Public health in the Saudi health system: a search for new guardian

Saudi Arabia has witnessed a significant improvement in its health indicators. The kingdom has spent generously on the curative health services and established hundreds of hospitals and primary health care centers. However, we believe that this huge health expenditures and the presence of curative services is not the only reason for this improvement. Public health services have also had a significant impact on people's health and that this improvement is due to a combination of public health programs such as immunization, environmental sanitation and health education with good formulation of sound health policies and health delivery systems. It is noted that health plans and expenditure in the health system are concentrating on the curative aspects and there is a significant weaknesses in public health services. Additionally, most jobs are allocated for curative care and there is scarcity of job titles related to public health in the health structure, such as public health officers, public health inspectors and public health specialists. A suggested body namely, Ministry of public health, will work to confirm that all issues related to health of the public in every aspect of daily life in the kingdom are within the genuine interest of all policy makers

Developing an integrated organ/system curriculum with community-orientation for a new medical college in Jazan, Saudi Arabia

Jazan province m located in the south-west of the Kingdom of Saudi Arabia, The province is offlicted with a wide spectrum of diseases and therefore have a special need for more health services. The Faculty of Medicine at Jazan has been following the traditional curriculum since its inception in 2001 The traditional curriculum has been criticized because of the students inability to relate what they learned in the basic sciences to medicine, thus stifling their motivation. It was felt that much of what was presented in preclinical courses was irrelevant to what the doctor really needed to know for his practice. The College therefore, decided to change to an integrated curriculum. The study wm conducted in 2004-2005 in the Faculty of Medicine, Jazan University It began with a literature survey/search for relevant information and a series of meetings with experts from various institutions. A Curriculum Committee was formed and a set of guiding principles was prepared to help develop the new curriculum. A standard curriculum writing format was adopted for each module, If was decided that an independent evaluation of the new curriculum was to be done by experts -in medical education before submission for official approval There were several difficulties in the course of designing the curriculum, such as: provision of vertical integration, the lack of preparedness of faculty to teach an integrated curriculum, and .difficulties inherent in setting a truly integrated examination, Curriculum: The program designed is for 6 years and In 3 phases: pre-med [year I], organ/system [years 2 and 3], and clinical clerkship [years 4, 5, and 6], This is to be fallowed by a year of Internship. The pre-med phase aims at improving the students' English language and prepare them for the succeeding phases. The organ/ system phase includes the integrated systems and the introductory modules. The curricidum includes elective modules, early clinical training, behavioral sciences, medical ethics, biostatistics, computer practice, and research methods. The curriculum provides active methods of instruction that include: small group discussion tutorials, problem-based learning [PBL], case-study/ clinical presentations, seminars, skills practice [clinical skill lab], practical demonstration, and .student independent [earning. Methods of evaluating students include continuous and summative assessment. The new curriculum adopted by the Jazan Faculty of Medicine Is an integrated, organ/ system based, community-oriented, with early clinical skills, elective modules, and innovative methods of instructions

Role of magnesium sulphate in treatment of severe persistent pulmonary hypertension of the neoborn

Treatment of severe persistent pulmonary hypertension of the neoborn remains controversial and various modalities of treatment have been tried. This study was performed to evaluate the effect of magnesium sulphate [MgSO4] as a treatment of persistent pulmonary hypertension of the neoborn [PPHN] in full term babies. This study was carried out in the Maternity and Children's Hospital, Jeddah, Kingdom of Saudi Arabia from January 1998 to 2000. A non-randomized study in 8 neoborn babies who where admitted to the Intensive Care Unit and diagnosis of PPHN based on echocardiogram was conducted to assess the efficacy of MgSO4 8% dilution in a loading dose of 200mg/kg followed by a maintenance dose of 20-100mg/kg/hour. No other vasodilators were given, patients were not hyperventilated. The aim was to keep magnesium levels 3.5-5.5mgmmol/l. Seven out of 8 patients showed marked improvement in partial pressure oxygen at 6 hours and maximum improvement at 24 hours. The same improvement noticed in peak inspiratory pressure, and ventilatory time support. Results suggests that MgSO4 may be considered as an alternative treatment in PPHN when no other modalities are available as it is a non aggressive and low cost treatment

Incidence of bronchial asthma in a children hospital, Jeddah

To study epidemiological and management pattern of asthmatic children attending the emergency room of the main children hospital at Jeddah and to determine the relation of temperature changes in the city to the rate of their attendance. A retrospective review of all emergency room records in 2 years. Yearly and monthly rates of acute asthma cases required medical intervention were calculated. Monthly ratios were correlated to mean grades of temperature in the city. A sample of 2504 cases were drawn randomly to reveal factors associated with presentation and management of asthmatic children. A total of 13802 acute asthmatic children presented to the emergency room [7.2% of all emergencies]. Saudis formed 61.2% and males formed 65.5% of asthmatics. Younger ages [< 2 years] showed a significant predominance and family history of bronchial asthma was recorded in 74% of the sample while previous use of prophylactic therapy was very low. Dyspnea was the most frequent presenting symptom followed by cough and wheezing. Most of the cases were managed primarily by nebulized Salbutamol and only 21% required systemic steroid. Months of low temperature grades were strongly associated with more presentation of asthmatics in the emergency room. Asthmatic children are forming a sizable portion of emergency attendances in Jeddah. An inadequate use of standard prophylactic therapies with a subsequent high impact on the utilization of health resources was noted. Efforts are needed by the medical community to adhere to national and international protocols for the diagnosis and management of bronchial asthma and promote the use of prophylactic drugs

