Digital Response During the COVID-19 Pandemic in Saudi Arabia.

BACKGROUND: The first case of COVID-19 in Saudi Arabia was confirmed on March 3, 2020. Saudi Arabia, like many other countries worldwide, implemented lockdown of most public and private services in response to the pandemic and established population movement restrictions nationwide. With the implementation of these strict mitigation regulations, technology and digital solutions have enabled the provision of essential services. OBJECTIVE: The aim of this paper is to highlight how Saudi Arabia has used digital technology during the COVID-19 pandemic in the domains of public health, health care services, education, telecommunication, commerce, and risk communication. METHODS: We documented the use of digital technology in Saudi Arabia during the pandemic using publicly available official announcements, press briefings and releases, news clips, published data, peer-reviewed literature, and professional discussions. RESULTS: Saudi Arabia's government and private sectors combined developed and launched approximately 19 apps and platforms that serve public health functions and provide health care services. A detailed account of each is provided. Education processes continued using an established electronic learning infrastructure with a promising direction toward wider adoption in the future. Telecommunication companies exhibited smooth collaboration as well as innovative initiatives to support ongoing efforts. Risk communication activities using social media, websites, and SMS text messaging followed best practice guides. CONCLUSIONS: The Saudi Vision 2030 framework, released in 2017, has paved the path for digital transformation. COVID-19 enabled the promotion and testing of this transition. In Saudi Arabia, the use of artificial intelligence in integrating different data sources during future outbreaks could be further explored. Also, decreasing the number of mobile apps and merging their functions could increase and facilitate their use.

Why mothers are not exclusively breast feeding their babies till 6 months of age? Knowledge and practices data from two large cities of the Kingdom of Saudi Arabia.

The noble practice of breast feeding is on the decline across the globe. Our objective was to research why women stop feeding their infants before the recommended 6 months of exclusive breast feeding and to assess the mothers' knowledge regarding importance and benefits of breast feeding. A cross-sectional study was conducted in two cities of Riyadh and Dammam using a structured questionnaire to 614 Saudi females in reproductive age group (15-45 years) from February to April 2016. Majority of the respondents were <30 years old, housewives and multiparous. The breast feeding initiation rate was 76% while only 37% continued to exclusively breast feed the infants until 6 months. Mothers of Dammam city showed higher rates of overall breast feeding, higher initiation of breast feeding within 24 hours of delivery and longer duration of breast feeding practices. Mothers older than 30 years (p < 0.014), residents of Dammam city (P < 0.000) and receiving information on breast feeding during antenatal care (P < 0.001) were associated with higher knowledge scores. Residents of Riyadh, working mothers, delayed initiation of breast feeding after 24 hours of giving birth, and those who did not get information on breast feeding during antenatal classes were at higher risk of stopping exclusive breast feeding before 6 months. Regional differences exist with Dammam city having greater awareness and better compliance to breast feeding practices. There is a need to strengthen the education facilities at ANC clinics in Riyadh regarding duration and benefits of breast feeding along with nationwide promotion of breast feeding practices as per guidelines.

Root-Cause Analysis of Persistently High Maternal Mortality in a Rural District of Indonesia: Role of Clinical Care Quality and Health Services Organizational Factors.

BACKGROUND: Despite significant reduction in maternal mortality, there are still many regions in the world that suffer from high mortality. District Kutai Kartanegara, Indonesia, is one such region where consistently high maternal mortality was observed despite high rate of delivery by skilled birth attendants. METHOD: Thirty maternal deaths were reviewed using verbal autopsy interviews, terminal event reporting, medical records' review, and Death Audit Committee reports, using a comprehensive root-cause analysis framework including Risk Identification, Signal Services, Emergency Obstetrics Care Evaluation, Quality, and 3 Delays. FINDINGS: The root causes were found in poor quality of care, which caused hospital to be unprepared to manage deteriorating patients. In hospital, poor implementation of standard operating procedures was rooted in inadequate skills, lack of forward planning, ineffective communication, and unavailability of essential services. In primary care, root causes included inadequate risk management, referrals to facilities where needed services are not available, and lack of coordination between primary healthcare and hospitals. CONCLUSION: There is an urgent need for a shift in focus to quality of care through knowledge, skills, and support for consistent application of protocols, making essential services available, effective risk assessment and management, and facilitating timely referrals to facilities that are adequately equipped.

Antibiotics and over the counter medication use and its correlates among Arab pregnant women visiting a tertiary care hospital in Riyadh, Saudi Arabia.

