Morbidity profile among older people at primary health care centers in Saudi Arabia during the period 2012-2020.

OBJECTIVES: To evaluate the morbidity profile and explore the geriatric giants, health problems, and their risk factors among old people in the older people health clinics at primary health care centers (PHCCs) in Saudi Arabia. METHODS: This is a record-based descriptive cross-sectional study. Data was collected between 2012-2020 using the health data of older people to whom comprehensive geriatric assessment (CGA) was carried out at 1,481 PHCCs in Saudi Arabia. Data included sociodemographic and health related characteristics, medications, results of CGA, complete clinical examination, and laboratory results. Assessment was carried out for diabetes, hypertension, obesity, underweight, vision and hearing impairments, depression, memory and cognitive impairment, risk of falls, urine incontinence, bronchial asthma, and anemia. RESULTS: A total of 193,715 older people were screened. A high prevalence of diabetes (55.4%), hypertension (49.1%), diabetes and hypertension co-morbidity (26.8%), and obesity (22.2%) were found. The overall prevalence of anemia was 4.7% and asthma 8.9%. The prevalence of positive screening for depression was 5.9%, 2.9% for memory and cognitive impairment, 6.3% for urine incontinence, and 4.0% for risk of fall. The prevalence of vision impairment was 20.6%, hearing impairments was 12.6%, and for underweight it was 5.4%. There was high prevalence of risk factors like smoking (8.5%), and polypharmacy (25.3%). Health regions varied widely in prevalence of the studied health conditions. CONCLUSION: The study findings highlight the importance of CGA in early detection of geriatric giants, health problems, and associated risk factors among Saudi older people.

Evaluation of older people health passport implementation at primary health care centers in Saudi Arabia.

OBJECTIVES: To evaluate the efficacy of older people health passport's use by older people and health workers in primary health care centers (PHCCs) in 5 regions of Kingdom of Saudi Arabia (KSA). METHODS: A quasi-experimental pre-post study was conducted to evaluate the health knowledge, attitudes and practices before and after the use of older people health passport. A cross-sectional study on the use of passport was carried out among older people and their healthcare staff (doctors, nurses, and health educators) in selected PHCCs in 5 regions (Al-Ahsa, Jazan, Qassim, Asir, and the Northern Borders) in KSA from August 2019 to February 2020. RESULTS: Statistically significant improvement (p<0.001) in mean total score for health knowledge, attitude and practice post-utilization of health passport was found. The relationship between knowledge and practice post-passport use is stronger as compared to before use. More than half of older people (66.5%) reported using the health passport during the past 3 months when a medical service was required, 66.7% used it regularly and 81.2% were motivated to continue using it. Among the healthcare workers, statistically significant difference (p=0.039) was reported between the groups with regard to the use of health passport saving time and effort with more health educators (86.5%) in agreement. CONCLUSION: Health passport use improved the health knowledge, attitude, and practice among the older people. Participant's impression regarding its use was positive since majority reported a favorable experience.

Assessing the cognitive status of older adults attending primary healthcare centers in Saudi Arabia using the Mini-Mental State Examination.

OBJECTIVES:  To assess the cognitive status of older adults in Saudi Arabia. METHODS:  This was a cross-sectional, multistage, stratified study of older individuals (≥60 years of age) attending primary healthcare centres in Riyadh, Saudi Arabia between January 2015 and April 2017. We collected data using a structured questionnaire, which incorporated questions regarding demographic and anthropometric variables, the Arabic version of Mini-Mental State Examination, the Mini-Nutritional Assessment tool, and the Modified Katz Index of Independence in activities of daily living. RESULTS:  Of the 1299 participants, 914 (70.4%) were male, with a mean age of 66.2 ± 5.9 years. Approximately 79.1% of the participants had intact cognitive function, 17.1 had mild cognitive impairment, and 3.8% had severe cognitive impairment. Impaired cognitive function was associated with increased age, female gender, low education, unmarried status, and unemployed (p less than 0.001). Reduced cognitive impairment was significantly associated with functional impairment and malnutrition (p less than 0.001). CONCLUSION:  Cognitive impairment affected around 21% of the participants. The reduced cognitive function was associated with increased age, female gender, low education level, unmarried, low income, dependency on others, functional impairment, and malnutrition. Such information could motivate health-policy makers to introduce appropriate measures to improve older adults' existing healthcare services in primary care, including cognitive function assessment.

