Patients' Perspectives on Type 2 Diabetes, Vitamin B12 Deficiency, and Supplementation in Buraidah, Saudi Arabia.

Objectives Long-term metformin is associated with vitamin B12 deficiency. There is a significant misunderstanding among both physicians and patients regarding vitamin B12 indications. This study aims to identify knowledge gaps and attitudes toward vitamin B12 among diabetic patients. Materials and methods A cross-sectional study was conducted among type 2 diabetic patients visiting four primary healthcare centers in Buraidah, Saudi Arabia. The data were collected using a structured self-administered questionnaire. Data were collected on diabetes and vitamin B12 knowledge and attitude toward vitamin B12 supplementation. Logistic regression analyses were used to assess the predictors of knowledge and attitude. Results Of the 388 participants, 192 (49.5%) were male. About 84.5% of the total diabetics were on metformin. Nearly three-fourths (72.7%) were taking vitamin B12. A large proportion, 160 (41.2%), believed that it is necessary to take vitamin B12 for every diabetic patient. Nearly half, 193 (49.7%), did not know the factors affecting vitamin B12 deficiency. Young (less than 39 years) diabetics were more likely to perceive that vitamin B12 is recommended for all diabetics, OR (95% CI) [6.26 (1.86-21.06)], as compared to participants aged more than 59. Similarly, younger patients were more likely to assume vitamin B12 necessary, OR (95% CI) [3.71 (1.26-10.89)]. Conclusion We found the knowledge and attitude of diabetic patients regarding vitamin B12 to be poor. It is, therefore, recommended that primary health care providers educate their patients about vitamin B12 supplementation to reduce the number of medications and financial burden. Further large-scale studies are also needed to generate stronger evidence of the problem.

Risk Factors Of Idiopathic Pulmonary Fibrosis In Pakistani Population: A Matched Case-Control Studyy.

OBJECTIVE: To evaluate the factors associated with idiopathic pulmonary fibrosisrisk. Methods: The case-controlstudywas conductedfromJanuary 5, 2017,toSeptember 4, 2018, attheprivate-sectorAga Khan University Hospital and the public-sector Jinnah Postgraduate Medical Centre, two large tertiary care centres in Karachi, andcomprisedadultpatientsof eithergenderwithdiagnosedidiopathicpulmonary fibrosis, asdefinedby the IndianChest Registry. Subjects without idiopathic pulmonary fibrosis but registered with the department of pulmonology of the two hospitalswere enrolledas controls.Datawas collectedusinga structuredquestionnaire, andanthropometricmeasurements were noted for each subject. Gastroesophageal reflux disease was assessed using GerdQ. This wasfollowed by serological evaluations and spirometry. Data was analysed using SPSS 21. RESULTS: Of the 459 subjects, 154(33.6%)were cases and305(66.4%)were controls.Amongthe cases, 81(52.6%)were females and 73(47.4%) were males with mean age 66.1±10.9 years. Among the controls, 162(53.1%) were females and 143(46.9%) were males with mean age 64.6±11.1 years(p>0.05.)The most common ethnicity wasUrdu-speaking; 89(58%) among the cases and 150(49%) among the controls (p<0.05). Ethnicity, number of persons in the household per room, and type of house were significantly associated with the risk of developing idiopathic pulmonary fibrosis(p<0.05). CONCLUSIONS: Ethnicity,type of house and the number of personsin a household perroom were found to be the significant risk factorsfor idiopathic pulmonary fibrosisIPF.

Telehealth as a public health approach to mitigate the COVID-19 pandemic in Pakistan: A narrative review.

