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).

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%).

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.

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.

Intestinal parasitic infections in schoolchildren of Abha (Asir), Saudi Arabia.

Stool specimens from 1282 children between the age of 5 and 13 years attending 10 primary schools for boys in the city of Abha, southwestern Saudi Arabia, were examined for the presence of intestinal parasites. Of these, 313, (24.4%) were found infected with one or more species of 11 intestinal protozoa and helminths. The most common pathogenic protozoa being Giardia lamblia (10.9%) followed by Entamoeba histolytica (4.1%). The nonpathogenic protozoan, Entamoeba coli had the highest prevalence rate (11.3%) in the children's stools. Hymenolepis nana was the commonest intestinal helminth (3.0%). Other intestinal helminths, including Ascaris lumbricoides, Trichuris trichiura. Schistosoma mansoni, Dicrocoelium dendriticum were detected to a lesser extent. The distribution of the common intestinal infections among the children surveyed were also analysed according to age, nationality and multiplicity of infection. Prevalence of E. histolytica was found to increase with age whereas Giardia infections were less common among older children. This pair of parasite species were strongly associated. Yemeni children had consistently the highest prevalence of infection with protozoa and helminths, followed by Saudi and non-Saudi children.

Teenage pregnancy: are teenagers a high risk group?

OBJECTIVES: To study health profile of pregnant teenagers and their pattern of utilization of primary health care services in comparison with pregnant women aged 20-35 years in Abha, Saudi Arabia. STUDY DESIGN: A cohort of 1938 Saudi pregnant women (214 teenagers less than 20 years and 1724 aged 20-35 years) was selected by stratified random sampling technique. They were screened for anemia and hypertension using WHO criteria and followed until delivery to observe the method of delivery. RESULTS: The prevalence of anemia (9.6% and 12.0%, respectively) and hypertension (1.1% and 3.5%, respectively) was not significantly different among primigravida of both age groups. The same trend was observed among multigravida. Follow-up showed that the rate of abnormal deliveries among primigravida of both groups was not significantly different, and even lower among multigravida teenagers. Pregnant women in both groups had similar average prenatal visits (6.6 +/- 1.1 and 6.7 +/- 1.2 respectively, P < 0.05) and the majority contacted the primary health care center early in pregnancy (87.4% and 88.9%, respectively, P < 0.05). CONCLUSION: These results indicate that pregnant teenagers are not a high risk group if good prenatal care is provided.

PIP: Teenage pregnancy has been shown to be associated with an increase in obstetric complications. In particular, gestation associated hypertension and anemia were found more frequently among these young women. The authors screened 1938 pregnant Saudi women for anemia and hypertension using WHO criteria and followed them until delivery to observe the method of delivery in the study of whether or not pregnant women younger than 20 years old are at greater risk of obstetric complications than pregnant women aged 20-35 years. The women were selected by stratified random sampling technique from Abha, Saudi Arabia. 214 were younger than 20 years old, while the rest were aged 20-35. Among primigravida pregnant women younger than 20 years old, 9.6% were anemic and 1.1% suffered hypertension. Among primigravida pregnant women aged 20-35 years old, 12.0% were anemic and 3.5% suffered hypertension. These differences in rates between age groups are not significant. The same trend was observed for multigravida women. Furthermore, the rate of abnormal deliveries among primigravida of both groups was not significantly different, and even lower among multigravida teens. Pregnant women in both age groups made, on average, 6.6-6.8 prenatal visits, while 87.4% and 88.9%, respectively, contacted the primary health care center early in pregnancy. It may be concluded from these findings that pregnant teens do not constitute a high-risk group if good prenatal care is provided.

Altitude and socio-biological determinants of pregnancy-associated hypertension.

OBJECTIVES: To study the prevalence of gestation-associated hypertension and to determine the effect of altitude and related socio-biological factors. METHODS: A stratified random sample of 3988 pregnant women living at high altitude and 2744 at sea level in the Asir region, Saudi Arabia was interviewed for socio-biological conditions and examined for blood pressure, proteinuria and body mass. RESULTS: An overall prevalence of 2.4% was found. Certain groups of pregnant women are at high risk of developing hypertension. They include women who are over 40 years, high multipara, having short inter-pregnancy spacing, are overweight, are illiterate and those living at high altitude. Multivariate analysis showed that high altitude is a strong risk factor (adjusted odds ratio (OR), 1.879; 95% confidence interval (CI), 1.123-2.819) and cannot be masked when other variables are controlled. CONCLUSIONS: Special health education and more frequent screening programs at primary health care level should be given to pregnant women living at high altitude.

Hypertension in Asir region, southwestern Saudi Arabia: an epidemiologic study.

A population study was carried out to determine the prevalence of hypertension among Saudis at primary health care level in the Asir region, Southwestern Saudi Arabia. All primary health care centers (PHCCs) were visited (238 PHCCs). Data were collected in relation to the updated Saudi population census for 1991. Chronic case registries were revised to identify existing cases of hypertension by age and sex till the end of 1991. Results showed that the prevalence of hypertension amounted to 2.4% among Saudis aged 45 years and more. Males and females aged 45 years and more living at high altitude had a significantly higher risk of developing hypertension (p < 0.05) compared to those living at sea level.

Prevalence of intestinal parasitic infections among Asian female house keepers in Abha District, Saudi Arabia.

A group of 5,518 female Asian house keepers working in Abha District of Saudi Arabia was examined (1990 through 1992) to determine the prevalence of intestinal parasitic infections. They came from Indonesia, Sri Lanka, Philippines and Thailand. Fresh stool specimens were obtained in special containers and examined by light microscopy of wet smears in normal saline and Lugoll's iodine solution within one hour of collection. The study revealed an overall prevalence of 46.5% which was higher than that reported among the Saudi population. The common parasites found included Trichuris trichiura (28.8%), Ascaris lumbricoides (22.2%), Hookworm (14.9%), Enterobius vermicularis (0.8%), Strongyloides stercoralis (0.6%), Entamoeba histolytica (1.2%), Hymenolepis nana (0.2%), and Giardia intestinalis (0.1%). The prevalence of intestinal parasites was statistically different among various studied nationalities. The possibility of spreading such diseases throughout the community should be considered in the light of the nature of work of this group being in close contact with different family members. It is recommended that all expatriate workers be checked and treated if necessary on arrival for the first time or from vacation. This policy must be strictly monitored, particularly for female house keepers.

Anemia among pregnant women in the Asir region, Saudi Arabia: an epidemiologic study.

A cross sectional study was conducted during August 1992, on a representative sample of 6,539 pregnant women attending 69 primary health care centers in the Asir region, southwestern Saudi Arabia for the assessment of their hemoglobin level. The overall prevalence of anemia (Hb < 11 g/dl) was found to be 31.9%. It was found that the prevalence was affected by age (37.3% among those who were less than 20 years old), parity (34.9% among those who had 7 and more deliveries), inter-pregnancy spacing (35.2% among those whose birth spacing was less than 1 year), gestational age, and education (35.1% among illiterates). Health education programs at primary health care level in the region should be revised to stress the importance of balanced diet, compliance with iron medication and sufficient spacing between subsequent pregnancies.

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.

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.

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.

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%).

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.