Factors affecting child mortality in Saudi Arabia

To estimate levels and trends, gender differentials, effect of modes of living, regional differentials, and the effect of parental educational on infant and child mortality. A nationwide stratified random sample was used to estimate levels, trends and differentials of infant and child mortality in Saudi Arabia. The study was executed during the period February 2006 to June 2006 and covered all the 20 health regions of Saudi Arabia. The randomly selected sample was limited to ever married Saudi women in the reproductive age group [15-49 years]. The findings show a continuous and considerable infant and child mortality decline during the 1994-2004 period. The infant mortality rate has decline from 22 per 1000 live births in 1994 to 17 per 1000 live births in 2004; while the child mortality rate has declined from 34 to 22 per 1000 live births in the same period. There is a strong relation between infant and child mortality and the mode of living and parental education. The study proves the continuous decline of infant and child mortality during the study period and affirms the effect of parental education on these indicators

HIV / AIDS epidemic features and trends in Sudi Arabia

More than 60 million persons have been infected since AIDS was described in 1981. By the end of 2003, an estimated 40 million individuals were living with HIV globally. The surveillance of HIV/AIDS still faces challenges in Saudi Arabia. This study describes the pattern and characteristics of HIV/AIDS cases in Saudi Arabia. This descriptive analytic study describes the reported HIV/AIDS data for all notifiable cases during the period 1984 to 2003 in the Kingdom of Saudi Arabia. Case definitions based on ELISA and Western Blot tests were used. Age, sex and regional distribution were studied in addition to survival rates. As of 2003, 1743 Saudi nationals and 6064 non-Saudi HIV cases were reported. Among Saudis, 872 were AIDS cases. Males accounted for 1329 HIV infections, comprising 77%, with a male-to-female ratio of about 3:1. Adults 15-49 years constituted 78% of cases, including 46% of cases infected through sexual activity, while 33% of reported HIV seropositive cases had already died. Most cases [67%] were registered in Jeddah, Riyadh and Dammam. Infection through blood transfusion declined with no reported cases since 2001. The number of reported HIV infections in KSA has increased in the last few years. Using the coverage rate estimating method, the number of Saudi HIV infections since the emergence of the epidemic was estimated to be 2640 cases as of the beginning of the year 2004. The estimated number of HIV infections is almost one and one-half times the reported number, indicating that a problem of underreporting of HIV/AIDS cases still exists

Measles in Saudi Arabia: from control to elimination

This article describes the tremendous efforts made in the field of measles immunization in Saudi Arabia in the past 20 years, from the control phase to the elimination phase. Mandatory measles vaccination with one-dose Schwartz vaccine was introduced in 1982 by a royal decree, a step aimed at increasing vaccine coverage. In 1991, a two-dose schedule was implemented using Edmonston-Zagreb measles vaccine, with a first dose at 6 months to protect children younger than 9 months and a second dose of MMR at 12 months of age to protect those who did not respond to the first dose. A marked reduction in the epidemic peak and a shift of infection to older age were noticed. But the same data showed that 50% of measles cases in the 1- to 4-year age group occurred in vaccinated children. In 1998, with the start of elimination phase, an MMR campaign was launched in two phases, targeting school children in 1998 [secondary schools] and in 2000 [primary and intermediate schools]. Evaluation of the MMR campaign and surveillance data was reflected in the measles immunization policy by shifting the age of measles immunization to 12 months and to preschool using the two-dose MMR schedule

