The impact of Adverse Childhood Experiences on social determinants among Saudi adults.

Background: Early exposure to violence has deleterious effect on the child's brain development. The aims for this project were to assess the prevalence of Adverse Childhood Experiences (ACEs) and their impact on social determinants in Saudi Arabia (SA). Methods: A cross-sectional, national study conducted in all regions of SA using the World Health Organization-ACE-International Questionnaire to determine the association between ACEs and socioeconomic outcomes. Results: A total of 10 156 participants completed the questionnaire with five main ACE categories (abuse, neglect, family dysfunction, peer and community violence). Over half of the sample (52%) experienced emotional abuse, followed by physical abuse (42%), bullying (39%), neglect (29%) and sexual abuse (21%). The most common family dysfunction was witnessing domestic violence against any household member (57%) and the least prevalent was living with a substance abuser (9%). Low educational attainment, disruption in marital life and substance abuse were significantly affected by all ACE categories. However, unemployment was marginally affected only by neglect and household dysfunction. Conclusions: ACEs are highly prevalent in SA and have significant negative impact on life opportunities. National preventive programs should be implemented to reduce ACE and their deleterious outcomes.

Prevalence of Sexual Abuse Among Secondary School Students in Saudi Arabia.

Child sexual abuse (CSA) is a public health problem that has been found to be linked to negative health outcomes. Data on CSA in Saudi Arabia are limited, and there are many gaps in research in this field. The aim of this study is to examine the prevalence of sexual abuse among children in Saudi Arabia. A cross-sectional, national survey (N = 16,010) utilizing International Society for Prevention of Child Abuse and Neglect Child Abuse Screening Tool Children's Version was conducted at secondary high schools in Saudi Arabia. Participant's mean age was 16.8 ± 0.9 years, and 50.8% were boys. Sixteen percent of the participants reported exposure to any type of CSA during their lives. Boys and those who lived with step-parent were more likely to be sexually abused compared to those who didn't (p < .05). Ordinary least squares regression analysis revealed that gender was the predictor significantly associated with CSA. Evidence-based prevention programs targeting mainly the high-risk groups should be implemented.

Professionals' Attitude Toward Reporting Child Sexual Abuse in Saudi Arabia.

Child sexual abuse (CSA) requires specialized knowledge and training that includes forensic interview skills. The aim of this study was to determine variations in professionals' attitudes toward CSA by measuring three aspects of forensic attitudes (sensitivity, specificity, and skepticism) and evaluating disagreements concerning the assessment of CSA cases in Saudi Arabia. A cross-sectional, web-based study, in which the Child Forensic Attitude Scale was used to measure professionals' attitudes, was conducted. Professionals who dealt with suspected cases of CSA as part of their jobs or were in professions that necessitated involvement with such cases, were selected as participants. Of 327 participants, 53% were aged ≤40 years, and 54% were men. In addition, 24% were doctors/nurses, 20% were therapists/psychiatrists, 24% were social workers, 17% were educators, 9% were law enforcement professionals, and 5% were medical examiners. Attitude subscale scores differed significantly according to participants' sex, specialty, and training. Women, healthcare professionals, and those who had participated in more than five training courses were more concerned about the underreporting of abuse (high sensitivity) relative to other professionals. In comparison, men, medical examiners, law enforcement officers, and undertrained professionals tended to underreport suspected sexual abuse cases (high specificity). High specificity in attitudes toward suspected cases of CSA could affect professionals' judgment and contribute to low reporting rates. Certain strategies, including increasing self-awareness of personal bias, specific CSA recognition courses, and team approaches to case assessment and management, should be implemented to control the influence of subjective factors.

Gender-based disparities in the impact of adverse childhood experiences on adult health: findings from a national study in the Kingdom of Saudi Arabia.