BACKGROUND AND OBJECTIVE: The use of over the counter medications (OTCMs) is a common practice globally. OTCMs are of special concern among pregnant women as they pose risk to the mother and fetus. The objective was to assess the use of OTCMs by pregnant woman, and factors associated with it. METHODS: A cross-sectional study, using a structured self-administrated questionnaire was conducted at the obstetric and antenatal clinics at King Khalid University hospital, Riyadh. 354 pregnant women were surveyed. RESULT: About 32% of the study participants used OTCMs without prescription at least once during their last pregnancy. The most commonly used OTCM was Paracetamol (22%). Pharmacists were the main source of knowledge (53%) for the participants. Correct knowledge regarding the drugs was associated with the usage of OTCM drug. CONCLUSION: Use of OTCMs and antibiotics during pregnancy is a common practice among Saudi pregnant women. General awareness regarding OTCMs use during pregnancy without prescription needs to be raised in the community. Pharmacists and media can help in providing accurate knowledge.

Depression and Associated Factors among Adolescent Females in Riyadh, Kingdom of Saudi Arabia, A Cross-sectional Study.

BACKGROUND: Adolescents who suffer from depression early in life, have an increase in suicidal tendency, anxiety, conduct disorders, substance abuse, and continue to be depressed, later on in life. This study was conducted to identify the prevalence and correlates of depression among adolescent girls in Riyadh city in order to carry out early intervention. METHODS: A cross-sectional, school-based survey was conducted among 1028 adolescent girls aged 15-19 years in secondary schools of Riyadh city. Riyadh was divided into clusters and within each cluster, both public and private schools were enrolled. From the selected schools students from grade 10-12 were surveyed. Survey was conducted using a structured questionnaire including the beck depression inventory-II, and questions exploring the correlates of depression. RESULTS: About 30% of participants were found to be depressed. Depression was more prevalent among female adolescents whose household income was <12,000 Saudi Riyal/month (odds ratio [OR] 2.17, confidence interval [CI] 0.97-6.84), did not have a good relationship with peers and family members (OR 4.63, CI 2.56-8.41), lived with single parent or alone (OR 1.77, CI 0.97-3.23), been emotionally abused (OR 3.45, CI 2.56-8.41), and those who had been subjected to physical violence, at least once (OR 3.34, CI 1.89-5.91). CONCLUSIONS: Strategies need to be developed to identify early signs and symptoms of depression among Saudi female adolescents. Training can be given to groups of students to help their peers, and also to the teachers to identify, and help students identify early signs of depression and provide them with better-coping strategies to combat progression of depression and anxiety among such adolescents.

Coping strategies for stress used by adolescent girls in Riyadh, Kingdom of Saudi Arabia.

OBJECTIVES: Secondary school girls, ages 15 - 19 yrs were surveyed to find out the coping strategies they used when stressed. Adolescents, who are affected with stress and depression early in life, suffer from depression throughout their lives especially if they are utilizing improper ways to cope with it. METHODS: A cross sectional school based survey among 1028 adolescent girls was conducted among the secondary schools in Riyadh city,Kingdom of Saudi Arabia. RESULTS: About 25% stated that they cry, 19% listen to music, 15% start eating a lot, 12% sit alone/isolate themselves, 11% pray/read the Quran, 10% get into a verbal argument or a fight. Only a few, 3% exercise, and 2% stated that they find someone to discuss and talk to. CONCLUSION: Majority of the adolescent girls in our survey, rely on emotion related coping mechanisms rather than problem solving mechanisms. This can cause long term implications in these adolescents as there is an increased probability to develop depression later on in life. Policy makers need to implement strategies for early identification of stress and depression. Talking to friends and family can serve as an effective way to cope with stress.

Assessing the Objective Structured Clinical Examination: Saudi family medicine undergraduate medical students' perceptions of the tool.

OBJECTIVES: To assess the perception and opinion of the medical students about Obejective Structured Clinical Examination. METHOD: The descriptive study was conducted at King Saud University College of Medicine, Riyadh, Saudi Arabia, from March to May 2010. Total population sampling, which is a type of purposive sampling technique, was used. A structured pre-tested questionnaire was circulated among the undergraduate medical students doing Family Medicine clerkship immediately at the end of Objective Structured Clinical Examination. RESULTS: Of the 97 questionnaires distributed, 95 (98%) were received. A number of positive aspects of the OSCE exam were identified by students such as 63 (66%) felt that it provided practical and useful experience; 63 (66%) perceived as having a positive impact on student learning; 62 (65%) stated it is a standardised exam; 53 (56%) felt that it should be used more often in undergraduate assessment; 54 (57%) stated that it evaluated a wide variety of clinical skills; 50 (53%) stated that the format allowed students to compensate for deficiency in some areas; 49 (52%) were of the opinion that the exam was fair; 45 (47%) preferred it over other forms of assessment; 39 (41%) perceived exam scores to be truly reflective of competence in clinical skills; and 34 (35%) felt that the format minimises chances of failure. Also, 46 (48% found it to be stressful, and 38 (40%) found it not easy. CONCLUSIONS: Overall, the Objective Structured Clinical Examination was perceived very positively and welcomed by the undergraduate family medicine students. Certain negative perceptions such as stress and difficulty were also highlighted, which could be managed through better orientation and preparation of the students.

