Hepatitis B virus infection in Aseer Region, south-western Saudi Arabia: a call for an immediate action against a preventable disease.

OBJECTIVES: The present study was designed as a large-scale cross-sectional study to cast some light on the magnitude of hepatitis B virus (HBV) infection in Aseer Region, south-western Saudi Arabia, a region reported to be of the highest endemicity. METHODS: During the WHO hepatitis day of 2013, an aggressive health education campaign was launched in all the hospitals and primary health care centres in Aseer Region. Posters were distributed to encourage the local population to visit the health facilities to be tested for HBV. They were interviewed using a structured questionnaire. Detection of hepatitis B surface antigen (HBsAg) was done using a fourth-generation ELISA kits. RESULTS: The present study included 10,234 persons. The study revealed an overall seroprevalence of 5.9% (95% confidence interval [CI] = 5.5-6.4%). A seroprevalence of 0.8% (95% CI = 0.2-2.1%) was found among persons aged less than 15 years, and a seroprevalence of 1.3% (95% CI = 0.4-2.9%) was found among persons aged 15-24 years. On the other hand, among persons aged 25 years and over (who were born before the expanded programme on immunization [EPI]), a seroprevalence of 6.3% (95% CI = 5.8-6.8%) was found. Pockets of unvaccinated individuals were identified. CONCLUSION: The present study has documented the efficacy of vaccination in protecting against HBV infection. It also identified the presence of pockets of unvaccinated persons requiring further investigations. Aggressive health education programmes and 'catch-up' mass vaccination of those aged over 25 years is mandatory.

Assessment of physical inactivity and perceived barriers to physical activity among health college students, south-western Saudi Arabia.

Physical inactivity is a public health problem in Saudi Arabia. A cross-sectional study was carried out to evaluate the pattern of physical activity, predictors of physical inactivity and perceived barriers to physical activity among health college students in King Khalid University. A total of 1257 students (426 males and 831 females) were recruited. The Arabic short form of the International Physical Activity Questionnaire was used. Overall, 58.0% of the students were physically inactive. Only 13.4% of the students performed vigorous physical activity, 14.8% moderate-intensity physical activity and 29.9% walking activities which met World Health Organization criteria of health-enhancing physical activities. The prevalence of inactive leisure time was 47.5%. The independent predictors of physical inactivity were non-membership of sports clubs and being a medical student. The top reported barrier to physical activity among inactive students was time limitations (51.3%). Overcoming perceived barriers may increase physical activity among students.

Nosocomial infections in a neonatal intensive care unit in south-western Saudi Arabia.

A cohort study measured the occurrence and risk factors of nosocomial infections in the neonatal intensive care unit of Abha general hospital, Saudi Arabia. Of 401 neonates who stayed at least 48 hours in the unit, 77 developed infections, a period prevalence of 19.2% and an incidence of 13.7 infections per 1000 patient-days. The most frequent infections were: pneumonia (50.0%), primary bloodstream (40.9%) and skin and soft tissues (6.5%). In logistic regression analysis, mechanical ventilation (OR = 2.69, 95% CI: 1.39-5.19) and total parenteral nutrition (OR = 5.62, 95% CI: 2.78-11.35) were identified as significant risk factors. Neonates suffering from nosocomial infections had more than 3 times the risk of dying compared to neonates free of infection.

Asthma knowledge and behaviours among mothers of asthmatic children in Aseer, south-west Saudi Arabia.

Mothers of children with bronchial asthma consecutively admitted to Aseer central hospital, Saudi Arabia (n = 171), were interviewed using a questionnaire based on the Chicago Community Asthma Survey to study their knowledge and behaviours concerning bronchial asthma. The least known information among mothers was the complications of bronchial asthma. Breathing exercises during asthma attacks were the least practised behaviour. In a multivariate analysis, significant risk factors for poor knowledge and behaviours among mothers were female sex of the child, illiterate mother and young age of mother (< 30 years). More education is needed to help the mothers of asthmatic children to acquire the necessary knowledge and practices to care for their children.

Injection safety at primary health care level in south-western Saudi Arabia.

In a study of injection safety in Abha health district, Saudi Arabia, data were collected from 47 physicians and 85 nurses at 24 primary health care centres, using an observation checklist and an interview questionnaire. All centres used individually packed disposable syringes and puncture-proof containers to collect used needles. Needlestick injury in the previous year was reported by 14.9% of physicians and 16.5% of nurses (0.21 and 0.38 injuries/person/year respectively). Logistic regression analysis identified recapping the needle after use (physicians and nurses) and bending the needle before disposal (physicians) as significant risk factors for injury.

