Factors associated with the spread of dengue fever in Jeddah Governorate, Saudi Arabia.

Dengue fever resurged sharply in Jeddah in 2004 and rose to 1308 cases in 2006. This case-control study determined factors potentiating the spread of the disease to provide an epidemiological baseline to help dengue control. All (650) suspected cases of dengue in Jeddah in 2007 were eligible for inclusion. Cases were those confirmed with dengue by laboratory investigations (n = 244) and controls those confirmed negative (n = 406). Of these, 129 cases and 240 controls could be contacted and were included in the study. Variables found significant in the bivariate analysis were included in a logistic regression analysis. The presence of stagnant water in indoor drainage holes (OR = 4.9), indoor larvae (OR = 2.2), nearby construction sites (OR = 2.2), and older age (OR = 1.2) were independent determinants of dengue infection (P<0.01 for all). Face-to-face health education significantly decreased the risk of dengue infection. Efforts are needed to control the modifiable factors identified in this study with emphasis on health education.

Factors associated with the spread of dengue fever in Jeddah Governorate, Saudi Arabia

Dengue fever resurged sharply in Jeddah in 2004 and rose to 1308 cases in 2006. This case-control study determined factors potentiating the spread of the disease to provide an epidemiological baseline to help dengue control. All [650] suspected cases of dengue in Jeddah in 2007 were eligible for inclusion. Cases were those confirmed with dengue by laboratory investigations [n = 244] and controls those confirmed negative [n = 406]. Of these, 129 cases and 240 controls could be contacted and were included in the study. Variables found significant in the bivariate analysis were included in a logistic regression analysis. The presence of stagnant water in indoor drainage holes [OR = 4.9], indoor larvae [OR = 2.2], nearby construction sites [OR = 2.2], and older age [OR = 1.2] were independent determinants of dengue infection [P< 0.01 for all]. Face-to-face health education significantly decreased the risk of dengue infection. Efforts are needed to control the modifiable factors identified in this study with emphasis on health education

Population-based survey of childhood disability in eastern Jeddah using the ten questions tool.

PURPOSE: To identify the prevalence of handicapping disabilities among children up to 15 years of age and their epidemiological pattern in the eastern part of Jeddah. METHODS: In a population-based cross-sectional household survey in the eastern Jeddah area, Saudi Arabia, a multistage sampling method was applied to screen children in 875 houses using the ten questions survey tool for identification of disabilities. Further information collected for detected disabilities included possible risk factors, cause of the disability as perceived by the family and services previously provided to the child. RESULTS: A total of 137 cases of disability were detected giving a point prevalence rate of 36.7 per 1,000 children. Twenty-nine children (21.2%) were discovered for the first time during the survey. The majority of cases were male (57.7%) and the mean age for all cases was 10 years (SD = 5.5) with no case detected under one year of age. Disabled children were in the fourth or fifth birth order among their brothers and sisters and 47 (34%) of them were recorded as a second or third disability in the same family. Number of disabilities in the same child varied widely: 59% of cases had a single disability. 22% had two conditions and 19% had three or more conditions. Speech. motor and mental disabilities ranked top of the disabilities detected by the ten-question tool. The commonest cause of these disabilities as perceived by the family was hereditary diseases followed by childhood illnesses. Significant risk factors associated to these conditions included larger number of children in the family, older age of either parent. histories of handicapping conditions in the original families of either of the parents and presence of handicapping condition in the mothers. Families reported lack of services provided to their disabled children in the community. CONCLUSIONS: The survey tool managed to document. successfully, a prevalence rate of childhood disabilities in the community with a general picture of their types and suspected causes which is quite comparable to that found in Saudi Arabia. It also reported a low service delivery for these disabilities and identified some risk factors related to their occurrence. It is recommended to apply this survey method with certain modifications to suit the local culture in Saudi Arabia. Improvement of the services rendered to handicapped children in Jeddah is also recommended.

Effect of maternal education on the rate of childhood handicap.

