Providing antenatal services in a primary health care system.

A study sample of 880 women attending the primary health care center in the Al-Baha region of Saudi Arabia was interviewed on their attitudes towards antenatal care services in the primary care setting. Some 91.3% of the women expressed positive views about obtaining the antenatal care in these centers. The major factor influencing their choice was the geographic location of primary health centers which are near to their residence and therefore more convenient for them to patronize. Other factors were the easier access to staff in primary care centers, especially mid-wives and female doctors. There was a significant relationship of age, parity and education with their current antenatal and delivery practices. The women also recommended less than ten antenatal visits before delivery. These findings are relevant to any policy regarding maternity services in the country.

PIP: Attitudes of 880 pregnant women attending prenatal clinics at 75 primary health care centers in Al-Baha region of Saudi Arabia were assessed to determine their opinions on maternity services. The study population was predominately aged 18-30 years (62.3%), and 70% were illiterates. 54% were multiparous, and 40% had delivered at home for their prior pregnancy. 15.8% had experienced previous obstetric complications, and 12% experienced complications during delivery. There were significant correlations between place of previous delivery and age, education, and parity of the mother. Increased level of education was related to a higher proportion experiencing hospital delivery. Low parity women had a higher proportion of hospital deliveries. 92.6% believed that prenatal care was important, and 91.3% desired prenatal care services in primary care centers. 49.9% of women desiring prenatal care in primary care centers gave the reason as closeness to home. 47.2% did not desire delivery at a primary care center because the centers were considered poor facilities which lacked privacy and did not have specialists or female doctors or midwives available. 74.1% considered 5-10 prenatal visits appropriate. 8.6% desired less than 5 visits, and 15.3% recommended 10 or more visits. 81.0% kept prenatal care appointments. 79.5% of the women who missed appointments reporting doing so because their spouse could not accompany them or because of distance to the centers. 70% had previously used prenatal care services at primary care centers; 10.9% rated services as poor. Higher recommendations for prenatal care visits were found among younger mothers and lower parity women. More prenatal visits were also associated with previous delivery at health centers.

Sampling in epidemiological research: a case study of the prevalence of brucellosis in Saudi Arabia.

The superficial description in biomedical journals of sampling methods used in epidemiological studies of the prevalence of some diseases can be attributed to shallow knowledge of basic sampling techniques. The population of interest in most community surveys is usually very large and resources and time available limited, so that researchers have little or no choice but to study a sample of the population. One of the basic principles of sampling is the avoidance of bias, guaranteed by taking a random sample. But the term 'random sample' has often been misinterpreted as synonymous with 'haphazard sample', taking a sample without a definite pattern. It is re-emphasised that a random sample is a probability sample that gives every unit in the population a known probability of being selected in the sample. The procedures for taking a random sample for a nationwide study in the Kingdom of Saudi Arabia are not easy because of the structure of the population, and therefore require more complex sampling methods like the stratified cluster sampling. It is also necessary in a stratified sample to calculate estimated persons affected by a condition for each selected subgroup of the population before obtaining the overall prevalence rate. A proper understanding and use of appropriate sampling techniques is most likely to result in the most desired representative sample, and guarantees that some underlying assumptions for inferential statistics will be satisfied.

Estimates of fertility levels in a rural community of Saudi Arabia.

There is a dearth of information on fertility levels in Saudi Arabia. In the absence of a reliable vital registration system, fertility level can be estimated from sample surveys. The Gompertz relational fertility model has been fitted to parity data on 923 women from a survey in the Al-Baha region. The estimated total fertility rate was 8.4. Education and age at marriage have strong association with the level of fertility. Those who married at early ages had higher parities, whereas women who had more than primary education reported lower parities.