Altitude and bronchial asthma in south-western Saudi Arabia.

Through a house-to-house survey, 1325 people aged 11+ years registered at 2 primary health care centres (1 at high altitude and 1 at sea level) in Asir region, Saudi Arabia, were interviewed and examined for weight, height and peak expiratory flow rate. The prevalence of bronchial asthma at sea level (19.5%) was significantly higher than at high altitude (6.9%). Illiteracy, low income, use of coal and wood for heating, having a mud or tent house, lack of electricity inside dwellings and presence of sheep were also significant risk factors for bronchial asthma. In multivariate logistic regression, only altitude was found to be significantly associated with bronchial asthma (adjusted odds ratio = 3.94).

Prevalence and risk factors of gallstone disease in a high altitude Saudi population.

To study the prevalence of gallstone disease and related risk factors in a Saudi Arabian population a cross-sectional community-based study was made of 291 people from Abha district, Asir region. A structured interview collected background data and all participants had upper abdominal ultrasonography to detect gallstones. The overall prevalence of gallstone disease was 11.7%. Using logistic regression multivariate analysis, the following were significant risk factors for gallstone disease: female sex, family history of gallstone disease and past history of pancreatitis. Age, education, blood pressure, smoking, coffee intake, overweight, diabetes mellitus, number of pregnancies and use of oral contraceptives were not significant risk factors. Discriminant analysis of symptoms showed that only right hypochondrium pain was significantly associated with gallstone disease.

Primary health care emergency services in Abha district of southwestern Saudi Arabia.

To study emergency services delivery in all 30 primary health care centres in Abha district of Asir region, Saudi Arabia, data were collected about equipment and facilities, physicians' practices and attitudes, and patients' utilization of and satisfaction with emergency services. Two centres had no devoted place for emergency services. Lack of some essential equipment and drugs was evident. The greatest continuing medical education need for doctors was the management of cardiovascular emergencies (72.3%). Many doctors (40.4%) did not consider the majority of cases as true emergencies. Many patients (43.7%) used the centres for emergency services, the most common being trauma, burns and orthopaedics (47.8%). Most patients were satisfied overall with emergency services (82.2%).

Compliance with good practice in prescription writing at outpatient clinics in Saudi Arabia.

A sample of prescription orders received from outpatient departments by a hospital pharmacy in Asir, Saudi Arabia, were analysed over 1 year for the essential elements of prescriptions. The prescriber's name, address and signature were on 83.3%, 9.6% and 81.9% of prescriptions respecti-vely. The patient's name, age and sex were on 94.6%, 77.3% and 51.3%. No prescription contained the patient's address and weight. Generic drug names were used in only 15.1% and strength of medication and dose units were included in 26.6% and 55.6% of prescriptions. Most prescriptions (94.0%) had no quantity indicated and had only partial instructions for patient use (90.7%); the diagnosis was included in about two-thirds. The prescriber's handwriting was illegible in 64.3% of prescriptions. Measures to improve the situation are suggested.

Primary health care services utilization and satisfaction among the elderly in Asir region, Saudi Arabia.

Use of primary health care (PHC) services and satisfaction among elderly people (60 + years) in Asir was studied in 26 PHC centres. They visited PHC centres significantly less often than younger adults but they were referred significantly more often to secondary and tertiary care and for more laboratory tests. A random sample of 253 elderly people attending the centres was interviewed about accessibility, continuity, humaneness, informativeness and thoroughness of care. Overall, 79.0% were satisfied with the services provided. The leading 3 items of dissatisfaction were: not enough audiovisual means for health education (65.1%), long time spent in the centre (46.4%), and not enough specialty clinics (42.5%).

Induction of labour using low and high dose regimens of prostaglandin E2 vaginal tablets.

