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Adolescents in the Arab Culture. Ashraf T Soliman MD PhD FRCP Profesor of Pediatrics and Endocrinology. Arab World . The Arab World.

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adolescents in the arab culture
Adolescents in the Arab Culture

Ashraf T Soliman MD PhD FRCP

Profesor of Pediatrics and Endocrinology

the arab world
The Arab World
  • Arabic-speaking countries stretching from the Atlantic Ocean in the west to the Arabian Sea in the east, and from the Mediterranean Sea in the north to the Horn of Africa and the Indian Ocean in the southeast.
  • It consists of 25 countries and territories with a combined population of 358 million people straddling North Africa and Western Asia.
arab world5
Arab World
  • The Arabic language forms the unifying feature of the Arab World.
  • Though different areas use local varieties of Arabic, all share in the use of the standardized classical language, which was constructed from Classical Arabic
religion
Religion
  • The majority of people in the Arab World adhere to Islam and the religion has official status in most countries.
  • Overall, Arabs make up less than one quarter of the world's 1.4 billion Muslims
christians
Christians
  • There are sizeable numbers of Christians, living primarily in Egypt, Syria, Lebanon, Iraq, Jordan, Palestine and Sudan.
poor and rich
Poor and Rich
  • There are economic disparities between oil-rich and oil-poor countries, and, particularly in the more sparsely populated states of the Arabian Gulf and Libya, triggering extensive labor immigration
  • Four Arab Gulf states, Saudi Arabia, the UAE, Kuwait, and Qatar, are among the top ten oil or gas exporters worldwide
rich and poor
Rich and poor
  • Algeria, Libya, Iraq, Bahrain, Egypt, Tunisia, and Sudan all have smaller but significant oil reserves
literacy in arab adolescents
Literacy in Arab Adolescents
  • In 2004, the regional average of youth literacy was 90% for male and 80 % for female
  • Illiteracy for 15-24 year olds ranges from less than 1% in Jordan to 50% in Yemen.
  • >one third of youth remain illiterate in the some Arab countries (Djibouti, Mauritania, Somalia, Sudan, and Yemen)
youth unemployment
Youth Unemployment

the Arab Labor Organization (ALO) rates unemployment in the Arab world as the worst worldwide.

According to the report the

general rate of unemployment in Arab countries exceeds 14 %

youth rate of unemployment in Arab world exceeds 26%

, which means that the Arab region has more than 17 million unemployed.

Algeria--- 46 percent;

Bahrain is 27 percent;

Saudi Arabia, 26 percent

The UAE has the lowest rate, 6.3 percent..)

the reasons behind the rise in youth unemployment
The reasons behind the rise in youth unemployment
  • Failure of development,
  • Neglect of critical social aspects,
  • poor economic performance (as indicated through inadequate growth averages),
  • The inefficacy of education and its failure to meet the requirements of the job market,
  • The failure to create attractive investment climates

Hamdi Selim . Unemployment in the Arab World. 26/07/2008, Alsharq Alawsat newspaper

problems of education quality the mena region
Problems of education qualityThe MENA region
  • According to the “the most worrying aspect of the crisis in education is education’s inability to provide the requirements for the development of Arab societies
  • In cases when education is available, it suffers from the low quality of its educational system, lack of educational materials or qualified teachers.
  • Access to colleges or universities is still limited.

2002 Arab Human Development Report,

Education in the Middle East and North Africa Wikipedia

problems of education quality universities
Problems of education quality (universities)
  • Crowded facilities
  • Centralization of most Arab universities in national capitals and primary cities.
  • Low living standards of university faculty.
  • “Many universities in the Arab world operate in seclusion from their surroundings, unable to open up and interact with society
  • Little or no academic freedom
  • Low-quality research with unclear goals (<0.5 % of public income is spent over research)
  • lack of a good and effective management, poor integration across the university programs
  • the absence of a link between pre-university and university education.
democracy in arab countries
Democracy? in Arab countries
  • Arab adolescents lack the right to freely express their social and political opinions
  • Presidents and kings remain too powerful. Constitutions and laws deliberately keep them that way.
  • Countervailing institutions remain weak, if they exist at all
  • Lack of broad-based political organizations pushing for democracy—political parties, social movements, labor unions, large civic organizations.
parenting styles and mental health of arab adolescents
Parenting Styles, and Mental Health of Arab Adolescents
  • The Psychological State Scale, Multigenerational Interconnectedness Scale, and the Parental Authority Questionnaire were administered to 2,893 Arab adolescents in eight Arab societies.

Journal of Cross-Cultural Psychology, Vol. 37, No. 3, 262-272 (2006)

parenting styles and mental health of arab adolescents17
Parenting Styles, and Mental Health of Arab Adolescents
  • Authoritative parenting was associated with:

1. Higher level of connectedness with the family and

2. Better mental health of adolescents.

  • A higher level of adolescent-family connectedness was associated with better mental health of adolescents.
  • Journal of Cross-Cultural Psychology, Vol. 37, No. 3, 262-272 (2006
tobacco global youth tobacco survey gyts
Tobacco (Global Youth Tobacco Survey (GYTS)
  • GYTS gave information on tobacco use in 21/22 countries of the region.
  • cigarette smoking generally

about 20% of 13-15 year olds in the region (in any country) are current users of any tobacco product.