BACKGROUND: Adverse Childhood Experiences (ACEs) have been linked to an increased risk of health and social problems throughout life. Studies on gender differences from developing countries are scarce. In this paper, we will examine gender variations in the types of reported ACEs and gender-specific relationships between cumulative ACEs and physical and mental health, and Risky Health Behaviors (RHB) in adulthood in the Kingdom of Saudi Arabia (KSA). METHODS: A cross sectional national study was conducted in all of the 13 regions in KSA in 2013 using the ACE- International Questionnaire (ACE-IQ). We used multivariate logistic regression to examine the relationship between 4 + ACEs and physical, mental health and RHBs for both men and women separately after adjusting for age, education, marital status and current employment. RESULTS: The total number of participants was 10,156 and women comprised 48% of the sample. The majority of respondents (80%) reported at least one ACE. Women had higher percentages of < =2 ACEs (65% vs 55%; p <0.05) while men were more likely to have 4+ ACEs (33% vs 25%; p < 0.05). When compared to participants with 0 ACE, men who reported 4+ ACEs were associated with the highest likelihood of using drugs (OR = 9.7; 95% CI: 6.4-14.5) and drinking alcohol (OR = 9.2; 95% CI: 6.3-13.6). On the other hand, women who experienced 4+ ACEs were associated with the highest likelihood of depression (OR = 7.0; 95% CI: 5.2-9.4), anxiety (OR = 6.4; 95% CI: 5.0-8.2) and other mental illnesses (OR = 7.4; 95% CI: 5.2-10.6). As for chronic diseases, abused men and women in childhood showed similarly a twofold increased risk of developing diabetes, hypertension, coronary heart disease and obesity when compared to non-abused participants. CONCLUSION: Findings highlight the need to consider gender specific differences in the development of preventive strategies to address ACEs in KSA.

Examining the relationship between child maltreatment and school performance in public schools in Saudi Arabia: A pilot study.

AIMS: The aim of this study was to examine the relationship between child maltreatment (CM) and school performance among adolescents in Saudi Arabia. METHODS: A cross-sectional study was conducted in Riyadh, Saudi Arabia, in 2014. The enrolment criteria included both male and female Saudi students ( n=674; 52.7% male) aged 12-19 years ( Mage=15.6±1.6 years), attending intermediate and secondary schools belonging to the Ministry of National Guard. A self-administered questionnaire was used to gather information on different forms of abuse that had occurred in the past or were currently occurring. RESULTS: Poor school performance was more likely in students who lived among substance-use family members or guardians compared with those who did not (33.3% vs. 11.4%; p<0.01), those with an imprisoned family member compared with those without (26.5% vs. 11.2%; p<0.01), those who were psychologically abused compared with those who were not abused (21.0% vs. 10.1%; p<0.01), those who were physically abused compared with those who were not abused (18.9% vs. 9.3%; p<0.01), and those suffering multiple forms of abuse compared with those not abused (23.4% vs. 9.7%; p<0.01). Logistic regression analysis showed that household dysfunction was the most predisposing factor to poor performance in school, and included living among substance-use family members or guardians (odds ratio=4.0; 95% confidence interval=1.7-9.5) and living with imprisoned family member (odds ratio=3.1, 95% confidence interval=1.5-6.3). CONCLUSIONS: CM, along with family structure and dynamics, has an adverse relationship with students' school performance. These findings highlight the importance of increasing awareness of the impact of CM on school performance among families, schools and the community.

Prevalence and factors associated with mental illness symptoms among school students post lockdown of the COVID-19 pandemic in the United Arab Emirates: A cross-sectional national study.

Limited data exists on the mental health of children in the United Arab Emirates (UAE). This study aimed to fill this gap by examining the prevalence of anxiety, depression, and risk for Post-Traumatic Stress Disorder (PTSD) among school students in post-lockdown of the COVID-19 pandemic. A sample of 3,745 school students participated, responding to standardized tests (Mood and Feeling Questionnaire-Child Self-Report, Screen for Child Anxiety Related Disorders-Child Version, and Children's Revised Impact of Event Scale-8). Findings showed that the risk for PTSD was the most prevalent (40.6%), followed by symptoms of anxiety (23.3%), and depression (17.1%). For gender differences, symptoms of the three conditions (depression, anxiety, and PTSD) were higher in female students (9.2%) compared to male peers (7.7%) (p = 0.09). Moreover, symptoms of depression and anxiety were found to be higher among late adolescents (p<0.05). Further analysis revealed that having medical problems was a positive predictor for anxiety (OR = 2.0, p<0.01) and risk for PTSD (OR = 1.3, p = 0.002); similarly, witnessing the death of a close family member due to COVID-19 (OR for depression, anxiety, and PTSD = 1.7, p<0.01) were positive predictors associated with PTDS, depression, and anxiety. The study concluded that post COVID-19 lockdown, symptoms of anxiety, depression, and risk for PTSD were found to be prevalent among school students in the UAE. Researchers put forward recommendations on the initiation of a national school mental health screening program, the provision of follow-up services for vulnerable students, and the integration of a mental health support system in the disaster preparedness plans.

