Department of Communicable Disease Surveillance & Control
Directorate General of Health Affairs Ministry of Health HQ, PO Box 393
PC 100, MUSCAT
Sultanate of Oman
Tel : + (968) 24601921/ 24607524
Fax : + (968) 24601832
Email : firstname.lastname@example.org
Children below 5 years of age constitute a high-risk group and were markedly affected by such communicable diseases. In early 70s, Infant Mortality Rate (IMR) was estimated to be 118 per 1000 live births and Under 5 Mortality Rate (U5MR) was 181. These were reduced in 1980 to 64 and 86; respectively. Developments in mortality rates can be found in other reviews.
Childhood diseases were highly prevalent during the 70s, 103 cases of Acute Poliomyelitis, 102 cases of Tetanus, and 43 cases of Diphtheria were reported in 1975 and in 1980 these became 44, 48 and 7; respectively. The number of cases of Measles, Mumps and Pertussis reported were very high. More than 16 thousands cases of Measles, 14 thousands cases of Mumps and 13 thousands cases of Pertussis were recorded in 1975. In 1980 these became 10,630, 7,335 and 1,534; respectively. The numbers of such diseases were very high if compared to the estimated population size of 824 thousands (759 thousands Omani) in 1975 and one million (914 thousands Omani) in 1980.
Other communicable diseases showed similar profile. There was 6,162 Pulmonary Tuberculosis and 241,431 Malaria cases diagnosed clinically in 1975. Tuberculosis was reduced by 1980 to 1,828 cases but Malaria showed an increase to 275,456 cases. About 5 thousand cases of Hepatitis and 24 thousands cases of Trachoma were reported in 1975. There were also 144 cases of Leprosy and 39 cases of Filariasis reported in the same year. Infections from contaminated hands, food and water were very frequent. Examples include Dysentery (Bacillary and Amoebic) and Acute Gastroenteritis; 27,381 and 131,780 cases were reported in 1975; respectively.
The above mentioned figures are number of cases reported by the MOH reporting system and cases seen at the health institutions. It is expected that the situation in the community be worse given the limitation of the reporting system at that time.
Several communicable diseases have shown a declining trend over the late 70s and beginning of the 80s. Such trend could be attributed to the developments in the health infrastructure. However, during that period there have been several defects and problems. There has been lack of standardized approach in management of communicable diseases especially childhood diseases such as diarrheal diseases and respiratory infections. The immunization and growth monitoring of infants and children were conducted by public health services with no association with curative services. Most activities of MOH were based on actions in response to effect, such as response to outbreaks, instead of preventive activities. The health system tended to concentrate on curative services on the expense of preventive measures. There had been lack of integration among MOH and other different health related bodies at the national level. On the other hand health education did not play an important role in raising community awareness towards benefits of immunizations, hygienic practices, proper nutritional habits, safe water, sanitary practices and other environmental factors.
The late 70s coincided with the crystallization of the policy goals and objectives of the World Health Organization (WHO) as regard "Health for All by the Year 2000". Sultanate of Oman was among the early countries to adopt such objectives. The MOH, thus, had undertaken a series of reforms during the 80s. These included the establishment of well-defined, realistic, achievable policies and health programs based on valid information. The health programs and year of their establishment are laid down in table 1. Among the very early health programs were "Malaria Control Program" in 1975, the "Expanded Program on Immunization" in 1981, and "Tuberculosis Control Program" in 1981. These were followed, in 1982, by the program of "Prevention of Blindness" which was directed to a highly prevalent communicable disease at that time, that was trachoma. Trachoma was then the most important cause of blindness. These health programs were run under the department of "National Health Programs (NHP)".
In-spite of these health programs, there had been a need to speed the process of control of communicable diseases to catch up with other parts of the world who have started their developments earlier. In 1985, several activities took place. The "National Primary Health Committee" was established with the responsibility to further strengthen and establish on ground basis the "Primary Health Care" in Oman. The committee has considered children below 5 years of age as most vulnerable to changes in the environment, and to social and economic changes. They would be an important target group for most communicable diseases. The committee has recommended the introduction of a comprehensive "Child Care Plan (CCP)" which was launched in 1986.