Outlier: Lebanon: 60% in 2005

  • Need more on other forms of tobacco use, especially arghile
smoking in egyptian adolescents n 1930 students
Smoking in Egyptian Adolescents ( n = 1930 students)
  • Male prevalence of ever-smoking, (34%)
  • 30-day smoking, (16%)
  • current smoking(8%) and
  • susceptibility to smoking(51%)
  • Female prevalence of ever-smoking, (16%)
  • 30-day smoking, (7%)
  • current smoking(4%) and
  • susceptibility to smoking(26%)

Health Promotion International 2005 20(2):135-145

qatar
Qatar
  • 2004 ---(age 13-15 yrs) 16.6% are current tobacco users.
  • Currently ----20.2% currently use any tobacco product (boys = 25.9% and girls = 14.9%).

(GYTS, Qatar, fact sheet)

algeria
Algeria
  • (age 15-29) 24% of youth consumed tobacco at least once in their lives (42.3% among males and only 0.3% among females).
  • Average age for starting to smoke is 16.3 yrs .
  • Around 36% of males consume between one and two packs per week (papfam Algeria).
the who report
The WHO report
  • Smoking causes 90% of the lung cancer cases in Egypt
  • Tobacco-related cancers as a percentage of all cancers are on the rise
prevention of adolescent smoking is crucial
Prevention of adolescent smoking is crucial
  • Studies have shown that most adult smokers start smoking during adolescence
  • Smokers who initiate smoking at younger ages are more likely to continue smoking, have more severe health consequences and a lower probability of quitting
  • Therefore, if children can be guided through their teenage years without becoming addicted to nicotine, the likelihood of becoming a life-long tobacco user would drop dramatically
alcohol other drugs
Alcohol & Other Drugs
  • Alcohol: data found for only three countries: Lebanon, Saudi Arabia, Syria

(~5%) of alcohol in Saudi Arabia and Syria, (low)

40% in Lebanon

  • Drug use: only three countries:
  • Lebanon (10% ever),
  • Saudi Arabia (6% ever use)
  • Kuwait (self medication-92%)
anorexia bulemia united arab emirates uae
Anorexia / BulemiaUnited Arab Emirates (UAE).
  • A representative stratified random sample of 495 adolescent girls completed the Eating Attitudes Test (EAT-40)
  • 23.4% scored above the recommended cut-off on EAT.
  • Half of those were found to have a propensity for anorexic behavior, while
  • 2% met the criteria for the full clinical syndrome.

Eating Behaviors Volume 7, Issue 1, January 2006, 53-60

slide29
OMAN
  • 33% of Omani teenagers (29.4% females and 36.4% males) showed a propensity for anorexic-like behavior.
  • On the Bulimic Investigatory Test, 12.3% of Omani teenagers showed a propensity for binge eating or bulimia (13.7% females and 10.9% males).
  • In contrast, barely 2% of Omani adults showed either a presence of or a severity of disorderly behavior with food.

J Am Acad of Child Adolescent Psychiatry

Volume 41, Issue 9, Pages 1124-1130 (September 2002)

summary
Summary
  • These studies demonstrate that eating disorders are not restricted to Western societies.
obesity34
Obesity
  • Seems to be particularly a problem in GCC countries – 25-30% of various samples are overweight
obesity in adolescents
Obesity in Adolescents

Comparison between Lebanon and other Eastern Mediterranean Region Countries who have completed the GSHS

and have fact sheets on the web http://www.cdc.gov/GSHS/results/index.htm accessed Sept. 30th 2006

reproductive health rh survey on knowledge attitude and practice kap
Reproductive Health (RH)Survey on Knowledge, Attitude and Practice (KAP )
  • An inventory of KAP studies in the MENA (Middle east north Africa) region was published by UNFPA in 2004 (Algeria, Bahrain, Egypt, Iraq, Jordan, Lebanon, Morocco, Oman, Syria, Tunisia)
rh general knowledge
RH General knowledge
  • The concept of RH is unknown;
  • knowledge of reproductive system anatomy & physiology is low in most countries
  • knowledge of at least one modern contraceptive is generally high
rh general knowledge38
RH General knowledge
  • knowledge (heard of) of HIV/AIDS is generally high but of other STIs is generally low;
  • knowledge of transmission of HIV/AIDS by sexual contact is high but of other modes of transmission is quite low;
  • The main source of knowledge seems to be the mass media specifically TV and the preferred sources of knowledge are parents and health professionals.
rh attitude
RH attitude
  • In general, youth agree with the concept of family planning/contraceptive use and spacing of births.
  • Overall, youth feel they are not susceptible to HIV infection.
rh behavior
RH behavior
  • Most of the data on behavior across countries is related to:
  • age at marriage,
  • number of children, and
  • use of contraception when married.
  • Results overall indicate the presence of a KAP gap
egypt youth rh kap n 1660 adolescents 14 24 years 55 females 80 single 20 married
EGYPT YOUTH RH (KAP)( n = 1660 adolescents 14:24 years , 55% females, 80% single, 20% married)
conclusion
Conclusion
  • There is a relative lack of knowledge of certain kinds of family planning methods, especially condoms
  • The relative lack of knowledge of STDs other than AIDS
  • The lack of knowledge about STD prevention
violence gshs
Violence - GSHS

