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World of Genomics: Bahrain

Welcome to Bahrain, a mesmerizing archipelago nestled in the Persian Gulf. Despite its small size, this enchanting nation boasts captivating treasures that include UNESCO World Heritage Sites, like the hauntingly beautiful Dilmun-era burial mounds, and the venerable Al-Khamis Mosque, an architectural masterpiece dating back to 692 AD. The country is also home to the world’s largest underwater theme park, sprawling over more than 100,000 square metres and boasting a sunken Boeing 747 adorned with vibrant coral formations. Bahrain’s allure extends far beyond its rich history. In World of Genomics: Bahrain, we will delve into the genetic makeup of Bahrain’s population and examine its unique demographic and geographic characteristics. Moreover, we will discuss the nation’s top healthcare priorities and the remarkable capabilities of its healthcare system in utilising genomic medicine to enhance patient care and foster personalised healthcare solutions.

Population of Bahrain

Bahrain’s small size might surprise you – only Singapore, a city-state, and the Maldives are smaller than this captivating archipelago in the Persian Gulf.

Despite its compactness, Bahrain is strategically positioned, with Saudi Arabia to the west, separated by the Gulf of Bahrain, and the Qatar peninsula lying to the east. The remarkable King Fahd Causeway, stretching 24 km, serves as the vital link connecting Bahrain to Saudi Arabia, symbolising the nation’s significance in the region.

Map of Bahrain and surrounding area.

Bahrain is a unique nation, comprising two distinct groups of islands. Bahrain Island encompasses an impressive seven-eighths of the total land area and is surrounded by smaller islands. Notably, the islands of Al-Muharraq and Sitrah have been ingeniously linked to Bahrain Island through well-engineered causeways, paving the way for residential and industrial development.

Southeast of Bahrain Island, the Ḥawār Islands hold an intriguing history, having been at the centre of a dispute with Qatar over ownership; they were eventually awarded to Bahrain in 2001. The Ḥawār Islands are believed to hold valuable reserves of petroleum and natural gas, however, they are sparsely inhabited, home primarily to a few fishermen and quarry workers.

Bahrain’s significance as a vital trading centre and a bountiful source of natural resources spans centuries. Historically, Bahrain Island has been closely associated with the ancient kingdom of Dilmun, a bustling commercial hub engaged in trade with the early Sumerian civilization, one of the earliest known civilizations in human history. Over the ages, Bahrain has witnessed settlement and colonisation by various groups, including the native Arab dynasty of the Khalīfah family (Āl Khalīfah), who have ruled the land since the late 18th century. Recognising the islands’ strategic importance, the Khalīfah family opened Bahrain’s port facilities to the naval fleets of foreign countries. This act solidified Bahrain’s position as a crucial maritime gateway and subsequently strengthened its ties with the global community.

Arabic is the official language of Bahrain, with approximately half of the population being Arab. However, English is widely used and is a compulsory second language in all schools. Most of the population lives in towns and urban areas. Over one-third resides in the two principal cities- Al-Muḥarraq and Manama (the capital city of Bahrain) which is also the main port. Located on the northeastern tip of Bahrain Island, Manama is a favourite destination for Saudi Arabian tourists due to its relaxed and cosmopolitan atmosphere. Despite this, Bahraini citizens maintain a traditional outlook, as highlighted in their constitution, which declares:

“The family is the cornerstone of society, the strength in which lies in religion, ethics and patriotism.”

Geographic and Demographic Information

Summary statistics:

  • Land area: 778 km²
  • Gross domestic product (GDP):
    • Total: 44.39 USD Billion (Dec 2022)
    • Per Capita: 24395.47 USD (Dec 2022)

Population statistics:

  • Population size: 1,603,000 (2023 estimate)
  • Birth rate: 12 per one thousand people (2021)
  • Death rate: 2 per one thousand people (2021)
  • Infant mortality rate: 2.97 per one thousand live births (latest)
  • Average life expectancy: 76.23 (2021)
    • Male: 77.6 years (2022)
    • Female: 82.2 years (2022)
  • Ethnicity: Non-nationals make up more than half of the population of Bahrain (52.65). The rest of the population is made up of native-born Bahrainis. The majority of foreign-born inhabitants come from other Asian and Arab countries. 

Healthcare System

Bahrain’s healthcare system encompasses both public and private medical facilities. It provides comprehensive healthcare services to the entire population, including non-nationals.