PIP: A systematic sample of 976 breast-feeding women was selected from attendance lists at 75 primary health care centers in rural Al-Baha in the southern region of Saudi Arabia in 1987-88. Fertility levels were obtained as well as current age of mother, total children ever born, duration of marriage, and education of the mother. Total fertility rates (TFR) from mean parities were estimated using the Gompertz relational fertility model, which is described. The results indicate that the average TFR of women aged 15-44 is 8.42 and 8.40 for women 20-40. Mean parity for women 20-24 years is 2.808, 25-29 is 4.136, 30-34 is 5.83, 35-39 is 7.305, and 40-44 is 8.021. In the 1-way analysis of variance, there was a significant decrease in parity with an increase in level of education (p.001), and similarly with increasing age at marriage. The mean number of children for illiterates was 5.42 vs. 2.91 children for postprimary women. The mean number for women 15 at age of marriage was 6.04 vs. 3.54 for those 25 years of age of marriage. Although the data do not reflect a national perspective, this region is well represented. The current TFR is 8.4 is high compared with other African countries e.g., Ghana at 7.1, Tunisia at 7.2, Algeria at 7.1, and Nigeria at 6.9. Overpopulation is not considered a problem in Saudi Arabia.

An appraisal of the utilization of antenatal services in primary health care.

This study was done to evaluate the practice of users of the antenatal care services of the primary health care centers, and correlated our findings with some of the risk factors and the outcome of the pregnancies. The records of 1946 women receivign antenatal care in the primary health care centers in Al-Baha region were reviewed. The majority of the women (58.5%) visited the clinic five times or less, while only 15.2% visited more than eight times. There was no significant association between maternal age and the frequency of visits. There was a statistically significant association between parity, gestational age at first visit, place of delivery, and outcome of the pregnancy on one hand and the number of antenatal visits on the other (P < 0.05). The majority of pregnant women (60.8%) were first seen before the 20th week of gestation. Eight percent delivered in the centers and 16.4% delivered at home. There were significant associations between maternal age, parity, and gestational age at presentation. There was also an association with a previous history of recurrent abortions and intrauterine fetal death. Previous bleeding and cesarean sections showed no significant relationship with maternal age at the time of first population.

A retrospective study of factors affecting breast feeding practices in a rural community of Saudi Arabia.

This study was conducted during 1987-1988 academic year in the rural areas of Tihama Saudi Arabia to assess the average duration of breast feeding and the effect of some factors. A multi-way analysis of variance approach was used to examine the effect of mother's age, parity and education on the duration of breast feeding. The mean duration of breast feeding was 11.2 months +/- and the results of the regression analysis shows all the three maternal variables, age, parity and education to have statistically significant independent effect on the duration of breast feeding. The results showed that 98.3% support breast feeding and 78.9% of the sample were illiterates. These findings are discussed in relation to previous work.

PIP: During 1987-1988, paramedical personnel interviewed 923 women who have attend the primary health care center in the Tiahama Valleys in mountainous southwestern Saudi Arabia to learn how long women breast feed and what factors affect its duration. 78.9% of the women were illiterate as compared to 50% for the total rural population of mothers in Saudi Arabia. 90% had 1 child. 98.35% believed in the importance of breast feeding, yet only 50.7% breast fed their infants. 47.3% mixed fed and 2% bottle fed their infants. 35% began solid foods (cereals, rice, eggs, and vegetables) when the child was 6 months old. Age of the mother had a statistically significant positive effect on the duration of breast feeding (p.05). Indeed mothers 25 years old were more likely to breast feed for 6 months than their older counterparts. Nevertheless these women did have an average duration of breast feeding of 9.3 months whereas the older mothers breast fed an average of 11 months. Parity also significantly affected duration of breast feeding in a positive manner (p.01). For example, 33% of grand multiparous mothers did not breast feed for 6 months compared to 66% of the primigravidas. Education had a significant negative effect (p.01). In fact, 68% of mothers with university level education breast fed for 6 months or less. The average duration of breast feeding stood at 11.2 months (median, 10 months; mode, 12 months) while the average of all rural areas in Saudi Arabia in 1988 stood at 14.2 months. Completion of weaning occurred on average at 11.7 months. Mothers who only bottle fed did so for an average of 11.4 months. These results indicate a need for health care teams to promote breast feeding in this area.