Comparison between Lebanon and other Eastern Mediterranean Region Countries who have completed the GSHS

and have fact sheets on the web http://www.cdc.gov/GSHS/results/index.htm accessed Sept. 30th 2006

mental health
Mental health

Comparison between Lebanon and other Eastern Mediterranean Region Countries who have completed the GSHS and

have fact sheets on the web http://www.cdc.gov/GSHS/results/index.htm accessed Sept. 30th 2006

attention deficit hyperactive disorder adhd
Attention deficit hyperactive disorder (ADHD)
  • ADHD rates in Arab populations were similar to those in other cultures

Lynn FJornal of Attention Disorders, v13 n3 p211-222 2009

2006 qatar 1 541 adolescent students
(2006) Qatar - 1,541 Adolescent students
  • (14.1%) in Boys
  • (4.4%)in Girls
  • Total 9.4%

scored above the cutoff for ADHD symptoms.

  • Students who have a higher score for ADHD symptoms have school performance poorer than those with lower scores (p = .003)

Journal of Attention Disorders, Vol. 10, No. 1, 77-82 (2006)

2008 in qatar schools 947 boys and 922 girls
(2008) In Qatar (Schools)947 boys and 922 girls
  • Boys (16.7%)
  • Girls (5.4%)
  • Scored above the cut-off (15) for ADH symptoms.
  • Giving an overall prevalence of 11.1% (95% CI 9.7-12.6).
  • Med Princ Pract 2008;17:440-446 (DOI: 10.1159/000151564)
in oman 1500 adolescent students
In Oman (1500 adolescent Students)
  • 7.8 % of the sample exhibited hyperactivity,
  • This was strongly associated with indices of conduct disorder, poor school performance, and behavioral disorders (such as aggression, stealing, and lying).
adhd in the usa
ADHD in the USA
  • US children aged 8 to 15 years, 8.7%, an estimated 2.4 million, meet DSM-IV criteria for ADHD.
  • Arch Pediatr Adolesc Med. 2007;161(9):857-864
slide53
Depression in UAE Adolescent Students

(15% )

Ghareeb A G

Royal college of psyciatrics Regionalmeeting in Bahrain 1991

in egypt
In Egypt
  • 2043 Adolescents in schools screened for Depression CDI Scores for junior and senior high schools.
  • Males 16% and 17.5%
  • Females 13.5 % and 15%

Ghareeb and Beshai 1998.

depression in 2ry school adolescents egypt oman
Depression in 2ry school adolescents Egypt/Oman
  • 552 Omani and 1544 Egyptian students screened
  • Oman:10.5 boys and 7.5 % girls
  • Egypt:7.0% in boys and 12.8 % in girls
  • In the whole sample; history of physical abuse during childhood and personal history of organic illness were correlates of depression
  • For girls, age, relationship with parents and current cigarette smoking were exclusive predictors
relationship between depression and anxiety among undergraduate students in 18 arab countries
RELATIONSHIP BETWEEN DEPRESSION AND ANXIETY AMONG UNDERGRADUATE STUDENTS IN 18 ARAB COUNTRIES
  • To gain more understanding of the relationship between anxiety and depression, the Kuwait University Anxiety Scale (KUAS; Abdel-Khalek, 2000) and the Beck Depression Inventory II (BDI-II; Ghareek, 2000) were administrated to 9168 participants (4230 males and 4938 females) in 18 Arab countries, (18-25 yr)
  • Findings indicate that depression is positively significantly correlated with anxiety (mdn= 0.66 p< 0.01).

Alansari, Bader M Social Behavior and Personality January 1, 2005

in egypt past
In Egypt- Past

In Cairo, Egypt, attempted suicide rate

  • 2.8 per 100,000 in 1959
  • 3.8 per 100,000 in 1979
  • 3 per 100,000 in 2005 (Alahram newspaper)

60% of the attempters were between 15-24 years of age.

in egypt recent 2009
In Egypt – recent (2009)
  • Recent data collected from Alexandria, Egypt, showed that

30% of the 1621 high-school adolescents sampled experienced a strong death wish in the year before the study

  • However, for many reasons, adolescents' suicide is still neglected in the Middle East.
summary61
Summary
  • Prevalence of emotional & behavioural disorders is increasing in Arab adolescents.
  • Concern about inability of specialist child and lack or deficiency of adolescent mental health services to meet growing need and demands.
  • Results = unmet need, deterioration in mental well-being, huge costs to services and children and families.
recommendations
Recommendations
  • A clear education policy that fulfills goals, measuring up to international education standards. More freedom to educational institutions
  • Adoption of a clear adolescent health education policy including (reproductive and mental health)
  • Introducing adolescent medical care as a specialty in public health facilities
  • Active Preventive measure for adolescent smoking and obesityEconomic and political reforms
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