Normative Data for Handgrip Strength in Saudi Older Adults Visiting Primary Health Care Centers.

Background and objective: Handgrip strength (HGS) plays a vital role as a predictor of adverse health outcomes. Several studies have established HGS norms by age, sex, hand, occupation, culture or disability in different countries and for children in Saudi Arabia. However, standardized values for Saudi older adults have not yet been reported. Therefore, the current study was aimed to establish normative data for HGS in Saudi older adults visiting primary health care centers (PHCCs). Material and Method: In this descriptive cross-sectional study, HGS in kilograms was measured using a hydraulic hand dynamometer in Saudi older adults (n = 2045) aged ≥60 years visiting 15 PHCCs selected randomly from the five geographical regions of Riyadh, Saudi Arabia between January 2015 and April 2017. The average mean from three successive trials, standard deviations, and 95% confidence intervals presented for the left and right hands of men and women in six age groups (60-64, 65-69, 70-74, 75-79, 80-84, and 85+ years). The analyses were performed using the ANOVA test for all the age groups and to determine whether any differences exist between them. Results: The average mean HGS was significantly (p < 0.0001) differ by the left and right hands of men and women in six age groups. Conclusions: The current study presents specific norms for HGS in Saudi older adults by age, sex, and hand. Further studies are required to examine the utility of these norms for prediction of morbidity and mortality in this population.

Evaluation of health care services provided for older adults in primary health care centers and its internal environment. A step towards age-friendly health centers.

OBJECTIVES: To evaluate the health care services provided for older adults by primary health care centers (PHCCs) in Riyadh, Kingdom of Saudi Arabia (KSA), and the ease of use of these centers by older adults. METHODS: Between October 2013 and January 2014, we conducted a descriptive cross-sectional study of 15 randomly selected PHCCs in Riyadh City, KSA. The evaluation focused on basic indicators of clinical services offered and factors indicative of the ease of use of the centers by older adults. Evaluations were based upon the age-friendly PHCCs toolkit of the World Health Organization. RESULTS: Coverage of basic health assessments (such as blood pressure, diabetes, and blood cholesterol) was generally good. However, fewer than half of the PHCCs offered annual comprehensive screening for the common age-related conditions. There was no screening for cancer. Counseling on improving lifestyle was provided by most centers. However, there was no standard protocol for counseling. Coverage of common vaccinations was poor. The layout of most PHCCs and their signage were good, except for lack of Braille signage. There may be issues of access of older adults to PHCCs through lack of public transport, limited parking opportunities, the presence of steps, ramps, and internal stairs, and the lack of handrails. CONCLUSIONS: Clinical services and the internal environment of PHCCs can be improved. The data will be useful for health-policy makers to improve PHCCs to be more age-friendly.

Clinical growth charts for pre-school children.

OBJECTIVE: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.

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

OBJECTIVE: 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). METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Breastfeeding practice among women attending primary health centers in riyadh.

OBJECTIVES: (1) To study the patterns of breastfeeding of last children, duration, factors and reasons for it. (2) To study the factors affecting breastfeeding among mothers who are breastfeeding and the reasons for continuing or failure to continue, at the primary health care centers (PHC) in Riyadh. METHOD: A cross-sectional study was conducted by distributing 1000 questionnaires in 10 PHC centers. The breastfeeding practices were categorized on WHO terms. RESULTS: Most of the studied last children (95.1%) were breastfed. Exclusive breastfeeding rate from birth was 62.9%, for up to four months was 13.2% and for six months was 3.3% . The mixed breastfeeding rate from birth was 32.2%, up to age of four months was 53.1% and for children more than six months old it was 20.3%. The mean age of the introduction of solid food was 4.6 ±1.4 months. Artificial feeding rate was 4.9% at birth , 30.3% up to four months and 49.7% for children more than six months old. The most frequent reason for the continuation of breastfeeding was Quranic instruction (55.1%) and its failure was inadequate milk (60.8%). The exclusive breastfeeding and the duration of breastfeeding had statistically significant association with the mothers' residence, marital status, number of children alive, occupation and the level of education. In addition, there was significant association of exclusive breastfeeding and the non-introduction of artificial feeding at the hospital but not with health education on breastfeeding at the centers . RECOMMENDATIONS: To promote the education of mothers on breastfeeding, promote the training of PHC center health professionals and modify the policy of hospitals in the Kingdom on the feeding of newborns.