World of Genomics: Oman

Oman (officially the Sultanate of Oman) is an Arab country with a rich heritage and an abundance of natural beauty. Bedouin values are still firmly at the heart of this nation, and visitors can expect a warm welcome. Oman is famed for its delicious dates, traditional souqs and for the hospitality of the Omani people. Join us for a tour of the oldest human-inhabited nations on Earth and find out more about the Sultanate’s healthcare system and genomic capabilities.

The population of Oman

Oman is located on the south-eastern coast of the Arabian Peninsula. It is an absolute monarchy led by a Sultan, with the current Sultan being Haitham bin Tariq. It spans the mouth of the Persian Gulf and shares land borders with Saudi Arabia, the United Arab Emirates and Yemen. It also shares maritime borders with Iran and Pakistan.

Oman is the oldest continuously independent state of the Arab world and is the only country composed mostly of oceanic crust and rocks originating from the Earth’s mantle. Much of the country falls in the sandy, treeless and largely waterless region known as Rubʿ al-Khali, which is still the domain of Bedouin nomads.

The capital city of Oman is Muscat, which was seized by Portugal during the 16^th century. Oman has been recognised as an empire since the 17^th century and has a history of competing with the Portuguese and British empires for influence in the Persian Gulf and Indian Ocean. In the 18^th century, the Āl Bū Saʿīd dynasty expelled Persian occupation and established Omani control over much of the Persian Gulf. This control lasted until the 21^st century, which was helped by close relations with the United Kingdom.

The empire of Oman was at its peak in the 19^th century, but its power and influence declined over the course of the 20^th century, and it soon came under the control of the United Kingdom. This relationship was supposedly based on mutual benefit, as Oman held geographical importance as a trading hub. A 1970 coup saw Qaboos bin Said (Qābūs ibn Saʿīd) come to power after deposing his father. After this point, Oman began the process of modernisation, rapidly developing an advanced economy and actively encouraging tourism. Chief among these modern policies, Qaboos bin Said abolished slavery – once a key part of Omani trade.

In 2010, the United Nations Development Programme ranked Oman as the most improved nation in the world in terms of development during the preceding 40 years. Though Oman has enjoyed more political stability than other regions in the Arab world, it was not immune from the 2011 political dissent in the region. The Sultan at the time responded to this dissent by promising more jobs and benefits to the Omani people.

More than half of the population is Arab, but there are large numbers of Baloch – an ethnic group descended from Iran and Pakistan – in the Al-Bāṭinah coastal region. The Muscat-Maṭraḥ urban area has long been home to significant numbers of ethnic Persians and to merchants of South Asian ancestry, some of whom also live along Al-Bāṭinah.

Geographic and demographic information

Summary statistics

• Land area: 309,500 sq km
• Gross domestic product (GDP):
  • Total: $88.19 billion (2021)
  • Per capita: $19,509.5 (2021)

Population statistics

• Population size: 4,520,471 (2021)
• Birth rate: 19 per 1,000 people (2020)
• Death rate: 3 per 1000 people (2020)
• Infant mortality rate: 9 per 1,000 live births (2021)
• Life expectancy: 75 (2020)
  • Male (2020): 73
  • Female (2020): 77
• Ethnicities: Arab, Baluchi, South Asian (Indian, Pakistani, Sri Lankan, Bangladeshi), African. Immigrants make up approximately 46% of the total population (2019).

Healthcare system

After the 1970 coup, the government improved health care throughout the country and instituted a free national health service. Government spending on health services, social security and welfare has increased during this time.

Healthcare services in Oman are mainly led and financially supported by the government in collaboration with the private sector. They are administered centrally in Muscat by the Ministry of Health (MOH) which coordinates healthcare provision in semi-autonomous regions. These regions have purpose-built family clinics and hospitals, and there are also tertiary referrals centres available nationally for specialised services – though these are mostly located in or near to the capital. At a national level, the Directorate General for Disease Surveillance and Control (DGDSC) is considered the responsible body to run and monitor day-to-day public health work.

During the last three decades, the Oman healthcare system has made great strides in improving care services, preventative and curative medicine, and in research. In 2000, Oman’s health system was ranked number 8 by the World Health Organization. Oman’s coverage of essential health services was 77% in 2015, which is higher than the world’s average of 54% – though lower than the 83% coverage seen in high-income economies. Oman’s health spending to GDP between 2015 and 2016 averaged 4.3%, while the world’s average during the same period averaged 10%. In 2000, 99% of the population had access to health care services.

Health priorities

In 2016 the Government of Oman and WHO set out their aims to work together to effectively improve the public health situation in the country with special emphasis on the five key regional priorities:

• health security and prevention and control of communicable diseases
• noncommunicable diseases, mental health, violence and injuries, and nutrition
• promoting health through the life-course
• health systems strengthening
• preparedness, surveillance and response.

