Factors associated with the spread of dengue fever in Jeddah Governorate, Saudi Arabia.

Dengue fever resurged sharply in Jeddah in 2004 and rose to 1308 cases in 2006. This case-control study determined factors potentiating the spread of the disease to provide an epidemiological baseline to help dengue control. All (650) suspected cases of dengue in Jeddah in 2007 were eligible for inclusion. Cases were those confirmed with dengue by laboratory investigations (n = 244) and controls those confirmed negative (n = 406). Of these, 129 cases and 240 controls could be contacted and were included in the study. Variables found significant in the bivariate analysis were included in a logistic regression analysis. The presence of stagnant water in indoor drainage holes (OR = 4.9), indoor larvae (OR = 2.2), nearby construction sites (OR = 2.2), and older age (OR = 1.2) were independent determinants of dengue infection (P<0.01 for all). Face-to-face health education significantly decreased the risk of dengue infection. Efforts are needed to control the modifiable factors identified in this study with emphasis on health education.

Perinatal mortality in Jeddah, Saudia Arabia.

The objective of the study was to estimate the perinatal mortality rate and to determine the antenatal and intrapartum risk factors associated with perinatal mortality in Jeddah, Saudi Arabia. A hospital-based, case-control study was carried out in a 40-week period in 1987-1988 in Jeddah at the Maternal and Child Health Hospital (MCH). The subjects comprised 323 perinatal deaths and 486 controls. The perinatal mortality rate (PMR) for Jeddah showed a decline from 42.5 in Islamic Calendar Year 1393H (1973) and 49.5 in 1400H (1979-1980) to 31.4 per 1000 live and stillbirths in 1408H (1987-1988). The risk factors independently associated with perinatal death included low birth weight, complications during labour, ethnic origin and mother's age being 35 and over. In addition to lethal deformities, direct causes of perinatal death were related to low birthweight, mechanical causes, antepartum haemorrhage and neonatal infection. No antenatal care was received by 36.5% of both cases and controls. The high mortality and the failure to attend for antenatal care suggest a need for closer surveillance of women throughout their pregnancies and for improvements in both obstetric services and neonatal management.

Population-based survey of childhood disability in eastern Jeddah using the ten questions tool.

PURPOSE: To identify the prevalence of handicapping disabilities among children up to 15 years of age and their epidemiological pattern in the eastern part of Jeddah. METHODS: In a population-based cross-sectional household survey in the eastern Jeddah area, Saudi Arabia, a multistage sampling method was applied to screen children in 875 houses using the ten questions survey tool for identification of disabilities. Further information collected for detected disabilities included possible risk factors, cause of the disability as perceived by the family and services previously provided to the child. RESULTS: A total of 137 cases of disability were detected giving a point prevalence rate of 36.7 per 1,000 children. Twenty-nine children (21.2%) were discovered for the first time during the survey. The majority of cases were male (57.7%) and the mean age for all cases was 10 years (SD = 5.5) with no case detected under one year of age. Disabled children were in the fourth or fifth birth order among their brothers and sisters and 47 (34%) of them were recorded as a second or third disability in the same family. Number of disabilities in the same child varied widely: 59% of cases had a single disability. 22% had two conditions and 19% had three or more conditions. Speech. motor and mental disabilities ranked top of the disabilities detected by the ten-question tool. The commonest cause of these disabilities as perceived by the family was hereditary diseases followed by childhood illnesses. Significant risk factors associated to these conditions included larger number of children in the family, older age of either parent. histories of handicapping conditions in the original families of either of the parents and presence of handicapping condition in the mothers. Families reported lack of services provided to their disabled children in the community. CONCLUSIONS: The survey tool managed to document. successfully, a prevalence rate of childhood disabilities in the community with a general picture of their types and suspected causes which is quite comparable to that found in Saudi Arabia. It also reported a low service delivery for these disabilities and identified some risk factors related to their occurrence. It is recommended to apply this survey method with certain modifications to suit the local culture in Saudi Arabia. Improvement of the services rendered to handicapped children in Jeddah is also recommended.

