Surveillance of childhood vaccine-preventable diseases at health facilities in Jeddah, Saudi Arabia.

A cross-sectional study was conducted at 33 randomly selected health facilities in Jeddah, Saudi Arabia, to assess health facilities' performance and health workers' knowledge of surveillance activities for childhood vaccine-preventable diseases. The WHO surveillance assessment questionnaire and a specially designed knowledge questionnaire were used. There were deficiencies in some surveillance items. The percentages of health facilities that had the surveillance manual and correctly filled clinical registers were 57.6% and 60.6% respectively. In the 6 months preceding the study, 36.4% of facilities lacked the appropriate surveillance forms while only 18.2% had received supervision reviews. Only one-quarter of health workers had a satisfactory knowledge score.

The distribution of peripheral arterial disease in a defined population of elderly high-risk Saudi patients.

OBJECTIVES: To find out the prevalence rate of peripheral arterial disease (PAD) in a defined population of high risk Saudi patients aged 50-80 years, using simple measuring techniques. DESIGN: A hospital-based cross-sectional study using a simple protocol. MATERIALS AND METHODS: Four groups of patients were studied: three high risk groups (214 cases of diabetes (DS), 60 of chronic renal failure (CRF), 78 of ischaemic heart disease (IHD) and 50 controls. PAD was only diagnosed if the ankle-brachial index (ABI) was < or =0.9. The contribution of a history of intermittent claudication (IC) and palpation of pulses to the diagnosis was assessed. RESULTS: A total of 402 patients was studied. Their mean age was 59.31+/-8.1 (range 50-80). There were 257 males (63.9%) and 145 females (36.1%). 171 cases of PAD were detected (42.5%) and distributed among the various groups: 105 (61.4%) in the DM, 23 (13.4%) in the CRF, 36 (21.4%) in the IHD and 7 (4.1%) in the control groups. The prevalence rate was highly significant in each of the 3 high risk groups compared to the control group; however, there was no statistically significant difference in the incidence of PAD between the high risk groups. Questionnaires for IC and palpation of peripheral pulses were of very limited validity in diagnosing PAD. Overall, DM headed the list of significant risk factors followed by smoking and greater age. CONCLUSIONS: In contrast to the general impression that PAD is an uncommon disease, we found a significant prevalence rate of PAD in elderly high risk patients. Screening for PAD in aged diabetics, IHD and CRF patients is a simple and cost-effective approach.

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.

Splenic artery aneurysm rupture during pregnancy.

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Efficacy and acceptability of depo-medroxyprogesterone acetate injection. As a method of contraception in Saudi Arabia.

OBJECTIVE: To determine the efficacy and acceptability of Depo-Medroxyprogesterone acetate (depo-provera) among the women using that method of contraception at King Faisal Military Hospital in the south-west region of Saudi Arabia. METHODS: A preliminary retrospective and questionnaire analysis of 165 Saudi women who had depo-provera as a method of contraception at the contraception clinic of King Faisal Military Hospital over a period of 2 months. RESULTS: The mean age of the women was 31.21 years and the mean parity 6.77. There was no pregnancy reported during the period of use of the contraceptive method which ranged from 3 months to 7.25 years. The side effects were mainly irregular spotting (69%), continuous bleeding per vaginam (7%), amenorrhoea (8%) and menorrhagia (1%). The rest reported normal menstrual pattern. Irregular spotting was common in women who had used the method for less than 2 years while amenorrhoea was the most common menstrual abnormality after 3 years of use. The other complaints included weight gain, loss of hair, abdominal pain and backache. The side effects were not acceptable to 4% of the women and they tried other methods of contraception. Thirteen percent of the women became pregnant after stopping the injections within intervals varying between 6 months to 2 years. Seventeen percent were using the method for the 2nd time. CONCLUSION: Depo-provera is a very effective form of contraception in our community. While a few of the patients (4%) in our series would try other methods if not happy with the side effects, the majority were prepared to cope with the side effects as long as the desired prevention of pregnancy was guaranteed. Further studies are needed to validate these findings.

A comparison of spontaneous labor with induced vaginal tablets prostaglandin E2 in grand multiparae.