All three forms of healthcare, Primary, Secondary and Tertiary, are available in Bahrain. At the heart of the healthcare system lie 27 MOH-operated health centres which offer an array of preventive, curative, and supportive services. These Primary Health Care services play a crucial role in ensuring the well-being of the population. For secondary and tertiary healthcare needs, the government operates three main hospitals, providing comprehensive medical services to those in need.

Bahrain’s healthcare landscape includes 19 private hospitals scattered across the kingdom, concentrated in and around the capital, Manama. The National Health Insurance Program (SEHATI) is expected to boost the private healthcare sector and subsequently present investment opportunities for businesses. SEHATI is part of the Supreme Council of Health’s National Health Plan (2016-2025). Specifically, the plan aims to ensure fair, efficient and high-quality healthcare services and entitles all Bahraini citizens to receive free treatment at government medical facilities. It also provides every citizen and resident with a chip-enabled card containing their medical history, test results, diagnoses, and prescription details. The Supreme Council of Health also established the Health Insurance Fund (SHIFA) to support this initiative. This fund covers the cost of treatment for citizens in government hospitals. This comprehensive approach ensures that healthcare services in Bahrain are accessible, efficient, and of high quality. 

To further enhance their healthcare system, the government aims to strengthen the integration between the MOH and private healthcare providers, encouraging a unified system with standardised guidelines and protocols and ensuring consistent and high-quality care across all healthcare facilities. 

Healthcare Priorities

Presently, Bahrain’s healthcare priorities focus on improving the overall health and well-being of the population. This government’s support of scientific research and continuous training of specialists has partially supported the achievement of this goal. The country’s Economic Recovery Plan (2021), summarised intentions to deliver 23 major infrastructure and strategic projects across key sectors. The initiative encompasses academic, medical and research facilities. It includes the construction of the 200-bed Dilmunia Health Services complex and the 125-bed King Hamad American Mission Hospital (which will derive 75% of its electricity from solar panels). The projects aim to address prevalent regional diseases such as cancer, diabetes, and obesity.

Emphatically, the rise in non-communicable diseases (NCDs) is a significant concern in Bahrain. NCDs, including cancer, cardiovascular diseases, diabetes, and chronic respiratory diseases, account for 75% of deaths in the country. Significantly, these diseases contribute to reduced socioeconomic development and long-term fiscal sustainability. Not only do they cost the Bahrain economy approximately 534 million BD (USD 1.4 billion) annually, but they result in the death of around 2,000 Bahraini citizens per year.

This surge in NCDs is accompanied by a parallel increase in obesity. In 2018, their first VNR report highlighted that 40% of adults and 24% of youth are classified as obese. Given that sedentary lifestyles and changing dietary habits are identified as key factors driving this trend, the Ministry of Health (MOH) established the country’s first nutrition clinic in 2007. The clinic aimed to address the high number of patients with obesity and related health complications. It was successful in reducing obesity and associated risks, thus, nutrition clinics were opened in all health regions. In addition, the government implemented several other health initiatives, including the National Health Insurance Law (NHIL), to ensure accessible and affordable healthcare for all residents of Bahrain.

The Bahraini government is dedicated to modernizing the Mental Health Law. They are focused on regulating patient-stakeholder relationships, safeguarding patient rights and promoting the integration of individuals with mental health conditions into society. Meanwhile, as part of this commitment, plans are underway to establish the country’s first psychiatric hospital for children, prioritising early diagnostics to provide effective care and support. Bahrain has made impressive strides in integrating mental health services into primary healthcare, by enhancing service efficiency and effectively reducing the stigma associated with psychiatric hospitals.

In 2018, the Ministry of Interior introduced the groundbreaking Ta’afee program. The program was a crucial component of the national plan to combat drug addiction. It offers invaluable psychological and social services to support individuals in their journey to recovery, with health services available when needed. Another key point of the Ta’afee program revolves around respecting individual privacy. This is done by breaking down barriers of fear that might discourage drug users from seeking help. The program’s resounding success is evident; a total of 672 participants enrolled by 2022.

Bahrain’s emphasis on preventive healthcare measures is exemplified by its provision of free immunisations for citizens, adhering to a carefully crafted schedule. Since 2012, immunisations have become a prerequisite for school entry, ensuring accessibility for all students. The nation takes pride in maintaining consistently high rates of coverage for routine childhood immunisations, surpassing 95% each year since 1997. Notably, some vaccines have achieved a remarkable 100% coverage, underscoring Bahrain’s unwavering commitment to protecting the health and well-being of its population.