Health Education in schools- The Tabuk Experience.

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Effect of maternal education on the rate of childhood handicap.

OBJECTIVE: The objectives of this study were to determine the relation between maternal education and various maternal risk factors, identify the impact of maternal education on the risk of childhood handicap and estimate the proportion of childhood handicap that can be prevented by maternal education. METHODS: Data was collected from all married women attending the two major maternity and child hospitals in Jeddah during April 1999. Women with at least one living child were interviewed for sociodemographic factors and having at least one handicapped child. The risk of having a handicapped child and the population attributable risk percent were calculated. RESULTS: Some potential risk factors are dominant in our society as approximately 30% of women did not attend school and 84% did not work. Consanguineous marriages accounted for about 43%. Pre-marriage counseling was limited as only 10% of women counseled before marriage. The proportion of unemployment and consanguineous marriages decreased significantly by increase in maternal education level. Conversely, the proportion of women reporting pre-marriage counseling increased significantly by increase in maternal education level. Approximately, 7% of women reported having at least one handicapped child. The risk of having a handicapped child showed a significant sharp decline with increase in maternal education level. At least 25% of childhood handicap can be prevented by achieving female primary education and up to half of cases can be prevented if mothers finish their intermediate education. CONCLUSION: Female education plays a major role in child health. The results of this study suggest investment in female education, which would have substantial positive effects in reducing incidence of childhood handicap in Jeddah.

Incidence of bronchial asthma in a children hospital, Jeddah.

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Early teenage marriage and subsequent pregnancy outcome.

The relationship between marriage before 16 years and pregnancy outcome throughout the childbearing period was examined. Participants included all married women attending six randomly selected primary health care units in Jeddah with at least one infant and complete medical files. Early teenage marriage was found for 27.2% of women. Most of these were illiterate (57.1%), housewives (92.4%) and grand multiparae (66.7%). They were at twice the risk of spontaneous abortion, four times the risk of combined fetal death and infant mortality, and twice the risk of losing pregnancies any time during their childbearing years. They remained at high risk of poor pregnancy outcome throughout their reproductive lives. Despite tradition, marriage should be discouraged before 16 years.

Knowledge of secondary-school female students on breast cancer and breast self-examination in Jeddah, Saudi Arabia.

A self-administered questionnaire was given to 6380 female secondary-school students (mean age = 18.1 years) in Jeddah to identify their knowledge of breast cancer and attitude towards breast self-examination (BSE). Knowledge of risk factors and presentation was very low. Over 80% of students failed to answer 50% of the questions correctly. A higher knowledge level was associated with older age, marriage and having children. Also students who had undergone mammography, had been exposed to breast surgery or had a positive family history of breast cancer showed significantly higher knowledge levels. Only 39.6% reported ever hearing of BSE and only 14.4% and 7.1% respectively knew the correct frequency and timing. However, 82.4% had a positive attitude towards learning BSE.

Dental caries among schoolchildren: report of a health education campaign in Jeddah, Saudi Arabia.

The study describes a dental health education campaign and reports the epidemiology and prevalence rates of dental caries among male and female primary-school children in Jeddah. Over a 2-year period, all 296 public primary schools in Jeddah were visited by dentists conducting a health education campaign. A total of 82,250 children in the first and fourth grades were screened. The rate of detected dental caries was 83%, with significantly higher rates detected among females and first-grade children. Lower social class was significantly associated with higher rates of dental caries. The study emphasizes the importance of health education programmes and the value of school health surveys for targeting this young group.

Epidemiology of diarrhoea in two major cities in Saudi Arabia.