OBJECTIVE: To compare the efficacy of low dose prostaglandin E2 vaginal tablets with that of high dose in induction of labour. DESIGN: A retrospective study. SETTING: Abha Maternity Hospital, a teaching hospital in the southern region of Saudia Arabia. PATIENTS: The outcome of induction of labour in 73 women induced with 1.5 mg prostaglandin E2 vaginal tablets was compared with those in 168 women induced with 3 mg vaginal tablets. RESULTS: There were no statistical significant differences in the success rate, induction-delivery interval, caesarean section rate and Apgar scores between the two groups. There were two incidences of uterine hyperstimulation and two of uterine rupture in the high dose group. These were not statistically significant. Logistic regression analysis showed that the success rate of induction of labour was dependent only on maternal age (P=0.0025) and Bishop score (P=-0.0403) and not on parity, gestational age, birthweight or dose of prostaglandin. CONCLUSION: The low dose regimen of 1.5 mg is as efficacious as the high dose regimen of 3 mg prostaglandin E2 vaginal tablets in inducing labour. This implies that using the low dose regimen reduces the cost of induction of labour effectively. Larger prospective randomized studies are needed to confirm this finding.

Reproductive health of married adolescent women in squatter areas in Alexandria, Egypt.

Through a house-to-house survey, 455 married adolescent women (< 20 years) and 455 married women aged 20-45 years from squatter areas in Alexandria were interviewed. Determinants of early marriage were consanguinity, illiteracy and unawareness of reproductive health. Of the currently pregnant adolescents, 22% were receiving antenatal care compared with 40% of the older women. Family planning methods were currently being used by 39% of the adolescents and 63% of the older wives. Determinants of non-use were: adolescence, illiteracy and previous miscarriage/stillbirth. There is a need to increase public awareness of reproductive health and change the behaviour of both groups of women in this under-privileged sector.

Reproductive tract infections among married women in Upper Egypt.

In a house-to-house survey using cluster sampling, 1344 married women from urban and rural areas of Upper Egypt (Minia, Assiut and Sohag) were interviewed and examined to study the magnitude and determinants of reproductive tract infections. Overall prevalence was found to be 52.8%, with the most prevalent forms being Candida albicans (28.0%), Trichomonas vaginalis (8.7%), Aspergillus species (7.4%), streptococci (4.6%) and Chlamydia trachomatis (4.2%). Multivariate analysis identified certain groups of women at high risk of developing reproductive tract infections (those currently using an intrauterine device, those who regularly practised internal vaginal washing). Discriminant analysis showed that symptoms were of low discriminating value. There is a great need to increase community and women's understanding of reproductive tract infections.

Hypertension and its determinants among primary-school children in Kuwait: an epidemiological study.

A multistage, stratified random sample of 1312 students (aged 6-10 years) was selected from the five regions in Kuwait. Parents were interviewed and weight, height and urine analysis of the children were taken. Blood pressure was measured on at least three separate occasions. The overall prevalence of hypertension (average systolic and/or diastolic blood pressure > 95th percentile for age and sex) was 5.1%. In multivariate logistic regression analysis, certain groups of Kuwaiti schoolchildren were much more likely to develop hypertension. They included children whose parents were consanguineous, children with a family history of hypertension and obese children.

Iodine deficiency disorders among school children in upper Egypt: an epidemiologic study.

Iodine deficiency disorders (IDD) are the world's single most significant cause of preventable brain damage and mental retardation. Data regarding IDD in upper Egypt are scarce and even lacking. The aim of the present work was to study the prevalence of IDD and some potential risk factors in upper Egypt. Using a two-stage cluster sampling technique, 6750 school children aged 8-10 years were screened for IDD through clinical examination of the thyroid gland and determination of urinary iodine, from three governorates in upper Egypt, namely Al-Minya (population of 3.3 million), Assyut (population of 2.9 million), and Suhag (population of 3.1 million). Iodine was determined in samples of soil and drinking water. Overall, the prevalence rate of goitre was 34.6 per cent. The median urinary iodine level for children with goitre was 5.04 micrograms/dl compared to 14.81 micrograms/dl among children free of goitre. Multiple logistic regression analysis showed that certain groups of school children were much more likely to develop goitre. They included females (OR = 3.07, 95 per cent CI = 2.78-3.39), children in households where drinking water had an iodine content of less than 0.5 microgram/100 ml (OR = 3.44, 95 per cent CI = 3.09-3.89), and children living in places where soil content of iodine was less than 0.2 microgram/100 g (OR = 2.67, 95 per cent CI = 2.30-3.10). We conclude that IDD is a severe public health problem in upper Egypt. The present situation in upper Egypt necessitates an urgent intervention programme.

Prescribing patterns at primary health care level in the Asir region, Saudi Arabia: an epidemiologic study.