Hartford's gun buy-back program: are we on target?

Gunbuy-backprograms have been proposed as away to remove unwanted firearms from circulation, but remain controversial because their ability to prevent firearm injuries remains unproven. The purpose of this study is to describe the demographics of individuals participating in Connecticut's gun buy-backprogram in the context of annual gun sales and the epidemiology of firearm violence in the state. Over four years the buy-back program collected 464 firearms, including 232 handguns. In contrast, 91,602 firearms were sold in Connecticut during 2009 alone. The incidence of gun-related deaths was unchanged in the two years following the inception of the buy-back program. Suicide was associated with older age (mean = 51 +/- 18years) and Caucasian race (n = 539, 90%). Homicide was associated with younger age (mean = 30 +/- 12 years) and minority race (n = 425, 81%). A gun buy-back program alone is not likely to produce a measurable decrease in firearm injuries and deaths.

Correction: Aleissa et al. The Association between Video Game Type and Aggressive Behaviors in Saudi Youth: A Pilot Study. Behav. Sci. 2022, 12, 289.

The authors would like to make the following correction to the published paper [...].

Determining the Prevalence of Child Maltreatment Among Young Adults in Saudi Arabia Using ISPCAN Child Abuse Screening Tool.

Background Child maltreatment is an important public health issue, thus determining its prevalence is critical to recognize the extent of the problem and mandate efforts to combat child abuse. We aimed to investigate child maltreatment prevalence among special populations of young adults in Riyadh, Saudi Arabia. Methods We used the retrospective version of the International Society for Prevention of Child Abuse and Neglect (ISPCAN) Child Abuse Screening Tool (ICAST-R). The survey included Saudi students of both genders aged between 18 to 24 years old and attending King Saud bin Abdulaziz University for Health Sciences (KSAU-HS). The questionnaire was provided electronically using Survey Monkey (Momentive Global Inc., San Mateo, CA, USA). Results A total of 713 students completed all sections of the questionnaire. The prevalence of any type of child maltreatment was estimated to be 42%. Physical abuse was the most prevalent (51.1%), followed by emotional abuse (49.9%), lack of protection and safety (38%), and sexual abuse (29.6%). The most common form of physical abuse was being hit or punched at 77.5% followed by 'beaten very hard with an object' at 58.8% while touching was the most common form of sexual abuse at 68.7%, and only 13.7% encountered penetrating form of sexual abuse. In comparison to female victims, male victims were more likely to be physically abused (odds ratio (OR)=1.5; confidence interval (CI)=1.1-2.0). Participants who lived with a single parent were more likely to be victims of a lack of protection and safety than those who lived with both parents (OR=1.9; CI=1.0-3.7). Most participants reported the abuse to occur after the age of nine years, and the perpetrator was the parents in 17.5% of cases.  Conclusion Our findings demonstrated a high prevalence of child maltreatment among the young adult population in Saudi Arabia. It is vital to obtain more information on the prevalence and risk factors of child maltreatment in various populations and regions of Saudi Arabia to raise awareness and improve services for the victims of abuse.

The feasibility of screening for violence in the pediatric emergency department.