Technology is instrumental in delivering health services, especially telehealth during the COVID-19 pandemic. This article aimed to explore the role of telehealth as a public health approach to support responses to address the COVID-19 pandemic in Pakistan. We developed this article by mapping existing telehealth initiatives developed and implemented during the COVID-19 pandemic in Pakistan. The initiatives were identified searching online portals such as Google Scholar, PubMed, and websites of various governmental and non-governmental agencies. The services are categorized into teleconsultation and follow-ups, online vaccine registration, information dissemination, high-risk subset tracking, virtual Health Care Worker (HCW) and medical student training, and tele-psychological counseling. The teleconsultation category offers online registration and follow-ups. Information dissemination services include federal helpline, SMS alerts, and social media campaigns. The high-risk subset tracking services include app-based COVID-19 checks and online surveys. Virtual HCW and medical student training services include tele-ICU support, COVID-19 critical care courses, and COVID management courses. The tele-psychological counseling services offer helplines for emotional support, proactive counseling for COVID-19 patients, and mental health support and psychiatry services. Telehealth interventions provided novel solutions amid health and social crises such as the COVID-19 pandemic. Health care systems need to expand telehealth services and ensure that health care organizations deliver effective and safe medical care. However, future research should focus on assessing the impact of telehealth on population health.

Alleviation of Asthma Symptoms After Ketogenic Diet: A Case Report.

Asthma is a chronic disease that affects the quality of life of patients, and asthma exacerbations are often a reason for hospitalization and activity limitations. Obesity has been linked to asthma as a risk and exacerbating factor. Evidence suggests that weight reduction has a positive effect on asthma control. However, there is also debate on the role of the ketogenic diet in asthma control. Here we present a case of asthma who reported markedly improved asthma after starting a ketogenic diet in the absence of any other lifestyle change. Over the four months on the ketogenic diet, the patient reported losing 20 kg of weight, reduction in blood pressure (without antihypertensives), and complete alleviation of asthma symptoms. This case report is important as the control of asthma after a ketogenic diet is not studied well in humans and therefore needs to be studied extensively.

Awareness, attitude, and practice of evidence-based medicine among primary healthcare physicians in Buraidah, Saudi Arabia.

Context: Evidence-based medicine (EBM) is essential for safe and cost-effective care provision to the population. Aims: To assess the awareness, attitude and practices and barriers among primary care physicians about EBM in Buraidah, Qassim. Settings and Design: Cross-sectional study in Primary Health Care centers (PHCCs) of Buraidah, Qassim. Materials and Methods: The study was conducted among physicians working in PHCCs of Buraidah. Data were collected online through Google forms. Statistical Analysis Used: Descriptive analysis was carried out to measure the frequencies and proportions. Chi-square test was used to compare barriers based on gender, academic degree, and experience categories. Results: A total of 96 out of 144 physicians (66.7%) responded to the invitation. About 82.3% of the participants welcomed the promotion of EBM and 92% of the physicians knew about concept of EBM. About 94.8% of the physicians agreed that EBM will improve patient outcomes. The reported barriers were; patient load (87.5%), time availability (70.8%), computer availability (33.3%), internet availability (45.8%), and 56.3% stated updated clinical letters, journals, or guidelines are not available. Conclusions: This study found that there was high self-reported knowledge about the EBM concept; however, the knowledge about tools was poor. A number of barriers were found such as patient load, time, availability of clinical guidelines and journals and other resources such as internet and computers. Primary care physicians should be trained and facilitated for EBM.

Verbal and Physical Abuse Against Nurses Working in Hospitals and Health Centers in Buraidah, Saudi Arabia.

Background Hospital staff, especially nurses, face violence of various forms in the workplace. This study aimed to assess the burden of verbal/physical abuse against nurses and their attitude towards such events in Buraidah, Saudi Arabia. Methods A cross-sectional study was conducted among nurses working in three public sectors and two private sector hospitals, and five primary healthcare facilities in Buraidah. Data was collected using a structured online questionnaire, disseminated among nurses through nursing departments of participating facilities. Data were analyzed using SPSS version 21.0. Results A total of 369 nurses participated in the survey, with a mean age of 34 (±6.9) years. About two-thirds, 68% (250) of respondents, had experienced at least one verbal/physical abuse incident during one year. The most common perpetrators were patients (44.4%). Sixteen percent of participants reported taking no action against the incident. Those working in private facilities were 80% less likely to experience abuse than those in public facilities, adjusted OR 0.20 (95% CI: 0.08-0.47). Conclusions There was a high burden of verbal/physical abuse against nurses, and they, therefore, suffer from disturbing memories. However, a little more than half do not officially report it to the managers, with only a small fraction seeing some action taken. Occupational health practitioners should take action to improve the policy and procedures related to workplace violence (WPV) in healthcare facilities. Further research is needed to characterize incidents to understand the patterns and develop interventions for the prevention of such events.