The burden of disease attributable to communicable diseases in Oman is 17.1%, noncommunicable diseases 67.7% and injuries 15.2%. In terms of communicable diseases, the government has adopted a strategy to provide quality treatment, care and support to people living with HIV. They have also taken steps to reduce the incidence of pulmonary tuberculosis by treating latent tuberculosis in close contacts, genotyping tuberculosis strains and introducing private–public partnership in tuberculosis control.

Within the burden of noncommunicable diseases, cardiovascular diseases account for 33%, cancers 9.5%, respiratory diseases 1.7% and diabetes 10.2% of all deaths. To counter this, a national vision for noncommunicable diseases has been defined in a strategic study accompanying Health Vision 2050 and a national policy for noncommunicable diseases has been drafted for approval. Efforts have been made to integrate mental health services in primary healthcare through training of primary healthcare physicians on early detection and screening for the most common mental disorders.

Over the past few decades, Oman has seen a drop in the percentage of the population that are undernourished (from 11.7% in 2003 to 5.4% in 2016), but this is still much higher than that of high-income countries. Vaccine uptake is high among Omani children (above 99% since 1995). In 2016, Oman achieved the highest effective vaccine management (EVM) score (99%) for all criteria for all levels out of the 127 EVM assessments conducted by WHO and UNICEF in 90 countries. Among noncommunicable diseases, genetic diseases are considered a major public health problem and are thus a key target of health policies moving forward.

Genomic medicine capabilities

Genetic diseases are prevalent among Arab nations, a phenomenon that has been attributed to consanguinity. In Oman, the average rate of genetic diseases is between 5.4% to 7% of live births, exceeding the global average of 4.5%. The main contributors to these high numbers are consanguinity, advanced maternal age, and high rates of inherited blood disorders. Around 3.5 to 7 per 1,000 Omani live births have a genetic blood disorder, and 60% of the population has genes for genetic blood disorders. The most common blood disorder in Oman is a G6PD deficiency, with 12% of women and 28% of men having the G6PD deficiency gene.

Overall, more than 300 different genetic diseases have been identified in Oman. The most common are autosomal recessive disorders, which result from inheriting two mutated genes. Examples of autosomal recessive disorders include cystic fibrosis, sickle cell disease, Tay-Sachs disease and alpha- and beta-thalassemia. Autosomal recessive conditions are a significant cause of handicap, morbidity, and mortality among Omani children. It has also been estimated that Down’s syndrome and haemoglobin disorders are reaching epidemic levels, with more than 100 cases per 100,000 live births. This increase is likely due to better diagnostic capabilities.

The development of community-based genetic services and improved early detection and diagnosis in Oman have been followed by the gradual reduction in infant and prenatal mortality. Information-based health education has also been implemented in Oman to improve genetic literacy.

The main MOH genetic centre is located in The Royal Hospital, supported by a cytogenetics laboratory and a molecular laboratory in another part of the city. The College of Medicine and Health Sciences of Sultan Qaboos University (SQU) has a Genetics Department with 4 sections: clinical genetics, cytogenetics, immunogenetics and molecular genetics. The MOH Central Public Health Laboratory (CPHL) serves as WHO’s regional reference laboratory for COVID-19. The CPHL linked with national and local academic partners to strengthen workforce capacities, increase national genomic surveillance coverage, and develop algorithms for selecting cases for sequencing.

In the Middle East, there are around 100 practicing genetic counsellors, with a handful of these located in Oman. Because the genetic counselling profession is still relatively new, there are very few practicing genetic counsellors in the country. Genetic counsellors are mostly locally trained as nurses or biologists before travelling abroad for specialization in countries where genetic counselling is an established activity. They study in places such as the UK, USA and South Africa, depending on their personal networks as well as Oman’s historical connections. In an attempt to spread expertise outside of the capital, an 18-month training program in genetic counselling was initiated in 2014 at the National Genetic Centre.

 

Notable projects

• The Ministry of Health’s Central Public Health Laboratory: During the COVID-19 pandemic, this laboratory served as WHO’s regional reference laboratory. It collaborated with national and local academic partners to increase genomic surveillance coverage for SARS-CoV-2.
• The National Program for the Control of Genetic Blood Disorders: This programme started in 1999 and operates in eight regional hospitals to provide care, genetic counselling, premarital screening and education in genetic health.

