Nutritional status, dietary practices and biochemical parameters of hemodialysis patients in Riyadh

Malnutrition is an evident problem in 40-50% of patients with end-stage renal disease [ESRD]. The aim of the present study was to assess the nutritional status and dietary practices of maintenance hemodialysis patients at Prince Salman Center for Kidney Diseases in Riyadh [PSCKD]. A cross-sectional study was conducted in [PSCKD] for 120 hemodialysis patients who agreed to participate in the study. Malnutrition score was used to quantify the degree of malnutrition. Two parameters from anthropometric and clinical manifestation data were used. Dietary practice score was measured the data showed that 79.2% of cases had normal nutritional status, while only 6.7% had moderate malnutritional status. Only 18.3% of them had good dietary practices while 65% had fair level. In patients with normal nutritional status, the body mass index [BMI] [29.57 +/- 10.34 vs. 17.19 +/- 1.80], mean weight [70.38 +/- 15.98 vs. 48.04 +/- 9.66], dry weight [68.537 +/- 15.55 vs. 46.188 +/- 7.93], mean albumin [35.50 +/- 3.63 vs. 35.07 +/- 4.06] and low density cholesterol [1.94 +/- 1.10 vs 1.25 +/- 0.52] were significantly higher than in moderately malnourished patients. In patients with normal nutritional status, the mean body height [154.67 +/- 9.47vs. 162.63 +/- 9.87], mean urea level [64.16 +/- 18.65 vs. 67.14 +/- 22.90] and mean creatinine level [750.94 +/- 271 vs. 926.63 +/- 358.79] were significantly lower than in moderately malnourished patients. Patient age, marital status were significant predictors for nutritional status. Patients aged >/= 50 years had 8 times the chance to develop malnutrition compared to those < 50 years. Single patients had 11 times the chance of getting malnutrition compared to married. These differences were statistically significant. [OR=8.213, 11.158, P=0.014, 0.011] respectively. Patient and nutrition education must be employed to hemodialysis for recommended dietary needs and for follow up of biochemical parameters

Physicians' therapeutic practice and compliance of diabetic patients attending rural primary health care units in Alexandria

The objectives of the study were to investigate physician's therapeutic practice and the compliance of diabetic patients attending rural primary health units in Alexandria. A cross-sectional study was conducted and a multistage stratified random sample method was used for the selection of 600 diabetic patients. Data were collected by means of an interviewing questionnaire, an observation checklist, review of prescriptions and laboratory investigations. A scoring system was made for a diabetic patient's knowledge and skills, patient's compliance, doctor-patient relationship, and glycemic control. About 57% always took their medication as prescribed by doctor and on time, only 2.2% always complied with dietary regimen while no one reported regular compliance with exercise regimen. Complications of the regimen was the commonest cause [63.3%] of noncompliance. A highly statistically significant difference was found between compliance with all regimens and patient's knowledge of diabetes. The scores for doctor-patient relationship were all unsatisfactory. Results of glycosylated hemoglobin [HbAlc] revealed that metabolic control of four-fifth of the patients was satisfactory, 12% had fair and 8% had poor metabolic control. Patient's compliance with most of the diabetes regimen was low. Doctor-patient relationship and patient's compliance should be improved by conducting educational and training programs

Impact of peridontitis education program on peridontitis patients` knowledge, beliefs, and behavior in Riyadh city

An intervention experimental study was conducted to assess the impact of Peridontitis education program [PEP] for Peridontitis patients in King Abdel Aziz University Hospital [KAAUH] in Riyadh City. The program was administered to 103 patients through one session and one immediate assessment. Another 103 patients formed the control group. The results showed that the mean knowledge score, the mean scores of the perceived seriousness [p. seriousness], p. benefits, and p. barriers of intervention group were significantly higher than the control group. Stepwise multiple regression models revealed that total knowledge, perceived benefits, patients' work, and family size were predictors of patients' practice of control group [beta=0.287, 0.218, 0194,and 0.192]. Total knowledge, patients' work and total health beliefs model [HBM] score were predictors of patients' practice of the intervention group [R[2]=0.303]. The study recommended the replication of such program and a more long term one to have more improvement in patients' knowledge, all beliefs, and practice