BACKGROUND: Youth violence is a significant public health concern. The objective of this study was to evaluate the feasibility of violence screening tools in a pediatric emergency department (PED). METHODS: Children between eight and 17 years presenting to the PED were prospectively enrolled. Two questionnaires were administered: Violence Prevention Emergency Tool (VPET) and Violence Exposure Scale for Children (VEX). RESULTS: One hundred children were enrolled: mean age was 12.9 years (SD 2.8), 42% girls, 48% Hispanic, and 13% African-American. Mean time to complete VPET was 9.0 minutes and VEX 4.9 minutes. Ease of understanding between VPET and VEX were 74% vs 92% (interviewer) and 74% vs 93%, (subjects) both P < 0.05. The number of repeated items was significantly less for VEX compared to VPET, 1% vs 6% (P < 0.01). CONCLUSION: It may be feasible to screen for exposure to violence in the PED. VEX is a more feasible screening tool compared to VPET.

Attitude of pediatricians toward suspected cases of child sexual abuse (CSA) in Saudi Arabia.

Objective: To assess the attitudes of pediatricians working at the Ministry of National Guard-Health Affairs (MNGHA) to report cases of child sexual abuse (CSA) and to determine the association between the demographic, cultural characteristics, and the attitude toward reporting. Participants and Settings: The participants included all pediatricians, from consultants to residents, employed at the Pediatric Department of the King Abdulaziz Medical City and King Abdullah Specialist Children's Hospital, Riyadh. Additional inclusion criteria were females and males, Saudis and non-Saudis, and age 20-60 years. Methods: A self-administered, hard copy questionnaire was distributed to 277 pediatricians, and the response rate was 58.48%. The sensitivity/specificity emphasis mean score was calculated. Categorical variables were tested against the sensitivity/specificity emphasis mean score using an ANOVA and an independent sample t-test. The reliability of the questionnaire was measured with Cronbach's alpha. Results: In total, 153 completed questionnaires were analyzed. The responses were inclined toward balanced (indecisive toward reporting) and high specificity (favors the decision not to report suspected CSA). No significant difference was found in the sensitivity/specificity mean score between the different levels of professionals, experience, age, gender, and number of prior child abuse-related courses. The skepticism scale showed, for the different professional levels, that the staff physician/resident believed the 3- to 5-year-old girls and boys to be genuine. The consultants/associate consultants believed 6- to 12-year and 13- to 17-year-old girls and boys to be true most of the time. Nearly half of the participants indicated that their reporting decision was affected by the possible consequences of reporting suspected CSA for the children's families and the social perceptions of sexually abused children as adults. Conclusion: The results highlight the low reporting rates of CSA cases. The findings suggest a lack of training and experience of the professionals in this area of assessing, detecting, and reporting CSA cases.

The Association between Video Game Type and Aggressive Behaviors in Saudi Youth: A Pilot Study.

Video gaming is a popular source of entertainment among children and adolescents. Although the Middle East is home to one of the fastest growing communities of video game users, most of the research established on this topic has been carried out through small scale studies. Our aim in this study is to assess the prevalence of video game use and its association with aggressive behaviors among adolescents in Saudi Arabia. This is a cross-sectional study involving boys and girls (aged 15−18 years) in both private and public secondary high schools in Riyadh, Saudi Arabia. Each participant completed a self-administered modified version of the aggression questionnaire, which consisted of 29 items scored on a 5-point Likert scale. This questionnaire assessed aggressive behaviors domains: physical aggression, anger, hostility, and verbal aggression and types of videogames and time of use. A total of 485 students were included in this study. The mean age of participants was 16.5 ± 0.9 years; 48% were boys. Adolescents who participated in action games had higher mean verbal (p < 0.01) and physical aggression (p < 0.01) scores. Adventure game players had significantly higher mean scores in all four types of aggressive behavior (p < 0.01). Participants who played simulation games had higher mean verbal aggressiveness (p < 0.01). Adolescents who participated in sports games had greater mean levels of anger (p = 0.01) and physical aggression (p = 0.01). Those who played strategy/puzzle games reported significantly higher mean scores of anger (p < 0.01), hostility (p = 0.01), and verbal aggression (p = 0.01). Females were more likely to show higher mean anger (p < 0.01) scores, whereas males were more likely to show higher mean physical aggression scores (p < 0.01). Conclusions: Our results do suggest that playing video games increases adolescent aggressive behaviors, which has been supported by other studies. We recommend educating parents on the pros and cons of playing video games and that parents schedule and limit the time their children spend playing video games.