Table 1: Health Programs directed to control communicable diseases (does not include programs directed to health problems other than communicable diseases).
Summary of Objectives Program &year of establishment Early detection and treatment. Reduction of morbidity and mortality. Later eradication. Malaria Control Program 1975< Reduction of mortality. Achieve 100% coverage with BCG (as part of EPI). Control of Tuberculosis (TB) 1981 To immunize all children below 1 years against 6 targeted diseases. To reduce morbidity and mortality early in life. Expanded Program of Immunization (EPI) 1981 Eradication of trachoma and blindness Prevention of blindness program. 1982. Reorganized in 1991 as Eye Health Care Proper cases diagnosis and management. Develop and emphasize on preventive measures Control of Diarrheal Diseases (CDD) 1985 Raise awareness of ARI. Early detection and management. Reduce mortality due to ARI in less than 5 age group Control of Acute Respiratory Infection (ARI) 1987 Develop and strengthen epidemiological capabilities to monitor communicable disease Program of strengthening epidemiological Surveillance 1991 Reduce prevalence of malnutrition. Reduce prevalence of iron deficiency anemia. Elimination of vitamin A and iodine deficiency. Program of combating malnutrition 1991 Provision of health education. Monitor and improve school health environment. Assessment of health status of students School Health 1991 Reduce prevalence. Health education. Rehabilitation Control of Leprosy 1991 Develop diagnostic capabilities Program of prevention and control of Hepatitis B 1991 Prevention of transmission. Reduce impact, morbidity and mortality. Program of Prevention of AIDS 1991 Control of environmental factors affecting health. Program of promotion of environmental sanitation 199
The CCP had three main pillars in the form of three health programs. The first was "Child Health Program" which was newly introduced at that time with the aim to improve the physical, mental and emotional health of all children. The "Control of Diarrhoeal Diseases Program (CDD)" was the second new program introduced in 1985 and was directed to reduce morbidity and mortality in children below 5 years from diarrhoeal diseases. The EPI program was added to the later two programs to constitute the third pillar of the CCP. Two years later and in 1987, the program of "Control of Acute Respiratory Infections (ARI)" was introduced to standardize case management of ARI and thus reduce its morbidity and mortality in children below 5 years.
Because infant and child health would be highly dependent on mothers' health, the CCP was expanded in 1988 into the "National Woman and Child Care Plan (NWCCP)". Such activities were strengthened and supported by the Royal Decree to establish an "Inter-Ministerial Health Committee" of ministries concerned with health-related activities in 1985. At the same year, 1985, the "National Maternal and Child Health (MCH) Committee" was established within MOH and regional MCH committees in the health regions of Oman followed. As a result of such activities, the first drafts of manuals of health programs, available at that time, were prepared. These drafts had documented polices, objectives, logistics, and detailed description of management and referral of cases as well as data collection procedures for each health program. This later was a major step towards standardized case management among all health workers.
By late 80s, there had been a considerable degree of integration between curative and preventive services within MOH. The NWCCP had provided the proper media for inter-ministerial interaction and mobilization of the community towards the importance of health. The introduction of the "Child Health Card" in August 1988 has invited mothers to follow their children's progress towards health. Mothers were asked to keep the card for each of her children and use it in place of the outpatient file. The child health card had the schedules for immunization and their completion, monitoring of the child growth and complete medical history of childcare in illness including those as diarrhoeal diseases, ARI and others till the child reaches the age of 5 years. The "AnteNatal Card" for mothers was introduced almost at the same time to complement mother care with child care and a link between the two cards was made for the completion of the clinical history of the child.
During 1988 the national "Oman Child Health Survey" was planned and implemented during the period November 1988 to February 1989 by MOH. It had the main objective to provide factual data to evaluate the ongoing maternal and child health programs and to allow the formulation of new health policies and programs in a cost-effective manner. The findings of the survey had contributed significantly to disease control activities. It had drawn insights on forms of treatment of diseases, sources of community knowledge and pattern of practice against diseases, breast-feeding and immunizations.