Preparatory pupils smoking behavior in Alexandria

The present study was conducted to assess pupil's knowledge, behavior about smoking. Their beliefs, attitude and intention were assessed based on the principals of theory of planned behavior [TPB]. A questionnaire was developed by the researchers and completed by 400 first grade preparatory school pupils [200 males, 200 females] from the west zone of Alexandria Governorate. It was found that 44.5% of females had satisfactory level of knowledge compared to 0.0% of males. It was noticed 92.7% of them had positive attitude toward non-smoking with higher percentage among females. It was observed that 71.5% of them had high general subjective norm with higher percentages among males. It was revealed that 88% of them had high-perceived behavioral control with higher percentages among females. It was demonstrated 88.5% of them had high intention not to smoke with higher percentage among females. The results revealed that 2.5% of the pupils are current smokers with higher percentages among males [3%]. Behavioral control [beta=0.176] and attitude toward non-smoking [beta=0.06] were the predictors of intention not to smoke. Knowledge [beta=2.302], indirect attitude toward non-smoking, intention not to smoke [beta=-1.225], behavioral control and general subjective norms were the predictors of smoking behavior. As part of NGOs to control smoking, this research was adopted by Social Welfare Association-Karmouz-Alexandria

Intension not to abuse drug among preparatory school pupils in Alexandria

The present study was conducted to assess pupil's knowledge about drug abuse. Their beliefs, attitude and intention were assessed based on the principals of theory of planned behavior [TPB]. A questionnaire was developed by the researchers and completed by 516 first grade preparatory school pupils from the west zone of Alexandria Governorate, 252 males and 264 females. The present study demonstrates that only 2.5% of females had satisfactory level of knowledge compared to 0.0% of males. The majority of them [88.7%] had positive attitude, while only 29.7% of them had positive indirect attitude toward not to abuse drug. The majority of them [86%] had high general subjective norm, while 52.5% of them had high normative beliefs. About two fifths of them [40.3%] had high-perceived behavioral control. More than three quarters of them [79.1%] had high intention not to abuse drug with higher percentage among females. Stepwise linear regression model reveals that knowledge, attitude toward not to abuse drug, socioeconomic level, normative beliefs and behavioral control were the predictors of intention not to abuse drug. These predictors contributed to explain 24.3% of the variation of intention not to abuse drug. As a part of the aim of NGOs to control drug abuse, this research was adopted by Social Welfare Association-Karmouz-Alexandria

Impact evaluation of nutrition education intervention for an elementary school in Riyadh city

An experimental study was conducted to assess the impact and suitability of nutritional education intervention [NEI] for the 5th and 6th graders at a girls' elementary school in Riyadh city. The NEI was launched in four classes through two sessions and two assessments with two months apart. The results show that at 1st assessment, the mean knowledge score of 6th grade intervention class was significantly higher than the control [t=13.986, p<0.001]. This score increased among all classes after the 2nd boostering session. The mean dietary self-efficacy [SE] score of the 5th grade control class and 6th grade intervention class at 1st assessment were significantly lower than their comparable classes. Three classes had a significant increase of SE score after the 2nd boostering session. The mean practice score at 1st assessment was inconsistent between intervention and control classes with higher scores among the 5th graders than the 6th graders. Only one class of the 6th graders showed increased mean practice score after the 2nd boostering session. Stepwise linear regression models revealed that exposure to NEI sessions was a major predictor of students' knowledge at 1st assessment [R[2] 345] and knowledge was a predictor of SE and practices scores [R[2].041 and .136]. SE was a predictor of students' dietary practices at both assessments [R[2].= 107 and 0.162]. The study recommends the replication of such a program among diverse school population to have more improvement in students' dietary knowledge, SE and practices

intervention study for prevention of HCV infection in some hemodialysis units in Alexandria

This study was conducted aiming to compare between strict adherence to the universal precautions and anti HCV seropositive patients isolation as a preventive measure. To fulfill this aim, 80 anti HCV seronegative patients and 44 staff members working in three hemodialysis units were included in the study. A predesigned questionnaire was filled for all patients that included history of hepatitis risk factors, which are related, or not to dialysis process. Another questionnaire was filled for all medical and paramedical staff in the studied units, which included their knowledge, attitude and practice [KAP] as regard HCV. Pretest was done, followed by health education program [HEP]. A post test was performed after one month and every 6 months for 18 months. An observational sheet was filled by one of the researchers to describe the hemodialysis units environment and to record the practice of the staff in the studied units. Blood samples were collected from the study subjects at baseline, every 3 months for patients and every 6 months for the staff. Sera were separated and tested for anti HCV seropositivity using enzyme linked immunosorbent assay [ELISA] test third generation. Marked increase in staff's knowledge was evident one month after HEP and decreased gradually throughout the follow up period. The attitude was slightly elevated and remained nearly unchanged throughout the follow up. Only in unit A the mean preventive score was markedly increased 6 months after HEP and remained high throughout the follow up period. The incidence rate of anti HCV seroconversion decreased in unit A from [10% to 0%], where universal precautions was applied, and in unit C from [24.4% to 10%], where isolation of anti seropositive patients was done in the first and third 6 months of the follow up period respectively. It increased in unit B, where no measure was taken, from 10.5% to 16.7%