Serosurvey of measles, mumps and rubella antibodies in Saudi children

A serosurvey study to evaluate the proportion of children with antibodies against diseases targeted by the Expanded Program of Immunization in the Kingdom of Saudi Arabia. Using multistage sampling techniques, we collected samples and sent them for laboratory assay from the following age groups; 100 samples at 6 months, 12 months, 18 months, 6 years, 13 years, and 17 years. We conducted the study from September 2001 to February 2002. We assayed sera for measles, rubella, and mumps antibodies in the measles-mumps-rubella reference laboratory in Germany, using enzyme immunoassay and plaque neutralization [PN] as a backup test for equivocal and negative samples. We only carried out a backup test for measles samples. The age group of 6 months had the highest proportion with negative measles antibodies. After adding the backup test [PN], the proportions of children with protective measles antibody were; 64% at 6 months, 87% at 12 months, 91% at 18 months, 75% at 6 years, 96% at 13 years, and 98% at 17 years. Rubella antibody positivity rates [>7 IU] were 28% at 6 months, 49% at 12 months, 97% at 18 months, 98% at 6 years, and 100% at 13 years. While positivity rates in mumps were 14% at 6 months, 29% at 12 months, 59% at 18 months, 64% at 6 years, and 75% at 13 years. The unexpected low proportion of children with protective level at 6 years, despite being vaccinated with 2 measle doses is an important phenomenon. This reflects the interference between the first and the second measles dose. The Ministry of Health decided to conduct a catch up campaign targeting 1st through 3rd grade primary schools, who did not catch the mass campaign conducted in 2000. Also, this supports the decision taken by the ministry to change the measles immunization schedule to MMR at 12 months and a second dose at 6 years of age

Impact of health education on knowledge and attitudes of Saudi paramedical students toward HIV/AIDS

To assess the impact of health education on the knowledge and attitudes of paramedical students in Saudi Arabia toward HIV/AIDS. We carried out an interventional study on a sample selected from students of health institutes and health colleges in Saudi Arabia during the calendar year 2002-2003. The intervention shows a positive effect on students' knowledge regarding means of transmission of HIV and means of protection from HIV/AIDS. Furthermore, it has a positive impact on students' attitudes toward accepting discussion of AIDS topics with others, acceptance of home care for HIV infected family member and acceptance of HIV-infected individual's right at work. Preference of confidentiality was also significantly increased after intervention. Health education intervention has a positive impact on students' knowledge and attitudes towards HIV/AIDS and we recommend a nationwide health education program on HIV/AIDS

Disease burden and case management of bacterial meningitis among children under 5 years of age in Saudi Arabia

This study was designed to explore the case management and disease burden of bacterial meningitis among children below the age of 5 years in the Kingdom of Saudi Arabia. A prospective descriptive study was conducted during June 1999 through to May 2001 in 8 hospitals from 5 cities in different areas of the country. Those were, King Fahad Specialist Hospital and Maternity and Children Hospital, Buraidah, Belgorashi General Hospital and King Fahad Specialist Hospital, Al-Baha, Maternity and Children Hospital and Ohud Hospital, Al-Madina, Al-Qatif General Hospital in the Eastern Region and Prince Abdulrahman Bin Ahmed Alsudairy Central Hospital, Sakaka. The study population was 171,818 children under the age of 5 years. During the study period 208 cases of bacterial meningitis were identified, 141 [67.8%] with a definite causative organism: Hemophilus influenzae type b, Neisseria meningitidis, Streptococcus pneumoniae and other bacterial species. The remaining 67 cases [32%] were labeled as aseptic meningitis. A considerable proportion of cases was found to have received an antibiotic prior to presentation. While symptoms such as fever or poor feeding were common among cases, meningeal signs were less prominent. A lumbar puncture was carried out on all cases to reach diagnosis by gram stain, latex agglutination test and cerebrospinal fluid [CSF] and blood cultures following standard procedures. The immediate burden of meningitis cases was found to be the lengthy stay of patients in the hospital wards and intensive care units. Some of the main causative agents were resistant to the conventional antimicrobial therapy, but susceptible to newer antibiotics. The study being based on a population based surveillance gave a better overview on causative organisms of meningitis emphasizing that Gram stain, serology of CSF and culture [of CSF and blood] should be used. A high index of suspicion is needed to diagnose meningitis in children. Lumbar tap should be encouraged and supported in terms of training and more authorization to apply in diagnostic tests of such conditions. Audiometric measurement is a crucial need in the assessment of meningitis cases and in the process of their follow up. This type of service is clearly missing in our system. Influential steps are to be planned to avail this service

Changes in epidemiological pattern of meningococcal disease in Saudi Arabia. Does it constitute a new challenge for prevention and control?