Out of 208 primary health care centres (PHCCs) in the Asir region, southwestern Saudi Arabia, a stratified random sample of 23 PHCCs was randomly chosen. Data regarding all the medical consultations (66,438) provided by all PHCCs physicians (49) and their prescriptions were collected to study prescribing patterns. The data were collected from the health information system of the PHCCs without the physicians' knowledge. The study showed that more than two-thirds of medical consultations (71.5%, 47,494) ended by prescribing medications. The average number of drug items prescribed for the individual patient was 1.44. The leading missing items in the studied prescriptions were, for how long should medication be taken (32.9%), the patient's name (15.8%) and the family health record number (6.5%). Prescribing drugs by generic name is very minimal among physicians (2.9%). The groups of drugs commonly prescribed were analgesics-antipyretics (61.9%), antibiotics (56.2%), cough medications (26.6%) and vitamins (22.7%). The observed defects identify fields to be addressed in continuing medical education programmes aimed at encouraging more rational prescribing among PHC physicians.

Symptomatology and chest roentgenographic changes of pulmonary tuberculosis among diabetics.

Symptoms and chest x-ray findings in 28 diabetics and 38 non diabetics with pulmonary tuberculosis were compared. The two groups of patients were age and sex-matched. There was no statistical difference in respiratory or constitutional symptoms between the two groups. Distribution of chest x-ray involvement including cavitary disease was again similar in the two groups of patients. These findings are contrary to previous reports and beliefs that diabetics were less symptomatic and that x-ray findings were more frequent in lower lung fields.

Ecological determinants of intestinal parasitic infections among pre-school children in an urban squatter settlement of Egypt.

Population growth in Egypt has led to the creation of several urban squatter settlements. The aim of the present work was to study the prevalence and some potential risk factors of intestinal parasitic infections among preschool children in a randomly chosen urban squatter settlement in Alexandria, Egypt. A house to house cross-sectional survey was conducted during late 1995. Data were collected through questionnaire interview regarding socio-demographic and environmental conditions from 1324 families residing in the settlement. Stool samples were collected from 658 preschool children below 5 years of age and examined for intestinal parasites. Overall, the prevalence rates of infections with the intestinal Helminths and Protozoa were 47.3 and 31.5 per cent, respectively, which were very high compared to previously reported figures for this age group in Egypt. Multiple logistic regression analysis showed that certain groups of preschool children were much more likely to develop the infection with both groups of intestinal parasites. They included children over 2 years of age (OR = 2.75, 95 per cent CI = 1.23-4.12 and OR = 2.65, 95 per cent CI = 1.70-3.45 for Helminths and Protozoa, respectively), whose families had pools of sewage around houses (OR = 2.13, 95 per cent CI = 1.22-3.19 and OR = 2.83, 95 per cent CI = 1.45-3.95 for helminths and protozoa, respectively) and shared toilets with another family (OR = 1.95, 95 per cent CI = 1.38-2.75 and OR = 1.65, 95 per cent CI = 1.06-2.58 for Helminths and Protozoa, respectively). In addition, certain groups of children were much likely to develop protozoal infections including children whose families lacked tap water inside dwelling (OR = 1.85, 95 per cent CI = 1.26-2.77) and disposed human excreta in septic tank very close to the dwelling (OR = 2.17, 95 per cent CI = 1.43-3.75). Efforts to reduce intestinal parasites should focus on reducing exposures. Improvement in domestic water supplies with the introduction of piped sewerage system is likely to have a marked decreasing effect on the prevalence of infection among this age group.

Skin diseases among adolescent boys in Abha, Saudi Arabia.

BACKGROUND: Adolescence is characterized by a sensitivity to issues of attractiveness. With dermatologic conditions, this may adversely affect early detection and compliance. METHODS: A cross-sectional study was carried out on a multistage stratified random sample of 647 adolescent schoolboys in Abha, Saudi Arabia, to determine the prevalence of skin diseases. The age of the boys ranged from 11 to 19 years with an average of 15.3 +/- 1.9 years. RESULTS: It was found that 19.8% of the children were affected by one form or another of transmissible skin diseases (TSD). The most common types were: pediculosis capitis (9.6%), verruca vulgaris (3.9%), and tinea pedis (1.9%). The prevalence of TSD increased significantly as the age decreased and as the crowding index increased. As for non-transmissible skin diseases, acne vulgaris was the most prevalent disease (56.3%). The prevalence and severity of acne increased significantly as the age increased. CONCLUSIONS: The findings indicate the need to develop regional intervention programs at the school level. Appropriate continuing medical education programs for school health workers in the region are mandatory to achieve this goal.