Prescribing patterns at primary health care level in the Asir region, Saudi Arabia: an epidemiologic study.

Out of 208 primary health care centres (PHCCs) in the Asir region, southwestern Saudi Arabia, a stratified random sample of 23 PHCCs was randomly chosen. Data regarding all the medical consultations (66,438) provided by all PHCCs physicians (49) and their prescriptions were collected to study prescribing patterns. The data were collected from the health information system of the PHCCs without the physicians' knowledge. The study showed that more than two-thirds of medical consultations (71.5%, 47,494) ended by prescribing medications. The average number of drug items prescribed for the individual patient was 1.44. The leading missing items in the studied prescriptions were, for how long should medication be taken (32.9%), the patient's name (15.8%) and the family health record number (6.5%). Prescribing drugs by generic name is very minimal among physicians (2.9%). The groups of drugs commonly prescribed were analgesics-antipyretics (61.9%), antibiotics (56.2%), cough medications (26.6%) and vitamins (22.7%). The observed defects identify fields to be addressed in continuing medical education programmes aimed at encouraging more rational prescribing among PHC physicians.

Impact of chlorination of water in domestic storage tanks on childhood diarrhoea: a community trial in the rural areas of Saudi Arabia.

During the period September 1991 to February 1992 standard chlorination packages of calcium hypochloride were provided for the first time to 171 families residing in the catchment area of the Sabt-Bany Bishr Primary Health Care Centre in the rural areas of the Asir region, south-western Saudi Arabia. The villagers added the packages to their home storage water tanks each time they added water from the 220 nearby wells. Analysis of the water samples taken from these wells showed that all of them were bacteriologically unfit for human use. By the end of the study period there were no bacteriologically unfit water samples taken from the tanks of the participating families. Children under 5 years of age whose families were not using chlorinated water had twice the risk of diarrhoea compared to children from the participating families (odds ratio = 1.98, P = 0.047). The use of chlorinated water was associated with a 48% reduction in diarrhoea. These results indicate that the chlorination of water can be successfully carried out locally in rural areas to improve the health of the population.

Teenage pregnancy: are teenagers a high risk group?

OBJECTIVES: To study health profile of pregnant teenagers and their pattern of utilization of primary health care services in comparison with pregnant women aged 20-35 years in Abha, Saudi Arabia. STUDY DESIGN: A cohort of 1938 Saudi pregnant women (214 teenagers less than 20 years and 1724 aged 20-35 years) was selected by stratified random sampling technique. They were screened for anemia and hypertension using WHO criteria and followed until delivery to observe the method of delivery. RESULTS: The prevalence of anemia (9.6% and 12.0%, respectively) and hypertension (1.1% and 3.5%, respectively) was not significantly different among primigravida of both age groups. The same trend was observed among multigravida. Follow-up showed that the rate of abnormal deliveries among primigravida of both groups was not significantly different, and even lower among multigravida teenagers. Pregnant women in both groups had similar average prenatal visits (6.6 +/- 1.1 and 6.7 +/- 1.2 respectively, P < 0.05) and the majority contacted the primary health care center early in pregnancy (87.4% and 88.9%, respectively, P < 0.05). CONCLUSION: These results indicate that pregnant teenagers are not a high risk group if good prenatal care is provided.

PIP: Teenage pregnancy has been shown to be associated with an increase in obstetric complications. In particular, gestation associated hypertension and anemia were found more frequently among these young women. The authors screened 1938 pregnant Saudi women for anemia and hypertension using WHO criteria and followed them until delivery to observe the method of delivery in the study of whether or not pregnant women younger than 20 years old are at greater risk of obstetric complications than pregnant women aged 20-35 years. The women were selected by stratified random sampling technique from Abha, Saudi Arabia. 214 were younger than 20 years old, while the rest were aged 20-35. Among primigravida pregnant women younger than 20 years old, 9.6% were anemic and 1.1% suffered hypertension. Among primigravida pregnant women aged 20-35 years old, 12.0% were anemic and 3.5% suffered hypertension. These differences in rates between age groups are not significant. The same trend was observed for multigravida women. Furthermore, the rate of abnormal deliveries among primigravida of both groups was not significantly different, and even lower among multigravida teens. Pregnant women in both age groups made, on average, 6.6-6.8 prenatal visits, while 87.4% and 88.9%, respectively, contacted the primary health care center early in pregnancy. It may be concluded from these findings that pregnant teens do not constitute a high-risk group if good prenatal care is provided.

Knowledge and attitudes towards AIDS among primary health care physicians in the Asir Region, Saudi Arabia.

