Aetiological factors contributing to road traffic accidents in Riyadh City, Saudi Arabia.

The study analysed 13,390 police records of road traffic accidents (RTAs) covering a three and a half year period according to different suspected aetiological factors. The majority of the accidents were recorded for vehicles in good condition on well-paved straight roads with well-operating traffic light systems. Adverse weather conditions such as precipitation, fog and dust were of minimal importance, with most of the accidents being reported during sunny days during the rush period of 12 noon to 3 pm. Driver's error was identified as the main contributing factor in about two thirds of all RTAs mainly as reckless driving and excess speeding. About 27% of the drivers were professional drivers and 41% were in the age group 25-35 years in good health with no alcohol or drug intake. Hence, human errors may be attributed to carelessness, experience, lack of knowledge or attention, over-exhaustion or fatigue. The effects of physical stressors on performance of drivers need to be further explored and clarified but this need not underestimate the importance of vehicle and environment since most accidents are multifactoral and a slight change in them may effectively enhance perception and minimise personal error. Recommendations for remedial measures adopting an interdisciplinary approach are presented.

Prevalence of hypertension and sociodemographic characteristics of adult hypertensives in Riyadh City, Saudi Arabia.

OBJECTIVES: To estimate the prevalence of hypertension in adults residing in Riyadh city and to study the sociodemographic characteristics of adult hypertensives. DESIGN: Cross-sectional survey. SETTING: Primary Health Care Centres (PHCCs) in Riyadh city selected by stratified random sampling, the subjects resident in each PHCC catchment area were selected by systematic sampling from their records in the PHCCs. SUBJECTS AND METHODS: A total of 1394 adults aged 15 years and over were interviewed and examined during March 1993 to March 1994. The average of three measurements of blood pressure (BP) was taken to represent their current pressures. A subject is considered hypertensive if the average BP reading is 160/95 mm Hg or more, or is currently under treatment. RESULTS: The total hypertensive subjects were 214 giving an overall prevalence of hypertension of 15.4%. Of these 157 (11.3%) subjects were known hypertensives and were under some form of treatment. On the other hand 57 (4.1%) other subjects were newly detected by the study. Hypertension (BP = 160/95 mm Hg or more) was significantly related to age, marriage, education, occupation and employment status and consanguinity. Male subjects had a higher prevalence of hypertension but the differences were not significant. Nationality and income were not related to high BP. CONCLUSION: Hypertension is a problem among adults in Riyadh city. It is significantly related to some sociodemographic and family factors. About 27% of all hypertensives are not aware of their disease and more than 31% of known hypertensives are apparently not well controlled. There is a need for a programme to prevent and control hypertension in Riyadh city. Similar studies need to be done in other areas of the country to estimate the prevalence of hypertension and associated factors as prerequisites for any programme to control the disease.

Planned vaginal delivery after two previous caesarean sections.

OBJECTIVE: To determine the outcome of trial of labour after two caesarean sections. DESIGN: Prospective observational study. SETTING: Maternity and Children's Hospital, Riyadh, Saudi Arabia. SUBJECTS: Women with two previous caesarean sections considered suitable for a trial of vaginal delivery. MAIN OUTCOME MEASURES: The rates of vaginal delivery, scar dehiscence, uterine rupture and associated complications among 115 women with two previous sections who underwent trial of labour were compared with 1006 women with two previous sections who did not have a trial of labour. RESULTS: Trial of vaginal delivery was requested by 230 out of 1136 women (20%) who had two previous caesarean sections. Of the 115 women accepted for the trial, 103 (89%) were delivered vaginally. Labour started spontaneously in 78 (68%) of the 115 women and was induced with prostaglandin (PGE2) in the remaining 37. Augmentation of labour with oxytocin was required in 32 (28%) of the trial labour group. There were no scar dehiscences among the women delivered vaginally. There was one scar dehiscence and one woman required hysterectomy after failed trial of labour, a frequency comparable to the occurrence of these complications in women who did not have a trial of labour. CONCLUSION: A trial of labour in selected patients with two previous caesarean sections appears a reasonable option.