Sexual practices of young educated men: implications for further research and health education in Kingdom of Saudi Arabia (KSA).

BACKGROUND: Considering the high prevalence of sexually transmitted infections (STIs) and other associated health problems among young people globally, it is important to identify sexual practices that could potentially compromise health. This study explored the sexual practices of young men in Riyadh city, the Kingdom of Saudi Arabia (KSA). Materials and methodology A cross-sectional study among young, male students was conducted using a pre-tested, structured, self-administered questionnaire. Descriptive analysis and adjusted odds ratio (OR) were calculated. RESULTS: Among 225 study participants, 31% had engaged in premarital sexual activity at least once and 61% viewed pornographic movies/materials. Only 51% knew that condom use could prevent STIs, 20% were not aware that HIV could be transmitted through both homosexual and heterosexual contacts. Premarital sexual activity was associated with the use of illegal drugs (OR: 2.51), viewing of pornographic movies (OR: 6.79) and traveling alone abroad (OR: 3.10). CONCLUSION: and recommendations Our study was the first to report the existence of premarital sexual practices among young educated men in KSA. There is a need to identify in detail the risks and the knowledge gaps, and base sexual health awareness among youth on such knowledge in order to prevent the spread of STIs and HIV.

Correlates of sexual violence among adolescent females in Riyadh, Saudi Arabia.

OBJECTIVE: To determine the frequency, experiences and correlates of sexual violence among female adolescents in Riyadh city, Kingdom of Saudi Arabia. METHODS: A cross-sectional survey was conducted in 2 schools in Riyadh city for adolescent females starting from January 2008 for 3 months. Five classes with 25 students in each were randomly selected from intermediate and secondary grade of each school. Four hundred and nineteen students were included. A self-answering questionnaire was distributed and collected after 15 minutes by 3 research assistants. RESULTS: Forty-two adolescent students (10%) were exposed to sexual violence. Only 31% of the students were taught how to react to sexual violence. Students whose order was > or = 5th among siblings and who had unsupportive parents in discussing sexual issues were more exposed to sexual violence (chi2=4.02, p=0.044, chi2=4.24, p=0.039). CONCLUSION: Being > or = 5th in order among siblings and having unsupportive parents in discussing sexual issues were correlates for exposure to sexual violence.

Knowledge and beliefs of adolescents regarding sexually transmitted infections and HIV/AIDS in a rural district in Pakistan.

OBJECTIVE: To assess the knowledge and beliefs of adolescents (15-19 years girls and boys) regarding sexually transmitted infections (STIs) and HIV/AIDS. METHODS: A community based cross-sectional survey was conducted in October 2002 in a rural district (Mirpurkhas) of Sindh province, Pakistan. RESULTS: A total of 428 adolescent girls and boys were interviewed. Only 44% correctly named at least one STI, while 55% knew at least two modes of transmission for HIV/AIDS. Adolescents with education greater than or equal to secondary level, those who were able to read the newspaper, possessed electricity in their homes and were allowed to meet their friends once in six months had significantly more HIV/AIDS knowledge. CONCLUSION: We conclude that rural adolescents of Sindh need more knowledge regarding STIs including HIV/AIDS. There is a need to formulate strategies to raise the levels of awareness and knowledge among adolescents regarding these conditions. Our findings indirectly support the use of mass media and peer education strategies to provide factual information to adolescents.

Knowledge, attitude and practice of parturients regarding Epidural Analgesia for labour in a university hospital in Karachi.

OBJECTIVE: To assess the knowledge, sources of knowledge, attitude (fears and misconceptions) regarding Epidural Analgesia (EA) and practices of parturients delivery at Aga Khan University hospital (AKUH). METHODS: A hospital based cross sectional study was conducted at the obstetric unit of AKUH, from November to December 2003. A questionnaire was filled through verbal interviews conducted on 448 parturients fulfilling the inclusion criteria. RESULTS: Seventy six percent of the females were aware of epidural analgesia as a labor pain relieving method. However, only 19% availed EA. About 40% had heard about EA from their obstetricians and 64% from friends or relatives. Twenty even percent believed that EA has detrimental effects on the baby while 9% stated that EA can prolong the duration of labour. CONCLUSION: Majority of the pregnant females delivering at Aga Khan University Hospital were aware of epidural analgesia for labour. However, only a small proportion are availing this service, due to fears and misconceptions.