Parents' views on the acceptability of a COVID-19 vaccine for their children: A cross-sectional study in Abu Dhabi-United Arab Emirates.

BACKGROUND: The United Arab Emirates had approved the COVID-19 vaccine for children. Assessing parents' acceptance of the vaccine for their children will influence decision-making in the COVID-19 vaccine roll-out. METHOD: Parents registered inthe AbuDhabiDepartmentofEducation (12,000 families) were invitedtocompleteanonlinequestionnaire from 8th September 2021 to 17th October 2021. Out of the 12,000 families, 2510 (21%) participants answered the survey. The questionnaire investigated the parents' attitudes and beliefs regarding the COVID-19 vaccine. RESULTS: The vaccination rate among this group of respondents was high, with 2255 (89.9%) having received two doses and 1002 (45.5%) having already received a booster dose. Acceptance of the respondents to vaccinate their children was high, (75.1%) said they would vaccinate their children, with 64.4% reporting that they would immediately vaccinate their children if the vaccine were made available. Determinants of COVID-19 child vaccination acceptance included the respondent's vaccination status-i.e., if the respondent is already vaccinated (OR 4.96 [2.89-8.53]) or has taken the third dose (OR 2.37 [1.4-4.01])-their children's age (OR 1.11 [1.30-1.18] for older children), and their trust in the following information sources: the government (OR 2.53 [1.61-3.98]), health care providers (OR 1.98 [1.2-3.24]), or social media (OR 2.17 [1.22-3.88]). Increased level of education had a negative impact on the acceptance of giving the vaccine to children (OR 0.63 [0.52-0.77]); fear of side effects OR 0.000164 (0.000039-0.001) was another determinant. The main factor that encouraged parents to give their children the vaccine was to protect their child's health as reported by 1537 (55.5%) participants. CONCLUSION: The Abu Dhabi community is highly accepting of the vaccine for their children. Future studies of how this vaccine acceptance can influence the pandemic are needed.

Impact of Connecticut's graduated driver licensing system on teenage motor vehicle crash rates.

BACKGROUND: In response to high rates of teen motor vehicle crashes (MVCs) many states have enacted graduated driver licensing (GDL) systems. GDL delays full licensure and allows beginners to obtain experience under lower risk conditions. The purpose of this study is to evaluate the impact over the past 10 years to determine its effect on teen MVCs. METHODS: Connecticut MVC data from 1999 to 2008 were analyzed. Percent change (1999 vs. 2008) in MVC rates per 10,000 registered drivers was calculated by age, gender, during the night restriction (11:00 pm and 5:00 am), and MVCs with passengers. Linear regression analysis estimated the decrease of MVC rates each year. RESULTS: The MVC rate decreased by 40% for 16-year-old and 30% for 17-year-old drivers. In comparison, rates among 18-year-old, 19-year-old, 25- to 29-year-old, and 30- to 59-year-old drivers were reduced by 16%, 7%, 8%, and 11%, respectively. The MVC rate for 20- to 24-year-old drivers increased by 1%. During nighttime restricted driving times, MVC rates decreased by 54% among 16-year-old and 49% among 17-year-old drivers. The MVC rate with passengers decreased by 65% for 16-year-old and 53% for 17-year-old drivers. In comparison, rates of nighttime and with passenger MVCs among older drivers were significantly less. CONCLUSIONS: Implementation of Connecticut's GDL system has resulted in significant reductions in MVC rates among novice drivers. This analysis provides a method for other states to examine the impact of their GDL system.

Underweight, body image, and weight loss measures among adolescents in Saudi Arabia: is it a fad or is there more going on?