STUDY OBJECTIVES: To assess the knowledge and attitudes towards AIDS among practicing physicians in the Asir Region, Saudi Arabia. DESIGN AND PARTICIPANTS: A survey was carried out among primary health care (PHC) physicians working in the 238 PHC centers in the region. Self administered questionnaires were distributed to the 361 physicians working in these centers. Three hundred and twenty-eight responded (90.1%) and were included in the study. Non-respondents were found not to differ significantly from respondents with regards to sex, age and qualifications. MAIN RESULTS: The study revealed several gaps in their knowledge regarding AIDS. Of particular concern are those who are to be considered at high risk and models of transmission of the disease. CONCLUSIONS: These results indicate an urgent need to develop AIDS specific continuing medical education program to deal with erroneous ideas to convey the message properly to the public.

PIP: Although acquired immunodeficiency syndrome (AIDS) has not yet emerged as a major public health problem in Saudi Arabia, a survey of primary health care physicians in the Asir Region revealed serious gaps in knowledge among those are central to AIDS prevention and control. Analyzed were questionnaires completed by 328 physicians from 118 urban and 210 rural primary health care centers in 1993 in this southwestern region of the country. 74% of physicians were male; their mean age was 36.5 years. Although 82.9% agreed that AIDS is a global health problem, only 6.7% felt it was of concern to Saudi Arabians. 19.5% acknowledged having extremely limited knowledge about AIDS, and 97.2% were interested in professional education on this topic. Not only did many physicians have misinformation about modes of transmission (e.g., 13.8% identified mosquito bites and 49.7% implicated casual kissing), 33.8% were unaware that tatooing is a known mode of transmission. Also inadequate was knowledge of groups at risk of human immunodeficiency virus (HIV); infants of HIV-infected women, those with multiple sex partners, patients with repeated blood transfusions, drug addicts, and homosexuals were identified by only 7.9%, 43.0%, 43.1%, 66.1%, and 63.7% of physicians, respectively. 7.9% thought that vaccines against HIV were available and 11% claimed AIDS was curable. None of the physicians had treated a person with AIDS and only 5.2% reported any personal contact with an AIDS victim. On the other hand, 89% were aware of the signs and symptoms of AIDS. 49% of physicians felt AIDS patients should be isolated; only 25.1% favored home-based care.

Continuing medical education needs regarding AIDS among Egyptian physicians in Alexandria, Egypt and in the Asir Region, Saudi Arabia.

A study was carried out on two groups of Egyptian physicians to assess their continuing medical education (CME) needs regarding AIDS. The first group comprised 330 physicians working in Alexandria, Egypt, in Mother and Child Health Care Units, School Health Units and Health Offices. The second group included 144 physicians working in Primary Health Care Centres in the Asir Region, southwestern Saudi Arabia. The demographic and socio-cultural background of both groups was similar. The results revealed similar deficiencies in their knowledge about the disease, especially modes of transmission. These results indicate the urgent need to develop an AIDS-specific CME programme to deal with erroneous ideas. Lectures and periodicals ranked first as the preferred educational strategy.

PIP: Control of the AIDS epidemic depends upon preventing HIV infection through education, information, and the curtailment or avoidance of known risk behaviors. Physicians are in an uniquely good position to provide the information and education needed to help limit the spread of HIV, with several studies having demonstrated the ability of physician counseling to promote health behaviors among patients. The curricula of faculties of medicine in Egypt, however, were only recently changed to include AIDS. It is clear that the overwhelming majority of physicians in Egypt graduated and have specialized without formal education about the disease. Continuing medical education (CME) programs are provided to physicians in Egypt and other Gulf countries. To plan for such programs, however, the extent of the knowledge and needs among physicians must be determined. This paper reports findings from an assessment of the AIDS education needs of two groups of physicians. One group was comprised of 330 physicians working in Alexandria, Egypt, in maternal-child healthcare units, school health units, and health offices. The second group included 144 physicians working in primary health care centers in the Asir Region of southwestern Saudi Arabia. The demographic and sociocultural background of both groups was similar; respondents were of mean age 36 years and approximately 65% were male. Similar deficiencies were found in their knowledge about AIDS, especially modes of transmission. 20% of the physicians considered themselves to have only minimal knowledge about AIDS and 97% of both groups were very interested to learn more about the disease. 8.2% and 13.2%, respectively, believed that a cure exists for AIDS, while 5.5% and 6.9%, respectively, thought that vaccines are available against the disease. Only 16.7% and 11.8% of physicians, respectively, recommended keeping identified cases of AIDS in the community, with the remainder endorsing confining people with AIDS to hospitals or elsewhere in isolation. These results highlight the urgent need to develop an AIDS-specific CME program for medical practitioners in Egypt and Saudi Arabia. 62.5% of the physicians preferred to receive CME from lecturers, 50.3% from books and periodicals, 44.8% in conferences, and 42.1% in workshops.