OBJECTIVE: The objectives of this study were to determine the relation between maternal education and various maternal risk factors, identify the impact of maternal education on the risk of childhood handicap and estimate the proportion of childhood handicap that can be prevented by maternal education. METHODS: Data was collected from all married women attending the two major maternity and child hospitals in Jeddah during April 1999. Women with at least one living child were interviewed for sociodemographic factors and having at least one handicapped child. The risk of having a handicapped child and the population attributable risk percent were calculated. RESULTS: Some potential risk factors are dominant in our society as approximately 30% of women did not attend school and 84% did not work. Consanguineous marriages accounted for about 43%. Pre-marriage counseling was limited as only 10% of women counseled before marriage. The proportion of unemployment and consanguineous marriages decreased significantly by increase in maternal education level. Conversely, the proportion of women reporting pre-marriage counseling increased significantly by increase in maternal education level. Approximately, 7% of women reported having at least one handicapped child. The risk of having a handicapped child showed a significant sharp decline with increase in maternal education level. At least 25% of childhood handicap can be prevented by achieving female primary education and up to half of cases can be prevented if mothers finish their intermediate education. CONCLUSION: Female education plays a major role in child health. The results of this study suggest investment in female education, which would have substantial positive effects in reducing incidence of childhood handicap in Jeddah.

Cumulative impact of early maternal marital age during the childbearing period.

Early marriage of girls, close to age of menarche, is a widespread practice in Arab countries. Knowledge on the cumulative effect of early maternal marriage on maternal and infant health during the childbearing period is insufficient. The objectives of this study were to estimate the prevalence of early maternal marriage in Jeddah, identify its relation with other maternal risk factors, and investigate the cumulative impact of early maternal marriage on subsequent maternal health and pregnancy outcomes throughout the reproductive period. Data were collected from six randomly selected primary health care units in Jeddah City. Married women with an infant < or = 12 completed months of age were interviewed and information on sociodemographic characteristics, maternal health and previous pregnancy outcomes were collected. Early marriage of girls before the age of 16 years accounted for 26.5% of the study population and was reported by a third of mothers currently below the age of 20 years. Illiterate mothers, housewives, multiparae, smokers and those married to a relative reported the highest proportion of marriages before their sixteenth birthday. Those who married before the age of 16 were at about double the risk of developing chronic diseases and experiencing miscarriage, stillbirths and infant deaths. These results suggest that early maternal marriage still exists in our community and is intimately related to other maternal risk factors. Maternal marriage < 16 years appears to be fraught with insecurities for the mother and infant throughout the whole length of the childbearing period and not merely the first pregnancy. Thus, even if culture norms claim early marriage of girls, it should be discouraged before the age of 16 years. Moreover, it is recommended that future research on maternal and infant health considers the cumulative effect of the various risk factors during the whole reproductive period and not only a single pregnancy outcome.

Health care services in saudi arabia: past, present and future.

Health services in Saudi Arabia have developed enormously over the last two decades, as evidenced by the availability of health facilities throughout all parts of the vast Kingdom. The Saudi Ministry of Health (MOH) provides over 60% of these services while the rest are shared among other government agencies and the private sector. A series of development plans in Saudi Arabia have established the infra-structure for the expansion of curative services all over the country. Rapid development in medical education and the training of future Saudi health manpower have also taken place. Future challenges facing the Saudi health system are to be addressed in order to achieve the ambitious goals set by the most recent health development plan. These include the optimum utilization of current health resources with competent health managerial skills, the search for alternative means of financing these services, the maintenance of a balance between curative and preventive services, the expansion of training Saudi health manpower to meet the increasing demand, and the implementation of a comprehensive primary health care program.

Hypercholesterolemia and 5-year risk of development of coronary heart disease among university and school workers in Jeddah, Saudi Arabia.

BACKGROUND: A study was performed among university and school employees as a step in detecting the prevalence of coronary heart disease (CHD) risk factors among school and university staff and the relation of the various risk factors to hypercholesterolemia and to predict the 5-years probability of development of CHD. METHODS: All university staff and a sample of school workers in Jeddah were included in the study. Data were collected by interview and self-administered questionnaires, as well as by direct observation and measurement of weight, height, blood pressure, and total blood cholesterol. Logistic regression analysis was performed to identify the impact of various risk factors on hypercholesterolemia. The 5-year risk of development of CHD was calculated to identify the proportion at highest risk. RESULTS: Some CHD risk factors were detected among the participants as 18.8% were current cigarette smokers, around half were classified as overweight, and 19.9% were classified as hypertensive. Hypercholesterolemia was present in 10.1% and was significantly related to older age (40 years and over) and place of work. The estimated risk of CHD in the coming half-decade for those classified in the fifth quintile was 0.068. The Q(5)/Q(1) ratio has shown that those classified in the fifth quintile were at 3.6 times more risk of developing CHD in the coming 5 years than those classified in the first quintile. CONCLUSION: CHD risk factors are becoming prevalent in our society. The risk of development of CHD in the coming decades is not trivial. Short- and long-term health strategies are recommended to decrease the risk of CHD and improve the quality of life.