COVID-19-Related Awareness and Behaviors of Non-Saudi Travelers and Their Satisfaction with Preventive Measures at Saudi Airports.

Airports could serve as hotspots for the spread of the COVID-19 infection. We aimed to assess the awareness, attitude, and behaviors of non-Saudi travelers about COVID-19 and their satisfaction with preventive measures at Saudi airports. A cross-sectional study was conducted among non-Saudi travelers arriving in Saudi Arabia at two international airports. Data were collected using a questionnaire in Arabic, Hindi, and Urdu languages. Awareness, attitude, behavior scores, and satisfaction levels were calculated. Linear regression analyses were done to assess the predictors of awareness, attitude, and behaviors. A total of 633 participants were included in the study. The mean awareness, attitude, and behavior scores were 16.3/22, 18.3/24, and 3.2/5, respectively. Nationality, education, and income were significant predictors of awareness. Nationality was the only significant predictor of attitude, while gender and nationality were predictors of behaviors. Overall satisfaction with preventive measures was: transportation (94%), lounges and corridors (96%), counters (98%), and airport staff (97%). There was overall good awareness and attitude among travelers. Behavior scores were relatively low, which needs to change as air travel poses a threat to the spread of infectious diseases. Airport authorities need to manage passengers properly to ensure adequate distancing to prevent the potential transmission of infections.

Psychological Well-Being and Coping Strategies among Pakistani Heads of Households during COVID-19 Pandemic: An Online Survey.

Background: Coronavirus Disease (COVID-19) pandemic can affect mental health. Heads of the household are at higher risk of this effect because of their financial and social responsibilities. This study aimed to assess the psychological well-being and its associated factors during the COVID-19 pandemic among heads of households in Pakistan. Methods: We conducted an online survey in May 2020. A convenience sampling strategy was used to enroll the heads of the households from all regions of Pakistan. A validated English and Urdu version of the WHO-5 well-being scale was used to assess well-being. The prevalence of poor well-being and its associated factors among heads of the households was measured using logistic regression. Results: A total of 509 heads of households participated in the survey. About 35% of the participants were dependent on financial sources other than salary. The news was considered a source of fear as 70% assumed that avoiding such news may reduce the fear. The most common coping strategies used during lockdown were; spending quality time with family, eating healthy foods, adequate sleep and talking to friends on the phone. The prevalence of poor well-being was found to be 41% (95% CI: 36.62-45.51). Individuals with any chronic illness were at a higher risk of poor wellbeing adjusted odds ratio of 1.64 (95% CI: 1.04-2.59). Worriedness was also found to be associated with a higher risk of poor wellbeing adjusted OR 1.13 (95% CI: 1.06-1.19). Reading books showed a protective association with poor mental wellbeing adjusted OR 0.64 (95% CI: 0.42-0.98). Conclusion: There was a high prevalence of poor mental wellbeing among heads of households in Pakistan. Worriedness related to the pandemic and having chronic illness were significant predictors of poor psychological wellbeing. Actions are required in the form of targeted mass psychological support systems for the heads of the families to improve their mental health during the COVID-19 crises.

Indoor Air Pollution and Respiratory Health in a Metropolitan City of Pakistan.

OBJECTIVE: We assessed the association of formaldehyde, carbon monoxide (CO), and particulate matter (PM 2.5 ) with respiratory symptoms, asthma, and post-bronchodilator reversibility. METHODS: We included 1629 adults in a community-based cross-sectional study in Karachi in 2015. Data were collected using the American Thoracic Society respiratory questionnaire and spirometry (available for 930 participants). YesAir eight-channel monitor was used for measuring concentrations of formaldehyde and CO, whereas PM 2.5 was measured using UCB PATS. RESULTS: Higher levels of formaldehyde and CO were associated with cough, phlegm, and wheeze, whereas those of PM 2.5 were associated with shortness of breath and presence of any of the respiratory symptoms (combined), as well as a "lower" risk of cough, phlegm, and bronchitis. CONCLUSION: Poorer household air quality was associated with poorer respiratory health in this population; however, further studies with a robust exposure assessment are required.