A manual to standardize the management of Protein Energy Malnutrition (PEM) was introduced in 1990 after the results of "PEM Survey" in 1989. The manual has streamlined control activities to reduce PEM in children below 5 years as one important predisposing cause of many communicable diseases in young ages. Apart from the manual no specific health program has been formulated specifically for PEM. However, such activities were supported by the "Program of Combating Malnutrition" developed in 1991 as part of the fourth Five-Year Health Development Plan.
With the beginning of the 1990s, the health system was tuned to the control of childhood diseases that constituted the majority of communicable diseases in the country. Other communicable diseases were considered for control but only some necessitated a special health program namely: Malaria, Tuberculosis and Trachoma.
This period has coincided with further tuning of the organizational structure of MOH and crystallization of strategies and objectives. Decentralization of health services to health regions introduced in 1990, was one important tool for promoting the delivery of health care. This later initiative has given a great momentum to the integration of preventive and curative health care. The role of health planning depending on valid information was emphasized. This has led to the development of a strong national health information system as well as a national body for health system research, both of which have contributed to the identification of priority health problems and risk factors. The available information at that time has led to the identification of the need for further strengthening of control activities directed to communicable diseases. Therefore, there were initiatives to extend control activities to other groups in the community, in addition to children below the age of 5 years. This has been addressed in the fourth Five-Year Health Development Plan. Several health programs were introduced directly targeting communicable diseases with the beginning of the plan in 1991. These include "School Health Program", "Program for Prevention and Control of Viral Hepatitis B", "Program for Prevention of AIDS", "Program of Promotion of Environmental Sanitation" and the "Program of Strengthening Epidemiological Surveillance System". There had been other health programs in the plan but not targeting communicable diseases.
The "School Health Program" introduced in 1991 is an example of integrated preventive and curative health services. Preventive aspects included: ensuring safe and healthy school environment and health education for personal and community health. These were integrated with curative aspects as early disease detection through medical examinations and medical management of detected cases. School health has taken health programs (e.g. EPI) targeting preschool children to target school children and thus complementing the control activities in the community. The program was an example of inter-ministerial collaboration and had an impact on control activities in the community. The "Program for Prevention and Control of Viral Hepatitis B" has contributed to the developments in the various diagnostic techniques. The program has recommended the identification and immunization of high risk groups against hepatitis B in addition to immunizations given to infants that was introduced in 1990 as part of the EPI program.
The integration of curative and preventive care took place in 1992 when the two directorates general, "Curative Medicine" and "Preventive Medicine" were amalgamated into one "Directorate General of Health Affairs". The later had been assigned the responsibility to supervise the delivery of comprehensive health care with its preventive and curative aspects as well as its promotive and rehabilitative aspects. Public health units distributed in different part of the country were associated with the nearest hospital for ensuring the provision of comprehensive health care.
The "Baby Friendly Hospital Initiative (BFHI)" was a great success in Oman. It had been first implemented in 1992 and within two years (in 1994) all hospitals in Oman had been declared as BFHI. Through promoting breast-feeding, it had the objective of improving infant and child health and survival. Its impact could be greatly appreciated in reducing overall infant and child morbidity especially as regard diarrhoeal disease and ARI. BFHI committee of MOH has created the "Community Support Groups" (CSGs). These were female volunteers from the community, trained to assist women in breast-feeding and complementary feeding practices. However, this CSGs have grown into a multi-purpose support system involved into a number of different health programs. They have played a crucial role in educating and assisting the people about different aspects related to communicable diseases.
Figure 1: Developments in communicable diseases in Sultanate of Oman
As a result of all such developments and activities, communicable diseases burden in the community has dramatically dropped. Figure 1 shows the drop in different communicable diseases. The fifth Five-Year Health Development plan (1996-2000) has also emphasized continuing control activities towards communicable diseases in order to sustain achievements and for further control. The program of "Control of (Priority) Communicable Diseases" was established and directed to certain communicable diseases for further control and sustainability. "Malaria Eradication Program", "AIDS and STDs Control Program" and "Program of Environmental Health" have continued in the fifth Five-Year Health Development Plan as programs directed towards communicable diseases.