Knowledge of secondary-school female students on breast cancer and breast self-examination in Jeddah, Saudi Arabia.

A self-administered questionnaire was given to 6380 female secondary-school students (mean age = 18.1 years) in Jeddah to identify their knowledge of breast cancer and attitude towards breast self-examination (BSE). Knowledge of risk factors and presentation was very low. Over 80% of students failed to answer 50% of the questions correctly. A higher knowledge level was associated with older age, marriage and having children. Also students who had undergone mammography, had been exposed to breast surgery or had a positive family history of breast cancer showed significantly higher knowledge levels. Only 39.6% reported ever hearing of BSE and only 14.4% and 7.1% respectively knew the correct frequency and timing. However, 82.4% had a positive attitude towards learning BSE.

Dental caries among schoolchildren: report of a health education campaign in Jeddah, Saudi Arabia.

The study describes a dental health education campaign and reports the epidemiology and prevalence rates of dental caries among male and female primary-school children in Jeddah. Over a 2-year period, all 296 public primary schools in Jeddah were visited by dentists conducting a health education campaign. A total of 82,250 children in the first and fourth grades were screened. The rate of detected dental caries was 83%, with significantly higher rates detected among females and first-grade children. Lower social class was significantly associated with higher rates of dental caries. The study emphasizes the importance of health education programmes and the value of school health surveys for targeting this young group.

Early teenage marriage and subsequent pregnancy outcome.

The relationship between marriage before 16 years and pregnancy outcome throughout the childbearing period was examined. Participants included all married women attending six randomly selected primary health care units in Jeddah with at least one infant and complete medical files. Early teenage marriage was found for 27.2% of women. Most of these were illiterate (57.1%), housewives (92.4%) and grand multiparae (66.7%). They were at twice the risk of spontaneous abortion, four times the risk of combined fetal death and infant mortality, and twice the risk of losing pregnancies any time during their childbearing years. They remained at high risk of poor pregnancy outcome throughout their reproductive lives. Despite tradition, marriage should be discouraged before 16 years.

Effect of a breast cancer health education program on the awareness and practice of jeddah female secondary school students.

OBJECTIVE: To identify the effect of a school health education program on the knowledge of secondary school girls in Jeddah, Saudi Arabia, of breast cancer and breast self-examination (BSE) and their practice of BSE. METHODOLOGY: A pre-tested, self-administered questionnaire was administered to secondary students before the commencement of the health education to assess their knowledge on breast cancer and their practice of BSE. The same questionnaire was handed 6 months later to a smaller group of these students as a post-test. As the post-test group was smaller than the pre-test group, an equal sample size from the pre-test group was drawn for comparison. Random sampling and further analysis was done using the SPSS program, and for the comparison of the two groups, the student t-test and chi square were used. RESULTS: The post-test was answered by 1372 students. The sampled re-test group comprised 1400 students (N= 7663) forming a sample of 18.3%. The ages for both groups ranged between 16-25 years (mean = 18.4; SD=1.9). Saudi nationals formed 73.4% of both groups and the proportion of married students was 8.4%. Those who reported that they had relatives with breast mass were 11.2%. The mean knowledge indexes on breast cancer reached 19.7 for the pre-test group and 43.0 for the post-group (t=31.2; p<0.0001). Correct answers for BSE rose significantly among the post-test group. A proportion of 27.2% students from the post-group reported that they had been motivated to practice BSE at least 3 times during the last 6 month. CONCLUSION AND RECOMMENDATION: The outcome of the school health education program on breast cancer had been successful in raising the awareness of secondary school girls and in helping them to practice BSE more. Hence, it is recommended that the programme be implemented in all female secondary schools and colleges.