Gender Difference In Awareness And Behaviours Of Medical And Dental Students About Corona Virus Disease (Covid-19) In Pakistan.

BACKGROUND: Medical and dental students are the future of health workforce and a potential volunteer pool in the COVID-19 crises. This study aimed to assess the level and gender differences in the awareness, attitude and behaviours of medical and dentals students about COVID-19 in Pakistan. METHODS: An online cross-sectional survey was conducted among medical and dental undergraduate students in Khyber Pakhtunkhwa province. Data was collected using a structured questionnaire having four sections: socio-demographics, knowledge, attitude and practices. RESULTS: A total of 1770 medical and dental students participated and completed the questionnaire. About 1239 (70%) of the respondents were female and 1526 (87%) were MBBS students. We found that 1685 (95%) of the students had adequate knowledge. Majority, 1565 (89%) of the students was concerned about COVID-19 and 1480 (84%) believed that disease will ultimately be controlled. Only about 1129 (64%) of the participants in our study had adequate practices. Male gender was associated with higher risk of inadequate practices. CONCLUSIONS: There were good knowledge and attitudes about COVID-19 among medical and dental students. However, one third of the participants did not have adequate practices and female had better practices than male students. This gap in the knowledge and practice calls for urgent interventions to improve practices.

Prevalence of Nocturnal Enuresis Among Children and Its Association With the Mental Health of Mothers in Northern Saudi Arabia.

Background Nocturnal enuresis (NE) is troubling for children and their families. This study aims to investigate the prevalence of NE, its associated health problems, and the outcome of the provided management among children aged 6-18 years and to assess the impact of NE on the mental health of mothers in Northern Saudi Arabia. Methodology A retrospective cross-sectional study was conducted in Arar, Northern Saudi Arabia, among children aged 6-18 years old. Data were collected using a structured questionnaire including a Perceived Stress Scale (PSS). Means ± standard deviations (SDs) were used to represent quantitative data, and frequencies and percentages were used to represent qualitative data. Ordinal logistic regression was used to assess the association of NE with perceived stress. Results A total of 420 participants were included in this study. Nocturnal enuresis was reported in 24% of the respondents' children. Around 51% of the mothers know about the causes of NE. Nocturnal enuresis caused embarrassment and social shame to 71% of the mothers. Two-thirds (66%) of the mothers wake up the child at night for urination. Three-quarters (76%) of the participants reported improvement on decreasing fluid intake before sleeping. Of the mothers, 19% perceived low stress, 78% perceived medium stress, and 3% perceived high stress. NE was associated with a higher risk of stress (adjusted odds ratio (OR): 2.14; 95% confidence interval (CI): 1.05-4.37). Conclusion About a quarter of the children suffer from NE, of which a large proportion of mothers face embarrassment and shame. There was a significant association between NE and a higher level of stress. Mothers of children with NE should be provided with counseling and social support to ensure good mental health.

Online family medicine training amid the COVID-19 crisis in KSA: A mixed-method study.

Objective: Literature on the perceptions and experiences of postgraduate trainees and trainers regarding online methods of learning is scarce. We aimed to assess the perceptions and experiences of family medicine trainees and trainers regarding online learning during the novel coronavirus (COVID-19) pandemic in Qassim, KSA. Methods: This was a mixed-method study involving trainees and trainers at the Family Medicine Academy, Qassim. Quantitative data were collected using structured questionnaires from 36 trainees and 26 trainers. Qualitative data were collected through in-depth interviews with trainees (n = 4) and trainers (n = 3). Descriptive analysis was performed on the quantitative data, while thematic analysis was performed on the qualitative data. Results: Among the trainees, 39% perceived online learning to be less effective than traditional classroom learning. Moreover, 61% and 64% of the respondents were concerned about the motivation and quality of online learning, respectively. Lack of direct contact with other students was the most commonly perceived concern among 80% of trainees. Among the trainers, the majority were either dissatisfied or neutral about participation and interaction, speakers' and students' motivation, the quality of online learning, and the online teaching experience. Qualitative data showed that online methods provide the advantages of learning from other institutions and flexibility, as well as a viable alternative during crises. However, there were issues with interaction, participation, and trainers' online teaching skills. Conclusion: Online learning has provided an opportunity to continue training during the COVID-19 crisis. However, there are widespread concerns regarding its effectiveness among trainees and trainers. There is a need to train trainers in online teaching and adopt interactive methods to increase trainees' interaction, motivation, and participation.