This review has demonstrated the struggle and various developments made by MOH for improving the health and survival of the people of Oman. Although developments have taken place in different aspects of health, the review has focused on developments that affected communicable diseases. This review is not intended to describe individual health programs; their description can be found in other documents. However, certain activities that had lead to the success of some health programs are worth to discuss.
Among the very first health programs was the "Malaria Control Program" in 1975. The program was run by the "Department of Control of Malaria" within preventive medicine and based on control principles namely: early detection and treatment, preventive measures mainly larvicide, vigorous response to epidemics and outbreaks and the existence of a reliable surveillance system. In-spite of this the malaria cases have initially increased over time possibly because the malaria control units spread over the Sultanate at that time gave more emphasis to act against outbreaks rather than prevention. Other factors at that time include the emergence of chloroquine-resistant strains of malaria falciparum and the emergence of insecticide-resistance by the anopheles vector.
MOH has then decided to move to a new strategy to cease malaria transmission within the country. In other words to move from reducing the disease burden to eradication of Malaria. This has necessitated a political commitment and leadership. MOH started its eradication activities as an experiment in Ash Sharqiyah region in 1991. A malaria eradication section has been established with a physician experienced in malarialogy, sanitary inspector, sanitary assistant and spray-men. Vigorous "Integrated Control" measures were coupled with every effort to eliminate the reservoir of infected cases. Integrated control measures included: larviciding as the main measure, selective residual house spraying, ULV spraying and the provision of impregnated mosquito bed-nets in remote areas. Efforts to detect malaria cases included: passive-case detection among all attendants to health services and active case detection through school health, epidemiological and blood donors' surveys.
After the success in Ash Sharqiyah region, the eradication project was expanded to other health regions. In 1998 about 80% of the population are covered by eradication projects. The success of the program can be clearly seen in graph 2-1. The number of malaria cases dropped from 275,456 in 1980 to only 1091 in 1998. The fact that only 114 cases are endogenous in 1998, reveals that complete cessation of transmission in Oman is a near and reachable goal.
Oman has shown a remarkable success in reducing the burden of various vaccine preventable diseases to the extent that some reached the level of eradication. The EPI program was launched in 1981; as previously mentioned. At that time, the program adopted 6 antigens targeting six diseases: Tuberculosis, Poliomyelitis, Diphtheria, Tetanus, Pertusis and Measles.
At initial stages, coverage did not exceed 60% for any given antigen and was about 10% for measles. The EPI program gained power when it was integrated as part of the "Child Care Plan" in 1985 (later the NWCCP). Several vigorous actions have been taken to increase vaccine coverage. At that time, every health institution assumed responsibility for a defined (catchment) population. All health institutions were held responsible for passive and active retrieval of children if they were due for any given vaccine dose (defaulters). Passive retrieval of defaulters were carried out through telephone, verbal or written messages and active retrieval were carried out through outreach teams of health visitors who visit the family for immunizing their child. Any contact of a child with the health institutions was used for checking for any missed vaccine schedule. The child was not allow to leave without receiving the appropriate vaccine (opportunistic contacts). The vaccines were made available for 24 hours in all health institutions throughout the year and multi-dose vials were used for immunizing a single child if necessary. This was accompanied with a well-designed mass media educational campaign to increase the awareness of the public.
The epidemiological profile of communicable diseases had to be continuously monitored. The "National Communicable Diseases Surveillance System (CDS)" came to function in 1987 and was further strengthened in the fourth Five-Year Plan in 1991. The CDS had a number of communicable diseases (today a total of forty) under close continuous surveillance. Such diseases have been classified into three groups based on urgency with which notification is required. Based on results of the surveillance system, the immunization schedule is continuously reviewed and new antigens are added.
