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Many things that come into or out of the body invalidate fasting, such as intentional eating or drinking, oral medications that reach the stomach, deliberate vomiting, sexual intercourse, parenteral nutrition, and others. Therefore, it is important for PCPs to know the main medication types, conditions, and procedures that may or may not invalidate fasting in order to have an informed discussion with their Muslim patients. This indicates that Ramadan could be an important cause for noncompliance with prescribed medications. For example, a cross-sectional survey among Muslims in Mumbai, India, showed that most of the respondents in the study believe that using eye drops during fasting hours of Ramadan would break the fast and about a third of them would not use drops for a painful eye condition during the fasting period, although eye drops do not invalidate fasting as long as the patient does not feel the taste as will be mentioned later on. TREATMENTS AND PROCEDURES THAT INVALIDATE OR DO NOT INVALIDATE FASTINGīoth Muslim and nonMuslim PCPs may encounter fasting Muslim patients who refuse, or do not adhere, to take a specific prescribed medication or have a specific procedure during Ramadan, thinking that it would invalidate their fast. To address these aspects and to ensure the delivery of culturally competent care, it is important for health-care providers to have a basic understanding of how Islamic teachings, including intermittent fasting, shape their Muslim patients' health, especially those with chronic medical conditions. Spirituality, religiosity, and personal beliefs are important components of the social determinants that affect patients' health behaviors and adherence to treatments. In addition to the changes in their dietary habits, sleep patterns of Muslims also change during Ramadan including prolongation of the awakening hours during night and changes to the rapid eye movement sleep. During Ramadan, Muslims usually eat 2 meals a day: one when they end their daily fast at sunset, known as iftar, and the other is a light meal before the break of the dawn, known as suhoor. Married couples also refrain from sexual intercourse while fasting. They should refrain from food, drinking water or any beverages, and smoking from dawn till sunset for 29–30 days. Millions of adult Muslims worldwide observe fasting the holy month of Ramadan each year. Pew Research Center estimated that Muslims accounted for 23% of the world population (1.6 billion) in 2010. Following a lunar calendar (355 days/year), Ramadan moves back each year by 10 days, which means it can occur in any of the four seasons, resulting in variations in the number of fasting hours.
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This article aims to provide an overview of the main topics that primary care physicians may need to know in order to improve their cultural competence when caring for their fasting Muslim patients.įasting “Sawm” the 9 th Islamic month “Ramadan” is one of the five fundamental Pillars of Islam.
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Since spirituality, religiosity, and personal beliefs affect patients' health behaviors and adherence to treatments, health-care providers need to learn how fasting Ramadan can affect the health of their Muslim patients, especially those with chronic medical conditions, and how to help them achieve safe fasting. Some patients may not be well educated about the effects of some medical treatments and procedures on the validity of their fast, which can unnecessarily lead to suboptimal management of their conditions or treatment nonadherence. While there are several exemptions from fasting, many Muslim patients with acute or chronic medical conditions still choose to fast, which may adversely affect their health if not addressed properly. Fasting Ramadan, in which Muslims abstain from specific habits and behaviors from dawn to sunset, is one of the five Pillars of Islam.