the rarity of exercise.
Our data showed that the prevalence of obesity,
hypercholestrolaemia, high blood pressure and diabetes were
34.7%, 21.3%, 11.3% and 10.0% respectively. Study done in
the Mishref area over period of three days screening, showed
that the prevalence of obesity, hypercholestrolaemia, high
blood pressure and diabetes were 29%, 14.3%, 22.1% and 34.1%
Our data confirm that hypercholestrolaemia,
high blood pressure and diabetes, asthma and CVD were more
common in overweight individuals.
Therefore, enhanced efforts to prevent
and control excessive weight gain from childhood are a critical
national priority. To be successful social, cultural and economic
influence should be considered , and this task must largely
be carried by primary care.
Information provided by HPC can be an important
tool in promoting a prevention strategy to address the emerging
epidemic of chronic diseases.
Smoking, hypercholestrolaemia, high blood
pressure, diabetes and low physical activity play a role in
development of CVD. So, health promotion research is essential
to translate research findings to practice in order to reduce
mortality and morbidity. Preventive strategies include educating
and mobilizing communities with effective outreach programs
are important, especially programs involving community institutions
such as schools, churches and worksites. Strong media campaigns
can help increase awareness among the population. Health care
practitioners should be encouraged to counsel their patients
about lifestyle and risk factors. Local public health practitioners
should emphasize the prevention and reduction of behavioral
risk factors in the community.
Table1. Socio-demographic characteristics
of 579 subjects included in the study
Mean age=41, SD±12.2
Table2. Distribution of diseases among subjects
included in the study by sex
High blood pressure
High blood pressure+Diabetes
High blood pressure+Hypercholestrolaemia
High blood pressure+ Diabetes + Hypercholestrolaemia
Table3. Distribution of BMI, smoking
and exercise among subjects included in the study: tested
<3 days /week
3-6 days /week
NS= Not Significant
Table 4. Distribution of diseases
among subjects included in the study according to BMI
High blood pressure
High blood pressure+ Diabetes
High blood pressure+ Hypercholestrolaemia
High blood pressure+ Diabetes + Hypercholestrolaemia
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