Monitoring COVID-19 pandemic in Saudi Arabia using SEIRD model parameters with MEWMA.

BACKGROUND: When the COVID-19 pandemic hit Saudi Arabia, decision-makers were confronted with the difficult task of implementing treatment and disease prevention measures. To make effective decisions, officials must monitor several pandemic attributes simultaneously. Such as spreading rate, which is the number of new cases of a disease compared to existing cases; infection rate refers to how many cases have been reported in the entire population, and the recovery rate, which is how effective treatment is and indicates how many people recover from an illness and the mortality rate is how many deaths there are for every 10,000 people. METHODS: Based on a Susceptible, Exposed, Infected, Recovered Death (SEIRD) model, this study presents a method for monitoring changes in the dynamics of a pandemic. This approach uses a Bayesian paradigm for estimating the parameters at each time using a particle Markov chain Monte Carlo (MCMC) method. The MCMC samples are then analyzed using Multivariate Exponentially Weighted Average (MEWMA) profile monitoring technique, which will "signal" if a change in the SEIRD model parameters change. RESULTS: The method is applied to the pre-vaccine COVID-19 data for Saudi Arabia and the MEWMA process shows changes in parameter profiles which correspond to real world events such as government interventions or changes in behaviour. CONCLUSIONS: The method presented here is a tool that researchers and policy makers can use to monitor pandemics in a real time manner.

Sociodemographic predictors of confirmed COVID-19 mortality and hospitalization among patients in Saudi Arabia: Analyzing a national COVID-19 database.

BACKGROUND: Even with the widespread availability of vaccines for the COVID-19 disease, there is no sign of decline in the rate of spread of the disease. Based on findings of different studies across the globe, the disease is characterized by poor outcomes in specific sociodemographic categories such as age, gender and presence of symptoms. METHODS: In this study, we carried out a multivariable logistic regression analysis on a national database (HESN+) of confirmed COVID-19 cases in Saudi Arabia to determine predictors of hospitalization and mortality for these patients. RESULTS: Data was extracted for 328,301 confirmed COVID- 19 patients (mean age (SD) = 37.79 (1.68)) with 34.92% females and 65.08% males. Of these, 59.87% were Saudi Arabian citizens and 40.13% were non-Saudi. 68.91% of cases were discovered in Riyadh (n = 67,384), Makkah (n = 72,590) and the Eastern Province (n = 79,666). 72.2% of all cases were diagnosed and treated by the Ministry of Health (MOH). Of all confirmed cases, 95.28% showed one or more symptoms associated with COVID-19. 5.48% of these were hospitalized and 1.11% died. Predictors of mortality and hospitalization, respectively, included age (OR; 1.088 and 1.03), being male (OR; 1.443 and 1.138), nationality (OR; 2.11 and 1.993), presence of symptoms (OR; 1.816 and 4.386), and the health care sector in which patients received treatment (MOH OR; 1.352 and 4.731). CONCLUSION: We found that COVID-19-related hospitalization or mortality was higher among males, older adults, and patients showing one or more symptoms, and mortality likelihood was more than fourfold for patients treated by the MOH. Immigrants were also more likely to be hospitalized or die from COVID-19 infection compared to Saudi nationals.

Characteristics and outcome of COVID-19 cases in Saudi Arabia: Review of six-months of data (March-August 2020).

BACKGROUND: This study presents the demographic, epidemiological, and clinical characteristics of Coronavirus Disease 2019 (COVID-19) in Saudi Arabia (KSA). It identifies the important predictors of the disease prognosis. METHODS: The study reviewed and analysed a sample of 307,010 confirmed symptomatic COVID-19 cases, between March and August 2020, available in the health electronic surveillance system (HESN) of the Ministry of Health of KSA. Descriptive and univariate analyses were conducted. RESULTS: The overall estimated prevalence of symptomatic COVID-19 cases in KSA between March and August 2020 was 6.1% . The estimated incidence proportion was 879.7 per 100,000 population. The overall case fatality ratio was 2.0%. Males represented 63.9% , with a mean age of 35.1 ± 16.6 years. Young adults (16-39 years) were the most affected ages (53.3%). Fever (90.5%) with a mean body temperature of 37.4 ± 2.0 Celsius, cough (90%), and sore throat (77.4%) were the most prevalent symptoms. A history of contact with a confirmed COVID-19 case was reported in 98.8% of patients.Males (2.1%) and elderly cases aged 65-99 years (25.6%) had the highest association with mortality (p < .001). Among the clinical characteristics investigated, low oxygen saturation (SpO2 ≤ 93%) had the highest association with hospital admission (50.8%) and mortality (19.1%) (p < .001). Cases with cardiovascular diseases (28.6%) and malignancy (28%) demonstrated the highest associations with mortality compared to other underlying diseases (p < .001). CONCLUSIONS: In KSA, the prevalent symptoms of COVID-19 are fever, cough, and sore throat. Makkah and Almadinah regions are significantly associated with highest burden of mortality. The low level of oxygen saturation, high fever, old age, and underlying cardiovascular disease are the most important predictors for prognosis.

Perception of the health surveillance users on the health electronic surveillance network (HESN), Saudi Arabia, 2016.