Gender differences in the distribution of cardio - vascular risk factors among school children

The occurrence of cardiovascular diseases in adulthood is predicted by factors in childhood and the prevention of the development of these cardiovascular risk factors in childhood is easier than the attempt to reverse the situation in adulthood. Information about these risk factors is scarce in Saudi Arabia. In addition, their distribution among male and female students is not clarified yet. To identify the difference in the distribution of cardiovascular disease risk factors among male and female school children of various ages and to discuss the potentials for future intervention. This study was conducted in the city of Jeddah during the year of 1997. A multi-stage stratified random sampling technique with proportional allocation was used to obtain 4850 students [3443 males and 1407 females] from 51 schools in the three levels of education [primary, intermediate, and secondary]. For all students an interview was conducted, anthropometric and blood pressure measurements were obtained, and for a random sub-sample of 30% of students fasting glucose and total cholesterol on a capillary blood sample were measured. Smoking habit was identified for secondary school students. Medical students of King Abdul-Aziz University in Jeddah were recruited to collect the data of the study. Males constituted 71% [3443 students] while females constituted 29% [1407 students]. For males, the mean age was 14.9 +/- 2.5 years and it was 15.3 +/- 2.4 for females. Body Mass Index and skin Fold Thickness for female students were greater than those for male students. This was true for all ages with minor exceptions at the ages of 17 and 18 years. Among males, the obese students constituted 23.5%, while obese females were 26.8% and the difference in obesity was statistically significant [p<0.05]. In addition, 5.8% of all students were found to have systolic hypertension and that 8.5% had diastolic hypertension. Males had higher systolic hypertension than females and the difference was statistically significant [p < 0.01]. However, the difference in diastolic blood pressure was not significant. More males [70.6%] performed regular physical exercise than females [25.3%], and the difference was statistically significant [p<0.01]. The blood cholesterol for male students was found to be statistically significantly lower than that for females [p < 0.01] and the proportion of female students with hypercholesterolemia [4.3%] was double that for male students [2.1%] and the difference between these proportions was statistically significant [p<0.05]. Hyperglycemia among students - both males and females was only 0.4% and the difference between males and females was not significant Finally. The proportion of smokers [current and ex-smokers] among males [7.2% and 8.7%] were statistically significantly greater than these proportions among females [0.3 and 0.5] [p < 0.01]. Since attitudes and behaviors that influence future health are established during childhood, intervention to prevent cardiovascular diseases should take place in childhood to reduce risk factors. Schools should have a great role to play in the promotion of good health. Differences in the distribution of cardiovascular risk factors among male and female students should be taken in consideration when designing health promotion programs

Stress in Schools: prevalence of hidden psychiatric illnesses among Jeddah school workers

To determine the prevalence and risk factors of hidden psychiatric illnesses [HPI] among Jeddah school teachers and administrators using general health questionnaire [GHQ] Subjects and methods: A sample of 676 workers from 38 randomly selected governmental and private schools filled out an Arabic version of GHQ. Answers were used to divide them into cases of HPI and normals. Personal and work environment factors were asked and analyzed to measure significant differences between cases and non cases and determine risk factors affecting these illnesses. Prevalence of HPI was 38.2% among school workers and association was significant with young ages, female sex and singles. Frequency of somatization of complaints was also high such as headache, body ache and sleeping problems. The study documented a high rate of HPI and discussed underlying factors of stress among school workers in relation to personal factors of workers and the work situation. The findings stressed the importance of social support strategies for those at risk and the need for further research in this occupational stress

Health profile of Balhareth Area in Taif region

To describe demographic, socio-economic, environmental factors and general health status of one of the rural and semi-urban areas around Taif city at the western province of the Kingdom. Methodology: A cross sectional multipurpose survey for 2 weeks composed of household and school surveys using questionnaires, anthropometric measurements and physical and dental examinations. 340 houses and 14 schools were surveyed. A higher percentage of young age population was found. Findings indicated a high illiteracy rate especially among females. Environmental status of the area was not optimum with a need for better services. Maternal data indicated a high fertility rate with high rate of unattended deliveries. Breast feeding was a common practice and children pattern of feeding was satisfactory. School survey revealed a lower weight and height compared to NCHS population and a high rate of dental caries. The area was not underprivileged and did not show specific endemic disease pattern. Improvements in the areas of sanitation, female education and school dental education is recommended based on the findings