Are Patients Aware of Their Rights? A Cross-Sectional Study of Visitors to Three Primary Healthcare Centers in Riyadh, Saudi Arabia.

Background and objective Patients' rights are an essential aspect of human rights. Thus, in Saudi Arabia, the Ministry of National Guard Health Affairs (MNGHA) established a Patients' Bill of Rights (PBR) and introduced it to the public about 30 years ago. This study aims to assess levels of awareness of PBR and to identify their information sources among visitors to primary healthcare centers (PHCCs). Methods This cross-sectional study included 358 visitors, aged 17 to 78, to three PHCCs at the National Guard Hospital in Riyadh, Saudi Arabia. The study was conducted between April and December 2017 using a self-administered questionnaire. The initial sample (convenience sampling) was refined to match the proportion of participants with the relative size of populations served by the centers. Descriptive statistics were used to determine the relationships between participants' demographic data and levels of awareness of patients' rights. Results Most participants (72.2%) were moderately aware of their rights, but the majority (65.3%) were unaware of the existence of the PBR. Healthcare providers were the main information source for patients' rights, although participants with the highest awareness scores obtained information from social media. Level of awareness was significantly associated with education, income, and regular hospital follow-ups. Conclusions The study results should motivate healthcare providers, stakeholders, and health organizations in Saudi Arabia to raise and maintain public awareness of patients' rights and to implement them.

Impact of COVID-19 on Antenatal Care Utilization Among Pregnant Women in Qassim, Saudi Arabia.

Background and objectives Coronavirus disease 2019 (COVID-19) pandemic has affected routine service delivery which might affect antenatal care (ANC) utilization among pregnant women. This study aimed to assess the proportion of missed appointments among pregnant women in the Qassim region of Saudi Arabia during the COVID-19 pandemic. Methods A facility-based cross-sectional survey was conducted among pregnant women admitted for delivery in Maternity and Children Hospital (MCH), Buraidah. Data were collected on socio-demographics, obstetric history, missed appointments and reasons for missing the appointment. Analysis was carried out in Statistical Package for the Social Sciences (SPSS), version 21.0 (IBM Corp., Armonk, NY). Medians with interquartile range (IQR) were presented for continuous variables and frequency and proportions for categorical variables. Logistic regression was used to assess the factors associated with the missed appointment. Results A total of 400 women were included in the study. About one-third (30%) of the women had missed at least one ANC appointment in their current pregnancy. The most common reasons for missing the appointments in primary care and hospitals, respectively, were: fear of infection 52% and 47%, facility not working usual 25% and 7.5%, fear of infection to child 19% and 17%. Family size and gravidity were the significant factors associated with missed appointments in our study. Conclusions Nearly one-third of women missed their ANC appointments during the COVID-19 pandemic. Major reasons were related to COVID-19 fear and its effect on services. This calls for proper health communication in the general population and delivering routine care with evidence-based guidelines to maintain continuity of care.

Financing mechanisms applied for successful Universal Health Coverage in Malaysia, Thailand and Singapore - Lessons for Pakistan.

Universal health coverage is a global agenda and, currently for Pakistan, achieving this goal is a challenge because of a number of constraints. The current narrative review was planned to describe an overview of the provision of health insurance in Malaysia, Thailand and Singapore that have achieved universal health coverage, and to propose a roadmap for Pakistan. Literature search was conducted on Google Scholar and PubMed databases as well as on the World Bank website to retrieve relevant articles. The three studied countries achieved universal health coverage by gradually increasing allocation for health and through various mechanisms, such as health insurance schemes which covered different segments of the population, and partnerships with private-sector care-providers. Pakistan needs to prioritise health in policy agenda because health insurance is negligible in Pakistan. Additionally, Pakistan also needs to efficiently utilise partnerships with the private sector to further increase healthcare coverage.