Attitudes of professionals in providing maternity care in a primary health care system in Saudi Arabia.

This study was done on a sample of the primary care centers in the Al-Baha region, Saudi Arabia to assess the opinions of the medical and paramedical staff regarding the capability and acceptability of providing antenatal and intrapartum care in the primary health care setting. The study showed that 96% of all the respondents supported the provision of antenatal care services in primary health care with 60% of them giving the reason that it is more convenient for pregnant women. 90% of the respondents wanted the antenatal care to be delivered through special clinics and the majority of them wanted to give a greater role to the midwives in antenatal care. Questioned about the intranatal care provision in the centers, 98% of all the respondents agreed to the utilization of primary health care in such service. A similar percentage of them claimed to have the ability to do deliveries in the centers with existing facilities. To avoid duplication of care and to best use of available resources, low risk pregnancies should be seen antenatally and delivered in the primary health care centers provided and quality of such care is kept under control.

PIP: This study examined a sample of primary care centers in the Al-Baha region of Saudi Arabia to assess the opinions of the medical and paramedical staff regarding the capability and acceptability of providing antenatal and intrapartum care in the primary healthcare setting. The study showed that 96% of all respondents supported the provision of antenatal care services in primary healthcare with 60% of them claiming it is more convenient for pregnant women. 90% of the respondents wanted antenatal care to be delivered through special clinics and the majority wanted to provide the midwives with a greater role in antenatal care. When questioned about the intranatal care provision within the centers, 98% of all respondents agreed to utilization of primary healthcare in such service. A similar % claimed to have the ability to deliver babies in the centers with existing facilities. To avoid duplication of care and to utilize existing resources as best as possible, low-risk pregnancies should be seen antenatally and delivered in primary healthcare centers provided the quality of care is closely monitored.

Prescribing patterns in primary healthcare in Saudi Arabia.

A systematic sampling of prescriptions from primary care centers in the Al-Baha region of Saudi Arabia was analyzed to determine the patterns of drug prescribing and the compliance of practicing physicians in these centers with the essential drug list issued by the Ministry of Health. The average number of drugs per prescription was 2.3 +/- 0.7 of which 86.5 percent of the prescriptions contained two to three drugs. In 53.7 percent of the prescriptions no duration for treatment was specific and 96.5 percent of the prescriptions did not indicate drug strength. The study showed that analgesics and vitamins were the two most common classes of drug prescriptions in the centers and that 18.6 percent of prescribed drugs were not from the allowed list of drugs. The causes of polypharmacy and noncompliance with the limited list are discussed with emphasis on the essential drug list as a method of rationalizing prescribing in primary healthcare.

Depression of phagocytic activity of the immune system following traditional cautery in experimental animals.

Traditional cautery, which is practiced widely in Saudi Arabia and some other countries, has not been exposed to detailed scientific investigation. In an attempt to elucidate some of its physiological aspects, we assessed the effect of cautery on a normal animal's nonspecific immune system. Male Wistar rats and guinea pigs were cauterized to simulate traditional cautery in size and percentage of cauterized area. Using radioactive sulfur colloid uptake and clearance, the effect of cautery on the mononuclear phagocyte system was evaluated in rats. The respiratory burst in peripheral polymorphonuclear leukocytes (PMNs) after cautery was measured in the guinea pigs using the chemiluminescence technique. The results showed marked reduction in the intravascular clearance of the colloid with prolonged clearance time following cautery. In addition, the liver uptake of the colloid was reduced in cauterized animals compared with control animals and the white cell count was also significantly reduced. The study showed marked inhibition of phagocytic function in guinea pigs in both whole blood and isolated PMNs. These results indicate that traditional cautery reduces the physiological function of the phagocyctic system in normal experimental animals. The influence of traditional cautery on infected animals deserved further investigation.