Health education program for mothers of children suffering from iron deficiency anemia in United Arab Emirates

The present study was designed to assess knowledge, beliefs and practices of mothers regarding factors leading to iron deficiency anemia among children, to develop a health education [HE] program according to the needs of the target group, to determine the effect of the program in terms of changes in mothers' knowledge, practices and beliefs using Health Belief Model [HBM], and to determine the hemoglobin and hematocrite levels of the children of the target group before and after the program. The sample size was 200 anemic children aged 6-24 months and their mothers, 100 of them were randomly assigned to face to face intervention program [experimental group] [I], the other 100 were the control group [II]. Only 16% of mothers of group I and 18% of mothers of group II got satisfactory level of knowledge. After the conduction of HE program, the mothers' knowledge was significantly increased among group I, while almost there was no change of the knowledge's level among group II. Only 7% of mothers of group I and 27% of those of group II had high perceived severity. Only 8% of mothers of group I and 14% of those of group II had low perceived barriers. After the program, 58% of mothers in group I got low perceived barriers. Only 28% of mothers of group I and 21% of those of group II had good dietary practice. After the program, 74% of mothers in group I showed good dietary practice. There were highly significant increases in the levels of hemoglobin and hematocrite of children of group I after the program, while the increases were not significant in group II

Part I: prevalence and some associated factors of childhood injuries in Alexandria

Unintentional injuries are a significant source of morbidity and mortality in Egypt. The present work was designed to determine the reported prevalence of injuries among children aged less than 6 years and some contributing epidemiological factors related to injuries. Accordingly, a cross-sectional study design was conducted at randomly selected MCH centers from the six administrative districts of Alexandria, yielding 311 mothers who were selected using the proportional allocation method. A predesigned questionnaire included: sociodemographic data and history of injuries among children aged less than 6 years during 12 months preceding the study. If injuries occurred, mothers were inquired about age, sex, birth order of the child, place, time, and cause of injury, in addition to place of treatment and the end result of injury. Items to assess mothers knowledge and practices related to childhood injuries were also inquired. Analysis of results revealed that the reported prevalence of childhood injuries was found to be 20.9%, with a male predominance in a ratio of 1.6:1. The highest prevalence [44.3%] of injuries occurred among the first child of the family. The majority of injuries occurred at home [72.7%], during day time [64.8%] and complete recovery was occurred [77.2%]. The highest prevalence of injuries was among children from West district [46.7%]. The most common causes of injuries were falls, cut wounds and burns [62.5%, 10.2% and 8.0% respectively]. After controlling for confoundings, using Stepwise Multiple Logistic Regression, injuries were significantly associated with decreased mean mothers' practice score [regarding childhood injuries] and increased number of children in the family [OR = 2.039; 95% C.I = 1.17-3.54 and 2.062; 95% C.I. = 1.12-3.79 respectively]. A major system for data collection and accident analysis should be established especially for children