Explaining COVID-19 Vaccine Rejection Using Social Cognitive Theory in Qassim, Saudi Arabia.

Acceptance of COVID-19 vaccines needs a health promotion approach to address various social, environmental and personal factors leading to vaccine hesitancy. We assessed the vaccine hesitancy rate and applied social cognitive theory (SCT) to understand COVID-19 vaccine rejection in Qassim, Saudi Arabia. A cross-sectional study was conducted among visitors of 10 randomly selected primary health care centers in Buraidah, Saudi Arabia. Data was collected by a self-administrated questionnaire. The variables were grouped into six constructs of SCT. Logistic regression was used to assess the predictors of vaccine rejection. Out of 486 participants included in the study, 30.5% rejected the vaccine. The most common reason for vaccine rejection was uncertainty about the vaccine's effectiveness (78%). Among various constructs of SCT, reciprocal determinism (nationality, income and suffering from COVID-19 infection), behavioral capability (knowledge about vaccine safety), self-efficacy (registered for vaccine), and observational learning (getting the vaccine after friends and family members) were significant predictors. Expectation and reinforcement constructs did not show significant association. There was high vaccine rejection in Qassim, KSA. This calls for further improving the mass education strategies. Social cognitive theory can be used to predict vaccine rejection and to develop strategies to increase the utilization of COVID-19 vaccines in Saudi Arabia.

Situation analysis of antimicrobial resistance control, policy and regulation - a reflection of Pakistan.

Antimicrobial resistance (AMR) is a global threat that affects 700,000 lives every year and could lead to 10 million deaths every year by 2050. World Health Organization (WHO) has instituted a global action plan in 2015 to deal antimicrobial resistance in the 68th World Health Assembly. This paper aimed to review the situation analysis of current bottlenecks of the health system and provision of recommendations to improve the current regulatory mechanism for antimicrobial drugs in Pakistan. Antimicrobial Resistance (AMR) emerged as a threat practically in all nations of the world including Pakistan which is the world's sixth most populous country. This qualitative document analysis has been done by using Pakistan's National Policy on AMR. In 2004, total expenditure on pharmaceuticals was 1844 million US$ with a total pharmaceutical expenditure per capita of 11.3US$. Total number of pharmacists licensed was10,000 technician and assists were 20,000 and licensed pharmacies were 7000. There are only 0.9 pharmacists per 100000 populations are deployed. The health system and society are at risk of an emerging epidemic of AMR. This investigational analysis of AMR control, policy and regulation in Pakistan highlights some facts about misuse, availability of over the counter medicine, self-medications and low effect of existing approaches. Drug prescription monitoring law and policy investment is needed in the regulation of drugs to reduce unnecessary drug consumption and prescription, and strengthening quality parameters at several levels to control epidemic of AMR.

Prevalence and Risk Factors of Falls Among the Elderly in Unaizah City, Saudi Arabia.

OBJECTIVES: Falls and fall-related consequences are a major public health problem in the elderly. This study aimed to measure the prevalence of falls and fall-related risk factors among elderly individuals in Saudi Arabia. METHODS: This cross-sectional study was conducted between January and October 2019 among 280 elderly patients aged >60 years old attending 10 randomly selected primary healthcare centres in Unaizah City, Qassim Province, Saudi Arabia. Data were collected using the validated 10-item Missouri Alliance for Home Care (MAHC-10) fall risk assessment tool. RESULTS: A total of 269 participants were included in the study (response rate: 96.1%). The prevalence of falls over the preceding year was 31.6%. Females fell more frequently than males (34.5% versus 28.5%) and most falls occurred indoors (84.7%). Various risk factors were associated with fall risk including being aged >80 years (adjusted odds ratio [aOR]: 5.17, 95% confidence interval [CI]: 1.66-16.14), polypharmacy (aOR: 2.40, 95% CI: 1.01-5.71) and environmental factors (aOR: 2.79, 95% CI: 1.24-6.28). However, more educated participants had a lower risk of falling (aOR: 0.26, 95% CI: 0.09-0.77). There was also a significant association with the MAHC-10 fall risk score (P = 0.043). CONCLUSION: There was a high prevalence of falls among the elderly in Unaizah City. Various factors were associated with falls including advanced age, polypharmacy, age-related changes and environmental factors. As the majority of fall events occurred indoors, home safety improvements are recommended. Moreover, additional larger-scale research is necessary regarding fall-related risk factors and fall prevention initiatives among elderly individuals in Saudi Arabia.