The year 1988 witnessed a polio outbreak where 118 cases were reported. Intense actions were taken to investigate and control the outbreak. At that time oral polio vaccine was administered at 3, 5 and 7 months of ages and a booster doses at 19 months. Investigations showed that coverage with the third dose was about 88%. The virus (proved to be type I) was probably imported from South Asia. As a result, the immunization schedule was revised and two additional doses of polio vaccine were added; at birth and at 6 weeks of age. A "Surveillance System for Acute Flaccid Paralysis (AFP)" was started in 1990. The later system has detected 20 cases suspected to be poliomyelitis in 1991, of which only 4 proved to be poliomyelitis (type 3). Again in 1993, two cases were reported (type I). Massive containment measures were initiated. An extra dose of the polio vaccine was administered; a total of 359,000 doses were administered throughout the country. A National immunization Days (NIDs) campaign was first launched in march 1995 in coordination with other Gulf Council Countries (GCC) and was followed by another campaign in April of the same year. The NIDs are repeated yearly since then and coverage of more than 95% was achieved on yearly basis. Since 1993, the Sultanate is free of poliomyelitis because of the above-mentioned vigorous actions for control.
An outbreak of measles occurred in 1992 and 1993. The outbreak was controlled and the number of reported and confirmed measles cases showed drastic reduction after conducting a mass immunization in 1994 to all children below 18 years of age. A second dose for measles was introduced (MR) in 1994 (and MMR in 1997). These measures have further controlled number of measles cases to only 5 confirmed cases in 1998. The Sultanate is on its way to achieve measles elimination by 2010.
In-spite of high coverage of vaccination, a local outbreak of whooping cough has occurred in 1997 mainly in the North Al Batinah Health Region in the Sultanate. A total of 694 cases were reported. Almost 40% of reported cases were of the age 0-7 months. This later finding has led to changes in the vaccination schedule to start the first dose of DPT as early as 6 weeks instead of 3 months. The number of Pertussis cases reported in 1998 declined to 484.
Zero status of Dephtheria was maintained since 1992 and only one single case of tetanus neonatorum was detected (in 1995) since 1991. The Sultanate is now eligible for consideration for International Certification of Neonatal Tetanus elimination.
Today EPI has nine antigens. In addition to the initial six, three were added: HepatitisB, Rublla and Mumps. The intense actions by the program have kept the coverage by these antigens continuously high since late 80s.
The achievements in the control of tuberculosis were remarkable. The "Tuberculosis Control Program" was launched in 1981. It had adopted two well-known control measures: case finding and treatment, and prevention through BCG vaccination. In 1998 there were only 287 cases of tuberculosis compared to 6,162 in 1975. The success could be attributed to high BCG immunization coverage maintained over the years, the implementation of DOTS schedule, effective case defaulter retrieval system, prompt and extensive contact tracing, cross-indexing system and detailed epidemiological investigations for every tuberculosis case. Tuberculosis control services continue and strive for Tuberculosis elimination.
Another important disease under communicable disease surveillance is Meningitis. The total number of Meningitis cases has shown a declining trend over the years. Meningococcal infections dropped from 41 cases in 1988 to only 4 cases in 1998. All the cases of Viral Meningitis are being investigated in the laboratory for viral studies. As there has been a proposal to add HIB vaccine in the routine immunization schedule, the close monitoring of HIB cases is being carried out. Family members and contacts of a confirmed case of Meningococcal and Haemophilus Influenza Meningitis are routinely given Rifampicin.
Only 39 new cases of leprosy were registered in 1998 compared to 144 in 1975. The "Program of Control of Leprosy" was launched in 1991 with the beginning of the fourth Five-Year Heath Development Plan. The program had promptly acted and 100% coverage by Multi Drug Therapy (MDT) was achieved. Cross-indexing system, epidemiological investigation of every case and aggressive screening of all contacts were important pillars for the control of the disease. Leprosy was not defined as a public health problem in the fifth Five-Year Health Development Plan.
The achievements in child health could be clearly appreciated if we compare Infant Mortality Rate (IMR) and Under 5 Mortality Rate (U5MR) of 1998 with that of early 70s. IMR has declined from 118 per 1000 live births in early 70s to 18 in 1998 and U5MR has declined from 181 to 24.5 per 1000 live births during the same period. Such achievements could be attributed to a number of factors. The "Program for Control of Diarrhoeal Diseases (CDD)" in 1985 and the "Program to Control Acute Respiratory Infections (ARI)" in 1987 contributed heavily to such achievements. There has been a steady decline in the incidence of both groups of diseases. Dirrhoeal diseases declined from 0.7 per child per year in 1991 to 0.3 in 1998 and ARI dropped form 3 in 1991 to 1.5 in 1998.