Meningococcal meningitis epidemics, which occurred in the Kingdom of Saudi Arabia [KSA] coincided with Hajj and Umra seasons; the 2 major pilgrims to Muslims. In many countries, the disease showed major changes of its epidemiological determinants, in particular to age and prevailing serogroup. This study was conducted to determine the epidemiological trend of meningococcal meningitis disease in KSA. All confirmed meningococcal meningitis cases reported in KSA during the period from January 1999 to December 2002 were studied retrospectively. Confirmation of cases was based on isolation of the causative organism from cerebrospinal fluid [CSF] or blood culture or detection of antigen in the CSF. Personal, clinical and laboratory results were analyzed using Epi info version 6 software. Categorical data were tested using X2 test. A total of 729 cases were reported, 304 cases [42%] were among people coming from abroad for Hajj or Umra and 425 [58%] were among local population. Nearly half of the later [48%] were reported at the 2 holy areas of Makkah and Madinah, KSA. Thirty-nine% of cases were children aged <2 years and 58% were <5 years of age. Proportion of cases affected with serogroup W135 increased over time [up to 95%] and significantly affected children aged <5 years [p<0.001]. Continuous monitoring of epidemiological determinants is essential to guide vaccination policy

Clinical growth charts for pre-school children

Growth standards are indicators for normal growth of the children and growth charts are important tools for their growth monitoring. Children from different populations are different in their growth pattern, it is important to create national standards for the growth of children in each population to develop local growth charts, and since these were not available in the Kingdom of Saudi Arabia [KSA], the aim of this study was to construct national growth standards and to develop growth charts for 0-5-years Saudi children. A cross-sectional study following World Health Organization [WHO] criteria in determining sample size was adopted, where by 24000 children from 5 regions in the KSA were selected during the period 1992 to 1995 to be the desired sample. One hundred and two Primary Health Care centers [PHCCs] were selected randomly from the 5 regions, from where the sample was drawn, and a special questionnaire was designed. Weight, height and head circumference were measured by standard procedures. The total number of children examined was 23821 [11913 boys and 11908 girls]. Saudi [0-5-years] boys weight and height for age measurements were significantly different from girls. The same difference was found between urban and rural boys and girls and between boys and girls from the different regions of the country [p<0.05]. These national standards derived from this study were used to develop national growth charts that are currently utilized to monitor growth in all Saudi health institutes

Disease burden and case management of bacterial meningitis among children under 5 years of age in Saudi Arabia

This study was designed to explore the case management and disease burden of bacterial meningitis among children below the age of 5 years in the Kingdom of Saudi Arabia. A prospective descriptive study was conducted during June 1999 through to May 2001 in 8 hospitals from 5 cities in different areas of the country. Those were, King Fahad Specialist Hospital and Maternity and Children Hospital, Buraidah, Belgorashi General Hospital and King Fahad Specialist Hospital, Al-Baha, Maternity and Children Hospital and Ohud Hospital, Al-Madina, Al-Qatif General Hospital in the Eastern Region and Prince Abdulrahman Bin Ahmed Alsudairy Central Hospital, Sakaka. The study population was 171,818 children under the age of 5 years. During the study period 208 cases of bacterial meningitis were identified, 141 [67.8%] with a definite causative organism: Hemophilus influenzae type b, Neisseria meningitidis, Streptococcus pneumoniae and other bacterial species. The remaining 67 cases [32%] were labeled as aseptic meningitis. A considerable proportion of cases was found to have received an antibiotic prior to presentation. While symptoms such as fever or poor feeding were common among cases, meningeal signs were less prominent. A lumbar puncture was carried out on all cases to reach diagnosis by gram stain, latex agglutination test and cerebrospinal fluid [CSF] and blood cultures following standard procedures. The immediate burden of meningitis cases was found to be the lengthy stay of patients in the hospital wards and intensive care units. Some of the main causative agents were resistant to the conventional antimicrobial therapy, but susceptible to newer antibiotics. The study being based on a population based surveillance gave a better overview on causative organisms of meningitis emphasizing that Gram stain, serology of CSF and culture [of CSF and blood] should be used. A high index of suspicion is needed to diagnose meningitis in children. Lumbar tap should be encouraged and supported in terms of training and more authorization to apply in diagnostic tests of such conditions. Audiometric measurement is a crucial need in the assessment of meningitis cases and in the process of their follow up. This type of service is clearly missing in our system. Influential steps are to be planned to avail this service