Factors associated with quality of life among joint and nuclear families: a population-based study.

BACKGROUND: Advantages and disadvantages associated with joint and nuclear family systems can affect quality of life (QOL). However, there is scarcity of literature about QOL among joint and nuclear family systems. This study aimed to assess the factors associated with QOL in joint and nuclear family systems. METHODS: We conducted a population based cross sectional study in all 52 Union Councils (UCs) of District Abbottabad, Khyber Pakhtunkhwa province, Pakistan from March 2015 to August 2015. Multistage cluster sampling technique was used to select participants from both nuclear and joint family houses. The validated Urdu version of World Health Organization Quality of Life Questionnaire-Brief Version (WHOQOL-BREF) was used to assess quality of life among participants. Univariate and multivariate analyses were performed to explore the associations of different socio demographic variables with QOL among both family systems. Also a multilevel linear regression using backward analysis to obtain final model for each domain was performed to find out the variables that are associated with QOL score in each of family systems. RESULTS: A total of 2063 participants were included in this study (51.0% joint family, 49.0% nuclear family) with the response rate of 97.4%. In multiple linear regression analysis of each domain for joint and nuclear family systems, rural residence compared to urban (p < 0.001), being female (p < 0.001), older age (p < 0.001), having comorbidity (p < 0.001) and lower socioeconomic status (p < 0.001) were found to be a strong predictor of poorer QOL. Furthermore, social capital (p < 0.001) had a positive effect on joint and nuclear family QOL scores. CONCLUSION: This study was the first of its kind which determined the factors of QOL in joint and nuclear families using the validated Urdu version of WHOQOL-BREF in Pakistan. Male gender, urban residence, younger age, higher socioeconomic status and social capital were positive predictors of QOL score while older age and presence of illness were associated with lower QOL scores among both family systems.

Knowledge, Attitude and Practices of Health Care Workers about Corona Virus Disease 2019 in Saudi Arabia.

BACKGROUND AND OBJECTIVES: Corona Virus Disease 2019 (COVID-19) pandemic is a global health emergency. Health Care Workers (HCWs) with sound knowledge and practices can help curb the pandemic. This study aimed to assess the knowledge, attitude and practices of HCWs about COVID-19 and compare physicians and non-physicians in Saudi Arabia. METHODS: An online survey was conducted among HCWs in Saudi Arabia in March and April 2020. Data were collected using a structured questionnaire having four sections including; socio-demographic and professional profile, knowledge, attitude and practices regarding COVID-19. Questionnaire link was sent through social media. Descriptive analysis was used for assessment of knowledge, attitude and practice and Chi-square test was used for comparing physicians and non-physicians. Data were analyzed using SPSS version 21.0. RESULTS: A total of 398 HCWs completed the questionnaire. Only 45% of the participants had correct knowledge about the agent while about 97% knew that close contact with infected person is the most important risk factor. Only 63% had correct knowledge about the role of antibiotics in COVID-19 treatment. Majority of the HCWs were worried and most frequently reported worry was risk to family. Carrying infection to home was most commonly reported fear, 92%. Cleaning hands often or always was 11.5% and 87% respectively. About 71% wore mask during work. Knowledge was better among physicians compared to non-physicians while attitude and practices were comparable between the two groups. CONCLUSION: We found that there was poor knowledge about causative agent and role of antibiotics for COVID-19 but for mode of transmission and prevention there was good knowledge. There were widely prevalent worries and fears among the participants. Overall, there were good infection control practices among the HCWs. Interventions are needed to improve knowledge and address worries and fears of HCW.