Part II: mothers' knowledge and practices about childhood injuries in Alexandria

The protection of children from injury ultimately depends on the action of adults. Knowledge of risks of childhood injury does not ensure that parents will adequately protect their children, but such knowledge has been shown to be an essential precursor of changes in behavior. The present work was designed to assess mothers' knowledge and practices related to unintentional injuries among their children. A cross sectional study design was conducted at six randomly selected MCH centers from the six administrative districts of Alexandria. The total number of mothers was 311 selected using the proportional allocation method. A pre-designed questionnaire included: sociodemographic data, 29 items to assess mothers' knowledge [23 items close ended and 6 items open ended], 29 items to assess mothers' practices related to injuries' risk factors and prevention in addition to items about mothers' opinion. The results demonstrated that 88% of mothers were knowledgeable about indoor risk factors, just above half [53.0%] recognized the family as a risk factor. More than one-fourth [28.9%] of mothers had a satisfactory level of knowledge, 58.9% had fair level and 12.2% had a poor level. Preventive outdoor safety practices were reported by the majority of mothers [85.2%]. Only 16.8% of mothers had good level of practice, 64.6% had average level and 18.7% had poor level. Stepwise Multiple Linear Regression revealed that mothers' educational level and age at birth of the first child were significant predictors of their knowledge about childhood injuries. As regards mothers' practices, only mothers' knowledge was the predictor of their practice towards injury prevention. Injury prevention training programs targeting parents focusing on increasing awareness of the scope of the problem and helping to build positive attitudes and behaviors related to childhood injuries are recommended

Knowledge, perceptions and practices of mothers regarding care of preschool children's teeth [Part I]

Early childhood caries is of epidemic proportions in many developing countries. A recent study, done in Alexandria, showed that more than half the children in age group 2-5 years had caries. The present study was designed to assess preschool children preventive dental practices and factors affecting these practices. Accordingly, a cross- sectional study was carried out at two MCH centers affiliated to the Directorate of Health Affaires in Alexandria. From each MCH center 100 mothers of preschool children were selected randomly to form a total of 200. A pre-designed questionnaire included: socio-demographic data and items to assess mothers' knowledge, perceptions and practices related to childhood dental caries. Analysis of results revealed that only 39.5% of mothers indicated that brushing of children teeth should start as early as 2 years and only 41.1% of them mentioned that the child should use tooth brush three times daily. Only 8.5% of mothers attained good knowledge score regarding childhood dental caries while about one third of them had poor knowledge. About two fifths of the mothers were not practicing tooth brushing for their children. Only one third of them used to brush their children teeth more than once daily. Two thirds of the mothers never took their children for dental check up. More than two thirds of them [69%] mentioned that their children consume excess sweets, 42% of them mentioned that their children eat vegetables and fruit more than once daily. After controlling for confounding, using Stepwise Multiple Logistic Regression, tooth brushing was significantly associated with higher mothers' perception of benefit of brushing, increased child age, higher mothers' perception of seriousness of dental caries and higher mothers' perception of barrier that the child still young [OR = 6.7, 5.9, 3.5, 4.2, P<0.01 respectively]. Also dental check up was significantly associated with higher mothers' perception of benefit of check up, increased mothers' educational level, increased mothers' knowledge score [regarding childhood dental caries], higher mothers' perception of benefit of treatment and their higher perception seriousness of dental caries [OR = 4.9, 3.2, 6.6, 2.4, 2.1 respectively]. Health education program should be done especially for mothers of preschool children to improve their knowledge, perceptions and practices regarding childhood dental caries

Perception of genital prolapse: a hospital-based study in Alexandria [Part II]

Genital prolapse is a common health problem, understanding women's perceptions and beliefs may illuminate our understanding of their health seeking behavior which form a first step in any effort to improve their health. The present study was designed to investigate the perception of genital prolapse among women attending the outpatient clinic in El-Shatby Maternity University Hospital in Alexandria. Data was collected from a sample of 291 women who had any form of genital prolapse. Women's knowledge about risk factors for genital prolapse, women's beliefs related to genital prolapse as well as their beliefs about assistance at delivery [beliefs were assessed through the Health Belief Model] were measured for women who knew that they were suffering of genital prolapse [n=40]. The results revealed that more than two thirds of cases [70.4%] had poor [36.4%] or fair knowledge [34%] and only 29.6% had satisfactory knowledge. The majority of women having positive perception to diagnosis and symptoms for genital prolapse had high perception of [susceptibility] to and [severity] of complications of genital prolapse [97.5%and 85% respectively].More than two thirds [67.5%] had high scores of [perceived benefits] of treatment and medical advice, while nearly one third [32.5%] scored moderate. The majority of women [82.5%] had either moderate scores [55%] or high scores [27.5%] of perceived barriers to compliance to medical instructions or recommended surgery. About two thirds of cases [65.6%] sought medical care later than one year of perception of symptoms. Women's knowledge and degree of genital prolapse were directly related to women's report of symptoms characteristic of prolapse, while the level of education was inversely related. Health education for women on different aspects of reproduction using appropriate materials is highly recommended