Dental caries among schoolchildren: report of a health education campaign in Jeddah, Saudi Arabia

The study describes a dental health education campaign and reports the epidemiology and prevalence rates of dental caries among male and female primary-school children in Jeddah. Over a 2-year period, all 296 public primary schools in Jeddah were visited by dentists conducting a health education campaign. A total of 82 250 children in the first and fourth grades were screened. The rate of detected dental caries was 83%, with significantly higher rates detected among females and first-grade children. Lower social class was significantly associated with higher rates of dental caries. The study emphasizes the importance of health education programmes and the value of school health surveys for targeting this young group

Early teenage marriage and subsequent pregnancy outcome

The relationship between marriage before 16 years and pregnancy outcome throughout the childbearing period was examined. Participants included all married women attending six randomly selected primary health care units in Jeddah with at least one infant and complete medical files. Early teenage marriage was found for 27.2% of women. Most of these were illiterate [57.1%], housewives [92.4%] and grand multiparae [66.7%]. They were at twice the risk of spontaneous abortion, four times the risk of combined fetal death and infant mortality, and twice the risk of losing pregnancies any time during their childbearing years. They remained at high risk of poor pregnancy outcome throughout their reproductive lives. Despite tradition, marriage should be discouraged before 16 years

Is there a role for automated eosinophil count in asthma severity assessment?

Advances in asthma clinical assessment help in categorizing patients based on their clinical severity. Eosinophilia is a common laboratory finding in asthmatics. This paper explores the correlation between the clinical severity of asthmatic children and the degree of total peripheral eosinophil count (TPEC). Eighty asthmatic children referred to pediatric and allergy clinics were selected. Their clinical severity levels were assessed using the recent Global Strategy for Asthma Management and Prevention guidelines. Absolute TPEC was performed for all cases by the Cell-Dyne 3500 automated hematology counter. Correlation between clinical severity and TPEC was measured and their means in each severity group were compared for any significant association. Asthmatic children aged between 6 months and 15 years (mean = 5.9 years; 67.5% male) were studied. The clinical severity of their bronchial asthma was divided into four groups: intermittent (6, or 7.5%), mild-persistent (48, or 60%), moderate persistent (20, or 25%), and severe-persistent (6, or 7.5%). TPEC for the groups ranged between 10 and 2100 cells/mm3 (mean = 581.7 cells) and showed a very significant positive correlation with increased asthma severity (R = 0.61, p<0.001). A high linear trend of TPEC within each clinical group was found (F = 51.3, p<0.0001), and the means among each group also showed a significant increase as asthma severity level increased (F = 19.98, p<0.001). The study documents a significant positive correlation between the clinical severity of bronchial asthma and eosinophil counts. The authors advocate the use of this simple and sensitive laboratory test as a significant adjunct objective technique in the assessment of asthma severity and management.

The effects of a training program on knowledge, attitude and practice of the staff of primary health care centers towards growth monitoring: an intervention study.

This study was carried out aiming at assessing the effects of a training program on the knowledge, attitude and practices (KAP) of health care workers (HCWs) in primary health care centers (PHCCs) regarding growth monitoring (GM). It included 148 health care workers (30 General Practitioners (GPs) and 118 nurses), from 17 PHCCs in Jeddah city, Kingdom of Saudi Arabia (KSA). Tests on KAP were held before and six months following a training program on GM conducted by the investigators. Results showed significant improvements in the KAP of the trained health care workers after training, the 44 trained HCWs obtained higher mean comprehension score (7.9 +/- 1.2), higher mean practice score (11.6 +/- 3.0), and higher mean general scores (32.3 +/- 4.6) compared to the mean scores they obtained in the pre-test (5.7 +/- 1.5; 7.4 +/- 2.2 and 25.7 +/- 4.4, respectively). These differences were statistically significant (P < 0.001). However; the difference in the mean knowledge scores, before and after the GM training program was not significant. The training has also led to the disappearance of the significant knowledge gap between GPs and nurses. And also, the 44 trained HCWs had higher mean comprehension score (7.9 +/- 1.2), mean practice score (11.6 +/- 3.0), and mean general scores (32.3 +/- 4.6) compared to those among untrained group (controls) (6.3 +/- 2.1; 8.5 +/- 3.7, and 27 +/- 6.1, respectively). These differences were statistically significant (P < 0.0005). Nevertheless, the difference in the mean knowledge scores, between the two groups, was not statistically significant. It also has led to some changes in the attitude of the trained HCWs towards GM compared to the untrained group. In conclusion, We credit the significant improvements in KAP of HCWs to the training program and recommend its adoption by the national MCH program in KSA. We also recommend new methods of teaching and training based on sound educational concept of active participation and practical work as well as supportive supervision and evaluation.