Establishment of a normal reference range for adenosine deaminase in plasma of healthy Saudis using the continuous spectrophotometric method.

The level of adenosine deaminase (EC. 3.5.4.4), was estimated in plasma of 389 healthy males and 493 healthy females in order to establish a normal reference range for Saudis. Using the continuous spectrophotometric method, the reference ranges were calculated in two ways using the mean +/- 2 SD and the 2.5th - 97.5th percentile value methods. In both methods of calculation, a slightly higher range was observed for children as compared to adults. The method of 2.5th - 97.5th percentile values brought almost all of our subjects within the recommended range of 11.5 - 25 U/l. In the current study, the normal range for adenosine deaminase totalled 15.0 - 23.2, 14.8 - 23.6, 15.0 - 23.0 and 16.7 - 24.6 U/l for the overall population, all males, females, and children, respectively. The ranges are discussed in the light of significantly different results obtained by the two calculation methods and recommendation of an appropriate method for healthy Saudis, namely the 2.5th - 97.5th percentile values. The choice of the Ellis and Goldberg kinetic continous monitoring method for the estimation of plasma ADA levels in the current investigation is also hereby justified.

Suspected synergism between consanguinity and familial aggregation in type 2 diabetes mellitus in Saudi Arabia.

A retrospective study of 210 cases of diabetes was carried out at King Khalid University Hospital diabetes clinic to delineate etiologic factors in non-insulin dependent diabetes mellitus (NIDDM). Standardised detailed questionnaires were administered to both cases and controls and the information sought included general demographics, dietary patterns, anthropometric values, family history, consanguinity and familial aggregation of Diabetes Mellitus (DM). Familial aggregation yielded an odds ratio of 6:2 which suggests a causal association with DM. A synergistic effect of familial aggregation was observed which needs to be further explored in future studies.

Epidemiologic studies of diabetes mellitus in Saudi Arabia--Part I--Screening of 3158 males in King Saud University.

A 14%, simple random sample of the King Saud University Community consisting of students, faculty and staff was screened for diabetes mellitus. The screening procedures used consisted of urine testing by means of the urine dipstick and blood glucose estimation in the fasting state by means of the reflomat glucose, a glucose oxidase meter. Participants whose fasting blood glucose (FBG) were 140 mg/dl or more were referred to the diabetes clinic for further evaluation and possible inclusion into the subsequent retrospective study. A period prevalence of 6.0% was observed for FBG greater than 140 mg/dl and all the referrals were confirmed for adult onset diabetes mellitus. The prevalence was similar to that in the USA and suggested that the rapid socio-economic changes in Saudi Arabia made a minimal contribution to the prevalence of diabetes mellitus.

The effect of consanguinity on pregnancy outcome in Saudi Arabia.

A simple random sample of 4498 Saudi pregnant women was analysed to study the effect of consanguinity on pregnancy outcome. The rate of consanguinity was found to be 54.3% which comprised 31.4% of first cousins and 22.9% of other relatives. The average proportion of outcome was higher and over 50% within the consanguinous marriages in all pregnancy outcome except prematurity and low birth weights. In general, more unfavourable outcomes occurred among consanguinous than non-consanguinous marriages. Perinatal, infant and neonatal deaths were the most deleterious outcomes among related marriages with 62%, 60.3% and 57.9% respectively. The differences between total consanguinity and unrelated marriages in the infant and perinatal death categories were significant (P = 0.05).

Assessment of compliance with the expanded program on immunization schedule in King Khalid University Hospital.

Analysis of 1,068 immunization records was carried out to assess the degree of compliance with the expanded program on immunization (EPI) schedule in King Khalid University Hospital. The overall compliance was found to be 66%, whereas individual vaccine compliance ranged between 28% to 88%. These results show that the EPI schedule is not strictly followed in this institution. A modification of the EPI schedule and the consideration of other strategies are suggested to achieve 100% coverage by 1990.