The epidemiological pattern of diarrhoeal diseases, causative agents and risk factors of their occurrence in two referral hospitals of Saudi Arabia is presented in this study. Stool specimens from 1726 admitted diarrhoeal cases were examined for parasites, yeast, enteropathogenic bacteria and rotavirus using the ELISA test. 41.3% of cases were due to rotavirus (RVGE) while 53.1% of cases showed no causative pathogens. Mean age of all cases was 20.2 months and RVGE cases showed a steady rise from the neonatal period onward, reaching a peak between 6-14 months. Males accounted for higher percentage of all diarrhoeal cases. Mothers of diarrhoea cases were mostly housewives with low educational level. Bottle fed children showed higher proportion (53.1%) of diarrhoea than other types of feeding suggesting the faeco-oral route of infection and the effect of poor sanitation. A pattern of higher RVGE cases was seen in warmer months in Al-taif and in cooler months in Jeddah. Findings demonstrated the interaction between host, pathogen and environmental factors in the epidemiology of infectious diarrhoeas in developing countries and the areas of possible prevention.

PIP: The epidemiological pattern of diarrheal diseases, causative agents, and risk factors of their occurrence in two referral hospitals of Saudi Arabia is presented in this study. Stool specimens from 1726 admitted diarrheal cases were examined for parasites, yeast, enteropathogenic bacteria, and rotavirus using the ELISA test. 41.3% of cases were due to rotavirus, while 53.1% of cases showed no causative pathogens. Mean age of all cases was 20.2 months and rotavirus gastroenteritis (RVGE) cases showed a steady rise from the neonatal period onward, reaching a peak between 6 and 14 months. Males accounted for a higher percentage of all diarrheal cases. Mothers of diarrheal cases were mostly housewives with low educational status. Bottle-fed children showed higher proportions (53.1%) of diarrhea than children fed otherwise, suggesting the feco-oral route of infection and the effect of poor sanitation. A pattern of higher RVGE cases was seen in warmer months in Al-taif and in cooler months in Jeddah. Findings demonstrated the interaction between host, pathogen, and environmental factors in the epidemiology of infectious diarrheas in developing countries and the areas of possible prevention.

Effects of cigarette smoking on lung function of Saudi students.

This study was carried out to investigate the association between cigarette smoking and state of lung function among Saudi male students. A cross sectional study was conducted on a group of 680 male Saudi students. Detailed personal questionnaire, British Medical Research Council questionnaire on respiratory symptoms and smoking habit, were administered and forced spirometry and anthropometric measurements were conducted on them. Multiple regression models were used to study the cumulative effect of smoking on the function of the lung of smoking students. The percentage of cigarette smoking among the studied group was 20.29%. Smoking students had significantly lower values for lung function tests (FEV1%, FEF200-1200, FEF25-75, FEF75-85, and PEFR) compared to non-smokers. After controlling for other confounding variables, increased duration of smoking and number of cigarette smoked per day were significantly associated with more limitation of airflow in airways of the smoking young students. Recommendations were discussed accordingly.

Flow volume curves as screening tests for early effects of smoking in asymptomatic children and young adults.

The objectives of this study were to investigate the early effects of smoking on ventilation function of the lungs of children and young adults, and to determine the suitable lung function tests that can be used for screening of this effect. Medical and personal questionnaires, spirometric tests for twelve different lung function indices as well as anthropometric measurements were conducted on 538 randomly selected asymptomatic subjects (134 smokers, 404 non-smokers). Smokers had significantly lower values for peripheral airway lung function tests compared to non-smokers and this is evident within a few years of initiating smoking. The number of cigarettes smoked per day was also significantly associated with decrease to these lung function parameters. Lung function tests suitable for screening were identified. The number of cigarettes and duration of smoking seem to interact to increase the insult on the peripheral airway function in children and young adults suggesting an irritant effect, probably mediated through an airway inflammation which starts at the periphery of the lungs. Lung function tests used here can be the early indicators of early changes in asymptomatic children and young adults and can be a valuable screening tool.

Factors affecting the use and attitude towards medical resources and educational methods in a Saudi medical school.