The achievements in both programs were because of standardized case management and judicious use of drugs. Anti-diarrhoeal drugs were banned since 1985 and antibiotic use in ARI was rationalized. Training was an important component of these programs. Master trainers are identified for every health region. Training of master trainers included lectures, group discussions, with emphasis on clinical practices and communications. Master trainers in turn trained all health workers in their respective regions. Continuous assessment for case management had been performed. The "Health Facility Survey" was performed in 1996. It had assessed 329 health staff in the quality of case management of children below the age of 5 years with ARI and 321 health staff in the management of diarrhoeal cases. Such close monitoring ensured proper implementation of the programs' strategies.
As previously mentioned, the economic and social statuses as well as the level of health service development in the 70s and 80s have contributed to the high prevalence of a number of communicable diseases. The prevalence of Trachoma was estimated to be 30% at that time. The high prevalence of trachoma had led to a large backlog of cases of eyelid complications as Ptosis, Entropion and Trichiasis that can lead to corneal opacities and finally blindness. Trachoma was the main leading cause of blindness in Oman. Such cases of blindness are easily preventable by trachoma control and therefore, MOH had started the "Prevention of Blindness Program" in 1982. The program then had two vertical components. The first was screening of all school children and the second was house-to-house screening of the community in trachoma endemic parts of northern and central of Oman. Due to limited resources at that time, the first component could be completed as planned in one year while the other took three years to complete. The data have revealed a prevalence of bilateral blindness of 3% and unilateral blindness of 3% and these were relatively high figures.
The high prevalence of trachoma and its complications had lead to huge backlog of patients with trachoma complications. The health services at that time could not provide timely management for these patients who had a very long waiting time to receive surgical correction of their complications which could lead indirectly to blindness.
The "Prevention of Blindness Program" had thus to be reorganized in 1991. The program reorganization had included a number of activities. All school students in first primary were screened for trachoma. Active cases were treated with supervision from the teachers (supervised treatment). The child-adult trachoma infection cycle had to broken through provision of prophylactic treatment to family members and contacts to active trachoma. Health education to school children and community as well as involving the community in addressing the underlying causes of trachoma infection, methods of control, safe practices and vision hygiene were important strategies for the program. The program had also expanded eye services to primary health care. The reorganization of the program coincided with fourth Five-Year Health Development Plan and was called "Eye Health Care Program". The same strategies have continued through the "Program of Control of Identified Specific Diseases in the fifth Five-year Health Development Plan.
As a result of program activities, the number of cases of active trachoma had declined among first year primary students. The number of trachoma cases reported in MOH institutions had declined to 2,283 case in 1998 compared to 24 thousands in 1975 and 21 thousands in 1980. However, data reveal that trachoma is still a public health problem. The same control measures have led to a decline in infective conjunctivitis as it shares the same underlying causes with trachoma.
MOH has performed a national survey in 1996 in attempt to evaluate the health status of eye diseases especially blindness and to identify its causes. The survey has shown a reduction in the prevalence of bilateral blindness to 1.1% and unilateral blindness to 1.7%. There has been also a reduction in the prevalence of trachoma to 2.2% of the total population. The causes of blindness have been studied and results show that cataract and not trachoma is the main cause of blindness now. MOH has thus responded through supporting the surgical eye services especially for cataract.
The survey has also shown that complications of trachoma like trichiasis and corneal opacities are still public health problems especially among elderly. Their prevalence was found to be 1.1% and 1.5%; respectively. The program has thus strengthened its activities in primary health care. Health workers in PHC were trained for control of common eye diseases and to identify and provide care for entropion and trichiasis cases especially in elderly people (above the age of 40 years). A monthly health information system to record activities of "Eye Health Care" in all MOH institutions has been initiated. There exist 140 health institutions within MOH without a specialized eye clinic but provide regular eye care since 1996.