Antenatal care and risk assessment in a working primary health care clinic: a critical look

Vistis to antenatal clinics are meant to detect, prevent or manage abnormalities in early pregnancy and prepare mothers for safe deliveries. Risk assessment, using risk scores, is one of the tools used for this purpose. This study describes the working procedure and the services delivered in a working clinic in Jeddah, Saudi Arabia, analyses antenatal visits and describes various aspects of the process of risk assessment. A total of 280 mothers made 1,007 clinic visits in 1991, a mean of 3.6 visits per mother. Attendance for the first visit was relatively late in pregnancy. One-third of all mothers were seen only once or twice in this clinic. Two-thirds of the expected delivery dates were mistaken by a difference of up to 4 weeks. The service lacked many important functions such as nutritional advice and proper health education. Feedback from the hospital was insufficient to judge the effect of risk assessment. Scores used for various pregnancy conditions were criticized for their subjective risk weight with regard to the Arabic pattern of pregnancy and delivery. It is recommended that antenatal care should be restructured according to the available resources of health centres in the community. Clear working protocols for these clinics, a two-way referral system, better training of the service provider and a review of risk scores are some of the recommendations

Standards of forced spirometric tests in normal Saudi males aged 12-16 years

The accurate assessment of various lung functions is basic to the care of children, adolescents and adults exposed to occupational lung hazards, or having asthma. What is required is the availability of standards of normal lung function measurements for those being evaluated. Subjects and Methods: Measurements of commonly performed spirometric lung function tests were evaluated in 404 healthy Saudi children and young adults aged 12-26 years. Data for FVC, FEV 1.0, PEFR, V max50% and V max25% and other flow rate indices support the need for ethnically specific standards of normal and Recommendations: The present study provides normal values for PEFR/FVC and V max50 /FVC and other lung function flow rates. Prediction equations are provided for calculating the standard norm of spirometric tests for the first time in Saudi children and young adults

Factors affecting the use and attidude towards medical resources and educational methods in a Saudi medical school

Medical colleges are using various teaching methods and educational resources in education. In order to explore the attitude of medical students towards these educational methods and resources and the factors playing a major role in their use in a medical school in an Arabic culture, a self answered questionnaire was directed to 283 medical students in their clinical years. Questions on the possible factors which affect the attendance and the use of these education resources were also included. Traditional methods of teaching, lectures, and clinical rounds were found to be the backbone of the educational process in this college. Attendance to lectures was related to both quality of subjects and to the lecturer, emphasizing the importance of a good lecture and lecturer. Clinical bedside teaching was found to be a popular and effective way of teaching medical knowledge, skill, and patient interactions to medical students. The library in this college was the least used resource and student appreciation of its importance was very low. General recommendations are to reduce dependence on lectures gradually in clinical years and to introduce new methods of clinical teaching

Hormones in premenstrual syndrome

Twenty patients with Premenstrual Syndrome [PMS] and eighteen control subjects were studied to determine whether estrogen, progesterone, or prolactin hormone levels are associated with PMS. Blood samples were collected 7-10 days before the menstrual cycle. There was no significant differences between the two groups [P>0.1] indicating the endocrine effect during the luteal phase which do not directly generate the symptoms of PMS

audit of caesarean section among Saudi females in Jeddah, Saudi Arabia

In this study the case records of 1414 patients who delivered at Alshaty hospital within one year were examined and some important variables related to cesarian section cases and their outcome were discussed. The Caesarean section rate was found to be 9.9%. The high number of grand multigravida and primigravida among these Saudi mothers hay, contributed to this high caesarean section rate. The high emergencies in these sections [73.6%] have resulted in higher incidence of maternal and fetal morbidity namely postoperative pyrexia [37%], maternal anemia [20%] and extensive neonatal resuscitation [34%]. The main indications of caesarean section in this hospital were repeated caesarean section [34.3%], failure of progress [19.3%] and fetal distress 12.9% The relation and interaction between the three groups were thoroughly discussed based on the mechanisms of these indications. It is concluded that the changing trend of indications of caesarean section was mostly related to the change' in departmental management rather than change in the characteristics of the patients

Outcomes of twin gestations for one Hijiri year at the main public maternity in Jeddah, Saudi Arabi

Twin pregnancies are considered as one of the high risk pregnancies. The rate of twin gestation counted in this hospital study in Jeddah, Saudi Arabia, is found to be 0.9% or 1 in 110 pregnancies and the perinatal mortality rate for twin gestation was found to be high compared to other hospitals in other countries [172 per 1000 births]. The characteristics of mothers and outcomes in twin pregnancy were described. High gravidity and the presence of previous abortion were associated with increased chances of perinatal deaths. Breech presentations of babies and their low birthweight were accompanied with more perinatal death. There was no sex or order of twin [first or second twin] preference in birth weight or perinatal death. The results confirm the extra risks carried by twin gestation and explore these risks factors in a mixed maternal population in a busy hospital in Jeddah