Comparison of the growth standards between Saudi and American children aged 0-5 years

To compare the national growth monitoring data with the National Centre for Health Statistics [NCHS] growth standards, which is currently used in the Kingdom of Saudi Arabia [KSA]. A cross sectional study following World Health Organization criteria in determining sample size was adopted, whereby 24,000 children from 5 regions were selected to be the desired sample. One hundred and two Primary Health Care centers were also selected randomly from the 5 regions, from where the sample was drawn. A special questionnaire was designed for the data collection. A pilot study was carried out to test the study instruments. Weight, height and head circumference were measured by standard procedures. This data was compared with the National Centre for Health Statistics [NCHS] data. The total number of children examined was 23,821, 11,913 boys and 11,908 girls, they were drawn from 102 health centers selected randomly. Comparing different percentiles for Saudi and NCHS data, there was a significant difference between the Saudi and American children. In order to ensure a correct follow up for our children in KSA, the national figures are more appropriate to follow than the NCHS data

use of FDA oral polio formula in vaccinating Saudi children

To evaluate the immunogenicity of USA [FDA] Oral polio vaccine versus WHO Oral polio vaccine. Open randomized trial where 210 children were randomized into three groups. First group received Hemophilus influenza type b [Hib] vaccine plus WHO DTP and OPV. The second group received Hib plus FDA DTP and OPV. The third group received WHO DTP and OPV without Hib vaccine. 3 doses were given at 6 weeks, 3 months and 5 months. Blood samples were collected at 6 months of age. Bar coded sera were used to assess for polio antibody for the three poliovirus types using microneutralization assay. The result of polio assay will be presented in this paper. Proportion of children with detectable antibody [titre =/> 1/8] polioviruses were higher in the group vaccinated with the FDA OPV formula but no significant difference was found for our sample size. FDA oral polio is not superior to WHO OPV at our sample size and there is an improvement in the seroresponse to WHO OPV compared to previous survey

Immunogenicity study for tetra and penta component vaccines in infants

A randomized controlled trial to evaluate the immunogenicity of combined Hemophilus Influenzae type b with DTP +/- injectable polio vaccine and the immunogenicity of giving one injectable polio vaccine combined with the first of 3 doses of oral polio vaccine. After parental consent, infants were randomized into 4 groups to receive the following vaccines; First group: Single Hemophilus Influenzae type b vaccine [PRP-T, Act-HIB[registered] in addition to DPT and oral polio vaccine. Second group: Combined [PRP-T+DTP] TETRAct-HIB[registered] and oral polio vaccine. Third group: First dose is combined [PRP-T+DPT+injectable polio vaccine] PENTAct-HIB[registered] and oral polio vaccine. Then, the 2nd and 3rd dose is TETRAct-HIB[registered] and oral polio vaccine. Fourth group: DPT and oral polio vaccine only [Control group]. Vaccines were given at 6 weeks, 3 months and 5 months. Blood samples were collected from all children, one month after the 3rd dose at the age of 6 months. Samples were sent for laboratory assay for anti-PRP, Diphtheria anti-toxin, Tetanus anti-toxin, polio antibody type 1, 2 and 3 and pertussis Agglutinins. Single Hemophilus Influenzae type b vaccine produced a higher anti-PRP level [15 ug ml[-1]] compared to combined Hemophilus Influenzae type b vaccine, [9.5 ug ml[-1]] in the second group and [11 ug ml[-1]] in the 3rd group but without significant level. It was found that 90% of non-vaccinated children in our sample are lacking the protective level against Hemophilus Influenzae type b diseases. Giving injectable polio vaccine with oral polio vaccine in the first of 3 doses did not affect the level of polio antibody for the 3 poliovirus types but positivity after the 3 polio doses increased compared to previous studies. In the 4 groups, 100% of the children achieved the protective level against Pertussis, Tetanus and 95% for Diphtheria. No significant negative interaction was found between vaccine antigens used in the study. Combined vaccines are effective methods to include Hemophilus Influenzae type b and injectable polio vaccine in the Extended Program of Immunization without unacceptable decrease in immunogenicity of each component