The situation regarding food borne communicable disease (Typhoid, Paratyphoid and Food Poisoning) have remained static for the last few years. The number of cases of Typhoid and Paratyphoid reported in 1998 were 105 compared to 265 in 1985. Food poisoning episodes in Sultanate have shown increasing incidence from 259 in 1991 to 978 in 1997 and 1,062 in 1998. This is possible due to change in food practices including storage and transport of food items. This trend is observed all over the world. Efforts are being made to control food poisoning through strict food hygiene, regular examination of food handlers and health education of the community. The strict guidelines have been issued for preventing and managing food poisoning episodes in health institutions.
The Zoonotic Communicable diseases of importance in Oman are Leishmaniasis, Burcellosis and Rabies. Prior to 1990, the Sultanate of Oman was known to be free from rabies. The first human case was reported in August 1990 following a fox bite. The epidemiological investigation at that time established the presence of sylvatic rabies in Oman and the danger of spillover to domestic animals exists. In this regard, strict guidelines are being followed for animal bite cases. During the period 1992-1997, as much as 25,500 doses of anti-rabies vaccine and 6,930 ml of Human Rabies Immunoglobulin was used. In the same period, only three cases of human rabies were reported. These resulted from bites of wild animal.
Leishmaniasis (Visceral and Cutaneous) shows indigenous transmission in Oman with periodic local quiescence and resurgence. The number of notified Leishmaniasis cases have remained static in the last few years; 30 in 1998. Efforts are being made to control the disease through case detection, treatment and use of insecticides in domestic and peridomestic areas around cases detected. The health staff are being briefed about the disease for early recognition and diagnosis.
Brucellosis is a public health problem in the Dhofar Governorate of Oman. There have been 307 cases registered in Oman of which 305 were registered in Dhofar Governorate. The efforts are being made to control the spread of disease in animals in Dhofar Region to control human Brucellosis.
The MOH has initiated number of activities to address the problem of emerging infectious diseases which is mainly due to population mobility, ecological imbalance, industrialization, improper use of antibiotics and or insecticides and globalization of food supplies and changes in food processing and packing. In this regard the MOH has made efforts to strengthen the epidemic preparedness capabilities centrally and at the regional level by introduction of epidemic preparedness plan for early detection and control of epidemics of communicable diseases. MOH has also upgraded the capabilities of Central Public Health Laboratory to respond to threats of emerging and re-emerging communicable diseases.
Activities also included strengthening health education activities that has contributed greatly to the control of communicable diseases. It also has an important role in educating the community about new emerging harmful global changes and ways to avoid.
The Sultanate of Oman is witnessing an epidemiological change in diseases pattern. The communicable diseases have declined to low levels and the non-communicable diseases have started to emerge. This later epidemiological transition was the result of control activities towards communicable diseases. Other factors include; demographic changes and the increase in life expectancy at birth to 72.2 years and the changes in the life style that have accompanied the economic developments in the country.
Non-communicable diseases constitute 54.5% of outpatient morbidity and 40.8% of inpatient morbidity in MOH institutions in 1998. These have increased from 42.5% and 37.4% in 1996, respectively. Cancer cases among inpatients accounted for 9 per 10,000 population in 1998, cardiovascular diseases accounted for 63 and diabetes mellitus accounted for 14 per 10,000 population. Cardiovascular diseases were the main cause of hospital deaths. They have accounted for 34.5% of all hospital deaths followed by cancer that accounted for 13.2%.
Road traffic accidents (RTA) represented about 27% of all causes of injuries among inpatients in MOH hospitals in 1998. There were 9,700 RTAs in 1995; 9,400 in 1996 and 8,444 in 1997. These have resulted in 432 deaths in 1995; 512 deaths in 1996 and 497 in 1997 representing about 5% of all deaths in Oman during the same period.
Such non-communicable diseases are usually difficult and require more time and costs to manage. Highly advanced technologies are required for diagnosis and management. They are highly related to style of life such as nutritional habits, exercises and smoking. Individuals should actively share the public sector for prevention of such diseases.