Anemia among pregnant women in the Asir region, Saudi Arabia: an epidemiologic study.

A cross sectional study was conducted during August 1992, on a representative sample of 6,539 pregnant women attending 69 primary health care centers in the Asir region, southwestern Saudi Arabia for the assessment of their hemoglobin level. The overall prevalence of anemia (Hb < 11 g/dl) was found to be 31.9%. It was found that the prevalence was affected by age (37.3% among those who were less than 20 years old), parity (34.9% among those who had 7 and more deliveries), inter-pregnancy spacing (35.2% among those whose birth spacing was less than 1 year), gestational age, and education (35.1% among illiterates). Health education programs at primary health care level in the region should be revised to stress the importance of balanced diet, compliance with iron medication and sufficient spacing between subsequent pregnancies.

Altitude and socio-biological determinants of pregnancy-associated hypertension.

OBJECTIVES: To study the prevalence of gestation-associated hypertension and to determine the effect of altitude and related socio-biological factors. METHODS: A stratified random sample of 3988 pregnant women living at high altitude and 2744 at sea level in the Asir region, Saudi Arabia was interviewed for socio-biological conditions and examined for blood pressure, proteinuria and body mass. RESULTS: An overall prevalence of 2.4% was found. Certain groups of pregnant women are at high risk of developing hypertension. They include women who are over 40 years, high multipara, having short inter-pregnancy spacing, are overweight, are illiterate and those living at high altitude. Multivariate analysis showed that high altitude is a strong risk factor (adjusted odds ratio (OR), 1.879; 95% confidence interval (CI), 1.123-2.819) and cannot be masked when other variables are controlled. CONCLUSIONS: Special health education and more frequent screening programs at primary health care level should be given to pregnant women living at high altitude.

Referral system in the Asir Region, Saudi Arabia: knowledge, attitude, and practice of physicians working in urban areas--a comparative study of governmental and private health sectors.

A comparative study of knowledge, attitude and practice regarding referral system was undertaken among all governmental primary health care and private dispensary physicians (56 and 50 respectively) in Abha and Kamis, Asir Region. Results show that knowledge about referral is adequate in both groups, but the attitudes and practice of both groups need to be positively modified specially among the private sector physicians. The paper recommends more orientation programs for both groups of physicians and urges the private sector physicians to be more involved in Ministry of Health training programs and activities. Cooperation in referral between the private sector and government hospitals is seen as one way of improving health care in Saudi Arabia.

Continuing medical education in primary health care in Saudi Arabia: an epidemiologic study of physicians' needs in the Asir region.

A cross sectional survey was carried out among doctors working in all the 238 Primary Health Care Centers in the Asir Region, Southwestern Saudi Arabia using self administered questionnaire. The response rate was 90.1%. The highly needed aspects of clinical practice include emergency skills (82.3%), diagnostic skills (74.4%) and management of common diseases (65.2%). Aspects that rated low include physical examination techniques, prescription skills, history taking and referral. Areas in medicine that rated high on the doctors' list of needs include critical care (60.7%), obstetrics and gynecology (52.7%) and family and community medicine (52.8%). The most highly preferred means of fulfilling these needs include clinical rounds (73.2%), consultation with specialists (69.8%) and regular lectures (62.5%). The objective of establishing baseline data which are essential for future continuing medical education (CME) planning in the Asir region was achieved in this study. Based on the doctors needs, it was recommended that regional CME units be established and related organizations and institutions that will jointly plan a program of CME be identified.

Hypertension in Asir region, southwestern Saudi Arabia: an epidemiologic study.

A population study was carried out to determine the prevalence of hypertension among Saudis at primary health care level in the Asir region, Southwestern Saudi Arabia. All primary health care centers (PHCCs) were visited (238 PHCCs). Data were collected in relation to the updated Saudi population census for 1991. Chronic case registries were revised to identify existing cases of hypertension by age and sex till the end of 1991. Results showed that the prevalence of hypertension amounted to 2.4% among Saudis aged 45 years and more. Males and females aged 45 years and more living at high altitude had a significantly higher risk of developing hypertension (p < 0.05) compared to those living at sea level.