Augmenting hospital support of maternal and child health care, Saudi Arabia

This paper describes the Saudi maternal and child health training programme [1988-1997] to augment hospital support of health centres. Maternal and child health trainer/trainee manuals were prepared, then implemented through 4-day trainers workshops and 2week trainee courses. Mid-term evaluation and follow-up demonstrated reasonable coverage and quality of training. Improved integration of care was reflected by a trainers attitude questionnaire and a trainees interview/observation questionnaire. To date, 589 trainers have been trained, three-quarters of them from hospitals. They in turn have trained about 7658 trainees, 93% of target. The programme is ongoing with continuous updating of content

Determinants of under-five mortality in Saudi Arabia

The study objectives were to find out factors associated with infant and child mortality in Saudi Arabia using the 1987 Saudi National Child Health Survey data. This survey was conducted taking a stratified sample of over 8,400 ever married/divorced/widowed women having at least one under-five child from over 9,000 households. Interviews were conducted by 120 trained nurses. Over 13,300 children were included in the study. The infant mortality rate [IMR] and child mortality rate [CMR] for the year 1985 were 55 and 63 for males and 50 and 58 for females. The rates were higher for rural and southern regions and lower for urban and eastern. The mean number of deceased children increased with an increase in mother's age and the number of children previously born. The rate of child loss also increased with increase in parity. Reproductive behaviors, such as high rates of consanguineous marriage, lower rates of antenatal, natal, postnatal checkup, institutional delivery and diarrhea care were associated with higher rates of IMR and CMR. Multivariate analysis confirmed the effect of parents' education and father's occupation, as well as source of drinking water and place of defecation on IMR and CMR. Regional as well as literacy factors are amongst the important differentials affecting infant and child mortality in Saudi Arabia

Changing marriage age and cosanguineous marriage in Saudi females

Current marital age and consanguinity are not precisely known in Saudi Arabia. Saudi National Child Health Survey data were used to examine marital age, consanguinity, status and outcome of marriage of Saudi females. The survey [1987-88] involved interviewing 8482 ever-married urban and rural females by 120 female nurses. The results showed that 16% of young females and about 1% of young males were married before age 20. The rate of first marriage of females under 15 years of age decreased from 33% 20 years earlier to only 3.6% recently. The highest of 90% of females [35 to 39 years] and 98% of males [50 to 54 years] were currently married. Widowhood increased from 8% in the age group 40 to 44 to nearly 54% in those 70 and over. Over all, nearly 0.5% of males and 3.4% of females remained widowed and 0.2% of males and 1.2% of females divorced. Thirty-four percent of all marriages were to first cousins in urban areas and 41% in rural areas. Thirty percent of marriages among literate groups and 39% in illiterate groups were consanguineous. Further research is needed to examine the causes and effects of [1] intercousin and [2] delayed marriage of females and [3] the welfare status of widowed and divorced females and their children

preliminary report on the effect of referral system in four areas of the kingdom of Saudi Arabia

The effect of implementation of the referral system in health care was studied in four administrative regions of the Kingdom of Saudi Arabia. The study covered the six-month period before and after the implementation of the system. These regions represented the northern, southern, eastern, and central parts of the country. The western region was not included because it was late to implement the system. The study concentrated on the changes that took place in the workload and types of patient problems in hospitals and primary health care centers. The study covered Majma, Dammam Central, Hail General, and Abu Arish hospitals and the 107 health centers attached to them. The size of the hospitals at the time of implementing the referral system was considered during the design of the study. The referral rate was found to range from 3.2 to 4.2%. The number of patients attending the hospital outpatient departments decreased from 43.7% to 65%, but the "number of patients attending the accidents/emergency departments increased from 1 to 129.7%. The consultations at the health centers increased from 2.5 to 35.2%. More severe conditions were managed at hospital outpatient departments, while less severe cases were screened and managed at the health care center level. The average duration of stay in all the hospitals remained approximately the same, except for Abu Arish Hospital where it declined by 50%. The bed occupancy rates showed a slight decrease in Dammam and Majma and increase in Hail and Abu Arish. The study suggested certain steps that are necessary to sustain improvement in the referral system