Infant feeding in King Khalid University Hospital.

PIP: A survey was carried out in King Khalid University Hospital between January 1985-May 1986 to study the pattern of infant feeding. It was found that 76% of the respondents favored breastfeeding while 58% preferred breastfeeding only. About 51% of the mothers began weaning their children between 6-12 months, while 21% weaned between 12-18 months. The most important reason to stop breastfeeding was to have another pregnancy. This was a more common reason among mothers who had female babies than males. An association was found between this reason and the parity; the odds ratio was 2.9.^ieng

Seroepidemiologic characterization of Streptococcus pneumoniae in a Saudi hospital.

Although Streptococcus pneumoniae are responsible for over 90 percent of bacterial pneumonia, different serotypes occur in different geographical locations. Studies show that the particular serotypes that cause pneumococcal infection in different countries have been identified, but such is not the case with Saudi Arabia.A preliminary study of 358 patients at King Saud University Hospital, Riyadh, conducted between October 1982 and December 1985, revealed the presence of somewhat different serotypes in Saudi Arabia. Hence the need for more comprehensive clinical and epidemiologic studies to generate data unique to Saudi Arabia and the Middle East.

Epidemiology of spontaneous abortions--the effect of previous abortions.

PIP: 1050 women who became pregnant between September 1980 and September 1981 were followed from their 1st prenatal visit until the termination of their pregnancy to confirm the suspected effects of previous abortions, especially spontaneous abortions on subsequent pregnancies. The pregnant women were included sequentially in the study, and they comprised 550 referrals to the Oklahoma Memorial Hospital Women's Clinic and 500 inpatients of 5 private doctors' clinics. The latter also were selected sequentially. To control for some demographic variables, the 5 private doctors' clinics were those located in the middle class neighborhoods within the Oklahoma City metropolis; the 550 referrals were restricted to women referred from these private clinics. A detailed questionnaire was given to each patient at her 1st visit. The information gathered included medical and obstetric history and habits, number of previous induced and spontaneous abortions, ectopic pregnancies, stillbirths, and type of previous therapeutic abortion techniques. Spontaneous abortion was restricted to any losses prior to the 20th week of gestation; fetal wastage comprised all losses after 20 weeks of gestation plus stillbirths. Both fetal wastage and spontaneous abortions were grouped together as nonlive births (NLB). During the study period, 1050 women were followed until pregnancy termination, and 79% of these ended in full-term uncomplicated delivery. Spontaneous abortions accounted for 15.9%, and 5.1% were classified as fetal wastage. 208 patients reported having had spontaneous abortions; 109 reported having had previous therapeutic abortions. The odds that a non-live birth would occur among previous spontaneous aborters was over 2 times greater than the odds that a live-birth would occur. The history of previous therapeutic abortions and pregnancy outcome yielded a nonsignificant relative risk of 0.5. The relative risk of 1.7 for having a non-live birth given a previous spontaneous abortion suggests a positive association between previous spontaneous abortions and the incidence of non-live births. The relative risk of 2.7 for 3+ previous spontaneous abortions suggests an association, but the distribution of previous therapeutic abortions with pregnancy outcome failed to show any positive association.^ieng

Epidemiology of spontaneous abortions: the effects of alcohol consumption and cigarette smoking.

A prospective epidemiologic study of spontaneous abortions and fetal wastage was undertaken over a period of 12 months in Oklahoma City. A total of 1,050 pregnant women were followed from their first prenatal visit until the termination of pregnancy. In addition to the available information in the patients' medical records, a questionnaire was administered to each patient during her first visit. Detailed information was sought on the patient's smoking and drinking habits. Alcohol and cigarettes were found to have an independent, positive association with adverse pregnancy outcome. A dose-response relationship was observed, and a synergistic effect was illustrated.