Medical colleges are using various teaching methods and educational resources in education. In order to explore the attitude of medical students towards these educational methods and resources and the factors playing a major role in their use in a medical school in an Arabic culture, a self answered questionnaire was directed to 283 medical students in their clinical years. Questions on the possible factors which affect the attendance and the use of these education resources were also included. Traditional methods of teaching, lectures, and clinical rounds were found to be the backbone of the educational process in this college. Attendance to lectures was related to both quality of subjects and to the lecturer, emphasizing the importance of a good lecture and lecturer. Clinical bedside teaching was found to be a popular and effective way of teaching medical knowledge, skill, and patient interactions to medical students. The library in this college was the least used resource and student appreciation of its importance was very low. General recommendations are to reduce dependence on lectures gradually in clinical years and to introduce new methods of clinical teaching.

An audit of caesarean section among Saudi females in Jeddah, Saudi Arabia.

In this study the case records of 1414 patients who delivered at Alshaty hospital within one year were examined and some important variables related to caesarean section cases and their outcome were discussed. The caesarean section rate was found to be 9.9%. The high number of grand multigravida and primigravida among these Saudi mothers have contributed to this high caesarean section rate. The high emergencies in these sections (73.6%) have resulted in higher incidence of maternal and fetal morbidity namely postoperative pyrexia (37%), maternal anemia (20%) and extensive neonatal resuscitation (34%). The main indications of caesarean section in this hospital were repeated caesarean section (34.3%), failure of progress (19.3%) and fetal distress 12.9%. The relation and interaction between the three groups were thoroughly discussed based on the mechanisms of these indications. It is concluded that the changing trend of indications of caesarean section was mostly related to the change in departmental management rather than change in the characteristics of the patients.

PIP: There has been an increase in the rate of cesarean section in some parts of the world. The rising number of indications for cesarean section, the use of fetal monitors, the current medico-legal climate, the importance of avoiding damage to the baby, and the increased safety of the cesarean section itself are some of the reasons cited for this trend. The authors set out to determine the rate of cesarean section in relation to parity and age, the main indications of cesarean section, and the mortality and morbidity associated with cesarean section to the mothers and their newborns. Alshaty hospital is a general hospital in Jeddah which has approximately 1500 deliveries per year. The case records were examined of 1414 patients who delivered at the hospital over the course of one year to ultimately find a cesarean section rate of 9.9%. A large number of grand multigravida and primigravida Saudi mothers contributed to this high rate. The high incidence of emergency cesarean sections (73.6%) resulted in a higher incidence of maternal and fetal morbidity such as postoperative pyrexia (37%), maternal anemia (20%), and extensive neonatal resuscitation (34%). Repeated cesarean section, failure of progress, and fetal distress were the main indications of cesarean section in the hospital. The authors conclude on the basis of this study that the changing trend of indications of cesarean section was related mainly to the change in departmental management rather than to any change in patients' characteristics.

The effects of a training program on knowledge, attitude and practice of the staff of primary health care centers towards growth monitoring: an intervention study.

This study was carried out aiming at assessing the effects of a training program on the knowledge, attitude and practices (KAP) of health care workers (HCWs) in primary health care centers (PHCCs) regarding growth monitoring (GM). It included 148 health care workers (30 General Practitioners (GPs) and 118 nurses), from 17 PHCCs in Jeddah city, Kingdom of Saudi Arabia (KSA). Tests on KAP were held before and six months following a training program on GM conducted by the investigators. Results showed significant improvements in the KAP of the trained health care workers after training, the 44 trained HCWs obtained higher mean comprehension score (7.9 +/- 1.2), higher mean practice score (11.6 +/- 3.0), and higher mean general scores (32.3 +/- 4.6) compared to the mean scores they obtained in the pre-test (5.7 +/- 1.5; 7.4 +/- 2.2 and 25.7 +/- 4.4, respectively). These differences were statistically significant (P < 0.001). However; the difference in the mean knowledge scores, before and after the GM training program was not significant. The training has also led to the disappearance of the significant knowledge gap between GPs and nurses. And also, the 44 trained HCWs had higher mean comprehension score (7.9 +/- 1.2), mean practice score (11.6 +/- 3.0), and mean general scores (32.3 +/- 4.6) compared to those among untrained group (controls) (6.3 +/- 2.1; 8.5 +/- 3.7, and 27 +/- 6.1, respectively). These differences were statistically significant (P < 0.0005). Nevertheless, the difference in the mean knowledge scores, between the two groups, was not statistically significant. It also has led to some changes in the attitude of the trained HCWs towards GM compared to the untrained group. In conclusion, We credit the significant improvements in KAP of HCWs to the training program and recommend its adoption by the national MCH program in KSA. We also recommend new methods of teaching and training based on sound educational concept of active participation and practical work as well as supportive supervision and evaluation.