Knowledge, attitude and practice of primary health care doctors and nurses in hypertension of pregnancy.

OBJECTIVE: To assess the status of knowledge, attitude and practice (KAP) of doctors and nurses in Primary Health Care (PHC) centers with regard to hypertension in pregnancy and to identify factors associated with KAP in Al-Khobar, Saudi Arabia. METHODOLOGY: Using a self-administered comprehensive questionnaire, all available doctors and nurses in PHC centers of the Al-Khobar area were approached to determine their knowledge, attitude and practice in hypertension during pregnancy. Questionnaires were validated and pilot tested. Each section of the questionnaire was scored and the mean scores calculated. Factors affecting each section were identified by means of multiple regression analysis. RESULTS: A total of 36 doctors and 91 nurses were enrolled in the study. Saudis formed 22.2% of the doctors and 47.3% of nurses. Mean years of practice after graduation were 12.6 and 8.7 years for doctors and nurses, respectively. Saudi nurses spend only 3 weeks in the obstetrics ward during the whole period of their internship. All Saudi nurses hold only diplomas and not many courses on the hypertensive disorder are offered to both doctors and nurses after graduation. The practice of doctors particularly in the management of patients after reaching a diagnosis and educating them on diet and salt intake was poor. Furthermore, their knowledge was also poor. Though their level of knowledge was poor, the nurses' practice was satisfactory, particularly in taking history and physical examination. The attitude of both doctors and nurses towards hypertensive disorders was in general, positive and satisfactory towards health education. Nurses' nationality and duration of post-internship training were the factors that influenced their attitude and scores on knowledge. CONCLUSION AND RECOMMENDATION: The study revealed that both doctors and nurses working in the PHC lacked training and knowledge in this area of their work. It is therefore necessary to give PHC doctors and nurses refresher courses on common and serious problems like hypertension. A longer period of training in action management is needed to improve the knowledge and practice of doctors and nurses working in antenatal clinics in this area.

Incidence of bronchial asthma in a children hospital, Jeddah.

Full text is available as a scanned copy of the original print version.

Health Education in schools- The Tabuk Experience.

Full text is available as a scanned copy of the original print version.

Effects of cigarette smoking on lung function of Saudi students.

This study was carried out to investigate the association between cigarette smoking and state of lung function among Saudi male students. A cross sectional study was conducted on a group of 680 male Saudi students. Detailed personal questionnaire, British Medical Research Council questionnaire on respiratory symptoms and smoking habit, were administered and forced spirometry and anthropometric measurements were conducted on them. Multiple regression models were used to study the cumulative effect of smoking on the function of the lung of smoking students. The percentage of cigarette smoking among the studied group was 20.29%. Smoking students had significantly lower values for lung function tests (FEV1%, FEF200-1200, FEF25-75, FEF75-85, and PEFR) compared to non-smokers. After controlling for other confounding variables, increased duration of smoking and number of cigarette smoked per day were significantly associated with more limitation of airflow in airways of the smoking young students. Recommendations were discussed accordingly.

The prevalence of cardiovascular risk factors among students in jeddah, saudi arabia.

OBJECTIVES: To determine the prevalence of cardiovascular risk factors among students in Jeddah, Saudi Arabia. METHODS: A cross-sectional study was conducted during 1994 on a sample of students selected from 49 public schools using a multistage stratified random sampling technique. For all students, an interview was conducted and anthropometric and blood pressure measurements were obtained. Fasting glucose and total cholesterol levels on a capillary blood sample were measured using Accutrend for a subsample of students. RESULTS: Of the 4042 students selected, 71% were males and the overall mean age was 15.3 ± 2.7 years. After age adjustment, about 23% of the students were found overweight. In addition, 6.4% and 9% of the students were found to have systolic and diastolic hypertension, respectively, with no statistically significant difference between males and females. Among 1432 students, 4% of males and 2% of females had hypercholesterolemia (p=0.06). Hyperglycemia was found in 0.4% of males and 0.6% of females. Among 1834 students in the 9(th) to 12(th) grades, 6.9% of males and 0.5% of females were current cigarette smokers. CONCLUSIONS: Since attitudes and behaviors that influence future health are established during childhood and adolescence, intervention to prevent cardiovascular diseases (in adult life) should take place in childhood and youth to reduce the risk factors and schools have a great role to play in the promotion of good health.