BACKGROUND AND OBJECTIVE: Adolescence is considered to be a pivotal point in which optimum nutrition and eating habits are developed. Although tackling the obesity epidemic has been much discussed, addressing the issue of underweight and body image is often neglected. This study was carried out to get a better understanding of underweight status among adolescents in Saudi Arabia, and exploring self-perceptions of body image and weight loss measures among underweight adolescents. METHODS: Data from Jeeluna®, a national cross-sectional school-based survey were utilized. Jeeluna® assessed the health status and health-risk behaviors of adolescents in school through data obtained by a self-administered questionnaire, anthropologic measurements, and laboratory investigations. RESULTS: A total of 12,463 adolescents participated. Eighteen percent of adolescent males and 12.4% of females were found to be underweight, representing 14.9% of adolescents collectively. Forty-five percent of underweight participants were happy with their weight. Underweight females between the age group of 10 and 14 years were the most likely to believe that they still need to lose weight (16.0%) followed by females aged 15-19 years (9.7%). Underweight females aged 10-14 years were also the group most likely to engage in purging (1.6%). Stepwise logistic regression found that the strongest association with being underweight was with having a lower household income (OR 2.0, CI 1.5-2.7) and having more than 5 siblings (OR 1.8, CI 1.5-2.3). CONCLUSION: Underweight status is prevalent among adolescents in Saudi Arabia and deserves more attention as a public health issue. Distorted body image and disordered eating behaviors exist, necessitating further investigation of underlying causes.

Epidemiology of Abusive Head Trauma Among Children in Saudi Arabia.

BACKGROUND AND OBJECTIVES: To examine abusive head trauma (AHT) trends using data obtained from hospital-based child protection centers (CPCs) and the distribution of age in months among young children in Saudi Arabia. METHODS: A retrospective study was conducted that includes data obtained from 58 hospital-based CPCs in all 13 regions of Saudi Arabia registered in the National Family Safety Registry from 2010 to 2020. AHT cases (n=106) were identified for inclusion in the registry by a daily review of the emergency department logbooks. RESULTS: Over the 11-year period, there was a sharp increase in the number of cases, specifically after 2014, from seven cases per year in 2010 to 16 cases in 2020. AHT affects predominantly children aged 0-12 months (72.6%), followed by 13-24 months (17.9%), 25-36 months (3.8%), 37-48 months (3.8%), and 49-60 months (1.9%). Victims were characterized by a predominance of crying infants (23.6%), past history of abuse (13.2%), a child's chronic disease and disability (7.6%), and prematurity (2.8%). CONCLUSION: Different training and educational programs need to be performed to raise awareness of AHT. Enacting the pediatrician's mandatory reporting law will improve the rate of reporting cases.

Readiness assessment for implementation of a large scale child maltreatment prevention program in Qatar.

BACKGROUND AND OBJECTIVES: Child maltreatment is a worldwide problem, with lifelong consequences for the survivors. The focus is shifting from Child Maltreatment Protection to Child Maltreatment Prevention. The objective of this descriptive study was to assess readiness for child maltreatment among stakeholders before implementation of large-scale prevention programs in Qatar. METHODS: The study involved structured interviews with 45 representatives of various stakeholders in sectors of national and local entities of Qatar. A survey was conducted among these stakeholders, to explore their perception and level of awareness of child maltreatment in Qatar. All of them responded, with a response rate of 100%. A multidimensional tool, developed by WHO and collaborators from several middle and low-income countries, was used to assess ten dimensions of readiness. RESULTS: Child maltreatment prevention readiness in Qatar is low with a total score of 37.8 on a scale of 0-100. The respondents scored high (≥ 5) in knowledge of child maltreatment (5.3), legislation, mandates and policies (6.8) and informal social resources (non-institutional) (5.6). Participants, however, scored low (≤ 5) in their knowledge about current program implementation and evaluation (1.1), human and technical resources (1.7), institutional resources and links (2.3), material resources (2.8), scientific data on child maltreatment prevention (3.1), attitude towards child maltreatment prevention (4.3) and will to address the problem (4.8). CONCLUSION: Child maltreatment prevention readiness in Qatar is low and requires improvement in some of the areas. It highlighted the need for capacity building among organizations across Qatar for a large scale CMP program to be successfully implemented.

Child maltreatment prevention readiness in Bahrain.