A study of the morbidity pattern of referred patients and the effectiveness of the referral system in primary health care centers.

Patient referral system is considered to be an important element in achieving the objectives of the Primary Health Care services. Patients attending the Primary Health Care Center (PHCC) expect basic medical care and appropriate follow-up services. Thus, patients requiring further evaluation and treatment are referred to a secondary health care facility. In this study the morbidity pattern as well as the referral system was evaluated in selected PHCC in the city of Jeddah. A systematic random sample of all the patient referrals from selected PHCC's were analyzed. A total of 1,164 referrals were studied, 59.9 per cent were females and 40.1 per cent were males. The contents of referral letters from PHCC to hospitals as well as feed back from hospitals were analyzed. The majority of referrals were for the age group 25-44 years old 458 (39.3%). The results demonstrated that 5 per cent of patients were routinely referred to the secondary health care centers, and the feedback from these secondary health care facilities was (22.7%). It was also noted that the majority of referral letters lack commonly accepted standards of information about the patient. It was concluded that the follow-up and feed-back system needs to be reinforced. The primary health care providers need to review the patient referral system and implement specific criteria for the optimum utilization of this essential service for the benefit of the community.

Cumulative impact of early maternal marital age during the childbearing period.

Early marriage of girls, close to age of menarche, is a widespread practice in Arab countries. Knowledge on the cumulative effect of early maternal marriage on maternal and infant health during the childbearing period is insufficient. The objectives of this study were to estimate the prevalence of early maternal marriage in Jeddah, identify its relation with other maternal risk factors, and investigate the cumulative impact of early maternal marriage on subsequent maternal health and pregnancy outcomes throughout the reproductive period. Data were collected from six randomly selected primary health care units in Jeddah City. Married women with an infant < or = 12 completed months of age were interviewed and information on sociodemographic characteristics, maternal health and previous pregnancy outcomes were collected. Early marriage of girls before the age of 16 years accounted for 26.5% of the study population and was reported by a third of mothers currently below the age of 20 years. Illiterate mothers, housewives, multiparae, smokers and those married to a relative reported the highest proportion of marriages before their sixteenth birthday. Those who married before the age of 16 were at about double the risk of developing chronic diseases and experiencing miscarriage, stillbirths and infant deaths. These results suggest that early maternal marriage still exists in our community and is intimately related to other maternal risk factors. Maternal marriage < 16 years appears to be fraught with insecurities for the mother and infant throughout the whole length of the childbearing period and not merely the first pregnancy. Thus, even if culture norms claim early marriage of girls, it should be discouraged before the age of 16 years. Moreover, it is recommended that future research on maternal and infant health considers the cumulative effect of the various risk factors during the whole reproductive period and not only a single pregnancy outcome.

Effect of a breast cancer health education program on the awareness and practice of jeddah female secondary school students.