Genomic Medicine Capabilities

Genetic blood diseases are frequent in Bahrain as in all Middle Eastern countries. Consanguineous marriages are a significant factor in the spread of genetic diseases in Bahrain, as both parents may carry the same recessive allele for an inherited trait. This increases the likelihood of their offspring being homozygous for that trait and expressing the specific genetic disease. Consanguineous marriage has been linked to the high incidence and prevalence of Sickle Cell Anaemia (SCA), which is a preventable genetic disorder. The sickle cell gene defect is a known mutation of a single nucleotide. This mutation consequently results in glutamic acid (E/Glu) being substituted by valine (V/Val). 

Premarital screening data from Bahrain, taken between 1993-1994, showed that 13% of screening subjects had the sickle cell trait. Additionally, 2% were b-thalassemia carriers and 8.1% of couples were at risk of having affected children.

To reduce the incidence of babies born with sickle cell disease and b-thalassaemia, the genetic clinic at the Salmaniya Medical Centre launched a premarital screening service in 1985. During that year, there was a rise in the number of couples who were at risk of having children with genetic disorders. Certainly, this increase may have been due to more at-risk individuals seeking genetic testing after learning of a family member who was affected. Afterwards, The Ministry of Health recognised the importance of this clinic and markedly decided to expand the service in 1992, making it available as part of general primary healthcare in all health centres. The expanded service was preceded by both an information and a training course for all physicians, nurses and health educators.

The Bahrain Government passed a law in 2004 that requires all engaged couples to undergo free premarital counselling. The central aspect of premarital genetic counselling is its educational nature, intending to empower individuals and at-risk couples to make informed decisions based on their values. As part of the service, couples go through a screening that includes a physical examination, lab investigations and the collection of their medical history. Abnormal results during blood sampling, or a positive family history for genetic disorders result in further investigation and referral to a genetic counsellor. Premarital counselling also includes interventions to address risks, such as illness treatment, vaccinations, behaviour counselling, and advice on contraception.

Obligatory premarital counselling has undeniably increased rates of “separation before engagement” in arranged marriages. Furthermore, the premarital screening and accompanying wide public health campaign implemented in Bahrain not only facilitated a 99%. reduction in babies born with sickle cell disease, but the country also saw a drop in sickle cell deaths by 40% from 2013-2017. Bahrain’s experience in significantly reducing the rate of sickle cell anaemia has indeed provided the country with important lessons when it comes to preventative healthcare measures and targeted interventions.

Notable Projects

In mid-2007, the screening service began after receiving approval from the MOH and receiving funding from the national budget. The goal was to study every newborn affected by SCD to determine if they belonged to a family with a previous case of the disease or were from a new family. Advice was given to parents about future pregnancy and care for the affected newborn. The service has successfully led to a reduction in the number of affected newborns from 2.1% in 1985 to 0.4% in 2010, potentially indicating a gradual decline in disease frequency.

The Bahrain Genome Project is a collaborative effort involving the Bahrain Ministry of Health, Brigham and Women’s Hospital, and the Broad Institute of MIT and Harvard. Chiefly, it aims to better understand the genetic susceptibility to disease among the Bahraini population. To achieve this goal, the project aims to conduct Whole Genome Sequencing for 6,000 participants and analyse the resulting data. Each participant will receive an individualised report based on the findings. Additionally, the project aims to support the development of professional Genomic Medicine skills in Bahrain through training and educational programs. The long-term plan includes establishing genomic and precision medicine clinics within the country.

As part of its National Genome Program, Bahrain intends to establish a specialised genetic analysis centre. This centre will play a crucial role in improving the quality of health services and preventing genetic, intractable, and deadly diseases. It will house a comprehensive database of the Bahraini population’s DNA, which will be thoroughly analysed to identify opportunities for disease diagnosis, early detection, and reducing the population’s risk of contracting various illnesses. What sets this program apart from others is its integrated approach, combining research, clinical expertise, capacity building, and technology transfer efforts. Moreover, as part of this initiative, 60 genomics technicians have already received training in advanced genetic decoding techniques.

The National Project for the Prevention of Hereditary Blood Diseases (NPPHBD) was begun in 1999 as a collaborative project between the Ministry of Health, the Ministry of Education, the Rotary Club of Manama, and the Bahrain Hereditary Anaemia Society.