OBJECTIVE: To compare the outcome of labor in grandmultiparous patients (para >5) who had induction of labor with prostaglandin E2 vaginal tablets with grandmultiparous patients in spontaneous labor, and to observe the complications during induction of labor. METHODS: A retrospective case control study was carried out at King Faisal Military Hospital, Khamis Mushayt between January 1993 through until December 1994. This included 64 grandmultiparous patients that were induced with prostaglandin E2 vaginal tablets. Ninety grandmultiparous patients who went into labor spontaneously served as controls. Maternal and fetal data extracted from their hospital record files included age, parity, indication for induction, Bishop score at induction, total dose of prostaglandin used and complications of induction of labor. Other information were length of labor, need for syntocinon augmentation, blood loss during the 3rd stage of labor, mode of delivery, birth weight, sex and Apgar score at 10 minutes. RESULTS: No serious complication of induction of labor such as rupture of the uterus was noted in the subjects studied. There were no significant differences when the mean age and parity of patients in the 2 groups were compared (P>0.05) but there was difference in the gestational age at delivery (p=0.00). There was no significant difference in the mean length of first and 2nd stages of labor. The cesarean section rate was 11% and 8% in the cases and controls, while the need for syntocinon augmentation was twice in the cases than controls, 27% vs 14%. These were not statistically significant. CONCLUSION: We conclude that induction of labor with prostaglandin E2 vaginal tablets may not have adverse effect on the outcome of labor compared with patients in spontaneous labor. It may be safe to use prostaglandin E2 vaginal tablets for induction of labor in the grand- multiparae. We recommend a randomized prospective trial to validate these observations.

The prevalence of cardiovascular risk factors among students in jeddah, saudi arabia.

OBJECTIVES: To determine the prevalence of cardiovascular risk factors among students in Jeddah, Saudi Arabia. METHODS: A cross-sectional study was conducted during 1994 on a sample of students selected from 49 public schools using a multistage stratified random sampling technique. For all students, an interview was conducted and anthropometric and blood pressure measurements were obtained. Fasting glucose and total cholesterol levels on a capillary blood sample were measured using Accutrend for a subsample of students. RESULTS: Of the 4042 students selected, 71% were males and the overall mean age was 15.3 ± 2.7 years. After age adjustment, about 23% of the students were found overweight. In addition, 6.4% and 9% of the students were found to have systolic and diastolic hypertension, respectively, with no statistically significant difference between males and females. Among 1432 students, 4% of males and 2% of females had hypercholesterolemia (p=0.06). Hyperglycemia was found in 0.4% of males and 0.6% of females. Among 1834 students in the 9(th) to 12(th) grades, 6.9% of males and 0.5% of females were current cigarette smokers. CONCLUSIONS: Since attitudes and behaviors that influence future health are established during childhood and adolescence, intervention to prevent cardiovascular diseases (in adult life) should take place in childhood and youth to reduce the risk factors and schools have a great role to play in the promotion of good health.

Surveillance of childhood vaccinepreventable diseases at health facilities in Jeddah, Saudi Arabia

A cross-sectional study was conducted at 33 randomly selected health facilities in Jeddah, Saudi Arabia, to assess health facilities' performance and health workers' knowledge of surveillance activities for childhood vaccine-preventable diseases. The WHO surveillance assessment questionnaire and a specially designed knowledge questionnaire were used. There were deficiencies in some surveillance items. The percentages of health facilities that had the surveillance manual and correctly filled clinical registers were 57.6% and 60.6% respectively. In the 6 months preceding the study, 36.4% of facilities lacked the appropriate surveillance forms while only 18.2% had received supervision reviews. Only one-quarter of health workers had a satisfactory knowledge score

Outcome of induced labour in pregnancies at 41 weeks gestation and over in Saudi Arabia

A retrospective, descriptive cohort study was conducted at King Faisal Military Hospital, Saudi Arabia, to compare pregnancy outcomes in patients induced with prostagl and in E2 from 41 weeks gestation. A total of 450 women whose antenatal care and delivery were conducted at the hospital during 1995-99 were studied. The main outcome measures used were caesarean section rate and perinatal morbidity and mortality. In otherwise normal pregnancies, the caesarean section rate was not significantly increased when induction of labour was carried out at 41 weeks gestation compared with >/=42 weeks. Although more perinatal complications occurred when induction was carried out at 42 weeks, the results were not statistically significant. A large prospective clinical trial is indicated

Induced labour with prostaglandin E2 in different parity groups after premature rupture of membranes

The study compared the outcome of induction of labour with prostagl and in E2 vaginal tablets in patients with premature rupture of membranes [PROM] at term in different parity groups. A retrospective review was made of the hospital records of 169 women attending the maternity unit of King Faisal Military Hospital, Saudi Arabia. There were no statistically significant differences between the 3 groups [parity 0, parity 1-4 and parity 5+] in rates of labour augmentation, caesarean sections, neonatal intensive care admissions or low Apgar scores. There were no serious complications of induction of labour such as infection or uterine hyperstimulation or rupture. Prostagl and in E2 may be used with care for labour induction in women with PROM at term, even gr and ultiparas, unless there is history of previous caesarean delivery