OBJECTIVE: To identify the effect of a school health education program on the knowledge of secondary school girls in Jeddah, Saudi Arabia, of breast cancer and breast self-examination (BSE) and their practice of BSE. METHODOLOGY: A pre-tested, self-administered questionnaire was administered to secondary students before the commencement of the health education to assess their knowledge on breast cancer and their practice of BSE. The same questionnaire was handed 6 months later to a smaller group of these students as a post-test. As the post-test group was smaller than the pre-test group, an equal sample size from the pre-test group was drawn for comparison. Random sampling and further analysis was done using the SPSS program, and for the comparison of the two groups, the student t-test and chi square were used. RESULTS: The post-test was answered by 1372 students. The sampled re-test group comprised 1400 students (N= 7663) forming a sample of 18.3%. The ages for both groups ranged between 16-25 years (mean = 18.4; SD=1.9). Saudi nationals formed 73.4% of both groups and the proportion of married students was 8.4%. Those who reported that they had relatives with breast mass were 11.2%. The mean knowledge indexes on breast cancer reached 19.7 for the pre-test group and 43.0 for the post-group (t=31.2; p<0.0001). Correct answers for BSE rose significantly among the post-test group. A proportion of 27.2% students from the post-group reported that they had been motivated to practice BSE at least 3 times during the last 6 month. CONCLUSION AND RECOMMENDATION: The outcome of the school health education program on breast cancer had been successful in raising the awareness of secondary school girls and in helping them to practice BSE more. Hence, it is recommended that the programme be implemented in all female secondary schools and colleges.

Health Profile of Balhareth area in Taif Region.

OBJECTIVE: To describe demographic, socio-economic, environmental factors and general health status of one of the rural and semi-urban areas around Taif city at the western province of the Kingdom. METHODOLOGY: A cross sectional multipurpose survey for 2 weeks composed of household and school surveys using questionnaires, anthropometric measurements and physical and dental examinations. RESULTS: 340 houses and 14 schools were surveyed. A higher percentage of young age population was found. Findings indicated a high illiteracy rate especially among females. Environmental status of the area was not optimum with a need for better services. Maternal data indicated a high fertility rate with high rate of unattended deliveries. Breast feeding was a common practice and children pattern of feeding was satisfactory. School survey revealed a lower weight and height compared to NCHS population and a high rate of dental caries. CONCLUSION: The area was not underprivileged and did not show specific endemic disease pattern. Improvements in the areas of sanitation, female education and school dental education is recommended based on the findings.

Knowledge, attitude and practice of primary health care doctors and nurses in hypertension of pregnancy.

OBJECTIVE: To assess the status of knowledge, attitude and practice (KAP) of doctors and nurses in Primary Health Care (PHC) centers with regard to hypertension in pregnancy and to identify factors associated with KAP in Al-Khobar, Saudi Arabia. METHODOLOGY: Using a self-administered comprehensive questionnaire, all available doctors and nurses in PHC centers of the Al-Khobar area were approached to determine their knowledge, attitude and practice in hypertension during pregnancy. Questionnaires were validated and pilot tested. Each section of the questionnaire was scored and the mean scores calculated. Factors affecting each section were identified by means of multiple regression analysis. RESULTS: A total of 36 doctors and 91 nurses were enrolled in the study. Saudis formed 22.2% of the doctors and 47.3% of nurses. Mean years of practice after graduation were 12.6 and 8.7 years for doctors and nurses, respectively. Saudi nurses spend only 3 weeks in the obstetrics ward during the whole period of their internship. All Saudi nurses hold only diplomas and not many courses on the hypertensive disorder are offered to both doctors and nurses after graduation. The practice of doctors particularly in the management of patients after reaching a diagnosis and educating them on diet and salt intake was poor. Furthermore, their knowledge was also poor. Though their level of knowledge was poor, the nurses' practice was satisfactory, particularly in taking history and physical examination. The attitude of both doctors and nurses towards hypertensive disorders was in general, positive and satisfactory towards health education. Nurses' nationality and duration of post-internship training were the factors that influenced their attitude and scores on knowledge. CONCLUSION AND RECOMMENDATION: The study revealed that both doctors and nurses working in the PHC lacked training and knowledge in this area of their work. It is therefore necessary to give PHC doctors and nurses refresher courses on common and serious problems like hypertension. A longer period of training in action management is needed to improve the knowledge and practice of doctors and nurses working in antenatal clinics in this area.