BACKGROUND: The established aim of the Saudi Health Electronic Surveillance Network (HESN) is to support the prevention and control of different health events, and to facilitate the delivery of other public health programs. This study aims to evaluate the perceptions of active HESN users regarding its general performance through five major components: practicability, design, data and communication, technical support, and general impression. METHODS: A cross-sectional study was conducted in 2016 using a sample of active HESN users. Out of 1535 active users, 700 were randomly selected. A predesigned electronic questionnaire was sent to each participant via email which was completed by 485 participants. Different composite scores were calculated and compared to the sociodemographic and other technical variables. RESULTS: The mean age of the participants was 36.92 ± 9.12 (24-65 years), and 57.8% of the sample were male. Riyadh and the KSA's eastern province represented the highest two regions of participation, at (18.4%) and (14.2%) participants, respectively. About 70.8% were generally satisfied with HESN, while 86.6%% believed that it is better than the traditional paper-work system. Participants who used to work more frequently expressed more level of satisfaction compared to those with minimal use per week or month (P ≤ 0.001). Internet speed displayed a significant association with the general level of satisfaction with HESN (P < 0.001). Additionally, users who accessed HESN with the Google Chrome browser displayed higher levels of satisfaction when compared to users who relied on other browsers (P = 0.003). CONCLUSION: Presently, the level of user satisfaction with HESN is reasonable. However, to achieve optimal outcomes for HESN usage, improvements should be considered.

At-risk marriages after compulsory premarital testing and counseling for ß-thalassemia and sickle cell disease in Saudi Arabia, 2005-2006.

Results from a screening program for sickle cell disease and ß-thalassemia suggest about 90% of couples in Saudi Arabia at risk of having affected children still decide to marry. This study determined the rate of at-risk marriages and identified several factors that may prevent at risk couples from marrying. The marriage status of 934 at-risk couples was determined from original screening program records in the Ministry of Health. Of 934 couples, 824 married (88.2%) and 110 (11.8%) did not. A case-controlled study was conducted on 104 couples who did not marry (cases) and 478 couples who did marry (controls) in order to assess relationships between various cultural and social factors and marriage decisions. In the case-controled study, 28.8% of couples (30/104) who did not marry (cases) knew their disease or carrier status before screening compared to 18% (86/478) of those who married (controls). Reasons couples gave for proceeding with marriage included: wedding plans could not be canceled, and fear of social stigma. Couples who did not marry reported being influenced by prior knowledge of their disease or carrier status and whether they or family members were affected. Approximately half of the cases and controls (n = 270, 46.4%) thought it best to undergo screening before proceeding with the engagement and wedding plans. Most couples received no advice to participate in genetic counseling services. Marriage decisions for the small number who received genetic counseling (n = 168, 27.6%) did not differ significantly from those that received no counseling. Recommendations are made for improving the effectiveness of this screening program.

Premarital screening programmes for haemoglobinopathies, HIV and hepatitis viruses: review and factors affecting their success.

This literature review is a comprehensive summary of premarital (prenuptial) screening programmes for the most prevalent hereditary haemoglobinopathies, namely thalassaemia and sickle cell disease, and the important infections HIV (human immunodeficiency virus) and hepatitis viruses B and C (HBV and HCV). It describes the background to premarital screening programmes and their value in countries where these diseases are endemic. The use of premarital screening worldwide is critically evaluated, including recent experiences in Saudi Arabia, followed by discussion of the outcomes of such programmes. Despite its many benefits, premarital testing is not acceptable in some communities for various legal and religious reasons, and other educational and cultural factors may prevent some married couples following the advice given by counsellors. The success of these programmes therefore depends on adequate religious support, government policy, education and counselling. In contrast to premarital screening for haemoglobinopathies, premarital screening for HIV and the hepatitis viruses is still highly controversial, both in terms of ethics and cost-effectiveness. In wealthy countries, premarital hepatitis and HIV testing could become mandatory if at-risk, high-prevalence populations are clearly identified and all ethical issues are adequately addressed.

Premarital screening for thalassemia and sickle cell disease in Saudi Arabia.

PURPOSE: To estimate the prevalence of sickle cell disorders and beta thalassemia, with their regional distribution, in the adult population screened as part of the Saudi Premarital Screening Program. METHODS: A cross-sectional, population-based study was conducted as part of the National Premarital Screening Program. It covered all the individuals who applied for a marriage license during the years 1425 and 1426 Hijra (February 2004 to January 2005). A network of 123 reception centers in the Ministry of Health facilities and 70 laboratories all over Saudi Arabia was involved in data collection. RESULTS: Of a total of 488,315 individuals screened, 4.20% had sickle cell trait, 0.26% had sickle cell disease, 3.22% had thalassemia trait, and 0.07% had thalassemia disease. Both the diseases were focused mainly in the eastern, western, and southwestern parts of the country. Among the 207,333 couples who were issued certificates for matching, 2.14% were declared high risk. Among the 2,375 high-risk couples contacted by telephone, 89.6% married each other, despite the known high-risk status. CONCLUSION: The results showed excellent access to the target population. However, the program's objective of decreasing high-risk marriages was not as successful, indicating the need for improvement of health education programs for the public, more efforts in counseling high risk couples, and changes in the strategy of timing of screening in relation to marriage.