Notable organisations and companies

• The Ministry of Health: Based in the capital Muscat, the MOH coordinates healthcare provision in semi-autonomous regions across Oman. The mission of the Ministry of Health is to enhance the health and wellbeing of all the people of Oman by ensuring the availability of comprehensive health services throughout the Sultanate. The main MOH genetic centre is in the Royal Hospital, backed up by another cytogenetics lab and a molecular lab in Muscat.
• The Royal Hospital: Founded in 1987, The Royal Hospital is owned and administered by the MOH. It is made up of 21 medical departments with 5 national centres of excellence – including the National Genetic Center.
• National Genetic Center (NGC): Part of the Royal Hospital, the NGC is a centre of excellence for genomic science providing a clinical genetics and laboratory service for Oman. This includes high-quality patient-centred care and a specialised facility for advanced, high-throughput genetic sequencing, counselling, education and specialised genetics clinics.
• Sultan Qaboos University: the Department of Genetics at SQU aims to provide high quality clinical and diagnostic care for families with genetic disorders, educate both the public and health professionals about medical genetics, and conduct research to help with the understanding of genetic disorders.
• Oman Hereditary Blood Disorder Association (OHBDA): A non-profit organisation based in Al-Hail Al-Junoubia-Muscat, Oman. The aim of the OHBDA is to raise awareness among the public about how to avoid the spread of hereditary blood disorders and to provide services such as counselling.

Notable individuals

• Dr Anna Rajab:A Senior Consultant Clinical Geneticist, Anna Rajab established the first Neonatal Service unit in Oman at the Khoula Hospital. She later founded the National Program for the Control of Genetic Blood Disorders alongside a genetic counselling service from 2000-2012. Besides this, she has published more than 100 scientific papers on genetics, served as a consultant for WHO and the EU Research Commission, and won the 2012 Hamdan Award honouring distinguished personalities form the Arab world.
• Dr Abeer El-Saegh: A medical geneticist at Sultan Qaboos University in Oman, Dr Abeer heads up a team of around 65 doctors, nurses, scientists and health professionals. Her research interests include discovering cures for rare genetic diseases and ensuring students have access to quality education in Oman. Her current research focusses on understanding colorectal cancer in Omani patients using whole genome expression microarray analysis.
• Sulayma Albarwani: Professor Sulayma Albarwani studied at the University of Oxford in 1991, gaining her DPhil. In 1994 she returned to Oman to join the College of Medicine and Health Sciences at Sultan Qaboos University, becoming the first female Omani physiologist.

 

The future genomics landscape

So, what does the future hold for genomics in Oman? The Centre of Studies and Research at the MOH has proposed a strategic plan, the “Health Vision 2050 for Health Research”. A steering committee was constituted and the process of developing this vision was through a series of well-planned scientific activities. Fourteen working groups of national and international experts were consulted. Each of them was directed to develop a detailed strategic study in one of the domains of the health system, discuss challenges, and consider their own future perspective. The aim of this plan is to make Oman the regional leader and research hub for health research:

“The mission is to promote, facilitate, and conduct high quality health research addressing national health priorities to improve health care services and enhance the efficiency and effectiveness of the health system, reduce health inequity, and contribute to socioeconomic development. The strategy includes setting health research priorities, strengthening the health research capacity, defining and implementing norms and standards, developing health research (quality and quantity), translating evidence into policy, strategy and practice, monitoring and coordinating research, financing health research, and evaluating the effectiveness of the health research system. It should generate a multifold increase in the quality and quantity of health research in Oman, positively impacting the health system and health care service.”

Off the back of the pandemic, Oman’s central public health laboratories have been designated a WHO collaborating centre for emerging and re-emerging infectious diseases. “The current pandemic has highlighted the importance of enhancing regional and national laboratory diagnostic capacities for emerging and re-emerging infectious diseases to enhance preparedness for future pandemics,” said Dr Jean Jabbour, WHO Representative to Oman. “I am confident that this new collaborating centre will fulfil its mandate in supporting countries in the Region and contribute to WHO’s programme of work and achievement of the Sustainable Development Goals.” Through collaborative projects such as this, Oman has found a place in international research and looks set to continue improving its genomic medicine capabilities into the future.

References:

Elegant Resorts. Ten Interesting Facts about Oman. Available at: https://www.elegantresorts.co.uk/eleganttraveller/story/ten-interesting-facts-about-oman

Britannica. Oman. Available at: https://www.britannica.com/place/Oman

World Bank. Indicators. Oman. Available at: https://data.worldbank.org/country/OM

World Health Organisation. Health System Development. Available at: https://www.emro.who.int/omn/programmes/health-system-development.html

World Health Organisation. Country Cooperation Strategy for WHO and Oman. Available at: https://apps.who.int/iris/rest/bitstreams/1093367/retrieve#:~:text=The%20health%20policy%20is%20based,3%2C%20remains%20a%20high%20priority.

Raeburn S. Genetic Services in the Sultanate of Oman and other Gulf Countries: Progress is needed now! Sultan Qaboos Univ Med J. 2008 Jul;8(2):129-35. PMID: 21748050; PMCID: PMC3074812.