BACKGROUND AND OBJECTIVES: Child maltreatment (CM) is a major public health problem worldwide. Despite the well-documented cases of all forms of CM and the improvement of the national response to CM in Bahrain, efforts on the prevention of CM are still limited. The objective of this study was to assess the readiness to implement a national evidence-based CM prevention (CMP) program in Bahrain. METHODS: The cross-sectional study was conducted with 45 key informants who had influence and decision-making power over CMP. RESULTS: The overall score indicated low to moderate readiness. The key informants scored the highest on legislation, mandates, and policies (7.9), which was followed by the knowledge of CM prevention (7.2), institutional resources and links (5.2), and informal social resources (noninstitutional) (5.2). However, the lowest scores were the human and technical resources (1.2), attitudes toward CM prevention (3.3), will to address the problem, and material resources (3.8), current programs implementation and evaluation, and scientific data on CM prevention (4.5). CONCLUSION: This research has identified strengths and gaps in the country that needs to be addressed to develop programs that are responsive to the needs of the community. The development of a comprehensive well-resourced CMP program requires the collaborative efforts of legislators, political leaders, and professionals.

Child mortality in Saudi Arabia: Time for action at all levels.

BACKGROUND AND OBJECTIVES: Although child mortality is declining in Saudi Arabia, new trends and causes are emerging. The objective of the study is to determine the causes of child death in a tertiary care hospital in Saudi Arabia and to identify its preventable causes and associated risk factors. METHODS: A modified UNICEF Multiple Indicator Cluster Survey (MICS) was used to analyze all deaths among children under the age of 18 which occurred at the King Abdullah Specialized Children's Hospital (KASCH) between 2010 and 2016. RESULTS: After reviewing all the death charts of 1138 children, the team determined that 15% (172) of all deaths could have been prevented and the preventability increased with age. Only 2% of the neonates died of preventable causes, while 53% of the children of 6 years of age or older died of preventable causes. The highest percentage of preventable deaths occurred in children aged 13-18 years (39.3%), followed by the age group of 6-12 years (32.4%) and the age group of 29 days to 5 years (13.9%). All 966 (85%) deaths from biological causes were considered to be unpreventable. Among the preventable causes, 142 (82.5%) had injuries and 30 (17.4%) were sudden unexpected infant death (SUID) with no documented autopsy or death scene investigation, and thus it was considered preventable by the researchers. The 5 major causes of deaths secondary to injuries were motor vehicle accidents (MVA) accounting for 86 deaths (60.6%), followed by drowning accounting for 19 deaths (13.4%), child maltreatment accounting for 13 deaths (9.2%), fire and weapon accounting for 12 deaths (8.5%), and finally home accident (fall, poisoning, suffocation) accounting for 12 deaths (8.5%). CONCLUSION: The State Child Death Reviews Board should thoroughly investigate deaths due to SUID and injuries by identifying the factors that contribute to the implementation of preventive strategies.

Using trauma registry data to guide injury prevention program activities.

BACKGROUND: Injury prevention programs should be based on objective injury data. This study demonstrates how local injury data can be used to help guide injury prevention programs. METHODS: We reviewed trauma registry data (2004-2006) from a Level I pediatric trauma center. Data included demographic information, anatomic location of injury, mechanism of injury, safety device utilization, Injury Severity Score (ISS), and temporal and geographic variables. The Injury Prevention Priority Score for each mechanism of injury was calculated. RESULTS: There were 1,874 trauma patients. Most admissions were among white males, aged 11 years to 15 years (mean, 7.9 years ± 5.2 years). Most admissions occurred during summertime and on weekend evenings. Blunt injuries (92%) and fractures (56%) predominated (mean ISS, 5.9). A severe ISS >15 was highest among 11 year to 15 year and lowest among patients older than 15 years (p < 0.01). Falls, cut, or pierce, ATV, and off-road motorcycle ranked highest in the Injury Prevention Priority Score. Of the 134 motor vehicle occupants, 52% (n = 70) were restrained in car seats/seat belts. Only 15% of bicyclists, 24% of motorcyclists, and 58% of ATV riders wore helmets. CONCLUSION: A significant percentage of injured children and adolescents were not using proven effective injury prevention devices at the time of their injury. These data identified areas for further study and will help guide community injury prevention programs at our institution.