As part of the NPPHBD, the National Student Screening Project aimed to screen all 11th-grade students in Bahrain. The target population was 7000 students, and the project took 10 months to complete. Students received test results cards that they could use in future medical checkups or clinical admissions. The project found that 68 students were homozygous sickle cell while 85% did not have the sickle cell gene. The precise and up-to-date statistics gathered from the project were used to plan future services.

Notable Organisations and Institutions

The National Genome Centre was launched in 2018 because of the government’s overall efforts in improving the quality of health services in Bahrain and preventing diseases- particularly genetic, intractable and deadly diseases- by using the latest scientific innovations. 

The Bio-Bank was established at Salmaniya Medical Complex- part of the Ministry of Health. It aims to become a leading regional centre for the provision of scientific samples for research and study.

The Bio-Bank will house a DNA database of Bahrain’s population, which will be analysed and studied to identify opportunities that contribute to improvements in disease diagnosis and early detection. It will contribute to the prevention of genetic diseases and to the development of effective medicines to treat them.

Notable People

Alireza Haghighi, M.D., L.L.B., D.Phil., FACMG (Director and Principal Investigator, Bahrain National Genome Program at Harvard) investigates the genetic basis for human disease. He has a focus on cardiovascular disease and translating research discoveries into better diagnostics and improved patient care. He has received many awards for his research and international projects, including the International Genetic Disorders Prevention Award in 2018.

Amani Al-Hajeri, M.D., CABFM, IBFM, M.SC. MG (Head of the Genetic Department at Salmanyia Medical Complex-Ministry of Health) is a Clinical Assistant Professor at Al Jawhara Center. She is also a senior editor at Bahrain Medical Bulletin, a consultant clinical geneticist and a consultant family physician. Dr Al Hajeri has more than 46 publications in local and international peer-reviewed journals. She has a special interest in evidence-based medicine and common complex genetic disorders and formerly managed the National Genome Project.

Amjad Ghanem Zaed MoHamed, M.SC. (Chief of the Public Health Lab, Kingdom of Bahrain) leads the team for the National Genome Project Implantation Plan and supervises the national viral genetic analysis laboratory activities. She is also the WHO focal point for Public Health Laboratory activities, National Influenza Centre and Food Poisoning PULS-NET.

Jameela Al Salman, M.D. (Associate Professor of Medicine, Arabian Gulf University) is a Senior Consultant in Infectious diseases, internal medicine and geriatric medicine. She is also the Chairperson of the national antibiotic stewardship committee in Bahrain. In 2020, Khalifa Bin Salman Al Khalifa the Prime Minister of Bahrain, awarded Dr Jameela a prize for her achievements in medical research and innovation. This is a first for a Bahraini Doctor.

Future Genomics Landscape

The future of genomics in Bahrain shows great potential for addressing genetic diseases and improving healthcare services. Evidently, they have already achieved considerable progress in the National Genome Program by recording the country’s first complete sequence of the human genome. The program included three human genome samples with a high coverage rate of 97 %. Significantly, the researchers also successfully monitored the genetic sequence of COVID-19 through integrated genetic sequencing by analysing over 31,000 samples. Bahrain’s emphasis on preventative measures, such as the National Student Screening Project, has also shown the effectiveness of targeted screening initiatives in guiding future healthcare planning.

Furthermore, The National Genome Centre is a testament to the government’s dedication to utilising the latest scientific innovations for disease prevention and early detection. Housing a comprehensive database of the DNA of Bahrain’s population will enable in-depth analysis and research opportunities, contributing to improvements in disease diagnosis, treatment development, and risk reduction for genetic disorders. As has been noted, Bahrain’s Genome Project will focus on understanding the genetic susceptibility to disease in the Bahraini population, thereby paving the way for precision medicine and tailored treatments. Furthermore, the Government plans to utilise artificial intelligence to support the digital transformation of the healthcare sector, focusing on modern practices in the use of information and modern technologies to reduce effort and cost and simplify procedures.

Bahrain’s commitment to genomics research, premarital screening, and comprehensive healthcare services positions the country for further advancements in the field. Subsequently, as technology continues to evolve and knowledge expands, the integration of genomics into clinical practice will provide new opportunities for disease prevention, early intervention, and personalised treatments, ultimately improving the health outcomes of the Bahraini population.

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